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THE 


MEDICAL  AND  SLIIGICAL  HISTORY 


OF  THE 

WAR  OF  THE  REBELLION. 

(1861-66.) 


PREPARED,  IN  ACCORDANCE  WITH  ACTS  OF  CONGRESS,  UNDER  THE  DIRECTION  OF 

Surgeon  General  JOSEPH  K.  BARNES,  United  States  Army. 


AVASlIINaTdN  : 

G O V E R N M E N T P R I N T I N G O F F I C i:  . 
Second  Issue,  1875. 


M E M 0 E A N D U M . 


Extract  from  an  Act  making  appropriations  for  sundry  civil  expenses  of  the  Government  for  the  fiscal  year  ending  June  thirtieth, 
eighteen  hundred  and  seventy-six,  and  for  other  purposes.  Approved  March  3,  1875. 

* * * “And  the  Congressional  Printer  is  hereby  authorized  to  print  and  bind  five  thousand  additional  copies  of  the  Medical  and  Surgical  His- 
tory of  the  War  of  the  Rebellion;  one  thousand  of  which  shall  be  for  the  use  of  the  Senate,  three  thousand  for  the  use  of  the  House  of  Representa- 
tives, and  one  thousand  for  distribution  by  the  Surgeon  General  of  the  Army.”  * * * 

In  accordance  tvith  the  foregoing  provision  of  tlie  law,  a second  issue  of  the  First  Part  of  the  Medical  and  Surgical  His- 
tory has  been  prepared,  corresponding,  as  nearly  as  practicable,  with  the  first  issue.  Obvious  typogi’aphical  errors  have  been 
corrected ; but  a minute  revision  of  the  text  has  not  been  attempted,  as  the  time  of  the  officers  engaged  on  the  work  is  fidly  occu- 
pied with  the  preparation  of  the  second  and  third  parts  of  tliis  large  statistical  work. 

JOSEPH  K.  BAENES, 

Surgeon  General  United  States  Army. 

War  Department, 

Surgeon  General’s  Office,  April,  1875. 

2 


TABLE  OE 


CONTENTS 


6^0 


3 


I 


OF 

VOLUME  II  OF  PART  I 


OF  THE 


BEING  THE 

E^IJRST  SUJKGICAlJL  VOLUME. 


Page. 

Prefatory,  by  tlie  Surgeon  General Ill 

Introduction  by  the  Editor XIII 

Chronological  Summary  of  Engagements  and  Battles XXXIII 


ON  SPECIAL  WOUNDS  AND  INJURIES  OF  THE  HEAD. 
CHAPTER  I.  Wounds  and  Injuries  of  the  Head. 


Section  I.  Incised  and  Punctured  Wounds 

Plate  I.  Sabre  wounds  of  the  Head opp. 

Incised  fractures  of  the  Cranium 

Plate  II.  Sabre  fracture  of  the  vault  of  the  Cranium opp. 


Punctured  wounds  of  the  Head 

Bayonet  and  sword  thrusts  through  Cranium 

Section  II.  Miscellaneous  Injuries  of  the  Head 

Railroad  Accidents 

Concussion  of  the  Brain 

Falls  producing  Scalp  Wounds 

Cemtusions,  Commotions,  and  Concussions 

Compound  fractures  of  the  Cranium  from  Falls 

Contusions,  lacerations,  and  cerebral  commotion  caused  by  Blows 

Head  injuries  from  falling  trees 

Contusions  and  fractures  from  kicks  by  Animals 

Contusions  and  fractures  by  clubs  or  other  Blunt  Weapons 

Head  injuries  from  unspecified  Causes 

Removal  of  fragments  after  Cranial  Fractures 

Trephining,  eighteen  Abstracts  of  Cases 

Analytical  review  of  the  cases  in  this  Section 

Table  I.  Cases  of  Concussion  and  Compi’cssion  of  the  Brain 

Table  II.  Seat  of  injury  in  one  hundred  and  five  miscellaneous  fractures  of  the  Skull 

Section  III.  Gunshot  Wounds  of  the  Head 

Gunshot  wounds  of  the  Scalp 

Table  III.  Results  of  seven  thousand  seven  hundred  and  thirty-nine  cases  of  gunshot  wounds  of  the  Scalp. . 

Abstracts  of  fifty-four  fatal  gunshot  Scalp  Wounds 

Gunshot  scalp  wound  followed  by  Encephalitis 

Erysipelas  in  gunshot  wounds  of  the  Scalp 

Gangrene  in  gunshot  wounds  of  the  Scalp 

Hsemonliage  in  scalp  wounds.  Abstracts  of  eleven  Ligations  of  the  Temporal  and  Occipital 

Tetanus  following  Scalp  wounds  by  gunshot 

Pyaemia  consecutive  to  gunshot  Scalp  Wounds 

Complications  of  gunshot  Scalp  Wounds  by  intercurrent  diseases 

Summary  of  cases  of  gunshot  wounds  of  the  Cranial  Integuments 

Table  IV.  Seat  of  injury  in  two  thousand  four  hundred  and  ninety-thre(!  gunshot  Scalp  Wounds 

Table  V.  Nature  of  missile  in  four  thousand  and  two  Scalp  Wounds 

Balls  lodged  beneath  the  Cranial  Integuments 

:! 


1 

4 

16 

215 

30 

32 

35 

35 

37 

39 

40 

42 

43 
45 
47 
47 
51 
55 
57 
61 
66 
68 
70 
70 

70 

71 
75 
77 

79 

80 

83 

84 
8.5 

89 

90 

91 

92 


f 


TABLE  OF  CONTENTS. 


Section  III — Contiimed.  Page. 

Gunshot  contusions  of  the  Cranial  bones 95 

IIscinoiThage  and  Erysipelas  in  this  class  of  Wounds — ligation  of  Temporal 101 

Gangrene  and  Periostitis  after  gunshot  contusions  of  the  Skull 102 

Exfoliations  following  Contusions  of  the  Skull  by  Balls 103 

Plate  III.  Gunshot  Scalp  wounds  and  contusions  of  the  Skull opp.  10.5 

Caries  after  gunshot  contusions  of  the  Cranium ■- 106 

Persistent  pain  in  the  head  following  gunshot  Contusions lOG 

Vertigo,  giddiness,  and  headache  after  gunshot  contusions  of  the  Skull 107 

Chronic  Irritahility  of  the  Brain  after  gunshot  contusions  of  the  Skull 109 

Meningitis  from  gunshot  contusion  of  the  Skull 110 

Cerebritis  from  the  same  cause Ill 

Intracranial  Extravasations  and  abscess  after  gunshot  contusions 112 

Paralyses  following  gunshot  contusions  of  the  Skull 113 

Loss  of  vision  from  gunshot  Cranial  contusions 115 

Deafness  from  like  cause 116 

Aphasia,  epilepsy,  and  mental  aberration  from  like  cause 118 

Pj’asmia  and  Tetanus  after  gunshot  contusion  of  the  Skull 122 

Trephining  in  cases  of  this  subdivision,  sixteen  abstracts 123 

Kec.apitulatioh  and  comments  on  this  subdivision 126 

Gunshot  fractures  of  the  Outer  Table  alone  of  the  Cranium 128 

Recapitulation  and  criticism  of  the  one  hundred  and  thirty-eight  foregoing  abstracts 140 

Gunshot  fractures  of  the  Inner  Table  alone  of  the  Cranium, — twenty  histories 141 

Plate  IV.  Gunshot  fractures  of  the  Inner  Table opp.  143 

Remarks  on  the  bibliography  and  mechanism  of  this  injury 150 

Gunshot  fractures  of  both  Tables  of  the  Cranium 159 

Linear  or  capillai’y  fissure  from  gunshot 159 

Ligation  of  the  anterior  Temporal  Artery 160 

Fractures  of  both  Tables  of  the  Cranium,  without  depression 161 

Plate  V.  Gunshot  wounds  of  Sergeant  Bemis opp.  162 

Balls  chipping  or  splitting  on  the  Cranial  bones 163 

Balls  lodged  in  the  sinuses  or  diploe 164 

Gunshot  fractures  of  the  Cranium,  without  known  depression,  indefinitely  diagnosticated 167 

Gunshot  depressed  fractures  of  the  Skull 167 

Survivors  of  gunshot  depressed  fractures  of  the  Skull  disch.arged  disabled 177 

Balls  splitting  on  the  Cranial  bones,  with  illustrations 180 

Recoveries  without  disability,  from  depressed  gunshot  fractures  of  the  Skull 182 

Extravasation  and  intracranial  abscess  after  gunshot 183 

Erysipelas,  caries,  and  necrosis  following  like  injuries 185 

Exfoliations  after  depressed  gunshot  Cranial  fractures 187 

Remote  results  of  depressed  fractures  of  the  Skull  by  gunshot 189 

Gunshot  wounds  penetrating  the  Cranium 190 

Balls  lodged  within  the  Cranial  cavity 193 

Missiles  extracted  from  within  the  Cranium 196 

Abstracts  of  thirty-eight  fatal  penetrating  gunshot  wounds  of  the  Head 200 

Abstracts  of  five  cases  of  balls  lodged  within  the  Skull  and  unsuspected 204 

Perforating  gunshot  fractures  of  the  Skull 206 

Plate  VI.  Gun.shot  fractures  of  Cranium  (chromo-lithograph) opp.  207 

Abstracts  of  partial  recovery  in  fourteen  cases  of  perforation  of  the  Skull  by  balls 208 

Crash  or  smash — abstracts,  with  illustrations  of  cases 212 

Removal  of  fragments  after  gunshot  Cranial  fractures 215 

Abstracts  of  seventy-three  cases  of  this  subdivision  which  ended  in  partial  recovery 215 

Abstracts  of  fifty-eight  cases  of  j)cnsioners  belonging  to  this  .subdivision 224 

Ligation  of  the  superficial  Temporal 225 

Recoveries  with  balls  lodged  within  the  Brain 234 

Foreign  bodies  removed  with  bone  fragments  from  within  the  Skull 236 

Abstracts  of  one  hundred  and  nine  cases  of  this  subdivision  of  presumed  recovery  not  pensioned 240 

Ligation  of  the  superficial  Temporal 241,244 

Fatal  cases  of  gunshot  fractures  of  the  Skull  treated  by  elevation  or  removal  of  fragments 247 

Ilsemori'hage,  jwajmia,  and  othei’  complications  of  such  operations — ligation  of  Carotid 255 

Trephining  after  gunshot  fractures  of  the  Skull 261 

Abstracts  of  fatal  cases  of  this  class,  with  many  illustrations 262 

Ligation  of  a Cerebral  arteiy 269 

Treiduning  after  gunshot  fractures  of  the  Skull — abstracts  of  cases  of  recovery,  with  disabilities 277 

Absti’acts  of  fifteen  cases  of  complete  recovery 285 


4 


TABLE  OF  CONTENTS. 


Section  III — Continued.  rage. 

Trephining  after  gunshot  fractiu-es  of  the  Skull — abstracts  of  four  cases  of  patients  sent  to  modified  duty. . . 286 

Six  patients  recovering  from  trephining  and  exchanged  or  furloughed 287 

Abstracts  of  thirty-five  cases  of  partial  recovery 287 

Ligation  of  supei-ficial  Temporal _ 288 

Hernia  or  fungus  cerebri 293 

Plate  VII.  Cerebral  Hernia  after  gunshot  fracture  of  the  occipital  (chromo-lithograph) opp.  295 

Ligation  of  superficial  Temporal 298 

Counter-stroke  fractm-es  from  gunshot  (?) 304 

Summary  of  gunshot  injuries  of  the  Head 305 

Table  VI.  Eesults  of  four  thousand  three  hundred  and  fifty  cases  of  gunshot  injuries  of  the  Cranium 307 


Table  VIII.  Results  of  nine  hundred  operations  on  the  Skull 309 

Review  of  the  nature  and  treatment  of  Head  injuries 310 

Ligations 313 

Ligations  of  Common  Carotid 313 

Abstracts  of  six  cases  of  ligation  of  Common  Carotid 313 

Ligation  of  External  Carotid 315 

Ligations  of  Superficial  Temporal 315 

Scalping,  as  practiced  by  North  American  Indians 315 

Foreign  Bodies 315 

Contre-coup,  with  bibliographical  references 316 

Trephining 316 

Abstracts  of  nine  cases  of  trephining 316 

Bibliography  of  trephining 317 

Bibliography  of  fungus  cerebri 318 

Forms  of  cranial  fracture 318 

Repair  of  cranial  fractures  and  trephine  orifices 319 

Dr.  Holston’s  remarks  on  trephining 320 

Bibliography  of  wounds  of  the  Head 320 

CHAPTER  II.  Wounds  and  Injuries  of  the  Face. 

Section  I.  Incised  and  Punctured  Wounds 321 

Sabre  wounds  of  the  Face 322 

Bayonet  wounds  of  the  Face ! 323 

Table  IX.  Results  of  sixty-four  Miscellaneous  fractures  of  the  bones  of  the  Face 324 

Table  X.  Results  of  two  hundred  and  seventy-one  lacerations,  etc.,  of  the  Face 324 

Section  II.  Wunshot  Wounds  of  the  Face 325 

Gunshot  wounds  of  the  Orbital  Regions 325 

Abstracts  of  thirty-nine  cases  of  destruction  of  both  Eyes 325 

Abstracts  of  two  hundred  and  fifty-four  cases  of  gunshot  injury  of  one  Eye 329 

Ligation  of  Common  Carotid 332,339 

Table  XI.  Eesults  of  one  thousand  one  hundred  and  ninety  gunshot  injuries  of  the  Eyes 343 

Gunshot  fractures  of  various  Facial  bones 345 

Ligation  of  Common  Carotid 346, 347,  349,  350,  351, 352,  353,  355 

Remarks.  Ligations  of  the  Carotid  in  thirteen  cases 367 

Plate  VIII.  Wounds  of  the  Face  and  Neck,  Silsbee  (chromo-lithograph) opp.  367 

Section  III.  Plastic  Operations  after  Gunshot  Wounds  of  the  Face 368 

Cases  of  Blepharoplasty  after  gunshot  wounds 368 

Cases  of  Meloplasty  after  gunshot  wounds 369 

Cases  of  Stomatoplasty  after  gunshot  wounds 370 

Cases  of  Rhinoplasty  after  gunshot  wounds 372 

Cases  of  Cheiloplasty  after  gunshot  wounds 374 

Cases  of  Genioplasty  after  gunshot  wounds 375 

Cases  of  Staphylorraphy  after  gunshot  wounds 378 

Review  of  abstracts  cited  in  this  Section 381 

Table  XII.  Results  of  three  thousand  three  hundred  and  twelve  gunshot  fractures  of  the  Face 381 

Table  XIH.  Eesults  of  four  thousand  nine  hundred  and  fourteen  cases  of  gunshot  flesh  wounds  of  the  Face. . 382 

Table  XIV.  Eesults  of  nine  thousand  eight  hundred  and  fifteen  Face  injuries 382 

Table  XV.  Eesults  of  six  hundred  and  seventy-one  Operations  on  the  Face 383 

HsemoiThage  in  gunshot  wounds  of  the  Face — ligation  of  Common  Carotid 392, 393 

Tabular  Statement  of  thirty-five  ligations  of  the  Common  Carotid 394 

Notes  of  six  ligations  of  the  External  Carotid 396 

Ligation  of  the  .lugular  Vein 397 

Excisions  of  bones  of  the  Face 398 


TABI.E  OF  CONTl'lNTS. 


CHAPTER  III.  Wounds  and  Injukie.s  ou  tiik  Neck.  Pago. 

Section  I.  Incised  and  Punctured  Wounds  and  Miscellaneous  Inj arks 399 

Table  XVI.  Results  of  forty-six  niiscellaneous  injuries  of  the  Neck 400 

Section  II.  Gunshot  Wounds  of  the  Neck 401 

Plate  IX.  Wounds  of  Neck  by  musket  balls  (chromo) opp.  403 

Balls  lodged  in  the  Neck 403 

Foreign  Bodies  extracted  in  gunshot  wounds  of  Neck 405 

Gunshot  Wounds  of  Larynx  and  Trachea 403 

Gunshot  wounds  of  Pharynx  and  (Esophagus 408 

Paralysis  after  gunshot  'wounds  of  Cervical  Nerves 40S 

Hemorrhage  after  gunshot  wounds  of  the  Neck j 411 

Eiysipelas,  gangrene,  and  other  complications 412 

Table  XVII.  Results  of  four  thousand  eight  hundred  and  ninety-live  cases  of  gunshot  wounds  of  the  Neck. . 414 

Section  III.  Operation  on  the  Neck  after  Gunshot  Wounds 415 

Table  XVIII.  Results  of  one  hundred  and  thirty-eight  Operations  on  the  Neck 415 

Operations  on  the  Air-passages 415 

Bronchotoiny,  Abstracts  of  six  cases r 417 

Abstracts  of  cases  of  laryngotomy  and  tracheotomy 418 

Ligations  of  arteries 419 

Tabular  Statement  of  fifteen  ligations  of  Carotid 421 

Ligations  of  the  Subclavian  and  minor  Trunks 422 

CHAPTER  IV.  Wounds  and  Injuries  of  the  Spine. 

Section  I.  Incised  Wounds  and  Miscellaneous  Injuries 425 

Incised  wounds  of  the  Spine 425 

Contusions  from  falls,  blows,  etc 426 

(For  illustration  of  first  case  on  page  426,  see  page  450.) 

Brief  abstracts  of  seventy-nine  cases  of  this  nature 427 

Section  II.  Gunshot  Wounds  of  the  Spine 430 

Gunshot  fractures  of  the  Cervical  Vertebrae 430 

Gunshot  fractures  of  the  Dorsal  Vertebra) : 433 

Gunshot  fractures  of  the  Lumbar  Vertebra) 441 

Tetanic  symptoms  after  gunshot  wounds  of  the  Spine 452 

Table  XIX.  Results  of  six  hundred  and  forty-two  cases  of  gunshot  Injury  of  the  Vertebras 452 

Remarks  on  gunshot  injuries  of  the  Vertebrie 453 

Section  III.  Operations 455 

Table  XX.  Results  of  sixty-two  operations  after  gunshot  fractures  of  the  Vertebra) 455 

Ligations  in  this  class  of  Injuries 455 

Ligations  of  the  Common  Carotid 456 

Removal  of  fragments  of  Vertebra) 457 

Removal  of  balls  from  Spinal  Column 400 

Excision  of  portions  of  Vertebra) 463 

CHAPTER  V.  Wounds  and  Injuries  of  the  Chest. 

Section  I.  Incised  Wounds,  Contusions,  and  Miscellaneous  Injuries 466 

Sabre  wounds  of  the  Chest, — nine  cases 463 

Bayonet  wounds  of  the  Chest, — twenty-nine  cases 467 

Punctured  and  Incised  wounds  of  the  Chest  by  various  weapons 470 

Miscellaneous  injui'ies  of  the  Chest 471 

Table  XXI.  Statement  of  two  hundred  and  ninety-six  cases  of  this  division 471 

Section  II.  Gunshot  Wounds  of  the  Chest 472 

Gunshot  flesh  wounds  of  the  Chest 472 

Foreign  Bodies  lodged  in  the  Thoracic  Parietes 473 

Non-peneti-ating  injuries  of  the  Chest 473 

Internal  Injuries  without  External  Wounds  of  the  Chest 476 

Penetrating  and  Perforating  Wounds  without  Fi'acture 478 

Gunshot  Fractures  of  the  Clavicle 482 

Gunshot  Fractures  of  the  Scajiula 484 

Gunshot  Fi’actures  of  the  Sternum 483 

Plate  X.  Penetrating  wound  of  Mediastinum,  Betts  (chromo-lithograph) opp.  486 

Gunshot  fractures  of  the  Ribs  488 

Complicated  wounds  of  the  Lung 491 

Gunshot  wounds  of  both  Lungs 495 

6 


TABLE  OF  CONTENTS. 


Section  II — Continued.  Page. 

Hermetical  Sealing  in  wounds  of  the  Chest 497 

Abstracts  of  twenty-seven  cases  of  Hermetical  Sealing  resulting  favorablj' 499 

Abstracts  of  forty-two  cases  of  Hermetical  Sealing  resulting  fatally 503 

Analysis  of  the  foregoing  cases 507 

Eeport  on  the  subject  of  Hermetical  Sealing  by  Assistant  Surgeon  Charles  Smart,  U.  S.  A 509 

Report  on  Hermetical  Sealing,  by  Sui'geon  H.  B.  Fowler,  T2th  New  Hampshire  Volunteers 511 

Eeport  on  Hermetical  Sealing,  by  Assistant  Surgeon  G.  Derby,  U.  S.  V 511 

Eeport  on  Hermetical  Sealing,  by  Assistant  Surgeon  B.  Howard,  U.  S.  A 512 

Hernia  of  the  Lung,  or  Pneumocele 514 

Plate  XI.  Gunshot  wound  of  Thorax  and  Abdomen  (chromo-lithogi’aph) opp.  515 

Plate  XII.  Gunshot  wound  of  Thorax  and  Abdomen  (chromo-lithograph) opp.  51G 

Hmmorrhage  in  wounds  of  the  Chest 519 

Wounds  of  the  Aorta  and  Cavac 519 

Wounds  of  the  Anonyma  or  Brachio-Cephalic 519 

Wounds  of  the  Subclavian  Artery  and  Vein 521 

Wounds  of  the  Internal  Mammary  Artery 523 

Abstracts  of  four  cases  of  wounds  of  Internal  Mammary  Artery 523 

Remarks  by  Surgeon  .1.  A.  Lidell  on  Ligation  of  Internal  Mammary  Artery 524 

Wounds  of  the  Intercostal  Arteries 525 

Abstracts  of  eight  cases  of  wounds  of  Intercostal  Arteries 526 

Aneurism,  axillary,  case  of 527 

Wounds  of  the  Pericardium 528 

Abstracts  of  eight  cases  of  wounds  of  the  Pericardium ' 528 

Wounds  of  the  Heart .* 530 

Abstracts  of  six  cases  of  wounds  of  Heart 530 

Cardiac  Diseases  resulting  fi’om  wounds 533 

Incised  wounds  of  Heart  and  Pathological  specimens 534 

Gunshot  wounds  of  the  Mediastinum 535 

Gunshot  wounds  of  the  Thoracic  Duct 535 

Gunshot  wounds  of  the  ffisophagus 535 

Gunshot  wounds  of  the  Nerves  of  the  Chest 53G 

Gunshot  wounds  of  the  Diaphragm 536 

Section  III.  Operations  on  the  Chest 537 

Ligations  of  the  Innominata 537 

Ligations  of  the  Subclavian 538 

Traumatic  aneurism  of  the  Subclavian 541 

Remarks  on  twenty-five  abstracts  of  ligations  of  the  Subclavian 547 

Ligations  of  the  Internal  Mammary  Artery 548 

Ligations  of  the  Suprascapular  Artery 549 

Ligations  of  the  Intercostal  Artery,  with  eight  abstracts 550 

Remarks  and  Bibliography 552 

Ligations  of  the  Axillary  Artery 553 

Series  of  thirteen  cases  of  ligations  of  the  Axillary  Artery 553 

Ligations  of  Thoracic  branches  of  the  Axillary 556 

Excisions  of  Bones  of  the  Chest 557 

Excisions  of  the  Clavicle 557 

Abstracts  of  nine  cases  of  excisions  of  portions  of  the  Clavicle 558 

Excisions  of  portions  of  the  Scapula 562 

Abstracts  of  four  cases  of  excisions  of  portions  of  the  Scapula 562 

Excisions  of  portions  of  the  Ribs 566 

Abstracts  of  six  cases  of  excisions  of  portions  of  the  Ribs 566 

Varieties  of  fractured  Ribs 568 

Excisions  or  Trephining  of  portions  of  the  Sternum 571 

Thoracentesis  or  Paracentesis  Thoracis 572 

Abstracts  of  twenty-one  cases  of  Thoracentesis 573 

Foreign  bodies  lodged  within  the  Chest 582 

Remarks  on  the  extraction  of  foreign  bodies 589 

Table  XXII.  List  of  specimens,  removed  from  the  Chest  during  life,  contained  in  the  Army  Medical  Museum . . 594 

Abstracts  of  cases  of  balls  or  foreign  bodies  remaining  in  the  Chest 596 

Table  XXIII.  Statement  of  four  hundred  and  ninety-four  operations  for  injuries  of  the  Chest 598 

Mortality,  complications,  diagnosis,  and  treatment  of  wounds  and  injuries  of  the  Chest 599 

Table  XXIV.  Statement  of  twenty  thousandsixhundredandsevencasesofwoundsandinjuriesoftheChest..  599 

Table  XXV.  Statement  of  wounds  of  the  Chest  in  the  field  or  primary  hosjntal,  1864-65 600 

Relative  frequency  of  wounds  of  the  Chest 601 

7 


TABLE  OF  CONTENTS. 


Section  III — Continued.  Page. 

Mortality  of  wounds  of  the  Chest G04 

Table  XXVI.  Statement  of  eight  thousand  seven  hundred  and  fifteen  cases  of  penetrating  gunshot  wounds 

of  the  Chest COG 

Table  XXVII.  Number  of  penetrating  wounds  of  the  Chest,  with  ratio  of  mortality,  from  various  authorities  G08 

Complications  of  injuries  of  the  Chest 611 

HtEmorrhage  in  wounds  of  the  Chest 611 

Emphysema  following  penetrating  wounds  of  the  Chest 613 

Fractures  of  the  bones  of  the  Chest 615 

Hernia  of  the  Lung 617 

Lodgment  of  Foreign  Bodies 617 

Traumatic  Pleurisy 617 

Traumatic  Pneumonia 619 

Carditis  and  Pericarditis 622 

Pneumothorax 623 

Hydrothorax 624 

Hsemothorax 624 

Empyema 626 

Abscesses  in  the  Lung 628 

Plate  XIII.  Metastatic  Abscess  in  Lung opp.  628 

Phthisical  tendencies 629 

Thoracic  Fistula; 630 

Collapse  of  the  Lung 631 

Contraction  of  the  Chest 633 

Secondary  Emphysema  and  Pneumothorax 633 

Wounds  of  the  OSsophagus,  Thoracic  Duct,  Nerves,  and  Diaphragm 634 

Wounds  of  both  Lungs 634 

Erysipelas  and  Gangrene ; 634 

Tetanus 635 

Diagnosis  and  Prognosis 635 

Tromatopnrea .• 635 

Htemoptysis 636 

Dyspnoea 638 

Nervous  anxiety 638 

Other  signs 639 

Treatment 642 

Local  treatment 642 

General  treatment 642 

Index  of  Eeporters I 

List  of  Lithographs 

8 


LIST  OF  LITHOGRAPHS. 


Pi.ATE  I,  facing  p.  4.  Sabre  Wounds  of  tue  Head.  Three  fgures:  Eight  hand,  case  of  Butcher,  p.  3;  middle,  case  of 
Howard,  p.  20 ; left  hand,  cese  of  Rogers,  p.  22. 

Plate  II,  facing  p.  22.  Sabre  Fractures  of  the  Vault  of  the  Cranium;  case  of  Strandhurg,  p.  22.  Two  figures:  Left 
hand,  external  view  ; right  hand,  internal  view. 

Pl.ate  III,  facing  p.  105.  Gunshot  Scalp  Wounds  and  Contusions  of  the  Skull.  Four  figures : Eight  hand,  case 
of  Wheeler,  fracture  of  temporal  bone,  p.  225;  upper  middle,  case  of  Beam,  contusion  of  parietal,  ]).  121;  lower 
middle,  case  of  Sullivan,  fracture  of  inner  table  of  skull,  p.  148 ; left  hand,  case  of  Scott,  contusion  of  the  skull,  p.  105. 

Plate  IV,  facing  p.  143.  Gunshot  Contusion  of  the  Cranium,  with  Fracture  of  the  Inner  Table.  Four  figures: 

Upper  left  hand,  case  of  L , p.  143 ; exterior  view  of  Specimen  2313,  A.  M.  M, ; upper  right  hand,  interior 

view  of  the  same,  exhibiting  a detached  fragment  of  the  lamina  vitrea;  lower  left  hand,  case  of  P , p.  142; 

exterior  view  of  Specimen  1568,  A.  M.  M. ; lower  right  hand,  interior  view  of  the  same,  exhibiting  a depressed 
fracture  of  the  inner  table. 

Plate  V,  facing  p.  162.  Gunshot  Wounds  of  Edson  D.  Bemis,  p.  162;  gunshot  fracture  of  both  tables  of  the  skull. 

Plate  VI,  facing  p.  207.  GUNSHO'f  Fractures  of  the  Cranium.  Two  figures:  Left  hand,  case  of  McK , p.  280; 

right  hand,  case  of  Hughes,  p.  206. 

Pl.vte  VII,  facing  p.  295.  Gunshot  Fracture  of  the  Cranium,— Hernia-  Cerebri.  Two  figures : Case  of  Kennedy, 
p.  294. 

Pl^vte  VIII,  facing  p.  367.  Gunshot  Wounds  of  the  Face  and  Neck.  Two  figures:  Left  hand,  case  of  Spiegle,  wound 
of  neck,  p.  402;  right  hand,  case  of  Silsbee,  fracture  of  facial  bones,  p.  367. 

Plate  IX,  facing  p.  402.  Wounds  of  the  Neck,  by  Conoidal  Musket  Balls.  Two  figures:  Left  hand,  case  of  Brown, 
p.  402 ; right  hand,  case  of  Keepers,  p.  402.  — 

Plate  X,  facing  p.  486.  Penetrating  Wound  of  Mediastinuji  ; case  of  Betts,  p.  486. 

Plate  XI,  facing  p.  515.  Gunshot  Wound  of  Thorax  and  Abdomen,  with  Hernia  of  the  Lung;  case  of  Captain 
S , p.  515. 

Plate  XII,  fltcing  p.  516.  Gunshot  Wound  of  Thorax  and  Abdomen, — wound  healed;  case  of  Captain  S , p.  515. 

Plate  XIII,  facing  p.  628.  Metastatic  Focus  in  the  Lung  ; case  of  S , p.  628. 

n* 


9 


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I 


4 


WAR  DEPARTMENT, 

SuRGEOx  General’s  Office, 

Novemhei^  12,  1870. 

In  the  first  year  of  the  War  it  became  evident  that  tlie  form  of  Returns  of 
Sick  and  Wounded,  then  in  use,  were  insufficient  and  defective  ; and,  on  May  21, 
1862,  measures  were  taken  by  the  then  Surgeon  General  of  the  Army,  Wm.  A. 
Hammond,  to  secure  more  detailed  and  exact  reports  of  sick  and  wounded,  by 
important  modifications  in  the  returns  from  medical  officers.  On  June  9,  1862, 
the  intention  to  prepare  for  publication  a Medical  and  Surgical  History  of  the 
Rebellion  w^as  announced  to  the  Medical  Staff,  in  a Circular  from  the  Surgeon 
General’s  Office.  On  July  1, 1863,  a Consolidated  Statement  of  Gunshot  Wounds, 
by  Surgeon  J.  H.  Brinton,  U.  S.  Yolimteers,  then  in  charge  of  the  Surgical 
Records,  and  Curator  of  the  Army  Medical  Museum  ; and  on  September  8,  1 863, 
a Report  on  Sickness  and  Mortality  of  the  Army  during  the  first  year  of  the  War, 
prepared  by  Assistant  Surgeon  J.  J.  Woodward,  U.  S.  Army,  in  charge  of  the 
Medical  Records,  were  published  by  this  Office. 

^ The  necessity  for  a thorough  revision  of  the  Returns  of  Sick  and  Wounded 
becoming  apparent,  a Medical  Board  was  assembled  for  this  purpose,  in  July, 
1862,  and  subsequently  the  following  order  was  promulgated : 

[CIRCULAR  No.  25.] 

GENERAL  ORDERS  1 WAR  DEPARTMENT, 

h Adjutant  Geneeal’s  Office, 

No.  355.  j Washington,  November  4,  1863. 

Medical  Directors  of  Armies  in  the  field  will  forward,  direct  to  the  Surgeon  General, 
at  Washington,  duplicates  of  their  reports  to  their  several  Commanding  Generals,  of  the 
killed  and  wounded,  after  every  engagement. 

By  order  of  the  Secretary  of  War  ; 

(Signed:)  E.  D.  TOWNSEND, 

Assistant  Adjutant  General. 


Suegeon  Geneeal’s  Office, 

Washington,  D.  C.,  Nov.  11,  1863. 

To  carry  out  the  intentions  of  the  above  order,  Medical  Directors  of  Armies  in  the 
field  will  detail  suitable  officers,  who  will,  under  their  instructions,  collate_  and  prepare  for 
transmission  to  this  office,  all  obtainable  statistics  and  data  in  connection  with  past  and 


IV 


PREFATORY. 


future  operations  of  those  armies,  which  may  he  essential  or  useful  in  the  accurate  compila- 
tion of  the  Medical  and  Surgical  History  of  the  War. 

Particular  attention  is  called  to  the  following  points:  The  morale  and  sanitary  condi- 
tion of  the  troops;  condition  and  amount  of  medical  and  hospital  supplies,  tents,  ambu- 
lances, etc. ; the  points  at  or  near  the  field  where  the  wounded  were  attended  to ; degree  of 
exposure  of  wounded  to  wet,  cold,  or  heat;  adequacy  of  supplies  of  water,  food,  stimulants, 
etc. ; mode  of  removal  of  wounded  from  field  to  field  hospitals ; to  what  general  hospitals 
the  wounded  were  transferred,  by  what  means  and  where ; the  character  and  duration  of 
the  action,  nature  of  wounds  received,  etc.  When  practicable,  separate  casualty  lists  will 
be  made  of  commissioned  officers,  non-commissioned  officers,  and  privates.  The  attention 
of  all  medical  officers  is  earnestly  directed  to  the  importance  of  this  subject;  without  their 
cooperation  no  reliable  record  can  be  preserved — the  vast  experience  of  the  past  will  remain 
with  individuals,  and  be  lost  to  the  service  and  the  country. 

J.  K.  BARNES, 

Medical  Inspector  General, 

Acting  Surgeon  General. 


To  facilitate  the  collection  and  preservation  of  all  important  information, 
medical  officers  serving  with  regiments  in  the  field  were  furnished,  in  January, 
18G4,  with  a compact  and  portable  Register  of  Sick  and  Wounded,  and  the  fol- 
lowing instructions  were  issued : 


[CIRCULAR  LETTER.] 

Surgeon  General’s  Office, 
Washington,  D.  G.,  January  20,  1864. 

The  Register  of  Sick  and  Wounded  hitherto  in  use  in  the  U.  S.  A.  General  Hospitals 
is  hereby  discontinued.  In  lieu  thereof  will  be  substituted  two  Registers  for  each  General 
Hospital,  viz: 

1.  A Register  of  Sick  and  Wounded. 

2.  A Register  of  Surgical  Operations. 

In  the  former  the  appropriate  entries  will  be  made  whenever  a patient  is  admitted  into 
hospital,  and  during  his  subsequent  stay  therein;  and,  to  assist  in  the  preparation  of  this 
Register,  a new  form  of  Bed-Cards  has  been  adopted. 

In  the  “Register  of  Surgical  Operations,”  will  be  entered,  minutely  and  in  detail,  the 
particulars  of  all  operations  performed,  or  treated  in  hospital.  These  entries  should  be 
made  by  the  medical  officers  in  charge  of  wards. 

The  above  Registers  and  Bed-Cards  are  now  in  the  hands  of  the  Medical  Purveyors, 
ready  for  issue,  and  you  are  directed  to  make  immediate  requisition  for  the  same,  adopting 
them  as  soon  as  received. 

J.  K.  BARNES, 
Acting  Surgeon  General. 

To  the  Surgeon-in-charge  of 

U.  S.  A.  General  Hospital. 


PEEFATORY. 


V 


111  February,  1864,  separate  Eeports  were  ordered  to  be  made  for  Sick  and 
Wounded  Eebel  Prisoners  of  War,  and  for  White  and  Colored  Troops,  in  order 
to  obtain  with  greater  facility  the  sickness  and  mortality  rates  of  each. 

A Classified  Eeturii  of  Wounds  and  Injuries  received  in  Action,  a Eeport 
of  Wounded,  and  a Eeport  of  Surgical  Operations,  were  adopted  in  March,  1864, 
and  distributed  with  the  folio wung  circulars : 

[CIECULAE  LETTER.] 

Surgeon  General’s  Office, 
Washington,  D.  C.,  March  23,  1864. 

Medical  Directors  of  Armies  in  the  field  will  issue  the  “Classified  Return  of  Wounds 
and  Injuries  received  in  Action,’’  to  the  Chief  Medical  Officers  of  Corps  and  Divisions,  who 
will  see  that  they  are  properly  distributed. 

This  form,  correctly  filled  up  by  the  Senior  Medical  Officer  of  the  command  engaged, 
will  be  transmitted,  in  duplicate,  through  the  proper  channel,  to  the  Medical  Director  of  the 
Army  within  three  days  after  every  action. 

The  Medical  Director  of  the  Army  will,  as  soon  as  possible,  forward  to  the  Surgeon 
General  a Consolidated  Return  of  all  Casualties,  according  to  the  same  form.  He  will,  at 
the  same  time,  transmit  one  copy  of  all  Duplicate  Returns  received  from  his  subordinate 
Medical  Officers. 

J.  K.  BARNES, 

* Acting  Surgeon  General. 


[CIRCULAR  LETTER.] 


Sir; 


Surgeon  General’s  Office, 
Washington,  D.  C.,  Alarch  28,  1864. 


You  are  hereby  directed  to  fill  up  the  accompanying  “Report  of  Wounded’’  and 
“Report  of  Surgical  Operations’’  for  the  months  of  January,  February,  and  March,  1864. 

The  Report  of  Wounded  will  consist  of  an  accurate  and  legible  copy  of  all  cases  of 
wounded  entered  on  the  Hospital  Register  during  the  quarter. 

The  Report  of  Surgical  Operations  will  consist  of  a correct  copy  of  the  Register  of  Sur- 
gical Operations  for  the  same  period. 

A list  of  wounded  remaining  under  treatment  on  the  31st  December,  1863,  in  the  hos- 
pital under  your  charge,  and  on  furlough,  is  inclosed;  you  are  directed  to  fill  up  the  column 
“Result, and  Date,’’  opposite  the  respective  names. 

Additional  details  for  the  present  quarter,  of  “Surgical  Operations  remaining  under 
treatment  December  31,  1863,”  you  will  report  on  appended  slips  of  paper. 

Blank  sets  of  Reports  on  Secondary  Haemorrhage,  Tetanus,  and  Pyaemia,  are  also 
inclosed.  These  you  will  fill  up  in  the  usual  manner.  Should  no  such  cases  have  occurred 
in  the  hospital  under  your  charge  during  the  time  specified,  you  will  so  state  in  your  letter 
of  transmission. 


VI 


P R E F A TORY. 


All  of  tlie  reports  above  alluded  to  will,  when  compiled,  be  forwarded  directly  to  tlie 
Acting  Surgeon  General. 

By  order  of  the  Acting  Surgeon  General : 

C.  H.  CRANE, 
Surgeon  U.  S.  Army. 

]\Iedical  Officer  in  charge  of 

U.  S.  A.  General  Hospital. 


Contemporaneously  with  the  establishment  of  a more  accurate  system  of 
Medical  and  Surgical  reports,  a pathological  collection  was  commenced,  which, 
under  the  charge  of  Surgeon  J.  H.  Brinton,  U.  S.  Volunteers,  and  Assistant 
Surgeon  J.  J.  Woodward,  U.  S.  Army,  became  the  basis  of  the  Army  Medical 
Museum,  itself,  as  it  now  exists,  an  eloquent  and  instructive  history  of  the  Medi- 
cine and  Surgery  of  the  War,  and  without  which  no  history  could  have  been  com- 
pletely illustrated. 

The  announcement  of  this  project  w^as  cordially  responded  to  by  Medical 
Officers  throughout  the  service ; and  the  list  of  contributors  comprises  the  names 
of  many  most  eminent  for  zeal  and  ability  in  the  discharge  of  their  duties  under 
the  Government,  whose  honorable  records  are  identified  with  this  work. 

The  following  Circular  was  published  more  to  secure  a certain  class  of  speci- 
mens, than  to  stimulate  the  liherality  with  which  most  valuable  pathological 
material  was  being  forwarded : 

[CIRCULAR  LETTER.] 

Surgeon  General’s  Office, 
Washington,  D.  C.,  June  24,  1864. 

Medical  Officers  in  charge  of  Hospitals  are  directed  to  diligently  collect  and  preserve 
for  the  Army  Medical  Museum,  all  pathological  surgical  specimens  which  may  occur  in  the 
hospitals  under  their  charge. 

The  objects  which  it  is  desired  to  collect  for  the  Museum  may  be  thus  enumerated : 

Fractures,  compound  and  simple;  fractures  of  the  cranium. 

Excised  portions  of  bone. 

Diseased  bones  and  joints. 

Exfoliations  ; especially  those  occurring  in  stumps. 

Specimens  illustrative  of  the  structure  of  stumps,  (obliterated  arteries,  bulbous  nerves, 
rounded  bones,  etc.) 

Integumental  wounds  of  entrance  and  of  exit,  from  both  the  round  and  conoidal  ball. 

Wounds  of  vessels  and  nerves. 

Vessels  obtained  subsequent  to  ligation,  and  to  secondary  hoemorrhage. 

Wounded  viscera. 

Photographic  representations  of  extraordinary  injuries,  portraying  the  results  of  wounds, 
operations,  or  {peculiar  amputations. 


P E E F A T O R Y . 


VII 


Models  of  novel  surgical  appliances,  and  photographic  views  of  new  plans  of  dressing. 

Plaster  casts  of  stumps  and  amputations,  and  models  of  limbs  upon  which  excisions 
may  have  been  performed. 

It  is  not  intended  to  impose  on  Medical  Officers  the  labor  of  dissecting  and  preparing 
the  specimens  they  may  contribute  to  the  Museum.  This  will  be  done  under  the  superin- 
tendence of  the  Curator. 

In  forwarding  such  pathological  objects  as  compound  fractures,  bony  specimens,  and 
wet  preparations  generally,  obtained  after  amputation,  operation,  or  cadaveric  examination, 
all  unnecessary  soft  parts  should  first  be  roughly  removed.  Every  specimen  should  then  be 
wrapped  separately  in  a cloth,  so  as  to  preserve  all  spiculai  and.  fragments.  A small  block 
of  wood  should  be  attached,  with  the  name  of  the  patient,  the  number  of  the  specimen,  and 
the  name  of  the  medical  officer  sending  it,  inscribed  in  lead  pencil.  The  inscription  will  be 
uninjured  by  the  contact  of  fluids.  The  preparation  should  be  then  immersed  in  diluted 
alcohol  or  whiskey,  contained  in  a keg  or  small  cask.  When  a sufficient  number  of  objects 
shall  have  accumulated,  the  cask  should  be  forwarded  directly  to  the  Surgeon  General’s 
Office.  The  expenses  of  expressage  will  be  defrayed  in  Washington.  The  receipt  of  the 
keg  or  package  will  be  duly  acknowledged  by  the  Curator  of  the  Museum. 

In  every  instance,  a corresponding  list  or  history  of  the  cases  should,  at  the  same  time, 
be  forwarded  to  this  office.  In  this  list  the  number  and  nature  of  every  specimen  should  be 
clearly  specified,  and,  when  possible,  its  history  should  be  given.  The  numbers  attached  to 
the  specimens  themselves,  and  the  numbers  on  the  list  forwarded  should  always  correspond, 
and  should  be  accompanied  by  the  name  and  rank  of  the  medical  officer  by  whom  sent. 
Every  specimen  will  be  duly  credited  in  the  Catalogue  to  the  medical  officer  contributing  it. 

J.  K.  BARNES, 

Acting  Surgeon  General. 


In  order  to  perfect  the  returns  under  examination,  as  far  as  possible,  the  fol- 
lowinof  Circular  was  issued : 


[CIRCULAR  LETTER.] 

Surgeon  General’s  Office, 
Washington,  D.  C.,  February  2,  1865. 

Medical  Directors  of  Armies  in  the  field  or  of  detached  commands  are  instructed  lo 
transmit  to  this  Office  copies  of  all  reports  in  their  possession  from  the  Recorders  of  Division 
or  other  Field  Hospitals,  and  in  future,  copies  of  such  reports  will  be  forwarded  to  the  Sur- 
geon General  within  twenty  days  after  every  engagement. 

Medical  Directors  of  Departments  will  forward  to  this  Office  copies  of  all  reports  of 
individual  cases  of  gunshot  injury  antecedent  to  the  adoption  of  the  present  system  of  regis- 
tration of  wounds,  (October  1,  1863,)  which  are  on  file  in  their  offices. 

By  order  of  the  Surgeon  General ; 

C.  II.  CRANE, 
Surgeon  U.  S.  Army. 


VIII 


PEEFATOK.Y. 


On  April  6, 1866,  a letter  was  addressed  to  each  Medical  Director,  requiring 
that  all  Eegisters  of  Hospitals,  Consolidated  Eegisters  of  Soldiers  treated,  and  all 
information  in  their  possession  pertaining  to  the  Sick,  Wounded,  Discharged,  and 
Dead  dnrino-  the  war,  shonld  he  transferred  to  this  Office.  Careful  revision  of 

O 

the  material  accumulated  np  to  that  date,  had  established  its  immense  value  to 
the  civilized  world,  and  it  seemed  to  be  demanded  that,  in  justice  to  humanity, 
and  to  the  national  credit,  it  should,  at  once,  he  made  available  by  publication. 

By  authority  of  the  Secretary  of  War,  Hon.  Edwin  M.  Stanton,  Circular 
No.  6,  A Eeport  upon  the  Extent  and  Nature  of  the  Materials  available  for  the 
preparation  of  a Medical  and  Surgical  History  of  the  War,  was  published,  and 
an  edition  of  seven  thousand  five  hundred  copies  distributed. 

Encouraged  by  the  approbation  of  Secretary  Stanton,  who  took  the  deepest 
interest  in  its  success,  and  aided  by  his  powerful  influence,  an  application  was 
made  to  Congress,  and  an  appropriation  was  granted  June  8,  1868,  for  the  pur- 
pose of  preparing  for  publication,  under  the  direction  of  the  Secretary  of  War, 
five  thousand  copies  of  the  First  Part  of  the  Medical  and  Surgical  History  of  the 
Eebellion,  compiled  by  the  Surgeon  General,  and  on  March  3,  1869,  by  a Joint 
Eesolution  of  Congress,  the  number  of  copies  mentioned  above  was  authorized  to 
be  printed  at  the  Government  Printing  Office. 

Assistant  Surgeon  J.  J.  Woodward,  U.  S.  Army,  who  had  been  in  charge 
of  the  Medical  Eecords  since  June  9,  1862,  and  Assistant  Surgeon  George  A. 
Otis,  U.  S.  Army,  who  was  assigned  to  the  charge  of  the  Surgical  Eecords,  Octo- 
ber 3,  1864,  were  directed  to  prepare  the  work  for  publication;  the  zeal  and 
intelligence  of  these  Officers  having  been  already  fully  established. 

No  work  of  this  character,  of  equal  magnitude,  had  ever  been  undertaken ; 
the  Medical  and  Surgical  History  of  the  British  Army  which  served  in  Turkey 
and  the  Crimea  during  the  war  against  Eussia  in  1854,  1855,  and  1856,  and  the 
Medico-Chirurgical  Eeport  of  Doctor  J.  C.  Chenu  upon  the  Crimean  Campaign, 
published  by  the  French  Government  in  1865,  being  the  only  national  publica- 
tions on  military  medicine  and  surgery. 

It  was  not  considered  advisable  to  follow  the  classification  of  either  of  these 
works,  and  a plan  was  determined  on  which  it  is  believed  will  be  found  adapted 
to  tlm  preservation  of  the  great  mass  of  flxcts  collected,  in  a form  for  convenient 
study.  Through  the  liberality  of  the  Government,  in  its  beneficent  pension  laws, 
it  has  been  found  practicable  to  obtain  accurate  histories  of  many  thousand 
wounded  or  mutilated  men  for  years  subsequent  to  their  discharge  from  service. 


PREFATOEY. 


TX 


The  success  which  has  attended  this  etfort  to  ascertain  the  ultimate  results 
of  operations  or  conservative  measures,  employed  in  the  treatment  of  the  wounded 
in  the  late  war,  is  largely  owing  to  the  cordial  cooperation  of  the  Surgeons  Gen- 
eral and  Adjutants  General  of  States,  the  Examining  Surgeons  of  the  Pension 
Bureau,  and  very  many  private  Physicians  throughout  the  country.  As  in  the 
official  returns  of  the  casualties  of  the  French  and  English  Armies  in  the  Crimean 
War,  the  cases  were  dropped  when  the  men  were  invalided,  pensioned,  or  dis- 
charged from  service,  this  information  was  considered  peculiarly  desirable. 

In  carrying  out  the  intentions  of  Congress,  it  has  been  my  earnest  endeavor 
to  make  this  Medical  and  Surgical  History  of  the  War,  not  only  a contribution 
to  science,  hut  an  enduring  monument  to  the  self-sacrificing  zeal  and  professional 
ability  of  the  Volunteer  and  Begular  Medical  Staff,  and  the  unparalleled  liberality 
of  our  Government,  which  provided  so  amply  for  the  care  of  its  sick  and  wounded 
soldiers.  To  the  Medical  Officers  connected  more  immediately  with  this  work, 
for  most  cordial  assistance  and  unceasing  industry ; to  those  who,  at  the  close  of 
the  war,  returned  to  civil  life ; to  the  members  of  the  Medical  Staff  of  the  Army 
and  Officers  of  the  various  Bureaux  of  the  War  Department,  for  the  courtesy  and 
promptness  with  which  requests  for  information  have  invariably  been  responded 
to,  I am  deeply  indebted.  My  thanks,  and  those  of  every  possessor  of  these 
volumes,  are  especially  due  to  the  Superintendents  of  the  Government  Printing 
Office,  and  their  skilled  assistants,  who  have  spared  no  pains  in  making  the 
typography  and  execution  of  this  pubhcation  worthy  of  the  Government  and  the 
Nation  it  represents. 

JOSEPH  K.  BAENES, 
Surgeon  General  U.  S.  Army. 

2* 


« 


I 


> . 


« • • 


I k 


C ’ 


r 


■J 


.1, 


THE 


MEDICAL  AND  SLEGICAL  HISTORY 

OF  THE 

WAR  OF  THE  REBELLION. 


PART  r. 

VOLUME  II. 

SURGICAL  HISTORY. 


Prepared,  under  the  direction  of  JOSEPH  K.  BARNES,  Surgeon  General  United  States  Army, 
By  GEORGE  A.  OTIS,  Assistant  Surgeon  United  States  Army. 


(SECOND  FIVE  THOUSAND.) 


I ■« 


INTRODUCTION. 


In  the  preparation  of  1116  surgical  portion  of  the  Medical  and  Surgical  History  of  the 
War  of  the  Rebellion,  it  was  at  first  proposed  to  treat  of  the  surgery  in  connection  with 
the  military  operations  of  the  several  battles  and  campaigns.  Surgeon  John  H.  Brinton, 
U.  S.  V.,  originally  assigned  to  the  task,*  prosecuted  his  work  on  this  plan.  After  giving  a 
general  account  of  a campaign,  enumerating  the  troops  engaged,  the  mode  of  transporting 
the  injured,  and  the  available  hospital  accommodations,  the  wounds  and  operations  of  each 
engagement  were  discussed,  the  reports  of  medical  directors,  and  all  other  reliable  sources 
of  information  being  brought  into  requisition.  Among  these  were  observations  personally 
made  in  the  base  and  field  hospitals  of  the  armies  of  the  Potomac  and  of  the  West,  after 
the  great  battles,  where  much  valuable  surgical  material  was  collected,  including  admirable 
illustrations  of  the  graver  injuries,  pathological  specimens,  and  a series  of  excellent  surgical 
drawings.  ’ Such  a plan  was  adapted  to  the  outset  of  the  War,  when  its  extent  and  pro- 
tracted duration  was  anticipated  by  no  one ; but  toward  the  close  of  the  year  1864,  it 
became  apparent  that  a plan  susceptible  of  wider  generalization  must  be  adopted,  for  the 
clerical  force  then  at  the  disposition  of  the  Surgeon  General  was  hardly  sufficient  to  classify 
the  immense  returns  from  the  hospitals  and  battle-fields  of  the  Army  of  the  Potomac  alone. 
During  that  year  there  were  no  less  than  two  thousand  slvirmishes,  actions,  or  battles,  and 
to  have  given  a correct  analysis  of  the  casualties  from  the  returns  from  the  field  and  base 
hospitals  would  have  been  impossible.  For  the  number  of  wounded  received  at  the  Wash- 
ington hospitals  alone,  during  the  quarter  ending  June  30th,  1864,  was  over  thirty  thousand, 
and  the  total  number  of  wounded  reported  by  all  the  general  hospitals  exceeded  eighty 
thousand. 

Therefore,  in  1865,  it  was  suggested,  in  the  report  of  materials  available  for  a Surgical 
HTstory  of  the  War,f  that  the  wounds  and  operations  be  classified  according  to  regions, — ■ 
important  cases  being  described  at  length,  and  brief  abstracts  or  numerical  tabular  state- 
ments being  furnished  of  the  less  important  cases. 

It  was  decided  that  this  plan  should  be  adopted,  and  that  the  reports  of  medical  direct- 
ors and  others,  relating  to  the  field  service,  should  be  published  as  “appended  documents” 
to  the  Medical  and  Surgical  History.  They  are  hound  in  Volume  I,  Part  I. 

In  the  preliminary  surgical  report  in  Circular  No.  6,  S.  G.  0.,  1865,  the  materials 
available  for  a complete  surgical  history  are  fully  described,  and  in  the  introduction  to  the 
medical  volume  of  Part  I,  of  the  Medical  and  Surgical  History,  the  form  of  the  monthly 
report  of  sick  and  wounded  required  of  each  hospital,  post,  regiment,  or  detachment  at  the 
beginning  of  the  war,  and  the  various  modifications  made  in  the  blanks  during  its  progress 
are  clearly  explained,  and  the  causes  of  discrepancies  and  probabilities  of  errors  plainly 
pointed  out.  It  remains  only  to  advert  briefly  to  some  other  sources  of  information  of  an 
exclusively  surgical  nature.  Though,  from  the  beginning,  it  had  been  customary  for  medi- 


* See  Circular  No.  5,  Surgeon  General's  OfiBcc,  June  9th,  1802. 


t Circular  6,  S.  G.  O.,  1805. 


XIV 


INTEODUCTION. 


cal  directors  to  forward  to  the  Surgeon  General  lists  of  the  killed  and  wounded  after  each 
engagement,  it  was  not  until  late  in  1863,*  that  these  returns  were  made  obligatory  and 
rigorously  exacted.  They  were  of  the  greatest  utility  in  furnishing  the  means  of  tracing 
patients  to  base  or  general  hospitals,  where  their  histories  were  more  fully  detailed.  The 
lists  were  on  forms,  twelve  by  sixteen  inches,  ruled  as  follows : 


List  of  Wounded  in  the Brigade^  _Divisionj Corps^  Army  of , at  the  Battle 

of 071  the day  of , 186 . 


D 

'A 

Najies. 

o 

Regimext. 

Corps. 

Injury. 

Treatment. 

Result 
AND  Date. 

Remarks. 

Surname. 

Christian 

name. 

Missile  or 
Weapon. 

Seat  of. 

Nature  of 
(slight 
or  severe.) 

Note  I. — TWs  List  will  be  made  with  the  strictest  accuracy,  and  will  be 
transmitted  bj’  the  Medical  Directors  of  Corps  to  the  Medical  Director  of  the 
Army,  within  seven  days  after  an  en"a{?ement.  The  names  of  all  men  treated 
in  the  Hospital  will  be  entered  upon  this  List.  When  men  are  transferred  to 
or  from  other  Division  Hospitals,  the  fact  of  the  transfer  and  the  date  will  be 
noted  in  the  “Remarks.” 

Note  II. — It  is  enjoined  upon  Medical  Officers  to  state  in  the  column 
“Nature  of  Injury,”  whether  the  wound  is  a flesh-wound  or  a fracture  or  a 
penetrating  wound  of  the  cavity. 


Surgeon  in  Chief Division j Corps, 


The  pocket  field  register,  five  and  one-half  by  eight  and  one-fourth  inches,  referred  to 
by  the  Surgeon  General  on  page  IV  of  his  prefatory  remarks,  as  issued  to  regimental  sur- 
geons, answered  a like  useful  purpose.  It  was  ruled  as  below.  Only  about  five  hundred 
were  transmitted  to  the  Surgeon  General’s  Office  at  the  close  of  the  war. 


Register  and  PrescAption  Booh  of,, Regiment 


No. 

Name. 

Rank. 

Reg't. 

Cojrp. 

Disease. 

Ln  Hospital 
OR  Quarters. 

Prescription  and  Resiakks. 

' 

*.See  Gen'EKAL  OupKHS  No.  355,  liar  Department,  A<ljutant  tJencral's  Office,  November  1th,  18(13, 


INTRODUCTION 


XV 


It  was  found,  as  the  troops  were  massed  in  a few  large  armies,  that  it  was  requisite 
to  obtain  more  prompt  information  of  the  aggregate  of  casualties  than  was  afforded  by  the 
nominal  returns.  Hence  the  following  form  was  employed.  It  appears  to  have  been 
filled  out  with  great  fidelity: 

Classified  Return  of  Wounds  and  Injuries  received  in  action  on  the day  of  , 186  _ , 

at Division Corps,  Army  of 


REGION  OF  BODY  WOUNDED. 


Flesh 

Wounds. 


Ile.id 

Face 

Neck 

Thoracic  Parietes 

Abdominal  Parietes 

Shoulder 

Back  and  Hips 

Perineum,  Genital,  and  ? 
Urinary  Organs ) 

Cranial  Bones 

Bones  of  Face 


( Thorax 


Pexe- 
TKATECG 
Wounds.  (Abdomen. 


Arm. 


Forearm. 


Thioh. 


Leo. 


( Flesh  Wound 

( Fracture 

Shoulder  Joint 

Elbow  Joint 

C Flesh  Wound 

( Fracture 

Wrist  Joint 

Metacarpus 

Fingers 

Hip  Joint 

(Flesh  Vv'ound 

Fractmc,  upper  3d  . . 
Fractui-e,  middle  3d . 
Fracture,  lower  3d  . . 

Knee  Joint 

^ Flesh  Wound 

( Fracture 

Ankle  Joint 

Metatarsus 

Toes 


Wounds  with  direct  injury  of  large 
arteries,  not  being  at  the’ same  time 
cases  of  compound  fracture 


Wounds  with  direct  injun|^  of  largo 
neiwcs,  not  being  at  the  same  time 
c.a.ses  of  compound  fracture 


Nature  of  Missile  or 
Weapon. 


Total 


Operations  and  Deaths. 


REMARKS. 


Snrycon, 

Division,  Cotps, 

Army  of 

r Ikis  statement  will  Im  transmitted,  in  duplicate,  by  tlie  Medical  Directors  of  Army  Corps  to  the  Medical  Director  of  tlio  Army  williin 

jiie  (lajs  after  an  engagement.  No  dxcuse  will  ire  received  foi-  faiinro  in  its  transmittal  witliin  the  time  here  .tii’ccted. 

.lO.SEPII  K.  ll.MtNES. 

Aclinp  tiurywii  tJcneral 


XVI 


INTEODUCTION 


✓ 


(D 

o 

!=1 

O 


cj 

<D 

O 

<D 

£:! 

ci 


fH 

tD 

&H 

<D 

!> 

• I— I 

-+^ 

c3 

Ph 


-4-^ 

CQ 

o 

c5 


o 

p 

s-i 

CO 


CD 


'°p  a 

?H 

cS  .!^ 

a ^ 

o 

tS  ^ 
<D  O 
ncJ  '-M 

g © 

o ':j3 

d)  o 


o 


I 

i 


i 

i 


■| 

'e 

S 

s 

CQ 

t£ 


o 

gs 


REMARKS. 

Here  state  cause  of  death,  of 

discharge,  or  of  transfer  to 

Veteran  Reserve  Corps. 

•xoixaasaa  tio  iionoi 
-an  j Koaa  <iaxiutav-aH 

Date. 

RESULT. 

Date. 

•90TA.Tag 

uio.g  poS.iuqosi(i 

Date. 

•panasad 

Date. 

■paqSnoHUd 

Cl 

■XjIO  JO  ‘ojcjg 
‘lipidsoH  lujaaa*) 
aaipo  o;  pa.uojsuujx 

a 

Cl 

•sdjo3  OAxasan  nma 
■l^A  paxiajsuujx 

« 

Cl 

•iCpip  o;  paatn^OH 

Date. 

IN  SURGICAL  CASES  ONLY. 

TREATMENT. 

Amputation Date  of 

Excision “ “ 

Other  operation. . “ “ 

Simple  dressings. 

■pjoAig 

‘|ouo.fnq  ‘joqs  PU^s 
‘japnq  ^uamoo  xo  puuoH 
’xoavaAV  ao 
aiissijsi  ao  aanxvH 

•aaaMHOAV 

XOISVOOQ  XVIIAV  XO 

DIAGNOSIS. 

In  Surgical  Cases, 
state  Seat  and 
Character  of 
Wound  or  In- 
jurj^ 

•0}9  ‘iTJ;id 

-soH  PPId  uio-y  ‘PPIJ  wiojj 

•aaxxiKav 

aoanos  aaiixo  xviiav  Koa^ 

•aaaaaasxvax  nvxi«T 
-SOH  nvaaxat)  xvhav  kouh 

•aaxxiKav  xanAV 

•aov 

■xxaitioaii 

•AXVJI^OO 

H.snrH 

s4 

a 

•aasKHK  'ivxijsoii 

8 

■& 


C& 


•H 

s 

SQ 

•I?. 


o« 


b-2 

2 c3 

'C  ^ 
C ^ 

20 

i 2 

II 

s a 


a 

£co 

c ” 

S|§ 

gla 
« s 
M 3 


ID  r-* 
W 


;[23 

; B B 
:oO 


'.  'll  a c3  « «? 

lai":  i| 

I b'-sI  . ^ I 
R-s 's :» s fe  5 

s U H O ®~< 

ft)  o 


•NOLivaadO  ■io  axva 


B ^ Q 

Q O H t, 

%<=>a'C 

g g B 

^ K 3 5 


•JiaflKHK  IVXIcTSOII 


IN  TKOD  UCTION. 


XVII 


That  a continuous  record  might  be  kept,  the  names  and  military  descriptions  of  all  sur- 
gical patients  remaining  under  treatment  at  the  conclusion  of  the  quarter,  were  copied,  at 
the  Surgeon  General’s  Office,  from  the  quarterly  reports  of  wounds  and  of  operations,  upon 
folio  blanks  of  the  form  following.  These  lists  were  mailed  to  the  hospitals,  where  the 
progress  or  result  of  each  case  was  recorded,  and  the  paper  thence  returned  with  the  suc- 
ceeding quarterly  reports : 


List  of  Wounded  remaining  under  treatment  at U.  S.  A.  Hospital,  at 

the  beginning  of  the  quarter  which  ends , 186 


[Note. — This  form,  with  the  cohunn  “Result  and  Date  ” properly  filled  up,  will  be  returned  by  the  Medical  Officer  in  charge  to  the  Surgeon  General,  U.  S.  A.] 


Hospital 

NUMUEI!. 

NAME. 

CO. 

REGIMENT. 

DIAGNOSIS. 

RESULT  AND  DATE. 

Prior  to  the  adoption  of  the  quarterly  reports  of  wounded  and  of  operations,  patients 
were  supplied  with  descriptive  lists,  on  foolscap,  ruled  and  lettered  in  the  following  form. 
Except  in  cases  of  transfer,  these  were  not  filled  out  with  much  fidelity,  but  occasionally 
they  furnished  important  facts  and  even  histories  of  grave  cases  that  would  otherwise  have 
escaped  notice : 

MEDICAL  DESCRIPTIVE  LIST. 


Ward , Bed 

Name 

Disease  or  Injury, 

Result, 

(Name  of  attending  Medical  Officer.) 


General  Hospital  at  _ 

, Ranlc , Co. , Regiment 


Date  of  < 


Admission, 

Return  to  duty,  cured, 

Furlough, 

Discharge  from  service, 
Transfer  to  another  Hospital, 
Death,  


Note. — When  a patient  is  first  receiTCd  into  a General  Hospital,  the  entries  on  this  Descriptive  List  will  be  commenced.  All  important  changes 
in  his  condition  will  be  noted  on  it  (in  ink),  from  time  to  time,  by  the  Surgeon  in  charge  of  the  Ward.  When  the  patient  has  been  wounded,  the  date 
and  character  of  the  wound  will  be  stated,  the  nature  of  the  operation  (if  any),  and,  above  all,  the  result.  In  case  of  transfer,  this  list  will  be  sent, 
through  the  officer  in  charge  of  the  transportation,  or  failing  one,  by  mail,  to  the  Surgeon  in  charge  of  the  Hospital  receiving  the  patient.  When  this 
medical  history  shall  have  been  completed,  by  the  cure,  discharge,  furlough,  or  death  of  the  patient,  it  will,  with  the  treatment  and  result  carefully 
noted,  be  transmitted  directly  to  the  Surgeon  General. 


Date. 

Tkeatmeat. 

Diet. 

Remarks  as  to  condition  of  patient,  &c. 

There  was  the  following  endorsement : 


Name  of  Hospital, 
Name  of  Patient, 
Disease  or  Injury, 
Result, 

Date  of  Transmission, 


3* 


XVIII 


INTROJIUCTION. 


The  entries  on  bed-cards  sometimes  supplied  missing  links,  in  tracing  the  chain  of  evi- 
dence of  important  cases.  These  cards  were  printed  on  thick  paper  or  card-board,  five  and 
one-half  by  three  and  one-half  Inches,  and  were  classified  and  transmitted  to  the  Surgeon 
General’s  Office  when  the  hospital  closed.  The  form  of  the  cards  used  (face  and  back)  may 
be  seen  below : 


Form  of  Bed-card  used  in  the 


United  States  General  Hospitals. 


HOSPITAL  NUMBER 

Name  

Age  , Nativity 

Married  or  Single 

Residence 

Post-Office  address  of 
wife  or  nearest  relative, 

Rank  , Co. , Regiment 

IVhen  admitted 
From  what  source 

Diagnosis : — (In  surgical  cases  state  explicitly  seat  and  character  of  wound 
or  injur}-.) 


On  what  occasion  wounded 

Date 

Nature  of  m issile  or  weapon 


TREATMENT. 

[IIKRE  NOTE  IMPORTANT  COMPLICATIONS  AND  ALL  OPERATIONS.] 


RESULT  AND  DATE. 


It  was  anticipated  that  much  information  would  be  derived  from  the  discharge  papers 
for  physical  disability,  but,  after  a laborious  examination,  it  was  found  that  the  surgical  cer- 
tificates were  generally  brief  and  vague,  and  comparatively  useless  for  statistical  purposes. 
The  rolls  of  soldiers  transferred  to  the  Invalid  Corps  were  searched  with  nearly  the  same 
result,  the  surgical  memoranda  being  practically  worthless.  The  objects  in  view  in  the 
formation  of  this  corps  were  jierverted,  many  sound,  healthy  soldiers  being  transferred  to 
suit  the  convenience  of  officers  who  took  them  from  the  ranks  to  serve  as  clerks,  cooks, 
nurses,  or  other  attendants,  and  it  became  necessary  that  the  corps  should  be  reorganized. 
This  was  effected  by  discharging  and  pensioning  the  utterly  disabled  men,  and  dividing  the 
remainder,  according  to  the  extent  of  their  disabilities,  into  two  battalions  of  “Veteran 
Pieserve  Corps,”  the  second  battalion  being  composed  largely  of  men  maimed  by  the  loss  of 
a limb.  The  entries  were  useless  in  a surgical  point  of  view,  being  as  concise  as:  “ampu- 
tation,” or  “amputated  leg,”  or  “excised  elbow.”  When,  in  1866,  four  regiments*  of  Vet- 
eran Reserves  were  incorporated  with  the  Regular  Army,  the  Surgeon  General  instructed 
the  examining  surgeons,  at  the  recruiting  stations,  to  take  careful  notes  of  all  extraordinary 
cases  of  injury  or  mutilation  presented  to  them.  Through  this  channel  much  valuable 
material  was  obtained. 

The  numerous  survivors  of  grave  wounds  and  mutilations  who  have  visited  Washing- 
ton to  prosecute  their  pension  claims,  or  to  solicit  places  under  Government,  or  to  obtain 
orders  for  artificial  limbs,  generally  visit  the  Army  Medical  Museum,  and  the  writer  has 
thus  had  the  opportunity  of  personally  examining  such  cases,  and  of  preparing  six  quarto 
volumes  of  photographs  of  the  more  remarkable  examples.*}*  The  Museum  also  possesses 

* The  42d,  43d,  44th,  and  45th  United  States  Infantry. 

t Sets  of  tltese  volumes  have  been  distributed,  by  the  Surgeon  General’s  direction,  to  the  principal  medical  colleges  and  learned  societies  of  the 

country. 


T NTRODITCTION. 


XIX 


fourteen  quarto  volumes  of  contributed  pliotographs,  and  a vast  number  of  card-size  pictui  es, 
indexed  and  classified,  but  not  bound. 

The  formal  reports  of  medical  directors  of  armies  give  a general  view  of  the  opera- 
tions of  the  Medical  Department.  For  the  Army  of  the  Potomac,  the  reports  of  Medical 
Directors  King,  Tripler,  Letterman,  and  McParlin  furnish  a connected  narrative  of  the  serv- 
ices rendered  by  the  medical  staff.  For  the  western  armies,  the  reports  of  Medical  Direct- 
ors McDougall,  Murray,  Mills,  Cooper,  Swift,  Perin,  Moore,  J.  H.  Brinton,  and  Hewit  afford 
similar  information.  These  papers  depict  an  outline  of  the  surgery  of  the  war,  and  place  in 
evidence  the  immensity  of  the  task  that  devolved  on  the  Medical  Department,  and  vindi- 
cate its  achievements,  in  showing  the  extent  of  the  succor  given  to  the  wounded  in  de- 
spite of  almost  incredible  obstacles.  Besides  these  authoritative  documents,  there  are  on 
file  in  the  office,  to  serve  as  supplementary  reports,  individual  narratives  of  observations 
in  active  service  from  each  member  of  the  regular  or  volunteer  medical  staff.  Such  por- 
tions of  these  reports  as  appeared  to  possess  historical  interest  are  printed  in  the  Appendix 
to  Part  I of  this  work. 

hluch  important  and  otherwise  unattainable  information  regarding  the  ulterior  conse- 
quences of  the  more  important  and  rare  injuries  has  been  collected  by  private  correspond- 
ence with  invalided  soldiers  and  their  surgical  advisers.  More  than  fifteen  hundred  cases 
have  been  examined  in  this  way.^ 

Several  interesting  cases  and  valuable  pathological  specimens  have  been  contributed  by 
officers  of  the  medical  staff  of  the  United  States  Navy.^ 

Many  of  the  former  medical  officers  of  the  Confederate  army  have  aided  in  the  prose- 
cution of  the  work  by  contributing  histories  of  cases,  pathological  specimens,  statistical  data, 
and  facts  concerning  the  terminations  of  the  major  injuries  and  operations.  It  may  be  per- 
mitted to  express  the  hope  that  the  claims  of  these  gentlemen,  with  those  of  all  others  who 
have  contributed  largely  to  the  materials  available  for  their  preparation,  will  be  favorably 
considered  by  Congress,  in  the  distribution  of  these  volumes.^ 

But  the  principal  sources  from  which  the  remote  results  of  wounds,  injuries,  and  opera- 
tions were  ascertained,  were  the  reports  of  pension  examiners,  and  communications  from  the 
surgeons  general  and  adjutants  general  of  States.  The  cordiality  and  zeal  with  which  all  of 
these  officials  have  responded  to  every  enquiry  of  this  office,  and  facilitated  its  researches  in 
many  ways,  have  been  acknowledged,  but  cannot  be  too  highly  appreciated.^ 

* Not  infrequently  the  addresses  of  sunTvors  of  rare  injuries  or  operations  were  unknown,  and  resource  was  liad  to  various  expedients  by  advertising 
in  the  secular  press  and  elsewhere.  Thus  the  ultimate  results  of  Dr.  Head's  case  of  successful  excision  at  tlie  knee-joint  and  Dr.  Compton's  primarj’ 
amputation  at  the  hip-joint  were  determined. 

2 Sec  Specs.  5884  and  2273,  Sect.  I,  Army  Medical  Mtisemn,  for  cases  cf  coxo-femoral  exarticulations  by  Surgeon  W.  E.  Taylor,  U.  S.  N.,  and 
Surgeon  A.  C.  Corgas,  U.  S.  N.,  and  Spec.  5662,  presented  by  Passed  Assistant  Surgeon  R.  J.  Tryon,  U.  S.  N.,  for  a fracture  of  the  leg  jiroduccd  by  a 
torpedo  explosion.  Dr.  Trj'on  also  ct.mmunicated  a number  (if  surgical  memoranda  from  his  private  case-book. 

* Among  the  large  number  who  have  thus  contributed,  I may  enumerate  the  following,  with  whom  I had  the  pleasure  of  personal  correspondence: 
Dr.  Thomas  Williams,  formerly  medical  director  of  the  Anny  of  Northern  Virginia;  Professor  HUNTEii  JIcGLOUih  late  medical  director  of  (Icncral 
Jackson's  Corps ; Dr.  J.  P.  Gilmokk,  late  chief  medical  officer  of  General  McLaws’s  Division  of  General  Longsfreet's  (’orps;  Dr.  John  D.  Jackso.v, 
late  surgeon  P.  A.  C.  S.;  Dr.  W.  W.  Comptox,  of  Holly  Springs,  Mississippi ; Dr.  Clalide  II.  MASTIN',  late  medical  inspector  C.  S.  A.;  Dr.  J.  F.  GRANT, 
of  Pulaski.  Tennessee;  Dr.  W.  L.  15AYLOR,  of  Petersburg,  Virginia;  Professor  J.  J.  CiiisOLM,  of  Baltimore,  Maryland;  Professor  Miles,  of  Baltimore, 
Maryland:  Dr.  11.  D.  THOMAS,  of  Richmond,  Virginia;  Dr.  T.  G.  RiCiiAUD.sOX,  of  New  Orleans;  Dr.  J.  R.  BuiST,  of  Nashville,  Tennessee;  Dr.  A.  C. 
CUVMES,  Fort  Browder,  Alabama;  Dr.  A.  M.  Fauxtlerov,  of  Hunton,  Virginia. 

Where  all  cooperated  cheerfully,  according  to  the  opportunities  at  their  command,  it  is  hoped  that  it  may  not  be  deemed  invidious  to  advert 
particularly  to  the  pains  taken  by  the  successive  adjutants  general  of  New  York  and  Pennsylvania  to  trace  the  histories  of  invalids  unaccounted  for  on 
the  national  records,  and  to  the  kind  and  constant  interest  shown  in  the  work  by  Surgeon  General  W.  J.  Dale,  of  Massachusetts,  Surgeon  General  James 
K.  Pomfret,  of  New  York,  formerly  surgeon  of  the  7th  New  York  Artillery,  and  Surgeon  General  II.  II.  Smith,  of  Pennsylvania.  Among  the  pension 
examiners,  of  whom  many,  fortunately  for  all  concerned,  were  formerly  military  surgeons,  cordial  and  discriminating  assistance  has  been  received  from 
Drs.  F.  Salter  and  T.  B.  Hood,  late  stalf-simgeons  of  volunteers,  and  Dr.  A.  L.  Lowell;  from  Dr.  A.  N.  Dougherty,  late  medical  director  of  the  Second 
Corps : from  Drs.  G.  Derby  and  S.  A.  Green,  of  Boston,  Dr.s.  H.  S.  Hewit  and  George  Suckley,  of  New  York,  late  medical  directors  of  tlie  Armies  of 
the  Ohio  and  of  the  James ; from  Drs.  George  C.  Ilarlin  and  H.  K.  Goodman,  of  Philadelphia,  Prof.  F.  Bacon,  of  New  Haven,  Dr.  D.  W.  Maull,  of 
Wilmington,  Drs.  T.  W.  Wislinrt,  and  G.  McCook,  of  Pittsburg,  Dr.  II.  M,  Dean,  of  I^itchfield,  Dr.  J.  M.  Woodworth,  late  medic.-il  inspector  of  the  Army 
of  the  Tennessee,  Dr.  C.  S.  Wood,  of  New  York,  Dr.  T.  H.  Squire,  of  Elmira,  and  many  others. 


XX 


INTRODUCTION. 


It  is  unnecessary  to  enlarge  on  the  great  facilities  afforded  hy  the  unrivalled  collections 
of  the  Army  Medical  Museum.^  It  is  sufficient  to  say  that  it  possesses  over  six  thousand 
surgical  preparations,  affording  illustrations  of  the  primary,  intermediary,  and  remote  effects 
of  most  of  the  injuries  incident  to  war,  and  of  the  morbid  processes,  which  characterize 
the  different  stages  of  most  surgical  diseases.  It  contains,  also,  a collection  of  weapons  and 
projectiles,  a good  series  of  dissections  and  studies  in  topographical  anatomy,  many  wax, 
plaster,  leather,  and  papier-machd  casts  of  the  results  of  operations,  and  a large  number  of 
specimens,  models,  and  drawings  illustrating  the  materia  chirurgica  and  methods  of  trans- 
jDort  for  the  wounded. 

The  various  manuals  and  systematic  treatises  on  military  surgery  and  the  numerous 
contributions  on  the  subject  published  in  periodicals  during  the  war,  or  since  its  conclusion, 
have  been  carefully  and  often  advantageously  consulted.^ 

Another  and  a very  valuable  store  of  information  was  added,  at  the  close  of  the  war, 
in  the  shape  of  portions  of  the  Confederate  Hospital  Eecords.  These  comprised  the  con- 
solidated monthly  reports  of  sick  and  wounded  of  the  Army  of  Northern  Virginia  from  July 
21st,  1861,  to  May  3d,  1863  ; two  hundred  and  thirty-three  hospital  registers  ; one  hundred 
and  sixty  case  books  ; fifty-two  diet  and  prescription  books  ; seventy-eight  order  and  letter 
books,  and  a number  of  records  of  clothing  issues  and  other  administrative  matters.  There 
were  also  many  books  of  miscellaneous  memoranda,* *  and  a large  collection  of  monthly  and 
quarterly  sick  reports,  discharge  papers,  muster  and  pay-rolls,  reports  of  boards  of  survey, 
and  the  like. 

^Of  csteological  preparations  of  the  results  of  injuries  of  the  head  there  are  422  specimens;  of  wet  preparations  of  lesions  of  the  soft  parts,  casts 
of  plastic  operations,  etc.,  72  specimens ; cf  specimens  of  injuries  and  diseases  of  the  spine,  128 ; of  preparations  of  all  kinds  illustrating  wounds  and  injuries 
of  the  chest,  there  are  210  specimens,  and  of  similar  preparations  belonging  to  the  abdomen,  82;  1,340  specimens  illustrate  the  amputations  and  1,200 
specimens  the  excisions,  and  there  are  1,570  preparations  of  the  different  degrees  of  destruction  or  repair  in  the  injuries  of  the  bones  cf  the  extremities. 

* Among  them  an  exceedingly  interesting  yolume  containing  the  correspondence  between  a benevolent  society,  entitled  the  “Association  for  the  Hclief 
of  Maimed  Soldiers,  ’ cf  which  Dr.  W.  A.  Carrington,  C.  S.  A.,  ■was  secretary',  and  a cooperative  association  in  England,  presided  over  by  Lord  Wharncliffe. 
From  this  volume  the  details  of  many  cases  of  amputations  and  excisions  have  been  gleaned,  which  will  appear  in  their  proper  places  in  this  History. 

* Among  the  American  books  and  papers  on  military  surgerjq  that  have  been  consulted,  the  following  may  be  enumerated.  The  foreign  medico- 
military  bibliography  will  be  referred  to  further  on:  JOXES,  J.,  Plain,  Concise,  Practical  Remarlcs  on  the  Treatment  of  Wounds  and  Fractures,  with  an 
Appendix  on  Camp  and  Military  Hospitals,  Principally  designed  for  the  use  of  young  Military  and  Naval  Surgeons  in  North  America,  Philadelphia, 
177G;  Rush,  Medical  Inquiries  and  Observations,  Philadelphia,  1793-94,  Vol.  I of  his  works;  Barton,  A Treatise  on  Marine,  Flying,  and  Military 
Hospitals,  Philadelphia,  1817 ; Mann,  J.,  Medical  Sketches  of  Campaigns,  1812-1814,  Dedham,  1816;  Parsons,  U.,  Prize  Dissertations  on  Inf  animation 
of  the  Periosteum,  Eneuresis  Irritata,  Cutaneous  Diseases,  Cancer  of  the  Breast,  Malaria,  2d  ed..  Providence,  1849;  PORTER,  J.  B.,  Medical  and 
Surgical  Notes  of  Campaigns  in  the  War  with  Mexico,  during  the  years  1845,  1846,  1847,  and  1848,  Am.  Jour.  Med.  Sci.,  Vols.  XXIII.  XXIV,  XXV, 
and  XXVI,  January,  1852,  to  January,  1853;  WRIGHT,  J.  J.  B.,  On  a Gunshot  Perforation  of  the  Chest  (in  Dr.  F.  II.  Hamilton’s  Pract.  Treat,  on  Mil. 
Surg.,  1861,  p.  157) ; Jarvis,  N.  S.,  N.  Y.  Jour,  of  Med.,  1847,  Vol.  VIII,  p.  151 ; Hulsk,  G.  W.,  Gunshot  Wound  of  the  Head,  Kew  York  Jour,  of  Med. 
and  Surg.,  January',  1841 ; Henderson,  T.,  Topography  of  Madison  Barracks,  Am.  Jour.  Med.  Sci.,  April,'  1841;  Vol.  I,  N.  S.,  p.  337;  Lawson,  T., 
Meteorological  Register  for  the  years  1826  to  1830,  inclusive,  From  observations  made  hy  the  surgeons  of  the  army  and  others  at  the  military  post  of  the 
U.  S.  Army,  To  which  is  appended  the  Meteorological  Register  for  the  years  1822  to  1825,  inclusive,  by  Joseph  Lovell,  Philadelphia,  1840 ; FORRY,  S., 
Statistical  Researches  on  Pulmonary  and  Rheumatic  Diseases,  based  on  the  Records  of  the  Medical  Department,  U.  S.  Army,  Am.  Jour.  lilcd.  Sci.,  Vol.  I, 
N.  S.,  1841,  p.  13 ; Trii*ler,  C.  S.,  Manual  for  the  Medical  Officer  of  the  Army  of  the  United  States,  Part  I,  Cincinnati,  1858 ; Tripler.  C.  S.,  and  BLACK- 
MAN, G.  C.,  Handbook  for  the  MUitary  Surgeon,  Cincinnati,  1861 ; ClllSOLM,  J.  J.,  A Manual  of  Military  Surgery,  for  the  use  of  Surgeons  in  the  Confederate 
States  Army,  3d  ed.,  Colmnbia,  1864 ; Hamilton,  F.  II.,  A Practical  Treatise  on  Military  Surgery,  New  York,  1864 ; and  A Treatise  on  Military  Surgery 
and  Hygiene,  New  York,  1865;  GROSS,  S.  D,,  A Manual  of  Military  Surgery,  Philadelphia,  1861 ; Warren,  E.,  An  Epitome  of  Practical  Surgery  for 
Field  and  Hospital,  Richmond,  1863 ; Manual  of  Military  Surgery,  Prepared  for  the  use  of  the  Confederate  States  Army,  hy  order  of  the  Surgeon  General, 
Richmond,  1863;  Smith,  S.,  Bandbookof  Surgical  Operations,  3d  ed.,  New  York,  1862;  Smith.  S.,  Statistics  of  the  Operation  of  Amputation  at  the 
Hip-Joint,  in  New  York  Journal  of  Medicine,  Sept.,  1852,  p.  93;  COOLIDGE,  R.  IL,  Statistical  Report  on  the  Sickness  and  Mortality  in  the  Army  of  the 
U nited  States,  Compiled  from  the  Records  of  the  Surgeon  General's  Office,  Embracing  a period  of  sixteen  years,  from  January,  1839-55,  Washington,  1856 ; 
the  same,  Embracing  a period  of  five  years,  from  January,  1855-60,  Washington,  1860 ; WARREN,  J.  51.,  Surgical  Observations,  with  Cases  and  Opera- 
tions, Boston,  1867 ; Nott,  J.  C.,  Contributions  to  Bone  and  Nerve  Surgery,  Philadelphia,  1866 ; SCHUPPERT,  51.,  A Treatise  on  Gunshot  Wounds,  Written 
for  and  dedicated  to  the  Surgeons  of  the  Confederate  States  Army,  New  Orleans,  1861 ; Andrews,  E.,  Complete  Record  of  the  battles  fought  near  Vicksburg, 
December,  1862,  Chicago,  1863;  Bartiioi.OW,  R.,  A Manual  of  Instruction  for  enlisting  and  discharging  soldiers,  Philadelphia,  1864  ; Bowditcii.  H.  I., 
A brief  plea  for  an  Ambulance  System  for  the  Army  of  the  United  States,  Boston,  1863 ; and  On  Pleuritic  Effusions,  and  the  necessity  of  Paracentesis  for 
their  removal.  Am.  Jour.  Sled.  Sci.,  Vol.  XXIII,  1852,  p.  320;  Brinton,  J.  11. , Consolidated  Statement  of  Gunshot  Wounds,  Washington,  1863;  Becker, 
A.  R.,  Gunshot  Wounds,  Particularly  those  caused  by  newly  invented  missiles,  1665 ; BUCK,  G.,  History  of  a Case  of  Partial  Reconstruction  of  the  Face, 
Albany,  1864;  and,  Case  of  destruction  of  the  body  of  the  Lower  Jaw  and  extensive  disfiguration  of  the  Face  from  a Shell  Wound,  Albany,  1866;  and. 
Description  of  an  Improved  Extension  Apparatus  for  the  treatment  of  Fracture  of  the  Thigh,  New  York.  1867 ; DERRY,  G.,  The  Le^^soiv:  of  the  War  to  the 
Medical  Profession,  5Iass.  5Iod.  Soc.  Pub.  Vol.  2,  Boston,  1867;  Ellis,  T.  T.,  Leaves  from  the  Diary  of  an  Army  S'urgeon.  New  York.  1863;  Green,  J., 
On  Amputation  of  the  Thigh,  Boston  5Icd.  and  Surg.  Joiu*.,  June,  1863;  Eve,  P.  F.,  A Contribution  to  the  History  of  the  lUp-Joint  Operations  Performed 
during  the  late  Civil  War,  in  Transactions  Am.  5Ied.  Association,  Vol.  XVIIT,  pp.  2.56,  263;  Gay,  G.  II.,  A few  Remarks  on  the  J^rimary  Treatment  of 


INTEODUCTION. 


XXI 


The  bulk  of  these  documents  were  received  from  the  officer  entrusted  with  turning  over 
public  propei'ty  under  the  convention  between  General  Sherman  and  General  Johnston,  April 
26th,  1865.  Other  fragmentary  portions  were  obtained  from  defeated  and  retreating  forces, 
or  from  captured  places.  It  is  greatly  to  be  deplored  that  many  more  of  these  precious  doc- 
uments were  destroyed  than  were  preserved, — being  burned  or  scattered  to  the  winds  wan- 
tonly, or  in  ignorance  of  their  value.  It  must  be  admitted  further,  that  a few  of  the  volun- 
teer medical  officers  retained,  for  their  private  use,  medical  documents  and  pathological 
preparations  that  came  into  their  possession.  It  is  difficult  to  understand  such  dereliction 
of  duty,  in  view  of  the  certainty  of  detection,  since  the  publication  or  the  exhibition  of  such 
data  alone  would  involve  an  admission  of  disobedience  of  orders. 

The  Confederate  medical  records  in  the  possession  of  this  Office  appear,  as  a general 
rule,  to  have  been  kept  with  commendable  exactness,  and  it  is  remarkable  that  physicians 
called  suddenly  from  civil  practice  should  have  so  speedily  mastered  the  intricacies  of  mili- 
tary routine.  The  forms  were,  in  nearly  all  instances,  identical  with  those  employed  prior 
to  the  war  in  the  United  States  Army,  and  the  medical  regulations  were  almost  liter- 
ally the  same,  with  the  exception,  in  both  cases,  of  the  substitution  of  the  words  Con- 
federate  States  for  United  States,  wherever  the  latter  occurred.  The  organization  of  the 
medical  hierarchy  was  very  similar  to  that  of  the  Union  Army.  There  was  a Surgeon 
General,  assisted  by  Medical  Directors  and  Medical  Inspectors,  assigned  to  military  depart- 
ments or  to  armies  in  the  field ; a regular  staff,  composed  chiefly  of  officers  who  had  with- 
drawn from  the  old  army  or  navy,  who  signed  as  Surgeons  or  Assistant  Surgeons,  C.  S.  A., 
a corps  analogous  to  the  Staff  Surgeons  of  Volunteers  of  the  Union  Army,  its  members 
being  addressed  as  Surgeons  or  Assistant  Surgeons  P.  A.  C.  S.;*  regimental  surgeons 
and  assistant  surgeons,  and  physicians  employed  by  contract.  The  inspections  appear  to 
have  been  frequent  and  thorough,  and  special  commissions  were  sometimes  instituted  to 
enquire  into  the  prevalence  of  hospital  gangrene,  erysipelas,  tetanus,  scurvy,  and  various 
epi  demies. f 

Among  the  means  adopted  in  the  Confederate  army  for  collecting  information  on  spe- 
cial subjects  in  military  medicine,  surgery,  and  hygiene,  was  the  organization  of  a society  of 
surgeons  of  the  army  and  of  the  navy  at  Richmond.  The  following  circulars  will  indicate 

Wounds  received  in  haWe,  Boston,  1862 ; GOLDSivniii,  M.,  A Report  on  Hospital  Gangrene,  Erysipelas,  and  Pyiemia,  as  observed  in  (he  Departments  of 
the  Ohio  and  Cumberland,  Louisville,  1863;  IIODGEX,  J.  T.,  Wound  of  Brain,  St.  Louis  Jled.  and  Sur.  Jour.,  Vol.  V,  1868,  p.  405;  Surgeons  Reel  and 
Artery  Forceps,  St.  Louis  Med.  and  Surg.  Jour.,  Vol.  IV,  1867,  p.  151 ; and  On  Fractures,  St.  Louis  Med.  and  Surg.  Jour.,  Vol.  VII,  1870 ; HUDSON,  E.  D., 
Save  the  Arm,  Remarks  on  Exsection,  etc..  New  York,  1864 ; and  Mechanical  Surgery,  New  York,  1871 ; HORWiiz.  P.  J.,  Report  of  Casualties  from  Gun- 
shot Wounds  in  the  U.  S.  Navy,  from  April  2d,  1861,  to  June  30th,  1865,  Washington,  1866 ; Letteumax,  J.,  Medical  Recollections  of  the  Army  of  the 
Potomac,  New  York,  1866;  Lidell,  J.  A.,  A Memoir  on  Osieo-myelitis,  New  York,  1866;  and.  On  the  Wounds  of  Blood-Vessels,  etc.;  On  the  Secondary 
Traumatic  Lesions  of  Bone.,  etc.;  and,  On  Pycemia,  New  York,  1870;  Mott,  V.,  Usemorrhage  from  Wounds  and  the  best  means  of  Arresting  it,  New 
York,  1860 ; MITCHELL,  S.  W.,  Injuries  of  Nerves  and  Their  Consequences,  Philadelphia,  1872 ; 3IOSES,  I.,  Surgical  Notes  of  Gunshot  Injuries  occurring 
during  the  advance  of  the  Army  of  the  Cumberland,  1863,  Am.  Jour.  Med.  Sci.,  Vol.  XLVII,  p.  324,  1864 ; McGill,  G.  M.,  Observation  Book,  National 
and  Hicks  U.  S.  A.  General  Hospitals,  Baltimore,  Maryland,  Baltimore,  1865-(i6;  OkdhoXAUX,  J.,  Manual  of  Instructions  for  Military  Surgeons,  on  the 
Examination  of  Recruits  and  Discharge  of  Soldiers,  New  York,  1863 ; Oils,  G.  A.,  Surgical  Part  of  the  Reports  on  the  Nature  and  Extent  of  the  Materials 
available  for  the  Preparation  of  a Medical  and  Surgical  History  of  the  Rebellion,  being  Part  I,  of  Circular  6,  S.  G.  ().,  1865 ; and  A Report  on  Ai  iputation 
at  the  Hip-Joint  in  Military  Surgery,  Circular  7,  S.  G.  O.,  1867 ; and  A Report  on  Excision  of  the  Head  of  the  Femur  for  Gunshot  Injury,  Circular  No. 
2,  S.  G.  O.,  1809 ; and  A Report  of  Surgical  Cases  treated  in  the  Army  of  the  United  States  from  I860  to  1871.  Circular  No.  3,  S.  G.  O..  1871  ; PaCKAkd, 
J.  II.,  A Handbook  of  Operative  Surgery,  Philadelphia,  1870;  Smith,  II.  II.,  Principles  and  Practice  of  Surgery,  Philadelphia,  1863;  Smith,  N.  R.; 
Treatment  of  Fractures  of  the  lower  extremity  by  the  use  of  the  Anterior  Suspensory  Apparatus,  8vo.,  Baltimore,  1867 ; Smith,  D.,  Experiences  in  the 
Practice  of  Military  Surgery,  Am.  Times,  1862,  Vol.  IV,  p.  331;  Smith,  G.  K.,  The  Insertion  of  the  Capsular  Ligament  of  the  Hip-Joint,  and  its 

Relation  to  Intro- Capsular  Fracture,  New  York,  1862;  THOMSON,  W.,  Report  of  Cases  of  Hospital  Gangrene  treated  in  Douglas  Hospital.  Washington, 
D.  C.,  Am.  Jour.  Med.  Sci.,  Vol.  XLVII,  18C4,  p.  378;  Wagxeu,  C.,  Report  of  Interesting  Surgical  Operations,  Performed  at  the  U.  S.  Army  General 
Hospital.  Beverly.  New  Jei’scy,  1864  ; WOODWARD,  Report  on  the  Causes  and  Pathology  of  Pytemia,  Trans.  Am.  Med.  Assoc..  Vol.,  p.  172,  1866;  Ukad, 
J.  B..  Report  on  Wounds  of  the  large  Joints,  Southern  Sled,  and  Surg.  Journal,  July  and  October,  1866. 

* I’rovisional  Army  of  the  Confederate  States. 

t Some  of  these  reports,  on  gangrene,  typhoid  fever,  and  the  mortality  of  prisoners  at  Andcrsonville,  have  been  i)iiblished  by  the  Sanitary  ('<  m- 
inission : Memoirs  of  the.  War  of  the  Rebellion,  Vol.  I,  1867.  Vol.  II,  1871,  New  York.  Huid  and  Houghton.  8 vo.  pp.  6(i7.  580.  wUh  colored  plates 


XXII 


INTEOD  UCTION. 


the  general  scope  of  their  inquiries.  Keference  is  frequently  made  in  this  work  to  the 
printed  and  unpublished  proceedings  of  this  society  : 

“Sir:  With  the  view  of  reeching  the  individual  experience  and  opinions  of  surgeons  and 
assistant  surgeons  on  debatable  ])oints  in  surgical  pathology,  based  upon  their  observations  in  this 
war,  an  ^Association  of  Army  and  Navy  Surgeons^  has  been  organized,  and  your  co-operation  in 
carrying  out  the  successful  fultilinent  of  its  purpose  is  solicited. 

Questions  proi)osed  by  the  president  will  be  forwarded,  and  as  early  a reply  as  practicable  will 
be  necessary  in  order  that  a majority  vote  may  be  taken  in  the  decision. 

The  following  are  the  questions: 

I.  In  gunsliot  ■wounds,  do  such  differences  exist  between  the  orifices  of  entrance  and  exit  as  to  indicate  them  with  certainty? 

II.  Have  gunshot  wounds,  in  youi’  experience,  ever  assumed  tlie  appearance  of  incised  wounds  and  healed  by  first  intention  ? 

III.  When  suppurating,  which  oiifico  seems  to  heal  first? 

SAM’L  PRESTON  MOORE, 

Pres’t  jlss’n  A.  N.  Surgeons. 

Sir:  In  replying  to  questions,  and  in  essays  or  papers  .sent  to  the  association,  a rmtwe  is 
requested,  coming  to  some  conclusion,  in  order  to  facilitate  taking  the  vote  in  the  decision  on  the 
subject. 

The  following  questions  are  proposed? 

I.  Any  DEATH  from  chloroform  in  YOUU  practice?  Give  particulars  of  the  case,  if  any.  Is  this  agent  always  used? 

II.  1st.  Does  ‘shock’  postpone  YttUIi  surgical  interference  ? At  what  period  of  time,  after  injury,  are  YOU  usually  able 
to  operate?  2d.  Any  relation  between  the  chaeacteii  of  the  injury  and  the  geavity  of  the  shock?  3d.  Any  death,  in  your 
practice,  fi’om  shock  alone? 

III.  Do  CICATEICES  from  gunshot  wounds  furnish  YOU  information  as  to  the  nature  of  the  missile  which  caused  the 
injury,  and  the  probable  exteance  and  exit  of  the  same? 

Further  particulars  on  these  subjects,  with  accounts  of  any  remarkable  course  which  balls  may 
hiive  taken  in  transit  through  the  body,  in  your  own  practice,  are  solicited. 

Third  .series  of  questions : 

V.  What  NUilBEE  of  cases  have  been  followed  by  .secoxdaey  haemorrhage  after  ligation  of  artery  ABOVE  the  wound  ? 
Mention  vessel,  part  of  artery  wounded,  and  the  point  ligated. 

VI.  In  arresting  hsemorrhage,  has  local  deligation,  or  ligature  above  the  wound  proved  the  safer  method  in  YOUE 
hands?  In  how  many  cases  have  you  resorted  to  the  one  or  the  other?  Mention  vessels  injured. 

VII.  Have  haemostatics  proved  of  any  avail  in  YOUE  experience?  How  have  they  been  used? 

VIH.  How  many  cases  of  GAXGEEXE  have  followed  ligation  for  pei.maey  ha?morrhage  and  how  many  for  secoxdaey 
haemorrhage?” 

The  replies  to  these  enquiries,  and  the  discussions  on  the  subjects  to  which  they  relate, 
furnished  much  interesting  material,  which  has  been  partly  compiled  and  published  in  the 
first  volume  of  the  Confederate  States  Medical  and  Surgical  Journal,  and  as  the  fourteen 
numbers  of  that  work  that  were  published  are  now  very  rare,  no  hesitation  has  been  felt  in 
reproducing,  with  due  acknowledgment,  the  reports  of  cases,  clinical  records,  debates,  and 
discussions,  in  which  the  surgical  experience  acquired  by  the  Confederate  medical  officers  is 
partially  set  forth.  The  general  conclusions  will  be  found  to  corroborate,  in  most  instances, 
those  accepted  by.  the  surgeons  of  the  Union  Army.  This  is  conspicuously  true  in  regard 
to  the  relinquishment  of  depleting  measures  in  the  treatment  of  gunshot  wounds  of  the 
chest,  in  the  sound  practice  that  gradually  came  to  prevail  in  the  treatment  of  wounds  of 
arteries,  and  in  the  estimates  formed  of  the  applicability  of  the  special  excisions,  and  the  < 
limits  to  be  assigned  to  conservative  measures.  On  one  point,  the  closing  of  gunshot  flesh 
wounds  after  their  conversion  into  incised  wounds,  with  the  hope  of  healing  by  first  inten- 
tion, a procedure  warmly  advocated  by  the  Confederate  surgeons  Chisolm  and  Michel,  the 
theory  and  practice  were  alike  rejected  by  the  Union  surgeons.  The  plan  was  tried  in 
the  Uew  Zealand  war,  by  instructions  of  the  English’Director-General,  but  the  reports  of 
Inspector  General  Mouat,  and  of  Staff-Surgeon  A.  D.  Home,  though  nob  decisive,  were 
unfavorable. 


INTRODUCTION. 


XXIII 


Since  the  conclusion  of  our  own  struggle,  two  great  wars  have  convulsed  Euiope, — 
the  Austro-Prusso-Italian,  or  “Six  Weeks’  War”  of  1866,  and  the  German- French  Wai 
of  1870-71.  It  has  been  sought  to  compare  our  results  with  those  set  forth  in  the  already 
numerous  publications  of  the  German  and  French  military  surgeons. ‘ I have  also  contin- 
ually referred  to  the  reports  of  the  antecedent  or  contemporaneous  or  subsequent  wars  in 
Algeria,^  in  Schleswig-Holstein  (1848-50),^  in  the  Crimea  (1854-56), in  Italy  (1859),®  in 
the  Prusso-Hanish  War  of  1864,®  in  the  Sepoy  Mutiny,'’'  and  the  Fnglish  and  French  expe- 
ditions to  China,®  the  Hew  Zealand  AVar  (1863-65),''’  and  the  Abyssinian  invasion  (1868).’“ 

^ BOYON,  A.,  Xote.s  et  Souvenirs  d'lin  Oiirurgien  D' Ambulance,  Paris,  ISIH ; GliKrxoiS,  E.  IJisfoire  Medicale  du  Blocus  de  Metz,  Metz,  187*2 : Cm- 
PAULT,  A.,  Fractures  par  Armes  tt  Feu,  Expectation,  Fesection  sous-Periostie,  Evidement- Amputation,  Armee  de  la  Loire,  Paris,  1872;  Vaslin,  L.,  l^tude 
sur  les  Plaies  par  Armes  d Feu,  Paris,  1872  ; FlSCIIEn,  H.,  Kriegschirurgische  Erfahrungcn,  Erlangen,  1872  ; Ll5  Four.  L.,  La  Chirurgie  MiUtaire  ct  les 
Societes  de  Secours  en  France  et  d I Stranger.  Paris,  1872 ; MacCoumAC.  W.,  Notes  and  KecoUections  of  an  Ambulance.  Surgeon,  London,  1871 ; Mac- 
POW  ALL,  C.  J.  F.  S..  On  a New  Method  of  Treating  ( Grubg's  System ) and  the  Medical  and  Surgical  Aspects  of  the  Siege  of  Paris,  London.  1871 ; 

BilluoTII.  T..  Chirurgische  Briefcatts  den  Kriegs-Lazarethenin  Weissenburg  und  Mannheim,  1870,  Berlin,  1872;  De;5PU^:s,  A.,  Rapport  sur  les  Travauxde 
la  leme  Ambulance  d V Armee  du  Rhin  et  d V Armee.  de  la  Loire,  Paris,  1871 ; Sazarin,  M.  C.,  Clinique  Chirurgicalc  de  V llopital  Mllitairede  Strasbourg, 
Strasbourg,  1870;  ScHATZ,  J.,  ^tude  sur  les  Hopitaux  sous  Tentes,  Paris,  1870;  Bon'XAFO.n'T,  J.  P.,  Da  Fonctionnement  des  Ambulances  CiviUs  et  Inter- 
nationales sur  le  Champ  de  Bataille,  Paris,  1870;  Langexiikck,  B.,  Ueber  die  Schusswunden  der  Gelenice  und  ihre.  Bcliandlung,  Berlin,  1868;  Passa- 
VANT,  G.,  Bemerlcungen  aus  dem  Gebiete.der  Kriegschirurgic,  Berlin,  1871;  Iwaxoff,  Bericht  ueber  die  Besichtigung  der  Militdr-Sanitdtsanstaltenin 
Deutschland,  Lothringen  und  Elsass  im  Jahre.  1870,  von  N.  PirogolF,  Leipsig,  1871 ; RUPPIIECIIT,  L.,  Mditdrdrztliche  Erfahrungcn  wdhrend  des  fran- 
zusischen  Krieges  im  Jahre  1^70-71, 'WdYzhiiT^,  iSll : ECKtlAIlT,  Geschichte  des  Jc.  b.  Aufnahms-Feldspitals  XII,  im  Kricge.  gegen  Frankreich  \%7\)-7\, 
AViirzburg,  1871 ; BECK,  Kriegs-chirurgische  Erfahrungcn  wdhrend  des  Feldzugcs  18()G  in  Suddeutschland,  Freibiu*g,  1867;  SlMOX,  G.,  Mitthcilungen 
aus  der  Chirurgischen  Klinik,  Prag,  1868;  BOALDES,  A.  W.  HE,  Des  fractures  compliquees  de  la  cuisse  par  Armes  de  guerre,  Paris,  1871 ; CouviiA,  Des 
Troubles  trophiques  consecutifs  aux  Lesions  traumatiques  de  la  Moelle  et  des  Nerfs ; CllUlSTdT,  F.,  Du  Drainage  dans  les  Plaies  par  Armes  de  Guerre, 
Paris,  1871;  QUESXOY.  F.,  Campagne  del%70,  Armee.  du  Rhin,  Camp  de  Chalons,  Bomy,  Rezonville  ou  Gravelotte,  Blocus  de  Metz,  Paris,  1871;  Laiouk, 
A.,  Journal  du  hombardement  de  Chdtillon,  Paris,  1871 ; JoULlX,  Les  caravanes  d'un  chirurgien  d'ambvlances,  Paris,  1871. 

^BehtiiEUAXD,  a.,  Campagnes  de  Kabylie,  Paris,  1862;  BauDEXS,  Clinique  des  Plaies  (T Armes  d Feu,  Paris,  1836;  BaI’DENS,  Relation  Uis- 
torique  de  V Exphlition  de  Tagdempt,  Pans,  IHAI K.,  V Algerie  Medicale,  Paris,  1854;  ViXCEXT,  Expose  clinique  des  Maladies  des  Kabyles, 
Paris,  1862;  S^:oiLLOT,  C.,  Campagnes  de  Constantine  de  1837,  Paris,  1838;  ]\IAUIT,  Hygiene  de  VAlgerie,  Paris,  1862;  LecEUC,  Une  Mission  Medicale 
en  Kabylie,  Paris,  1864. 

® Stuomicyeu,  L.,  Maximen  der  Hannover,  1855;  ESMAUCII,  F.,  Besclireibung  einer  Resectionsschiene.  Ein  Beitrag  zur  Conser 

vativen  Kriegsheilkunst,  mit  fiXnf  Holzschnitten,  Kiel,  1859,  and  Ueber  Resectionen  nach  Schusswunden,  Kiel.  1851 ; ScilWAUTZ,  II.,  Beitrdge  zur  Lchrc 
von  den  Schusswunden:  gesammelt  in  den  Feldzugen  der  Jahre  1848-50,  Schleswig,  1854;  GUULT,  E.,  Militdr-Chirurgische  Fragmente,  Berlin,  1864; 
LoumeyEU,  Bie  .S'c/tasstiJMnc/c/i  und  ihre  Bchandlung,  Goettingen,  1859 ; Lcefleu,  Grundsdtze  und  Regelnfiir  die  Behandlung  der  Schusswunden  im 
Kriege,  Berlin,  1859  ; BECK,  Die  Schusswunden,  Heidelberg,  1850 ; Stuomeyeu,  Ueber  die  hei  Schusswunden  vorkommenden  Knochen-  Verletzungen, 
Freiburg,  1850. 

The  principal  authorities  on  the  Surgery  of  the  Crimean  War  are:  M.vniiEW,  T.  P.,  Surgical  Part  of  \he  Medical  and  Surgical  History  of  the 
British  Army  in  the  Crimea,  during  the  JPar  against  Russia,  in  the  years  1855  and  1856,  London,  1858,  Vol.  II,  p.  253;  CUEXU,  J.  C.,  Rapport  au  Con- 
seil  de  Sante  des  Armees  sur  les  Resuliats  du  Service  Medico-  Chirurgical  aux  ambulances  de  Ct'imh  et  aux  Hopitaux  Militaires  Fran^ais  en  Tiirquie  pen- 
dant la  Campagne  (T Orient  en  1854-1856,  Paris,  1865 ; PiROcOFF,  N.,  Grundzuge  der  allgemeinen  Kriegsehirurgie  nach  Reminiscenzen  aus  den  Kriegen 
in  der  Krim  und  in  dem  Kaukasus,  Leipzig,  1864  ; Scuive,  G.,  Relation  Medico- Chirurgical  de  la  Campagne  d'Orient,  Paris,  1857 ; Baudf.XS,  L.,  La 
Guerre  de  Crimec,  les  Campements,  les  Abris,  les  Ambulances,  les  Hopitaux,  etc. < etc.,  etc.,  Deuxieme  Edition,  Paris.  1858 ; Fraseu,  P.,  A Treatiseupon  Pene- 
trating Wminds  of  the  Chest,  London,  1859;  Legouest,  L.,  TraiU  de  Chirurgie  d' Armee,  Paris,  1863;  SalleuoX,  M.,  in  Rccueil  dc  Mem.  de  .Med.  tt  de 
Chir.  Mil.,  2e  S^rie,  T.  21,  1858,  p.  320 ; LawsoX,  On  Gunshot  Wounds  of  the.  Thorax,  London;  Akmaxd,  A.,  Histoire  Medico-Clururgicalc  de  la 
Guerre  de  Crimee,  Paris.  1858;  BLEXKIXS,  On  Gunshot  Wounds,  in  8th  ed.  of  Cooper's  Dictionary,  London,  1869;  B.\UDENS,  L.,  Souvenirs  d'une 
Mission  Medicale  a V Armee.  d' Orient,  Paris,  1857;  MACLEOD,  G.  H.  B.,  Notes  on  the  Surgery  of  the  TPar  in  the  Crimea,  London,  1858;  Cazal.vs,  L., 
Maladie.s  de  V Armee  d' Orient,  Vans,,  1860;  POUTA,  Della  Disarticulazionc  del  Cotile,  Milano,  I860;  Makuoix,  Histoire  Mddicale  de  la  Flotte.  Fraiu^aise 
dans  la  Mcr  Noire  pendant  la  Guerre,  de  Crimee,  Paris,  1661. 

® CiiEXU,  J.  C.,  Statistique.  M^ico- Chirurgicalc  de  la  Campagne  d'ltalie  en  1859  et  1860,  Paris,  1869 ; Rodolfi,  R.,  Campagna  Chirurgica  del  1866 
Osservazioni  Cliniche,  Milano,  1867 ; GlIERiXl,  A.,  Vade  Mecumper  le  Ferite  D'Arma  da  Fuoco,  Milano,  1866;  GuiTTi,  R.,  Dell  Fratture  del  F*  morc  per 
Arma  da  Fuoco,  Milano,  1866;  ROUX,  J.,  De  V Osteomyelite  et  des  Amputations  Secondaires  d la  Suite  des  Coups  di  Feu,  Paris,  1860;  Apfia,  P.  L..  The 
Ambulance  Surgeon,  Edinburgh.  1862;  DEMMIC,  H.,  Studien.  AUgemeine  Chirurgie  der  Kriegswunden,'\\\irLh\iT^,  •,  StuoMEYEU, 
ucher  Schusswunden  im  Jahre  Hannover,  1867 ; LOHMEYEU,  C.  F.,  Die  Schusswunden  und  ihre  Behandlung,  kurz  bearbcilct,  Gottingen,  1859; 
Billroth,  T.,  Ilistorische  Studien  uber  die  Be.urtheilung  und  Behandlung  der  Schusswunden  vom  15.  Jahrhundert  bis  avf  die  neueste  Zeit,  Berlin,  1859  ; 
Bertheraxd,  Campagne  d'ltalie,  Paris,  1860 ; BruCK,  A.,  Observations  in  the  Military  Hospitals  of  Dresden,  London^  1866 ; Maas,  II..  Kr-egsehirur- 
gischc  Beitrdge  aus  dem  Jahre  1866,  Breslau,  1870;  Gurlt,  E.,  Der  Internationale  Schutz  der  im  Fclde.  Verwundeten  und  Krkrankten  Krieger,  etc..  Ber- 
lin, 1869 ; BOUDIX,  J.  C.  M.,  Souvenirs  dc  la  Campagne  d'ltalie.,  Paris,  1861  ; Ev’AXS,  T.  W.,  Les  Institutions  Sanitaires  pendaid  le  CnnJIit  Austro- Prussien- 
Italien,  Paris,  1867;  XEl'DORFER,  Handbuch  der  KHegschirurgic,  Leipzig,  1864  ; Cazalas,  Maladies  de  V Armees  d'ltalie,  Paris,  1864. 

®IlAXXOVER,  A.,  Das  Endre.sultat  der  Resectionen  im  Kriege  in  den  Unterklassen  der  Ddnischrn  Armee,  und  Die  Ddnischni  Invalidcn  aus 
dem  Kriege  1864,  Berlin,  1870,  (from  vox  Laxgexrec’K's  Arch.  f.  k.  ch.  B.  XII,  II.  2);  L(T.FLER,  F.,  Gcneral-Bericht  uber  den  Gesundheitsdien.  t im  Fchl- 
zugc  gegeri  Bdnem/zrA*.  1864,  Berlin,  1867 ; IIEIXE,  C.,  Die  Schvssvcrletzungen  der  unteren  Berlin,  1866 ; OCinvADT,  Krieg.xldrurgisdu 

Erfahrungcn,  Berlin,  18(j5;  Uessel,  J.,  Die  Kriegshospitdhr  des  St.  Johanniter-ordens  ini'Ddnischen  FeMzugc  von  1864,  Breslau,  1866. 

^ Williamson,  G.,  Military  Surgery,  London,  1863:  Fayrer,  J.,  Clinical  Surgery  -tn  India,  London,  1866;  COLE.  J.  J..  Military  Surgery  or 
Experience  of  a Field  Practice  in  India  during  the  yejirs  1848  and  1849,  London.  1852;  GORDON',  C.  A.,  Experiences  of  an  Army  Surgeon  in  India, 
Londtn,  1872. 

^^Castaxo.  F..  VExpidition  de  Chine,  Paris,  1864;  Didiot,  Relatimi  Medico  Onir  rgicale  de.  I Expedition  de  Cochinehine,  Paris,  186.5;  Laure. 
Histoire  medicale  de  la  Marine  Fran(^aise.  pendant  les  Expeditions  de  Chine  et  de  Cochinehine,  Paris,  1864. 

® MOUAT,  J.,  Special  Report  on  Wounds  arul  Injuries  Received  in  Battle.,  Extracted  from  the  Mwlieal  and  Surgical  History  of  the  > cw  /e.aland 
War,  London,  1867. 

General  KAiTF.rds  Official  Report,  London.  1869 ; Papers  connected  with  the  Abyssinian  Expedition.  prcBcntcd  to  bi  th  Houses  of  Parliamcct,  1867. 


XXIV 


INTEODUCTIOX. 


In  arranging,  the  surgical  data  of  the  American  war,  it  has  been  thought  wisest  to  pro- 
ceed from  particulars  to  generals,  and  to  begin  with  an  account  of  the  special  wounds  and 
injuries.  Several  advantages  are  secured  by  this  arrangement.  Thus  the  returns  to  the 
Adjutant  General,  Quartermaster  General,  and  Surgeon  General  differ  in  their  aggregates 
of  killed  in  battle,  and  there  are  discrepancies  in  the  reports  of  wounded  in  action  made 
to  the  Adjutant  General  and  to  the  Surgeon  General.  These  statistics  are  still  undergoing 
revision,  and  it  may  reasonably  be  anticipated  that  near  approximations  will  be  ulti- 
mately attained.  Although  the  memoranda  of  205,235  cases  of  wounds  and  injuries, 
including  39,163  operations,  have  been  examined  and  compared  and  placed  upon  the  per- 
manent registers,  yet  many  thousands  of  cases,  belonging  chiefly  to  classes  not  considered 
in  the  first  volume,  remain  to  be  investigated  and  entered.  Hence  generalizations  on  the 
relative  frequency  of  wounds  according  to  regions,  would  be  premature.  The  influence 
of  climate  and  other  hygienic  conditions  on  the  state  of  health  of  the  troops,  and  conse- 
quently on  the  residts  of  wounds,  can  be  more  readily  appreciated  when  the  Tables  in  the 
Medical  Volume  of  Part  I,  shall  have  been  discussed.  Deductions  derived  from  the  vital 
statistics  of  the  Provost  Marshal  General’s  Bureau,  from  the  Census  returns,  and  from  the 
reports  of  the  Commissioner  of  Pensions,  will  afford  further  data  for  general  conclusions. 
From  these  and  other  considerations,  it  has  been  decided  to  postpone  the  general  observa- 
tions to  a later  portion  of  the  work. 

A chronological  table  of  engagements  and  battles,  compiled  from  ofiicial  sources  where 
practicable,  but  often  from  popular  estimates  that  appeared  to  be  honest  attempts  at  fair 
approximations,  and  sometimes  from  almost  any  statement  available  that  was  not  obviously 
false — such  a table,  in  which  completeness  rather  than  unattainable  accuracy  is  sought,  is 
introduced  to  indicate  the  actions  that  were  fought  during  the  period  of  four  years  during 
which  the  war  was  protracted,  from  April,  1861,  to  April,  1865.  The  surgical  history 
proper  follows,  and  is  continued  through  five  chapters,  the  first  chapter  being  devoted  to 
wounds  and  injuries  of  the  head,  the  second  to  those  of  the  face,  the  third  to  those  of  the 
neck,  the  fourth  to  those  in  which  injury  of  the  spinal  column  was  the  most  prominent  fea- 
ture, and  the  fifth  to  wounds  and  injuries  of  the  chest.  The  operations  performed  are  con- 
sidered in  connection  with  the  injuries  of  each  region,  an  arrangement  much  more  difficult 
than  a distinct  classification,  but  affording  many  advantages,  in  avoiding  repetitions  and  in 
presenting  each  subject  as  a whole.  In  the  second  volume,  now  nearly  ready  for  the  press, 
the  wounds  and  injuries  of  the  abdomen,  pelvis,  and  genito-urinary  organs,  the  upper  and 
lower  extremities  with  the  amputations  and  excisions,  are  discussed ; and  in  the  third  vol- 
ume, gunshot  wounds  in  general,  with  the  complications  of  pyaemia,  gangrene,  tetanus,  and 
secondary  haemorrhage  will  be  considered,  and  also  the  materia  chirurgica,  the  transporta- 
tion and  field  supplies  of  the  wounded. 

It  has  been  mentioned  that  the  cases  belonging  to  the  regions  which  will  come  first 
under  consideration,  have  been  examined  with  especial  care,  and  there  are  here  probably 
few  omissions,  the  aggregates  being  even  larger  than  called  for  by  the  returns  on  the 
monthly  reports,  doubtless  because  of  the  number  of  Confederate  cases  adduced.  Yet 
among  these  few  omissions,  it  must  be  anticipated  that  some  cases  of  especial  interest 
may  be  included.  Wounded  officers,  for  example,  were  often  treated  in  private  quarters, 
and  in  many  or  most  instances,  it  has  been  difficult  to  procure  precise  narratives  of  their 


cases. 


INTRODUCTION. 


XXV 


The  preliminary  reports  and  the  prefatory  and  introductory  matter  in  the  medical 
volume  and  in  this,  sufficiently  place  in  evidence  the  impossibility  of  compiling  a satisfac- 
tory surgical  history  of  the  war  by  the  simple  consolidation  of  data  derived  from  any  con- 
secutive series  of  reports  in  existence.  The  inadequacy  of  the  entries  in  the  class  than- 
atiei  of  the  monthly  report  of  sick  and  wounded  was  early  acknowledged,  and  it  was 
officially  declared  that  previous  to  September,  1862,  “the  surgical  statistics  of  the  war 
were  absolutely  worthless,”  and  that  “the  only  information  procurable  is  such  as  can  be 
derived  from  the  examination  of  a mass  of  reports,  all  of  which  present  merely  certain 
figures  under  the  vague  and  unsatisfactory* heading,  Vulnus  sdo’peticufmy'^  After  the 
revision  of  the  forms  of  reports  and  the  addition  in  June,  1862,  of  the  “tabular  statement 
of  gunshot  wounds  and  operations,”  the  consolidations  for  the  first  two  quarters  of  1863 
were  found  to  abound  in  errors  to  such  an  extent  that  it  was  deemed  inexpedient  to  print 
them.  The  quarterly  reports  of  wounded  and  of  surgical  operations  {ante,  p.  xvi)  and  the 
nominal  lists  of  casualties  in  battle  were  required  in  September  and  November,  1863  ; 
the  classified  return  of  wounds  and  iniuries  received  in  action  was  instituted  in  March, 
1864. 

The  following  is  a consolidation  of  the  aggregates  of  entries  in  Class  V,  of  the  monthly 
reports  of  sick  and  wounded,  from  May  1st,  1861,  to  June  30th,  1865,  as  printed  in  tables 
of  the  Medical  Volume  of  Part  I : 


1 

CLASSIFICATION. 

WniTE  Troops. 

COLORED  Troops. 

TOTAL. 

Cases. 

Deaths. 

Cases. 

Deaths. 

Cases. 

Deaths. 

1 

Burns 

9,487 

94 

613 

4 

10,100 

98 

2 

Contusions 

44,323 

161 

2,649 

11 

46,972 

172 

3 

Concussion  of  Brain 

873 

193 

49 

22 

922 

215 

4 

Compression  of  Braint 

61 

17 

61 

17 

5 

Drowning 

672 

125 

797 

6 

• 

Sprains 

38,387 

3 

4,317 

42,704 

3 

7 

Dislocations.- 

2,908 

9 

108 

1 

3,016 

10 

8 

Fractures 

1,287 

53 

1,287 

53 

9 

Simple  Fractures 

4,215 

61 

131 

15 

4,346 

76 

10 

Compound  Fractures  

1,316 

378 

55 

19 

1,371 

397 

11 

Gunshot  Wounds 

229,119 

32,731 

6,466 

922 

235,585 

33,653 

12 

' Incised  Wounds 

21,444 

186 

1,305 

3 

22,749 

189 

13 

Lacerated  Wounds 

14,153 

459 

595 

8 

14,748 

467 

14 

Punctured  W'’ounds 

5,285 

191 

499 

8 

5,784 

199 

15 

Poisoning 

3,087 

93 

67 

17 

3,154 

no 

16 

Other  Accidents  and  Injuries 

13,099 

1,003 

2,174 

72 

15,273 

1,075 

Aggregates 

389,044 

36,304 

19,028 

1,227 

408,072 

37,531 

* Circular  No.  9,  S.  G.  O.,  July  1st,  18G3.  Consolidated  Statement  of  Gunshot  Wounds.  liy  Surgeon  .1.  H.  liui.NTON,  U.  S.  V. 
t After  .Tune  3Cth,  ]8fi3,  this  olnss  wns  <imittc(I,  as  it  rvas  founJ  that  depressed  fraeturcs  of  the  skull  were  stnnetinies  entered. 

4* 


XXVI 


1 N T 11  O D U a T I O N . 


The  aggregate  of  235,583  gunshot  wounds  here  given,  with  the  resulting  mortality  of 
33,653,  or  14.2  per  cent.,  is  explained,  in  the  introduction  to  the  medical  volume,  to  rep- 
resent the  total  returned  from  about  nine-tenths  of  the  mean  strength  of  the  Union  Army, 
and  to  be  exclusive  of  the  injuries  of  those  killed  in  action.  The  latter  category  embraces, 
according  to  the  Adjutant  General,  not  less  than  44,238 ; according  to  the  alphabetical 
registers  of  the  Surgeon  General’s  Office,  35,408  ; according  to  the  Chronological  Summary 
in  this  work,  59,860.* * 

However  useful  these  approximations  may  be  for  many  purposes,  any  anticipation 
that  they  may  afford  reliable  guidance,  or  much  assistance  in  framing  a surgical  history  of 
the  war,  must  evidently  prove  illusory.  But  the  consolidation  of  the  data  of  the  detailed 
quarterly  surgical  reports  might  be  justly  expected  to  furnish  a very  complete  record  of  the 
surgical  practice  in  the  Union  Army  during  the  latter  two  years  of  the  war ; and  for  the 
last  year,  the  classified  return  of  wounds  received  in  action  should  serve  as  a nearly  accurate 
check-list. 

The  clinical  histories  contained  in  the  quarterly  surgical  reports  were  provisionally 
classified  in  the  order  specified  on  page  6 of  the  Introduction  to  the  surgical  report  in 
Circular  No.  6,  S.  G.  0.,  1865.  It  has  been  severely  criticised,j*  and  would  be  open  to 
graver  objections  than  have  been  offered,  had  it  been  designed  as  a nosological  system.  It 
was  simply  a nomenclature  for  a series  of  blank  books,  in  which  surgical  facts  derived 
from  a variety  of  sources  might  be  entered  for  facility  of  reference,  and  has  been  modified 
as  frequently  as  convenience  dictated.  It  has  been  found  to  answer  the  purpose  for  which 
it  was  intended  reasonably  well.  As  the  presentation  of  the  naked  statistics  of  the  monthly 
reports  of  sick  and  wounded,  as  consolidated  on  the  preceding  page,  would  have  been 

* The  Chronological  Summary.  comi>iled  by  the  faithful  and  indefatigable  chief  <4erk  of  the  Surgical  Division,  Mr.  FkedkuicK  R.  Sparks,  indicates 
the  following  losses:  Union  Troops,  killed  59,860,  wounded  280,040,  missing  184,791.  Confederate  Troops,  killed  51,425,  wounded  227,871,  missing  384,281. 
The  last  aggregate  includes  the  armies  surrendered.  Allowing  for  many  exaggerations  and  omissions,  the  errors  appear  to  balance  remarkably,  and  the 
results  to  correspond  with  statistics  derived  from  entirely  different  sources. 

t In  the  fifty-fourth  volume  of  the  Medico- Chirurgical  Transactions  is  an  article  of  fifty-two  pages,  by  Deputy  Inspector-General  T.  Longmore, 
C.  B.,  on  the  classification  and  tabulation  of  injuries  and  surgical  operations  in  time  of  war,  in  which  he  claims  that  some  of  the  best  established  rules  of 
field  surgerj',  especially  as  regards  gunshot  injuries,  have  been  attained  by  the  collection  of  the  statistical  results  of  expectant  and  operative  treatment; 
describes  the  classification  adopted  in  the  British  army  and  those  of  other  countries ; considers  how  far  those  statistics  are  comparable ; discusses  which 
system  ensures  the  greatest  accuracy  and  completeness,  with  the  greatest  economy  of  labor  and  cost  in  compilation  ; advocates  an  international  congress 
for  the  adoption  of  a uniform  system,  and  concludes  that  the  British  system  is  the  best.  I cannot  ft)llow  him  through  this  discussion,  but  must  con'cct 
several  serious  errors  in  liis  <lescription  of  the  “collection  and  classification  of  surgical  statistics  of  war  injuries  in  the  United  States.”  After  j>remising  that 
the  figures  of  our  tabular  statements  are  “almost  practically  worthless,”  Dr.  Longmore  remarks  that  “the  vast  amount  of  labor  and  time  ” expended  in 
their  compilation  was  such  that  “as  tlie  documents  successively  arrived  at  the  Surgeon  General's  Office  in  Washington,  a large  number  of  medical  officers 
and  clerks  were  occupied  in  classifying  and  transcribing  their  contents  ’’  (p.  223) ; and  elsewhere,  more  specifically  (p.  243),  “the  labor  on  the  American 
system  is  .so  great  that  an  American  friend  once  informed  me  that  when  he  was  in  Washington  there  were  two  hundred  intelligent  clerics  employed  at  the 
Surgeon  General's  Office  in  collecting  and  airanging  the  surgical  statistics  of  the  war,  for  the  preparation  and  publication  (ff  wdiich  a vory  large  sum  of 
money  had  been  liberally  granted  by  Congress.”  I am  sure  that  Dr.  I.iongmore  will  wash  to  correct  these  misrepresentations.  The  maximum  force 
employed,  at  any  time,  at  the  Surgeon  General's  Office,  upon  the  surgical  statistics  of  the  war.  has  been  one  medical  officer,  one  clerli,  and  sixteen  hospital 
stewards,  occasionally  aided  by  one  acting  assistant  surgeon  : and  the  “very  large  sum  of  money  ” (£6,000),  voted  for  the  preparation  of  five  thousand 
copies  of  the  medical  and  surgical  volumes  of  the  First  Part  of  the  Medical  and  Surgical  History  of  the  AVar,  only  subserved  its  purpose  because  nearly  all 
those  occupied  with  the  work  were  already  in  Government  employ.  I will  not  complain  of  the  unfairness  of  contrasting  the  results  of  the  preliminary 
report  in  Circular  No.  6 with  the  perfected  histories  of  Dr.  Matthew’  and  AL  Clienu ; but  I do  complain  of  an  “ American  System  ” being  described  and 
unfavorably  contrasted  with  the  classification  of  Inspector-General  Taylor,  when,  as  I have  shown,  there  was  no  complete  series  of  surgical  reports  in  the 
Army  of  the  United  States,  and  information  w’as  of  necessity  to  be  derived  from  heterogeneous  data.  “ The  surgeons  in  the  field  on  the  American  system 

* * make  no  distinction  between  the  various  kinds  of  cranial  fractures.  * * Where  all  such  injuries  are  tabulated  together,  as  they  are  in  the  primary 
American  returns,  what  useful  information  can  be  obtained  from  a table  showing,  for  example,  the  results  of  the  operation  of  trephining?”  (p.  240).  I 
cordially  concur  in  the  warm  praise  accorded  to  the  histories  of  the  Crimean  and  Italian  campaigns  by  M.  C’hcnu.  I w'ill  obsciwo  that  in  his  latter  work  he 
very  materially  modifies  the  classification  employed  in  the  former.  In  the  history*  of  the  surgery  of  the  Italian  war.  he  n'ports  nine  cases  of  trephining ; 
in  his  Crimean  history  Dr.  Alatthew*  reports  twenty-six  cases.  I shall  record  tw'o  hundred  and  twenty  cases,  and  shall  be  disappointed  if  their  results  afford 
no  useful  infunnati  ;n.  Dr.  Tajdor's  classification  may  be  excellent  for  the  British  army,  w’ith  its  corps  (T  trained  medical  <'fficcrs;  it  could  not  have  been 
advantageously  introduced  in  (uir  seiwficc,  chietly  attended  by  surgeons  hastily  called  from  civil  life.  Dr.  Longmore  says  (p.  235)  that  in  Germany  “no 
fixed  classification  exists.”  This  is  quite  true,  yet  the  statistical  work  of  General- Artz,  Dr.  Loefllcr,  is  a marvel  of  accuracy  and  completeness  to  those  who 
occupy  themselves  with  these  studies;  and  the  cxten<lcd  treatises  of  Drs.  II.  Fischer,  Socin,  and  Klebs,  following  so  soon  upon  tlic  conclusion  of  the 
Franco-German  war,  are  monuments  of  well-directed  industiy*.  I think  that  in  war,  “ systems  ” must  be  made  to  confi)rm  to  the  exigencies  of  the  occasion 
and  to  national  habits  and  organizations.  There  arc  certain  great  rules  to  which  all  nations  will  conform  ; the  details  must  be  adapted  to  varying  cinmm- 
stances.  The  British  system  may  be  best  fot  Britain;  but  not  necessarily  for  all  other  countries.  On  pent  etre  plus  sage  qu'un  gens,  mais  point  que 
tcus  Ics  gens. 


I N T K O D U C T I O X . 


XXV II 


barren, — as  there  was  no  other  consecutive  series  of  reports, — and  as  it  was  undesirable  to 
sacrifice  the  information  collected  in  the  earlier  period  of  the  war,  a plan  was  adopted 
which  permitted  the  endeavor  to  group  together  data  from  any  quarter,  from  case  books, 
from  field  registers,  from  nominal  casualty  lists,  from  numerical  classified  returns,  from  the 
memoranda  accompanying  pathological  specimens,  from  the  careful  clinical  records  of  hos- 
pitals, and  the  hasty  pocket-book  memoranda  of  field  surgeons.  From  a surgical  point  of 
view,  there  was  no  motive  to  exclude  information  that  could  be  obtained  of  the  Confederate 
wounded, — levrai  chirurgien  ne  regarde  pas  V uniforme.  Estimates  of  the  ratio  of  wounded 
to  the  forces  engaged,  and  other  attempts  at  approximations  to  unattainable  numerical  pre- 
cision, were  held  to  be  very  subordinate  to  the  accumulation  of  the  greatest  possible  number 
of  practical  surgical  facts. 

In  dealing  with  these  large  bodies  of  facts,  I have  thought  best,  commonly,  to  imitate 
the  practice  of  the  legal  profession,  and  to  set  forth  all  the  evidence  regarded  as  important, 
on  each  particular  subject,  with  as  little  interruption  as  possible,  and  to  append  the  argu- 
ment or  discussion.  As  nearly  as  practicable,  the  wounds  and  injuries  and  surgical  diseases 
of  each  region  of  the  body  have  been  arranged  together,  as  the  simplest  and  most  natural 
order  that  could  be  adopted.  The  most  interesting  clinical  histories  have  been  printed  in 
full,  or  in  abstracts  including  the  attainable  essential  details,  and  the  remaining  cases,  or 
sometimes  the  whole  number  of  cases  of  the  class,  are  set  forth  in  tabular  statements.  In 
many  cases  the  result  could  not  be  ascertained,  yet  the  proportion  of  undetermined  cases,  as 
indicated  by  the  aggregates  in  the  tables,  was  much  smaller  than  could  have  reasonably 
been  anticipated.^  In  the  earlier  part  of  the  work,  the  number  of  histories,  and  especially 
of  very  brief  histories,  that  are  printed,  may  appear  unnecessarily  large  ; but  it  was  desired 
to  give  some  insight  into  the  method  by  which  cases  were  traced  and  followed  to  their  ter- 
mination, with  the  hope  that  the  reader,  on  being  assured  that  many  of  these  brief  memo- 
randa presented  a digest  of  the  results  of  a search  through  half  a dozen  reports,  perhaps, 
and  that  the  cases  represented  numerically  only  had  undergone  precisely  similar  investiga- 
tion, would  entertain  a reasonable  confidence  in  the  accuracy  of  the  statistical  conclusions. 
In  the  later  portions  of  the  work,  the  typical  cases  are  more  elaborated  and  fewer  are 
selected  to  be  printed  in  full.  In  stating  in  the  abstracts  that  a case  is  reported  by  a med- 
ical officer  whose  name  is  given,  it  is  not  designed  to  intimate  that  he  is  responsible  for  the 
language  employed.  Very  possibly  some  details  are  taken  from  several  field  or  hospital 
reports  or  registers,  each  supplying  some  facts  omitted  in  the  others.  It  is  simply  designed 
to  ascribe  whatever  merit  belongs  to  the  abstract  to  the  surgeon  giving  the  fullest  account, 
or  to  give  the  history  the  authority  of  his  name.  Wherever  the  surgeon’s  own  language 
is  employed  quotation  marks  are  used,  and  whenever  complete  histories  have  been  fur- 
nished by  a single  observer,  they  have  been  preferred,  and  printed  in  the  reporter’s  own 
words.  The  classification  adopted  has  rendered  it  necessary  to  encounter  first  in  order  tlie 
most  obscure  and  complicated  subjects,  and  the  writer  has  been  keenly  sensible  of  the 
difficulties  involved  in  this  arrangement.  On  wounds  of  the  extremities,  on  amputations, 
excisions,  and  conservative  measures  in  fractures  and  wounds  of  joints,  and  almost  all  mat- 
ters demanding  prompt  active  interference,  the  materials  at  his  disposition  have  been  very 
extensive,  and  the  means  of  illustration  almost  unlimited ; for  the  army  surgeons  showed 
great  diligence  in  preserving  statistical  details  on  these  subjects,  and  freely  ex})ressed  their 


* !n  computing  percentages,  the  undetermined  cases  are  net  included. 


XXVIII 


I N T E O D U G T I 0 N . 


opinions  on  the  relative  merits  of  different  methods  of  treatment,  while  admi)able  draw- 
ings and  specimens  of  recent  injuries  were  early  secured,  and  preparations  showing  their 
progress  and  results  were  largely  accumulated.  On  wounds  of  the  trunk,  the  materials 
were  also  abundant ; but  the  obstacles  to  satisfactory  analysis  and  exposition  were  great. 
Generally,  the  medical  officers  were  very  concise  in  reporting  on  wounds  of  the  head,  of 
the  chest,  and  of  the  abdomen,  often  failing  to  record  all  important  points  of  professional 
interest,  and  commonly  refraining  from  critical  discussion  or  comment.  It  was  not  easy  to 
obtain  good  pictorial  representations  of  these  injuries,  their  progress  and  results.*  Whether 
the  obscurity  attending  them,  or  the  comparative  inadequacy  of  therapeutical  resources 
against  them,  renders  them  less  attractive  to  surgeons,  it  is  certain  that  less  real  reli- 
able information  relating  to  them  is  to  be  found  than  in  regard  to  those  in  which  brilliant 
operative  dexterity  may  be  displayed.  In  regard  to  injuries  of  the  head,f  it  may  be  that 
writers  are  deterred  from  enlarging  on  them  by  doubt  of  their  ability  to  add  to  the  knowl- 
edge imparted  by  the  great  teachers  of  the  past ; but  the  conditions  the  elder  authors  had 
in  view  were  not  identical  with  those  observed  by  the  moderns,  and  the  latter  cannot  be 
exonerated  from  the  duty  of  collecting  facts  with  which  to  judge  the  conflicting  views  of 
their  predecessors,  or  of  applying  to  these  difficult  problems  the  more  reflned  means  of 
investigation  that  the  advances  of  science  have  placed  at  their  command.  The  obscurity 
which  attends  wounds  of  the  head,  and  renders  their  pathology  so  ambiguous,  does  not,  as 
Hennen  observes,  exist  in  an  equal  degree  in  those  of  the  thorax ; yet  Dr.  Fraser,  in  pre- 
paring his  monograph  on  the  subject,  was  able  to  find  but  one  treatise  especially  devoted  to 
penetrating  wounds  of  the  chest,  that  by  Dr.  Mayer,  of  St.  Petersburg.  J As  to  wounds  of 
the  abdomen,  it  may  be  that  their  extreme  fatality  and  brevity  of  the  period  through  which, 
commonly,  they  remain  under  observation,  deprive  them  of  the  interest  with  which  they 
would  otherwise  be  regarded ; for,  as  Sir  Charles  Bell  has  remarked,  although  wounds  of 
the  belly  are  common  enough  immediately  after  a battle,  bearing  a fair  relative  proportion 
to  other  wounds,  yet  a few  days  suffice  to  remove  them,  so  that,  by  the  end  of  the  first 
week,  there  is  scarcely  one  to  be  seen. 

That  the  experience  acquired  during  the  war  should  have  added  largely  to  every  sub- 
ject connected  with  military  surgery  was  not  to  be  anticipated.  But  it  may  be  safely 
asserted  that,  in  many  directions,  it  has  advanced  the  boundaries  of  our  knowledge.  Even 
in  the  very  difficult  field  of  investigation  presented  by  the  wounds  and  injuries  of  the  head, 

* The  gifted  artist,  Mr.  Staucii,  whose  services  Surgeon  Brintou  had  fortunately  secured,  after  preparing  many  water-color  drawings  of  recent 
injuries,  at  the  field  hospitals,  tlied  from  pernicious  fever  contracted  before  Petersburg,  witliout  completing  the  exquisite  studies  of  embolism,  cranial  abscess, 
false  aneurism,  osteomyelitis,  and  gangrene,  which  he  had  drawn  from  dissections  made  at  the  JIuseum. 

t “ Injuries  of  the  head  affecting  the  brain  are  dilficult  of  distinction,  doubtful  in  character,  treacherous  in  their  course,  and,  for  the  most  part,  fatal  in 
their  results.  The  symptoms  which  appear  especially  to  indicate  one  kind  of  accident  arc  frequently  prevalent  in  another.  It  may  be  even  said  that 
there  is  no  one  symptom  which  is  presumed  to  demonstrate  a particular  lesion  of  the  brain,  which  has  not  been  shown  to  have  taken  place  in  another  of  a 
different  kind.  Examination  after  death  has  often  proved  the  existence  of  a most  serious  injury,  which  had  not  been  suspected;  and  death  has  not 
uufrequently  ensued  immediately,  or  shortly  after  the  most  marked  and  alarming  symptoms,  without  any  adequate  cause  for  the  event  being  discovered 
on  dissection.  Such  are  the  deficiencies  in  our  knowledge  of  the  complicated  functions  of  the  brain,  that  although  we  think  we  can  occasionally  point  out 
where  the  derangement  of  structure  will  be  found,  which  has  given  rise  to  a particular  symptom  dming  life,  the  very  next  case  may  probably  show  an 
apparently  sound  structure  with  the  same  derangement  of  function.  One  man  shall  lose  a considerable  portion  of  his  brain  without  its  being  productive 
at  the  momeni,  or  even  after  his  restoration  to  health,  of  the  slightest  apparent  functional  inconvenience ; whilst  another  shall  fiill  and  shortly  die  without 
an  effort  at  recovery,  in  spite  of  any  treatment  which  may  be  bestowed  upon  him.  after  a very  much  slighter  injury  inflicted  apparently  on  the  same 
pari.” — GUTHIIIE,  on  Injuries  of  the  Head  affecting  the  Brain,  4to,  London,  1842.  ‘’Of  all  the  accidents  met  with  in  field  practice,  these  are,  beyond 
doubt,  the  most  serious,  both  directly  and  remotely — the  most  confusing  in  their  manifestations,  and  the  least  determined  in  their  treatment,  although  they 
have  engaged  the  attention  of  the  master  minds  of  all  ages  and  countries  from  the  time  of  the  old  surgeon  of  Cos  down  to  the  present  day.’* — l\lACLKOl), 
Notes,  etc.  {op.  cif.,  p.  175). 

JDr.  Fraser  justly  remarks  {op.cit.,  p.  2)  that  “while  Army  surgeons  have  displayed  great  care  and  attention  on  matters  relating  to  statistics; 
while  they  have  laboriously  discussed  the  relative  merits  <-f  excisions  and  disarticulations,  and  displayed  consummate  skill  in  the  treatment  of  wounds 
of  the  joints  and  extremities;  in  a word,  on  all  matters  which  demand  active,  and  ‘truth  must  out,’  showy  manual  ability;  the  less  attractive, 
because  more  obscure,  but  not  the  less  important,  subject  of  wounds  of  the  head,  chest,  and  abdomen,  appeam  to  have  elicited  only  passing  and  imperfect 
notice.” 


INTRODUCTION. 


XXIX 


we  have  learned  something.  Surgeons  have  been  schooled  to  deal  with  the  most  ghastly 
injuries  of  the  face  without  dismay,  to  obtain  unexpected  results,  and  to  accomplish  favor- 
ably reparative  operations  from  which,  formerly,  they  would  have  recoiled  ; and  they  have 
been  taught  the  futility  of  tying  the  great  arterial  trunks  of  the  neck  for  hsemorrhage  from 
face- wounds.  The  true  principles  of  treatment  of  wounded  arteries  in  the  neck  are  now 
generally  understood ; and  while,  before  the  war,  there  were  few  surgeons  who  chose  to 
undertake  operations  on  the  great  vessels,  there  are  now  thousands  who  know  well  when 
and  how  a great  artery  should  be  tied.  Our  information  respecting  injuries  of  the  vertebral 
column  has  been  augmented ; and,  passing  to  the  wounds  of  the  chest,  we  find  a complete 
revolution  in  theory  and  practice.  Without  further  illustration,  we  may  claim  that  the 
additions  to  surgical  knowledge  acquired  in  the  war  are  of  real  and  practical  value.  On 
those  topics  in  which  the  materials  at  his  disposition  merely  corroborated  or  confirmed 
views  already  generally  entertained,  the  editor  has  sought  to  be  concise,  and  to  enlarge  on 
those  subjects  to  which  some  material  addition  to  our  knowledge  has  been  brought  by  the 
observations  made  during  the  war,  either  because  of  novelties  in  nature  or  in  treatment,,  or 
through  the  large  number  of  rare  or  of  analogous  cases  permitting  the  occasional  presenta- 
tion of  crucial  instances,  and  the  more  frequent  application  of  the  theories  of  averages  and 
of  probabilities.*  Though  the  labor  upon  matters  of  detail,  inseparable  from  carrying  out 
instructions  to  regard  the  “preservation  of  the  great  mass  of  facts  collected,  in  a form  for 
convenient  study,”  as  the  chief  object  in  view,  has  generally  confined  the  editor’s  atten- 
tion to  the  arrangement  and  grouping  and  illustration  of  the  observations,  he  has  sought, 
whenever  time  and  opportunity  permitted,  to  facilitate  the  student’s  inquiries  by  analyses, 
and  summaries,  and  references  to  the  surgical  results  of  other  wars,  without  abstaining 
from  critical  comments ; but  censuring  bad  practice,  intending  no  discourtesy  to  individu- 
als, nor  violation  of  the  homines  amare,  errores  immolate  precept  of  St.  Augustine.  The 
learned  historian  of  the  inductive  sciences  has  not  included  pathology  and  therapeutics  in 
his  outline,  and  we  must  perhaps  be  content  to  wait  until  some  genius  as  sublime  as  New- 
ton’s shall  explain  the  laws  of  life  by  a generalization  as  simple  and  perfect  as  the  law  of 
gravitation,  before  the  physiological  sciences  shall  be  recognized  among  the  strictly  exact 
sciences.  But,  meanwhile,  the  tendency  among  surgeons  to  seek  to  establish,  by  inductive 
methods,  at  least  those  less  general  and  more  complicated  rules  to  which  the  name  of 
“empirical  laws”  has  been  given,  cannot  be  gainsaid.^  Though  unable  yet  to  aim  at 
establishing  laws  of  cause  and  effect,  they  are  constantly  seeking  to  determine  by  statisti- 
cal calculation  the  influence  exerted  by  different  modes  of  practice,  and  thus  to  open  the 
way  for  framing  inductions ; and  as  these  less  general  relations  require  a very  much  larger 
number  of  cases  than  are  needed  to  establish  laws  of  causation,  they  continually  resort  to 
the  numerical  method.  This  is  peculiarly  applicable  to  military  surgery  ; for  some  of  the 
variable  circumstances  which  contribute  to  the  production  or  modification  of  the  result,  and 

*La  Place,  Essai philosophique  sur  le  calcul  des probabilites,  page  *220,  says  that  the  mathematical  theory  of  probabilities  is,  fundamentally,  only 
“/e  b(m  sens  reduit  au  calcul.'^  It  has  so  often  been  misapplied  in  medical  inquiries,  that  PEISSE  (La  Medecine  ct  les  Medecins,  Paris,  1857,  Vol.  1.  p. 
175)  profanely  suggests  that  the  inverse  operation  might  often  be  profitably  instituted,  and  “^cyphering  put  in  accord  with  common  sense.” 

^ Ars  iota  in  ohservationibus,  said  an  ancient  master.  Tliose  who  deride  the  numerical  method  as  an  absurd  caricature  (ff  the  inductive  or  experi- 
mental method  in  philosophy,  say  that  in  obsercatione  would  bo  better,  and  censure  the  unfortunate  plural,  as  having  promoted  the  introduction  of  the 
statistical  system  into  the  medical  enquiries.  MoiiG.\GXi‘s  famous  Non  numcrandic  sed  perpendendx  siini  observatioms  is  oltcii  cited  against  the  Humor- 
ists; but  these  who  do  not  relish  so  formidable  an  adversary  may,  with  Bouillaud  (Essai  sur  la  philosophic  viddicale,  Paris,  183G,  p.  186),  write  the 
aphorism:  Non  SOLU.M  numcrandse  SED  ETIAM  perpendendse  sunt  observationes.  I'or  more  serious  obseiwations  on  this  most  iinjiortant  subject,  consult : 
Gavaruet,  Principcs  generates  de  Statistique  Medicate;  Laycock,  Medical  Observation  and  Itesearch ; Guv,  On  the  best  Method  of  colle/Mng  and 
arranging  FactSy  in  Jour,  of  Stat.  Soc.  of  Lond&n,  Vol.  Ill;  Barclay,  Medical  Errors^  London,  1864;  TODD,  The  Book  of  Analysis;  Quktelkt, 
Ssur  Vhomme.  * 


XXX 


] N T R O IMJ  C!  T I O N . 


whicli  cannot  well  be  eliminated  from  ordinary  statistics,  are  here  excluded, — for  example, 
sex,  age,  and  bodily  vigor,  within  certain  limits, — while  there  is  comparative  uniformity  in 
the  external  circumstances  of  food,  air,  nursing,  and  attendance.  The  simple  rehearsal  of 
cases  would  be  a very  profitless  addition  to  our  knowledge,  unless,  through  their  agency,  we 
sought  for  analogies  and  relations  that  may  establish  rules  of  practice. 

The  surgical  lessons  of  the  war,  like  its  other  good  results,  were  only  obtained  at  the 
expense  of  great  sacrifices.  The  army  surgeon  is  not  only  exposed  to  the  dangers  arising 
from  excessive  fatigue,  and  constant  contact  with  disease,  but  to  the  fatalities  directly  inci- 
dent to  war.  I have  not  the  names  of  the  numerous  Confederate  medical  officers  whose 
devotion  to  duty  cost  their  lives,  nor  space  for  the  long  list  of  Union  surgeons  who  perished 
from  diseases  strictly  consequent  upon  the  nature  of  their  avocations,  but  will,  at  least, 

, record  the  names  of  the  latter  who  fell  in  battle.  The  following  officers  of  the  medical 
staff  of  the  regular  and  volunteer  forces  of  the  Union  Army  were  killed  in  action  : 

Surgeon  SAMUEL  Everett,  U.  S.  V.,  at  Sbiloli,  April  Gth,  18G2. 

Surgeon  W J.  II.  White,  U.  S.  A.,  at  Autietaui,  Sei)teiuber  ITtli,  18G2,  while  j)lacing  the  field 
h<)si)it:ds  of  Ihe  Sixth  Corps,  of  which  he  was  medical  director.  (See  Appendix,  p.  100.) 

Assistant  Surgeon  A.  A.  Kendall,  12th  Massachusetts  Volunteers,  at  Antietam,  September 
17th,  18G2.  (See  Appendix,  ji.  100.) 

Assistant  Surgeon  Edward  H.  R.  Revere,  20th  Massachusetts  Volunteers,  at  Antietam, 
September  17th,  1802.  (See  Appendix,  p.  100.) 

Surgeon  J.  D.  S.  Uaslett,  59th  Illinois  Volunteers,  at  Perry  ville,  October  8th,  18G2. 

Surgeon  J.  Foster  Haven,  15th  Massachusetts  Volunteers,  at  Fredericksburg,  December 
13th,  18G2.  (See  Appendix,  p.  104.) 

Assistant  Surgeon  John  Hurley,  G9th  New  York  Volunteers,  April  15th,  18G3. 

Surgeon  Charles  A.  Hartman,  107th  Ohio  Volunteers,  at  Chancellorsville,  May  2d,  18G3. 

Acting  Assistant  Surgeon  A.  Hiciiborn,  at  Chancellorsville,  May  3d,  18G3 

Surgeon  E.  L.  Watson,  1st  California  Volunteers,  near  Fort  Craig,  New  Mexico,  July  19th,  18G3. 

Surgeon  J.  S.  Weiser,  1st  Minnesota  Cavalry,  near  Big  Mound,  Dakota  Territory,  in  a fight 
with  Sioux  Indians,  July  24th,  18G3. 

Surgeon  Thomas  Jones,  8th  Pennsylvania  Reserves,  at  Spottsylvania,  May  14th,  18G4. 

Surgeon  H.  S.  I’otter,  105th  Illinois  Volunteers,  tiear  Ackworth,  Georgia,  June  2d,  18G4.  (See 
Appendix,  j).  308.) 

Assistant  Surgeon  A.  S.  French,  114th  Illinois  Volunteers,  at  Guutown,  June  lOth,  18G4. 

Surgeon  L.  B.  Smith,  7th  Minnesota  Volunteers,  at  Tujielo,  Mississi|)pi,  July  13th,  18G4. 

Surgeon  J.  C.  Stoddard,  50th  U.  S.  Colored  droops,  Wallace’s  Ferry,  Arkansas,  July  2Gth,  18G4. 

Surgeon  Charles  J.  Lee,  11th  United  States  Colored  Troops,  near  Fort  Smith,  Arkansas, 
August  24th,  1804. 

Surgeon  W.  H.  Rulison,  9th  New  York  Cavalry,  medical  director  of  the  cavalry  of  the  Middle 
Militaiy  Division,  at  Smithfield,  V^irginia,  August  29th,  18G4.  (See  Appendix,  p.  22G.) 

Assistant  Surgeon  Frederick  Wagner,  3d  Tennessee  Cavalry,  at  Sulphur  Branch  Trestle, 
Alabama,  September  25th,  18G4. 

The  following  officers  of  the  medical  staff,  while  in  the  discharge  of  their  duty,  were 
killed  by  partizan  troops  or  assassinated  by  guerrillas  or  rioters : 

Surgeon  H.  N.  Gregory,  1st  Wisconsin  Cavalry,  June  9th,  18G2. 

Assistant  Surgeon  F.  L.  Hunt,  27lh  Massachusetts  Volunteers,  November  18th,  18G2. 

Assistant  Surgeon  Jared  Free,  83d  Pennsylvania  Volunteers,  December  10th,  18G3. 

Surgeon  Shuball  York,  54th  Illinois  Volunteers,  Charleston,  Illinois,  March  28th,  18G4. 

Assistant  Surgeon  S.  A.  Fairchild,  Gth  Kansas  Cavalry,  Stone’s  Farm,  April  Gth,  18G4. 

Assistant  Surgeon  J.  A.  Jones,  115th  Illinois  Volunteers,  July  9th,  18G4. 

Assistant  Surgeon  Eli  M.  Hewitt,  15th  U.  S.  Colored  Troops,  July  24th,  18G4. 

Surgeon  J.  B.  Moore,  5th  Tennessee  Cavalry,  September  5th,  18G4. 

Acting  Assistant  Surgeon  I''.  M.  Osborne,  September  22d,  18G4. 

Surgeon  J.  B.  CooVER,  Gth  Pennsylvania  Cavalry,  September  27, 18G4.  (See  Appendix,  p.  22G.) 

Assistant  Surgeon  John  B.  Porter,  89th  Indiana  Volunteers,  November  1st,  18G4. 

Surgeon  J.  L.  SllERK,  7th  Pennsylvania  Cavalry,  at  Bardstown,  Kentucky,  December  29th,  18G4. 

Acting  Assistant  Surgeon  Samuel  Fahnestock,  April  13th,  18G4. 


INTRODUCTION. 


XXX  I 


The  following  medical  officers  died  of  wounds  received  in  action  : 

Assistant  Surgeon  S.  Alexander,  1st  Pennsylvania  Cavalry,  died  November  29tli,  of  wounds 
received  at  Drainesville,  Virginia,  on  November  2Gtb,  1861. 

Assistant  Surgeon  J.  E.  Hill,  19tb  Massachusetts  Volunteers,  died  of  wounds  received  at 
Eaiiiax,  Virginia,  on  September  11th,  1862. 

Assistant  Surgeon  W.  S.  Moore,  61st  Ohio  Volunteers,  died  of  wounds  received  at  Gettysburg- 
on  July  2d,  1863. 

Acting  Assistant  Surgeon  W.  B.  Cary,  died  of  worPnds  on  January  20th,  1864. 

Assistant  Surgeon  Hezekiah  Fish,  15th  Iowa  Volunteers,  died  August  19th,  of  wounds 
received  near  Atlanta  on  August  17th,  1864. 

Surgeon  Otto  Schenk,  46th  New  York  Volunteers,  died  on  August  21st,  1864,  of  wounds 
received  near  Petersburg,  August  20th,  1864.  {See  Appendix,  p.  175.) 

Acting  Assistant  Surgeon  Emil  Ohlenschlager,  died  October  8th,  of  wounds  received  in 
action  on  October  8th,  1864.  {See  Appendix,  p.  226.) 

Surgeon  Thomas  J.  Shannon,  116th  Ohio  Volunteers,  died  October  20th,  of  wounds  received 
at  Cedar  Creek  on  October  19th,  1864.  {See  Appendix,  p.  226.) 

The  following  medical  officers  died  through  accidents  occurring  in  the  line  of  duty ; 
Surgeon  Frederick  S.  Weller,  9th  New  Jersey  Volunteers,  drowned  at  Hatteras  Inlet, 
January  15th,  1862,  in  the  courageous  and  perilous  attemjit  to  land  to  procure  food  and  water  for 
the  lamine-stricken  regiment,  its  transport  being  driven  off  shore  in  a terrific  storm. 

Assistant  Surgeon  W.  M.  Knox,  78th  Pennsylvania  Volunteers,  April  27th,  1862. 

Assistant  Surgeon  Jesse  J.  Thomas,  lOth  New  Jersey  Volunteers,  May,  1862. 

Assistant  Surgeon  Charles  Johnson,  10th  Tennessee  Volunteers,  killed  by  a fall,  April  5, 1863. 
Surgeon  George  Hammond,  U.  S.  A.,  drowned  in  the  Mississippi  River,  August  14,  1863. 
Assistant  Surgeon  W.  B.  Witt,  69th  Indiana  Volunteers,  drowned  at  Saluria  Bajou,  Texas, 
March  13th,  1864. 

Assistant  Surgeon  S.  C.  Person,  74th  Illinois  Volunteers,  at  Varnell,  October  7,  1864. 

Surgeon  William  K.  Sadler,  19th  Kentucky  Volunteers,  shot  by  a soldier,  December  2d,  1864. 
Assistant  Surgeon  A.  F.  Marsh,  56th  Illinois  Volunteers,  lost  at  sea,  on  the  steamer  General 
Lyon,  March  31st,  1865. 

If  the  above  sad  mortuary  record,  proportionately  larger  than  that  of  any  other  staff 
corps,  is  insufficient  to  correct  the  popular  fallacy  that,  in  time  of  battle,  the  post  of  the 
medical  officer  is  one  of  comparative  safety,  that  false  impression  may  be  removed  by  the 
following  list  of  medical  officers  wounded  in  action  : ' 

Surgeon  J.  Marcus  Rice,  25th  Massachusetts  Volunteers,  at  Roanoke  Island,  February  7th,  1862. 

Acting  Assistant  Surgeon  W.  A.  Kittredge,  Fort  Fillmore,  New  Mexico,  June  25th,  1862.  {See  Appendix,  p.  353.) 
Surgeon  A.  A.  Edmeston,  92d  New  York  Volunteers,  at  Savage’s  Station,  June  27th,  1862. 

Assistant  Surgeon  G.  M.  McGill,  U,  S.  A,,  at  Beverly  Ford,  Virginia,  October  22d,  1863, 

Assistant  Surgeon  W.  M,  Not.son,  U.  S.  A.,  at  Gettysburg,  Jub’  3d,  1863. 

Surgeon  J.  M.  Stevenson,  3d  Maryland  Cavalry,  at  Gettysburg,  July  3d,  1863. 

Surgeon  Charles  Alexander,  16th  Maine  Volunteers,  at  Gettysburg,  July  2d,  1863. 

Assistant  Surgeon  E.  B.  Heckel,  27th  Pennsylvania  Volunteers,  at  Gettysburg,  July  3d,  1863. 

Assistant  Surgeon  Joseph  U.  Stewart,  74th  New  Y'ork  Volunteers,  Gettysburg,  .Jiily  2d,  1863. 

Surgeon  F.  H.  Gross,  U.  S.  V.,  at  Chickamauga,  September  19th,  1863.  {See  Appendix,  p.  270.) 

Surgeon  J.  R.  Wei.st,  4th  Ohio  Cavalry,  wounded  in  1863. 

Assistant  Surgeon  A.  H.  Landis,  35th  Ohio  Volunteers,  at  Chickamauga,  September  19th,  1863. 

Surgeon  E.  A.  Merrifield,  44th  Illinois  Volunteers,  at  Chickamauga,  September  19th,  1863.  {See  Appendix,  p.  277.) 
Assistant  Surgeon  W.  H.  Forwood,  U.  S.  A.,  at  Brandy  Station,  October  8th,  1863. 

Surgeon  N.  R.  Derby,  U.  S.  V.,  on  Cane  River,  Louisiana,  April  21st,  1864.  Permanently  maimed  and  pensioned. 
Assistant  Surgeon  Robert  Ficnw'ICK,  140th  New  York  Volunteers,  by  a shell  fragment,  at  the  Wilderness,  May  8th,  1804. 
Surgeon  T.  E.  Mitchell,  at  Winchester,  May  25th,  1862.  {See  Appendix,  p.  230.) 

Assistant  Surgeon  W.  A.  Barry,  98th  Pennsylvania  Volunteers,  Wilderness,  May  6th,  1804. 

Assistant  Surgeon  R.  S.  Vickery,  2d  Michigan  Volunteers,  Petersburg,  July  30th,  1864.  I’emoral  art('ry  ligated. 
Assistant  Surgeon  Isaac  Smith,  26th  Massachusetts  Volunteers,  at  Ope(|uan,  September  19th,  1864.  lie  is  a pensioner. 
{See  Appendix,  p.  220. ) 

Surgeon  John  T.  Scearce,  11th  Indiana  Volunteerf?,  at  Cedar  Creek,  October  19th,  1864.  {See  Appendix,  p.  226.) 
Assistant  Surgeon  Preston  B.  Rose,  .5th  Michigan  Volunteers,  Hatcher’s  Run,  October  27th,  1864.  He  is  a pensioner. 
Assistant  Surgeon  C.  C.  V.  A.  Crawford,  102d  Pennsylvania  Volunteers,  Petersburg,  .Inly  12th,  1864. 

Assistant  Surgeon  Thomas  Hfxm,  148th  New  York  Volunteers,  Petersburg,  September,  1864. 

Assistant  Surgeon  Austin  Mandeville,  169th  New  York  Volunteers,  Dutch  Gap,  August  13th,  1864.  He  is  a pensioner. 
Assistant  Surgeon  D.  W.  Richard.s,  145th  Pennsylvania  Volunteers,  .June  2d,  1864. 

Surgeon  W.  A.  Smith,  lO.’d  New  York  Volunteer.s,  Suft’olk,  May  3d,  1863.  He  is  a pensioner. 

Assistant  Surgeon  Samuel  B.  Shepard,  7th  Connecticut  Volunteers,  ca])tured,  .lune  2d,  1864. 

Surgeon  Isaac  Walburn.  17th  Pennsylvania  Cavalry,  at  Beverly  Ford,  .June  9th,  1863. 

Assistant  Surgeon  H.  T.  W’iht.man,  5th  Pennsylvania  Volunteers,  at  Bethesda  Church,  Virginia,  May  30th,  1864. 
Assistant  Surgeon  L.  Barnes,  6th  United  States  Colored  Troops,  explosion  of  magazine  at  Fort  Fisher,  .January  16th,  1865. 
Surgeon  M.  M.  Manly,  2d  United  States  Colored  Troops,  at  Fort  Darling,  Virginia,  May  14th,  1864. 

Assistant  Surgeon  G.  V.  R.  Micrrill,  6th  United  States  Colored  Troops,  ivt  Petersburg,  .June,  1864. 


xxxir 


INTEODUGTION. 


Acting  Assistant  Surgeon  Samuel  H.  Boone,  January  17tli,  1865. 

Surgeon  J.  T.  Stewart,  64tli  Illinois  Volunteers,  Atlanta,  July  19tii,  1864. 

Assistant  Surgeon  A.  G.  Picket,  50th  Illinois  Volunteers,  at  Allatoona,  October  5th,  1864. 

Surgeon  A.  N.  Dougherty,  U.  S.  V.,  Wilderness,  May  6th,  1864. 

Assistant  Surgeon  James  Aj.len,  89th  New  York  Volunteers,  Petersburg,  September,  1864. 

Assistant  Surgeon  O.  H.  Adajis,  8th  New  York  Cavalry,  at  Lacy’s  Springs,  December  21st,  1864.  (See  SuRG.  Hist.  p.  2.) 
Assistant  Surgeon  Jacob  C.  Barr,  1st  Ohio  Volunteers,  Wauhatchie,  Tennessee,  October  29th,  1864. 

Assistant  Surgeon  JuLius  Bray,  25th  Missouri  Volunteers,  at  Shiloh,  April  6th,  1832. 

Assistant  Surgeon  James  Brown,  4th  Tennessee, Cavalry,  Franklin,  Tennessee,  September  23d,  1864. 

Assistant  Surgeon  G.  B.  Bailey,  9th  West  Vii'g(fhia  Cavalry,  at  Guyandotte,  November  10th,  1861. 

Assistant  Surgeon  Charles  Bunce,  59th  Illinois  Volunteers,  July,  1864. 

Assistant  Surgeon  A.  T.  C.  Conner,  9th  New  York  Cavalry,  Woodville,  Virginia,  May,  1864. 

Assistant  Surgeon  D.  O.  Crouch,  13th  Pennsylvania  Reserves,  Fredericksburg,  December  13th,  1862. 

Surgeon  J.  W.  Green,  95th  Illinois  Volunteers,  Spanish  Fort,  Alabama,  April  8th,  1865. 

Assistant  Surgeon  T.  Gilfillan,  59th  Massachusetts  Volunteers,  Petersburg,  July  8th,  1864. 

Assistant  Surgeon  Joseph  Gardner,  24th  Kentucky  Volunteers,  near  Atlanta,  August  5th,  1834.  He  is  a pensioner. 
Assistant  Surgeon  C.  E.  Goldsborough,  5th  Maryland  Volunteers,  Petersburg,  August  5th,  1864. 

Acting  Assistant  Surgeon  Ralph  C.  Huse,  January  16th,  1865. 

Assistant  Surgeon  Levi  Jewett,  14th  Connecticut  Volunteers,  Reams  Station,  August  28, 1834.  (See  Appendix,  p.  173. ) 
Assistant  Surgeon  David  D.  Kennedy,  57th  Pennsylvania  Volunteers,  Fredericksburg,  December  13th,  1862. 

Surgeon  Jajies  A.  Morris,  117th  New  York  Volunteers,  Fort  Fisher,  January  16th,  1865. 

Assistant  Surgeon  Edwin  W.  Magann,  9th  Indiana  Cavalry,  Sulphur  Branch  Trestle,  Alabama,  September  25th.  1864. 
Assistant  Surgeon  Thomas  L.  MORGAN,  10th  Missouri  Volunteers,  April,  1864. 

Assistant  Surgeon  Peter  M.  Murphy,  134th  New  York  Volunteers,  Resaca,  Georgia,  May  15th,  1864. 

Assistant  Surgeon  George  A.  Munroe,  3d  Rhode  Island  Cavalry,  on  a scout,  November  29th,  1834. 

Surgeon  Charles  Newhaus,  29th  New  York  Volunteers,  second  Bull  Run,  August  29th,  1882.  He  is  a pensioner. 
Surgeon  WiLLiAJi  D.  Newe.ll,  28th  New  Jersey  Volunteers,  Fredericksburg,  December  13th,  ISbM. 

Surgeon  FowLER  Prentice,  73d  New  York  Volunteers,  August,  1864. 

Surgeon  HENRY'  Root,  58th  New  York  Volunteers,  May,  1863. 

Surgeon  PETER  E.  SiCKLER,  8th  New  York  Cavalry,  Petersburg,  April,  1865. 

Assistant  Surgeon  George  R.  Sullivan,  15th  New  Jersey  Volunteers,  Fredericksburg,  May  9th,  1833. 

Assistant  Surgeon  Thomas  S.  Stanway,  102d  Illinois  Volunteers,  Nashville,  December  22d,  1863. 

Surgeon  William  P.  Thurston,  1st  Rhode  Island  Artillery,  Fairfax,  June  28th,  1862. 

Surgeon  James  Wilson,  99th  New  York  Volunteers,  Suffolk,  April  24th,  1863. 

Surgeon  A.  A.  C.  Williams,  Second  United  States  Sharpshooters,  Chancellorsville,  May  3d,  1863. 

Surgeon  Arvin  F.  Whelan,  1st  Michigan  Sharpshooters,  Petersburg,  August  3d,  1864. 

Assistant  Surgeon  Charles  A.  Wheeler,  Pith  Massachusetts  Volunteers,  Wilderness,  May  6th,  1864. 

Assistant  Surgeon  T.  W.  C.  Willlvmson,  24th  Indiana  Volunteers,  Champion  Hills,  !^Iay  i6th,  1863. 

Assistant  Surgeon  J.  S.  Waggoner,  84th  Pennsylvania  Volunteers,  in  May,  1833. 

Surgeon  John  Dickson,  111th  United  States  Colored  Troops,  at  Sulphur  Branch  Trestle,  Alabama,  September  25th,  1864. 

I had  hoped  to  complete,  in  this  first  part  of  the  Surgical  History  of  the  War,  the  dis- 
cussion of  the  Wounds  and  Injuries  of  the  Head  and  Trunk.  But  the  preliminary  matter 
that  has  been  included  occupies  so  much  space,  that  it  is  necessary  to  reserve  many  of  the 
general  observations  upon  the  Injuries  of  the  Head,  Spine,  and  Blood-vessels,  and  the  con- 
sideration of  Wounds  and  Injuries  of  the  Abdomen  a,nd  of  the  Pelvis,  and  to  place  the  latter 
at  the  commencement  of  the  succeeding  surgical  volume. 

GEORGE  A.  OTIS. 


A,  M.  M. 


CHRONOLOGICAL  SUMMARY 


6* 


CHRONOLOGICAL  SUMMARY  OF  THE  ENGAGEMENTS  AND  BATTLES. 


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LXXIX 


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LXXX 


CimONOLOGICAL  SUMMARY  OF 


REMARKS  AKD  REFERENCES. 

Report  of  Adjutant  General  of  Massachusetts,  1863, 
page  935. 

Unofficial. 

Unofficial. 

Report  of  Adjutant  General  of  Kentucky,  Vol.  II, 
page  495. 

Official  Report  of  Major  General  Rosecrans. 

Official  Reports  of  Jlajor  General  Banks,  U.  S.  A., 

and  General  Greene,  C.  S.  A.  Report  of  Adju- 

tant General  of  Maine,  1803,  page  104. 

See  Vickshurer.  May  28th. 

Unofficial. 

Official. 

Confederate  sources. 

Official. 

Casualty  List,  S.  G.  0.  Official  Report  of  Major 

General  Meade. 

Official  reports.  Union  and  Confederate.  Appendix 

to  Fart  1,  Medical  and  Surgical  History  of  the 

War,  page  140.  Casualty  List.  S.  G.  0.  In- 

cludes the  cavalry  skirmish  at  Hunterstown. 
Among  tlie  casualties  in  tlie  national  army  were 

Major  General  .John  F.  Reynolds,  Brig.  Generals 

Stephen  H.  Weed,  Kosciusko  Zooli,  and  Elon  J. 

Farnsworth,  killed;  Major  Generals  I).  E.  Sick- 

les and  W.  S.  Hancock,  and  Brigadier  Generals 
Paul,  T.  A.  Rowley,  J.  Gibbons,  and  F.  C.  Bar- 

low,  wounded.  In  the  Confederate  army,  Major 

General  I’ender,  Brigadier  Generals  R.  B.  Gar- 

nett, W.  Barksdale,  and  Semmes,  killed;  Major 
Generals  Hood,  Trimble,  and  Ileth,  and  Brig- 

adier Generals  Kemper,  Scales,  G.  T.  Anderson, 
Hampton,  J.  M.  Jones,  Jenkins,  Pettigrew,  and 

Posey,  wounded. 

CONFER.  LOSS. 

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LXXXI 


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LX  XXIV 


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LXXXV 


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LXXXVIII 


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LXXXIX 


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EKGAGEMESTS  AND  BATTLES. 


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CXXII 


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CXXIV 


CHEONOLOGICAL  SUMMAEY  OF 


ENGAGEMENTS  AND  BATTLES. 


cxxv 


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cxxvi 


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CXXVIII 


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CXL 


CONCLUSION  OF  THE  CHEONOLOGICAL  SUMMARY 


* Killed,  wounded,  and  missing. 


INDEX 


TO 


CHRONOLOGICAL  SUMMARY  OF  ENGAGEMENTS  AND  BATTLES. 


Aberdeen,  Ark 

Aberdeen,  Ala 

Abbeville,  Miss 

Abb’s  Valley,  Va 

Abingdon,  Va 

Acton,  Minn 

Ackworfh,  Ga 

Adamsville,  Tenn 

Adair  County,  Mo 

Adairsville,  Ga 

.aitna.  Mo 

Aiken,  S.  C 

Alimosa,  N.  Mex 

Alpine  Station,  Va 

Alpine  Gap,  Ga 

Algiers,  La - 

Allen’s  Farm,  Va 

Aldie,  Va 

Alexandria,  La 

Alexandria,  near.  La 

Alabama,  Rebel  Steamer 

Alabama,  raid  in 

Albemarle,  Ram,  N.  C 

Albemarle,  Ram,  destruction  of 

Allatoona  Hills,  Ga 

Allatooxa,  Ga 

Amelia  Springs,  Va 

Amite  River,  La 

Ammunition,  explosion  of,  at  City  Point,  Va 

Anandale,  Va 

Axmetam,  Md 

Anxvois  River,  Mo 

Antioch  Station,  Tenn 

Anderson's  Gap,  Tenn 

Anderson's  Cross  Roads,  Tenn 

Antoine,  Ark 

Anthony's  Hill,  Tenn 

Apache  Canon,  N.  Mex 

Apache  Pass,  Ariz 

Apalachicola  River,  Fla 

Appomattox  River,  Va 

APPOlIATrOX  COURT-HOUSE,  VA 

Aqu'ia  Creek  Batteries,  Va 

Aranzas  Pass,  Tex 

Armstrong  Ferry,  Tenn 

Arrow  Rock,  Mo 

Arrowfield  Church,  Va 

Arkansas  Post,  Ark 

Arkansas  River,  Ark 

Arkansas,  Rebel  Ram,  attempt  to  destroy  . . . 

Arkadelphia,  Ark 

Arthur's  Swamp,  Va 

Assault  on  Fort  Wagner 

Asliland,  La 

Ashland,  Va 

Ash  Bayou,  La 

Ashwood  Landing,  La 

Ashepoo  River,  S.  C 


Page. 

LI 

CXXIX 

exx,  CXXI 

cvn 

cxxxii 

LVII 

CXI 

XLVI 

LIII 

CIX 

, XXXV 

CXXXV 

XXXVII 

XL 

LXXXVI 

XLIX 

L 

.LX,  LXI,LXXVIII 

CIV 

CV 

LXVI,  CXIII 

CXVI 

CV 

CXXVIII 

cx 

CXXVI 

CXXXIX 

XLIX,  LXX 

CXIX 

XXXIX 

LVIII 

LX 

LXXI 

LXXXVHI 

LXXXVHI 

' CII 

cxxxiii 

XLIII 

LII 

LX 

CXXXIX 

CXXXIX 

XLIII 

XCIII 

: XCVl 

LXXXIX 

evil 

LXVI 

CXVI 

LI 

LXVIH,  Cl 

CXXII,  exxv 

LXXXIl 

LXXVII 

CVII,CX,  CXXXVII 

CXXIX 

CV 

evil 


Page. 

Ashley’s  Mills,  Ark LXXXVI 

Ashley  Station,  Ark CXXI 

Ashby’s  Gap,  Va LIX,  LXXXIl,  CXVII,  CXXXV 

Attack  by  guerrillas  on  transport  Crescent  City LXXVI 

Atchafalaya  River,  La LXXXVI 

Atlee’s,  Va c 

Athens,  Mo XXXVI 

Athens,  Ala XLVI,  XCVI,  CXXIV,  CXXV 

Athens,  Ky LXVIII 

Atlanta,  capture  of  the LXXIX 

Atlanta  Railroad,  raid  on CXXI 

Atlanta,  Ga CXXIX 

Atlanta,  Ga.,  Hood’s  first  sortie CXVII 

Atlajjta,  Ga.,  Hood’s  second  sortie CXVIll 

Atlanta,  Ga.,  campaign  to,  from  Chattanooga CXXII 

Atlanta,  Ga.,  siege  of CXVlII 

Atlanta,  Ga.,  occupation  of CXXII 

Austin,  Miss LIII,  LXXVI 

Austin,  Ark LXXXV 

Auburn,  Va XC 

Auburn,  Ga CXVII 

Augusta,  Ky LIX 

Augusta,  Ark Cl 

AvmriH's  Raid,  W.  Va LXXXV 

Averin’s  Raid,  Southwestern  Va XCIV 

Avoyelle’s  Prairie,  La CVHI 

Avebysboro’,  N.  C CXXXVII 

Baltimore,  streets  of XXXIV 

Baltimore  Cross  Roads,  Va LXXX,  LXXXI 


Bayou  Cache,  Ark 

Bayou  De  View,  Ark 

Bayou  Barnard,  C.  N. . . 

Bayou  Teche,  La 

Bayou  Bontecou,  La 

Bayou  Vennilion,  La  . . . 

Bayou  Pierre,  Miss 

Bayou  Tensas,  La 

Bayou  Metoe,  Ark 

Bayou  Borbeaux,  La  . . . 

Bayou  Sara,  Miss 

Bayou  Rapides,  La 

Bayou  La  Mouric,  La  . . 
Bayou  He  Glaize,  La 

Bayou  Biddell,  La 

Bayou  La  Fouche,  La  . . 
Ball's  Cross  Roads,  Va. . 

Ball’s  Bluff,  Va 

Ball’s  Ferry,  Ga 

Barbomsville,  W.  Va... 
Bayles’  Cross  Roads,  La 

Bagdad.  Ky 

Bath,  Va 

Barry  County,  Mo 

Bates  County,  Mo 

Banks's  Retreat,  Va  . 

Battle  Creek,  Tenn 

Batesville,  Ark 

Baton  Rouge,  La 


LI 

LI 

LII 

LXII,  LXVI 

LXHI 

LXXI 

LXXIV 

LXXX 

LXXXV 

XCI 

XCII 

Cl 

CVI 

CIX 

CXXVII 

CXXIX 

XXXVI 

XXXVIII 

exxx 

XXXV,  XXXVII 

XXXVIII 

XL 

XL,  LXXXVI 

XLII 

XLVI 

XLVII 

XLIX 

LI,  LXVI  I.  XCIX 

LIII,  LXXI,  LXXXVI,  CV 


CXLIT 


INDEX 


Page. 

Bardstown,  Ky LIX 

Barbee’s  Cross  Roads,  Va , . . LXII,  LXXXVl 

Bachelor’s  Creek,  N.  C LXII,  LXXVI,  XCVII,  CX 

Bacon  Creek,  Ky LXV 

Baxter  Springs,  Ark LXXXVIII 

Baker  Springs,  Ark XCV^ 

Baker's  Creek,  Miss LXX'V,  XCVII 

Barton  Station,  Miss XC 

Bay  Springs,  Miss XCI 

Barnwell’s  Island,  S.  C XCIII 

Barren  Fork,  I.  T XCV 

Barnett’s  Ford,  Va XCVIII 

Barber’s  Place,  Fla XCVIII 

Baylor’s  Farm,  Va CXIII 

Baldwin,  Miss XLVIII,  LIX 

Baldwin,  Fla LXX 

Battery  Huger,  Va LXXII 

Battery  Gregg,  S.  C LXXXVl 

Bealington,  W.  Va XXXV 

Bealton,  Va XCI,  XCVI 

Bean’s  .Station,  Tenn XCIV,  XCV,  CXXXII 

Beaver  Creek,  Mo LXIII 

Beaver  Creek,  Ky LXXX 

Beaver  Dam  Lake,  Miss LXXVI 

Beaver  Dam  Station,  Va CVII 

Bear  Wallow,  Ky LXV 

Bear  River,  W.  T CXITI 

Bear  Creek,  Mo LXVH 

Bear  Creek,  Ala LXXI,  XCI 

Bear  Creek  Station,  Ga CXXIX 

Beiu-  Skin  Lake,  Mo ^ LXXXVl 

Beverly,  W.  Va XXXV,  LXXII,  LXXXI,  CXXVIII,  CXXXFV 

Bicveuly  FoiiD,  Va LXXVm,  XC 

Bennet's  Mills,  Va XXXVI 

Beber's  Mills,  Va XXX VH 

Beckwill  Farm,  Mo XXXVIll 

Belmont,  Mo XXXIX 

Bertrand,  Mo XL 

Beech  Creek,  W.  Va LIII 

Beech  Grove,  Ky XLI 

BEECH  Grove,  Tenn LXXIX 

Bentonville,  Ark XLII 

bentonvtlle,  n.  c cxxxvn 

Berr3wille,  Va LXHI,  LXXVH,  LXXVIH,  XC,  CXXIH,  CXXXIX 

Berrjwille  Pike,  Va CXIX 

Berrj'’s  Farm,  Va LXXV 

Berwick  City,  La LXIX 

Beersheba  Springs,  Tenn XCIII,  Cl 

Benton,  Miss CVI 

Bent’s  Old  Fork,  Tex CXXX 

Belcher  s Mills,  Va CIX,  CXXIH 

Bermuda  Hundred,  Va CVIH,  CXI,  CXXI,  CXXIX,  CXXXI 

Bellefield,  Va CXXXII 

Big  Hurricane  Creek,  Mo XXXVIH 

Big  Creek  Gap,  Tenn XLH,  LVII 

Big  Creek,  Ark LXXXH,  CXVII 

Big  Indian  Creek,  Ark XLVH 

Big  Beaver  Creek,  Mo LXH 

Big  River  Bridge,  Mo XXXVIll 

BIG  Black  River,  Miss LXXV,  LXXXI,  LXXXIX,  XCVII 

Big  Black  River  Bridge,  Miss CXXX 

Big  Hatchie  River,  Miss LIX 

Big  Sandy  River,  Ky LXHI 

Big  Sandy,  C.  T CXXX 

Big  Pigeon  River,  Tenn CXXIX 

Big  Piney,  Mo LII 

Big  HiIl,'Ky LV 

Big  Hill  Road,  Ky LXI 

Big  Mound,  D.  T LXXXIV 

Big  Sewell,  W.  Va XCV 

Big  shantj',  Ga CXI,  CXXIH 

Big  Blue.  Mo CXXVIII 

Bird's  Point,  Mo XXXVI,  XXXVIH 

Birch  Coolie,  Minn LVII 

Bisland,  La LXXI 

Bidnella's  Cross  Roads,  Va C 


Page. 

Binnaker’s  Bridge,  S.  C CXXXV 

Blue  Springs,  Mo LXIX 

Blue  Springs,  Tenn LXXXVIU,  LXXXIX 

Blue  Mount,  Ala CXL 

Blue  Mills,  Mo XXXV,  XXXVII 

Blue  Gap,  Va XL 

Blue  Island,  Ind LXXIX 

Black  River,  Mo XXXVn,LI,  CXXIH 

Black  River,  Miss LXXXI,  LXXXII 

Black  River,  La CXXIX 

Blackwater,  Mo XL,  LXXXIX,  CXXIV 

Blaekwater,  Va LIX,  LXI,  LXIV,  LXIX 

Blackwater,  Fla CXXVII.  CXXVIII 

Black  Creek,  Fla CXVHI 

Black  'Warrior  Creek,  Ala LXX  HI 

Black  Walnut  Creek,  Mo XXXIX 

Blackford’s  Ford,  Va LVIll 

Black  Baj-ou  Expedition,  Miss LXXI 

Blackburn’s  Ford,  Va XXXV,  XC 

Black  Jack  Forest,  Tenn XLIII 

Blackland,  Miss XLVIII 

Blackville,  S.  C CXXXV 

Blooming  Gap,  Va XLI 

Bloomfield,  Va LXI 

Bloomfield,  Mo XLVI,  LV,  LVII,  LXXIH 

Blount’s  Mills,  N.  C LXXI 

Blount’s  Farm,  Ala LXXIV 

Blountsville,  Tenn LXXXVH,  LXXXIX 

Blain’s  Cross  Roads,  Tenn XCV 

Block-House  No.  2,  Tenn CXXXI 

Block-House  No.  4,  Tenn CXX 

Block-Hoiise  No.  5,  Tenn CXXH 

Block-House  No.  7,  Tenn CXXXI 

Blockade  Runners  in  Tampa  Bay,  Florida,  destruction  of XC 

Bluffton,  S.  C LXXVII 

Booneville,  Mo XXXIV,  XXXVII,  CXXVI 

BoonvilIc,  Miss XLVII,  LI 

Boone  Court-house,  W.  Va. XXXVI 

Bolivar  Heights,  Va XXXVIH,  LXXXIII,  CXV 

Bolivar,  Tenn LVI,  LXVIII,  LXIX,  XCV,  XCVIH,  Cl,  CV 

Bolivar,  Miss LIX 

Bowling  Green,  Ky XLI,  XLII 

Boles  Farm,  Miss LII 

Bolt’s  Farm,  Mo LII 

Bollinger’s  Mills,  Mo LIII 

Boonsboro’,  Md LVIH,  LXXXII 

Boonsboro’,  Ark LXIII 

Boston  Mountain,  Ark LXIII 

Bone  Yard,  Tenn LXVII 

Bombardment  of  Fort  Sumter,  S.  C LXXI 

Boston,  Ky LXXVIH 

Boone,  N.  C CXXXVIII 

Boj’d's  .Station,  Ala CXXXVU 

Bogler’s  Creek,  Ala CXXXVHI 

Boj'kin’s  Mills,  S.  C CIV,  CXXXIX 

Bottom’s  Bridge,  Va LXXXI,  LXXXV 

Bolton  Depot,  Miss XCVH 

Bolton  and  Birdsong  Ferry,  Miss LXXXI 

Bonfouca,  La XCHI 

BOYDTOWN  PLANK  ROAD,  VA CXXVI,  CXXVUI,  CXXXVIII 

Bogg’s  Mill,  N.  C CXXXIV 

Brunswick,  Mo XXXVI 

Briar,  Mo XLIH 

Bridgeport,  Ala XLV 

Brownsville,  Tenn LIT,  LIU 

Brownsville,  Ark LXXXV,  LXXXVH,  CXXVIII 

Brownsville,  Miss XC 

Brown  Springs,  Mo LII 

Brown's  Feny,  Tenn XCI 

Brown’s  Gap,  Va CXXIV 

Browne’s  Cross  Roads CXXX 

Brandy  Station,  Va LV,  LXXVIH,  LXXXIV,  LXXXI  I 

Bristoe  Station,  Va XC,  CHI 

Britton's  Lane,  Tenn LVI 

Bristol,  Tenn LXXXVH,  CXXXII 

Brashear  City,  La LXII,  LXIX,  LXXIX 


CXLUl 


INDEX. 


Page. 

Brentsville,  Tenn LXIV 

Brentsville,  Va LXVTII,  XCIX 

Bradyville,  Tenn LXVIII,  LXXV 

Branchville,  Ark XCVI 

Brentwood,  Tenn LXX,  CXXII 

Broad  Run,  Va LXX 

Broad  River,  S.  C LXXI,  CXXX 

Bradeuburg,  Ky LXXXII 

Brandon,  Miss LXXXIII 

Brimstone  Creek,  Tenn LXXXVI 

Brazios  Santiago,  Tex XCI 

Brook  Turnpike,  Va C 

Brice’s  Cross  Roads,  Miss CXII 

Brier  Creek,  Ga CXXXI 

Bradford  Springs,  S,  C CXXXIX 

Buchanan,  Va LU,  CXII 

Buckbannon,  AV.  Va XXXV 

Bunker  Hill,  W-Va XXXV 

bull  Run,  Va XXXV,  LVI 

Bushy  Creek,  Ark XL 

Bushy  Creek,  Mo LXXVII 

Burke’s  Station,  Va XLII 

Butler,  Mo XLVI,  LXI 

Butler  Creek,  Ala CXXTX 

Burnt  Ordinary,  Va LXVIl 

Bute  La  Rose,  La LXXII 

Buikesville,  Ky LXXXI 

Buffington  Island,  Ohio LXXXIII 

Buford’s  Gap,  Va CXIII 

Buford's  Station,  Tenn CXXXIII 

Bull  Pasture  aiountain,  Va XLVI 

Bull  Run  Briuge,  Va LV 

Bulltown,  Braxton  County,  Va LXXXIX 

Bull  Bayou,  Ark CXXI 

Bull's  Gap,  Tenn CXXIV,  CXXIX 

Buffalo  Hill,  Ky XXXVII 

Buffalo  Mills,  Mo XXXVIU 

Buffalo,  AV.  Va LIX 

Buffalo  Creek,  I.  T LXXXVII 

Buffalo  Creek,  Ga CXXX 

Buffalo  Gap.  AV.  Va CXI 

Burning  of  Royal  Yacht,  Galveston  Harbor,  Tex XXXIX 

Buckton  Station,  Va XLAHI 

Buokland’s  Mills,  A'a XC 

Buck  Head  Creek CXXX 

Buzzard  Roost,  Ga C 

Buzzard  Roost  Gap,  Ga CVU 

Buzzard  Roost  Block-House,  Ga CXXVII 

Burton’s  Ford,  A’a C 

Burned  Hickory,  Ga ! CX 

Buraed  Church,  Ga CX 

Burger's  Farm,  A’a CXXVIII 

Butler's  Bridge,  N.  C CXXXII 

Byhalia,  Miss LXXXIX 

Camp  Jackson,  Mo XXXIV 

Camp  Cole,  Mo XXXIV 

Camp  Cullenden,  Mo XXXVII 

Camp  Advance,  A’^a XXXATI 

Camp  Alleghany,  AV.  Va XL 

Camp  Babcock,  Ark LXIII 

Camp  Moore,  La  LXXV 

Cape  Hatteras  Inlet,  N.  C XXXVI 

Cape  Fear  River,  N.  C LX 

Cape  Girardeau,  AIo LXXUI,  XCVIII 

Carthage,  Mo XXXIV,  XLIII,  LXXV 

Carthage,  Ark LXIII 

Cameron,  Mo XXXVHI 

Cameron,  Va XCVI 

Calhoun,  Mo XL 

Calhoun,  Tenn LXXXVIIl 

Calhoun  Station,  La CTX 

Canton,  X,  C XLVI 

Canton,  Miss LXXXIII,  XC,  C 

Canton,  Ky : CXXI 

Cache  River,  Ark CIV  | 


Cache  River  Bridge,  Ark 

Cassville,  Mo 

Cassville,  Ga 

Cassville  Station,  Ga 

Cass  County,  Mo 

Cane  River,  La 

Cane  Hill,  Ark 

Cane  Creek,  Ala 

Carsville,  A’'a 

Cainsville,  Tenn 

Carter’s  Station,  Tenn 

Carter's  Station,  Ark 

Carter’s  Raid  in  East  Tennessee 

Carter’s  Farm,  Va 

CaiToll  County,  Ark 

Carrolton  Store,  Va 

Carrolton  Landing,  Miss 

Caroline  Bend,  Miss 

Capture  of  Rebel  Steamer  Fair  Play. 
Capture  of  Steamtug  Columbine,  Fla 

Capture  of  Fort  Hell,  Va -w  - . - 

Campbell  County,  Tenn 

Cajvipbell  Station,  Tenn 

Campbellville,  Tenn 

Campbelltown,  Ga 

Cabin  Creek,  I.  T 

Cabin  Point,  Va 

Cambridge,  Mo 

Campti,  La 

Camden,  Ark 

Carrick’s  Ford,  AV.  A^a 

Camifex  Ferry,  AV.  Va 

Catlett’s  Station,  Va 

Cacapon  Bridge,  Va 

Castor  River,  Mo 

Carrion  Crow  Bayou,  La 

Caddo  Gap,  Ark 

Canon  de  Chelley 

Calf  Killer  Creek,  Tenn 

Cabletown,  Va 

Cavalry  Raid  (Kautz’s),  A"a 

California,  Mo 

Catawba  River,  N.  C 

Cedar  Mountain,  Va 

Cedar  Run,  Va 

Cedar  Run  Church,  Va 

Cedar  Creek,  Va 

Cedar  Springs,  Va 

Cedar  Bluffs,  C.  T 

Cedar  Keys,  Fla 

Celina,  Ky 

Celina,  Tenn 

Centreville,  La 

Centreville,  Tenn 

Centreville,  Ala 

Central  Railroad,  A’^a 

Centralia,  Mo.,  Massacre  at 

Charlestown,  Mo 


Page. 

XLVU 

LIX 

CIX 


LXII 

CIV 

LXIII 

XCI,  CXII 

LX,  LXVlI,  LXXV,  LXXVI 

Lxvm 

LXV,  LXXXVII 

cxxv 

LXV 

CXVII 

LXX,  cm 

Cl 


— CXVII 
CXVII 

LV 

CIX 

— cxxiii 

LXV 

— xcm 

CXXIII,  CXXX 

CXVIII 

LXXXI,  CXXIII 
CXIX 
LIX 


CII 

cm 

XXXV 
XXXVII 
LV,  LXI,  LXV  I 
LVII 
Lxxm 
...  XCI, xcm 
. XCVI,  XCVIII 
XCVII 
C,  Cl 

c 

...  CV,CVII 
CXXVI 
CXL 
LIV 
LIV 
CXXVII 
CXXVII 
CXXIX 

cv 

cxxxv 

LXXII 
XCIV 
LXXI 
. . . XCI,  cxxv 
...  cxxxvm 

CXII 

cxxv 

..  .XXXVI,  XLI 


Charlestown,  "VV.  Va XLVII,  LVII,  LX,  LXIII,  LXXXIX,  XC,  CXIV 

Charleston,  Tenn XCV 

Charleston,  Ills ^ ^ 

Charleston,  S.  C CXXXV 

Charleston  Bar,  ,S.  C LXV  II 

Charleston  Harbor,  S.  C LXXI,  XCIX 

Chariton  Bridge,  Mo LIII 

Cheat  Mountain,  W.  Va XXXV  II 

Cheat  River,  W.  Va 

Chalk  Bluffs,  Mo XLVI,LXXm 

Chalk  Bluffs,  Ark I>XX,  CXL 

Chester  Gap,  Va • LXII,  LXXXIV 

Chester  Station,  Va CV'I,  CXXIX 

Chesterfield,  S.  C CXXXV  I 

Chapinansville,  \V.  Va XXXVII 

Chapel  Hill,  Tenn LXVTII 


CXLTV 


INDEX 


Page. 

CuAM’iON  Hills,  Miss LXXV,  XCVII 

Chapin’s  Farm,  Va CXXV 

Chambersburg,  Va CXVIII 

Charles  City  Cross  Roads,  VA L,  XCIII,  CXII,  CXXV 

Cliantilly,  Va LVI 

Chancellorsville,  Va LXXIV 

Chackahoola  Station,  La LXXIX 

Chattanooga,  Tenn LXXXV,  XCIII,  CXXXI,  CXXXVI 

Chattahoochie  River,  Ga CXVI 

Cheese  Cake  Church,  Va XL 

Cherokee  Station,  Ala XC,  XCI 

Cheek’s  Cross  Roads,  Tenn Cl 

Cherry  Grove,  Va CIH 

Chewa  Station,  Ga CXVII 

Cheraw,  S.  C CXXXVI 

Chickamicomico,  N.  C XXXVIII 

Chichahominy,  Va XLVII,  L,  CVHI 

Chickasaw  Bayou,  Miss LXV 

Chickamauga,  Ga LXXXVII 

Childsburg,  Va CVII 

Chickasaw,  Ala.,  to  Macon,  Ga.,  Wilson’s  Raid CXXXVII 

Church  in  the  Woods,  Mo LIII 

Chuckatuck,  Va LXXII 

Chunky  .Station,  Miss XCVIII 

City  Belle  Transport,  La CV 

City  Point,  Va CVI,  CXIX 

Civicjues  Ferry,  La LXXIV 

Clark’s  Hollow,  W.  Va XLVI 

Clarendon,  Ark LIV,  Cl,  CXIV 

Clarendon  Road,  Ark LXVI 

Clarksville,  Tenn LV,  LVII 

Clarksville,  Ark XCI,  XCII,  CXXV 

Clarkson,  Mo LXI 

Clark's  Neck,  Ky LXXXV 

Clara  Bell  transport.  Miss CXVII 

Clay  County,  Mo LXXVI,  CXV 

Clear  Creek,  Mo LIII,  CVHI 

Clear  Springs,  Mo CXVIII 

Clear  Lake,  Ark CXXXVI 

Clendenin’s  Raid  below  Fredericksburg,  Va LXXVI 

Cleveland,  Tenn XCIV,  XCV,  CII,  CHI,  CXX 

Clinton,  Miss XC,  XCVII,  CXV,  CXVI 

Clinton,  La LXV,  LXXVII,  CV,  CXXI,  CXXXVI 

Clinton,  N.  C XLVI 

Clinton,  Ga CXXIX 

Clinton,  Mo LI 

Clinton  County,  Mo XXXIX 

Clinton  Creek,  La CXXIX 

CUnch  River,  W.  Va XCIV 

Clinch  IMountain,  Tenn XCIV 

Cloutersville,  La CIV 

Cioyd's  Mountain,  Va CVII 

Columbus,  Mo XLI,  LII 

Columbus,  Ky CXXXIV 

Columbus,  Ga CXXXIX 

Columbia,  S.  C CXXXV 

Columbia,  Tenn LVII,  CXXX 

Columbia,  Kj' LXXXI 

Columbia  Bayou,  La CXI 

Cobb’s  Point,  N.  C XLI 

Cochran’s  Cross  Roads,  Miss LVII 

Coffeeville,  Miss LXVIII 

Coggins's  Point,  Va LIII 

Cold  Harbor,  Va L,  CXI 

Coldwater,  Miss LII, 

LVII,  LXII,  LXIII,  LXVIII,  LXXII,  LXXXIV,  LXXXV 

Coldwater  Grove,  Mo CXXVIII 

Cold  Knob  Mountain,  Va LXIII 

College  Hill,  Miss CXXI 

Cohnan’s,  Miss C,  CXV 

Colliersville,  Tenn LXXXIX,  XCI,  XCV 

ColUersville,  Miss CXIV 

Comfort,  N.  C LXXXI 

Como,  Miss LXXXIX 


Page. 

Combahee  River,  S.  C CXXXIV 

Construction  train  ^ear  Murfreesboro’,  Tenn..., LXVII 

Convalescent  Corral,  Miss LXXXII 

Concha’s  Spring,  N.  Mex LXXXIV 

Conee  Creek,  La CXXI 

Congaree.  Creek,  S.  C CXXXV 

Coosaw  River,  S.  C XL,  CXXXI 

Coohomo  County,  Miss LIII 

Coon  Creek,  Mo LV 

Coosa  River,  Ala CXVI 

Corinth  Road,  reconnoissance  on.  Miss XLV 

Corinth,  Miss XLVI,  LIX,  LXXXII,  CXII 

Corinth,  Miss.,  evacuation  of XLVII 

Corydon,  La LXXXII 

Com-tland,  Tenn LV 

Courtland,  Ala CXVII 

Courtland  Bridge,  Ala LH 

Courtland  Road,  Ala CX 

Cosby  Creek,  Tenn XCVI 

Cotton  Plantation,  Ark LI,  CIV 

Cotton  Hill,  W.  Va LVH 

Cotton  Gap,  Ark LXXXVI 

Cottage  Groove,  Tenn J.XIX 

Cove  Creek,  N.  C LXIII 

Cove  Mountain,  Va CVH 

Covington,  Tenn LXIX 

Cow  Skin,  Mo CXIX 

Cow  Creek,  Kas CXXIX 

Coyle  Tavern,  Va LXXXV 

Coxe’s  Bridge,  N.  C CXXXVII 

Cross  Lanes,  W.  Va XXXVI 

Cross  Keys,  Va XLVill 

Cross  Hollows,  Ark LXI 

Cross  Timbers,  Mo XC 

Crump’s  Landing,  Tenn XLHT 

Crump’s  Hill,  La CII 

Crab  Orchard,  Ky LV 

Crawford  County,  Mo LXIII 

Crawford  County',  Ark CXIX 

Craig’s  Meeting-House,  Va CV 

Crew’s  Farm,  Va LI 

Creek  Agency,  I.  T XCI 

Creelsboro’,  Ky , XCIV 

Crooked  Creek,  Ala LXXIII 

Crooked  Run,  Ohio CIX 

Crooked  Run,  Va CXX 

Cripple  Creek,  Tenn LX  XV 

Culpeper,  Va LI,  LXXXVII,  LXXXIX,  XCII 

Culp’s  House,  Ga CXIV 

Cumberland,  Md CXIX 

Cumberland  River,  Ky XLI 

Cumberland  Mountains,  Tenn XLIII,  XLVI 

Cumberland  Mountain,  W.  Va XLVI 

Cumberland  Gap,  Tenn XLIX,  LXXXVI,  XCVII,  XCIX 

Cumberland  Iron  Works,  Tenn LV,  LXVII 

Cuyler's  Plantation,  Ga CXXXII 

Cypress  Bridge,  Ky XXXIX 

Cypress  Bend,  Miss.  River LXXIX 

Cypress  Swamp,  Ga CXXXI 

Cynthiana,  Ky LII,  CXII 

Dabney^’s  Mills,  Va CXXXV 

Dallas,  JIo XXXVI,  LV 

Dallas,  Ga CX 

Dallas,  N.  C CXXXIX 

Dalton,  Ga XCVI,  CVH,  CXX,  CXXVH 

Dam  No.  4,  Potomac,  Va XL 

Dandridge,  Tenn  XCVI 

Danville,  Ky LXIX 

Danville,  Ark 01 

Darbytown  Roads,  Va CXXVI,  CXXVH 

Dardanelle,  Ark LXXXVI,  CVII,  CXXXIV 

Darkesville,  Va CXVII,  CXXIII 

Darnestown,  Md XXXVII 

Davis’s  Farm,  Va CXIV 


INDEX 


CXLV 


Davis’s  Miss 

Davis's  Cross  Koads,  Ga  . . . 

Da3*'s  Gap,  Ala 

Decatur,  Ga 

Decatur,  Teun.,  near 

Decatur,  Miss 

Decatur,  Ala 

Deer  Creek,  Miss 

Denmark,  Tenn 

Dent  Count}',  Mo 

Dcs  Alleinands,  La 

Des  Arcs,  Ark 

Dead  Buffalo  Lake,  D.  T . . 

Deatonsville,  Va 

Denver,  C.  T 

Deep  Bottom,  Va 

Deep  Bottom  Run,  Va 

Deep  River  Bridge,  N.  C . . 

Deserted  House,  Va 

Devil  s Backbone,  Ark 

Devaux's  Neck,  S.  C 

Diamond  Grove,  jMo 

Dinwiddie  Court-house,  Va 

Ditch  Ba^’ou,  Ark 

Dobbin's  Feriy,  Tenn 

Dodge  Count}’,  Mo 

Dog  Walk.  Ky 

Donaldsonville,  La 

Doniphan,  Mo 

Doubtful  Canon,  A.  T 

Douglas  Landing,  Ark 

Dover,  Tenn 

Dover  Road,  N.  C 

Downer’s  Bridge,  Va 

Draft  Riot,  New  York  City. 

Drainesvillc,  Va 

Dresden,  Ky 

Dripping  Springs,  Ark 

Driver’s  Gap,  Ala 

Droop  Mountain,  Va 

Drur}''s  Bluff,  Va 

Dry  Forks,  Iffo 

Dry  Forks,  W.  Va 

Dry  Wood,  Mo 

Dry  Creek,  Ala 

Dutch  Gap,  Va 

Dutch  Mills,  Ark 

Dug  Springs,  Mo 

Dug  Gap,  Ga 

Duck  River  Shoals,  Tenn . . 

Duck  Run,  Tenn 

Dukedom,  Ky 

Dunbar's  Plantation,  La  .. . 

Dumfries,  Va 

Dunksburg,  Mo 

Dunn’s  Bayou,  La 

Dunn’s  Lake,  Fla 

Durhamviile,  Tenn 

Dutton’s  Hill,  Ky 

Duval’s  Bluff,  Ark 

Duvall’s  Mills,  Va 

Dyersburg,  Tenn 

Eaglevillc,  Tenn 

East  Pascagoula,  Miss 

East  Point,  Miss 

Ebenezer  Church,  Ala 

Ebenezer  Creek,  Ga 

Eden  Station,  Ga 

Edgefield  Junction,  Tenn  . . 

Edisto  Island,  S.  C 

Edwards’s  Ferry,  Va 

Edwards’s  Station,  Miss 

Eg\’pt  Station,  Miss 

Klkwater.  W.  Va 

1!>» 


Page. 

LXV 

LXXXVI 

LXXIH 

CXVII.CXIX 

LII 

XCVIII 

C,  CIV,  CX,  exx,  CXXVllI,  CXXXIII 

LX  VIII,  LXIX 

LVI 

XXXIX 

LVII 

LXVI,CXVH 

LXXXIV 

CXXXIX 

cm 

CXVII,  CXVIII 

exx 

CXXXIX 

LXVII 

LXXXVI 

CXXXI 

XLV 

CXXXVIII 

CXI 

LXIV 

LUI 

LX 

LXXX,  LXXXIII,  XCVIII,  CXIX 

XLIII,  CXXIII 

CV 

CXXXVI 

XLI 

LXXIII 

CIX 

LXXXIII 

XXXIX,  XL,  XCIX 

XLVI 

LXV 

LXXIII 

XCII 

evil 

XXXIV 

XLI 

XXXVII 

LXXXV 

LXXXIV,  exm,  CXXIII 

GUI 

XXXVI 

LXXXVI,  CVI 

LXXII 

exxx 

c 

LXXI 

LXV 

XL 

CV 

CXXXV 

LVIII 

LXX 

LXVI,  XCIV,CXXI 

CXXXI 

LXVII 

LXVIII 

LXXI 

^ CXXVI 

CXXXVIII 

CXXXI 

CXXXI 

LV 

XLVI 

XXXIV,  XXXVIII 

LXXV 

CXXXIII 

XXXVII 


Elk  River,  W.  Va 

Elk  River,  Tenn 

Elk  Fork,  Tenn 

Elk  Shute,  Mo 

Elkton,  Ky 

Elkton  Station,  Ala. . 
Elkliom  Tavern,  Ark 

Elkin’s  Ford,  Ark 

Elizabethtown,  Ky  . . . 
Elliott  Mills,  Mo 


Page. 

EVJI 

LXXXI,  LXXXIII 

LXV 

, CXIX 

CXXXII 

XLVI 

XLII 

CU 

...LXV,  CXXXIII 
XXXVII 


Ellison's  Mills,  Va 

Eltbam’s  Landing,  Va  . . 

Estill  County,  Ky 

Evlington  Heights,  Va.  - 

Ezra  Chapel,  Ga 

Fairfax  Court-house,  Va. 

Fairfax  Station,  Va 

Fairfield,  Penn 

Fairburn,  Ga 


XLIX 

XLVI 

LXXXIV 

LI 

CXVIII 

XXXIV,  LI,  LXIX,  LXXX 

CXXIII 

LXXXI 

exx 


Fair  Gardens,  Tenn 

Fairmount,  W.  Va 

Fair  Oaks,  Va 

I’alliug  Waters,  Va 

Falmouth,  Va 

Farmington,  Miss 

Farmington,  Tenn 

Farmville,  Va 

Farr's  Mills,  Ark 

Fayette,  Mo 

Fayetteville,  Ark 

Fayetteville,  W.  Va 

Fayetteville,  Tenn 

Fayetteville,  N.  C 

Federal  Point,  N.  C 

Fishing  Creek,  Ky 

Fish  Springs,  Tenn 

Fish  Bay,  Ark 

Fisher’s  IHll,  Va 

Fitzhugh's  Crossing,  Va 

Fitzhugli’s  Woods,  Ark 

Five  Points,  Va 

Five  Forks,  V.\ 

Flat  Lick  Ford,  Ky 

Flat  Shoals,  Ga 

Flint  Creek,  Ark 

Flock's  Mills,  Md 

Florida,  Monroe  County,  Mo 

Florence,  S.  C 

Florence,  Ky 

Florence,  Ala 

Floyd's  Fork,  Ky 

Floyd  County,  Ky 

Fort  Abercrombie,  D.  T 

Fort  Adams,  La 

Fort  Anderson,  Ky 

Fort  Anderson,  N.  C 

Fort  Blair.  Ark 

FORT  Blakely,  Ala 

Fort  Blunt,  1.  T 

Fort  Brady,  Va 

Fort  Burnham,  Va 

Fort  Cobb,  1,  T 


xcvn 

LXXIII 

XLVIII,  CXXVIll 

XXXIV,  LXXXIII 

XLVI 

XLVI 

LXXXIX 

CXXXIX 

CXYI 

CXXIV 

LII,  LXI,  LXIV,  LXXII,  CIX,  CXXVIll 

LVII,  LXIII,  LXXV 

XCI 

CXXXVI 

CXXXV 

XLI,  LXXVI 

LXVII 

CXI 

eXX,  CXXIV,  CXXVI 

LXXIII 

Cl 

XCV 

CXXXVIII 

XLI 

CXVIII 

c 

CXIX 

XLVn,  LII 

CXXXVI 

LVIII 

Lxxvii,  xcvi,  cm,  CXXVI 

LIX 

LXXX 

LVII 

CXXVI 

Cl 

CXXXV 

LXXXIX 

CXXXIX 

LXXVI 

CXXXIV 

CXXXIV 

LXI 


Fort  Craig,  N.  Mex 

Fort  Cottonwood,  Nev 

FORT  DARLING,  VA 

Fort  Davidson,  Mo 

Fort  Do  Russy,  La 

Fort  Donelson,  Tenn 

Fort  Esperanza,  Tex 

Fort  Fillmore,  N.  Slex 

FORT  Fisher,  N.  C 

FORT  Gaines,  Mobile  Harbor,  Ala 

Fort  Gibson,  I.  T 

Fort  Gilmore,  Va 


...XXXVII,  XLH.XEVII 

CXXII,  CXXIII 

XLVI,  CVH 

CXXIV 

Cl 

XLI,  LV,  LXVII,  CXXVI 

XCIV 

XXXV,  LIV 

CXXXIII,  CXXXIV 

CXIX 

LXXVI,  CXXIII 

exxy 


CXLVI 


INDEX 


Fort  Halleck,  1.  T 

Fort  Harrison,  Va 

Fort  Hatteras,  N.  C 

Fort  Heinian,  Tenn 

FouT  HENtiv,  Tenn 

Fort  Hill,  Vicksburg,  Miss 

Fort  Hindman,  Ark 

Fort  Jackson  and  St.  Philip,  La 

Fort  Johnson,  S.  C 

Fort  Jones,  N.  G 

Fort  Kelly,  AV.  Va 

Fort  Leavenworth,  Kans 

Fort  Lyon,  I.  T 

Fort  Lyons,  Va 

Fort  McAllister,  Ga 

Fort  McCook,  Ala 

Fort  McRae,  N.  Mex 

Fort  Macon,  N.  C 

Fort  Morgan,  Ala 

Fort  Myers,  Fla 

Fort  Pemberton,  Miss 

Fort  Pickens,  Fla 

Fort  Pike,  La 

Fort  Pillow,  Tenn 

Fort  Pulaski,  Ga 

Fort  Rice,  D.  T 

Fort  Ridglej^,  Minn 

Fort  Sanders,  Tenn 

Fort  Scott,  Mo 

Fort  Scott,  Ark 

Fort  Sedgwick,  Va 

Fort  Smith,  Ark 

Fort  Steadm.vn,  Va 

Fort  Stevens,  D.  C 

Fort  Sumner,  N.  Mex 

Fort  Sumter,  S.  C 

Fort  Taylor,  Ga 

FORT  Wagner,  S.  C 

Fort  Wright,  Tenn 

Fort  Brown  Road,  Tex 

Forsyth,  Mo 

Forty  Hills,  Miss 

Fosters  Bridge,  N.  C 

Foster's  Expedition,  N.  C 

Fourteen  Mile  Creek,  liliss 

Fox  Creek,  Mo 

Frankfort,  Va 

Frankfort,  Ky 


Page^ 

LXXXli 

CXXV 

XXXVI 

CXXVIII 

XLI 

LXXIX.LXXX 

LXVI 

XLVI 

XLIX.CXV 

CXXXV 

CXXX 

CXXVII 

CXXXII 

Lxxvn 

LXVH,  LXVIll,  CXXXII 

LV 

LXXIX 

XLVI 

CXIX,CXXI 

CXXXV 

LXTK 

XXXIX 

LXIII 

XLA^  XLVI,  XLVHI,  Cl,  CHI 

XLV 

CXXV 

LV 

XCIV 

XXXATI 

LXXXVHI 

CXXV,CXXIX 

LXXXVI,  CXVHI,  CXXI 

cxxxvn 

CXVI 

xcv 

XXXIV,  LXXI,  LXXXVI 

CXXXIX 

-LXXXII,  LXXXIII,  LXXXVI 

XLVHI 

LXIV 

XXXV,  LIII 

LXXIV 

CXXXII 

LXIV 

LXXV 

XLII 

LXIII 

CXI 


Filvnklin,  Tenn LXIV, 

LXVII,  LXIX,  LXX,  LXXIII,  LXXVII,  CXXII,  CXXX,  CXXXIII 

Franklin,  Mo CXXV 

Franklin,  Miss CXXXIV 

Franklin,  Va LIX,  LXI,  LXIII 

Franklin,  La LXXVl 

Franklin’s  Crossing,  Va LXXVII 

Franklin  County,  Ark LXXXVHI 

Franklin  Creek,  Miss CXXXIII 

Frazier’s  Farm,  Va L 

Frederick,  Md LVII,  CXVI 

Fredericksburg,  JMo CXVII 

Fredericksburg,  Va XLVI,  LXII,  LXIV,  LXXVl 

Fredericksburg  Road,  Va CVIII 

Fredericktown.  Mo XXXVIII 

Freeman’s  Ford,  Ya LV 

Fremont’s  Orchard,  C.  T CIII 

French  Broad,  Tenn XCVII 

Front  Royal,  Va XLV1I,CXX 

Front  Royal  Pike,  Va CXXIV 

Frying  Pan,  Va LXXVII 

Fulton,  Mo XXXV 

Fulton  County,  Mo UII 

Funkstown,  Md LXXXII 

Gaines’s  Mill,  Va L,  CXI 

Gainesville,  Va LVI 


Page. 

Gainesville,  Fla XCIX,  CXX 

Gallatin,  Tenn LIV,  LIX 

Galveston,  Texas LXVI 

Garrettsburg,  Ky LXII 

Gaulcy  Bridge,  AV,  Va XXXIX 

Geiger  Lake,  Ky LVII 

Genesis  Point,  Ga LXVII,  LXVIII 

Georgia  Landing,  La LXI 

Georgia,  Raid  in CXVI 

Gei-mantown,  Tenn XLVHI,  XCVIII 

Gettysburg,  Pa LXXX 

Ghent,  Ky CXXH 

Glade  Springs,  Va CXXXII 

Gladesville,  A^a CXXV 

Glasgow,  Ky LX,  LXV,  LXXXVHI 

Glasgow,  Mo CXXVII 

Glendale,  Miss XLVI 

Glendale,  A^a L 

Glorietta,  N.  Mex XLIII 

Gloucester,  A’a LXIII 

Gloucester  Point,  A'a LXVII 

Golding's  Farm,  A^a L 

Goldsboro’,  n.  C LXIV,  CXXXVII 

Golgotha,  Ga CXllI 

Goose  Creek,  A’^a LATH 

Gordon  s Landing,  La LXATII 

Gordonsville,  Va CXXXI,  CXXXIII 

Gov.  Moore's  Plantation,  La CV 

Grafton,  AV.  A’a XXXVI 

Grahamsville,  S.  G CXXX 

Grand  Lake,  Ark - XCIX 

Grand  Haze,  Ark LI 

Grand  Prairie,  Ark LI 

Grand  Prairie,  Mo LXI 

Grand  River,  Mo LIV 

Grand  Gulf,  Miss LXXIII,  XCVI,  CXVI 

Grand  Pass,  I.  T LXXXII 

Grand  Coteau,  La XCI 

Grant's  Creek,  N.  C CXXXIX 

Grass  Lick,  W.  A’^a XLAT,  CVII 

Gravel  Hill,  A^a CXX 

Gravell}’’ Run,  A^a CXXXVII 

Graysville,  Ga LXXXVI,  XCIV 

Great  Bethel,  A’a XXXIV,  XLIII 

Great  Falls,  Va XXXV 

Great  Cacapon  Bridge,  Va XLI 

Greasy  Creek,  Ky LXXV 

Greenville,  Mo lAI 

Greenville,  N.  C XCIII,  XCV 

Greenville,  Miss LXA'HI 

Greenville,  Tenn CXXIII,  CXXVII 

Green  Bridge,  AA^.  A'a XXXA’^II 

Green's  Chapel,  Ky LXV 

Greenville  Road,  Ky LXII 

Greenville  Road,  N.  C XLATII 

Greenland  Gap,  AA^.  A^a LXXII 

Greenland  Gap  Road,  AV.  Va CXI 

Green  Springs  Depot,  Md CXIX 

Greenwich,  A’a LXXVII 

Greencastlo,  Pa I^XXIX 

Green  River  Bridge,  Ky LXXXI 

Gregory's  Farm,  S.  C CXXXI 

Grenada,  Miss LXXXV 

GriswoUlville,  Ga CXXIX 

Grosse  Tete  Bayou,  La XCIX,  Cl 

Ground  Squirrel  Church  and  Bridge,  Va CATI 

Groveton,  A’a EVI 

Guerrilla  Campaign  in  Missouri LIV 

1 Gum  Swamp,  N.  C LXXVl 

I Gunter's  Bridge,  S.  C CXXXV 

' Guyandotte,  AA''.  A’'a XXXIX 

Guy's  Gap,  Tenn LXXX 

Hampton,  Yu XXXVI 

Hampton  Roads,  Va XXXII 


INDEX. 


OXLVII 


Page. 

IIauper's  Perry,  Va XXXIV,  XLVII,  LVII,  LXXXVIII 

Harper's  Ferry  Bridge,  Va JjXXXII 

Harper's  Farm,  Va CXXIX 

Harpeth  River,  Tenn LXVIII,  LXXI 

Harrisonville,  Mo XXXV,  LXII 

Harrison  s Island,  Va XXXVIII 

Harrison  s Handing,  Va LUI 

Harrisonburg,  Va XHVIII 

Harrisonburg,  La C 

Harrison,  Mo CXXV 

Hairisburg,  Pa LXXX 

Han'odsburg,  Ky LX,CXXVII 

Hartsville,  Tenn LXIV 

Hartville,  Mo LX  VI 

Hartwood  Church,  Va LXIII,  LXVIII 

Hartford,  Ky LXXVI 

Hamilton,  N.  C LI,CXXXII 

Hamilton,  Va CXXXVII 

Hanover,  Pa LXXX 

Haxoveu  Court-house,  Va XLVII,  LXXX,  CX 

Hanoverton,  Va CX 

Hancock,  Md XL 

Hanging  Rock,  W.  Va XXXVII 

Hankinson's  Ferrj-,  Miss LXXIV 

Hawk  s Nest,  W.  Va XXXVI 

Hatchie  River,  Tenn LII 

Hatcher'S  Run,  Va CXXVIII,  CXXXI,  CXXXV 

Hall's  Ferry,  Miss LXXV 

Halltown,  Va LXXXIII,  CXXI,  CXXH 

Hager's  Mountain,  Md CXVI 

Hagerstown,  Md LXXXI,  LXXXH,  CXV 

Ilaguewood  Prairie,  Tenn LXXXVHI 

Half  Mount,  Ky CHI 

Hammack's  Mills,  W.  Va CXV 

Half  Moon  Battery,  N.  C CXXXIV 

Hardy  County,  W.  Va LXVI 

Harney  Lake  Valley,  Oreg ClI 

Hatteras,  U.  .S.  Steamer LXVI 

Hawe's  Shop,  Va CX,  CXI 

Haxal's,  Va LI 

Haymarket,  Va LX 

Haynesville,  Va XXXIV 

Hazel  Bottom,  Mo LX 

Hedgeville,  Va LXI,  XC 

Helena,  Ark LIV,  LVIH,  LX,  LXIII,  LXVI,  LXXVI,  LXXXI 

Henderson  Hills,  La Cl 

Henderson's  Mill,  Tenn LXXXIX 

Henderson,  Ky' CXVII,  CXXFV 

Hendricks,  Miss LXXXVII 

Hernando,  Miss LXXII,  LXXIX 

Henrytown,  Mo XXXVHI 

Hicksford,Va CXXXII 

Hickory  Grove,  Mo LVIII 

Hickman,  Ky LV 

High  Bridge,  Va CXXXIX 

Hillsboro’,  Ky XXXVHI 

Hillsboro’,  Ga CXIX 

Hillsborough,  Ala LXXI 

Hill's  Plantation.  Ark LI 

Hill's  Plantation,  Miss LXXIX 

Hill’s  Point,  Va LXXII 

Hodgeville,  Ky XXXVHI 

Holly  River,  AV.  Va XLVI 

Holly  Springs,  Miss LXHI,  LXV,  CIX,  CXXH 

Hollow  Tree  Gap,  Tenn CXXXHI 

Holland  House,  Va LXXV 

Holston  River.  Tenn XCHI,  XCIX 

Honey  .Spring,  I.  T LXXXIII 

Honey  Hill,  S.  C CXXX 

Hoover's  Gap,  Tenn LXXIX 

Hopkinsville,  Ky CXXXII 

Horse-shoe  Bend,  Ky LXXV 

Horton's  Mills,  N.  C XLVI 

Hot  Springs,  Ark XCVII 


Page, 

Howard  County,  Mo LVI,  CXXH 

Howe’s  Ford,  Ky LXXHI 

Housatonic,  loss  of,  S.  C XCIX 

Hudnot's  Plantation,  La CV 

Hudson,  Mo XL 

Hudsonville,  Miss LXII 

Huff’s  Perry,  Tenn XCH 

Hunnewell,  Mo XL 

Humonsville,  Mo XLHI,  XC 

Huntersville,  Va XL 

Huntsville,  Ala XLV,  CXXV 

Huntsville,  Tenn LXII 

Hurricane  Bridge,  W.  Va LXX 

Hurricane  Creek,  Miss CXX,  CXXI,  CXXVIII 

Hutchinson,  Minn LVII 

Hlinois  Creek,  Ark LXIV 

Independence,  Mo XXXIV, 

XXXIX,  XLH,  XLHI,  LFV,  LXVH,  CXXVHI 

Indian  Bay,  Ark CHI 

Indian  Village,  La LXVH 

Indian  City  Village,  La CXIX 

Indian  Ridge.  La LXXI 

Indiantown,  N.  C XCV 


Ingraham's  Plantation,  Miss. . . 

Ingham’s  Mills,  Miss 

Ironton,  Mo 

IRISH  Bend,  La 

Irwinsville,  Ga 

IiA'ine,  Ky 

Isle  of  Wight  Coiu-t-house,  Va 

Island  No.  10,  Tenn 

Island  No.  76,  Miss 

Island  Ford,  Va 

lUKA,  MISS 


XXXIX 

LXXXIX 

XXXVH,  XXXVHI,  CXXIV 

LXXI 

CXL 

LXXXIV 

LXV 

XLV 

XCVI 

CXVH 

LVIII.  LXXXH 


Ivy  Ford,  Ark 

Ivy  Ford,  Ky  , 

Ivy  Hills,  Miss 

Jackson,  Tenn 

Jackson,  miss 

Jackson,  L.a 

Jackson  Cross  Roads,  La 

Jacksonville,  Fla 

Jacksonport,  Ark 

jaebsboro’,  Tenn 

Jack's  Shop,  Tenn 

Jack's  Shop,  Va 

James  City,  Va 

James  River,  Va 

James  Island,  S.  C 

JaiTett's  .Station,  Va 

Jefferson,  Tenn 

Jefferson  City,  Mo 

Jeffersonton,  Va 


XCVI 

CXXXIV 

XCIX 

LXIV,  LXXXHI 

LXXV,  LXXXH,  LXXXHI,  CXV 

CXXVI,  CXXIX 

LXXIX 

LXX,  CV 

XCV,  CIV 

XLH 

LXXXVII 

CXXXHI 

LXXXIX 

. .XLVI,  LXXXIV,  CVI,  CXIII,  CXXVIII 
XLVHI,  XLIX,  LXXXHI,  CXV,  CXXXV 

CVH 

LXV 

CXXVI 

LXXXIX 


Jeffersonville,  Va 

Jenkins’s  Ferry,  Ark 

Jenk’s  Bridge,  Ga 

Jennie's  Creek,  Ky 

Jerusalem  Plank  Road,  Va  . . 

Johnstown,  Mo 

Johnson  Depot,  Tenn 

Johnson’s  Mills,  Tenn 

Johnsonvillc,  Tenn 

John's  Island,  .S.  C 

John  Day’s  River,  Oreg 

Jonesboro’,  Mo 

Jonesboro’,  Ark 

JONESBORO’,  Ga 

Jones’s  Bridge,  Va 

Jones’s  Ford,  Jliss 

Jones's  Hay  .Station,  Ark 

.Tonesville,  Va 

Jomado  Del  Muerto,  N.  Mex. 

.ludah.  Rebel  I’rivateer 

Julesburg,  I.  T 


evil 

CV 

CXXXI 

XLI 

CXIV,  CXXHI 

XXXIX 

LXXXVII 

XCIX 

CXXIV,  CXXIX 

CXV 

CXXXIX 

XXXVI,  LXXXIX 

LllI 

CXXI,  CXXH,  CXXIX 

CXIV 

LXXXH 

CXXI 

XCV 

LXXVHI 

XXXVI 

CXXXIV 


OXLVITI 


INDEX 


\ 


Kearnstown,  Va 

Keurneysville,  Va 

Kearsarge  and  Alabama,  off  France 

Kelly’s  Island,  Va 

Kelly’s  Foi'd,  Va 

Kelly's  Store,  Va 

Kellar’s  Bridge,  Ky 

Kenesaw  IMountalv,  Ga 

Kentucky  River,  Ky 

Kettle  Run,  Va 

Keytesville,  Mo 

Kincaels,  Tcnn 

Kilpatrick’s  raid  in  Virginia 

Kilpatrick’s  raid  in  Georgia 

Kinderhook,  Tenn 

Kikston,  N.  C 

Kingston,  Tenn 

Kingston,  Ga 

King  George  County,  Va 

King  George  Court-house,  Va 

King’s  School  House,  Va 

lung’s  River,  Ark 

Kingsport.  Tenn 

Kingsville,  Mo 

Kirks ville.  Mo 

Knob  Noster,  Mo 

Knoxville,  Tenn •. 

Kock's  Plantation,  La 

Lavergne,  Tenn 

Labadiesville,  La 

Lacey’s  Springs,  Va 

Ladija,  Ala 

Lafayette  County,  Mo 

Lafayette,  Tenn 

La  Fourche  Crossing,  La 

La  Grange,  Ark 

La  Grange,  Tenn 

Lake  Providence,  La 

Lake  City,  Fla 

Lake  Chicot,  Ark 

Lamar,  Mo 

Lamar,  Miss 

Lamb's  Ferry,  Tenn 

Lamine  Crossing,  3Io 

Lancaster,  Mo 

Lancaster,  Ky 

Lane’s  Prairie,  Mo 

Lanquelle  Ferry,  Ark 

Lauderdale  Springs,  Miss 

Laurel  Hill,  W.  Va 

Lattemore's  IMills,  Ga 

Lawrence,  Kans 

Lawrence  County,  Ky 

Lawrenceburg,  Ky 

Luwrenceburg,  Ohio 

Lawrenceburg,  Tenn 

Leatherwood,  Ky 

Leavenworth,  Ind 

Lebanon,  IMo  

Lebanon,  Tenn 

Lebanon,  Ky 

Lebanon,  Ala 

Leesburg,  Va 

Leesburg,  ISIo 

Leesburg  Road,  Va 

Lcetown,  Ark 

Leetown,  Va 

Lee’s  Mills,  Va 

Lee,  Surrender  of 

Legate  s Point,  S.  C 

Legaresville,  S.  C 

Leiper’s  Ferry,  Tenn 

Lowisburg,  Va 

Lewisburgh,  Ark 


Page. 

XLII,  CXVII 

CXXI 

CXIII 

XXXIV 

LV,  LXIX,  LXXXIV,  XCII,  XCVII 

LXVII 

CXII 

CXI,CXIV 

LXII 

LV 

XLII 

XCII 

c 

CXXI 

LTV 

LXIV,  CXXXVI 

XCII 

CIX 

LXXXV 

LX  III 

XLIX 

cm 

cxxxii 

cxn 

LIII 

XLI 

. . . . LXXXVI,  XCIII,  XCIV,  XCVII 

LXXXIII 

. . -LX,  LXni,  LXIV,  LXVI,  CXXII 

LXI 

CXXXIII 

cxxvm 

jtLIlI,  CXII 

XCV,  CXI,  CXIV,  cxv 

LXXIX 

, . . . LVn,  LX,  LXII,  LXVI,  LXXIV 

Lxn,  LXXI,  cxv 

LXVII,  LXXVU,  LXXVIII,  LXXX 

XCVIII 

CXI 

LXII 

LXIII 

CXXXIII 

LXXXIX 

XXXIX 

LX 

XXXV,  CX 

LIII 

XCIX 

XXXV,  exxv 

CXIII 

LXXXV 

LXXXV 

LX 

LXXXIII 

xci,  exxx 

LXII 

LXXIX 

XLIII 

XLVI,  LXII,  LXIII,  LXVII 

LI,  LXXXI,  CXVIII 

XCVII 

XXXVIII 

exxv 

LVIII 

XLII 

CXV 

XLV,  CXVI,  CXVIII 

CXXXIX 

XLVIII 

XCV 

XCI 

XLVII 

XCVI 


LewinKville,  Va 

Lett’s  Tan  Yard,  Ga 

Lexikgton,  mo 

Lexington,  Ky 

Lexington,  Tenn 

Lexington,  W.  Va 

Ley’s  Ferry,  Ga 

Liberty,  Mo 

Liberty,  Va 

Liberty,  La 

Liberty  Gap,  Tenn 

Liberty  Mills,  Va 

Liberty  Post  Office,  Ark 

Liberty  Creek,  La 

Licking,  Mo 

Licking  River,  Ky 

Lick  Creek,  Ark 

Limestone  Station,  Tenn 

Linden,  Va 

Linden,  Tenn 

Linn  Creek,  Va 

Linn  Creek,  Mo 

Little  Bear  Creek,  Ala 

Little  Black  River,  Mo 

Little  Blue,  Mo 

Little  Blue,  D.  T 

Little  Cacapon,  Va 

Little  Creek,  N.  C 

Little  Harpeth,  Tenn 

Little  Missouri  River,  Ark  . . , 
Little  Missouri  River,  D.  T . 
Little  Osage  River,  Kans  . . . 

Little  Pond,  Tenn 

Little  Red  River,  Ark 

Little  River,  Tenn 

Little  Rock,  Ark 

Little  Rock  Road,  Ark 

Little  Rock  Lauding,  Tenn  . 

Little  Santa  F6,  Mo 

Little  Tennessee  River 

Little  Washington,  Va 

Liverpool  Heights,  Miss 

Lock’s  Ford,  Va 

Lockridge  Mills,  Ivy 

Lotspeach  Farm, Mo 

Logan  County,  Va 

Logan  Cross  Roads,  Ky 

Lone  Jack,  Mo 

Long  Prairie,  Ark 

Longview,  Ark 

Lookout  Station,  Mo 

LOOKOUT  Mountain,  Tenn 

Lost  Mountain,  Ga 

Loudoun  County,  Va 

Loudoun  Heights,  Va 

Louisa  Court-house,  Va 

Louisv'ille,  Tenn  

Lovejoy  Station,  Ga 

Lovettsville,  Va 

Low  Creek,  AV.  A'a 

Lowndesboro’,  Ala 

Lucas  Bend,  Ky 

Lumkin’s  Mills,  Miss 

Luna  Landing,  Ark 

Lundy's  Lane,  Ala 

Luray,  Va 

Lynchburg,  Va 

Lynch  Creek,  S.  C 

Lynnville,  Tenn 

McAtee’s  Cross  Roads,  Ga  . . 

MoConuellsburg,  Tenn 

McCook's  raid  in  Georgia  . . . 

McDowell,  Va 

McLean’s  Ford,  Va 


Page. 

XXXVII 

LXXXVII 

XXXVI,  XXXVII,  XLin,  CXII,  CXXVII 

LX,  LXXXIV,  CXII 

LXIV 

CXI,  CXII 

evin 

LX 

exm 

cxxix 

LXXIX 

xc 

cm 

CXXIX 

XLVI 

CXII 

LXVI 

LXXXVI 

XLVI 

LXXV 

XLI 

xxxvm 

LXIII,  LXIV 

LXXVII 

XXXIX,  XLV,  cxv,  CXXVII 

exx 

CHI 

LXII 

LXX 

ClI 

CXIX 

CXXVIll 

LVI 

XLIX 

CXXVII 

LXXXVI,  CX 

LXX 

LX  XII 

XXXIX,  XLIII 

XCI 

LXIII 

XCVII 

CXXHI 

XLVI 

LI 

XLI 

XLI 

LV 

CXXI 

Cl 

XXXVI 

XCIII 

CXI 

LXI 

XCVI 

LXXIV 

XCIV 

CXVIU,  CXXI,  CXXII,  CXXIX 

XXXVI,  LXI 

LXXIX 

CXXXIX 

XXVH 

LXIII 

XCIX 

LXXI 

L,  CXXIV 

CXIII 

CXXXVI 

eXXX,  CXXXIII 

CXII 

LXXIX,  LXXX 

CXVII 

XLVI 

XC 


INDEX 


CXLIX 


McMinnTille,  Tenn 

Macon,  Ga 

Macon  County,  Tenn 

Madison.  Ark 

Madison  Coui-t  house,  Va 

Madison  Court-house,  Vu 

Madison  Station,  Ala 

Madison  County,  Ky 

Madisonville,  Ky 

Madisonville,  La 

Magoffin  County,  Ky 

Magnolia  Hills,  Miss 

Malvern  Hill,  Va 

Manassas,  Va 

Manassas  Junction,  Va 

Manassas  Gap,  Va 

Manchester,  Tenn 

Mansfield,  La 

Mansura,  La 

Markham,  Va 

JIarksville,  La 

Mark  s Mills,  Auk 

Maria  Des  Cygnes,  Kan 

Marj’land  Heights,  Md 

Marietta,  Ga 

ivlarianna.  Ark 

Marianna,  Fla 

Marrowbone,  Ky 

Marshall,  Mo 

Marysville,  Tenn 

Marion  County,  "W.  A^'a 

Marion,  Miss 

Marion,  Va 

Marshfield,  Mo 

Mason’s  Neck,  Va 

JIason’s  Bridge,  S.  C 

Mattapony,  Va 

Maysville,  Ark 

Jlaysville,  Ala 

Mayfield,  Ky 

Maplesville,  Ala 

Matagorda  Bay,  Tex 

Mazzard  Prairie,  Ark 

Martinsburg,  Va 

Martinsburg,  Mo 

Martin’s  Creek,  Ark 

Mathias’s  Point,  A’a 

Memphis,  Tenn 

Memphis,  Mo 

Jlerriweather's  Ferry,  Tenn . . . 

Mesila,  N.  Mex 

Mf.chanicsville,  Va 

Jlechanicsville,  Miss 

Medon  Station,  Tenn 

Jleadow  Bridge,  Va 

Meadow  Bluff,  \V.  Va 

Aledalia,  Miss 

Mcchanicsburg,  Miss 

Medley,  ’W.  Va 

Meridian,  Miss.,  Expedition  to 

Aloridian,  Miss 

Merrill’s  Crossing,  Mo 

Messenger’s  Ferry,  Jliss 

Metlcy’s  Ford,  Tenn 

Metamora,  Miss 

Middle  Creek  Ford,  AV.  Va. . . 

Jliddle  Creek,  Ky 

Middleburg,  A'a 

Middleburg,  Miss 

Middletown,  Va 

Middletown,  Tenn 

Middletown,  Aid 

Millsville,  AIo 

Mill  Creek  Mills,  AV.  Va 

Mill  Creek  AAalley,  AV.  Va  . . . 
-Mill  Springs,  Ky 


Page. 

LAM,  LXXII,  LXXXATII 

CXVII,  CXVIll,  CXXIX,  CXL 

CXIV 

LXX 

LXXXA'II 

CXXXHI 

CIX,CXXX 

LV 

LV,  LX 

XCVI 

CHI 

LXXIV 

LI,  LIII,  CXIII,  CXAHII 

XXXV,  LVI 

LXI 

LXII,  LXXXIV 

LVI,  Cl 

CII 

CVIII 

LXII 

' CVIII 

CIV 

CXXVIII 

cxv 

CXI 

LXII 

exxv 

LXXXI 

LXXXIV,  LXXXIX 

XCII 

XXXVI 

XCIX 

CXXXHI 

XLI,  LXI 

XLU 

CXXXI 

LIII 

LXI 

LXXXV,  LXXXIX 

XCVI 

CXXXVIH 

xcv 

CXVHI 

XXXIV,  LVII,  LXXVIH,  CXX,  CXXHI 

XXXV 

XCV 

XXXIV 

XLVIH,  LIX,  CV,  CXXI,  CXXXH 

LH 

LIV 

XXXVI 

XLIX 

LXXAH 

LXVIH 

CVIII 

XCV 

LXXI 

LX  XVII 

XCAHI 

XCVII 

XCIX 

LXXXIX 

LXXXI 

XCI 

LIX 

XXXV 

XLI 

XLHI,  LXXIX 

LXV 

XLAHI,  LXXVIH,  CXXVH 

. .LX VI,  LXAHI,  LX XVI,  LXXIX,  XCAH 

eXAH 

XXXV 

XXXVHI 

XCII 


Page. 

Mill  Point,  ■\V.  Va XCII 

Mill  Creek,  Ga  . CVI 

Mill  Creek,  Tenn CXXXI 

IMillen  Grove,  Ga CXXXI 


Millwood,  Ya CXXXHI 

Milton,  Tenn LXVIII,  LXIX 

Milton,  Fla CXXVIII 

Millikex's  Bend,  La LV,  LXXVII 

Milford,  Mo XL 

Milford,  Va LI 

Milford  Station,  Va CIX 

Mingo  Swamp,  Mo  LXVII 

Mine  Run,  Va.,  Operations  at. XCIII 

Mine  Creek,  Kan CXXVIII 

Mississippi  River,  Miss LXVIII 

Mississippi  City,  Miss XLII 

Mississippi  Central  Railroad LVI,  LXV,  CXXX 

Missouri  River,  D.  T LXXXIV 

Missionary  Ridge,  Tenn XCIII 

MitchelVs  Station,  Va LIV 

Mitchell’s  Creek,  Fla CXXXHI 

Moorefield,  Va LXII, 

LXVI,  LXXXVI,  LXXXVn,  XCVII,  CXI,  CXIX 

^loore’s  Mills,  Mo LIII 

Moresburg,  Tenn XCIV 

3IoDroe  Station,  Mo XXXV 

Monroe  County,  Mo » XLVII 

Monroe’s  Cross  Roads,  N.  C CXXXVI 

Morristown,  Mo XXXVII 

Morristown,  Tenn XXXIX,  XCIV,  CXXVIII,  CXXTX 

Morris  Island,  S.  C LXXXII,  LXXXV,  LXXXVI 


Morris  County,  Mo CX 

Morgan’s  Mills,  Ark XCVHI 

Morgantown,  Ky XXXIX,  LXI 

Morgan  County,  Tenn XLI 

Morgansville,  Ky LVI 

Morgan’s  Raid  in  Kentucky.  Indiana,  and  Ohio LXXXI 

Morganzia,  La LXXXVHI 

Monday’s  Hollow,  Mo V- XXXVHI 

Monocacy,  Md CXVI 

Monocacy  River,  Md LX 

Moffat’s  Station,  Ark CHI 

Mosby’s  Raid  in  Virginia LXIX 

Moscow,  Tenn XCI,  CXHI 

Moscow,  Ark CIII 

Moscow  Station,  Miss XCIV 

Mosquito  Inlet,  Fla XLHI 

Mount  Zion,  3Io XL 

Mount  Zion  Church,  Va CXV 

Mount  Sterling,  Ky LIH,  LXIX,  CXI 

Mount  Washington,  Ky LIX 

Mount  Vernon,  Ark LXXV 

Mount  Tabor  Church,  N.  C LXXXIV 

Mount  Jackson,  Va XCIII 

Mount  Ivy,  Miss XCIX 

Mount  Elba,  Ark Cl 

Mount  Pleasant  Landing,  La CVIII 

Mount  Clio,  S.  C CXXXVI 

Mount  Pleasant,  Miss CIX 

Mount  Pleasant,  Ala CXXXVIH 

Mount  Crawford,  Va CXI,  CXXXVI 

Mount  Carmel,  Tenn CXXX 

Mobile  Harbor,  Ala CXIX 

Mossy  Creek,  Tex XCV 

Mossy  Creek,  Tenn XCVI 

Morton’s  Ford,  Va XCVHI 

Morton,  Miss XCVHI 

Moneti’s  Bluff,  La CIV 

Morrow  Creek,  Ark CIV 

Moreauville,  La CVHI 

Moulton,  Ala CX 

Montgomery  County,  Ark CXVI 

Montgomery  and  West  Point  Railroad,  Ga CXVII 

Montgomery,  Ala CXXXIX 

Moreau  Bottom,  Mo ('XXVI 

Monteith  Swamp,  Ga C'XXXH 


CL 


INDEX 


Page. 

Mocassin  Gap,  Va CXXXIII 

Mountain  Grove,  Mo XLII 

Mountain  Store,  Mo LH 

Monterey,  Ky XLIX 

Monterey,  Va XLV 

]\ronterej%  Tenn XLVI 

Monterey  Gap,  Md LXXXI 

Slontavallo,  ]\Io XLV,  LIII 

Montavallo,  Ala CXXXVIII 

Morning  Sun,  Tenn LI 

Mobile,  Ala CXXXVII 

Monticello,  Ky LXXIV,  LXXVII 

Monticello,  Ark Cl 

Munson's  Hill,  Va XXXVI,  XXXVII 

Munford's  Station,  Ala CXL 

Munfordsville,  Ky XL,  LVII,  LIX 

Murfreesboro’,  Tenn LI,  LXV, 

LXIX,  LXXVII,  LXXIX,  CXXIII,  CXXXI,  CXXXII,  CXXXIII 

Murfreesboro’  R()ad,  Tenn LXXXVIII 

Muldraugh’s  Hill,  Ky LXV 

Muddy  Run,  Va XCII 

Mud  Springs,  1.  T CXXXV 

Mussel  Shoals,  Ala CXXVIII 

Mulberry  Gap,  Tenn XCIX 

Mustang  Island,  Tex XCIII 

Myerstown,  Va CXXIX 

Xansemond,  Va *. LXXI 

Nansemond  River,  Va LXXIV 

Namozin  Church,  Va CXXXVIII 

Karrows,  Ga CXXVI 

Nashville,  Tenn XLII,  LII,  LX,  LXII,  CIX,  CXXXI,  CXXXII 

Nashville  and  Chattanooga  Railroad,  Tenn CXX,  CXXII 

Natches,  Miss LXXXIV,  XCII,  XCIV 

Natchitoches,  La Cl,  CIV 

Natural  Bridge,  Fla CXXXVI 

Nauvoo,  Ala CXXXIV 

Nelson’s  Farm,  Va L 

Neosho,  Mo XLVI,  XLVIII,  LXXXVIII 

Neuse  River,  N.  C CXXXIX 

Newark,  Mo LIII 

Newnan,  Ga CXVIII 

New  Berne,  N.  C XLiil, 

XLVI.  XLVII,  LXII,  LXVHI,  LXIX,  XCVII,  C 

New  Market,  Va CVIII,  CXVIII,  CXXVI 

New  Market  Bridge,  Va XL 

New  Market  Cross  Roads,  Va L 

New  Market  Heights,  Va CXXV,  CXXVI 

Newport  News,  Va XXXIV,  XL,  XLII 

Newport  Barracks,  N.  C XCVII 

Newtonia,  Mo LVII,  CXXVIII 

Newton,  La LXXXVIII 

Newtown,  Va XLVII,  CXXIX 

New  Creek,  W.  Va XXXIV,  CXIX,  CXXX 

New  Creek  Valley,  MV.  Va XCVII 

New  Albany,  Miss LXXII,  LXXXVIII 

New  Baltimore,  Va LXII 

New  Bridge,  Va XLVII 

New  Hope,  Ky LI 

New  Hope  Church,  Ga CX 

New  Lisbon,  Ohio LXXXIV 

New  Madrid,  Mo. . . . XLII,  XLIII,  LXXXV 

New  Madrid  Bend,  Tenn XCl 

New  Orleans,  La XLVI 

New  River  Bridge,  Va CVII 

New  Ulm,  Minn LV 

Nickajack  Trace,  Ga CIV 

Nickajack  Creek,  Ga CXV 

Nineveh,  Va CXXIX 

Niobrara,  Neb XCIV 

Nolansville,  Md LVII 

Nolansville,  Tenn LXV,  LX^VTII 

Noonday  Creek,  Ga C X III 

Norfolk,  Va XLVI 

Northeast  River,  N.  C LXVI 


Northport,  Ala 

NORTH  Anna  River,  Va 

North  Edisto  River,  S.  C 

North  Fork,  Va 

North  Mountain,  Va 

North  Missouri  Railroad 

North  River,  MV.  Va 

North  Shenandoah,  Va 

Nose’s  Creek,  Ga 

Nottaway  Creek,  Va 

Nottaway  Court-house,  Va  . . 

Nueces  River,  Tex 

Oak  Grove,  Va 

Oakland,  Miss 

Obion  River,  Tenn 

Occoquan,  Va 

Occoquan  Creek,  Va 

Occoquan  Bridge,  Va 

Ocean  Pond,  Fla 

Oconee  River,  Ga 

Offett’s  Knob,  Mo 

Ogeechec  River,  Ga 

Okalona,  Jliss 

Okaloua,  Ark  . . : 

Oldtown,  Md 

Old  Church,  Va 

Old  Fort  Wayne,  Ark 

Old  Oaks,  La 

Old  River,  La 

Old  River  Lake,  Ark 

Olive  Branch,  La 

Olive  Hill,  Ky 

Olustee,  Fla 

Oostenaula,  Ga 

Opelousas,  La 

Opequan,  Va 

Orangeburg,  S.  C 

Orange  Court-house,  Va 

Orchards,  Va 

Orchard  Knob,  Tenn 

Oregon  Mountains 

Orleans,  Ind 

Osage,  Mo 

Osceola,  Mo 

Osceola,  Ark 

Otter  Creek,  Va 

Overall’s  Creek,  Tenn 

Overton’s  Hill,  Tenn 

Owens  Valley,  Tenn 

Owens  River,  Cal 

Owen  County,  Ky 

Owensburg,  Ky 

Oweusborough,  Ky 

Oxford  Hill,  Miss 

Oxford  Bend,  Ark 

Ox  Hill,  Va 

Ozark,  Mo 

Paint  Rock  Railroad  Bridge 

Paintsville,  Ky 

Palo  Alto,  Miss 

Palmyra,  Mo 

Palmyra,  Tenn 

Palmetto  Ranch,  Tex 

Paducah,  Ky 

Pamunkey  River,  Va 

Panther  Creek,  Mo 

Panther  Springs,  Tenn 

Panther  Gap,  W.  Va 

Papinsville,  Mo 

Paris,  Ky 

Paris,  Tenn 

Parkersville,  Mo 

Parker's  Cross  Roads,  Tenn 
Pasquotank,  Mo 


Page. 

CXXXVIII 

LU,  CVII,  CIX 

CXXXV 

CXXXVI 

CXV 

CXXV 

CXV 

CXXVI 

..  CXI,  exm,  CXXV 

CVII 

CXIV 

LIV 

XLIX 

LXIII 

LIV 

XLII,  LXV 

XXXIX 

XLI 

XCIX 

CXXX 

CIV 

CXXXI 

XCIX 

CII 

CXIX 

CX,  CXII 

LXI 

CIX 

LXVII,  CIX 

CXI 

CXXXVI 

LIX 

XCIX 

CVIII 

xc 

CXXIII 

CXXXV 

LII,  LIII 

XLIX 

XCIII 

XCVII 

LXXVII! 

LXI 

XXXVII,  XLVII 

CII,  CXIX 

CXIII 

CXXXI 

CXXXII 

LXVIII 

XLV 

XLIX 

LVIII 

exxu 

CXXI 

LXI 

LVI 

...LUI,  LXin,  CXVI 

XLVI 

XLI,  XCIII 

LXXII 

XXXIX 

XCII 

CXL 

Cl 

CX 

LIV 

C 

CXI 

XXXVII 

LIII,  LXIX,  LXXXIV 

XLII,  LX  XXVII 

XXXV 

LXV 

LXXXV 


INDEX. 


GDI 


Page. 

Pass  Chiistian,  Sliss XLIII 

Pattacassey  Creek,  N.  C LXXXIV 

Patton,  Mo 

Patterson,  Mo LXXII 

Pattersonville,  La LXX 

Patterson  Creek,  Va XXXIV,  XCA  II 

Pawnee  Reservation LXXIX 

Pawnee  Porks,  Kan CXXX 

Peach  Ouchaud.  Va L 

PEACH  Thee  Cheek,  Ga CXVII 

Pea  Ridge,  Auk XLII 

Pea  Vine  Creek,  Ga XCIV 

Peehacho  Pass,  D.  T XLV 

Pembiscott  Bayou,  Ark Cil 

Pensacola,  Pla XXXIX,  CII 

Peralto,  N.  Mex XLV 

Perry  County,  Ky LXII 

Pekuyville,  Ky LX 

Perryville,  Ark LX  XXV 

Petersburgh,  W.  Va XXXVII,  XCVI 

Peteusuuug,  Va LIII,  CXII, 

cxiii,  cxv,  cxviii,  cxix,  cxxn,  cxxxi,  cxxxvn,  cxxxviii 

Petersburg,  Tenn LXVIll 

Petit  Jean,  Ark CXVI 

Philadelphia,  Tenn XC,  XCI 

Philip's  Creek,  Miss XLVII 

I’hillippi,  W.  Va XXXIV 

Philouiont,  Va LXI 

PIEDMONT,  Va CXI 

Piedmont  Station,  Va LXXV 

Pierce's  Point,  Fla CXXVII 

Pierson's  Farm,  Va CXIII 

Pike  County,  Ky , XXXIX 

Piketown,  Ky XXXIX 

Pike  Creek,  Ky ■ CVIII 

Pikeville,  Ky LX XI 

Pikesville,  Ark CXIV 

Pilot  Knob,  Mo CXXVIII 

Pineknej"  Island,  S.  C LV 

Pine  Blull',  Ark XCI,  XCVI,  CXIII,  CXV,  CXVIII,  CXXVI 

Pine  Bluff,  Tenn CXXI 

Pine  Barren  Creek,  Ala CXXXIII,  CXXXVII 

Pine  Knob,  Ga CXIII 

Pine  Mountain,  Ga CXII 

Pinevilie,  Mo - LXXXV 

Piney  Factory,  Tenn XCI 

Piney  Woods,  La CII 

Pinos  Altos,  Ariz LXVII 

Pittman's  Ferry,  Ark LII 

Pittman's  Ferry,  Mo LXI 

Pittsburg  Landing,  Tenn XLII,  XLV 

Plaquemine  Bayou,  La LXVII 

Plaquemine,  La LXXI.X,  CXIX 


Plain  Stores,  La 

Plattsbmg,  Mo 

Platte  City,  Mo 

Pleasant  Hill,  Mo 

Pleasant  Hill,  La 

Pleasant  Hill  Lauding,  La 

Pleasant  Grove,  La 

Pleasant  Valley,  Md 

Plymouth,  X.  C 

Plantersville 

POCATALIGO,  S.  C 

Pocahontas  County,  AV.  Va 

I’oint  Lookout,  A'a 

Point  of  Rocks,  Md 

Point  Lick,  Ky 

Point  Pleasant,  AV.  Va 

Point  Pleasant,  La 

Point  AVashington,  Fla 

Poison  Springs,  Ark 

Polk's  Plantation,  Ark 

POPLAIl  Si’ULNGS  CHUKCH,  VA 


LXXA'I,  (TI 

XXXIX 

CXV 

LI,  CX 

CHI 

CHI 

CH 

CXV 

...-LATI,CIH,  CXXIX 

CXXXATH 

XLVII,  LXI,  CXXXIV 

XCH 

CVIH 

....XXXVI,  CXI,  CXV 

LXI 

LXX 

CXIV 

XCA'HI 

CHI 

LXXVI 

CXXV 


Pollocksville,  N.  C 

Polk  County,  AIo 

Pond  County,  Ky 

Pond  Spring,  Ala 

Pontotoc,  Miss 

Ponchatoula,  La 

Poolesville,  Md 

Pope's  Campaign  in  A'irginia . 

Port  Royal,  S.  C 

Poet  Republic,  Va 

Port  Gibson,  Miss 

Poet  Hudson,  La 

Port  Hudson,  La 

Port  Hudson  Plains,  La 

Port  AValthal,  Va 

Poole’s  Station,  Ga 

Potosi,  Mo 

Pound  Gap,  A’a 

Pound  Gap,  Tenn 

Pound  Gap,  Ky 

Powel’s  River  Bridge,  Tenn.. 

Powder  Springs,  Ga 

Powhattan,  A'a 

Prairie  D’Ann,  Ark 

Prairie  Station,  Mo 

Prairie  Station,  Miss 

PuAiuiE  Grove,  Ark 

Preble's  Farm,  A'a 

Prentis,  Miss 

Price’s  Invasion  of  Missouri . . 

Princeton,  AA’.  Va 

Princeton,  Ky 

Princeton,  Ark 

Prince's  Place,  Mo 

Pritchard's  Jlill,  Md 

Pueblo  Colorado,  N.  M 

Pulaski,  Ala 

Pulaski,  Tenu 

Pulaski,  Ga 

Pumpkin  A’ine  Creek,  Ga 

Putnam's  Ferry,  Mo 

Quaker  Bridge,  N.  C 

Quaker  Road,  A’a 

Qualltown,  N.  C 

Quicksand  Creek,  Ky 

Raccoon  Ford,  Va 

Raccoon  Ford,  Ala 

Raeeland,  La 

Randolph  County,  Mo 

Rapidan,  Va 

Rapidan  Station,  A’a 

Rapidan  Railroad  Bridge,  Va. 

Rappahannock,  Va 

Rappahannock  River,  A’a 

Rappahannock  Bridge,  Va  ... 
Rappahannock  Crossing,  A’a. 
Rappahannock  Station,  Va . . . 

Rawle's  Mills,  N.  C 

Ray  County,  Mo 

Raymond,  Miss 

Raytown,  Mo 

Ready ville,  Tenn 

Ream’s  Station,  A’a 

Rectortown,  Va 

Red  Bone,  Miss 

Bed  Bono  Church,  Mo 

Red  Clay,  Ga 

Red  HilJ,  Ala 

Red  House,  AV.  Va 

Red  Mound,  Tenn 

Red  Oak,  Ga 

Red  River,  La 

Redwood  Creek,  Cal 

Redwood,  Miss 


Page. 

XLV,  LXVI 

XLIII 

CVIH 

CXXXHl 

CXVI 

LA’IH,  LXX,  LXXV 

LA  TI 

LAT 

XXXIX,  XL 

XLA’HI 

LXXIA’,  XCV,  eXA’,  CXVI 

LXIX 

,LXXVH,  LXXVHI,  LXXXH,  CH 

LXXA’I 

CVI 

CXXXI 

XXXVI,  XXXVHI 

CXXV 

XLIII,  LXXXI 

CHI 

XCIX 

CXHI,CXXV 

CXXXIV 

CHI 

LXVIII 

XCIX 

: LXIV 

CXXV 

LIX 

CXXIV 

XLA’H,  CVI 

CXII 

XCIV,  CIH,  CXXA’HI 

CXXVI 

XXXVH 

LXXXV 

LXXXHI 

LXXXIX,  CXXV,  CXXXHl 

CVIH 

CX 

XLIII 

LXXXI 

CA’II 

XCA’HI 

CII 

LXXXVH 

CXXVIII 

XLIX 

XXXIX 

LXXXIX,  XC,C 

LXXIV,  LXXXVH 

LI 

LXXXIX,  Cl 

LA’,  LXXHI 

LXII,  XCI 

XC 

LXXXIV,  XCH 

LXII 

XXXVHI 

LXXV,  XCVII 

XLIX 

LAT 

CXIV,  CXVI,  CXXI 

XCV 

CIV 

LXXXVHI 

CV 

CXXXIV 

XXXV 

LXV 

CXXI 

LXVIII,  CIV,  CV 

LXXXH 

LV 


CLII 


I N 1)  E X 


Page. 


I’cod’a  Mountains,  Ark ' 

P>ee(ly  Creek,  W.  Ya 

Kcnick,  JIo 

Iterock,  Ariz 

P,ESACA,  GA 

Itcynold's  I’lantation 

Khea's  Mills,  Ark 

P.hcatown,  Tenn 

Pacliiield,  Mo 

Pdichland,  Ark 

Kicliland,  Tcnn 

llioli  Mountain,  'SV.  Ya 

ItiCiniOKD.  KY 

lliohmond.  La 

IIICII.MONI),  Ya 

Richmond  & Petersburg  Railroad,  Ya 

Rickett’s  Hill,  Tenn 

Riddle’s  Shop,  Ya 

Rienzi,  Miss 

Ringgold,  Ga 

Riple}’,  Tenn 

Ripley,  Miss 

River’s  Bridge,  S.  C 

Robertson's  Run,  Ya 

Roan’s  Tan  Yard 

Roanoke  Island,  N.  C 

Roanoke  River,  N.  C 

Roach’s  Plantation,  Miss - 

Rocheport,  Mo 

Rockford,  Tenn 

Rockingham,  N.  C 

Rockport,  Mo 

Rockville,  Md 

Rocky  Creek  Church,  Ga 

Rocky  Crossing,  Miss 

Rocky  Face  Ridge,  Ga 

Rocky  Gap,  Ky 

Rocky  Gap,  Ya 

Rocky  House,  AY.  Ya 

Rocky  Mount  Raid,  N.  C 

Rodgcrsville,  Ala 

Rodgersville,  Tenn 

Rodney,  Miss 

Rogersville,  Tenn 

Rolla,  Mo 

Rolling  Fork,  Miss 

Rolling  Prairie,  Ark 

Rolling  Prairie,  Mo 

Rome,  Ga 

Romney,  W.  Ya 

Rood’s  Hill,  Va 

Rosecrans’  Campaign  in  Tennessee 

Roseville,  Ark 

Rousseau’s  Raid  in  Alabama  and  Georgia 

Rousseau's  Pursuit  of  lYheeler,  Tenn 

Round  Away  Bayou,  La 

Round  Hill,  Ark 

Round  Hill,  Tenn 

Rover,  Tenn  

Rowanty  Creek,  Ya 

Rowlett’s  Station,  Ky 

Running  Yicksburg  Batteries 

Rural  Hills,  Tenn 

Rush  Creek,  I.  T 

Russel’s  House,  Miss 

Russellville,  Tenn 

Russellville,  Ky 

Rutherford’s  Creek,  Tenn 

Sabine  Pass,  Tex 

Sabine  Pass,  La 

Sabine  Cross  Roads,  La 

Sacramento,  Ky 

Sacramento  Mountain,  Va 

Salem,  N.  C 


LXHI 

XLYI 

XXXIX 

CXXXVII 

cvm,  cxxvii 

exxx 

LXII 

LXXXIX 

LXXVI 

cv 

CXXIV 

XXXV 

LYI,  LXXXIV 

LXX,  LXXYHI 

C,  evil.  CXXVIII,  CXXXYHI 

evil 

LYII 

CXII 

LV 

LXXXVI,  XCIV 

LXVI 

XCIY,  CXI,  CXII,  CXVI 

cxxxv 

LXXXIX 

XLI 

XLI 

CV 

Cl 

LXXVII 

XCII 

CXXXVI 

CXXIV 

LXXXVII 

CXXXI 

LXXIX 

C,  CVI 

LXXVII 

LXXXV 

XCVIII 

LXXXIH 

XLYI 

CXXI 

XCV,  C 

XCII 

XXXV,  CXIX 

CXXIX 

XCYI 

XCVII 

LX  XIII,  CVIII,  CIX 

. . . -XXXIV,  XXXYHI,  LXYIII 

evin,  exxx 

LXXIX 

XCII,  CII 

CXYI 

CXXII 

LXX 

LI 

LYI 

LXYII 

CXXXV 

XL 

LXXI 

LXIH 

CXXXV 

XLYI 

LI 

LIII,  LIX 

LXIX,  CXXXHI 

LXXII 

LXXXVI 

CII 

XL 

CXXI 

CXXXYHI 


.Salem,  Miss 

.Salem,  Va 

Salem,  Mo 

Salem,  Ark 

.Salem  Cemetery,  Tenn 

Salem  Pike,  Tenn 

Salem  Church,  Va 

.Salkahatchie,  S.  C 

Salisbury,  Tenn 

Salisbury,  N.  C 

Saline  County,  Mo 

Saline  River,  Ark 

Salt  Lick,  Va 

Saltville,  Va 

Salyersville,  Ky 

Sailor's  Creek,  A^a 

Saint  Charles  River,  Ark 

Samaria  Church,  Va 

Sam  Gaty,  Massacre  on  Steamer. 

San  Carlos  River,  Cal 

.Sand  Creek,  I.  T 

Sand  Mountain,  Ala 

Sandersville,  Ga 

.Sangster’s  Station,  Va 

Santa  I’e,  N.  M 

Santa  Fe,  Mo 

Santa  Rosa.  Fla 

Saratoga,  Ky 

Sartoria,  Miss 

Saunders,  Fla 

Saulsbury,  Miss 

Savage  Station,  Va 

Savannah,  Tenn 

Savannah,  Ga.,  Siege  of 

ScatterviUe,  Ark 

Scott’s  Mills  Road,  Tenn 

Scott’s  Farm,  Ark 

Scottsboro’,  Ala 

.Scottstdlle,  Ala 

Scrougesville,  Tenn 

Scully ville,  I.  T 

Seabrook’s  Point,  S.  C 

Searcy,  Ark 

.Searcy  Landing,  Ark 

Scarytown,  AV.  Va 

Secessionville,  S.  C 

Sedalia,  Mo 

Selma,  Ala 

Senatobia,  Miss 

Seneca,  Md 

Seneca  Station,  I.  T 

Seven  Days’  Retreat,  Va 

Seven  Pines,  A'^a 

Seviersville,  Tenn 

Shady  .Springs,  Va 

Shanghai,  Mo 

Shannon  Hill,  Va 

Sharjisburg,  Md 

Shawnee  Mound,  Mo 

Shawnee  Town,  Kan 

.Shelby  Depot,  Tenn 

Shelby  County,  Ky 

Shelbjwille,  Tenn 

Shelbjwllle  Pike,  Tenn 

Shelbina,  Mo 

Shelburne,  Mo 

Shenandoah,  A’a 

Shenandoah  River,  Va 

Shepherdstown,  A’a 

Sheppardstown,  A’a 

Shepherdsville,  Ky 

.Sheridan’s  Cavahy  Raid,  Va  . . 

.Sherwood,  Mo 

Siiii.oH,  Tenn 


Page. 

LXXXIX 

LXII.CXIH 

XXXIX 

XLHI 

Lxrv 

LXIX 

CXI 

cxxxv 

LI V,  XCIV 

CXXXIX 

LXXXIV 

CV 

xc 

eXXA’,  CXXXII,  CXXXHI 

XCIV 

CXXXIX 

CXIV 

CXIH,  CXIV 

LXX 

CX 

CXXXII 

LXXHI 

exxx 

XCV 

XLHI 

LII 

XXXVHI 

XXXVHI 

LXXVII 

CIX 

cxv 

L 

XLV 

CXXXII 

LI 

XCVII 

XCVIII 

CXXXIV 

CXXXVHI 

LXIH 

cm 

XLVIII 

CXI,  cxv,  CXXIII 

XLVI 

XXXIV 

XLIX,  LXXXIH 

XXXIX,  CXXA'II 

CXXXVHI 

LXXA’I 

Lxxvm 

LXXXVH 

L 

XLVIII 

XCVII 

LVI,  LXXXIH 

XXXVII,  XXXVHI 

LXXIV 

LVIII 

XL 

LXXVII 

LXI 

XL 

LXXX 

LXXVH,  LXXIX,  LXXXIX 

XXXVII 

LVIII 

CXXXVI 

CXVH 

LIX,  CXXI 

LVUI,  LXXXIH 

LIX 

CVH,  CXXXVI 

LXXV 

XLV 


INDEX 


CLIII 


• Page. 

Ship's  Gap,  Ga CXXVII 

Shirley's  Ford,  JIo LVIII 

Shoal  Creek,  Ala CXXIX 

Sibley's  Landing,  JIo LX,  LXX 

Silver  Creek,  Mo XLI 

Silver  Lake,  Fla XCIX 

Silver  Run,  N.  C CXXXVI 

Simmsport,  La CIX 

Simpsonville,  Ky CXXXIV 

Sinking  Creek,  Va LXIII 

Sipsey  Swamp,  Ala CXXXIX 

Six  Mile  House,  Va CXX 

Six  Mile  Creek,  Ala CXXXVIII 

Skeet,  N.  C LXVIH 

Slatersville,  Va XLVI 

Slaughter  Mountain,  Va LFV 

Slaughterville,  Ky LVII 

Smithfield,  Va LXVII,  LXXXVII,  XCVII,  CUI,  CXXI,  CXXII 

Smithfield,  Ky CXXXIV 

Smithshurg,  Md LXXXI 

Smith's  Farm,  N.  C CXXXVII 

Smith's  Raid  in  Tennessee XCVIII,  CXV 

Smith's  Station,  I.  T CVII 

Smithville,  Ark  XLIX 

Smoky  Hill,  C.  T CVIII 

Smoky  Hill  Crossing,  Kan CXX 

Smyrna,  Ga CXV 

Snaggy  Point,  La CV 

Snake  Creek  Gap,  Ga CVII,  CXXVII 

Snia  Hills,  Mo CIV,  CIX 

Snicker's  Gap,  Va LXI,  CXVI 

Snicker's  Gap  Pike,  Va CXXI 

Snicker's  Ferry,  Va LXIII,  CXVII 

Snow  Hill,  Tenn LXX 

Snyder's  Bluff,  Miss LXXIII 

Snydersville,  Miss Cl 

Solomon’s  Gap,  Md CXVI 

Somerset,  Ky XLI,  LXX 

Somendlle  Heights,  Va XLVI 

Somerville,  Tenn LXX 

Sounding  Gap,  Tenn XLIII 

South  Anna,  Va LXXX,  C,  CVII,  CXXXVI 

South  Branch  of  Watonwan,  Minn LXXI 

South  Edisto  River,  S.  C CXXXV 

South  Fork,  Potomac,  Va LXII 

South  Fork,  Oreg CXXXIX 

South  Mills,  N.  C XLVI 

SOUTH  Mountain',  md LVIII 

South  Qua}',  Va LXXI 

South  Quay  Bridge,  Va LXXFV 

Southside  Railroad,  Va CXXVni 

South  Tunnel,  Tenn CXXVI 

South  Union,  Ky LXXV 

Southwest  Mountain,  Va LIV 

Southwest  Creek,  N.  C LXIV 

Spanish  Fort,  Ala CXXXVn 

Spanish  Fort  Canon,  U.  T LXXI 

S'parta,  Tenn LIH,  LXXXV,  XCIII 

SpeiTj-ville,  Va LI 

Spoon-ville,  Ark CII 

Sporting  Hill,  Pa LXXX 

SrOTTSYLVANIA  COURT  HOUSE,  VA LXXIII,  CVI 

Springfield,  Mo XXXVUI,  XXXIX,  LXVI 

Springfield,  W.  Va XCVII 

Springfield  Landing,  La LXXXI 

Spring  Hill,  Tenn LXIX,  CXXX 

Spring  River,  Ark XLHI,  XCVIII 

Spring  River,  Mo LVIII,  LXVUI 

Stanardsville,  Va C 

State  Creek,  Kan LXXVIII 

Statesboro’,  Ga CXXXI 

.Stamford,  Ky Lx 

Stahcl's  Reconnoissance,  Va LXIII 

.Staunton  Bridge,  Va CXIV 

20* 


Page. 

Stanton  Road,  Va XLVUI 

St.  Augustine,  Fla XCV 

St.  Catharine's  Creek,  Miss LXXXIV 

St.  Franeois  River,  Mo LXXIII 

St.  George’s  Creek,  Ohio LXXXIII 

St.  Charles,  Ark XLIX 

St.  Francis  County,  Mo LXXI 

St.  John’s  River,  Fla CIX 

St.  Mary's  River,  Fla XCVIII 

St.  Mary's  Trestle.  Fla CXVII 

St.  Louis,  Mo XXXIV 

St.  Vrain’s  Old  Fort,  N.  Mex CXXX 

Steele's  Bayou,  Miss LXIX 

Sterling’s  Farm,  La LXXXVHI 

Sterling’s  Plantation,  La LXXXVII 

Steamer  Empress,  Miss CXIX 

Stevensburg,  Va XCII,  C 

Stevens’  Gap,  Ga LXXXVI 

Stevenson,  Ala LVI 

Stevenson’s  Depot,  Va CXVII 

Stewart’s  Plantation,  Ark L 

Stewart’s  Creek,  Tenn LXV,  LXVI 

Stone’s  Farm,  Ark CII 

Stone’s  Ferry,  Ala CXVI 

Stone’s  River,  Tenn LXVI 

Stony  Lake,  D.  T LXXXIV 

Stony  Creek,  Va CXIV 

Stony  Creek  Station,  Va CVI,  CXXVI,  CXXX 

Stono  Inlet,  S.  C LXXI,  XCV 

Stockton,  Mo LIV 

Stockade  at  Stone’s  River,  Tenn LXXXVHI 

Stoneman’s  Raid  in  Va LXXIII 

Stoneman’s  Raid  to  Macon,  Ga CXVII 

Stoneman’s  Raid  in  Tenn.  and  Va CXXXII 

Stoneman’s  Raid  in  Southwest  Va.  and  N.  C-. CXXXVII 

Strasburg,  Va XLIH,  XL VIII,  CXX,'CXXVI,  CXXVII 

Strasburg  Road,  Va LXVIll,  LXXII 

Strawberry  Plains,  Tenn XCVI 

Strawberry  Plains,  Va CXX 

Streight’s  Raid  in  Georgia  and  Alabama LXXIII 

Sturgeon,  Mo LIX 

Sugar  Creek,  Mo XLI,  XLII 

Sugar  Creek,  Tenn LXXXIX,  CXXXIII 

Sugar  Loaf  Mountain,  Md LVII 

Sugar  Loaf  Hill,  N.  C CXXXIV 

Sugar  Loaf  Battery,  N.  C - CXXXV 

Sugar  Valley,  Ga CVIII 

Sulphur  Braneh  Trestle,  Ala CXXIV 

Sulphirr  Springs,  Va LV 

Sulphur  Springs  Bridge,  Va CXIX 

Suffolk,  Va LXV,  LXXI,  LXXV,  C 

Summerville,  W.  Va XXXVI,  LXVII 

Summerville,  Miss LXIII 

Summerville,  Tenn XCV 

Summit  Point,  Va CXXI 

Sumtervillo,  S.  C CXXXVII,  CXXXIX 

Sunshine  Church,  Ga CXIX 

Surrender  of  Genl.  Lee CXXXIX 

Surrender  of  Genl.  Johnston CXL 

.Surrender  of  Genl.  Taylor CXL 

Surrender  of  Genl.  Sam.  Jones CXL 

Surrender  of  Genl.  Jeff.  Thompson CXL 

Surrender  of  Genl.  Kirby  Smith CXL 

Supply  Train,  Tenn XCI 

Sutton,  Va LIX 

Suwano  Gap,  N.  C CXL 

Swallow's  Bluff,  Tenn LXXXVHI 

Swan  Lake,  Ark • CIV 

.Sweden’s  Cove,  Tenn XLVHI 

Sweetwater,  Tenn XCI 

Sweetwater  Creek,  Ga CXXV 

.Swift  Creek,  Va CVII 

.Swift  Creek,  .S.  C CXXXIX 

Swift  Creek  Bridge,  N.  C L 


CLIV 


INDEX. 


Sycamore  Church,  Va 

Sykestown,  Mo 

Sylamore,  Ark 

Sylvan  Grove,  Ga 

Taberville,  Mo 

Taben’ille,  Ark 

Tah-Kah-o-Kuty,  D.  T 

Tahliquah,  I.  T 

Talladega,  Ala 

Talbott's  Ferry,  Ark 

Talbot's  Station,  Tenn 

Tallahatchie,  Fla 

Tallahatchie,  Miss 

Tallahassee,  Fla 

Tallapoosa  River,  Ala 

Tanner’s  Bridge,  Ga 

Tar  River,  N.  C 

Taylor's  Ford,  Ky 

Taylor’s  Ridge.  Ga 

Taylor’s  Hole  Creek 

Taylorsville,  Va 

Tazewell,  Tenn 

Tebb's  Bend,  Ky 

Telford,  Tenn 

Ten  Islands,  Ala 

Ten  Miles  from  Columbus,  Ky 

Tennessee  River,  Tenn 

Terrapin  Creek,  Ala 

Terre  Noire  Creek,  Ark 

Terrisville,  Tenn 

Texas  County,  Mo 

The  Island,  Mo 

Thibodeaux,  La 

Thibodeauxville,  La 

Thomas  Station,  Ga 

Thompson  Cove,  Tenn 

Thompson's  Hill,  Miss 

Thompson's  Station,  Tenn 

Thornburg,  Va 

Thornhill,  Ala 

Thoroughfare  Gap,  Va 

Tiekfaw  River,  Miss 

Tillaflnney  River,  S.  C 

Tiiton,  Tenn 

Tilton,  Ga 

Tishamingo  County,  Miss 

Tobosofkee,  Ga 

Todd's  Tavern,  Va 

Tolopotomy,  Va 

Tolopotomy  Creek,  Va 

Tompkinsville,  Ky 

Tom’s  Brook,  Va 

Toon’s  Station,  Tenn 

Town  Creek,  Ala 

Town  Creek,  N.  C 

Township,  Fla 

Tracy  City,  Tenn 

Trantner’s  Creek,  N.  C 

Trenton,  Tenn 

Trenton,  N.  C 

Trenton  Bridge,  N.  C 

Trevillian  Station,  Va 

'Trinity,  Ala 

Trinity  River,  Cal 

Trion,  Ala 

Triplett's  Bridge,  Ky 

Truine,  Tenn 

Try  Mountain,  Ky 

Tullahoma,  Tenn 

Tuniea  County,  Miss 

Tunnel  Hill,  Ga 

Tunnel  Hill,  Miss 

Tunstall  Station,  Va 

Tupelo,  Miss 


Page. 

LIII,  CXXIII 

XLII 

XLII 

CXXX 

LIII 

LIV 

CXVIII 

LXX 

CXL 

XLVI 

XCV 

XLIX 

LXXIX,  LXXXIX,  CXIX 

CXL 

CXVI 

CVIII 

LXXXIII 

XXXIX 

XCIV.CXXVII 

CXXXVII 

C 

Lrv,xcvi 

LXXXI 

LXXXVI 

CXVI 

CXXXIV 

CXXI 

CXXVIll 

CII 

XCVI 

Lxni,  LXXXVI 

LXX 

LXXIX 

LXI 

CXXX,  CXXXI 

Lxxxvm 

LXXIV 

LXIX 

LIII 

CXXXIV 

LX,  LXII 

LXXIV 

CXXXI 

CVIII 

CXXVII 

XCI 

CIV 

CVI 

cx 

cx 

LI,  LXXII 

CXXVI 

LVI 

Lxxm 

cxxxv 

LXVII 

XCVI 

XLVIII 

LIV,  LXV 

LXIV 

XLVI 

CXII 

LII 

XCII 

CXXXVHI 

LXXVIII 

LXXVIII 

XXXIX 

LXXIX,  LXXX,  XCI 

Lin 

XCVII,  C,  CVI 

XCIX 

XLIX,  LXXIV,  C 

LXXIV,  CXV,  CXVI 


Page. 

Turkey  Bend,  Va L 

Turkey  Island  Bridge,  Va LII 

Turman’s  Ferry,  Ky XCVI 

Turnback  Creek,  Mo XLVI 

Turner’s  and  Crampton’s  Gaps,  Md LVIII 

Tuscumbia,  Ala LXVIII,  LXXII,  LXXIII,  XCI 

Tuscumbia  Creek,  Miss XLVII 

Tuscaloosa,  Ala CXXXIX 

Two  Hills,  Bad  Lands,  D.  T CXIX 

Union,  Va LXI 

Union  City,  Tenn XLIII,  LXXXII,  XCIII 

Union  City,  Ky Cl 

Union  Church,  Va XLVIII 

Union  Church,  Miss LXXIII 

Union  Mills,  Mo LV 

Unionville,  Tenn LXIX 

Union  Station,  Tenn CXXIX 

University  Place,  Tenn LXXXI 

Upper  Missouri  River,  Ark LX 

Upperville.  Va LXI,  LXXIX,  LXXXVIII 

Upton  Hill,  Ky XXXVIU 

Utoy  Creek,  Ga XLIX 

Vache  Grasse,  Ark CXXIV 

Valverde,  N.  Mex XLII 

Van  Buren,  Ark LXV,  CXIX 

Vamell’s  Station,  Ga CVII 

Vaughn,  Miss CVII 

Vaughn  Road,  Va CXXVIU,  CXXXV 

Vaught’s  Hill,  Tenn LXIX 

Vera  Cruz,  Ark CXXIX 

Vermillion  Bayou,  La LXXXIX 

Vernon,  Ind LXXXII 

Verona,  Miss CXXXIII 

Vicksburg,  Miss XLIX,  LXV, 

LXVm,  LXXXVI,  LXXIX,  LXXX,  LXXXV,  XCVH,  XCVHI,  CXV 

Vidalia,  La LXXXVH,  XCVIII,  CXVII 

Vienna,  Va XXXIV,  XXXIX,  LVU 

Village  Creek,  Ark XLIX,  L 

Vincent’s  Cross  Roads,  Miss XCI 

Vinegar  Hill,  S.  C LXXXV 

Vining  Station,  Ga CXV 

Volusia  County,  Fla CXXXV 

Wachita,  Indian  Agency,  Tex LXVTI 

Wadesburg,  Mo XL 

Waddel's  Farm,  Ark XLIX,  L 

Waldron,  Ark LXXXVH,  LXXXIX,  XCV,  XCVII 

Wallace's  Ferry,  Ark CXVH 

Wall  Bridge,  Va CV 

Walkersville,  Mo XLV 

Walker’s  Ford,  W.  Va XCIV 

Walkertown,  Va C 

Walthal,  Va CXIII 

Wapping  Heights,  Va LXXXIV 

Wardensville,  Va XLVII 

Warm  Springs,  N.  Mex LXXIX 

Warm  Springs,  N.  C XCIH 

Warrenburg,  Mo XLHI,  XLIX 

Warrenton  Junction,  Va LIX,  LXXIV,  LXXV 

WaiTenton  Springs,  Va LXXXIX 

Warsaw,  Mo XXXVIU,  LXXXIX 

Wartrace,  Tenn LXXXVIII 

Washington,  N.  C XLVHI,  LVII,  LXX,  XCI 

Washington,  D.  C CXVI 

Watauga  River,  Tenn CXXV 

Waterford,  Miss LXIIl 

Waterford,  Va LXXXIV 

Waterloo  Bridge,  Va 

Water  Proof,  La XCIII,  XCIX,  CIV 

Water  Valley,  Miss LXUI 

Waugh's  Farm,  Ark XCIX 

Wauhatchie,  Tenn ^^I 

Wautauga  River,  Tenn XXXIX 

Wautauga  Bridge,  Tenn LXV,  CIV 

Waverly,  Tenn LXI,  LXXl 


INDEX 


CLV 


Page. 

Wayne  Countj',  W.  Va XCVIII 

WajTio  Court  house,  W.  Va XXXVI 

Wajniesville,  Mo LXXXV 

Wajaiesboro’,  Va CXXV,  CXXXVI 

WajTiesboro’,  Ga CXXX,  CXXXI 

Weaver’s  Store,  Ky LXXIII 

Weber's  Falls,  I.  T LXXXVI 

Welaka,  Fla CIX 

Weldox  llAiLitOAD,  Va CVI,  CVII,  CXIV,  CXX,  CXXV,  CXXXI 

Wentzville,  Mo XXXV 

Western  North  Carolina,  Expedition  into CXXXII 

Westminster,  Md LXXX 

Westport,  Mo LXXVm,  CXXVHT 

Weston,  W.  Va LVI 

West  Branch,  Va LXXI 

Wet  Glaze,  Mo. XXXVIII 

West  Liberty,  Ky XXXVIII 

West  Point,  Va XLVI 

West  Point,  Ark LXXXV,  CXIII,  CXVUI 

West  Point,  Miss XCIX 

West  Point,  Ga CXXXIX 

West  Virginia,  AveriU’s  Raid LXXXV 

Weyer's  Cave,  Va CXXIV 

Whistler’s  Station,  Ala CXXXIX 

Whitemarsh,  Ga XLV 

White’s  Bridge,  Va CVII 

White’s  Ford,  Va LXXXVII 

Whiteside,  Fla CXVIII 

Whittaker's  Mills,  Va LXXI 

White  County,  Ark XCVIII 

White  Count}',  Tenn XCIX 

Whitehall,  N.  C LXIV 

White  House,  Va CXIII 

White  Oak  Swamp,  Va L 

White  Oak  Swamp  Bridge,  Va LIU,  CXII 

White  Oak  Bridge,  Ky LV 

White  Oak  Road,  Va CXXXVIII 

White  Post,  W.  Va - CXH,  CXIX.  CXXXI 

White  River,  Ark XLIX,  LXXXV,  CXIV,  CXXVIII 

White  Stone  Hill,  D.  T LXXXVI 

White  Sulphur  Springs,  Va LXIII,  LXXXV,  LXXXIX 

White  Water,  Mo LXXII 

Wier  Bottom  Church,  Va  CXIII 

Wilcox’s  Bridge,  N.  C CXXXVI 

Wild  Cat.  Ky XXXVIII 

WiLDERXESS,  Va CVI 

Wiliston,  S.  C CXXXV 

Willis’  Church,  Va L 

Williamsburg,  Va XLVI,  LI,  LVII,  LXVII,  LXX,  LXXI 

Williamsburg,  Ky LXI 

Williamsburg  Road,  Va XLIX 

Williams’  Bridge,  La XLIX 


Page. 

Williams’  Farm,  Va CXIV 

Williamsport,  Tenn LIV 

Williamsport,  Md LIX,  LXXXI 

Williamsport,  W.  Va XCVII 

Williamston,  N.  C LXII 

Willicomack,  Va CXXXVIII 

Willmarsh  Island,  S.  C XCIX 

Willow  Creek,  Cal XCITI 

Wilmington  Island,  Ga XLV 

Wilmington,  N.  C CXXXVI 

Wilson’s  Creek,  Mo XXXVI 

Wilson’s  Creek,  Ky LXXVIII 

Wilson’s  Farm,  La CII 

Wilson’s  Landing,  Va CXII 

Wilson’s  Wharf  Landing,  Va CIX 

Wilson’s  Raid  on  Weldon  R.  R.,  Va CXIV 

Wilson’s  Raid  in  Alabama  and  Georgia CXXXVII 

Winchester,  VA.XLIII,XLVn,LXXVI,LXXVin,CXVn,CXX,CXXllI 

Wireman’s  Shoals,  Ky LXIII 

Wirt  Court  House,  W.  Va XXXIX 

Wise’s  Fork,  N.  C CXXXVI 

Wolf  Creek  Bridge,  Miss LIX 

Wolf  River,  Tenn CII 

Wolf  River,  Miss LXV 

Wolf  River  Bridge,  Miss XCIV 

Woodbury,  Ky XXXIX 

Woodbury,  Tenn LXVII,  LXX 

Wood  Lake,  Minn LIX 

Wood’s  Fork,  Mo LXVI 

Woodson ville,  Ky XL 

Woodstock,  Va CXXIV,  CXXVI 

Wood  ville,  Tenn LXI 

Woodville,  Miss CXXVI 

Wonnley’s  Gap,  Va CXXII 

Worthington,  W.  Va XXXVI 

Wyatt’s,  Miss LXXXIX,  XCVIII 

Wyerman’s  Mills,  Tenn XCIX 

Wyoming  Court  house,  W.  Va LIV 

Wytheville,  Va LXXXHI,  CVII,  CXXXHI,  CXXXVHI 

Yates’  Ford,  Ky LVI 

Yazoo  Pass,  Miss LXVIII 

Yazoo  City,  Miss LXXXII,  C,  CV,  CXXXI 

Yazoo  River,  Expedition  up.  Miss XCVII 

Yellow  Bayou,  La CIX 

Yellow  Medicine,  Minn LIX 

Yellow  Tavern,  Va CVII,  CXXV 

Yemassee,  S.  C LXI 

Yorktown,  Va XLin,  XLV,  XLVI 

Young's  Cross  Roads,  N.  C Lll 

Zagonyi’s  Charge XXXVIII 

Zollicoffer,  Tenn LXXXVIII 

Zuni,  Va LXIV 


ON  SPECIAL  WOUNDS  AND  INJURIES. 


CtlAPTKIl  I 

WOUNDS  AND  INJURIES  OF  THE  HEAD. 

The  wounds  and  injuries  of  the  head  will  be  described  in  three  categories  : incised  and 
punctured  wounds,  comprising,  mainly,  the  sabre-cuts,  bayonet-stabs,  and  sword-thrusts  ; 
miscellaneous  injuries,  resulting  from  falls,  blows  from  blunt  weapons,  and  various  acci- 
dents ; and  lastly,  and  principally,  gunshot  wounds. 

Section  I. 

INCISED  AND  PUNOTUEED  WOUNDS. 


Tlie  cases  of  incised  and  punctured  wounds  of  the  head  are  subdivided  into  those  in 
which  the  lesions  involved  the  integuments  only,  and  those  in  which  the  bones  of  the 
skull,  and,  in  some  instances,  its  contents,  were  injured.  Brief  abstracts,  arranged  in 
alphabetical  order,  are  given  of  all  the  examples  of  incised  and  punctured  wounds  of  the 
head,  recorded  in  the  Surgeon  General’s  Office.  The  names  of  the  wounded  of  the  United 
States  Armies  are  printed  in  small  capitals ; those  of  the  Confederate  Armies  arc  distin- 
guished by  italics. 

Incised  Scalp  Wounds. — The  returns  furnish  memoranda  of  two  hundred  and 
eighty-two  cases  of  incised  wounds  of  the  head  which  appeared  to  involve  the  integuments 
only,  as  follows : 


2 


WOUNDS  AND  INJURIES  OF  THE  HEAD. 


Adams,  Oscak  H.,  Assistant  Surgeon  8tli  New  York  Cavalry,  aged  32  years.  Wounded  at  Lacey’s  Springs,  Virginia, 
December  21st,  1864,  ny  a sabre-cut  five  inches  in  length  over  the  right  parietal  and  temporal  legions.  Admitted  to  Officers’ 
General  Hospital,  Annapolis,  Maryland,  January  4th,  1865.  On  leave  January  18th.  Re-admitted  February  5th.  Suffers 
from  frequent  attacks  of  vertigo,  incipient  amaurosis,  loss  of  memory,  partial  paralysis  of  right  eyelid,  and  imperfect  vision. 
Resigned  February  17th,  1865.  , 

Adams,  J.  F.,  Private,  Co.  I,  21st  Virginia  Cavalry.  Incised  wound  of  the  scalp.  Opequan,  Virginia,  September  19th, 
1864.  Admitted  to  Sheridan  Field  Hospital,  September  24th.  Recovered  and  transferred  for  exchange,  November  15th,  1864. 

Agee,  John,  Private,  Co.  G,  21st  Virginia  Cavalry.  Incised  wound  of  the  scalp.  Newtown,  Virginia,  November  9th, 
1864.  Captured  and  admitted  to  Sheridan  Field  Hospital,  November  14th.  Transferred  for  exchange  November  15th,  1864, 
well. 

Akins,  Charles,  Sergeant,  Co.  A,  3d  New  Jersey  Cavalry,  aged  24  years,  received  at  Appomattox  Court  House,  Vir- 
ginia, April  8th,  1865,  a slight  cut  over  the  forehead,  implicating  the  scalp  only,  and  a gunshot  wound,  for  which  the  middle  toes 
of  the  right  foot  were  amputated.  Admitted  to  Jarvis  Hospital,  Baltunore,  Maryland,  on  April  22d,  and  transferred,  July  24th, 
to  Hicks  Hospital,  from  whence  he  was  transferred,  well,  September  6th,  1865,  to  New  York,  to  be  mustered  out  of  service. 

Anderson,  Ransom  A.  D.,  Private,  Co.  B,  6th  U.  S.  Colored  Artillery,  aged  22  years.  Three  sabre-cuts  of  the  scalp 
and  one  of  the  right  hand.  Fort  Pillow,  Tennessee,  Apiil  12th,  1864.  Admitted  to  Mound  City  Hospital,  Illinois,  April  17th. 
Returned  to  duty  June  21st,  1864.  {See  Report  No.  55,  House  of  Representatives,  1st  Session  'iSth  Congress.) 

Austin,  George  W.,  Private,  Co.  B,  1st  Vermont  Cavalry,  aged  23  years.  Incised  wound  of  scalp  over  left  parietal 
region.  Wilderness,  May  5th,  1864.  Admitted  to  Douglas  Hospital,  Washington,  D.  C.,  May  11th.  Transferred  May  14th 
to  Mower  Hospital,  Philadelphia.  Returned  to  duty  September  4th,  1864. 

Bailey,  Simon  Z.,  Private,  Co.  B,  18th  Pennsylvania  Cavalry,  aged  28  years,  received  a sabre-cut  of  the  scalp  at  Han- 
over, Pennsylvania,  June  30th,  1863.  Admitted  to  Cuyler  Hospital,  Germantown,  Pennsylvania,  October  2d,  1863.  Trans- 
ferred to  Christian  Street  Hospital,  Philadelphia,  December  21st.  Deserted  February  17th,  1864. 

Baker,  Ezekiel,  Private,  Co.  K,  4th  Pennsylvania  Cavalry.  Sabre-cut  of  the  scalp.  Middleburg,  Virginia,  June  19th, 
1863.  Admitted  to  Emory  Hospital,  Wasluugton,  June  21st.  Returned  to  duty  August  13th,  1863. 

Beals,  D.  A.,  Private,  Co.  A,  1st  Michigan  Cavalry,  aged  23  years.  Sabre-cut  of  the  scalp.  Gettysburg,  July  1st,  1863. 
Admitted  to  Satterlee  Hospital,  Philadelphia,  July  10th.  Returned  to  duty  October  23d,  1863. 

Bates,  George  L.,  Piivate,  Co.  B,  1st  Vermont  Cavalry.  Sabre-cut  of  the  head.  Mount  Jackson,  Virginia,  October 
7th,  1864.  Admitted  to  hospital  at  Brattleboro,  Vermont,  April  2d,  1865.  Returned  to  duty  June  23d,  1865. 

Baugh,  J.  F.,  Private,  Co.  A,  1st  Georgia  Cavalry.  Sabre-cut  of  the  head.  Admitted  to  hospital,  Petersburg,  Virginia, 
November  18th,  1862.  Returned  to  duty  December  2d,  1862. 

Bcckner,  Abner,  Private,  Co.  G,  21st  Viiginia  Cavalry,  aged  45  years.  Sabre-cut  of  the  left  parietal  region.  Front 
Royal,  Virginia,  November  12th,  1864.  Admitted  to  West’s  Buildings  Hospital,  Baltimore,  Maryland,  November  16th.  Trans- 
ferred to  Fort  McHenry,  January  8th,  1865,  and  thence  to  Point  Lookout,  and  exchanged  June  28th,  1865. 

Belcher,  A.  F.,  Lieutenant,  4th  Massachusetts  Cavalry,  received  a sabre-cut  an  inch  and  a half  long  over  the  left  super- 
ciliary ridge,  and  a fracture  of  the  left  clavicle  by  a fall  from  his  horse.  High  Bridge,  Virguiia,  April  8th,  1865.  Admitted  to 
Officers’  Hospital,  Point  of  Rocks,  Virginia,  April  14th.  Loss  of  vision  of  the  left  eye  resulted,  but  whether  from  division  of 
the  supra-orbital  nerve,  or  derangement  of  the  optical  apparatus  caused  by  the  concussion,  was  not  determined.  The  fractured 
clavicle  united  and  the  wounds  healed.  He  was  discharged  from  service  June  16th,  1865,  and  placed  on  the  Pension  List.  On 
September  4th,  1867,  he  was  reported  as  suffering  from  the  permanent  loss  of  the  left  eye ; but  without  other  disability. 

Benntltt,  Edward  H.,  Corporal,  Co.  F,  2d  New  York  Cavalry,  received  a slight  sabre-cut  on  the  right  side  of  the 
scalp,  at  New  Market,  Virginia,  October  19th,  1863.  Admitted  to  Lincoln  Hospital,  Washington,  October  21st,  and  transferred 
October  31st. 

Bennett,  Thomas  F.,  Private,  Co.  K,  10th  Virginia  Cavalry,  received  a sabre-cut  of  the  scalp  at  Gettysburg,  July  2d, 
1863.  Admitted  to  Seminary  Hospital,  Gettysburg,  July  3d,  and  transferred  thence  to  David’s  Island,  New  York  Harbor,  on 
July  17th,  and  on  August  24th,  being  entirely  well,  he  was  pafoled  and  sent  to  Fort  Monroe  for  exchange. 

Benton,  H.  L.,  Private,  Co.  G,  1st  Massachusetts  Cavalry.  Sabre-cut  of  the  scalp.  Aldie,  Virginia,  June  17th,  1863. 
Returned  to  duty  September  25th,  1863. 

Bertrajm,  Harry,  Corporal,  Co.  K,  6th  Ohio  Cavalry,  aged  30  years.  Sabre-cut  of  the  left  occipital  region  two  inches 
in  length.  Sheridan’s  Raid,  May  12th,  1864.  Admitted  to  Hammond  Hospital,  Point  Lookout,  Maryland,  May  16th.  Returned 
to  duty  June  28th,  1864. 

Best,  Thomas  W.,  Private,  Co.  A,  6th  Pennsylvania  Cavalry.  Sabre-cut  of  the  right  occipital  region.  Admitted  to 
Second  Division  Hospital,  Annapolis,  Maryland,  June  14th,  1863.  Deserted  July  7tli,  1863.  His  name  was  on  the  Pension 
List  September  4th,  1867,  his  disability  being  rated  as  “ total  and  temporary.” 

Bigger,  Samuel  T.,  Private,  Co.  C,  1st  Delaware  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  July  1st,  1863. 
Admitted  to  Tilton  Hospital,  Wilmington,  Delaware,  July  4th.  Returned  to  duty,  well,  August  22d,  1863. 


INCISED  AND  PUNCTUEED  WOUNDS. 


3 


Bu'STJsrs,  John,  Private,  Co.  K,  1st  Alabama  Cavalry,  received  a slight  sabre-cut  of  the  scalp  at  Moore’s  Cross  Koads, 
North  Caroliua,  March  10th,  1865.  Mustered  out  of  service  July  19th,  1865.  • 

Bohije,  Charles,  Bugler,  Co.  I,  18th  Pennsylvania  Cavalry.  Sabre-cut  of  the  left  parietal  region,  and  a wound  of 
the  arm.  Hagerstown,  Maryland,  July  6th,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  August  3d. 
Deserted  October  15th,  1863. 

Boileau,  Jajies  P.,  Private,  Co.  A,  1st  Delaware  Volunteers,  aged  21  years.  Sabre-cut  of  the  scalp.  Weldon  Eail- 
road,  Virginia,  August  25th,  1864.  Admitted  to  Tilton  Hospital,  Wilmington,  Delaware,  November  1st,  from  Harewood  Hos- 
pital, Washington.  Eeturned  to  duty  November  14th,  1864. 

Bolton  Marvin,  Corporal,  Co.  G,  1st  Michigan  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  July  1st,  1863.  Admitted 
to  Jarvis  Hospital,  B.iltimore,  July  20th.  Transferred  to  Carver  Hospital,  Washington,  July  23d.  Eeturned  to  duty  November 
17th,  1863. 

Boulson,  Edward  F.,  Sergeant,  Co.  B,  5th  Michigan  Cavalry.  Sabre-cut  of  the  occipital  region.  Trevillian  Station, 
Virginia,  June  12th,  1864.  Missing  in  action.  Died  at  Andersonville,  Georgia,  August  15th,  1864. 

Bourne,  L.,  Private,  Co.  K,  51st  Virginia  Infantry.  Sabre-cut  of  the  scalp.  Opequan  Creek,  Virginia,  September  19th, 
1864.  Admitted  to  Field  Hospital,  Winchester,  Virginia,  on  the  same  day.  Eecovered  and  transfeiTed  for  exchange  December 
20th,  1864. 

Boyer,  Joseph  C.,  Captain,  Co.  L,  12th  Tennessee  Cavalry,  aged  28  years.  Sabre-cut  of  the  forehead,  received  in  a 
hand  to  hand  fight  with  a rebel  officer  of  General  Forrest’s  command.  Nashville,  December  16th,  1864.  Mustered  out  of  service 
October  7 th,  1865. 

Bradford,  Jaahss,  Private,  Company  B,  3d  Pennsylvania  Cavalry,  sabre-cut  of  the  scalp.  Gettysburg,  July  1st,  1863. 
Admitted  to  Field  Hospital  July  7th.  Transferred  to  Satterlee  Hospital,  Philadelphia,  July  9th.  Eeturned  to  duty  July  27th, 
1863. 

Brees,  Theodore  J.,  Private,  Co.  L.,  2d  United  States  Cavalry.  Sabre-cut  of  the  scalp,  and  gunshot  wound  of  left 
hand.  Culpeper,  Virginia,  August  1st,  1863.  Admitted  to  Douglas  Hospital,  Washington,  August  3d.  Transferred  to  Carlisle 
Barracks  September  11th,  1863,  and  returned  to  duty. 

Brenage,  Lafayette,  Sergeant,  Co.  D,  21st  Pemisylvania  Cavalry.  Sabre-cuts  of  the  scalp  and  face.  Jettcrsville, 
Vir^ia,  April  5th,  1865.  Admitted  to  Cavalry  Corps  Hospital  April  12th.  Eeturned  to  duty  April  18th,  1865. 

Briggs,  William  H.,  Private,  Co.  M.,  5th  Michigan  Cavalry,  aged  17  years.  Sahre-cuts  of  the  scalp  and  right  ear. 
Lynchburg,  Virginia,  June  11th,  1864.  Admitted  to  Mount  Pleasant  Hospital,  Washington,  Jime  20th.  Eeturned  to  duty 
July  26th,  1864. 

Brill,  William,  Private,  Co.  H,  15th  New  York  Cavalry,  aged  18  years.  Sabre-cuts  of  the  scalp.  Winchester,  Vir- 
ginia, November  15th,  1864.  Admitted  to  hospital  at  Annapolis  Junction,  Maryland,  January  4th,  from  Patterson  Park  Hospi- 
tal, Baltimore.  Eeturned  to  duty  March  25th,  1865. 

Brooks,  J.  K.,  Sergeant,  Co.  C,  1st  Maine  Cavalry.  Sahre-cut  of  right  side  of  scalp.  Rliddleburg,  Virginia,  June  19th, 
1863.  Admitted  to  Emory  Hospital,  Washington,  June  21st.  Eeturned  to  duty  July  3d,  1863. 

Brown,  James,  Private,  Co.  H,  1st  Maryland  Volunteers,  aged  34  years.  Sahre-cut  of  the  scalp,  while  on  picket  at 
Hatcher’s  Eun,  Virginia,  March  20th,  1865.  Admitted  to  Satterlee  Hospital,  Philadelphia,  April  7th,  from  Lincoln  Hospital, 
Washington.  Furloughed  April  25th,  1865.  Discharged  from  service  July  10th,  1865. 

Brown,  Jasper,  Private,  Co.  D,  5th  Michigan  Cavalry.  Sabre-cuts  of  the  scalp  and  neck.  Hanover,  Pennsylvania, 
June  30th,  1863.  Admitted  to  hospital  at  Gettysburg  July  3d.  Transferred  to  Pattei-son  Park  Hospital,  Baltimore,  November 
11th.  Eeturned  to  duty  February  24th,  1864. 

Brown,  R.  H.,  Private,  Co.  K.,  1st  Arkansas  Cavalry,  aged  18  years.  Sabre-cut  of  the  scalp.  Osage,  Missouri,  October 
25th,  1864.  Admitted  to  hospital  at  Fort  Scott,  Kansas,  October  28th.  Eeturned  to  confinement  November  30th,  1864,  and 
subsequently  exchanged. 

Bryan,  George  P.,  1st  Lieutenant,  Co.  G,  2d  North  Carolina  Eegiment.  Sabre-cut  of  the  scalp.  Upperville,  Virginia, 
June  2l8t,  1863.  Admitted  to  Stanton  Hospital,  Washington,  June  23d.  Sent  to  Old  Capitol  Prison  August  1st,  1863,  and 
subsequently  exchanged. 

Buck,  Dennis  M.,  Sergeant,  Co.  D,  2d  United  States  Cavalry,  aged  32  years.  Sahre-cut  of  the  scalp.  Trevillian 
Station,  Virginia,  June  11th,  1864.  Admitted  to  Finley  Hospital,  Washington,  June  21st.  Eeturned  to  duty,  well,  August 
22d,  1864. 

Burroughs,  Harmon,  Commissary  Sergeant,  8th  New  York  Cavalry,  aged  17  years.  Sabre-cut,  four  inches  in  length, 
over  the  left  parietal  region.  Beverly  Ford,  Virginia,  June  9th,  1863.  Admitted  to  Lincoln  Hospital,  Washington,  June  10th. 
Eeturned  to  duty  July  4th,  1863. 

Butcher,  Eobkrt  A.,  Private,  Co.  H,  82d  Pennsylvania  Volunteers,  of  the  3d  Brigade,  1st  Division,  0th  Corps,  aged 
21  years,  received,  in  an  encounter  with  the  enemy’s  cavalry  near  Burke’s  Station,  Virginia,  on  April  6th,  1865,  two  sabre-cuts 
over  the  vertex,  parallel  to  each  other,  and  at  right  angles  to  the  sagittal  suture.  The  wounds  appeared  to  implicate  the  8C.alp 
only,  and  were  approximated  by  adhesive  plaster,  after  the  hair  had  been  shaven  away.  The  patient  was  conveyed  to 


4 


WOUNDS  AND  INJURIES  OE  THE  HE2VD, 


Wiisliiiigton,  and  entered  Harevvood  Hospital  on  April  lOtli.  The  wounds  healed  rapidly,  and  no  unpleasant  symptoms 
occurred  until  May  29th,  when  he  complained  of  severe  headache,  accompanied  by  intolerance  of  light  and  sensitiveness  to 
noise.  A day  or  two  subsequently  the  anterior  wound  reopened,  and  discharged  thin  unhealthy  pus.  An  exfoliation  was 
suspected,  but  no  denuded  bone  could  be  detected,  and  under  a mild  evacuant  treatment  the  headache  subsided,  and  the  wound 
again  assumed  an  healthy  aspect.  On  June  8th,  1805,  it  had  almost  entirely  healed,  and,  at  his  own  I'equest,  the  patient  was 
discharged  from  the  hosjiital  and  from  the  service  of  the  United  States.  Soon  after  his  admission  to  Harewood,  a jdiotograph 
of  his  w'ounds  had  been  taken,  by  direction  of  the  surgeon  in  charge,  Brevpt  Lieut.  Col.  E.  B.  Bontecou,  U.  S.  Vols.  This  is 
preserved  as  No.  30  of  the  first  volume  of  Photographs  of  Surgical  Cases,  Army  Medical  Museum,  and  is  very  faithfully  copied 
in  the  figure  on  the  left  of  the  grou])  of  heads  in  the  accompanying  plate. 

Cain,  Patrick,  Private,  Co.  G,  ()2d  New  York  Volunteers,  aged  38  years.  Sabre-cut  of  the  scalp.  Cold  Harbor,  Vir- 
ginia, June  3d,  1864.  Admitted  to  McKim’s  Mansion  Hospital,  Baltimore,  June  11th.  Eeturned  to  duty  August  3d,  1864. 

Campbelr,  Haeri.son  G.,  Private  of  Co.  5th  United  States  Cavalry,  aged  25  years,  was  wounded  in  action  near 
Louisa  Court  House,  Virginia,  on  May  4th,  1863,  and  fell  into  the  hands  of  the  enemy.  He  was  exchanged,  and  sent  to 
Annapolis  on  the  hospital  transport  State  of  Maine,  and  was  admitted  to  the  general  hospital  at  that  place  on  May  17th,  with 
two  suppurating  sahre  wounds  of  the  scalp,  one  over  the  light  parietal  eminence,  the  other  behind  the  left  ear.  He  had  head- 
ache, with  frequent  jmlse,  constipated  bowels,  and  ajipeared  to  be  very  feeble.  He  was  purged,  and  then  ordered  good  diets 
and  “whiskey  and  (piinine  frealy.”  On  May  20th  erysipelas  attacked  the  left  leg,  which  had  received  no  injury.  Tincture  ot 
iodine  locally  and  tincture  of  the  sesquichloride  of  iron  internally  were  employed  to  combat  this  complication.  On  May  21st 
there  was  epistaxis ; the  pulse  was  small,  at  110;  the  tongue  heavily  coated.  On  the  23d  there  was  diarrhoea,  which  was 
controlled  by  pills  of  ojiium  and  camphor.  The  next  day  the  pulse  had  risen  to  120,  and  was  soft.  The  abdomen  w'as 
tympanitic.  Stimulants  were  freely  given.  The  catheter  was  resorted  to,  on  account  of  retention  of  urine,  which  was  scanty 
and  high  colored,  and  oil  of  turpentine,  in  doses  of  ten  drops,  thrice  daily,  was  ordeied.  On  the  28th  the  erysipelatous  inflam- 
mation had  extended  up  the  back  and  over  the  right  leg.  The  teeth  were  covered  with  sordes.  Turpentine,  with  carbonate  of 
ammonia  and  whiskey  and  concentrated  nutriment,  and  tincture  of  iodine  locally,  constituted  the  treatment.  On  June  6th,  the 
erysipelas  had  extended  to  the  face  and  throat,  and  the  patient  became  delirious.  He  continued  in  ah  unconscious  state  until 
.June  14th,  1863,  when  he  died.  Acting  Assistant  Surgeon  J.  M.  Matlock,  who  reports  the  case,  ascribes  the  fatal  event  to 
“ exhaustion  following  typhoid  erysipelas,”  and  as  unconnected  with  the  scalp  wounds,  which  maintained  an  healthy  appearance 
to  the  last. 

Capron,  Jaimes  P.,  Sergeant,  Co.  E,  3d  United  States  Artillery.  Sabre-cut  of  the  forehead,  and  a shell  wound  of  the 
left  side  of  the  neck.  Bisland,  Louisiana,  April  14th,  1863.  Discharged  from  service  July  26th,  1864. 

Carbough,  Daniel,  Private,  Co.  E,  18th  Pennsylvania  Cavalry,  aged  46  years.  Sabre-cut  of  the  right  parietal  region, 
in  a skirmish  on  the  Eapidan,  Virginia,  November  17th,  1863.  Admitted  to  Douglas  Hospital,  Washington,  November  23d. 
Transferred  to  Satterlee  Hospital,  Philadelphia,  November  28th.  Eeturned  to  duty  March  24th,  1864. 

Carey,  William  H.,  Private,  Co.  G,  15th  New  York  Cavalry,  aged  18  years.  Sabre-cut  of  the  scalp.  Newmarket, 
Virginia,  December  21st,  1864.  Admitted  to  hospital  at  Frederick,  Maryland,  December  23d.  Discharged  from  service  May 
20th,  1865. 

Carney,  William,  Private,  Co.  L,  2d  New  York  Cavalry.  Sabre-cut  of  the  scalp,  and  a shell  and  gunshot  wound  of 
the  upper  third  of  the  right  thigh.  Aldie,  Virginia,  June  17th,  1863.  Admitted  to  Hospital  No.  1,  Annapolis,  Maryland,  June 
22d.  Died  .Tune  22d,  1863,  from  the  effects  of  the  gunshot  injury. 

Carper,  Philip  W.,  Private,  Co.  A,  35th  Virginia  Cavalry.  Sabre-cut  of  the  left  parietal  region ; also  a wound  of  the 
right  arm  and  left  hand.  Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  Second  Division  Hospital,  Alexandria,  Vir- 
ginia, June  10th.  Transferred  to  Old  Capitol  Prison  .June  17th,  1863,  for  exchange. 

Carson,  W.  L.,  Private,  Co.  B,  10th  New  York  Cavalry,  aged  21  years.  Sabre-cut  of  the  scalp.  Admitted  to  Second 
Division  Hospital,  Annapolis,  Marj-land,  June  22d,  1863.  Discharged  from  service  September  17th,  1864. 

Cebutt,  George,  Private,  Co.  F,  11th  United  States  Infantry,  aged  19  years.  Sahre-cut  of  the  right  parietal  region. 
Petersburg,  Virginia,  August  17th,  1864.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  August  24th.  Deserted 
November  10th,  1864. 

Chambers,  James  M.,  Private,  Co.  K,  14th  Pennsylvania  Cavalry,  aged  18  years.  Sabre-cut  of  the  scalp.  Millwood, 
Virginia,  December  17th,  1864.  Admitted  to  hospital  at  Annapolis  Junction,  Maryland,  January  4th,  1865.  Dischai-ged  fi’om 
service  May  30th,  1865. 

Chambers,  John,  Private,  Co.  I,  1st  Michigan  Cavalry.  Sabre-cut  of  the  left  side  of  the  head.  Gettysburg,  July  1st, 

1863.  Admitted  to  Fort  Schuyler  Hospital,  New  York  Harbor,  July  15.  Eeturned  to  duty  August  28,  1863. 

Chan,  H.,  Private,  Co.  P,  2d  Georgia  Cavalry.  Sabre-cut  of  the  head.  Admitted  to  hospital,  Petersburg,  Virginia, 
December  10th,  1862.  Fuiloughed,  December  19th,  1862. 

CiiANTRELL,  OcTAVE,  Private,  Co.  M,  4th  Now  York  Cavalry.  Sabre-cut  of  the  scalp  and  of  the  light  arm.  Upper- 
villo,  Virginia,  June  21st,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  July  9th,  1863. 

Chapman,  Samuel,  Chaplain,  Mosby’s  command.  Sabre-cut  of  the  head.  Dranesville,  Virginia,  Aju  il  1st,  1863. 

Clemens,  A.,  Private,  Co.  C,  51st  Virginia  Infantry.  Sabre-cut  of  the  scalp.  Oiiequan  Creek,  Virginia,  Sejitember  19th, 

1864.  Admitted  to  Field  Hospital,  Winchester,  Virginia,  September  20th.  Transferred  for  exchange,  well,  November,  1864. 


Med.»  S'urg.  Hist  , of  die  Wur  of  the  Kebellidn,  I'art  I.  Vol  U.  Op  page  *1 


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cs 


INCISED  AND  PUNCTURED  WOUNDS.  5 

Clemmens,  Lawrence,  Bugler,  Co.  I,  1st  Massachusetts  Cavalry,  aged  27  years.  Sabre-cut  of  the  scalji.  Adiuitted 
to  Judiciary  Square  Hospital,  Washington,  February  20th,  1804.  Deserted  March  24th,  1864. 

Coclcrill,  Q.  J.,  Private,  Co.  G,  5th  Alabama.  Sabre-cut  of  the  head.  Petersburg,  Virginia,  April  2d,  1805.  Admitted  to 
Lincoln  Hospital,  Washington,  April  10th.  Sent  to  Old  Capitol  Prison,  April  25th,  1865,  for  exchange. 

Colley,  John,  Private,  Co.  E,  2d  West  Virginia  Cavalry,  aged  20  years.  Sabre-cut  of  the  left  parietal  region.  Five 
Forks,  Virginia,  April  2d,  1805.  Admitted  to  Slough  Hospital,  Alexandria,  Virginia,  June  7th.  Discharged  from  service 
June  20th,  1865. 

CoLLVER,  Edward  A.,  Private,  Co.  B,  2d  New  York  Cavalry.  Sabre-cut  of  the  left  occipital  region,  two  and  a half 
inches  in  length.  Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  First  Division  Hospital,  AnnapolE,  Maryland,  June 
14th.  Returned  to  duty  August  10th,  1864. 

Connelly',  Thomas,  Sergeant,  Co.  I,  1st  United  States  Cavalry,  aged  47  years.  Sabre-cut  of  the  scalp,  and  fracture  of 
lower  third  of  the  left  arm.  W^ajmesboro’,  Virginia,  September  28th,  1864.  Admitted  to  Chestnut  Hill  Hospital,  Phila- 
delphia, October  9th,  and,  after  several  transfers,  was  admitted  to  hospital  at  Carlisle  Barracks,  Pennsylvania,  and  discharged 
from  service  June  3d,  1865. 

Conner,  Charles,  Private,  Co.  I,  5th  Oliio  Cavalry,  aged  45  years.  Sabre-cut  of  the  scalp.  Fayetteville,  North 
Carolina,  March  10th,  1865.  Admitted  to  Dennison  Hospital,  Cincinnati,  Ohio,  April  15th.  Discharged  from  service  July 
19th,  1865. 

Conover,  Ralph,  Private,  Co.  H,  18th  Pennsylvania  Cavalry.  Sabre-cuts  of  the  head  and  neck.  Hanover,  Pennsyl- 
vania, June  30th,  1863.  Admitted  to  Satterlee  Hospital,  Philadelphia,  July  4th.  Returned  to  duty  September  23d,  1863. 

COREY',  Leander  a.,  ISIusician,  Co.  K,  2d  New  York  Cavalry,  aged  21  years.  Sabre-cut  of  the  scalp.  Admitted  to 
Judiciary  Square  Hospital,  AVashington,  February  8th,  1864.  Returned  to  duty  March  14th,  1864. 

CORSTION,  Robert,  Private,  Co.  H,  1st  Michigan  Cavalry,  aged  19  years.  Sabre-cut  of  the  right  pai-ietal  region. 
Smithfield,  Virginia,  August  29th,  1864.  Admitted  to  Jarvis  Hospital,  Baltimore,  Maryland,  September  4th.  Returned  to  duty 
October  1st,  1864. 

Couch,  Daniel,  Private,  Co.  F,  1st  Massachusetts  Cav'alry.  Sabre-cut  of  the  scalp,  and  pistol  wound  of  the  abdomen. 
Aldie,  Virginia,  June  17tli,  1863.  Admitted  to  Armory  Square  Hospital,  Washington,  July  3d.  Transferred  to  Lovell  Hospital, 
Portsmouth  Grove,  Rhode  Island,  July  8th.  Returned  to  duty  September  21st,  1863. 

Cowley,  Frank,  Corporal,  Co.  G,  6th  United  States  Cavalry.  Sabre-cut  of  the  scalp.  Fairfield,  Pennsylvania,  July 
3d,  1883.  Admitted  to  hospital  at  Gettysburg  July  22d.  Returned  to  duty  September  11,  1863. 

Coyne,  Thomas,  Corporal,  Co.  B,  10th  New  York  Cavalry.  Sabre-cut,  two  and  a half  inches  in  length,  over  the  left 
occipital  region;  also  a wound  of  light  side  of  face.  Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  First  Division 
Hospital,  Annapolis,  Maryland,  June  14th.  Returned  to  duty  October  19th,  1863. 

Craft,  J.  H.,  Private,  Co.  H,  60th  Virginia  Infantry.  Sabre-cut  of  the  scalp.  Opequan  Creek,  Virginia,  September  19th, 
1864.  Admitted  to  Field  Hospital  at  AVinchester,  Virginia,  the  same  day.  Transferred  for  exchange  December  10th,  1864, 
well. 

Crane,  Jajies,  Private,  Co.  A,  0th  Michigan  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  July  1st,  1863.  Admitted 
to  Satterlee  Hospital,  Philadelidiia,  July  10th.  Returned  to  duty  September  23d,  1803. 

Crocker,  Jay*,  Private,  Co.  D,  10th  New  A’ork  Cavalry.  Sabre-cut  of  the  left  parietal  region,  two  and  a half  inches  in 
length,  directly  over  the  parietal  eminence.  Brandy  Station,  Virginia,  June  9th,  1803.  Admitted  to  Hospital  No.  1,  Annapolis, 
Maryland,  June  14th.  Returned  to  duty  August  15th,  1863. 

Crodon,  John,  Private,  Co.  C,  23d  Illinois  Volunteers.  Sabre-cut  of  the  forehead.  Annapolis,  Maryland,  May  21st, 
1863.  Admitted  to  First  Division  Hospital  the  same  day.  Returned  to  duty  June  12th,  1863. 

Cusack,  AVilllvji,  Captain,  Co.  I,  96th  Pennsylvania  A^olunteers,  aged  34  years.  Sabre-cut  of  the  forehead  over  the 
left  eye.  Spottsylvatiia,  A^'irginia,  May  8th,  1864.  Admitted  to  Seminary  Hospital,  Georgetown,  District  of  Columbia,  May 
12th.  Discharged  from  service  J uly  28th,  1804. 

CUTTICR,  AVilliam,  Private,  Go.  H,  4th  Vermont  Infantry,  aged  38  years.  Sabre-cut  of  the  scalp.  Strasburg,  A'^irginia, 
August  16th,  1864.  Admitted  to  Field  Hospital  at  Sandy  Hook,  Maryland,  August  19th,  and  transfemul  to  Bratlleboro’,  Ver- 
mont, February  6th,  1865,  for  muster  out  of  service. 

Dancer,  George  W.,  Private,  Co.  A,  0th  Michigan  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  Pennsylvania, 
July  1st,  1863.  Admitted  to  Satterlee  Hospital,  Philadelphia,  July  10th.  Returned  to  duty  August  0th,  1863. 

De  Graw,  Isa^vc,  Private,  Co.  A,  0th  Michigan  Cavalry.  Sahre-cut  of  the  scalp.  Gettysburg,  July  list,  1863.  Admitted 
to  Satterlee  Hospital,  Philadelphia,  July  10th.  Returned  to  duty  September  23d,  1863. 

De  Groot,  Henry',  Private,  Co.  A,  17th  Connecticut  Volunteers.  Sahre-cut  on  the  left  side  of  the  scalp.  Admitted  to 
Knight  Hospital,  New  Haven,  Connecticut,  January  23d,  1864.  Transfi'rred  to  Fort  Trumbull  I’ebruary  27th,  1804,  for  duty. 

Dela-MATER,  IL,  Corporal,  Co.  M,  15th  New  A’ork  Cavalry,  aged  24  years.  Sahre-cut  of  the  scalp.  Newmai-ket, 
Virginia,  December  21st,  1834.  Admitted  to  hospital  at  Frederick,  Maryland,  December  23d.  Retui-ned  to  duty  January 
31st,  1865. 


6 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


DiiNiiURST,  H.,  Private,  Co.  D,  17th  Connecticut  Volunteers.  Sabre-cut  of  the  scalp.  Gettysburg,  July  Ist,  1863. 
Admitted  to  Seminary  Hospital,  Gettysburg,  same  day.  Transferred  to  South  Street  Hospital,  Pliiladelphia ; thence  to  Knight 
Hospital,  New  Haven,  Connecticut,  on  March  24th,  1864.  Returned  to  duty  April  “21st,  1864. 

Dodd,  Thomas,  Sergeant,  Co.  B,  6th  United  States  Cavalry.  Sabre-cut  over  the  anterior  and  posterior  regions  of  the 
scalp.  Funktown,  Maryland,  July  7th,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  August  3d.  Returned 
to  duty,  well,  October  l‘2th,  1863. 

Donun,  John,  Private,  Co.  K,  6th  Pennsylvania  Cavalry.  Sabre-cut  of  right  parietal  region.  Admitted  to  First 
Division  Hospital,  Annapolis,  Maryland,  June  14th,  1863.  Returned  to  duty  June  17th,  1863. 

Dougherty,  Patrick,  Private,  Co.  A,  6th  United  States  Cavalry.  Sabre-cut  of  the  left  forehead,  two  inches  above 
the  eye.  Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  June  14th. 
Discharged  fi-om  “service  October  12th,  1864. 

Douglas,  Joseph,  Private,  Co.  A,  6th  Michigan  Cavalry.  Sabre-cut  of  the  scalp  and  left  shoulder.  Gettysburg,  July 
3d,  1863.  Admitted  to  Hospital  No.  1,  Annapolis,  Maryland,  July  16th.  Returned  to  duty  July  31st,  1863. 

Downs,  Adam,  Private,  Co.  G,  1st  Pennsylvania  Cavalry.  Sabre-cut  of  the  scalp.  New  Hope  Church,  Virginia,  Novem- 
ber 27th,  1863.  Admitted  to  Regimental  Hospital  the  same  day,  and  returned  to  duty  December  5th,  1863. 

Doyle,  Joseph  C.,  Private,  Co.  A,  1st  Alabama  Cavalry.  Sabre-cut  of  the  scalp,  received  on  Sherman’s  campaign 
through  the  Carolinas,  1865.  Mustered  out  of  service  with  regiment  October  20th,  1865. 

Doyea,  John,  Private,  Co.  K,  1st  Maine  Cavalry,  aged  22  years.  Sabre-cut  of  the  occipital  region.  Brandy  Station, 
Virginia,  June  9th,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  June  14th.  Returned  to  duty  August 
1st,  1863.  ^ 

Drew,  Horace  W.,  Sergeant,  Co.  A,  6th  Ohio  Cavalry,  aged  25  yeai-s.  Sabre-cut,  two  inches  in  length,  of  the  right 
frontal  region.  Ashland  Station,  May  12th,  1864.  Admitted  to  Hammond  Hospital,  Point  Lookout,  Maryland,  May  16th. 
Ti-ansferred  to  the  Veteran  Reserve  Corps,  May  4th,  1865.  Mustered  out  of  service  August  24th,  1865. 

Drew,  J.  H.,  Private,  Co.  F,  45th  North  Carolma.  Sabre-cut  of  the  head.  Gettysburg,  July  1st,  1863.  Admitted  to 

Hospital  No.  1,  Frederick,  Maryland,  July  6th.  Transferred  to  Annapolis  July  7th,  1863,  for  exchange. 

Dunn,  Willis,  Private,  Co.  F,  35th  Virgmia  Infantry.  Sabre-cut  of  the  right  parietal  region.  Brandy  Station,  Virginia, 
June  9th,  1863.  Admitted  to  Second  Division  Hospital,  Alexandria,  Virginia,  June  10th.  Transferred  to  Old  Capitol  Prison, 
Washington,  June  12th,  1863,  for  exchange. 

Duchet,  J.,  Private,  Co.  E,  Thomas’s  Legion.  Sabre-cut  of  the  scalp.  Opequan  Creek,  Virginia,  September  19th,  1864. 
Admitted  to  Field  Hospital,  Winchester,  Virginia,  September  20th.  Transferred  for  exchange  December  20th,  1864,  entirely 
well. 

Dudley,  C.  V.,  1st  Lieutenant,  Co.  K,  15th  Virginia  Cavalry,  aged  25  years,  received  several  sabre-cuts  of  the  scalp,  and  ■ 
one  of  the  right  side,  at  Culpeper,  Virginia,  September  13th,  1863.  Admitted  to  Lincoln  Hospital,  Washington,  September 

17th.  Recovered,  and  was  transferred  to  the  Old  Capitol  Prison  October  19th,  1863,  for  exchange. 

Dursten,  Thomas,  Quartermaster  Sergeant,  15th  New  York  Cavalry,  aged  20  years.  Sabre-cut  of  the  scalp.  New- 
market, Virginia,,  December  21st,  1864.  Admitted  to  hospital  at  Frederick,  Maryland,  December  23d.  Returned  to  duty 
February  1st,  1865. 

Dustan,  George  L.,  Private,  Co.  G,  1st  Maine  Cavalry,  aged  25  yeare.  Sabre-cut  of  the  scalp  over  the  occipital 
region,  Br.andy  Station,  Virginia,  June  9th,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  June  14th. 
Returned  to  duty  October  25th,  1864. 

Edmunds,  Howard,  Captain,  Co.  L,  3d  Pennsylvania  Cavalry.  Sabre-cut  of  the  scalp,  and  gunshot  wound  of  the 
shoulder.  Gettysburg,  July  3d,  1863.  Discharged  from  service  August  24th,  1864.  His  name  is  not  on  the  Pension  List. 

Edwards,  David,  Corporal,  Co.  H,  5th  Ohio  Cavalry.  Sabre-cut  of  the  scalp.  Sherman’s  campaign  through  the 
Carolinas,  1865.  Mustered  out  of  service  October  30th,  1865. 

Edwards,  William  A.,  Private,  Co.  B,  5th  United  States  Cavalry.  Sabre-cut  of  the  left  parietal  region.  Chancellors- 
ville,  Vu-ginia,  May  4th,  1863.  Admitted  to  Second  Division  Hospital,  Annapolis,  Maryland,  May  19th.  Deserted  August  7th, 
1863. 

Ells,  William  S.,  Private,  Co.  K,  9th  New  York  Cavalry.  Sabre-cut  of  the  scalp  and  right  arm.  Culpeper,  Virginia, 
August  1st,  1863.  Admitted  to  Douglas  Hospital,  Washington,  August  3d.  Returned  to  duty  October  10th,  1863. 

Eynatten,  Francis,  Sergeant,  Co.  I,  198th  New  York  Volunteers.  Sabre-cut  of  the  face  extending  from  the  ang'j  of 
the  mouth  to  the  superior  portion  of  the  forehead.  Pleasant  Hill,  Louisiana,  April  9th,  1864.  He  was  taken  prisoner  and 
admitted  to  a rebel  hosjutal,  and  the  wound  closed  with  sutures.  Discharged  fi-om  service  April  20th,  1866. 

Fagle,  Frederick,  Private,  Co.  C,  10th  New  York  Cavalry.  Two  sabre-cuts  on  the  vertex  of  the  scalp,  one  of  the 
left  cheek,  and  one  of  the  left  shoulder.  Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  Fii-st  Division  Hospital, 
Annapolis,  Maryland,  June  14th.  Returned  to  duty  May  2d,  1864. 

Filler,  Joseph,  Private,  Co.  A,  4th  New  York  Cavalry.  Sabre-cuts  of  the  scalp  and  wrist.  Upperville,  Virginia, 
June  21st,  1863.  Admitted  to  Emory  Hospital,  Washington,  June  23d.  Returned  to  duty  July  25th,  1863. 


INCISED  AND  PUNCTUEED  WOUNDS. 


t 

Fink,  Anthony,  Private,  Co.  G,  15th  New  York  Cavalry,  aged  35  years.  Sabre-cut  of  the  scalp.  Newmarket,  Virginia,' 
December  21st,  1864.  Admitted  to  hospital  at  Frederick,  Maryland,  December  23d.  Eeturned  to  duty  January  3d,  1865. 

Finnigan,  W.,  Private,  Co.  L,  4th  New  York  Cavalry.  Sabre-cut  of  the  scalp.  Aldie  Gap,  Virginia,  June  17th,  1863. 
Admitted  to  Third  Division  Hospital,  Alexandria,  Virginia,  June  18th.  Furloughed  July  22d.  Returned  to  duty  August  22d, 
1863. 

Fishkr,  Charles  W.,  Private,  Co.  C,  3d  Pennsylvania  Cavalry.  Sabre-cut  of  the  right  occipital  region  while  attempt- 
ing to  escape  fiom  the  patrol  guard  at  Annapolis,  Maryland,  March  29th,  1863.  Admitted  to  Hospital  No.  1,  at  Annapolis,  the 
same  day.  Eeturned  to  duty  April  13th,  1863. 

Foley,  Miles,  Sergeant,  Co.  B,  3d  Pennsylvania  Cavalry.  Sabre-cuts  of  the  scalp  and  arm.  Gettysburg,  July  1st, 
1863.  Admitted  to  Satterlee  Hospital,  Philadelphia,  July  9th.  Eeturned  to  duty  July  13th,  1863. 

Folsom,  William  M.,  Private,  Co.  E,  5th  Wisconsin  Volunteers,  aged  31  years.  Sabre-cut  of  the  scalp  and  hand. 
July  20th,  1864.  Admitted  to  Harvey  Hospital,  Madison,  Wisconsin,  August  1st.  Eeturned  to  duty  August  7th,  1864. 

Fox,  Elias,  Private,  Co.  G,  15th  New  York  Cavalry,  aged  26  years.  Sabre-cut  of  the  scalp.  Newmarket,  Virginia, 
December  21st,  1864.  Admitted  to  hospital  at  Frederick,  Maryland,  December  23d.  Returned  to  duty  January  21st,  1865. 

Fox,  Jasper  C.,  Private,  Co.  L.,  14th  Pennsylvania  Cavalry,  aged  18  years.  Sabre-cut  of  the  scalp.  Millwood,  Virginia, 
December  17th,  1864.  Admitted  to  McKim’s  Hospital,  Baltimore,  January  15th,  1865.  Eeturned  to  duty  March  20th,  1865. 

Foster,  Joshua  E.,  Private,  Co.  M,  6th  Pennsylvania  Cavalry.  Sabre-cut  of  the  right  parietal  region.  Admitted  to 
Second  Division  Hospital,  Annapolis,  Maryland,  August  21st,  1863.  Eeturned  to  duty  October  14th,  1863. 

Frisbie,  Samuel,  Private,  Co.  E,  Ringgold’s  Battalion,  aged  23  years.  Sabre-cut  .of  three  inches  in  length  extending 
diagonally  across  the  parietal  region.  September  16th,  1863.  Admitted  to  hospital  at  Cumberland,  Maryland,  September  16th. 
Deserted  October  16th,  1863. 

Frontman,  Philip,  Private,  Co.  L,  14th  Pennsylvania  Cavalry,  aged  18  years.  Sabre-cut  of  the  scalp.  Millwood, 
Virgmia,  December  17th,  1864.  Admitted  to  Field  Hospital,  Winchester,  Virgmia,  December  20th.  Eeturned  to  duty  January 
17  th,  1865. 

Gardner,  George,  Private,  Co.  K,  17th  Veteran  Reserve  Corps,  aged  21  years.  Sabre-cut  of  the  head.  Indianapolis, 
Indiana,  January  5th,  1865.  Admitted  to  City  Hospital,  in  that  place,  January  12th,  from  Soldiers’  Home.  Eeturned  to  duty 
J anuary  23d,  1865. 

Gardner,  William,  Private,  Co.  H,  15th  New  York  Heavy  Artillery,  aged  26  years.  Sabre-cut  of  the  scalp.  South 
Side  Railroad,  Virginia,  March  31st,  1865.  Admitted  to  White  Hall  Hospital,  Pennsylvania,  May  27th,  from  Lincoln  Hospital, 
Washington.  Discharged  fi-om  service  July  22d,  1865. 

Gatewood,  C.  T.,  Private,  Co.  F,  9th  Virginia  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  Pennsylvania,  July  1st, 

1863.  Admitted  to  hospital  at  David’s  Island,  New  York  Harbor,  July  17th.  Transferred  for  exchange,  well,  August  24th,  1863. 

Geiirett,  James  W.,  Private,  Co.  D,  1st  Louisiana  Artillery,  aged  33  years.  Sabre-cut  of  the  scalp.  Cedar  Creek, 
Virguiia,  October  19th,  1864.  Admitted  to  McClellan  Hospital,  Pliiladelphia,  October  24th.  Eeturned  to  duty  November  24th, 

1864. 

Giddings,  Benjamin,  Private,  Co.  G,  1st  Michigan  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  July  3d,  1863. 
Admitted  to  Jarvis  Hospital,  Baltimore,  July  19th.  Transferred  to  Carver  Hospital,  Washington,  July  23d.  Returned  to  duty 
October  20th,  1863. 

Gilbert,  Nahum,  Sergeant,  Co.  I,  1st  Michigan  Cavalry,  aged  24  years.  Sabre-cut  of  the  head,  and  a penetrating 
gunshot  wound  of  the  abdomen  by  a conoidal  ball  which  entered  at  the  umbilicus.  Gettysburg,  July  1st,  1863.  Admitted  to 
Camp  Letterman  Hospital,  Gettysburg,  July  6th.  Fmcal  discharges  took  place  from  the  wound  in  the  abdomen.  Much  pain 
and  difficulty  in  micturition.  July  7th,  paralysis  of  lower  extremities.  August  28th,  wounds  healed.  September  1st, 
paralysis  of  lower  extremities  continues,  together  with  partial  paralysis  of  the  rectum.  The  treatment  consisted  of  com- 
presses and  bandage  to  the  abdomen,  with  diuretics  and  enemata.  Transferred  to  Mulberry  Street  Hospital,  Harrisburg,  Sep- 
tember 15th.  Discharged  from  service  October  31st,  1863. 

Good,  Martin,  Private,  Co.  M,  2d  United  States  Cavalry,  aged  22  years.  Sabre-cut  of  the  scalp.  Beverly  Ford,  Vir- 
^nia,  June  9th,  1863.  Admitted  to  Satterlee  Hospital,  Philadelphia,  June  23d.  Deserted  October  1st,  1863. 

Goodall,  Charles,  Private,  Co.  B,  5th  Georgia  Cavalry,  aged  42  years.  Sabre-cut  of  the  left  frontal  region.  Woodbury, 
Tennessee.  Admitted  to  Hospital  No.  1,  Murfreesboro,  Tennessee,  September  6th,  and  transferred  for  exchange,  well,  Septem- 
ber 12th,  1864. 

Goodman,  George  N.,  Private,  Co.  E,  21st  Virginia  Cavalry,  aged  19  years.  Sabre-cut  of  the  scalp.  Front  Royal, 
Virginia,  November  12th,  1864.  Admitted  to  West’s  Building  Hospital,  Baltimore,  November  17th.  Transferred  to  Fort 
McHenry,  Baltimore,  December  9th,  1864,  for  exchange. 

Graves,  William,  Private,  Co.  G,  46th  Virginia  Infantry,  aged  42  years.  Sabre-cut  of  the  scalp.  Petersburg,  Virginia, 
June  17th,  1864.  Admitted  to  Emory  Hospital,  Washington,  June  24th.  Transferred  to  Lincoln  Hospital  June  26th,  and 
thence  to  the  Old  Capitol  Prison  for  exchange,  October  26th,  1864. 


8 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Gi:ay,  Elijah  G.,  Private,  Co.  F,  Ist  ^lieliigaii  Cavalry,  aged  25  years.  Sabre-cut  of  the  head,  and  wound  of  breast  by 
))istol  ball.  Gettysburg,  July  1st,  18CI5.  Admitted  to  Satterlee  Hospital,  Pbiladelpbia,  July  9tb.  Returned  to  duty  December 
23d,  18G3. 

Gkeen,  John,  Sergeant,  Co.  D,  18tb  New  York  Cavalry,  aged  20  years.  Sabre-cut  of  the  scalp.  Alexandria,  Louisiana, 
April  21st,  1864.  Admitted  to  Marine  Hosj)ital,  New  Orleans,  Louisiana,  May  23d.  Furloughed  June  18th,  1864.  Deserted 
August  31st,  1865. 

Giheein,  Stephen,  Private,  Co.  B,  2d  Massachusetts  Cavalry,  aged  23  years.  Sabre-cuts  of  the  scalp  and  left  ear. 
Rockville,  Maryland,  July  18th,  1864.  Admitted  to  Campbell  Hospital,  Washington,  July  21st.  Transferred  thence  to  Lovell 
Hospital,  Portsmouth  Grove,  Rhode  Island,  July  28th.  Returned  to  duty  August  23d,  1864. 

GitiFFiTii,  G.  W.,  Private,  Co.  G,  2d  United  States  Cavalry,  aged  23  years.  Sabre-cut,  an  inch  and  a half  long,  of  the 
left  frontal  region.  Culpeper,  Virgini.a,  August  1st,  1863.  Admitted  to  Douglas  Hospital,  Washington,  August  2d.  Returned 
to  duty  August  14th,  1863. 

Hand,  CTiaeles  F.,  Ih-ivate,  Co.  F,  2d  United  States  Cavalry.  Sabre-cut,  two  inches  in  length,  of  the  occipital  region. 
Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  June  14th.  Returned 
to  duty  October  26th,  1863. 

Hanna,  John,  Private,  Co.  I,  6th  Michigan  Cavalry,  aged  25  years.  Sabre-cut  of  the  scalp.  Gettysburg,  July  2d, 
1863.  Admitted  to  Satterlee  Hospital,  Philadelphia,  July  9th.  Returned  to  duty  July  Jlst,  1863. 

Harmon,  Martin,  Sergeant,  Co.  I,  9th  New  Yoi-k  Cavalry.  Sabre-cut  of  scalp.  Rapidan,  Virginia,  October  11th, 
1863.  Admitted  to  Regimental  Hospital,  and  returned  to  duty  October  11th,  1863. 

Harvey,  Joshua,  Sergeant,  Co.  I,  60th  Virginia  Infantry,  aged  40  years.  Sabre-cut  of  the  scalp.  Winchester,  Virginia, 
September  19th,  1864.  Admitted  to  West’s  Building  Hospital,  Baltimore,  October  19th.  Transferred  for  exchange,  well, 
October  25th,  1864. 

Haskell,  David  E.,  Sergeant,  Co.  F,  8th  New  York  Cavalry.  Sabre-cut  of  the  scalp.  Beverly  Ford,  Virginia,  June 
9th,  1863.  Admitted  to  Lincoln  Hospital,  Washington,  June  11th.  Returned  to  duty  June  17th,  1863. 

Hazelet,  Lewis,  Private,  Co.  L,  14th  Pennsylvania  Cav.alry,  aged  38  years.  Sabre-cuts  of  the  scalp  and  arm.  Mill- 
wood,  Virginia,  December  17th,  1864.  Admitted  to  McKim’s  Mansion  Hospital,  Baltimore,  January  15th,  1865,  from  Field 
Hospital.  Transferred  to  Mower  Hospital,  Pliiladelphia,  Febi'uary  10th.  Returned  to  duty  February  23d,  1865. 

IIiGGiNSON,  Henry  Lee,  Major,  1st  IMassachusetts  Cavalry.  Sabre-cuts  of  the  scalp  and  neck.  Aldie  Gap,  Virginia, 
June  17th,  1863.  Admitted  to  First  Division  Hospital,  Alexandria,  Virginia,  June  24th.  Dischai’ged  from  service,  well, 
August  9th,  1864. 

Hobbs,  J.  F.,  Private,  Co.  M,  1st  Rhode  Island  Cavalry.  Sabre-cut  of  the  scalp  and  right  shoulder.  Kelley’s  Ford, 
Virginia,  March  17th,  1863.  Admitted  to  Fii'st  Division  Hospital,  Annapolis,  Maryland,  Api-il  6th.  Returned  to  duty  October 
5th,  1863. 

Hood,  Thomas,  Sergeant,  Co.  E,  6th  United  States  Cavalry.  Sabre-cut  of  the  scalp.  Upperville,  Virginia,  June  21st, 
1863.  Discharged  July  28th,  1864,  on  exjiiration  of  term  of  service. 

IloitSEFiELD,  James,  Private,  Co.  K,  73d  Indiana  Volunteers,  aged  49  years.  Sabre-cut  of  the  scalp.  May  11th,  1864. 
Admitted  to  Second  Division  Hospital,  Madison,  Indiana,  November  28th.  Returned  to  duty  March  17th,  1865. 

IIoi’.TON,  L.  P.,  Private,  Co.  L,  10th  New  York  Cavalry.  Sabre-cut  of  the  scalp.  Virginia,  May  11th,  1884. 

Hosey,  William,  Private,  Co.  A,  8th  New  Jersey  Volunteers,  aged  34  years.  Sabre-cut  of  the  scalp.  Chancellorsville, 
Virginia,  May  3d,  1863.  Admitted  to  Mower  Hospital,  Philadelphia,  April  27th,  ,1864,  from  Tilton  Hospital,  W^ilmington,  Dela- 
ware. Transferred  to  Trenton,  New  Jersey,  for  muster  out,  August  26th,  1864. 

Hguse,  Wesley  L.,  Corporal,  Co.  A,  1st  United  States  Cavalry.  Sabre-cut,  one  inch  in  length,  of  the  left  occipital 
region.  Biandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  June  14th. 
Returned  to  duty  December  2d,  1863. 

Huckehy,  Bobert  A.,  Private,  Co.  I,  53d  Georgia  Infantry,  aged  27  years.  Sabre-cut  of  the  scalj).  Cedar  Creek,  Virginia, 
October  19th,  1864.  Admitted  to  West’s  Building  Hospital,  Baltimore,  October  24th.  Died  October  26th,  1864,  of  “chronic 
diarrhoea.” 

Huntley,  Ira,  Private,  Co.  C,  2d  Kentucky  Cavalry,  aged  23  years.  Three  sabre-cuts  of  the  scalp.  Cynthiana,  Ken- 
tucky, June  12th  1864.  Admitted  to  Seminary  Hospital,  Covington,  Kentucky,  June  13th.  Meningitis,  with  serous  effusion, 
supervened,  and  death  resulted  on  June  21st,  1864. 

Ingraham,  Chauncey,  Private,  Co.  K,  4th  New  York  Cavalry,  aged  23  years.  Sabre-cut  of  the  scalp.  Upperville, 
Virginia,  June  21st.  Returned  to  duty  Sejdember  28th,  1863.  Received  a similar  wound  at  Fiont  Royal,  Virginia,  August 
16th,  1864.  Admitted  to  Camp  Parole  Hosj)ital,  Annapolis,  Maryland,  October  7th.  Deserted,  while  on  furlough,  November 
18th,  1864. 

Jacobs,  A.  B.,  Private,  Co.  H,  6th  United  States  Cavalry.  Sabre-cut  of  the  scalp.  Fairfield,  Pennsylvania,  July  3d, 
1863.  Admitted  to  Camden  Street  Hospital,  Baltimore,  August  29th.  Transferi'ed  to  Cuyler  Hospital,  Germantown,  Pennsyl- 
v.ania,  October  27th.  Returned  to  duty  December  3d,  1863. 


INCISED  AND  PUNCTURED  WOUNDS. 


9 


JoxES;  William,.  Private,  Co.  L,  Gth  United  States  Cavalry.  Sabre-cut  of  the  scalp  and  arm.  Fairfield,  Pennsylvania, 
July  3d,  1863.  Admitted  to  West's  Building  Hos])ital,  Baltimore,  July ’iOth.  Transferred  to  Carver  Hospital,  Washington, 
July  24th.  Returned  to  duty  September  11th,  1863. 

Kellea',  Jefferson,  Corporal,  Co.  K,  6th  Michigan  Cavalry,  .aged  21  years.  Sabre-cut  of  the  scalp  aud  face.  Yellow 
Tavern,  Virginia,  June  11th,  1864.  Admitted  to  !Mt.  Pleasant  Hospital,  Washington,  June  21st.  Returned  to  duty  September 
13th,  1864. 

Kella’,  .Iosepii,  Serge.ant,  1st  New  Jersey  Cavalry.  Sabre-cut  of  the  scalp.  Beverly  Ford,  Virginia,  June  9th,  1863. 
As  no  further  record  can  be  found  of  this  case,  the  injury  was  ju'obably  trivial.  Mustered  out  Sej)tember  16th,  1864. 

Kemp,  Alfred,  Sergeant,  Co.  H,  7th  Michigan  Cavalry.  Sabre-cut  of  the  scalp  and  neck.  Gettysburg,  July  3d,  1863. 
Admitted  to  Jarvis  Hospital,  Baltimore,  July  19th.  Transferred  to  Detroit,  Michigan,  October  19th.  Discharged  May  2d,  1864. 

Kenla',  MTlliaji,  Private,  Co.  F,  4th  New  York  Cavalry.  Sabre-cuts  of  the  head  and  hand.  Aldie  Gap,  Virginia, 
June  17th,  1863.  Admitted  to  Third  Division  Hospital,  Alexandria,  Virginiti,  June  20th.  Discharged  from  service  February 
19th,  1864. 

, Kern,  Frederick,  Private,  Co.  D,  4th  New  York  Cavalry.  Sabre-cut  of  the  scalp  and  chest.  Front  Royal,  Virginia, 
August  16th,  1864.  Discharged  from  service  June  1st,  1865. 

Kidwell,  Philip,  Private,  Co.  C,  3d  Virginia  Mounted  Infantry,  aged  23  years.  Sabre-cut  of  the  scalp.  Cumberland, 
Maryland,  July  11th,  1863.  Admitted  to  hospital  at  Cumberland  the  same  day,  and  returned  to  duty  November  18th,  1863. 

Kiernlan,  Michael,  Private,  Co.  A,  Gth  United  States  Cavalry.  Sabre-cut  of  the  scalp.  Upperville,  Virginia,  June  21st, 
1863.  Admitted  to  Emory  Hospital,  Washington,  June  24th.  Furloughed  July  12th.  Returned  to  duty  August  13th,  1863. 

King,  Samuel,  Private,  Co.  H,  149th  Pennsylvania  Volunteers,  aged  33  years.  Sabre-cut  of  the  scalp.  Cold  Harbor, 
Virginia,  June  1st,  1864.  Admitted  to  Convalescent  Hospital,  Philadelphia,  June  11th.  Transferred  to  Harrisburg,  Pennsyl- 
vania, September  23d,  and  returned  to  duty  October  Gth,  1864. 

Kirby,  Andrew  H.,  Private,  Beckham’s  Battalion.  Sabre-cut  of  the  scalp.  Admitted  to  Lincoln  Hospital,  W’^ashington, 
September  17th,  1863.  Transferred  for  exchange  October  19th,  1863. 

Kirkpatrick,  William,  Private,  Co.  M,  14th  Pennsylvania  Cavalry,  aged  45  years.  Sabre-cut  of  the  scalp.  Mill- 
wood,  Virginia,  December  17th,  1864.  Admitted  to  Camden  Street  Hospital,  Baltimore,  December  22d.  Transferred  to  Phila- 
delphia March  12th,  1865.  Discharged  from  service  May  16th,  1865. 

Klim,  William  J.,  Private,  Co.  L,  1st  Maryland  Cavalry.  Sabre-cut  of  the  left  frontal  region.  Chambersburg, 
Pennsj’lvania,  July  28th,  1864.  Admitted  to  Yoi’k  Hospital,  Pennsylvania,  August  3d.  Returned  to  duty  September  15th,  1864. 

Knox,  Benj.vmin  E.,  Sergeant,  Co.  B,  2d  New  York  Cavalry.  Sabre-cut,  an  inch  and  a half  long,  over  occipital  pro- 
tuberance. Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  June  14th.  Returned 
to  duty  October  19th,  1863. 

Lago,  William,  Private,  Co.  L,  14tlr  Pennsylvania  Cavalry,  aged  22  years.  Sabre-cut  of  the  right  side  of  the  seal]). 
Millwood,  Vir’ginia,  December  17th,  1864.  Admitted  to  Patter-son  Park  Hospital,  Baltimore,  March  3d.  Returned  to  duty 
March  8th,  1865. 

Leahy,  John,  Sergeant,  Co.  D,  13th  Pennsylvania  Cavalry.  Sabre-cut  of  the  left  side  of  the  head.  Admitted  to  Hos- 
pital No.  1,  Annapolis,  Maryland,  March  8th,  1863.  Deserted  April  7th,  1863.  Returrred  from  desertion  April  30th,  1863,  and 
ordered  to  report  to  Colorrel  Waite,  Military  Commander  at  Annapolis. 

Leavitt,  Frank  W.,  Pr-ivate,  Co.  E,  1st  Maine  Cavalry,  aged  25  years.  Three  sabre-cuts  on  left,  ceirtre,  and  back  of 
the  head,  and  pistol  wound  through  left  side  of  upper  lip.  Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  Hospital 
No.  1,  Annapolis,  June  15th.  Returned  to  duty  Septendier  13th,  1863. 

Lee,  Jeremiah,  Private,  Co.  K,  Gth  I’ennsylvania  Cavalry.  Sabre-cut  of  right  occipital  region.  Culpeper,  Virginia, 
June  9th,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  June  14th.  Tran.sferred  to  Philadelphia  October 
3d,  1863.  He  was  discharged,  and  his  application  for  a pension  was  rejected  May  13th,  1864,  his  wound  having  produced  no 
disabilitj'. 

Lee,  Thomas,  Private,  Co.  C,  14th  Pennsylvania  Cavalry,  aged  22  years.  Sabre-cut  of  the  left  side  of  the  scalp.  P'ive 
I orks,  Virginia,  April  2d,  186.5.  Admitted  to  Slough  Hospital,  Alexandria,  Virginia,  .June  Gth.  Discharged  from  service  .June 
29th,  1885.  a.  O.  Xo.  77,  A.  G.  0.,  April  28th,  1865. 

Little,  Jicsse  IL,  Private,  Co.  B,  18th  Pennsylvania  Cavalry.  Sabre-cuts  of  the  head  and  shoulder.  Hanover,  Penn- 
sylvania, .June  30th,  18.i3.  Aihnittod  to  Satterlee  Hospit.al,  Philadelphia,  July  9th.  Returned  to  duty  .January  22d,  1864. 

Lockwood,  S.,  Private,  Co.  K,  1st  United  States  Cavalry.  Sabre-cut  of  the  scalp.  Upperville,  Virginia,  June  21st, 
1863.  Admitted  to  Emory  Hospital,  Washington,  June  23d.  Returned  to  duty  July  13th,  1863. 

Logan,  M.  M.,  Sergeant,  Co.  M,  16th  Pennsylvania  Cavalry,  aged  21  years.  Seven  sabre-cuts  of  the  scalf),  one  of  the 
right  shoulder,  one  of  the  left  forearm,  and  a pistol-shot  wound  of  the  right  hip.  Aldie,  Virginia,  .June  18th,  1863.  Admitted 
to  Lincoln  Hospital,  Washington,  June  21st.  Returned  to  duty  January  17th,  1864. 

Lotz.  William  L.,  Private,  Co.  L,  1st  Pennsylvania  Cavalry,  aged  17  years.  Sabrc-ciit  of  the  right  side  of  the  scalp 

2 


10 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 

Near  Richmond,  Virginia,  May  9tli,  1864.  Admitted  to  Hammond  Hospital,  Point  Lookout,  Maryland,  May  16th.  Returned 
to  duty  July  19th,  1864. 

Lowry,  Isaac,  Private,  Co.  C,  11th  Georgia  Infantry,  aged  23  years.  Sabre-cut  of  the  scalp.  Fisher’s  Hill,  Virginia, 
October  19th,  1864.  Admitted  to  hospital  at  Point  Lookout,  Maryland,  January  3d,  1865.  Transferred  for  exchange,  well, 
February  11th,  1865. 

Lucas,  Willard  H.,  Private,  Co.  B,  1st  Maine  Cavalry,  aged  28  years.  Sabre-cut  of  scalp.  Yellow  Tavern,  Virginia, 
May  12th,  1864.  Transferred  to  United  States  Navy  July  4th,  1864. 

Lunt,  Albert  C.,  Private,  Co.  I,  1st  Vermont  Cavalry.  Sabre-cut  of  the  left  parietal  region,  two  inches  above  the 
ear  ; also  one  of  the  vertex.  Dranesville,  Virginia,  April  1st,  1863.  Admitted  to  Hospital  No.  1,  Annapolis,  April  8th.  Trans- 
ferred to  Brattleboro’,  Vermont,  July  29th ; thence  to  Bedloe’s  Island,  New  York  Harbor,  November  8th.  Returned  to  duty 
November  16th,  1863. 

Lutes,  James  W.,  Private,  Co.  F,  1st  Michigan  Cavalry.  Sabre-cuts  of  forehead  and  vertex  of  scalp.  Gettysburg, 
July  3d,  1863.  Admitted  to  First  Di^sion  Hospital,  Annapolis,  Maryland,  July  16th.  Returned  to  duty  August  15th,  1863. 

Luther,  James,  Private,  Co.  G,  8th  Illinois  Cavalry.  Sabre-cut  of  the  scalp.  Upperville,  Virginia,  June  21st,  1863. 
Recovered,  and  re-enlisted  in  the  Veteran  Reserve  Corps.  Mustered  out  of  service  July  17th,  1865. 

Luther,  Nicholas,  Private,  Co.  B,  21st  Veteran  Reserve  Corps,  aged  49  years.  Sabre-cut  of  forehead.  Troy,  New 
York,  while  on  guard.  Admitted  to  hospital  at  Albany,  New  York,  August  24th.  Returned  to  duty  September  26th,  1864. 

Lyons,  Jajies,  Private,  Co.  E,  18th  Pennsylvania  Cavalry.  Sabre-cut  of  the  scalp.  Hanover,  Pennsylvania,  June 
30th,  1863.  Admitted  to  Jarvis  Hospital,  Baltimore,  July  14th,  and  transferred  to  First  Division  Hospital,  Annapolis,  Mary- 
land, July  16th.  Returned  to  duty  August  11th,  1863. 

Mack,  John,  Private,  Co.  E,  1st  Connecticut  Cavalry,  aged  26  years.  Sabre-cut  of  the  scalp.  Cedar  Creek,  Virginia, 
October  17th,  1864.  Admitted  to  Field  Hospital  at  Sandy  Hook,  Maryland,  October  21st.  Transferred  to  Satterlee  Hospital, 
Philadelphia,  October  27th.  Returned  to  duty  December  1st,  1864. 

Mann,  Nehemiah  H.,  Captain,  Co.  M,  4th  New  York  Cavalry.  Sabre-cut  of  the  scalp,  and  gunshot  flesh  wound  of 
chest.  Upperville,  Virginia,  June  21st,  1863.  Admitted  to  Emory  Hospital,  Wasliington,  June  23d.  Returned  to  duty  Sep- 
tember 29th,  1863. 

McAlexander,  D.,  Private,  Co.  G,  21st  Virginia  Cavalry,  aged  18  years.  Sabre-cut  of  the  scalp.  Front  Royal,  Virginia, 
November  9th,  1864.  Admitted  to  West’s  Building  Hospital,  Baltimore,  November  16th.  Transferred  for  exchange,  well, 
December  9th,  1864. 

McCabe,  George,  Private,  Co.  C,  2d  Maryland  Cavalry.  Sabre-cut  of  the  left  parietal  region.  Monocacy,  Maryland,  July 
9th,  1864.  Admitted  to  West’s  Building  Hospital,  Baltimore,  September  3d.  TransfeiTed  to  Fort  McHenry,  Baltimore,  for 
exchange,  well,  September  24th,  1864. 

McClellan,  Williaji  T.,  Private,  Co.  B,  12th  Pennsylvania  Cavalry,  aged  24  years.  Sabre-cut  of  the  scalp.  Raid 
on  Hamilton,  Virginia,  March  21st,  1865.  Admitted  to  hospital  at  Harper’s  Ferry,  Virginia,  March  25th.  Transferred  to 
Cumberland,  Maryland,  April  6th.  Returned  to  duty  April  24th,  1865. 

McCool,  Michael  H.,  Sergeant,  Co.  B,  71st  New  York  Volunteers,  aged  30  years.  Sabre-cut  of  the  scalp.  Chancel- 
lorsville,  Virginia,  May  3d,  1863.  Admitted  to  Turner’s  L.ane  Hospital,  Philadelphia,  March  14th.  Discharged  from  service  May 
17th,  1864. 

McCoy,  John,  Private,  Co.  K,  9th  Indiana  Cavalry,  aged  29  years.  Incised  wound  of  the  scalp.  In  an  aflfray. 
Admitted  to  hospital  at  Indianapolis,  Indiana,  April  13th.  Returned  to  duty  May  6th,  1864. 

McDowell,  James,  Private,  Co.  H,  6th  United  States  Cavalry.  Sabre-cut  of  the  scalp.  Fairfield,  Pennsylvania,  July 
3d,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  August  3d.  Returned  to  duty  August  15th,  1863. 

McFall,  .Jonatilan,  Private,  Co.  A,  6th  Michigan  Cavalry.  Sabre-cuts  of  the  scalp  and  shoulder.  Gettysburg,  July 
1st,  1863.  Admitted  to  Satterlee  Hospital,  Philadelphia,  July  10th.  Returned  to  duty  December  4th,  1863. 

McKenna,  Davenport,  Private,  Co.  G,  14th  Pennsylvania  Cavalry,  aged  21  years.  Sabre-cut  of  the  scalp.  Mill- 
wood,  Virginia,  December  17th,  1864.  Admitted  to  Camden  Street  Hospital,  Baltimore,  December  21st.  Returned  to  duty 
February  23d,  1865. 

McKowen,  William,  Corporal,  Co.  G,  1st  Maryland  Cavalry.  Sabre-cut  of  the  forehead,  and  one  on  the  back  of  the 
neck.  Culpeper,  Virginia,  September  3d,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  September  24th. 
Returned  to  duty  November  9th,  1863. 

McLean,  William,  Captain,  Co.  H,  5th  United  States  Cavalry.  Two  or  three  sabre-cuts  of  the  posterior  portion  of 
the  scalp.  Hanover,  Virginia,  June  13th,  1862.  Taken  prisoner,  and  confined  in  Libby  Prison,  Richmond,  for  a few  weeks, 
when  he  was  released.  Died  of  inflammation  of  the  brain  April  13th,  1863. 

McVeigh,  T.  E.,  Corporal,  Co.  F,  15th  Virginia  Cavalry.  Sabre-cut,  three  inches  in  length,  of  the  superior  occipital 
region.  Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  Prince  Street  Hospital,  Alexandria,  June  10th.  Transferred 
to  provost  marshal  June  12th,  1863,  for  exchange. 


INCISED  AND  PUNCTURED  WOUNDS.  11 

Meagher,  Edward,  Private,  Co.  M,  Cth  United  States  Cavalry.  Sabre-cut  of  the  scalp.  Fairfield,  Pennsylvania, 
July  3d,  1833.  Discharged  September  2Gth,  1864,  on  expiration  of  term  of  service. 

Meredith,  D.  H.,  Private,  Co.  C,  1st  Delaware  Cavalry,  aged  28  years.  Sabre-cut  of  the  scalp ; also  gunshot  wound 
of  the  left  leg.  Westminster,  Maryland,  June  29th,  1863.  Admitted  to  Tilton  Hospital,  Wilmington,  Delaware,  July  4th. 
Transferred  to  Mower  Hospital,  Philadelphia,  April  27th,  1864.  Returned  to  duty  July  11th,  1864. 

Might,  Johx,  Private,  Co.  E,  6th  United  States  Cavalry.  Sabre-cut  of  the  scalp.  Upperville,  Virginia,  June  21st, 

1863.  Admitted  to  Emory  Hospital,  Washington,  June  24th.  Returned  to  duty  August  13th,  1863. 

Miller,  Fraxk  E.,  Sergeant,  Co.  B,  1st  New  York  Cavalry.  Sabi’e-cuts  of  the  scalp  and  ear.  Dinwiddle  Coui  t House, 
Virginia,  March  31st,  1865.  Recovered,  and  mustered  out  with  his  regiment  June  27th,  1865. 

Miller,  John  W.,  Private,  Co.  L,  14th  Pennsylvania  Cavalry,  aged  22  years.  Sabre-cut  of  the  scalp.  Ashby’s  Gap, 
Virginia,  February  9th,  1865.  Admitted  to  hospital  at  Frederick,  Maryland,  March  1st,  1865.  Discharged  from  service  July 
10th,  1865. 

Mills,  W’^.  S.,  Private,  Co.  F,  1st  Michigan  Cavalry.  Sabre-cut  of  the  scalp  and  shoulder.  Gettysburg,  J uly  1st,  1863. 
Admitted  to  Broad  and  Cherry  Streets  Hospital,  Philadelphia,  July  15th.  Returned  to  duty  August  12th,  1863. 

Montgomery,  John,  Private,  Co.  F,  18th  Pennsylvania  Cavalry,  aged  20  years.  Sabre-cut  of  the  occipital  region. 
Hanover  Junction,  Pennsylvania,  June  30th,  1863.  Admitted  to  Cuyler  Hospital,  Germantown,  Pennsylvania,  July  5th. 
Returned  to  duty  December  10th,  1863. 

Morris.  J.,  Private,  Co..  H,  1st  Virginia  Artillery,  aged  20  years.  Sabre- wound  of  the  scalp.  Lynchburg,  Virginia, 
June  13th,  1864.  Admitted  to  Post  Hospital,  New  Creek,  West  Virginia,  June  20th.  Returned  to  duty  July  6th,  1864. 

IMortsolf,  Martin,  Corporal,  Co.  C,  10th  New  York  Cavalry.  Three  sabre-cuts — one  of  forehead,  one  of  right  arm, 
and  one  of  back,  extending  from  left  shoulder  to  right  hip.  Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  Prince 
Street  Hospital,  Alexandria,  June  10th.  Returned  to  duty  July  6th,  1863. 

Nellis,  John,  Corporal,  Co.  A,  6th  Ohio  Cavalry.  Sabre-cut  of  the  scalp.  Upperville,  Virginia,  June  21st,  1863. 

Nelman, , Private,  Co.  B,  Irish  Dragoons,  Fremont’s  Body  Guard.  Sabre-cut  of  the  scalp  and  several  bruises. 

Springfield,  Jlissouri,  October  25th,  1861.  As  no  further  record  can  be  found  of  this  case,  the  injuries  were  probably  tr  ivial. 

Newkirk,  Jajies  C.,  Private,  Co.  C,  1st  Delaware  Cavalry.  Sabre-cut  of  the  scalp.  Westminster,  Maryland,  June 
29th,  1863.  Admitted  to  Tilton  Hospital,  Wilmington,  Delaware,  July  4th.  Returned  to  duty  August  25th,  1863. 

O'Connell,  C.,  Private,  Co.  C,  5th  Illinois  Cavalry.  Sabre-cut  of  the  scalp.  Ellisville,  Mississippi,  June  23d,  1863. 
Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  July  15th.  Returned  to  duty  September  17th,  1863. 

Odell,  Charles  L.,  Private,  Co.  B,  86th  New  York  Volunteers.  Sabre-cut  of  the  scalp.  Beverly  Ford,  Virginia, 
June  9th,  1863.  Admitted  to  Lincoln  Hospital,  Washington,  June  11th.  Returned  to  duty  June  24th,  1863. 

O’Neil,  Thomas,  Private,  Co.  I,  1st  Maryland  Cavalry,  aged  24  years.  Accidental  incised  wound  of  the  scalp.  Admitted 
to  Jarvis  Hospital,  Baltimore,  March  11th,  1864.  Returned  to  duty  April  14th,  1864. 

Overton,  George  P.,  Private,  Co.  E,  15th  New  York  Cavalry,  aged  41  years.  Sabre-cut  of  the  scalp.  Newmarket, 
Virginia,  December  21st,  1864.  Admitted  to  hospital  at  Frederick,  Maryland,  December  23d.  Returned  to  duty  January  21st, 
1865. 

Palmer,  David,  Private,  Co.  K,  6th  Oliio  Cavalry,  aged  19  years.  Sabre-cut  of  right  occipital  region.  Yellow  Tavern, 
Vir^uia,  May  12th,  1864.  Admitted  to  hospital  at  Point  Lookout,  Maryland,  May  16th.  Returned  to  duty  June  28th,  1864. 

Parcells,  Joseph  A.,  Private,  Co.  F,  3d  Pennsylvania  Cavalry,  aged  22  years.  Sabre-cut  of  the  head,  and  also  over 
the  right  clavicle.  Gettysburg,  July  2d,  1863.  Admitted  to  Chester  Hospital,  Pennsylvania,  July  9th,  1863.  Returned  to  duty 
December  23d,  1863. 

Parris,  George  W.,  Private,  Co.  D,  5th  New  York  Cavalry.  Sabre-cut  of  the  scalp.  September  13th,  1863.  Admitted 
to  Armory  Square  Hospital,  Washington,  September  14th.  Returned  to  duty  December  4th,  1863. 

Patterson,  John,  Private,  Co.  B,  1st  United  States  Cavalry.  Sabre-cut  of  the  right  side  of  the  scalp.  Upperville, 
Virginia,  June  21st,  1863.  Admitted  to  Hospital  No.  1,  Annapolis,  July  15th.  Returned  to  duty  August  15th,  1863. 

Phetteplace,  Madison,  Private,  Co.  I,  23d  Ohio  Volunteers,  aged  35  years.  Sabre-cut  of  the  scalp.  Cedar  Creek, 
Virginia,  October  19th,  1864.  Admitted  to  Satterlee  Hospital,  Philadelphia,  October  23d.  Transferred  to  Tripler  Hosjwtal, 
Columbus,  Ohio,  June  28th.  Mustered  out  of  service  July  7th,  1865. 

Pickett,  Thomas,  Private,  Co.  I,  2d  Maine  Cavalry.  Sabre-cut  of  left  side  of  scalp.  Pino  Barrens,  Florida,  October, 

1864.  Admitted  to  Regimental  Hospital,  and  returned  to  duty  the  same  day. 

Pool,  George  S.,  Private,  Co.  F,  1st  Michigan  Cavalry.  Sabre-cut  of  the  head  and  right  wrist.  Gettysburg,  .July  1st, 
1863.  Admitted  to  Broad  and  Cherry  Streets  Hospital,  Philadeljihia,  July  15th.  Discharged  from  service  October  3d,  1863. 

PORTELL,  Patrick,  Private,  Co.  B,  10th  Massachusetts  Volunteers.  Sabre-cut  of  the  right  side  of  the  head,  one  inch 
above  the  frontal  protuberance.  Gettysburg,  J uly  3d,  1863.  Admitted  to  Satterlee  Hospital,  Philadelphia,  J uly  5th.  Returned 
to  duty  April  22d,  1864. 

Pullen,  T.  E.,  Lieutenant,  Co.  G,  15th  Virginia  Cavalry,  aged  30  years.  Sabre-cut  of  the  occipital  region.  Admitted 
to  Chimborazo  Hospital,  Richmond,  Virginia,  May  17th.  Returned  to  duty  June  20th,  1864. 


12 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Putnam,  Oijrin  J.,  Corporal,  Co.  I,  1st  Vermont  Cavalry,  aged  24  years.  Sabre-cut  of  left  side  of  file  scalp.  Dranes- 
ville,  Virginia,  April  1st,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  April  8th.  Transferred  to  Invalid 
Corps,  ^Marcli  loth,  1864,  and  mustered  out  on  expiration  of  his  term  of  service. 

Pye,  Oliver,  Private,  Co.  K,  1st  New  Hampshire  Cavalry,  aged  37  years.  Sword  wound  of  the  scalp.  Newtown, 
Virginia,  November  12th,  1864.  Admitted  on  the  same  day  to  the  Cavalry  Corps  Hospital,  and  transferred  November  20th  to 
McKim's  Mansion,  Baltimore,  Died  December  10th,  18()4,  of  “effects  of  sabre  wound,” 

Quinn,  Michael,  Bugler,  Co,  D,  4th  United  States  Cavalry,  aged  19  years.  Sabre-cut  of  the  scalp,  Franklin,  Ten- 
nessee, November  30th,  1864.  Admitted  to  No.  15  Hospital,  Nashville,  December  23d.  Returned  to  duty  January  4th,  1865. 

Quinn,  Peter,  Private,  Co.  B,  17th  Veteran  Reserve  Corps,  aged  43  years.  Severe  incised  wound  of  the  scalp.  Acci- 
dental. Admitted  to  hospital,  Indianapolis,  Indiana,  June  23d,  from  Ekin  Bawacks.  Returned  to  duty  October  27th,  1864. 

Remington,  George  W.,  Captain,  Co.  H,  2d  New  York  Cavalry,  aged  24  years.  Sabre-cut  of  the  scalp.  Mount 
Jackson,  Virginia,  November  22d,  1864.  Admitted  to  Field  Hospital  at  Sandy  Hook,  Maryland,  November  30th.  Clustered 
out  on  expiration  of  term  of  service,  June  5th,  1865. 

Rice,  Horatio  H.,  Sergeant,  Co.  A,  10th  New  York  Cavalry,  aged  24  years.  Sabre-cut  of  the  scalp,  and  a gunshot 
flesh  wound  of  the  thigh.  Trevillian  Station,  June  11th,  1864.  Admitted  to  Mount  Pleasant  Hospital,  Washington,  June  21st, 
1864.  Transferred  to  Satterlee  Hospital,  Philadelphia,  June  29th.  Discharged  December  7th,  1864,  on  account  of  expiration 
of  term  of  enlistment. 

Richardson,  E.,  Private,  Co.  B,  2d  Georgia  Cavalry.  Sabre-cut  of  the  head.  Admitted  to  rebel  hospital,  Petersburg, 
Virginia,  December  10th,  1862.  Returned  to  duty  December  23d,  1862. 

Richie,  J.  R.  F.,  Private,  Co.  H,  12th  Virginia  Cavalry.  Sabre  wound  of  the  head.  Admitted  to  Chimborazo  Hospital, 
Richmond,  Virginia,  June  12th,  1863.  Furloughed  June  24th,  1863,  for  sixty  days. 

Robinson,  Charles  E.,  Ihivate,  Co.  C,  9th  Virginia  Cavalry,  aged  43  years.  Sabre-cut  of  the  parietal  region  three  inches 
in  length.  UppervUle,  Virginia,  June  21st,  1863.  Admitted  to  Stanton  Hospital,  Washington,  June  23d.  Transferred  to  Old 
Capitol  Prison  August  16th,  1863,  for  exchange. 

Robinson,  WTlliaji,  Commissaiy  Sergeant,  2d  Ohio  Cavalry.  Sabre-cut  of  the  scalp.  September,  1864.  Mustered 
out  of  service  September  11th,  1865. 

Rogers,  George  A.,  Private,  Co.  H,  1st  Vermont  Calvary.  Sabre-cut  of  the  scalp.  Brandy  Station,  Virginia,  October 
11th,  1863.  Admitted  to  hospital  at  Annapolis,  October  29th;  transferred  to  Brattleboro,  Vej'mont,  December  9th;  transferred 
to  Baxter  Hospital,  Burlington,  December  Kith.  Returned  to  duty  February  25th,  1864. 

Rowie,  James  II.,  Private,  5th  Virginia  Cavalry.  Sabre-cut  of  the  scalp.  Aldie  Gap,  Virginia,  June  17th,  1863. 
Paroled. 

Ruffin,  Thomas,  Major,  1st  North  Carolina  Cavalry.  Sabre  wound  of  the  head.  Admitted  to  Hospital  No.  4,  Richmond, 
Virginia,  July  22d,  1863.  Furloughed  .July  29th,  1863. 

Russell,  George,  Sergeant,  Co.  I,  1st  Maine  Cavalry,  aged  21  years.  Sabre-cut  of  the  scalp.  Sheridan’s  Raid  in  Vir- 
ginia, May,  1864.  Discharged  the  service  August  17th,  1864. 

Ryan,  Jeremiah,  Private,  Co.  H,  22d  New  York  Cavalry,  aged  24  years.  Sabre-cut  of  the  scalp.  Admitted  to  De 
Camp  Hospital,  David’s  Island,  New  York  Harbor,  June  3d,  1865.  Discharged  from  service  July  15th,  1865. 

Ryan,  Saxey,  Sergeant,  Co.  G,  13th  Indiana  Volunteers,  aged  23  years.  Sabre-cut  of  the  scalp.  Bermuda  Hundred, 
Virginia,  June  19th,  1864.  Admitted  to  Filbert  Street  Hospital,  Philadelphia,  July  6th.  Transferred  to  Satterlee  Hospital  July 
16th.  Returned  to  duty  August  6th,  1864. 

Salisbury,  Frederick,  Private,  Co.  C,  10th  New  York  Cavalry.  Sabre-cut  of  the  left  parietal  region.  Beverly  Ford, 
Virginia,  June  9th,  1863.  Admitted  to  Second  Division  Hospital,  Annapolis,  Maryland,  June  14th.  Returned  to  duty  July 
24th,  1863. 

Saunders,  Edward,  Private,  Co.  AI,  7th  Michigan  Cavalry,  aged  18  years.  Sabre-cut  of  the  occipital  region.  Front 
Royal,  Virginia,  August  16th,  1864.  Admitted  to  Jarvis  Hospital,  Baltimore,  Maryland,  August  21st.  Returned  to  duty  Sep- 
tember 27th,  1864. 

Saxton,  Edward  P.,  Private,  Co.  D,  6th  Pennsylvania  Cavalry.  Sabre-cut  of  the  scalp.  Beverly  Ford,  Virginia, 
.June  9th,  1863.  Admitted  to  Second  Division  Hospital,  Annapolis,  Maryland,  June  14th.  Returned  to  duty  June  18th,  1863. 

Schaefer,  Gustavus,  Priv.Tte,  Co.  B,  12th  Pennsylvania  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  July  1st, 
1863.  Admitted  to  Satterlee  Hospital,  Philadelphia,  July  9th.  Returned  to  duty  August  11th,  1863. 

SciiEER,  WiLLiAJi,  Private,  Co.  M,  2d  United  States  Cavalry.  Sabre-cut  of  the  right  parietal  region.  Beverly  Ford, 
Virginia,  June  9th,  1863.  Admitted  to  Second  Division  Hospital,  Annapolis,  June  14th.  Returned  to  duty  July  27th,  1863. 

SCHiEViLBiEN,  Edward,  Corporal,  Co.  F,  3d  Indiana  Cavalry.  Sabre-cut  of  the  scalp.  Admitted  to  Field  Hospital, 
Hope’s  Landing,  Virginia,  March  23d,  1863.  Discharged  in  consequence  of  aberration  of  mind,  resulting  from  the  injury,  April 
12th.  1863. 

Secrer,  James,  Sergeant,  Co.  C,  1st  United  States  Cavalry.  Sabre-cut  of  the  scalp.  Upperville,  Virginia,  June  21st, 
1863.-  Admitted  to  Tilton  Hospital,  Wilmington,  Delaware,  August  12th.  Returned  to  duty  October  2d,  1863. 


I^ICISED  AND  PUNCTURED  WOUNDS. 


13 

Shaw,  C.  C.,  Private,  1st  Virginia  Cavalry,  aged  18  years.  Sabre-cut  of  the  left  parietal  region.  Warrenton,  Virginia, 
May  3d,  18C3.  Admitted  to  ^Mansion  House  Hospital,  Alexandria,  Virginia,  May  3d,  18G3.  Transferred  for  exchange,  well,  June 
15tli,  18G3. 

SiiEPiiEUD,  Heubekt  L.,  Private,  Co.  11,  1st  Massachusetts  Cavalry.  Sabre-cut,  two  inches  in  length,  of  the  right 
parietal  region,  and  slight  cut  of  the  hand.  Manassas  Gap,  Virginia,  June  17th,  18G3.  Admitted  to  First  Division  Hospital, 
Annapolis,  Maryland,  July  IGth.  Returned  to  duty  October  5th,  18G3. 

Shotwei.l,  Joiix,  Sergeant,  Gtli  Kentucky  Cavalry.  Sabre-cut  of  the  scalp.  Sherman’s  Campaign  through  the  Caro- 
linas,  1865. 

Sheffield,  John,  Private,  Co.  D,  1st  Arkansas  Cavalry,  aged  18  years.  Sabre-cut  of  the  forehead.  Osage,  Missouri, 
October  25th,  18G4.  Admitted  to  hospital  at  Fort  Scott,  Kansas,  October  28th.  Returned  to  confinement  November  17th,  1864. 
Subsequently  exchanged. 

Singleton,  William,  Piivate,  Co.  B,  Kith  New  York  Cavalry.  Sabre-cut  of  the  scalp.  Near  Opelousas,  Louisiana, 
October  22d,  1863.  Admitted  to  hospital  at  New  Orleans,  November  11th.  Returned  to,  duty  December  3d,  1863. 

Skid,  John,  Private,  Co.  A,  6th  Michigan  Cavalry,  aged  27  years.  Sabre-cut  of  the  scalp.  Gettysburg,  July,  1863. 
Admitted  to  Satterlee  Hospital,  Philadelphia,  July  9fh.  Returned  to  duty  November  27th,  1863. 

Small,  John  F.,  Sergeant,  Co.  H,  1st  United  States  Cavalry.  Sabre-cut  of  the  left  parietal  region.  Upperville,  Vir- 
ginia, June  21st,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  July  15th.  Returned  to  duty  September 
26th,  1863. 

Smith,  Geobge  W.,  Private,  Co.  D,  1st  Michigan  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  July  1st,  1863. 
Admitted  to  hospital  at  Gettysburg  .July  2d.  Returned  to  duty  July  9th,  1863. 

S.MITH,  PIeney  M.,  Private,  Co.  C,  11th  Pennsylvania  Volunteers,  aged  34  years.  Sabre-cut  of  the  scalp.  Wilderness, 

Virguiia,  May  5th,  1864.  Admitted  to  hospital  at  Pittsburg  June  23d.  Returned  to  duty  March  Ist,  1865. 

Smith,  John  B.,  Private,  Co.  K,  6th  Pennsylvania  Cavalry.  Sabre-cut  of  the  scalp.  Beverly  Ford,  Virginia,  June  9th, 

1863.  As  no  further  record  can  be  found  of  this  case,  the  injury  was  probably  trivial. 

Smith,  Patkick,  Private,  Co.  A,  8th  New  York  Cavalry,  aged  21  years.  Sabre-cut  of  the  scalp.  Lacey’s  Springs, 
Virginia,  December  21st,  1864.  Admitted  to  hospital  at  Frederick,  Maryland,  December  23d.  Returned  to  duty  January  21st, 
1865. 

Southeeland,  Joseph,  Private,  Co.  D,  1st  Illinois  Artillery,  aged  22  years.  Sabre-cut  of  the  scalp.  December  25th, 

1864.  Admitted  to  hospital  at  Nashville,  Tennessee,  the  same  day.  Returned  to  duty  January  4th,  1865. 

Staff,  Isaac,  Private,  Co.  H,  14th  Pennsylvania  Cavalry.  Sabre-cut  of  the  scalp.  Millwood,  Virginia,  December 
17th,  1864. 

Stanton,  C.  S.,  Private,  Co.  D,  2d  United  States  Cavalry,  aged  23  years.  Sabre-cut  of  the  scalp.  Winchester,  Virginia, 
September  19th,  1864.  Admitted  to  hospital  at  Frederick,  Maryland,  October  12th.  Returned  to  duty  December  3d,  1864. 

Steakem,  M.,  Private,  Co.  1, 16th  Massachusetts  Volunteers.  Sabre-cut  of  the  scalp.  Gettysburg,  July,  1863.  Admitted 
to  South  Street  Hospital,  Philadelphia,  July  8th.  Returned  to  duty  July  27th,  1863. 

Steinhausee,  J.,  Private,  Co.  C,  1st  United  States  Cavalry,  aged  22  years.  Sabre-cut,  two  and  a half  inches  long,  of 
the  right  temporal  region;  also  a wound  of  the  thoracic  parieties.  Culpeper,  Virginia,  August  1st,  1863.  Admitted  to  Douglas 
Hospital,  Washington,  August  2d.  Returned  to  duty  October  17th,  1863. 

Stellman,  Chaeles,  Private,  Co.  B,  6th  Ohio  Cavalry.  Sabre-cut  of  the  scalp.  Beaver  Dam,  Virginia,  May,  1864. 

Stevens,  Daniel,  Private,  Co.  I,  36th  Virginia  Infantry,  aged  34  years.  Sabre-cut  of  the  scalp.  Winchestei-,  Virginia, 
September  19th,  1864.  Admitted  to  West’s  Building  Hospital,  Baltimore,  October  13th.  Transferred  for  exchange  October 
17th,  1864. 

Sti.mpson,  Robeet  E.,  Private,  Co.  G,  1st  Michigan  Cavalry,  aged  20  years.  Sabre-cut  of  the  head.  Gettysburg,  July 
2d,  1863.  Admitted  to  Satterlee  Hospital,  Philadelphia,  July  9th.  Returned  to  duty  September  23d,  1863. 

Steuble,  L.  G.,  Corpoi’al,  Co.  A,  5th  Michigan  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  July  1st,  1863.  Admitted 
to  Fort  Schuyler  Hospital,  New  York  Harbor,  July  15th.  Transferred  to  De  Camj)  Hospital,  David’s  Island,  February  9th, 
1864.  Returned  to  duty  February  20th,  1864. 

Sl’LHAm,  Jonas  G.,  Private,  Co.  I,  1st  Vennont  Cavalry,  aged  40  years.  Sabre-cut  of  the  left  side  of  head;  also  gun- 
shot wound  of  right  side  of  head,  and  two  bruises  of  right  side  of  scalp  by  a revolver  barrel.  Di'anesville,  Virginia,  April  1st, 
1863.  Admitted  to  Hospital  No.  1,  Annapolis,  April  8th.  Returned  to  duty  May  1st,  1863.  He  was  captured  June  9th,  1864, 
and  died  in  a southern  piison. 

Swain,  D.  P.,  Sergeant,  Co.  A,  6th  Michigan  Cavalry.  Sabre-cut  of  the  scalp.  Hunterstown,  Pennsylvania,  .July  2d, 
1863.  Recovered  and  returned  to  duty.  Subsequently  he  was  captured,  and  died  in  prison  at  Andersonville,  Georgia. 

Taesaei,  Adolphus,  Private,  Co.  B,  12th  New  York  Cavalry,  aged  19  years.  Sabre-cuts  of  the  scalp  and  right  hand; 
September  29th,  1864;  for  the  latter,  amputation  of  the  index  finger  was  performed.  June  27th,  1865.  Admitted  to  McDougall 
Hospital,  New  York  Harbor,  .July  9th.  Deserted  August  3d,  1865. 


14 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Taylor,  C.  M.,  Private,  Co.  D,  Jeff.  Davis  Legion.  Sabre-cut  of  the  occipital  region  ; also  a gunshot  w'ound  of  left  arm. 
Ujiperville,  Virginia,  June  21st,  1863.  Admitted  to  Stanton  Hospital,  Washington,  June  23d.  Transferred  for  exchange 
August  1st,  1863. 

Tewksbuky,  Benjamin  P.,  Private,  Co.  E,  3d  New  York  Cavalry,  aged  46  years.  Sabre-cut  of  the  head,  and  contu- 
sion of  the  back  by  a fall  from  his  horse.  Ream’s  Station,  Virginia,  June  2Dth,  1864.  Admitted  to  Balfour  Hospital,  Portsmouth, 
Virginia,  from  Regimental  Hospital,  May  24th,  1865.  Discharged  July  20th,  1865. 

Thomas,  J.  IF.,  Sergeant,  Co.  A,  1st  Georgia  Cavalry.  Sabre-cut  of  the  head.  Admitted  to  hospital  at  Petersburg, 
Virginia,  November  18th,  1862.  Returned  to  duty  December  2d,  1862. 

Thompson,  C.  S.,  Lieutenant,  Co.  E,  2d  South  Carolina  Cavalry.  Sabre- wound  of  the  head.  Admitted  to  Hospital  No.  4, 
Richmond,  Virginia,  August  6th,  1863.  Furloughed  August  12th,  1863. 

Thompson,  John,  Private,  Co.  C,  7th  Michigan  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  July  3d,  1863.  Admitted 
to  First  Division  Hospital,  Annapolis,  Maryland,  July  16th.  Returned  to  duty  August  26th,  1863. 

Thompson,  William  H.,  Private,  Co.  K,  18th  Alabama  Infantry,  aged  24  years.  Sabre-cut  of  the  scalp.  Nashville,  Ten- 
nessee, December  15th,  1864.  Admitted  to  hospital  at  NashvUle  December  25th,  1864.  Transferred  to  Provost  Marshal  January 
3d,  1865,  for  exchange. 

Tomein,  John  F.,  Captain,  Co.  M,  3d  New  Jersey  Cavalry.  Sabre-cut  of  the  scalp.  Sailor’s  Run,  Virginia,  April  6th, 
1865.  Admitted  to  Cavalry  Corps  Hospital  April  11th.  Furloughed  April  18th.  Mustered  out  of  service  August  1st,  1865. 

Towiste,  Edward  O.,  Corporal,  Co.  D,  1st  Massachusetts  Cavalry,  aged  39  years.  Sabre-cut,  three  inches  in  length, 
behind  the  right  ear.  Aldie,  Virginia,  June  17th,  1863.  Admitted  to  Third  Division  Hospital,  Alexandria,  Virginia,  Jime  18th. 
Furloughed  July  18th,  1863.  Returned  to  duty  and  mustered  out  with  regiment  October  3d,  1864. 

Townslee,  Giles,  Private,  Co.  A,  6th  Michigan  Cavalry.  Sabre-cuts  of  the  scalp  and  left  arm.  Hunterstown,  Penn- 
sylvania, July  2d,  1863.  Admitted  to  Satterlee  Hospital,  Philadelpliia,  July  10th.  Returned  to  duty  September  23d,  1863. 

Trauer,  William  D.,  Private,  Alabama  Reserves,  aged  47  years.  Sabre-cut  of  the  scalp.  Milton,  Florida,  December 
24th,  1864.  Admitted  to  St.  Louis  Hospital,  New  Orleans,  Louisiana,  December  28th.  Transferred  to  Military  Prison  March 
11th,  1865,  for  exchange. 

Tweedale,  T.,  Private,  Co.  I,  1st  United  States  Cavalry.  Sabre-cut  of  the  scalp.  Upperville,  Virginia,  June  21st, 

1863.  Admitted  to  Emory  Hospital,  Washington,  June  23d.  Returned  to  duty  September  11th,  1863. 

Updyke,  Everett  C.,  Private,  Co.  D,  10th  New  York  Cavalry.  Sabre-cut  of  the  right  occipital  region,  three  inches 
in  length.  Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  Hospital  No.  1.  Annapolis,  June  14th.  Returned  to  duty 
August  15th,  1863. 

Updyke,  J.  R.,  Private,  Co.  B,  5th  New  York  Cavalry.  Sabre-cut  of  the  scalp,  and  gunshot  wound  of  the  hip.  Han- 
over, Pennsylvania,  June  30th,  1863.  Admitted  to  Fort  Schuyler  Hospital,  New  York  Harbor,  July  15th.  Returned  to  duty 
August  28th,  1863. 

Walker,  John  B.,  Private,  Co.  K,  36th  Virginia  Infantry,  aged  38  years.  Sabre-cut  of  the  scalp.  Winchester,  Virginia, 
September  19th,  1864.  Admitted  to  hospital  at  Winchester  the  following  day.  Transferred  to  Baltimore  December  11th. 
Sent  to  Fort  McHenry  January  5th,  1865,  for  exchange. 

Watson,  John,  Private,  Co.  H,  1st  Michigan  Cavalry.  Sabre-cut  of  the  scalp.  Gettysburg,  Pennsylvania,  Jidy,  1863. 
Admitted  to  South  Street  Hospital,  Philadelphia,  July  8th.  Returned  to  duty  July  27th,  1863. 

Watts,  IF.  C.,  Private,  Co.  D,  14th  Virginia  Cavalry,  aged  26  years.  Sabre-cut  of  the  scalp.  Front  Royal,  Vir^ia, 
November  12th,  1864.  Admitted  to  Field  Hospital,  Winchester,  Virginia,  November  14th.  Transferred  to  Fort  McHenry 
December  9th,  1864,  for  exchange. 

Weed,  William  H.,  Private,  Co.  C,  2d  West  Virginia  Cavalry.  Sabre-cut  of  the  scalp.  Five  Forks,  Virginia,  April 
Ist,  1865.  Mustered  out  of  service  June  3d,  1865. 

Wegman,  Jacob,  Private,  Co.  I,  16th  Illinois  Cavalry.  Sabre-cut  of  the  scalp.  Accident.  Admitted  to  West  End 
Hospital,  Cinemnati,  Ohio,  October  26th.  Returned  to  duty  December  19th,  1863. 

Welch,  Henry  L.,  Private,  Co.  B,  6th  Michigan  Cavalry.  Sabre-cut  of  the  scalp.  Front  Royal,  Virginia,  August 
16th,  1864.  Deserted  June  23d,  1865. 

Wentworth,  George  A.,  Private,  Co.  G,  2d  Massachusetts  Cavalry,  aged  24  years.  Sabre-cut  of  the  scalp. . Aldie, 
Virginia,  July  6th,  1864.  Admitted  to  Third  Division  Hospital,  Alexandria,  Virginia,  July  12th.  Returned  to  duty  September 
12th,  1864. 

Wilson,  Dana  S.,  Private,  Co.  K,  6th  Michigan  Cavalry,  aged  32  years.  Sabre-cut  of  the  scalp.  Front  Royal,  Vir- 
ginia, August  16th,  1864.  Admitted  to  Field  Hospital  at  Sandy  Hook,  Maryland,  August  18th.  Transferred  August  20th, 

1864.  Recovered  and  returned  to  duty.  Subsequently  died  of  chronic  diarrhoea,  November  13th,  1865. 

Wilson,  M.  D.,  Private,  Co.  H,  14th  Virginia  Cavalry,  aged  20  years.  Sabi'e-cut  of  the  scalp.  Front  Royal,  Virginia, 
November  12th,  1864.  Admitted  to  Field  Hospital,  Winchester,  Virginia,  November  14th.  Transferred  to  Baltimore  November 
16th,  and  thence  to  Fort  McHenry,  December  9th,  1864,  for  exchange. 

WiNGROVE,  George,  Private,  Co.  F,  9th  New  York  Heavy  Artillery.  Sabre-cut  of  the  right  parietal  region.  Shep- 


INCISED  AND  PUNCTUEED  WOUNDS.  15 

herdstown,  Virginia,  August  25th,  1864.  Admitted  to  Patterson  Park  Hospital,  Baltimore,  August  27th.  Transferred  to  Camp 
Parole  August  29th.  Eetm-ned  to  duty  October  5th,  1864. 

Winters,  August,  Private,  Co.  kl,  5th  Ohio  Cavalry,  aged  23  years.  Sabre-cut  of  the  scalp,  and  shell-wound  of  the 
ann.  Near  Fayetteville,  North  Carolina,  March  lOth,  1865.  Admitted  to  Grant  Hospital,  New  York  Harbor,  March  30th. 
Transferred  to  Camp  Dennison,  Ohio,  April  10th.  Discharged  from  service  June  23d,  1805. 

Wood,  Samuel,  Sergeant,  Co.  L,  2d  New  York  Cavalry.  Sabre-cuts  of  the  occipital  and  parietal  regions;  also  wound 
of  neck.  Culpeper  Court  House,  Virginia,  September  13th,  1863.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland, 
September  24th.  Transferred  to  De  Camp  Hospital,  New  York  Harbor,  October  29th.  Furloughed  October  31st.  Returned 
to  duty  November  21st,  1863. 

Woodson,  W.  It.,  Private,  Co.  B,  15th  Virginia  Cavalry,  aged  27  years.  Sabre-cut  of  the  occipital  region,  five  inches  in 
length.  Brandy  Station,  Virginia,  October  11th,  1863.  Admitted  to  Hammond  Hospital,  Point  Lookout,  Maryland,  November 
8th,  from  Campbell  Hospital,  Washington.  Transferred  for  exchange,  well,  March  3d,  1864. 

Weigut,  John,  Private,  Co.  K,  1st  Alabama  Cavalry.  Sabre-cut  of  the  scalp.  Sherman’s  Campaign  through  the 
Carolinas,  1865. 

Wright,  J.  N.,  Private,  Co.  C,  1st  Veimont  Cavalry.  Sabre-cut  of  the  scalp  on  median  line,  three  inches  above  the 
forehead,  and  pistol-shot  wound  of  the  thorax.  Dranesville,  Virginia,  April  1st,  1863.  Admitted  to  Hospital  No.  1,  Annapolis, 
April  8th.  Returned  to  duty  May  6th,  1863. 

Yeagle,  Joseph,  Private,  Co.  L,  5th  New  York  Cavalry,  aged  32  years.  Sabre-cut  of  the  scalp.  Middleburg,  Virginia, 
June  21st,  1863.  Admitted  to  Stanton  Hospital,  Washington,  June  25th.  Retiu-ned  to  duty  June  29th,  1863. 

Young,  Seth,  Private,  Co.  D,  Ist  Massachusetts  Cavalry.  Sabre-cut  of  the  scalp,  and  gunshot  wound  of  the  left  leg. 
Admitted  to  Lovell  Hospital,  Portsmouth  Grove,  Rhode  Island,  July  8th.  Returned  to  duty  November  18th,  1863. 

Of  tlie  two  hundred  and  eighty-two  cases  of  incised  wounds  of  the  scalp  above 
recorded,  six  terminated  fatally ; one  hundred  and  sixty  of  the  officers  and  men  thus 
wounded  were  returned  to  duty,  or  transferred  to  the  Veteran  Reserve  Corps  for  modified 
duty  ; one  officer  resigned ; thirty-seven  prisoners  of  war  were  placed  in  the  custody  of  the 
Provost  Marshal  for  exchange  or  parole ; fifty-one  United  States  enlisted  men  were  dis- 
charged from  service  on  account  of  physical  disability  in  a few  instances  only,  and  com- 
monly because  of  the  expiration  of  their  terms  of  enlistment ; twelve  patients  deserted  ; 
four  were  furloughed  from  Confederate  hospitals  and  did  not  return,  and  eleven  remain 
unaccounted  for,  but  undoubtedly  recovered  without  disability,  since  their  names  do  not 
appear  on  the  mortuary  records  or  the  lists  of  applications  for  pensions. 

An  examination  of  the  record  in  each  individual  case  indicates  that  the  deserters  and 
furloughed  men,  and  the  great  majority  of  the  discharged  men  and  exchanged  prisoners 
fully  recovered,  and  that  of  the  whole  number  of  two  hundred  and  eighty-two  wounded, 
three  died  from  some  form  of  encephalitis  directly’  resulting  from  the  injuries  received, 
while  in  five  other  cases,  chronic  diarrhoea,  intemperate  habits,  or  intercurrent  diseases 
contracted  in  hospitals  or  prisons,  were  the  proximate  causes  of  the  fatal  issue.  Cf  those 
discharged  for  physical  disability  or  invalided  or  pensioned,  two  suffered  from  mental 
aberration,  others  from  vertigo,  imperfect  vision,  headache,  persistent  pain  at  the  seat  of 
injury,  ptosis,  and  amaurosis.  Of  those  who  recovered  and  were  returned  to  duty,  three 
were  subsequently  captured,  and  died  from  privation  at  Andersonville.  In  short,  two 
hundred  and  sixty-three  of  the  wounded  recovered,  eleven  were  temporarily  or  per- 
manently disabled,  three  died  from  complications,  -and  three  from  the  direct  results  of  the 
injury. 

The  treatment  of  incised  wounds  of  the  scalp  calls  for  few  comments.  Our  surgeons 
commonly  shaved  a sufficient  space  about  the  wound,  and  after  suppressing  hajmorrhage, 
and,  if  necessary,  cleansing  the  parts  and  removing  foreign  bodies,  approximated  the  incised 


16 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


parts  Ly  adhesive  plasters.*  A compress  dipped  in  cold  water  and  a retentive  bandage 
were  usually  applied.  Some  surgeons  were  not  averse  to  sutures,  silver-wire  sutures 
especially,  and  employed  them  without  disadvantage  in  cases  in  which  slanting  sword 
cuts  had  raised  flaps  of  integument.  Surgeon  S.  W.  Gross,  U.  S.  V.,  alludesf  to  a case 
which  came  under  his  care  during  the  war,  but  whidi  has  not  been  reported  in  detail,  in 
which  a large  semilunar  flap,  raised  from  the  vertex  and  side  of  the  head,  pi’esented  a 
wound  thirteen  inches  in  length.  He  approximated  the  wound  by  nine  points  of  silver 
suture.  On  the  fourth  day,  union  was  perfect.  There  can  be  no  doubt  that  exaggerated 
apprehensions  have  been  entertained  with  respect  to  the  employment  of  sutures  in  wounds 
of  this  class;  but,  as  the  scalp  has  but  slight  elasticity,  and  retracts  but  little  after  division, 
stitches  are  rarely  indispensable.  Heudorfer  J makes  the  practical  observation  that  when 
vjounds  of  the  scalp  are  approximated  by  adhesive  strips  the  lips  are  inverted,  and  the 
healing  of  the  wound  is  long  delayed  by  the  growth  of  the  hair.  On  this  account  he 
greatly  prefers  to  unite  such  wounds  by  points  of  suture.  Hennen  and  Guthrie  and 
Adams  § also  sanction  the  employment  of  sutures  in  scalp  wounds  where  there  is  much 
retraction  of  the  edges.  Whatever  the  mode  of  coaptation  adopted,  the  importance  of 
leaving  sufficient  intervals  for  the  escape  of  discharges  was  generally  recognized. 

There  was  not  sufficient  haemorrhage  in  any  of  the  cases  above  enumerated  to  require 
the  employment  of  ligatures.  Pressure,  which  can  be  so  conveniently  applied  over  almost 
any  part  of  the  skull,  was  adequate  to  arrest  bleeding  in  every  instance. 

It  does  not  appear  that  rest  in  bed,  spare  diet,  and  an  antiphlogistic  regimen,  were 
often  enjoined  in  this  class  of  cases.  It  is  probable  that  the  unfavorable  issue  of  a certain 
proportion  of  the  cases  was  due  to  the  neglect  of  these  precautions.  While  many  military 
surgeons  of  the  present  day  call  in  question  the  rigid  rules  of  the  older  surgeons  for  the 
general  treatment  of  scalp  wounds,  and  contest  the  utility  of  purging,  of  antimonials,  of 
cold  lotions,  and  of  strict  diet,  none  have  the  hardihood  to  deny  that  quiet  and  abstinence 
from  stimulating  food  and  drink  are  imperatively  demanded  in  such  cases. 

Incised  Fractures  of  the  Cranium. — Forty-nine  cases  of  incised  wounds  of  the 
head  are  recorded  on  the  registers.  They  furnish  illustrations  of  all  the  varieties  of  such 
injuries  : the  superficial  marking  of  the  outer  table,  the  division  of  the  outer  table  and 
diploe,  the  section  of  both  tables  and  more  or  less  profound  penetration  of  the  cranial 
cavity,  and  the  separation  of  an  osseous  flap.|| 

Adams,  J.  F.,  Private,  Co.  G,  21st  Virginia  Cavalry,  aged  34  years.  Sabre  fracture  of  the  left  parietal  bone.  Front 
Royal,  Virginia,  November  12tli,  1804.  Admitted  to  hospital  at  Point  Lookout,  Maryland,  January  31st,  1865,  Transfen-ed 
for  exchange,  well,  February  11th,  1865. 

Allen,  Robert,  Piivate,  Co.  I,  4th  Kentucky  Volunteers.  Sabre  fracture  of  the  frontal  bone  over  the  external  portion 
of  the  left  orbital  i-idge.  Chickamauga,  Georgia,  September  20th,  1863.  Admitted  to  hospital  at  Stevenson,  Alabama,  October 
4th,  1863.  Returned  to  duty  October  22d,  1863.  Mustered  out  August  21st,  1865. 

* Surgeons  in  the  field  were  supplied  with  two  kinds  of  “sticking  plaster;”  isinglass  plaster  (Emplastrum  Icthyocollse) 
and  adhesive  plaster  (Emplastrum  Resinae,  U.  S.  P.)  The  first  was  readily  detached  if  water  dressings  were  applied  over  it;  the 
second  was  thought  by  many  surgeons  to  be  too  irritating  to  be  used  in  scalp  wounds.  French  surgeons  recommend  strips  of 
muslin  spread  with  diachylon  for  the  coaptation  of  these  wounds.  Strips  of  linen,  secured  at  the  ends  by  collodion,  have  also 
been  employed. 

t Gross,  (S.  W.)  Review  of  Worhs  on  Military  Surgery,  in  Am.  Jour,  of  Med.  Scienres.  N.  S.  Vol.  LVI.,  p.  427,  Octo- 
ber, 1867. 

INeudorfer.  Ilandhuch  der  Kriegschirurgie.  Leipzig,  1867.  Zweite  Halfte. 

^ Hennen.  Military  Surgery,  p.  286  ; Guthrie.  Commentaries  on  the  Surgery  of  the  War,  etc.,  6th  London  ed.,  p.  387 ; 
Adams.  Additions  to  Cooper’s  Dictionary,  8th  London  ed.,  p.  374. 

11  The  \\jhimsical  designations  of  these  accidents  by  the  older  surgeons,  as  hedra,  (superficial  cut;)  cceop6,  (perpendicuhi.r 
cut);  diacopk,  (oblique  section);  and  aposMparnismos,  (detachment  of  portions  of  bone,)  have  become  obsolete. 


INCISED  EIIACTURES  OE  THE  CRANIUM. 


17 


Akmstroxg,  Maktix,  Sergeant,  Co.  M,  Ctli  Unitetl  States  Cavalry.  Sabre  fracture  of  the  ci-aniinn.  I'airlield,  Penn., 
July  ‘Jd,  ISCd.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  Septend)er20tli.  Died  October  4tli,  1863,  of  pya}niia. 

Bassek,  Adam,  Private,  Co.  F,  6th  United  States  Cavalry,  aged  27  years,  received  a sabre  wound  of  the  seal])  at  Gettys- 
burg, July  3d,  1SG3.  Admitted  to  hospital  at  Annapolis,  Maryland,  August  4th.  Transferred  to  Annapolis  Junction,  April  9th, 
1864;  thence  to  Mower  Hospital,  Philadelphia,  April  27th  ; thence  to  Pittslmrg,  June  7th,  where  it  was  found  that  then'  rvas  a 
loosened  exfoliation  of  the  outer  table  of  the  skull.  This  w’as  removed;  the  wound  then  healed,  and  the  man  returned  to  duty, 
cured,  July  22d,  1864. 


13 , James  F.,  Private,  Co.  F,  7th  Michigan  Cavalry,  was  captured  at  Gettysburg  July  3d,  18,63,  his  horse  being 

shot  under  him.  He  was  hurried  to  the  real-  with  other  prisoners.  In  the  subsequent  retreat  of  the  rebel  army  he  was  unable 
to  keep  up  with  the  column,  and,  all  efforts  to  goad  him  on  being  unavailing,  a lieutenant  in  command  of  the  provost  guard  cut 
him  down,  and  left  him  for  dead  by  the  roadside.  He  was  brought  in  by  a scouting  party,  and  was  admitted  to  the  Cavalry 
Corps  Hospital.  On  the  25th  of  July  he  was  sufficiently  rational  to  give  the  above 
account  to  Surgeon  Eulison,  9th  J^etv  York  Cavalry.  He  was  in  a very  depressed 
state  at  this  time.  His  pidse  was  weak,  and  heat  from  forty  to  hfty  pei-  minute. 

He  was  indisposed  to  mental  exertion  ; but  when  aroused  and  interested  was 
quite  rational.  He  lingered  until  August  If.th,  1863,  the  tendency  to  stupor  increas- 
ing towards  the  close.  The  autopsy  revealed  a sabre-cut  six  inches  long,  which 
had  raised  an  osseous  flap,  adherent  at  its  base,  from  the  left  parietal,  and  cloven 
the  right  parietal,  with  great  splintering  of  the  vitreous  plate.  The  sabre  had  pene- 
trated the  dura  mater  on  the  left  side,  and  on  the  right  side  the  meninges  were 
injured  by  the  depressed  inner  table.  The  posterior  lobes  of  both  hemispheres  of 

the  brain  were  extensively  disorganized.  The  specimen,  with  tho  above  history.  Fig.  1.— Interior  view  of  a segment  ef  tlie  pane- 

was  contributed  by  Surgeon  W.  H.  Eulison,  9th  New  York  Cavalry,  since  killed  iff"  ^Sect”™  a'*'m  “ sabre-cut.— 

in  battle.  An  external  view  of  the  specimen  is  presented  in  Figure  55,  page 

40,  Circular  No.  6,  Surgeon  General's  Office,  Washington,  1865.  An  internal  view  is  given  in  the  adjacent  wood-cut.  (Fig.  1.) 


Blood,  A.  N.,  Corporal,  Co.  C,  1st  New  Hampshire  Cavalry.  Sabre-fracture  of  the  skull.  Neivtown,  Virginia,  November 
12th,  1864.  Admitted  to  Field  Hosjiital  at  Winchester,  Virginia,  on  the  same  day.  Inllammation  of  the  brain  siqiervened,  and 
ho  died,  November  30th,  1864. 

Bradley,  AleXjVXDER,  Private,  Co.  E,  5th  New  York  Cavalry,  aged  23  years.  Compound  comminuted  fracture  of  the 
occipital  bone  by  a sabre.  Hanover,  Pennsylvania,  June  30th,  1863.  Admitted  to  Satterlee  Hospital,  Philadelphia,  November 
17th.  Seventeen  spiculm  of  bone  were  removed.  Eeturned  to  duty  November  28th,  1863. 

Browx,  James  W.,  Musician,  Co.  F,  13th  Ohio  Volunteers,  'aged  30  years.  Sabre-fracture  of  the  cranium.  Atlanta, 
Ga.,  August  17th,  1864.  Admitted  to  Hospital  No.  1,  Nashville,  Tenn.,  August  27th.  Discharged  from  service  May  18th,  1865. 

Browx,  S.  L.,  Private,  Co.  G,  8th  New  York  Cavalry.  Sabre-cut  of  the  scalp,  with  fracture  of  the  left  parietal  bone. 
Gettysburg,  July  1st,  1833.  A segment  of  bone  removed  primarily.  Insensibility  lasted  seven  days.  Admitted  to  hospital  at 
York,  Pennsylvania,  July  19th.  Eeturned  to  duty  November  24th,  1863. 

CjVXFIELD,  J.  N.,  Corporal,  Co.  G,  15th  New  York  Cavalry,  aged  55  years.  Fracture  of  the  cranium,  w'ith  depression  of 
the  inner  table  by  a blow  from  a sabre.  Newmarket,  Virginia.  December  21st,  1864.  Admitted  to  hospital  at  Frederick,  Mary- 
land, December  23d.  Discharged  from  service  May  20th,  1865. 

Clark,  Eichard,  (colored,)  officers'  servant,  aged  19  years.  Sword  fracture  of  tho  left  side  of  cranium.  Iceport, 
Mississippi,  February  2d,  1865.  Admitted  to  Strader  Hospital,  Louisville,  Kentucky,  March  23d,  from  Field  Hospital.  Trans- 
ferred Itlarch  26,  1865,  to  New  Albany,  Indiana,  Floating  Hospital.  Eeturned  to  duty  June  27th,  1865. 

COLVix,  JoiiX",  Corporal,  Co.  B,  IGth  Pennsylvania  Cavalry,  being  detached  for  s(!rvice  with  the  provost  marshal  of  the 
brigade,  while  in  the  performance  of  his  duty,  received,  on  January,  2d,  1864,  a sabre-cut  on  the  forehead.  The  right  parietal 
bone  was  badly  fractured  near  the  sagittal  and  frontal  -sutures.  About  one  square  inch  of  the  bone  being  loose,  was  removed, 
together  with  several  spicul®,  and  a sharp  projection  was  removed  by  Hey’s  saiv.  The  integuments  were  replticed  over  the 
opening  in  the  skull  by  means  of  sutures,  and  the  wound  healed  nearly  by  first  intention.  No  unpleasant  symptom,  save  one 
delirious  night,  occurred  after  the  injury,  and  the  man  was  returned  from  the  Cavalry  Corps  Hospital  to  his  regiment  on  .Janu- 
ary 28th,  1864.  The  operation  was  performed  by  Dr.  George  W.  Colby,  surgeon  in  chief  of  the  brigade,  and  the  case  was 
reported  by  Assistant  Sui’geon  A.  F.  Herrmann. 

B , TnOMA.S,  Private,  Co.  G,  5th  Connecticut  Volunteer.s,  aged  48 

years,  was  wounded  at  Chantilly,  Virginia,  on  September  1st,  1862,  by  sev- 
eral sabre-blows  over  the  right  ear.  He  was  taken  to  Washington,  and  ad- 
mitted to  Douglas  Hospital  on  September  5th.  Pie  was  then  suffering  from 
partial  hemiplegia,  with  mental  hebetude.  There  was  great  tumefaction  of 
the  scalp.  It  was  found  that  the  right  parietal  was  very  extensively  frac-' 
tured,  (Fig.  2,)  one  fissurit  running  near  the  tem])oro-parietal  suture,  and 
others  upwards  and  backwards  from  the  ear.  Near  the  parietal  eminence 
there  was  a marked  depression.  It  was  determined  to  raise  the  depres.sed 
bone,  and  on  September  Gth,  Acting  Assistant  Surgeon  J.  W.  Williams 
applied  the  trephine,  and,  after  removing  a button  and  several  fragments 
of  bone,  he  excised  a sharj)  depressed  angle  by  a Hey’s  saw.  It  was  ascer- 

3 


Fk;.  2. — Vault  of  tho  cranium,  fihowin^  sovonil  sabre  outs 
of  tho  right  iJurietal.— 235,  Scot.  I,  A.  M.  M. 


18 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


tinned  tliut  the  dura  mater  had  been  injured  by  the  salire-cnts.  After  tlie  elevation  of  the  depressed  fracture,  the  paralysis  of  the  left 
side  was  relieved.  The  bead  was  shaven,  and  cold  a])jilieations  were  iiorseveringly  employed.  For  ten  days  subsequently  the  case 
iqipeared  to  jn-ogress  favorably;  but,  on  September  14tb,  the  patient  began  to  be  heavy  and  drowsy,  and  the  following  day  there 
were  clonic  spasms  of  the  left  side  and  pleurosthotonos.  At  night  the  breathing  was  stertorous,  the  pnjiils  were  dilated,  and  the 
general  symptoms  of  compression  of  the  brain  were  very  marked.  Death  took  place  on  September-  IGth,  1802.  There  was  a 
targe  coaguhim  of  extravasated  blood  under  the  scalp  near  the  vertex,  as  though  the  man  had  fallen  upon  his  head  after 
being  wounded.  A jjiortcm.  examination  was  made  on  September  17th.  On  removing  the  calvari.a,  which  was  remarkable 
for  its  extreme  thinness,  it  was  found  that  the  dura  mater  was  jierfbrated  beneath  the  intersection  of  the  wounds,  and  that,  for 
a sjiace  of  several  inches,  there  was  thickinung,  with  other  evidences  of  inflammatory  action.  The  arachnoid  and  j)ia  mater 
were  disintegrated  in  this  vicinity,  and  a space  comprising  nearly  half  of  the  right  cerebral  hemis])here  was  occupied  by  an 
abscess.  The  calvaria  was  forwarded  to  the  Army  Medical  Museum  by  Assistant  Surgeon  Warren  Webster,  U.  S.  Ai-my.  It 
is  rejiresented  by  FiG.  2,  on  the  preceding  page. 

D , J.  M.,  Private,  Co.  M,  1st  New  Jersey  Cavalry,  aged  24  years,  in  a skirmish  with  the  retreating  enemy, 

near  Burkesville,  Virginia,  on  April  (ith,  1885,  received  a sabre  wound  on  the  right  side  of  the  head.  There  was  a cut  tlu'ough 
the  seal))  and  pericranium  three  inches  long,  extending  into  the  outer  table  of  the  skull  and  diploc,  from  the  jiarietal  eminence 
downwards  and  backwards.  The  wounded  man  was  conveyed  to  the  Cavalry  Corps  Ilosiiital,  and  thence  to  the  Base  Ilosjiital 
at  City  Point,  and  thence  by  water  to  Baltimore,  where  he  was  admitted  to  West’s  Building  Hospital,  on  May  11th,  1805. 
No  re|)ort  of  his  symptoms  is  given  until  his  admission  to  the  Baltimore  hospital,  when  Acting  Assistant  Surgeon  W.  G.  Knowles 


records  that  he  suffered  se- 
vere paroxysms  of  ))ain,  re- 
curring frequently,  and  an- 
nounced by  loud  screams. 

In  the  intervals,  he  answered 
questions  readily  and  ration- 
ally. In  the  evening  of  May 
11th,  he  became  composed 
and  slejit  tranquilly.  He 
manifested  signs  of  intelli- 
gence until  within  half  an 
hour  of  his  death,  which  oc- 
curred on  May  12th,  1885. 

On  May  13th,  thirty-seven 
days  after  the  reception  of 
the  injury,  an  antojisy  was 
made  by  Acting  Assistant 
Surgeon  J.  H.  Butler.  The 
incised  fracture  of  the  outer 
table  was  two  and  a half 
inches  in  length.  At  one  point  it  penetrated  through  the  diploe.  Its  edges 
were  necrosed  and  suppurating.  On  removing  the  \ninlt  of  the  cranium,  a sjdinter  of  the  internal  talde,  one  and  tliree-fourths  of 
an  inch  in  length  and  one-quarter  of  an  inch  wide,  was  found  under  the  cut,  depi'essed  about  two  lines.  This  fragment  was 
covered  by  a thick  deposit  of  lymph,  which  filled  the  angles  of  the  depression,  and  adhered  to  the  dura  mater.  In  this  mem- 
brane there  were  two  small  perforations,  due  to  idceration.  These  communicated  with  an  abscess  of  the  right  hemisjdiere, 
filled  with  offensive  pus.  The  dura  mater  was  thickened  and  softened  near  the  fracture,  and  discolored  on  its  inner  surface  over 
a s])ace  an  inch  in  diameter.  The  specimen  is  preserved  at  the  Army  Medical  ^luseum  as  a wet  prejiaration,  and  is  numbered 
4208  of  the  Surgical  Section.  It  is  represented  in  the  adjacent  wood-cuts.  (Fig.  3 and  FiG.  4.) 


ric..  3. — Sabre-cut  of  the  right  parietal.- 
Sect.  1,  A.  51.  51. 


-Spec.  420G, 


rio-  ‘1. — latcriur  view  of  the  furogohig  specnneii. 


Dunn,  Geougio,  Corporal,  Co.  E,  7f)th  New  York  Volunteers.  Fracture  of  the  left  side  of  the  front.al  hone,  near  the 
coronal  suture,  by  a sabre.  There  was  a depression  of  both  tables  of  the  skull  one  inch  in  extent.  Admitted  to  Carver  Hospital, 
Washington,  November  30th,  1832.  Deserted  March  21st,  1863. 

Englekee,  Wir,ElA5l,  Private,  Co.  B,  54th  Kentucky  Volunteers,  aged  33  years.  Three  sabre  wounds  of  the  occipital 
region,  and  one  of  the  left  superciliary  ridge.  The  latter  fractured  the  outer  plate  of  the  frontal  hone,  and  destroyed  the  vision 
of  the  left  eye.  There  were  also  three  cuts  over  the  dorsum  of  the  right  hand.  Saltville,  Virginia,  December  23d,  1864. 
Admitted  to  hospital  at  Lexington,  Kentucky,  January  8th,  1865,  and  discharged  from  service  and  pensioned.  May  19th,  186.5. 
On  March  4th,  1867,  the  examining  surgeon  of  the  I’ension  Office  rejiorted  his  disabilities  as  permanent. 


Fueybeut,  Ai)A5I,  Private,  Co.  B,  1st  Maryland  Cavalry,  aged  34  j'ears.  Compound  comminuted  fracture  of  the  left 
parietal  hone  by  a blow  from  a sabre.  Brandy  Station,  Virginia,  June  9th,  1863.  Admitted  to  First  Division  Hosiiital,  Annap- 
<dis,  Maryland,  Juno  21st.  ReturncHl  to  duty  April  21st,  1864.  On  the  expiration  of  his  term  of  service,  ho  re-enlisted  in  the 
1st  Regiment,  1st  Army  (.'oiqis,  (Hancock's  Corp.s,)  in  the  spring  of  1865.  On  Jidy  18th,  186.5,  he  was  treated  at  Htanton 
Hospital,  Washington,  foi-  catarili,  was  furloughed,  and  then  transfeia-ed  to  Douglas,  and  thence  to  Harewood  llosjiitals,  and 
limdly  discharged  on  surgeon’s  certilicate  of  disability,  February  21st,  1866.  From  the  hospital  records  it  appears  that  he 
suffered  little  or  no  inconvenience  from  his  head  injury,  and  that  he  was  ju-obably  an  incorrigible  malingerer. 

GOD.SMAliK,  George  A.,  Private,  Co.  F,  7th  Michigan  Cavahy,  aged  19  years.  Sabre-cut  of  the  right  parietal  region,  four 
inches  in  length,  with  partial  fracture  of  the  l)one.  Gettysburg,  July  3d,  183.5.  Admitted  to  Harev.’ood  Hospital,  Washington,  Juiy 


INCISED  FEACTURES  OF  THE  CRANIUM. 


19 


24tli,  where  a spicula;  of  bone,  one  inch  in  length,  was  removed.  August  18th,  the  patient  was  mnch  improved,  and  the  wound 
was  nearly  healed.  The  intellect  at  times  was  dull  and  impaired,  with  defective  hearing.  Returned  to  duty  November  11th,  1863. 

Haixes,  Walteu  F.,  Corporal,  Co.  K,  Ist  Maine  Cavalry,  aged  30  years.  Sabre-cut  of  the  scalp,  two  and  a half  inches 
long,  with  fracture  of  the  vertex  of  the  cranium.  Middleburg,  Virginia,  June  19lh,  1863.  Admitted  to  First  Division  Hospital, 
Annapolis,  Maryland.  July  9th.  Returned  to  duty  September  1.3th,  1833. 


Hall,  Asa  A.,  Private,  Co.  K,  1st  New  Hampshire  Cavalry,  aged  35  years.  Sabre-cut  of  the  scalp,  injuring  the  cranium. 
Lacey’s  Springs,  Virginia,  December  21st,  1864.  Taken  prisoner  by  the  enemy,  and  admitted  to  hospital  December  25th. 
Exchanged,  and  admitted  to  Patterson  Park  Hospital,  Baltimore,  February  23,  1835,  from  Annapolis.  On  May  23d  fragments 
of  the  outer  table  were  removed.  Transferred  to  Hicks  Hospital,  Baltimore,  June  14th.  Discharged  the  service  June  25th, 
1865.  Surgeon  T.  Sim,  U.  S.  V.,  reports  the  case. 


H , RoEEitT,  Private,  Co.  C,  6th  United  States  Heavy  Artillery,*  (colored,)  aged  18  years,  while  sick  in  hospital  at 

Fort  Pillow,  Tennessee,  received,  at  the  capture  of  that  w'ork,  April  12th,  1864,  three  sabre-cuts  over  the  left  parietal  bone,  and 
a blow  from  some  blunt  weapon,  which  produced  a depressed  fracture  of  the  right 
parietal.  One  of  the  sabre  wounds  fissured  the  inner  table,  and  drove  a portion 
of  it,  an  inch  and  a quarter  in  length,  through  the  dura  mater.  As  he  raised  his 
arm  to  protect  his  head,  he^'cceived  a sabre-cut  on  the  left  hand,  nearly  severing 
the  index  finger.  The  patient  was  conveyed  by  water  to  the  hospital  at  Mound 
City,  Illinois,  and  was  admitted  there  on  the  14th  of  April.  The  case  book  of  the 
hospital  describes  him  as  very  low,  and  at  times  irrational.  On  the  17th,  the  record 
states  that  he  was  weak  and  very  restless,  disposed  to  sleep  in  the  day-time,  and 
it  is  added  that  his  appetite  was  tolerably  good.  On  the  18th,  he  was  “ very  bad.”  ■ 

On  the  19th,  he  was  at  times  delirious.  He  died  at  half  past  ten  in  the  morning  of 
April  21st,  1864.  At  one  in  the  afternoon  an  autopsy  was  made  by  Acting  Assistant 
Surgeon  Melvin  L.  Rust,  when  a large  extravasation  of  blood  was  found  over  the 
left  cerebral  hemisphere,  and  a piece  of  the  vitreous  lamina,  an  inch  and  a half 
long  and  an  inch  wide,  detached  from  the  left  parietal  by  the  severest  of  the  sabre- 
cuts,  was  driven  through  the  dura  mater,  into  the  substance  of  the  brain.  The 
calvaria,  which  is  depicted  in  the  accompanying  wood-cut,  (Fig.  5,)  was  forwarded 
to  the  Army  Medical  Museum  by  Surgeon  Horace  Wardnei',  U.  S.  V.  The  detached 
fragment  of  bone  was  lost  in  transportation.  The  superior  portions  of  the  external  Fig.  .5.— Sabre-cuts  on  the  back  of  the  skull.— 
table  of  the  parietals  is  discolored,  as  if  from  ecchymosis. 


H , James,  Private,  27th  Company,  2d  Battalion,  Veteran  Reserve  Corps,  aged  22  years,  a patient  at  Eicord  Hospital, 

Washington,  in  an  altercalion  with  one  of  the  hospital  guards,  on  the  25th  of  January,  1865,  received  a sabre  wound,  two  and  a 
half  inches  in  length,  on  the  left  side  of  the  forehead,  a little  within  the  left  frontal  protuberance.  A cleft,  an  inch  long,  was 
made  in  the  outer  table  of  the  bone.  The  patient  was  conveyed  into  the  hospital,  and  the  wound  was  closed  by  silver  sutures, 
and  simple  dressings  were  applied,  and  he  was  restricted  to  low  diet.  On  the  25th,  the  man  was  feverish,  and  his  bowels  were 
consti]iated.  He  had  a dose  of  s.alts,  which  was  repeated  on  the  27th.  On  the  28th  he  complained  of  headache,  and  was 

ordered  a mixture  with  bromide  of  potassium,  lupulin,  and  hyoscyamus,  and 
was  alloived  full  diet.  On  the  31st,  the  repoi’t  says  that  his  appetite  was  good, 
but  he  was  ordered  a drachm  of  tincture  of  gentian  thrice  daily.  On  February 
2d,  he  vvas  reported  as  having  passed  a restless  night,  and  'was  ordered  eight 
grains  of  Dove-r’s  jiowder  at  bedtime.  On  February  Cth,  he  was  very  comfort- 
able, and  walked  about  the  ward.  On  the  next  day,  his  bowels  being  sluggish, 
he  took  three  grains  of  blue  pill  and  si.x  of  the  compound  extract  of  colocynth, 
and  was  placed  on  light  diet.  On  the  afternoon  of  the  8th,  he  complained  of 
headache,  which  was  aggi’avated  at  night.  On  the  next  morning  he  was  par- 
tially insensible.  He  was  roused  with  difficulty  ; he  answered  questions  slowly, 
but  rationally.  The  pupils  re.sponded  to  light ; the  tongue  when  protruded, 
after  great  efi'ort,  did  not  deviate  laterally.  He  had  a dose  of  salts,  a blister, 
three  by  five,  to  the  nucha,  and,  later  in  .the  day,  a terebinthinate  enema.  He 
had  several  involuntary  dejectioms,  and  his  urine  dribbled  away.  In  the  evening 
he  seemed  brighter,  and  the  control  of  the  sphincters  was  re-established.  On 
February  10th,  ho  was  perfectly  rational.  The  urine  and  fmces  were  discharged 
voluntarily;  the  tongue  when  protruded  deviated  slightly  to  the  right;  the 
pulse  was  weak  at  70  ; slight  cephalalgia.  February  11th,  he  had  passed  a bad 
night,  and  he  had  but  little  appetite.  From  the  12th  to  the  1.5th,  anorexia,  weak  pulse,  regular  bowels,  no  aggravation  of  the 
head  symptoms.  On  the  ICth,  the  ])atient  complained  of  severe  headache  at  4 A.  M.,  and  soon  after  began  to  breathe  ster- 
torously.  At  7 o’clock  he  was  perfectly  unconscious ; the  ])upils  were  slightly  but  eciually  contracted,  and  did  not  respond 


Fig.  G. — Cavity  of  an  abscess  in  the  cerebrum, 
resuhin^j  from  a sabre  wound. — Spec.  3C85,  Surg.  .Sect 
A.  M.  M. 


In  the  brief*  abstract  of  tliis  case  given  at  page  40  of  Circular  No.  G,  S.  O.  O.,  1865,  it  is  stated  that  tlie  patient  was  a private  of  tlie  7th  Colored 
Kegiment,  (J.  .S.  Artillerj'.  In  the  report  of  the  Congressional  Committee  on  the  Conduct  of  the  War,  (38th  (Jongross,  1st  session.  House*  of  Roprosenta* 
tives,  Report  No.  G5,  p.  55,)  Robert  Hall  is  named  as  of  the  Ist  Alabama  Artillery.  Tlie  Adjutant  General  of  the  Army  informs  the  compiler  tliat  the 
organiziUion  in  which  this  man  enlisted  was  first  known  as  the  “ 1st  Alabama  .Siog(^  Artillery."  Its  designation  was  afterwards  changed  to  “ (itJi  U.  .S. 
Artillery,  (colored"),  afterwards  to  “7th  U.  .S.  Heavy  Artillery,"  and  finally  to  “iltli  U.  S.  Colored  Troops." 


20 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


to  light;  there  was  stertor,  with  foam  about  the  lips.  Coma  became  more  and  more  profound,  and  at  half  past  twelve  on  the 
following  day,  February  17th,  1835,  the  patient  ox|iirod.  At  the  autopsy,  an  incised  fracture,  an  inch  long,  involving  the 
outer  table  only,  was  found  near  the  loft  frontal  protuberance.  The  condition  of  the  diploe  beneath  it  is  not  mentioned. 
The  left  side  of  the  os  frontis  was  sent  to  the  Army  Medical  Museum.  It  is  numbered  Specimen  .3384  of  the  Surgical  Section, 
and  is  figured  by  a wood-cut  on  page  34  of  the  Catalogue.*  Two  discolored  spots  on  the  specimen  are  stains  from  iron  rust,  acci- 
dentally made  during  the  preparation  of  the  specimen.  An  abscess  was  found  in  the  left  anterior  lobe  of  the  cerebrum,  measuring 
two  and  one-half  inches  antero-posteriorly,  and  one  and  one-half  inch  laterally,  the  anterior  and  superior  portions  extending  on 
the  left  nearly  to  the  suiface  of  the  cerebral  substance,  and  within  six  lines  of  the  median  line  of  the  cerebrum.  It  contained  two 
ounces  of  i)us.  Pus  had  also  found  its  way  through  all  the  ventricles,  largely  distending  the  left  lateral,  and,  from  the  foui  th 
ventricle,  had  i)assod  between  the  substance  of  the  medidla  oblongata  and  its  membranes  as  low  as  the  origin  of  the  twelfth 
nerve.  The  boundaries  of  the  uj)per  and  posterior  portions  of  the  abscess  are  indicated  in  ElG.  G.  Specimen  3571  of  the 
Sui-gical  Section  of  the  Aiiny  iledical  Museum  shows  the  I'emaining  portion  of  the  abscess. 

Hixnan,  Hkxry,  Private,  Co.  F,  1st  Nc'w  York  Mounted  Rilles.  Sabre-cut  of  the  scalp,  with  fracture  of  the  extenial 
table  of  the  cranium.  Suilblk,  Virginia,  May  17th,  1833.  Admitted  to  Regimental  Hosj)ital,  and  leturned  to  duty  in  the  same 
month. 

IIow.vui),  JouiT  A.,  Private,  Co.  G,  21st  Pennsylvania  Cavalry,  aged  24  years,  was  wounded  in  tlie  engagement  of  the 
2d  Cavalry  Divi.siou  with  the  enemy  near  Jettersville,  Virginia,  April  5th,  1835,  by  two  sabre-cuts,  one  of  the  right  side  of  the 
liead,  and  the  other  on  }he  l)ack.  lie  wa.s  admitted  to  the  Field  Ho.spital  of  the  Cavalry  Corps  on  tlu!  day  of  his  injury,  when 
it  was  ascertained  that  the  wound  in  the  back  was  not  .seiious,  but  that  the  cut  on  the  head,  six  inches  in  length,  and  nearly 
parallel  to  the  coronal  suture,  had  involved  the  external  table  of  the  ])arietal  hone.  The  hair  was  shaven,  the  wound  approxi- 
mated by  adhesive  strips,  and  cold  water  dressing  apj)lied.  There  were  no  grave  cerebral  symptoms,  and  on  Ai)iil  28th  the 
wouiuh'd  man  was  sent  to  the  Base  Hosjutal,  at  City  Point,  and  thence,  on  April  30th,  to  Harewood  Hospital,  at  AVashington. 
A day  or  two  after  his  admission,  a photogi'aph  of  his  wound  was  made,  by  direction  of  Surgeon  R.  15.  Bontecou,  U.  S.  A’^ols., 
which  is  preserved  as  No.  13  of  Volume  I,  Photographs  of  Surgical  Cases,  A.  M.  M.  The  middle  figure  in  the  preceding  litho- 
graph of  “ Sabre  wounds  of  the  head”  is  a fiiithful  copy  of  this  pictm-e.  His  case  progressing  very  favorably,  Howard  was 
transferred,  on  May  18th,  to  Mow’or  Hospital,  at  Philaddphia.  He  was  mustered  out  of  service  on  July  18th,  1035,  with  a 
pension  of  six  dollars  a month.  In  December,  1837,  Howard  was  living  at  Shippensburg,  Pennsylvania.  He  writes  that  he 
suli'ers  greatly  from  dizziness,  and  that  there  have  been  several  exfoliations  from  the  parietal  bones  since  he  went  to  his  home. 

Hoxey,  I.Iautix  B.,  Private,  Co.  B,  11th  Connecticut  Volunteers.  Fracture  of  the  outer  table  of  the  left  paiietal  bone 
by  a sabre-cut.  Autietam,  Maryland,  Sejdember  17th,  1832.  Admitted  to  hospital  at  Frederick,  Maryland,  October  1st. 
Insanity  was  subseijuently  developed,  and  he  was  discharged  from  service  December  23d,  18G2. 

Ilulston,  John  A.,  Private,  Co.  11,  Trestoe’s  Cavalry,  aged  20  years,  received  a sabre  fracture  of  the  occipital  bone, 
with  penetration  of  the  skull,  at  Independence,  Alissouri,  October  22d,  1834.  Admitted  to  hospital  at  Fort  Leavenworth,  Kansas, 
October  25th.  Died  November  5th,  1834. 

Kautxer,  CllAliLKS  II.,  Private,  Co.  E,  SCth  Pennsylvania  Ahdunteers,  tiged  20  years.  Sabre  fracture  of  Ihe  craniuin. 
Drury’s  Bluff,  Virginia,  May  loth,  1834.  Admitted  to  Chesapeake  Hospital,  Fort  Monroe,  May  18th.  Transferred,  June  5th, 
to  De  Camp  Hospital,  David’s  Island,  New  York  Harbor.  I’urloughed  July  Gth,  18'34,  and  did  not  return. 

Lambert,  Joseph  C.,  Corporal,  Co.  G,  21st  I’ennsylvania  Cavalry.  Sabre  fracture  of  the  cranium,  and  incised  wound 
of  the  left  hand.  Jettersville,  Virginia,  April  5th,  1835.  Admitted  to  Cavalry  Corjis  Hospital,  April  12th.  Transferred  to 
Second  Division  lIo.spital  at  Annapolis,  Maryland,  April  15th.  Returned  to  duty  May  8th,  18G5. 

Lawler,  David  E.,  Sergeant,  Co.  E,  3d  Missouri  Cavalry,  aged  29  years.  Sabre-cut  of  the  left  side  of  the  skull,  with 
fracture  of  the  cranium.  Little  Blue  River,  Missouri,  October  21st,  1834.  Admitted  to  hospital  at  Fort  Leavenworth,  Kansas, 
October  27th,  and  transferred,  on  November  13th,  1834,  to  Post  Hosi)ital.  lie  subsequently  recovered  and  was  released. 

Lucas,  Philip,  Private,  Co.  G,  1st  New  York  Cavalry,  at  AVinchestcr,  Virginia,  .lime  13th,  18G‘3,  received  a sabre 
fracture  of  the  anterior  edge  of  the  occipital  bone;  also  a sabre-cut  of  the  right  shoulder,  fracturing  the  head  of  the  scapula.  Ho 
was  discharged  from  the  service  on  August  24th,  1834,  and  in  May,  1835,  was  examined  by  Di'.  Charles  Rowland,  I’cnsion 
Surgeon  at  Brooklyn,  Niwv  York,  who  I'eported  that  there  was  an  extensive  indentation  of  the  skull,  and  that  Lucas  sufi’ered 
from  partial  loss  of  memory,  and  frequent  attacks  of  vertigo,  resulting  from  his  injury. 

AIahoxey,  Dexxis,  Priv'ate,  Co.  C,  132d  New  York  Volunteers,  aged  20  years.  Incised  wound  four  inches  in  length, 
extending  from  frontal  protuberance  along  the  temporal  ridge,  with  fracture  of  the  cranium ; also  a cut  tw’o  and  one-half  inches 
long  in  the  left  p.arietal  region,  and  the  little  finger  severed,  by  a sword  in  the  hands  of  tJie  officer  of  the  guard,  April  4th,  1833. 
Admitted  to  Foster  Hospital,  at  Newberne,  Nortli  tbirolina,  April  Cth.  Tetanus  sujiervened,  and  death  resulted  on  April  25th, 
1833. 

Marshall,  Thomas,  7th  Virginia  Cavalry,  aged  31  years.  Sabre-cut  of  the  scalp,  with  fracture  of  the  cranium.  Orange 
Court  House,  Virginia,  August,  1832.  Admitted  to  Old  Capitol  Prison,  Washington.  Exchanged  September,  18G2. 

McGee,  Willia.m,  Orderly  Sergeant,  Co.  F,  1st  New  York  Mounted  Rifles.  Sabre-cut  of  the  scalp,  with  fracture  of  the 
external  table  of  the  cranium.  Sufl’olk,  Virginia,  May  17 th,  1833.  Admitted  to  Regimental  Hospital,  aiul  returned  to  duty  during 
the  same  month. 

* Catalogue  of  the  Surgical  Section  of  the  United  Stales  Aring  Medical  Museum,  Waslun;jt:in.  IHCj,  p.  IM. 


INCISED  FRACTURES  OF  THE  CRANIUM. 


21 


McInto.sti,  FliAXCIS,  Private,  Co.  B,  SOtli  Illinois  Volunteers.  Sabre-cut  of  tlie  cranimn  at  tlie  vertc'X.  Day’s  Claj), 
xVlabaina,  April  30,  18t)3.  Admitted  to  First  Division  Hospital,  Annapolis,  Maryland,  July  3d.  Returned  to  duty  Sejiteinber 
7tli,  1833. 

Mosiei!,  Jacod,  Private,  Co.  G,  86tli  New  York  Volunteers,  aged  21  years.  Sabre  fracture  of  the  left  parietal  and  occi- 
pital bones,  while  on  picket  duty  at  Petersburg,  Virginia,  October  2d,  1834.  Admitted  to  Armory  S<iuare  Hospital,  Wasbiugton, 
October  29th.  Died  November  5th,  1834. 

Muixen,  Charles,  Private,  Co.  D,  GOth  Pennsylvania  Volunteers,  received  a sabre-cut  on  the  left  side  of  the  head  at 
South  Mountain,  September  14th,  1862.  The  blow  of  the  sabre  was  directed  obli(piely,  and  inflicted  a wound  commencing  near 
the  left  frontal  protuberance,  extending  two  incbes  backwards  along  the  jiarietal  ridge,  and  downwards  over  the  s(piamous  por- 
tion of  the  temporal,  the  scalp,  muscles,  and  periosteum,  and  possibly  a portion  of  the  external  table  being  included  in  the  tlaj). 
The  man  fell  to  the  ground  senseless.  After  a primary  dressing  ho  was  placed  in  a field  hospital,  and  thence,  on  October  2d,  he 
was  convey’ed  to  Frederick,  and  admitted  to  Ilosjntal  No.  5,  under  the  chai’ge  of  Surgeon  11.  S.  Hewit,  U.  S.  Vols.  The  wound 
was  suppurating  profusely  at  this  time.  The  patient  lay  in  a stupor,  and  was  unable  to  articu- 
late. It  was  supposed  that  he  had  traumatic  meningitis,  and  the  ti’eatment  was  conducted  in 
accordance  with  this  diagnosis.  There  was  a very  gradual  amendment ; but  after’ several  months 
the  mental  hebetude  disapjreared,  and  the  power  of  speech  returned.  On  Jmuiai’y  2d,  1833,  tbrr 
patient  was  ti’airsferi’ed  to  Hospital  No.  1,  at  Frederick,  rtrrder  the  char’ge  of  Assistarrt  Sitr-geou 
R.  F.  Weir-,  U.  S.  A.  At  this  date,  there  was  atr  oirerr  gr’arnrlatitrg  wourrd,  at  the  ba.se  of  which 
dead  borre  was  exposed ; the  pericr’anium  was  separated  fr’orrr  the  botre  trear  the  irrargiirs  of  the 
wound.  Irr  the  middle  of  March  the  cranium  was  exposed  to  a much  greater  extent.  The 
patient  cornplairrcd  ntuch  of  headache,  arrd  there  was  partial  hemiplegia  of  the  right  side.  'The 
bare  portion  of  the  parietal  was  necrosed,  arrd  was  felt  to  bo  partly  detached.  Cataplasrrrs  were 
ajtplied  continuously  for  a few  days,  when  it  was  decided  that  the  irecrosed  jrortiorr  of  botre  was 
suflicieittly  detached  to  warrarrt  air  attempt  to  remove  it.  On  March  28th,  Actiirg  Assistarrt  Sitr- 
geoir  Panllin  perfornred  the  operatioir.  The  entire  irecrosed  part  was  exposed  by  atr  L incision 
contrecting  with  the  wourrd.  The  fragment  was  then  seized  by  forceps,  and,  by  gentle  ti-actiorr, 
was  readily  removed.  The  lips  of  the  wounds  were  then  ap]rroxitrrated  by  adhesive  jrlasters, 
over  which  compresses  dipped  in  cold  water  were  applied.  The  case  progressed  satisfactorily 
until  April  2d,  when  the  patient  had  spasmodic  movements  of  the  muscles.  These  ceased  upon 
the  removal  of  a detached,  blackened  bit  of  bone,  half  an  inch  square,  from  the  arrterior  portiorr 
of  the  wound.  Another  small  scale  of  dead  bone  was  extractrrd  on  April  10th.  In  May  the 
jratient’s  general  condition  was  excellent,  and  the  wound  was  healing  rapidly ; in  the  latter  part 
of  the  mouth  it  had  closed  except  at  one  small  poirrt,  fi-onr  which  there  was  a constarrt  puru- 
lent discharge.  On  June  8th,  Mulleir  was  discharged  fi-orrr  service  on  account  of  hemiplegia. 

His  mental  faculties  were  much  impaired.  The  exfoliation  which  was  removed  is  represented 
in  Fig.  7.  Mullen  was  pensioned  at  the  rate  of  eight  dollars  per  month.  On  SejRembcr 
4th,  1337,  the  examining  surgeon  of  the  Pension  Office  reported  that  the  henii()legia  continued,  and  that  the  disability  would 
j)robably  be  permanent. 

O'Hare,  B.arxey,  Private,  Co.  A,  6th  New  York  Cavalry,  aged  3.5  years,  of  robust  constitution  and  heallh,  received  at 
the  liands  of  a sentinel,  at  Camj)  Scott,  Staten  Island,  New  Y'ork,  November  1.3th,  1861,  a sabre-cut  on  the  left  side  of  the  head, 
extending  from  near  the  outer  angle  of  the  eye  across  the  temporal  region  nearly  five  inches.  The  squamous  portion  of  the 
temporal  and  the  parietal  were  incised  for  about  two  inches,  and,  in  the  middle  of  the  incision,  the  bone  and  subj.acent  mem- 
branes were  penetrated.  Nearly  two  drachms  of  brain  substance  escaped.  The  wound  was  immediately  dres.sed,  and  there 
being  much  cerebral  disturbance,  and  the  pulse  full  and  bounding,  fifteen  grains  of  calomel  were  given  and  twenty-one  ounces 
of  blood  was  taken  from  the  arm,  and  the  eighth  of  a grain  of  tartarized  antimony  was  given  every  two  hours.  Next  morning 
the  man  was  sitting  u]),  and  stated  that  he  was  quite  comfortable.  Surgeon  A.  P.  Clark,  (ith  New  Y’ork  Cavalry,  who  reports 
the  foregoing  ])articulars,  proceeds  to  state  that  the  scalji  wound  healed  by  first  intention,  and  tlnit  on  November  22d,  18i>l,  nine 
days  after  the  receiRion  of  the  injury,  the  man  returned  to  duty,  and  that  no  subsecpient  untoward  symptoms  a|ipeareil.  ( I’llare’s 
name  does  not  appear  on  the  Pension  List.  In  October,  1834,  he  was  employed  as  a blacksmith  at  the  Headquarters  of  the 
Army  of  the  Potomac. 

Pl.STORIUS,  William,  Private,  Co.  E,  bth  Pennsylvania  Cavalry,  aged  39 years.  Sabre-cut,  with  fracture  and  depression 
of  the  parietal  bone.  Petersburg,  Virginia,  June  9th,  1834.  Admitted  to  hospital  at  Hamj)ton,  Virginia,  June  11th.  Died 
June  18th,  1834,  from  compression  of  the  brain. 

Reed,  Jame.S  T.,  Private,  Co.  C,  1st  Y^’ermont  Cavalry,  aged  29  years,  was  wounded  in  a charge  at  Boousboro, 
Maryland,  .Inly  6th,  1833,  receiving  two  sabre-cuts,  one  on  the  head,  the  other  on  the  left  arm.  The  first  was  a slanting  cut  on 
the  right  parietal,  which  uncovered  the  dura  mater,  completely  detaching  a portion  of  the  bone,  the  piece  of  the  external  table 
sliced  off  being  two  and  a half  inches  in  length  and  an  inch  and  a quarter  in  breadth,  while  the  portion  including  the  diploe  and 
internal  table  was  much  smaller.  The  integumental  flap  was  not  entirel}-  separated  from  the  scalp.  The  second  cut  involved 
the  left  elbow,  and  chipped  off  the  olecranon  process.  The  head  was  shaved  on  the  field ; the  piece  of  bone  sliced  off  was  se])a- 
rated  from  the  flap,  and  the  integument  was  replac(!d  and  secured  by  adhesive  straps.  Water  dressings  W(‘re  aj)plied  to  the 
wound  of  the  elbow,  and  the  arm  was  placed  in  a sling.  On  July  16th,  the  patient  was  admitted  to  Hospital  No.  1,  Frederick, 
Maryland.  The  wound  of  the  head  ha<l  almost  entirely  healed.  The  elbow  was  swollen  and  ])ainful.  On  .1  iily  20th,  there  was 
an  attack  of  erysipelas  of  the  arm.  This  subsided,  and  the  limb  was  i)laced,  fixed  at  a right  angle,  in  a starched  bandage,  tins 


Fio.  7. — Exfoliation  from  the 
left  parietal,  resulting  from  a sahre 
wound. — SjfiT.  3SG3,  Scot.  1,  A.  M. 
M.,  natural  size. 


22 


WOUNDS  AND  TN.TUETES  OF  THE  UEAD, 


■wound  being  exposed.  There  was  a copious  discharge  of  i)us  mixed  with  synovial  iluid.  At  this  date  the  wound  of  the  scalp 
was  completely  healed.  On  September  20th,  the  patient  had  recovered  with  anchylosis  of  the  elbow.  He  sulFered  from  head- 
ache, and  from  fixed  pain  at  the  seat  of  the  head  injury,  especially  when  he  was  exposed  to  the  sun.  On  January  23d,  1864,  he 
was  transferred  to  the  1st  Battalion  of  the  Veteran  Reserve  Corps,  and  on  September  26th,  1864,  he  was  discharged  from  service 
on  account  of  disability. 

Rice,  Maecus  M.,  Corporal,  Co.  K,  1st  Vermont  Cavalry,  aged  39  years,  received  a sabre  fracture  of  the  frontal  bone, 
and  a wound  of  the  right  thigh,  at  Gettysburg,  July  3d,  1863.  Admitted  to  hospital  at  Brattleboro,  Vermont,  August  5th. 
Returned  to  duty  November  24th,  1863,  and  mustered  out  with  his  regiment  on  February  22d,  1865. 

liogers,  Thomas  K.,  Private,  Co.  C,  fith  Alabama  Infantry,  aged  41  years,  was  wounded  near  Petersburg,  Virginia,  April 
2d,  1865,  by  a sabre-cut  over  the  left  supra-orbital  lidge  extending  upwards  and  backwards  two  inches,  and  frticturing  the 
frontal  bone.  On  Ajull  8th,  he  was  admitted  to  Lincoln  Hospital,  Washington.  A few  days  after  his  admission  his  photograph 
was  taken  for  the  collection  of  Photographs  of  Surgical  Cases  of  the  Army  Medical  Museum.  The  picture  is  No.  6 of  Volume  3 
of  that  series.  It  is  well  copied  in  the  right-hand  figure  of  the  group  in  Plate  I.  On  April  20th,  the  patient  showing  symptoms 
of  compression,  Surgeon  J.  Cooper  McKee,  U.  S.  Army,  applied  the  trephine  about  one  inch  above  the  supra-orbital  ridge  and 
elevated  the  depressed  bone.  On  klay  27th,  the  patient  was  recovering  rapidly,  having  manifested  no  bad  symptoms  since  the 
removal  of  the  bone.  The  large  incision  in  the  integument  w'as  cicatrizing  favorably,  covering  the  dura  mater,  so  that  pulsation 
was  no  longer  visible.  On  June  14th,  1865,  the  patient  had  completely  recovered,  and,  upon  taking  the  oath  of  allegiance,  he 
was  released. 

Royaix,  William  B.,  Captain,  5th  U.  S.  Cavalry,  received  several  sabre  wounds  on  June  13th,  1862,  near  Old  Church, 
Hanover  county,  Virginia.  While  posted,  in  observation,  on  the  extreme  right  of  General  kIcClellan’s  army,  his  small  com* 
mand  was  overwdielmed  by  the  Cimfederato  cavalry  column  of  General  J.  E.  B.  Stuart.  Captain  Royall  made  a stubborn 
resistance  with  his  squadron.  Though  surrounded,  and  grievously  wounded,  he  escaped  from  the  field.  On  joining  the  main 
body,  his  injuries  w'ere  examined  by  Surgeon  C.  M.  Ellis,  fith  Pennsylvania  Cavalry.  There  were  two  sabre  contusions  on  the 
right  side  of  the  head,  a cut  two  inches  long  on  the  forehead  through  the  scalp  only,  a long  cut  on  the  left  cheek  which  bled  pro- 
fusely, a cut  on  the  right  w’rist  dividing  the  tendon  of  the  extensor  projirius  jiollicis,  and  an  incised  fracture  four  inches  long  of 
the  left  parietal,  dividing  the  outer  table  and  diploe.  Entire  rest  and  restricted  diet,  with  cold  applications  to  the  head,  W’ere 
enjoined;  but  after  a few' days  the  patient  was  removed  to  Washington.  Here  he  was  attended  by  Surgeon  General  C.  A. 
Finley,  and  Surgeon  G.  E.  Cooper,  U.  S.  A.,  who  directed  a continuance  of  the  antiphlogistic  regimen.  The  flesh  wounds  soon 
cicatrized ; but  the  incised  fracture  continued  to  suppurate  for  almost  three  months,  after  w'hich  the  wound  firmly  healed.  A 
condition  of  extreme  nervous  irritability  persisted  for  many  months,  with  attacks  of  headache  and  vertigo  which  incapacitated 
the  sufferer  for  active  service.  In  May,  1862,  Captain  Royall  was  breveted  Major,  and  in  June,  Lieutenant  Colonel,  and,  in 
October,  he  was  assigned  to  duty  as  mustering  officer  at  Louisville,  Kentucky.  He  W'as  promoted  Major  December  7th,  1863, 
and  brevetted  Colonel  March  13th,  1865.  In  April,  1866,  he  w'as  examined  at  the  Surgeon  General’s  Office.  His  health  was 
still  impaired  from  the  effects  of  his  injuries,  but  was  gradually  improving.  In  1869,  his  health  was  good. 

SiiAW,  Joiix  IlEXitY,  Private,  Co.  1.  10th  New’  York  Cavalry,  received  a sabre-cut  of  the  left  side  of  the  scalp,  with 
fracture  of  the  outer  table  of  the  frontal  bone,  at  Brandy  Station,  Virginia,  June  9th,  1863.  He  was  admitted  to  First  Division 
Plospital  at  Annapolis,  Maryland,  on  June  13th,  and  returned  to  duty  June  30th,  1863. 

SiiUREY,  Amos,  Saddler,  Co.  H,  21st  Pennsylvania  Cavalry,  was  wounded  by  sabre-cuts  at  the  affair  at  Jettersville, 
Virginia,  April  5th,  1865.  The  outer  tables  of  the  parietal  bones  were  fractured,  and  also  the  ulna  and  fifth  metacarpal  bone. 
He  was  admitted  to  First  Division  Hos])it:d,  Annapolis,  Maryland,  April  15th,  and  on  May  9th  he  was  transferred  to  the  Second 
Division  Hospital  at  Annapolis.  He  died  May  12th,  1865. 

SiDEKS,  Hiram,  Private,  Co.  H,  21st  Pennsylvania  Cavalry,  aged  18  years.  Sabre-cut  of  the  skull,  producing  a com- 
minuted fracture  of  the  left  parietal  bone.  Amelia  Court  House,  Virginia,  April  fith,  1865.  Admitted  to  Carver  Hospital, 
Washington,  April  16th.  Discharged  from  service  June  21st,  1865. 

Steele,  Jacor,  Private,  Co.  E,  1st  Michigan  Cavalry,  aged  20  years,  received  at  the  battle  of  Gettysburg,  Pennsylvania, 
July  1st,  1833,  three  sabre-cuts  of  the  head,  fracturing  the  cranium ; also  a cut  on  the  neck,  a gunshot  wound  penetrating  the 
left  lung,  and  a wound  of  the  right  arm.  He  was  found  lying  in  a barn  in  a state  of  insensibility.  The  ball  was  removed  from 
the  lung,  the  wounds  were  dressed,  and  he  was  admitted  to  Cam])  Letterman  Hosj)ital,  at  Gettysburg,  on  July  fith.  Transferred 
to  Jarvis  Hospital,  Baltimore,  July  19th ; thence  to  West’s  Buildings,  July  21st,  and  finally  to  Carver  Hospital,  Washington,  on 
the  25th.  He  recovered  and  retui’ned  to  duty  October  20th,  1863. 

Straxdbui!G,  Axdrew,  Private,  Co.  H,  5th  Minnesota  Volunteers,  aged  42  years,  was  admitted  on  December  18th,  1864, 
to  the  Cumberland  Hospital,  at  Nashville,  Tennessee,  for  a gunrJiot  wound  of  the  scrotum,  received  at  the  battle  on  the  previous 
day  before  that  cit}’.  The  wound  was  not  dangerous ; but  the  man  had  epileptic  fits,  and  it  was  remarked  that  there  were 
several  depressions  in  the  cranium  on  the  right  frontal  and  parietal  regions.  The  patient  stated  that  he  had  been  wounded 
several  years  previously  by  a sabre  blow  uj)on  the  head,  and  that  he  had  ever  since  been  subject  to  convulsions,  which  were 
commonly  slight,  but  occasionally  severe  and  frequent.  A wounded  captain  of  his  regiment  stated  that  the  patient’s  fits  had 
rarely  disqualified  him  for  duty.  After  his  admission  to  hospital,  Strandburg  had  recurrences  of  epileptic  seinures,  at  first  every 
two  or  three  days,  and  then  at  shorter  intervals,  until  at  last  the  intermissions  between  the  attacks  were  of  half  an  houFs  dura- 
tioii  only.  The  intensity  of  the  attacks  increased  with  their  frequency.  He  died  in  one  of  the  convulsions,  January  3d,  1865. 
At  the  autopsy,  the  upper  portion  of  the  anterior  lobe  of  the  right  homisi)here  was  found  to  be  softened.  There  was  a collection 
of  about  two  ounces  of  limpid  serum  above  the  right  orbital  plate  of  the  frontal  bone.  The  brain,  in  this  vicinity,  was  darker 
in  color  than  natural.  Over  the  right  frontal  and  ])arietal  regions  tlu' dura  mater  was  very  liiinly  attached  to  the  skull.  The 


Med.a- Sur^.  Hist  , of’ the  War  of  the  Rebellion,  Part  1.  Vol  II  0])  .page.  1 


PLATE  II.  SABRE  FRACTURES  OFTHE  VAULT  OFTHE  CRANIUM. 


INCISED  FRACTURES  OF  THE  CRANIUM. 


23 


rigl.t  orbital  i)late  was  fracturLHl.  The  calvaria,  which  was  contributed  to  the  Army  Medical  Museum  by  the  attending  mediotil 
officer,  Asst.  Surgeon  S.  C.  Ayres,  U.  S.  Vols.,  exhibited  multiple  united  sabre  fractures  of  the  os  frontis,  and  united  linear 
fractures  of  both  parietals,  and  disjunction  of  the  corotial  suture  on  the  right  side.  Most  of  the  fractures  had  penetrated  the 
lamina  vitroa,  which  was  much  thickened  in  the  vicinity  of  the  fractures.  Sev'eral  detached  fragments  of  tlie  inner  table  had 
reunited,  and  exhibited  an  eburnated  appearance.  Along  the  sagittal  and  coronal  sutures,  and  in  the  neighborhood  of  the 
incised  fractures,  there  were  osseous  deposits  of  long  standing.  An  internal  and  external  view  of  the  calvaria  {Specimen  4730, 
A.  M.  M.)  is  presented  in  the  accompanying  lithograph. 

Sweeney,  D.,  Private,  Co.  D,  2d  United  States  Artillery,  received  several  severe  sabre-cuts  of  the  scalp,  one  of  which 
fractured  the  cranium.  November,  1833.  Admitted  to  Douglas  Hospital,  Washington,  November  23d.  Returned  to  duty 
December  9th,  1833. 

Vernor,  Foster,  Private,  Co.  E,  1st  New  York  Mounted  Rifles,  received  a sabre-cut  of  the  left  parietal  region  two  and 
a half  indies  in  length,  which  partially  fractured  the  outer  table  of  the  skull.  Smithlield,  Virginia,  May  17th,  1833.  Admitted 
to  First  Division  Ilospittil,  Annapolis,  Maryland,  May  25th.  Returned  to  duty  August  9th,  lH3!i. 

OF  the  forty-nine  patients  with  incised  fractures  of  the  cranium  above  enumerated, 
forty-four  were  Union  and  five  Confederate  soldiers.  Of  the  whole  number,  thirteen  died, 
ten  were  discharged,  four  were  paroled,  two  deserted,  and  twenty  were  returned  to  duty. 
In  the  thirteen  fatal  cases,  death  resulted  from  epilepsy,  several  years  after  the  reception 
of  the  injury,  in  one  instance;  in  another,  tetanus  was  the  cause  of  death;  and,  in  a third, 
pyaemia.  In  the  ten  remaining  fatal  cases,  death  resulted  from  inflammation  of  the  brain  or 
its  membiTines,  or  from  compression.  In  three  of  the  thirteen  fatal  cases,  the  fractures  were 
incomplete,  extending  through  the  external  table  and  diploe  only.  Of  the  ten  patients 
who  were  discharged  for  disabilities  resulting  from  sabre  fractures  of  the  skull,  one  became 
insane,  one  lost  vision  in  an  eye,  three  suffered  from  attacks  of  vertigo  or  dizziness,  and, 
in  two  of  these,  the  mental  faculties  were  impaired,  loss  of  memory  being  particularly 
noticeable.  A sixth  patient  was  hemiplegic,  and  his  mind  was  much  deteriorated.  • The 
other  four  men  discharged,  and  the  four  paroled  men,  suffered  only  from  occasional  head- 
aches or  from  slight  disabilities.  In  eleven  of  the  forty-nine  patients,  fragments  of  bone 
were  removed  by  the  forceps,  elevator,  Tley’s  saw,  or  trephine.  But  one  of  these  eleven 
cases  terminated  fatally.  In  thirty-seven  cases,  the  site  of  fracture  is  definitely  described. 
The  frontal  bone  was  principally  involved  in  seven  cases.  Two  of  these  terminated 
fatally ; from  tetanus,  in  one  instance ; in  the  other,  with  fracture  of  the  outer  table  only, 
secondary  encephalitis  and  abscess  of  the  brain  supervened.  There  were  two  cases  of  fracture 
of  the  temporal  region,  that  recovered.  In  twenty-two  cases,  one  or  both  parietals  were 
fractured,  and  six  of  these  cases  resulted  fatally.  Of  six  patients  with  incised  fractures  in 
the  occipital  region,  three  recovered  and  three  died.  These  statistics  corroborate  the  obser- 
vations of  HenneA  and  others,  that  sabre  wounds  on  the  top  of  the  head  are  not,  by  any 
means,  so  dangerous  as  those  of  the  sides.  Boyer'  insisted  emphatically  on  this  distinction, 
citing  cases  from  La  Motto,  [Traite  cle  Chir.  Paris,  1732,  T.  II,  p.  238,  Obs.  139,)  Marchetti, 
and  Bohn,  of  numerous  recoveries  from  very  free  incisions  of  the  upper  part  of  the  skull, 
with  injury  of  the  membranes  or  to  the  brain.  He  pronounced  incised  fractures  of  the 
lateral  parts  of  the  head,  with  penetration  of  the  brain  tissue,  far  graver,  and,  indeed, 
almost  invariably  fatal  accidents.  Of  two  cases  of  recovery  from  sabre  fractures  in  the 
temporal  region  mentioned  in  the  foregoing  return,  [Lawler,  p.  20,  and  OTIare,  }).  21,) 
the  contents  of  the  cranium  were  uninjured  in  one  Instance,  and  in  the  other,  the  incision 
ran  across  the  squamo-parietal  suture,  and  the  hemisphere  was  probably  wounded  at  its 
upper  portion.  The  very  rapid  recovery  in  the  latter  case  is  sufficiently  surprising.  In 
the  three  cases  of  recovery  from  sabre  fractures  of  the  occipital  region,  (Bradley,  p.  17, 


* IlF.NN'KN,  l*rinciples  of  Military  Surycry,  3d  cd.  London,  18:i9,  ju  28(L 
UOYIvU,  Traitodcs  Maladies  OhiruryicaUs,  5®  cd.  Pari.s,  1847,  Tb  IV,  p.  25Ii. 


21 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Engelkee,  p.  18,  Lucas,  p.  20,)  there  was  no  evidence  of  lesions  of  the  encephalon,  and 
in  two  of  these  three  cases,  the  incisions  appear  to  have  implicated  only  the  outer  table 
and  diploe.  The  seat  of  injury  is  specified  in  eleven  of  the  thirteen  fatal  cases  of  incised 
fractures  of  the  cranium,  and  was  low  down  laterally  or  posteriorly  in  nine. 

In  five,  of  the  eleven  instances  in  which  operative  interference  was  employed  in  the 
treatment,  it  consisted  in  the  early  removal  of  detached  or  depressed  fragments  ; in  three 
cases,  in  the  extraction  of  loose  exfoliations  at  a later  period;  and,  in  three  cases,  in  the 
formal  application  of  the  trephine. The  five  patients  treated  by  the  early  removal  of 
fragments  recovered,  and  three  were  returned  to  duty  ; one  of  them,  however,  suffering 
from  deafness  and  dullness  of  intellect;  while  two  were  invalided,  partly  on  account  of 
disabilities  unconnected  with  the  head  injuries.  The  three  patients  who  had  exfoliations 
removed,  eleven,  seven,  and  thirty-two  months,  respectively,  from  the  date  of  the  reception 
of  their  injuries,  also  recovered,  and  one  was  returned  to  duty,  and  two  were  discharged 
and  pensioned ; in  the  former,  and  one  of  the  latter,  necrosis  involved  the  outer  table  only ; 
the  third  patient  suffered  from  hemiplegia  and  mental  dullness.  Two  of  the  three  patients 
subjected  to  trephining,  on  the  first  and  eighteenth  day,  respectively,  recovered;  and  the 
third,  trephined  on  the  sixth  day,  survived  the  operation  ten  days.  These  cases  will  bo 
further  considered  in  the  discussion  of  the  results  of  trephining  for  gunshot  injuries. 

When  sword-cuts  slice  away  parts  of  the  skull  and  the  detached  fragments  of  bone 
adhere  to  flaps  of  integument  not  entirely  separated  from  the  scalp,  the  treatment  to  be 
pursued  has  been  a subject  of  discussion  from  an  early  period,^  and  is  still  a disputed 
c{uestion.  Dononvilliers  and  Grosselin,^  Legouest,^  and  Jamain,'*  advise  that  the  isolated 
fragment  of  bone  should  be  removed  from  the  integument,  and  that  the  latter  should  then 
be  replaced  and  kept  in  position  by  adhesive  straps  if  possible,  or  else  by  sutures  inserted 
at  such  intervals  as  to  admit  of  the  free  dischafge  of  pus.  They  follow  the  teaching  of 
Dupuytren,®  Ijased  on  the  dangers  of  protracted  suppuration,  of  necrosis  of  the  detached 
fragment,  and  of  secondary  meningitis,  from  leaving  the  bone  to  act  as  a foreign  body. 
But  these  dangers  would  appear  to  be  overrated,  and  John  Bell,  Hennen,  Guthrie,  and 
Macleod,  were  in  favor  of  the  practice  of  Pare,  the  re-application  of  the  flap,  bone  and  nil. 

Berengarius  de  Carpiensis,  [Opera  Omnia,  p.  640,)  Fallopius,  [De  Vulner.  Capitis, 
Cap.  XXII,)  and  Magatus,  report  instances  of  recovery  after  the  removal  of  the  detached 
section  of  bone  and  the  re-application  of  the  flap  of  integument.  Larrey  and  Lombard, 
[Remarcpncs  sur  les  Lesions  de  la  Tete,  Strasbourg,  1796,)  followed  successfully  the  prac- 
tice of  Berengarius,  and  cite  many  interesting  cases  of  recovery  from  sword  cuts  in  the 
head,  through  the  bone.  Pard  [CEuvres  Completes,  ed.  Malgaigne,  Book  VIII,  Chap.  7) 
advises  that  the  osseous  flap  should  be  re-applied  and  kept  in  place  by  a few  stitches,  a 
practice  which  he  successfully  adopted  in  the  case  of  “Captain  ILydron,”  and  he  quotes 

‘Since  the  foregoing  sheets  were  in  print,  some  additional  information  has  been  obtained  in  relation  to  the  case  of  S.  L.  BROWN,  (p.  17.) 
The  sabre-ent  ran  along  the  lower  border  of  the  left  parietal  for  two  and  a half  inches,  and  produced  a depressed  fracture.  The  patient  was  conveyed, 
ip  an  insensible  condition,  to  a field  hospital,  and  was  trephined,  a button  of  bone  and  a detached  fragment  of  both  tables,  an  inch  and  a half  in  length, 
being  removed.  He  was  completely  unconscious  until  July  8th,  when  he  recovered  fi-om  his  profound  stupor  and  was  perfectly  rational.  He  was  kept 
on  a strict  antiphlogistic  treatment  for  ten  days  longer,  and  was  then  conveyed  to  a hospital  at  York,  Pennsylvania. 

^ Thcsavrvs  Chirvnjke,  contlnens  preestantissimorvM  Avtorvin,  vtpote  Ambrosii  Pauei  Parisiensis  Ioannis  Tagavltii 
Ajibiani  VimaCI,  Alpiionsi  Ferrh  Neapolitani,  Gvilelmi  Fabritii  Hilbani,  etc.,  Opera  Chiranjica,  nunc  vere  in  vnum 
collccta per  Petrum  Uffenbachium.  Fraucofvrti,  aimo  MDCX,  p.  199. 

'^Compendium  de  Chirurgie  Pratique,  T.  II,  p.  570. 

® Traite  de  Chirurgie  d’Armee,  p.  319. 

'^Manuel  de  Pathologic  et  de  Clinique  Chirurgieales,  2(1  od.  Paris,  18G7,  T.  1,  j).  5S0. 

^Clinique  Cldrurgieule,  T.  VI,  p.  151.' 


INCISED  FRACTURES  OF  THE  CRANIUM. 


25 


Celsiis  {Dc  re  viedica,  Liber  VIII,  Gap.  IV)  in  support  of  liis  precept.  Saliatier  (Dc  la 
Med.  Operatoire,  ed.  1832,  T.  II,  p.  18)  cites  other  examples  of  successful  results  by  Pard’s 
plan  from  Ldaultd,^  Le  Dran,  [Observations  de  Chirurgie,  T.  I,  p.  156,  Paris,  1731,)  and 
Plainer,  [Opuseula,  Lipsiae,  1748.)  In  the  Museum  of  the  Royal  College  of  Surgeons,  at 
London,  there  are  ten  skulls  which  have  suffered  from  severe  slicing  cuts.  The  large  portions 
of  bone  cleft  from  these  crania  have  reunited,  often  a little  out  of  their  proper  places.  The 
fissures  are  all  in  a state  of  progress  towards  being  filled  up  by  bone  ; and  the  patients  must 
have  survived  their  respective  injuries  months,  if  not  years.  These  crania  are  said  to  have 
been  collected  from  a cemetery,  near  a military  asylum  in  Germany.  Several  remarkable 
examples  of  the  reunion  of  osseous  flaps  sliced  off  by  sabre-cuts'  are  preserved  in  the 
Museum  of  the  School  of  Val  de  Grace.  Hennen  [Principles  of  Military  Surgery,  3d  ed., 
p.  286)  saw,  in  the  Peninsula,  many  cases  of  this  nature  successfully  treated  by  replacing 
the  parts  with  the  aid  of  a.  few  stitches,  and  of  a supporting  bandage.  Macleod  records 
[Surgery  of  the  War  in  the  Crimea,  p.  I8I)  the  case  of  a Russian  soldier  under  his  charge, 
who  recovered  perfectly,  the  osseous  flap  being  left  undisturbed.  Guthrie  [On  Injuries  of 
the  Head  affecting  the  Brain,  p.  96)  adduces  examples  of  recovery  under  both  methods  of 
treatment,  and  teaches  that  when  the  detached  portion  of  bone  adheres  firmly  to  the  peri- 
cranium or  integumental  flap,  it  should  be  reapplied  ; but  if  it  has  but  little  adherence,  it 
should  be  removed. 

The  reports  of  these  slanting  cuts  of  the  head,  with  detachment  of  a flap  of  bone,  in  the 
records  of  the  American  war,  are  insufficient  in  number  and  details  to  decide  this  question. 
In  the  case  of  Bedel,  [ante  p.  17,)  an  osseous  flap  from  the  occiput,  attached  to  the  integu- 
ment, and  partially  adherent  at  its  base  to  the  skull,  was  reapplied,  and  had  nearly 
reunited  through  the  deposition  of  new  bone,  at  the  date  of  the  man’s  death,  forty-two 
days  after  the  reception  of  the  injury.  Evidently,  the  presence  of  the  slice  of  bone  in 
the  flap  had  not  been  injurious  ; the  fatal  issue  having  been  due  to  the  irritation  caused 
by  the  splinters  of  the  inner  table,  driven  in  on  the  right  side.  In  the  case  of  Strandburg, 
(p.  22,)  illustrated  by  Plate  II,  detached  fragments  had  completely  reunited,  the  man 
surviving  his  injuries  for  years.  On  the  other  hand,  in  the  cases  of  S.  L.  Brown,  (p.  17,) 
and  Reed,  (p.  21,)  the  fragments  of  bone  sliced  off  were  removed  from  the  integumental- 
flaps,  which  were  then  replaced  and  retained,  and  both  men  made  excellent  recoveries. 
Little  is  known  of  the  practice  of  Confederate  surgeons  in  this  |)articular.  Dr.  Chisolm' 
advises  that  all  sabre-cuts  should  be  closed  by  adhesive  strips  or  sutures,  followed  by  cold 
water  dressings.  Dr.  E.  Warren^  suggests  that  the  osseous  flap  should  be  reapplied ; but 


' Observations  in  Surgery,  written  originally  in  Frencli,  by  H.  F.  Le  Dran,  Senior  Master  of  the  Company  of  Surgeons  at 
Paris.  Translated  by  J.  S.,  2d  ed.,  London,  1770,  p.  77.  The  XXII  Observation,  reported  by  M.  Leaultc,  sworn  surgeon  at 
Paris,  relates  to  a sabre-cut  of  the  occiput,  “taking  off  about  the  extent  of  a shilling  from  the  first  table  of  the  occijutal  bone, 
and  from  the  internal  table  the  bigness  of  a silver  groat,  without  olfending  the  dura  mater,  only  leaving  it  uncovered.'’  I<6ault6 
attempted  “the  reunion  of  the  teguments  and  the  bone.”  51.  Le  Dran,  “being  at  Tuernoy  with  the  5Iareschal  de  Villiers,  came 
to  visit  the  patient,  and  apprehended  that  it  would  be  necessary  to  separate  the  bone  from  the  teguments  entirely ; but,  upon 
second  thouglits,  we  concluded,”  says  L6ault6,  “that  I had  always  time  enough  to  propose  this  operation,  if  my  former  intentions 
did  not  succeed ; and  therefore  we  agreed  to  continue  the  same  manner  of  dressing,  which  afforded  me  the  satisfaction,  in  a few 
days,  of  approximating  the  pieces,  and  securing  them  so  well  to  the  neighboring  parts  that  they  perfectly  reunited,  forming  a 
cicatrix  in  the  space  of  twenty-five  days,  without  the  least  accident.” 

‘^A  Manual  of  Military  Surgery  for  the  use  of  Surgeons  in  tlic  Confederate  States  Army ; by  J.  Julian  Ciii.SOLM,  51.  D., 
3d  ed.,  Columbia,  S.  C.,  1834,  p.  213. 

^An  Epitome  of  Surgery  for  Field  and  JlospiUd;  by  Edwaiju  WAitUKN,  51.  D,,  Richmond,  Virginia,  1803,  p.  353. 


26 


WOUNDS  AND  INJUDJES  OF  THE  HEAD. 


does  not  present  facts  in  support  of  the  recommendation.  The  other  Confederate  surgical 
writers  are  silent  on  the  subject. 

Although  the  dangers  from  permitting  the  flap  of  hone  adherent  to  the  scalp  to  remain 
have,  perhaps,  been  exaggerated,  yet  it  is  probably  safer  to  remove  it,  if  it  can  be  detached 
without  much  difficulty.  That  the  dangers  are  not  altogether  imaginary,  is  proved  by  the 
examples  of  necrosis  of  the  segment  of  bone  cited  by  Ravaton  and  Baerwindt.  Should  the 
bone  fragment  comprise  only  the  outer  table  and  diploe,  it  seems  useless  to  preserve  it ; 
for  the  lu’ain  cavity  remains  closed  by  the  viti'eous  table,  and  a flap  of  scalp  alone  has, 
incontestably,  a tendency  to  reunite  more  promptly  than  an  osseous  surface.  If  the  portion 
of  bone  sliced  off  includes  the  entire  thickness  of  the  cranial  wall,  and  is  reapplied  with  the 
intcgumental  flap,  cicatrization  must  be  necessarily  slow,  and  there  will  bo  a period  of 
many  weeks,  during  which  complications  are  liable  to  arise.^ 

Had  it  been  practicable,  the  cases  of  incised  fractures  of  the  skull  would  have 
been  arranged  in  accordance  with  the  classification  proposed  by  Mr.  J.  Adams,"  viz: 
“First,  the  simple  section  of  the  outer  table,  in  which  a mere  superficial  mark  is  left; 
secondly,  the  division  of  both  tables  by  a perpendicular  section  ; thirdly,  an  oblique 
or  horizontal  cut,  where  both  tables  are  divided,  but  not  completely  detached ; and, 
fourthly,  the  entire  ablation  of  a piece  comprising  both  tables,  in  which  the  bone 
adheres  to  the  soft  parts,  or  is  completely  removed  with  them.”  But  the  records 
are  so  incomplete  that  it  has  been  possible  to  determine  these  distinctions  in  only 


' Tlie  literature  of  the  subject  has  only  been  glanced  at  above.  The  question  seems  to  have  been  a favorite  topic  of 
discussion  with  the  older  surgeons.  La  Motte  {Traite  complet  de  Chirurc/ie.  I’aris,  1771,  j)p.  534,  535,  556,  597)  recorded  foui' 
cases  (Ohs.  140,  141,  1.57,  161)  of  slanting  sahre-cuts,  producing  osseous  llap.s,  which,  in  three  cases,  included  both  tables  of  the 
.skull,  and  in  the  fourth,  the  outer  table  only.  In  all  four  cases,  the  fragments  of  bone  were  removed,  the  integuniental  Hap 
reapplied,  and  recovery  promptly  ensued.  Bilguer,  J.  M.,  (Chirunjische  Walimehmungcn  in  denen  KonirjUch  Freussisrhen  Feld 
Lazarcthev,  Berlin,  1763,  ]ip.  89,  114,  143,  145,  147,)  cites  five  cases  of  the  same  nature,  all  of  which  recovered  after  the  removal 
of  the  detached  Hap  of  bone,  (Obs.  1.5,  23,  35,  36,  37.)  D.  J.  Larrey  report.s,  altogether,  eleven  cases  of  this  description. 
{Relation  Illstorique  et  Chb’urgicalc  de  V Expedition  de  V Armee  d’ Orient.  Paris,  1803,  p.  290;  Clinique  Chirurijicalc,  Paris,  1829, 
T.  I,  pp.  140,  188,  286,  306,  et  T.  V,  pp.  11,  40,  322;  Mem.  de  Chir.  Mil.  et  Campaynes,  Paris,  1812,  T.  Ill,  ]>p.  140,  260.)  In 
seven  of  these  cases,  the  piece  of  bone  sliced  off  was  removed,  and  six  of  the  patients  recovered  ; in  four  cases  the  Hap  of  bone 
was  reapplied,  and  two  ])atients  recovered,  and  two  died.  M.  H.  Larrey  (Relation  Chiruryicale  des  Jzvenemens  de  Juillct,  1830, 
Paris,  1831,  p.  35)  cites  the  case  of  a locksmith,  who,  supposing  himself  to  he  followed  by  a large  body  of  insurgents,  rushed 
ui)on  a squadron  of  grenadiers  and  received  eight  or  ten  sabre  cuts  on  his  head.  There  were  several  Haps ; one,  including  a 
large  j)ortion  of  the  j)arietal,  fell  over  the  right  ear,  exposing  the  dura  mater  over  a space  two  inches  long  and  an  inch  broad. 
Another,  behind  and  above  the  left  ear,  contained  a detached  fragment  of  bone.  51.  Magistel  dressed  the  wounds,  removing 
(uitirely  the  fragments  of  bone,  and  adjusting  the  flaps  by  sutures  .and  .adhesive  strips.  The  patient  was  then  jdaced  in  the 
Be.aujon  Hospital,  under  the  care  of  5Iarjoliu  .and  Blandin.  Complete  recovery  followed  in  about  six  weeks,  and  the  man  was 
presented  to  the  Academy  of  5Iedicine.  II.  5Ieyer  (lleiluny  von  Scliddelverletzungcn  in  LanycnhecFs  Archiv.,  B.  II,  S.  91  uiid 
101.  Berlin,  1832)  cites  two  cases  of  this  nature;  in  one,  the  severed  segment  of  bone  w.as  removed  and  the  patient  recoveu’ed; 
in  the  other,  it  was  replaced,  and  the  patient  died  of  meningitis.  The  jiathological  j)re]>aration  from  the  latter  case  is  specimen 
1052,  at  the  Museum  of  the  University  of  Zurich.  Baerwindt  (Die  Bchandluny  von  Kranhcn  und  Venoundeten  untcr  Zcltcn  im 
Sommer  1866.  W’urzburg,  1867,  S.  93)  relates  two  cases  of  rejilacement  of  the  segment  of  bone,  followed  by  necrosis,  the 
])atients  recovering  after  the  extraction  of  the  exfoliation.  Eavaton  (Chiruryic  d’Anncc,  Paris,  1768,  p.  549)  also  reports, 
in  detail,  two  cases  with  a similar  history.  Kavoth  und  Vocke  (Chiruryisrhe  Klinil:,  Berlin,  1852,  S.  437)  record  tw'O 
e.xamples  of  recovery  after  removal  of  the  osseous  ttaj).  B.  Beck  (Kricys-Chiruryische  Erfahrunyen  wdlirend  des  Feld- 
znyes,  1886,  in  Siiddeutschland.  Freiburg,  1867,  .S.  161)  cites  a very  interesting  case  of  recovery  after  the  removal  of  a 
large  segment  of  bone  and  the  reapplication  of  the  Hap  of  integument.  On  the  other  hand,  Weiifer  (Olscrvaiions  Medko- 
Fracticce  de  Affectihus  Capitis,  Scaphusii,  1827,  j).  34,  Obs.  16)  reports  a very  successful  ease  in  which  the  osseous  flap  was 
reapplied.  Another  is  cited  by  Baudens,  (Clin,  des  Flaks  d' Amies  d Feu,  I’aris,  1836,  p.  122,)  a complicated  and  very  unjn-om- 
ising  case  at  the  outset.  Theden  (Neue  Bemerlunyen  und  Erfahrunyen,  1782,  Theil.  I,  S.  77)  approves  of  replacing  the  bone. 
Chopart  and  Desault  (Traite  des  Maladies  Chirurykales  et  des  Operations,  Paris,  1796,  p.  70)  are  of  the  same  opinion,  and 
C.  .1.  51.  Langenbeck  (Nosoloyie  und  Thcrapie  dcr  Chiraryischen  Krankheiten,  Gottingen,  1830,  S.  57)  inclines  in  that  direction. 
The  authorities  are  about  equally  divided ; but  the  facts  adduced  seem  to  favor  the  ])ractice  of  removing  the  detachi'd  or 
|)arti.ally  detached  segment  of  bone. 

‘‘Additions  to  the  Eighth  Edition  of  Coopeds  Dktionary  of  Frartkal  Surgery,  London,  1861,  Vol.  I,  p.  885. 


INCISED  FRACTUEES  OF  THE  CRANIUM. 


27 


lliiiLy-one  of  flic  forty-nine  cases  reported.  Fifteen  cases,  of  which  two  were  fatal, 
would  be  included  under  the  first  head ; eight  cases,  four  recoveries  and  four  deaths,  under 
the  second  ; six  cases,  three  of  which  were  fatal,  under  the  third  ; and  two  cases,  a recovery 
and  a death,  under  the  fourth.  In  only  one  of  the  cases  reported  (R.  Hall,  p.  19),  did  the 
question  arise  of  the  treatment  to  be  pursued  in  the  event  of  a complete  ablation  of  a 
portion  of  the  skull,  together  with  the  integument,  the  connections  of  the  flap  with  the 
head  being  entirely  severed.  In  this  case,  the  complications  were  so  gra^m  that  the  ques- 
tion was  of  little  interest.  It  is  not  impossible  that,  if  the  portion  of  scalp  shorn  off,  the 
fragment  of  bone  being  removed,  were  immediately  replaced,  and  secured  by  stitches, 
reunio]!  might  ensue.  But  no  example  of  such  a plastic  procedure  has  been  recorded.  On 
the  contrary,  authors  advise  that  the  dressing  should  be  that  of  a wound  with  irreparable 
loss  of  substance,  a simple  dressing  : for  example,  a compress  spread  with  cerate  and  a 
retentive  bandage. 

The  utility  of  the  trepan  in  incised  fractures  of  the  skull  will  be  considered  in  the 
general  discussion  of  the  subject  of  trephining,  at  the  close  of  this  chapter.  It  will, 

therefore,  be  unnecessary  to  make  any  further  observations  on  the  treatment  of  incised 
fractures  of  the  cranium  ; since,  unless  it  be  decided  that  the  symptoms  demand  operative 
interference,  the  treatment  should  be  identical  with  that  of  incised  scalp  wounds.  [See  p.  15.) 

The  returns  confirm  the  observation  of  Thomson,^  renewed  liy  Dr.  Macleod,^  on  the 
remarkable  rarity  of  hernia  of  the  cerebral  substance  after  sword,  or  compared  with  gun- 
shot wounds.  This  complication  did  not  supervene  in  any  of  the  cases  reported,  although 
in  many  of  them  the  membranes  of  the  brain  were  divided,  wliile  in  several  there  was 
loss  of  brain  tissue. 

In  addition  to  those  figured  in  previous  pages  of  this  section,  the  Army  Medical 

Museum  possesses  eleven  crania  affording  excellent  illustrations  of  almost  eAmry  variety 
of  incised  fractures  of  the  skull.  As  these  specimens  do  not  pertain  to  the  Surgical  His- 
tory of  the  American  War,  the  reader  must  be  referred  to  the  Catalogue  of  the  Museum  for 

full  descriptions  of  them.^ 

The  three  hundred  and  thirty-one  cases  of  incised  wounds  of  the  scalp  or  cranium 
recorded  in  the  earlier  part  of  this  section,  comprise  all  of  the  sabre  or  sword  cuts  of  the 
head  entered  on  the  registers  of  the  Surgeon  General’s  Office  that  can  be  satisfactorily 
verified.  Others  are  alluded  to  by  medical  officers,  but  so  indefinitely  that  identification 

‘ Report  of  Observations  made  in  the  Hriiish  Military  Ilospitals  in  licltjium  after  the  battle  of  Waterloo,  Ediiibiirgli,  1810, 
p.  50.  Thomson  cites  a remarkable  case  of  removal  of  the  npjicr  part  of  the  occipital  bone  along  with  the  dura  mater,  in  which 
“a  tendency  to  protrusion  of  the  brain  took  jdace  during  an  attack  of  inllammation ; a slight  degree  of  stupor,  with  loss  of 
memory,  occurred ; but  on  the  inflammatory  state  having  been  subdued  the  brain  sank  to  its  former  level,  tbe  stupor  went  olf, 
and  the  memory  returned.”  Further  on,  he  remarks:  “we  had  frequent  opportunities  of  seeing  the  upper  and  the  lateral  parts 
of  the  cerebrum  exposed  by  sabre  wounds;  but,  in  no  case,  except  that  which  I have  mentioned,  did  any  tendency  to  ju’otrusion 
of  the  brain  present  itself  to  our  notice.” 

Notes  on  the  Surgery  of  the  War  in  the  Crimea,  by  George  11.  B.  Macleod,  M.  D.,  London,  1858,  p.  181. 

® Specimens  970  and  971,  Section  I,  are  crania  of  Araucanlan  Indians,  killed  by  Chilian  troops.  No.  970  shows  nine 
sabre-cuts,  illustrating  almost  every  variety  of  such  injuries.  It  is  figured  at  ]i.  39  of  the  Catalogue  of  the  Surgical  Section  of 
Ai-my  Medical  Museum.  No.  971  shows  four  cuts,  which  have  sliced  oft'  a large  portion  of  the  left  jiarietal.  No.  5107  is  a skull 
obtained  at  Waterloo,  by  Professor  William  Gibson,  and  exhibits  a long  perpendicular  cut  through  the  right  parietal.  Nos. 
5249  and  5250  are  crania  of  California  Indians,  killed  near  Fort  Crook,  and  exhibit  incised  fractures  of  tbe  vaidt  of  the  skull 
by  the  tomahawk.  No.  5529  is  the  skull  of  a Mataco  Indian,  showing  two  clean  cross  cuts  on  the  vertex,  and  a deep  oblique 
cleft  in  the  left  parietal;  the  inner  table  is  divided  without  splintering;  the  wounds  were  inflicted  by  a very  sharp  sabre.  Nos. 
5530,  5532,  5534,  5537,  are  crania  of  California  Indians,  showing  multiple  incised  fractures  of  the  vault.  No.  5544  is  the  skull 
of  a Ponka  squaw,  showing  a deep  oblique  section  of  the  occipital  by  a sword;  the  inner  table  is  cleaidy  divided.  'J'he  last  nine 
Specimens  will  be  fully  described  in  tbe  next  edition  of  the  Surgical  Catalogue. 


28 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


has  been  impraclioable.  Tims,  for  example,  Surgeon  D.  S.  McGuigan,^  3d  Iowa  Cavalry, 
in  liis  report  after  the  battle  of  Pea  Ridge,  refers  to  several  sabre  fractures  of  the  skull, 
which  do  not  appear  upon  the  casualty  lists,  nor  on  any  of  the  nominal  or  numerical 
returns  of  wounded  : 

“The  cavalry  were  pursued  by  Texan  cavalry  and  mounted  Indians, 
armed  with  a short  and  heavy  sabre,  made  from  large  saw-mill  files,  and 
manufactured  by  their  own  mechanics.  One  blow  with  this  rude  weapon 
would  crush  through  the  integuments  and  bony  walls  of  the  cranium,  into 
the  brain.” *  * “The  wounds  were  mainly  produced  by  rifle  balls, 

and  by  the  sword  or  knife  already  described.  A number  were  killed  by 
one  stroke  of  this  weapon,  and  I saw  several  who  were  severely  wounded 
by  it.”  “The  cavalry  were  wounded  more  frequently  on  tlie 

upper  part  of  the  trunk  or  the  face,  upon  the  head  or  upper  extremities.” 

* “Here,  too,”  [at  Leetown,  Arkansas,]  Surgeon  McGuigan 
continues,  “ I found  several  wounded  by  the  sabre,  two  on  the  head.  The 
integument  only  was  divided  in  one  case,  and,  in  the  other,  the  weapon 
had  penetrated  the  calvarium,  through  the  prominence  of  the  left  parietal 
bone,  in  a horizontal  direction,  and  had  divided  the  membranes,  through 
which  portions  of  the  cerebral  substance  protruded.  I also  found  three  of 
our  men  with  sabre-cuts  upon  the  head  and  upper  extremities,  and  several 
with  minor  injuries  from  the  -same  weapon.  These  wounded  were  carried 
to  Cassville,  Missouri.”" 

A number  of  the  reports  of  medical  directors  and  chief  medical  officers  contain  remarks 
on  sabre  wounds,  that  will  be  quoted  in  the  general  observations  in  the  concluding  volume 
of  this  work. 

The  records  of  miscellaneous  wounds  and  injuries  include  no  cases  of  incised  fractures 
of  the  skull,  and  but  few  of  incised  wounds  of  the  scalp.  These  cases  were  commonly 
entered  numerically,  on  the  monthly  report,  under  the  rubric  “incised  wounds,”  or  “vulnus 
incisum,”  and  rarely  by  name.  The  total  number  of  “incised  wounds”  reported  during 
the  four  years  of  the  war  was  twenty-one  thousand  four  hundred  and  forty-four,  with  one 
hundred  and  ninety-six  deaths;  but  it  is  impossible  to  determine  how  many  of  those  were 
injuries  of  the  head,  since  the  seat  of  the  wounds  is  not  designated. 

The  following  cases  of  incised  scalp  wounds,  which  it  is  thought  best  to  separate  from 
the  sword  wounds,  were  reported  by  name: 

Hunt,  John  M.,  Private,  Co.  K,  Cist  Illinois  Volunteers,  aged  2.5  years,  received  an  incised  wound  on  the  left  side  of 

^ IlcpoH  of  the  Operations  of  the  Medical  Department  at  the  Battle  of  Pea  llklrje,  Arlcansas,  on  March  Gth,  7th,  and  8th, 
1862.  Bound  MSS.,  S.  G.  O.,  Div.  Surg.  Roc.,  A.  125. 

^ There  is  no  regimental  surgical  register  of  the  od  Iowa  Cavalry  on  file,  at  the  Surgeon  General’s  Otilco,  for  the  dates 
I’eferred  to.  No  monthly  sick  reports  for  ^March  and  April,  1832,  were  received  from  the  medical  officer  in  charge  of  the 
regiment.  There  are  no  records  on  file  from  Cassville,  Missouri,  ])rior  to  February,  1865.  The  records  of  the  military  hospitals 
at  Kolia,  Springfield,  Jefierson  City,  and  St.  Louis,  Missouri,  and  of  Keokuk  and  Davenport,  Iowa,  whither  wounded  were 
conveyed  after  the  battle  of  I’ea  Ridge,  have  been  carefully  searched  and  found  not  to  contain,  at  the  period  mentioned,  the 
name  of  a single  wounded  man  from  the  3d  Iowa  Cavalry.  The  “Death  Registers”  and  the  Casualty  Lists  of  the  Medical 
Director  are  equally  silent  respecting  the  killed  and  wounded  of  this  regiment  at  the  battle  of  Pea  Ridge.  The  regimental 
olficeis  of  cavalry  had  peculiar  difficulties  in  making  prompt  and  accurate  returns.  When  the  commands  were  engaged  in 
scouting  and  picket  duty,  they  were  dispersed  in  small  detachments,  and  casualties  took  place  of  which  the  regimental  surgeon 
was  not  cognizant;  when  they  were  engaged  in  expeditions  in  large  columns,  or  raids,  the  marches  were  so  rapid  that  there 
was  little  time  for  clerical  work. 

* Similar  weapons  were  carried  by  a large  number  of  the  Confederate  sohliers  captured  at  Roanoke  Island,  February  8th, 
1832.  These  knives  were  styled  by  those  who  wore  them  : “ Yankee-killers.”  They  were  from  eighteen  inches  to  twenty-four 
inches  in  length,  and  were  made  from  scythe-blades  or  long  files,  sharpened  to  an  edge,  and  set  in  wooden  hilts.  They  were 
not  used  offensively  at  Roanoke  Island,  no  disposition  for  hand-to-hand  combat  being  manifested  after  the  intrenched  position 
was  carried.  The  wood-cut  is  copied  from  two  speciimms  procureil  at  Roanok(f  Island,  by  the  compiler  of  this  worlc. 


Fio,  8. — Knife  or  hang*- 
cr  v/ern  by  Indian  and 
other  savages  in  the 
Confederate  ser\’ice  in 
the  early  part  of  the 
American  \Var.* 


INCISED  WOUNDS  OF  THE  SCALP.'  29 

fho  licad  by  a kiiifi',  at  Miirfrcosboio,  Tumiesseo,  ISIarch  4tli,  I860.  lie  was  admitted  to  liosidtal  011  the  same  day,  and  returned 
to  duty,  cured,  on  April  lltli,  1865. 

Jacksox,  John,  Freedman,  was  cut  on  the  scalp  by  a knife,  in  an  affray  at  Vicksburg,  Mississippi,  May  8th,  1884.  lie 
was  received  into  the  Fieedman’s  Hospital,  whence  he  deserted  on  May  l»ith,  1834. 

Lewis,  John,  Private,  Co.  K,  13th  New  York  Artillery,  aged  22  j'cars,  received  an  incised  wound  of  the  scalp  by  a 
knife,  on  April  2Eth,  1865.  He  was  admitted  to  Balfour  Hospital,  Portsmouth,  Virginia,  on  the  following  day.  He  was 
discharged  frem  service  on  June  17th,  1865. 

!McEai!LAXD,  John,  Private,  Co.  I,  8th  Ohio  Cavalry,  aged  25  year.s,  received  an  incised  wound  of  the  scalj)  by  a blow 
from  a knife,  on  January  7th,  1865.  He  was  admitted  to  Island  Hospital,  Harper’s  Ferry,  Virginia,  on  January  Cth,  and 
returned  to  duty  on  March  6th,  1865. 

ScHUALA,  Joseph,  Private,  Co.  K,  12th  New  .Tersey  Volunteers,  aged  32  years,  on  May  7th,  1865,  was  struck  by  a 
comrade  with  a knife  on  the  left  side  of  the  scalp,  producing  an  incised  wound.  He  was  admitted  to  Lincoln  Hospital, 
Washington,  on  June  24th,  and  was  discharged  from  service  on  July  31st,  1865. 

Gheen,  F.  JL,  Piivate,  Co.  H,  45th  Kentucky  Volunteers,  aged  19  years,  received  an  incised  wound  of  the  scalp  over 
the  superior  angle  of  the  parietal  bone  by  a blow  from  an  axe,  on  December  16th,  1864.  He  was  admitted  to  hospital  at 
Lexington,  Kentucky,  on  December  21st,  and  returned  to  duty  on  April  1st,  1865,  for  muster-out  of  service  with  his  regiment. 

L];niih:x,  Daniel,  Private,  Co.  F,  2Cth  New  York  Volunteers,  on  November  3d,  1864,  received  a blow  on  the  head  from 
an  axe,  which  produced  an  inciseol  scalp  wound.  He  ^vas  admitted  to  Lincoln  Hospital,  Washington,  on  November  15th,  and 
returned  to  dutj-  on  December  17th,  1864. 

S^iirii,  Joel,  Private,  Co.  I,  127th  New  York  Volunteers,  aged  21  years,  was  admitted  to  No.  1 Hospital,  Beaufort 
South  Carolina,  on  February  21st,  1835,  with  an  incised  wound  of  the  scalp,  produced  by  a blow  from  an  axe.  He  was  trans- 
ferred to  hospital  at  Hilton  Head  on  May  28th,  and  discharged  from  service  on  June  8th,  1865. 

Wa'ON,  Feederick,  Piivate,  Co.  G,  6th  Wisconsin  Volunteers,  aged  17  years,  received  an  incised  wound  over  the  left 
parietal  and  occipital  regions,  by  a blow  from  an  axe,  on  iMarch  5th,  1865.  Ho  was  admitted  to  Lincoln  Hospital,  Washington, 
on  April  4th,  transferred  thence  to  Mower  Hospital,  Philadelphia,  on  April  7th,  and,  on  May  31st,  he  was  received  into  the 
Harvey  Hospital  at  Madison,  Wisconsin.  He  was  discharged  from  service  on  July  13th,  1835. 

In  the  lollowing  examples  of  incised  wounds  of  the  scalp,  the  nature  of  the  weapon  by 
which  the  wound  was  inflicted  is  not  reported  : 

Arle,  Hicnry,  Private,  Co.  A,  107th  IT.  S.  C.  T.,  aged  27  years,  was  admitted  to  Crittenden  Hospital,  Louisville,  Ken- 
tucky, on  July  30th,  1865,  with  an  incised  wound  of  the  scalp.  He  returned  to  duty  on  July  31st,  1865. 

Atlas,  George,  Private,  Co.  I,  32d  North  Carolina  Degiment,  aged  37  years,  received  an  incised  wound  of  the  scalp  at 
Spottsylvania,  Virginia,  May  10th,  1864.  He  was  received  into  the  Second  Division  Hosj)ital  at  Alexandria,  on  May  14th,  and 
tran.sferred  to  Lincoln  Hospital,  Washington,  on  May  23th,  whence  he  was  sent  to  the  Old  Capitol  Prison  on  June  1st,  1864. 

Boi.ton,  .James,  Private,  Co.  I,  Cth  Missouri  Cavalry,  was  received  into  the  Post  Hospital,  Schofield  Barracks,  St.  Louis, 
^lissouri,  on  September  28th,  1834,  with  an  incised  wound  of  the  left  side  of  the  head.  He  returned  to  duty  on  October  3d,  1834. 

BowEits,  J.,  Private,  Co.  H,  12th  New  York  Cavalry,  aged  34  yeiirs,  was  admitted  to  Foster  Hospital,  Newberne,  North 
Carolina,  on  September  25th,  1863,  with  an  incised  scalp  wound.  He  was  rtJurned  to  duty  December  9th,  1833. 

BuTTitREiitLD,  S.  H.,  Unassigned  Substitute,  aged  18  years,  received  an  incised  scalp-wound,  and  was  admitted  to 
hospital,  at  Pittsburgh,  Pennsylvania,  on  May  20,  1865.’  He  was  discharged  from  service  on  May  27th,  1865. 

Dinne,  Michael,  Private,  Co.  B,  19th  Pcnn.sylvania  Cavalry,  received  an  incised  wound  of  the  scalp  on  February  22d, 
1834,  at  West  Point,  Mississippi.  He  was  admitted  to  Washington  Hospital,  at  Memphis,  Tennessee,  on  February  27th,  and 
returned  to  duty  March  28th,  1834. 

Gaffney,  J.,  Private,  Co.  B,  169th  IJcw  York  Volunteers,  aged  36  years,  received  an  incised  wound  of  the  scalp  at 
Fort  Fisher,  North  Carolina,  on  January  ICth,  1865.  He  was  admitted  to  McDougal  Hospital,  Fort  Schuyler,  New  York,  on 
January  25th,  and  discharged  from  service  on  May  25th,  1865. 

Hall,  A.,  Private,  Co.  A,  169th  New  York  Volunteers,  aged  51  years,  receiv'cd  an  incised  wound  of  the  seal]i,  and  was 
admitted  to  McDoug.al  Hospital,  Fort  Schuyler,  New  York,  on  June  6th,  1865.  He  was  discharged  from  service  on  July 
18th,  1865. 

IIoiVAitD,  .John,  Private,  Co.  B,  3d  Khode  Island  Volunteers,  aged  23  years,  was  admitted  to  Sickel  Hospital,  Alexan- 
dria, Viiginia,  on  May  Cth,  1865,  with  an  incised  wound  of  the  scalp.  He  returned  to  duty  on  May  18th,  1835. 

Johnson,  F.,  Private,  Co.  F,  39th  Ohio  Volunteers,  aged  19  years,  was  admitted  to  Crittenden  Hospital,  Louisville, 
Kentucky,  on  June  25th,  186.5,  with  an  incised  sc.alp  wound.  He  was  returned  to  duty  on  July  18th,  1865. 

Kella',  J.,  Piivate,  Co.  1),  2d  Louisiana  Cavalry,  aged  30  years,  received,  in  an  afi'ray,  a severe  incised  wound  ( f the 
sc.-ilp.  He  was  admitted  to  hospital  at  Baton  Bouge,  I.ouisiana,  on  May  2.5th,  and  returned  to  duty  .Juno  13th,  1834. 

McCttACKEN,  W.  N.,  Private,  Co.  M,  Cth  Pennsylvania  Heavy  Artillery,  aged  18  year.s,  received  an  incised  wound  of 
the  scalp  on  October  7th,  1834.  He  was  admitted  to  3d  Division  Hosiiital,  Alexandria,  Virginia,  on  October  10th,  and  returned 
to  duty  January  24th,  1865. 


30 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


McUonalo,  F.,  Riivato,  Co.  G,  HEtli  Keiitiiclcy  Volimtoers,  aged  29  years,  was  received  into  Main  Street  IIosi)ital, 
Covington.  Kentucky,  on  April  lltli,  1805,  with  an  incised  wound  of  the  scalp,  not  received  in  action.  He  died  on  May  8th,  1805. 

Sattcrwhile,  M.,  Private,  Co.  A,  44th  North  Carolina  Regiment,  received  an  incised  wound  of  the  scalp  on  June  2Gth, 
IStiJ.  lie  was  admitted  to  Hospital  No.  4,  Richmond,  Virginia,  and  furlonghed  on  July  Gth,  1863. 

Stuuuk,  John  J.,  Private,  Co.  K,  178th  New  York  Volunteers,  aged  20  year.s,  received  an  incised  scalp-wound,  and  was 
admitted  t(>  Jefferson  Barracks  Hospital,  St.  Louis,  Missouri,  September  20th,  1834.  He  was  returned  to  duty  on  September 
27th,  1834. 

VAltliLIC,  Henky,  Private,  Co.  C,  22d  Indiana  Volunteers,  aged  21  years,  received  an  incised  scalp-wound  at  Franklin, 
Tennessee,  on  November  30th,  18G4.  He  was  admitted  to  Brown  Hospital,  Louisville,  Kentucky,  on  June  21st,  18G5,  and 
mustered  out  of  service  July  24th,  18G5. 

'WiLEi.vtMS,  A.  M.,  Private,  Co.  G,  7th  Pennsylvania  Cavalry,  was  admitted  to  Cavalry  Corps  Hospital  at  Gallatin, 
Tennessee,  on  January  11th,  1835,  with  an  incised  wound  of  the  scalp.  He  was  transferred  to  Nashville  on  February  25tli, 
and  discharged  from  service  July  28th,  1835. 

Wyman,  Joseph,  Lieutenant,  Co.  FI,  9th  Minnesota  Volunteers,  received  an  incised  scali)-wound,  and  was  .admitted  to 
Post  Hospital,  St.  Louis,  Missouri,  on  May  19th,  18G4.  He  returned  to  duty  on  M.ay  30th,  18G4. 

Young,  H.  C.,  Ihivate,  Co.  F',  20th  Kentucky  Volunteers,  aged  28  years,  received  an  accidental  incised  scalp-wound,  on 
FY'bruary  28th,  18G5.  He  was  admitted  to  Brown  Hospital,  Louisville,  Kentucky,  on  June  7th,  18G5.  He  was  furloughed, 
and  returned  to  duty  on  July  29th,  18G5. 

* 

Of  these  twenty-eight  cases  of  incised  wounds  of  the  scalp  by  various  weapons,  one 
resulted  fatally.  Fifteen  of  the  patients  were  returned  to  duty,  one  deserted,  and  eleven 
were  mustered  out,  or  paroled,  or  discharged,  not  for  disability,  but  because  their  terms  of 
enlistment  had  nearly  expired.* 

Punctured  Wounds  of  the  Head. — The  experience  accpiired  in  the  late  war  con- 
firms the  common  impression  that  punctured  wounds  of  the  integuments  of  the  cranium, 
or  perforations  of  the  cranial  bones  by  bayonet  or  lance,  or  sword  thrusts,  arc  rare  in 
modern  times.  On  the  infrequent  occasions  on  which  they  are  used  offensively,  these 
weapons  are  commonly  directed  against  the  chest  or  abdomen  of  an  adversary.  The 
majority  of  punctured  wounds  of  the  scalp  or  skull  met  with  in  military  practice  at  the 
present  day,  result  from  accidents,  or  are  inflicted  in  private  quarrels,  or  by  sentinels. 

Punctured  Scalp  Wounds. — Only  eighteen  cases  of  this  nature  arc  recorded. 
Nine  were  inflicted  by  sentinels,  or  received  in  broils  or  attempts  to  desert.  Nine  were 
received  in  action. 

Armsteong,  Ebenezer,  Pi'ivate,  Co.  K,  8Gth  Illinois  Infantry.  B.ayonet  wound  of  the  scalp.  Kenesaw  Mountain, 
Georgi.a,  June  27th,  1864.  Returned  to  duty. 

B.vll,  Patisick,  Private,  Co.  IT,  49th  Pennsylvania  Volunteers,  aged  37  years.  Bayonet  wound  of  the  scalp.  Wilder- 
ness, Virginia,  May  8th,  1864.  Admitted  to  Emory  Hospital,  Washington,  May  13th.  Returned  to  duty  M.ay  IGth,  1864. 

Blake,  Thomas,  Priv<ite,  Co.  B,  9th  New  Hampshire  Volunteers.  Bayonet  wound  of  the  sc.alp,  in  an  attempt  to  desert. 
Admitted  to  post  hospital  at  Albany,  New  York,  December  2Cth.  Deserted,  December  30th,  1863. 

Call,  John  W.,  Private,  Co.  D,  8th  Regiment,  1st  Army  Corps,  aged  24  years.  Bayonet  wound  of  occipital  region 
and  ot  left  eyebrow.  May  23d,  1865.  Admitted  to  post  hospital  at  Camp  Stoneman,  May  2.5th.  Returned  to  duty  June  7th, 
1865. 

Davis,  John,  Private,  Co.  G,  2d  Maine  Volunteers,  aged  21  years.  Bayonet  wound  of  the  right  temporal  region.  Falls 
Church,  Virginia,  .July  18th,  1861.  Patient  remained  unconscious  for  eight  days.  Was  returned  to  duty  in  October,  1861.  On 
June  27th,  1862,  constitutional  symptoms  were  manifested,  and  he  was  .admitted  to  Pennsylv.ania  Hospit.al,  Phil.adelphia,  and 
again  returned  to  duty.  On  November  18th,  1832,  he  w.as  admitted  to  Eckingtou  Hospital,  Washington,  and  discharged  the 
service  December  23d,  1832,  for  partial  imbecility  and  such  symptoms  as  dizziness,  faintness,  and  sensitiveness  to  pressure 
over  the  se.at  of  the  wound.  Ho  was  pensioned  at  four  dollars  per  month,  and  on  September  13th,  1837,  his  pension  was 
increased  to  six  dollars  ])er  month.  The  pension  examiner  at  Bangor,  !Maine,  Dr.  Jones,  reported,  F^ebruary  15th,  1867,  that 
dizziness  had  increased  and  was  constant,  and  th.at  the  pensioner  often  fell,  and  became  unconscious.  He  drew  his  pension  on 
March  4th,  1839,  but  liD  condition  at  that  time  is  not  reported. 


* The  total  number  of  incised  wounds  returned  during  the  four  years  of  the  war,  on  the  monthly  rejiorts  of  white  troops 
in  the  United  States  service,  was  twenty-one  thousand  four  hundred  and  forty-four  (21,444,)  with  one  hundred  and  ninetv-six 
(196)  deaths;  but  there  is  no  means  of  determining  how  many  of  these  were  injuries  of  the  head. 


PUNCTURED  WOUNDS  OF  THE  HEAD. 


31 


DuNMOiiK,  Gix)1:gi;,  I’rivute.  Co.  E,  4tli  Now  Ilnnippluro  Volunteers,  nged  22  ye.ars.  B.iyonet  wound  of  tlie  scalp. 
Cold  Harbor,  Virginia,  June  5tli,  lfc'C4.  Admitted  to  Knight  Hospit.al,  New  Haven,  Connecticut,  June  19th.  Deserted,  June 
2bth,  leoi. 

Fox,  .losicrii.  Sergeant,  Co.  G,  148th  Pennsylvania  Volunteers.  Bayonet  wound  of  the  scalp.  August  25th,  1804. 
Admitted  to  Lincoln  Hospital,  Washington,  August  JCth.  Returned  to  duty  September  21st,  1864. 

Kosciiico,  Gultill,  Private,  Co.  C,  IJtli  Connecticut  Volunteers.  Ba3’onet  wound  of  the  scalp.  March  2,<th,  1804. 
Admitted  to  University'  Hospital,  New  Orleans,  Louisiana,  March  26th.  Returned  to  duty  July  1st,  1804. 

Laiiky,  Andrew,  Pi  ivate,  Co.  C,  10th  Tennessee  Volunteers.  Bayonet  wound  of  the  scalp.  May  4th,  1804.  Admitted 
to  Hospital  No.  2,  Nashville,  Tennessee,  ^lay  0th.  Died  from  intlammation  of  the  brain.  May  0th,  1804. 

Lentemar,  FitiCDERiCK,  Corporal,  4th  Ohio  Battery,  aged  27  years,  received  a jmnctured  wound  of  the  scalp  on  March 
10th,  1805,  and  was  received  into  Hospital  No.  2,  at  Nashville,  Tennessee,  on  the  following  day.  He  recovered,  under  simple 
dressings,  and  was  returned  to  duty'  March  18th,  1865. 

McCarty,  George,  Private,  Co.  G,  2Jd  Pennsylvania  Volunteers,  aged  18  years.  Bayonet  wound  of  the  scalp.  Cold 
Harbor,  Virginia,  Jim(;2d,  1864.  Admitted  to  South  Street  Plospital,  Philadelphia,  June  Kith.  Returned  to  duty  July  10th, 
1804. 

McDonald,  Joseph  W.,  Private,  Co.  D,  7Cth  Illinois  Volunteers,  aged  05  y'ears.  Bayonet  wound  of  the  scalp.  Colum- 
bus, Georgiii,  November  24th,  1804.  Admitted  to  Hospital  No.  5,  Quincy,  Illinois,  December  8th.  Returned  to  duty  F'ebruary 
7th,  1865. 

McGinpsicy,  IH’GII  W'.,  Sergeant,  Co.  E,  155th  Pennsylvania  Volunteers,  aged  22  year.s.  Bayonet  wound  of  the 
occipital  and  ])arietal  regions.  October  0th,  1804.  Admitted  to  hospital  at  Pittsburgh,  Pennsylvania,  the  same  day.  Returned 
to  duty  February'  25th,  1865. 

McGovern,  Piiilip,  Private,  Co.  B,  158th  New  York  Volunteers,  aged  25  years.  Bayonet  wound  of  the  .scalp.  Mai'ch 
28th,  1834.  Admitted  to  hospital,  Beaufort,  South  Carolin.a,  March  28th.  Returned  to  duty  April  27th,  1864. 

Meade,  Michael,  Private,  Co.  B,  00th  Now  York  Volunteers,  aged  22  years.  Bayonet  wound  of  the  scalp.  Chicka- 
mauga,  Georgia,  September  2Cth,  1863.  Admitted  to  Hospital  No.  1,  Louisville,  Kentucky',  February'  17th.  Returned  to  duty 
February  22d,  1834. 

Tomoney,  Edward  F.,  Private,  100th  Pennsylvania  Volunteers,  aged  38  years.  Bayonet  wound  of  the  scalp.  Peters- 
burg, Virginia,  April  2d,  1865.  Admitted  to  Slough  Hospital,  Alexandria,  Virginia,  April  27th.  Deserted  IMay  15th,  1805. 

Turney,  Jajie.S,  Private,  Co.  K,  lOEth  Penn.sylvania  Volunteers,  received  a bayonet  wound  of  the  side  of  the  scal)i  at 
Fair  Oaks,  Vii-ginia,  May  31st,  1802.  He  was  sent  to  the  rear  and  admitted  to  the  Hospital  at  Mills  Creek,  on  Juno  4th,  1802. 
The  iiatient-died  on  June  13th,  1862.  The  particulars  of  the  treatment  are  not  recorded.  The  case  is  reported  by  Surgeon  A. 
P.  Heichhohl,  105th  Pennsylvania  Volunteers. 

W'arner,  George,  Private,  Co.  I,  1st  Veteran  Reserve  Corps,  aged  21  y'ears.  Bayonet  wound  of  the  scalp.  March 
25th,  1805.  Admitted  to  hospital  at  Elmira,  New  York,  April  4th.  Returned  to  duty. 

Of  tlie  eighteen  patients  with  punctured  scalp  wounds,  eleven  were  returned  to 
duty;  three  deserted;  one  was  discharged  for  disability;  and  two  died.  Punctured  wounds 
of  the  scalp,  when  made  by  a weapon  directed  perpendicularly  to  the  skull,  arc  necessarily 
slight  in  depth;  when  made  obliquely,  the  point  of  the  weapon  soon  penetrates  from 
within  outwards,  on  account  of  the  convexity  of  the*  cranial  vault.  They  are  occasionally 
complicated  by  erysipelas,  burrowing  of  pus  under  the  occipit-frontalis  aponeurosis,  or  by 
hiemorrhage  ;*  but  are  commonly  trivial  in  extent  and  importance.  AVhen  uncomplicated, 
the  treatment  consists  in  shaving  the  surrounding  scalp  and  keeping  the  wound  covered 
with  a compress  saturated  with  cold  water  or  some  resolvent  lotion.  The  complications 
which  existed  in  the  two  fatal  cases  above  noted  are  not  reported  in  detail. 

Punctured  Fractures  of  the  Cranium. — Only  six  examples  of  punctured  frac- 
tures of  the  skull,  by  sharp-pointed  weapons,  have  been  reported.  Five  of  these  were 
inflicted  by  the  bayonet,  and  one  by  a sword. 

Allen,  D.  K.,  Private,  Co.  F,  50tli  Ohio  Vciluuteer.s,  aged  20  years,  received  a lamctured  bayonet  wound  of  the  scal]i, 
wi'.li  fracture  and  depression  of  the  left  jiarietal  bone,  at  Franklin,  Tennessee,  November  30tb,  1804.  Admitted  to  Dennison 
Hospital,  Cincinnati,  Ohio,  January  18tli,  1835,  from  Madison  Hospital,  Indiana.  Temporary  insensibility,  paralysis  of  right 
arm,  ami  ai)bonia,  followed  the  injury.  A jxirtion  of  the  bone,  one  and  a half  ineln's  in  length  and  thi-ee-fourtlis  of  an  inch 
in  breadth,  was  removed.  'J'he  wound  healed,  the  scalp  adhering  to  the  dura  matei'.  Fuiloughed  March  10th,  I.8G5,  and 
never  returned  to  hosi)ital.  He  was  examined  by  Surgeon  John  C.  Hupp,  at  W'heeling,  West  Virginia,  July,  1805.  There  was 


32 


WOUNDS  AND  INJUDIKS  OF  THE  HEAD, 


a depressed  cicatrix  over  the  solution  of  continuity  cf  the  skull.  The  aperture  in  the  jtarietal  seemed  to  he  about  an  inch  in 
length,  by  three-fourths  t'f  an  inch  in  breadth.  The  patient’s  speech  was  interrupted  and  stanuiiei  iug.  There  was  defective 
sensation  in  the  right  hand,  and  numbness  over  a tract  extending  from  the  seat  of  the  wound  to  the  left  side  of  the  bone.  Exer- 
cise of  body  or  mind  occasioned  pain  in  the  cicatrix  and  left  temporal  region.  Any  jolting,  or  stooping,  efi'ort  in  lifting,  or  any 
sudden  or  loud  noise  produced  a sensation  as  of  straining  of  the  brain  substance  through  the  aperture.  Tho  patient  described 
this  sensation  as  very  painful.  In  March,  18G9,  this  pensioner  resided  at  Bridgeport,  Belmont  county,  Ohio,  and  the  examining 
surgeon  of  tho  Pension  Bureau  reported  that  he  was  totally  ar.d  permanently  disabled,  and  required  cautious  aud  watchful  care 
by  night  and  d.ay. 

Buckley,  John  B.,  Corporal,  Co.  D,  02d  Pennsylvania  Volunteers,  aged  24  years,  received  a bayonet  wound  of  the 
forehead,  through  the  right  superciliary  ridge,  at  Chancellorsville,  Virginia,  May  Jd,  1853.  It  was  found,  on  examination,  that 
the  weapon  had  penetrated  the  frontal  sinus,  and  passed  horizontally  backwards  into  the  brain.  The  patient  W'as  transferred  to 
Washington,  and  was  admitted  to  Finley  Hospital  on  the  Cth,  in  a perfectly  conscious  condition,  with  a natural  pulse  and  free- 
dom from  febrile  excitement.  Acting  Assistant  Surgeon  Lewis  Heard  passed  a bougie  along  the  track  of  the  wound  into  tho 
right  anterior  lobe  of  tho  brain  the  distance  of  four  inches,  without  force,  and  without  the  least  pain  to  the  patient.  The  perfo- 
ration in  tho  skull  barely  admitted  the  point  of  the  index  linger.  There  v^ere  found  a f.'W  small  fragments  of  bone  still  'hanging 
at  the  inner  edge  of  tho  orifice.  There  was  no  haemorrhage.  Perfect  ([uietness  was  strictly  enjoined,  a saline  laxative  was 
ordered,  and  cold  water  dressings  were  applied.  The  diet  was  light.  On  May  14th,  he  continued  conscious  and  comparatively 
comfortable,  complaining  of  but  little  p.ain  in  the  head.  Temporizing  treatment  was  continued.  For  the  next  two  days  signs  of 
mental  disturbance  were  noticeable,  and  partial  loss  of  vision,  with  optical  illusions.  He  comjilaincd  of  headache,  and  a febrile 
movement  arose,  w'ith  intense  thirst.  The  bowels  were  kept  open  by  Epsom  salts.  Pus  and  disorganized  brain  tissue  were  dis- 
charged from  the  wound.  At  noon,  on  the  ICth,  he  moved  his  arms  about  tremulously,  catching  at  imaginary  objects,  arousing, 
occasionally,  from  the  stupor  into  which  he  had  fallen,  complaining  of  increased  pain  in  the  head,  and  then  talking  incoherently. 
The  skin  was  of  natural  temperature,  and  the  pulse  at  80.  On  May  17th,  the  patient  had  passed  a quiet  night.  The  pulse  was 
at  12.5;  there  was  greater  tremulousness  of  the  arms,  with  increased  stupor,  and  vision  was  nearly  extinct.  The  patient  had 
great  thii'st,  but  no  appetite.  The  discharge  of  pus  and  disorganized  brain  substance  continued.  Slight  convulsions  occurred 
in  the  afternoon,  and  tho  patient  sank  gradually,  and  died  at  six  o’clock  P.  M.,  thirteen  days  after  the  reception  of  the  injury. 
At  the  post  moi-tem  examination,  made  fourteen  hours  after  death,  the  sinuses  and  the  dura  mater  were  found  to  bo  highly 
engorged  with  blood.  The  right  hemisphere  of  the  brain  was  sliced  off,  and  over  tho  right  lateral  ventricle  a slight  prominence 
was  observed,  which,  on  being  punctured,  gave  exit  to  a quantity  of  pus.  Tho  wound  penetrated  through  tho  anterior  lobe  of 
tlie  brain  under  the  right  edge  of  tho  corpus  callosum,  opened  tho  right  Lateral  ventricle,  and  extended  back  to  the  posterior 
crus  of  the  fornix,  which  seemed  to  have  sustained  injury.  The  two  lateral  and  third  ventricles  were  filled  with  pus,  and  pus 
was  also  found  in  the  fourth  ventricle,  and  beneath  the  cerebellum  around  the  medulla  oblongata.  Acting  Assistant  Surgeon 
Lewis  Heard  reported  the  case.* 

G , Thomas,  Private,  Co.  B,  90th  Ohio  Volunteers,  was  admitted,  on  November  27th,  1833,  to  Hospital  No.  1, 

Nashville,  Tennessee,  with  a bayonet  wound  behind  the  left  parietal  eminence,  inflicted  by  a sentinel.  For  several  days  the 
patient  was  in  a state  of  stiqjor,  and  was  obstinately  constipated.  Both  of  these  conditions  were  removed  by  the  use  of  powerful 
])urgative  medicines.  Meanwhile  the  cicatrization  of  tho  wound  progressed  rapidly,  and  on  December  8th  it  had  nearly  closed. 
On  this  day  the  patient  complained,  for  the  first  time,  of  severe  headache.  A probe,  passed  through  the  small  orifice  of  the 
wound,  indicated  denuded  and  detached  bone  at  its  base.  A X-shaped  incision  was  made,  and  several  fragments  of  dead  bone 
were  extracted.  On  tlie  11th,  there  was  somnolence  and  cephalalgia,  and  in- 
creased stupor,  with  a slight  intolerance  of  light  aud  sound;  the  pulse  was  full 
and  slow,  forty-eight  beats  per  minute.  The  scalp  was  tumid;  the  wound  gaped, 
and  was  filled  with  fungous  gr.anulations.  The  incisions  in  the  scalp  were  ex- 
tended, and  some  of  the  loose  bits  of  bone  were  removed.  An  ice  bladder  was 
aj)plied  to  the  head,  and  purgatives,  with  purgative  enfmata,  were  administered. 

On  the  12th,  the  jiatient  had  some  little  appetite.  The  pulse  was  44  and  feeble. 

'riiere  had  been  no  alvine  evacuations,  notwithstanding  repeated  doses  of  calo- 
mel and  rhubarb,  Epsom  salt,  podophylliu,  with  terebinthinate  enemata.  In  the 
forenoon,  pills  containing  half  a drop  of  croton  oil  were  ordered  to  be  given 
every  hour  until  the  bowels  moved.  On  the  13th,  the  patient  w.as  freely  purged. 

A fungus  began  to  protrude  from  the  wound.  On  tho  14th,  tho  headache  was- 
slight  but  constant,  the  skin  cool,  the  pulse  42  and  feeble.  The  cerebral  hernia, 
tense  and  clastic,  and  indolent  on  pressure,  still  covered  by  tho  meninges,  was 
steadily  incre.asing  in  size.  He  was  ordered  half  an  ounce  of  wine  every  houi-, 
v.'ith  beef  tea.  On  the  15th,  the  membranes  covering  the  hernia  sloughed,  and  fig.  9. — Perforation  of  the  loft  rarietal  by  a bayo- 

the  fungus  appe.ared  with  a dark  red  granulated  surface,  not  sensitive  to  tho  a®*- — Surg.  .Sect.  A.  M.  M. 
touch,  nor  bleeding  readily.  When  the  patient,  in  his  rc-stloss  sleep,  rolled  over  upon  the  fungous  growth,  ho  would  aw.ake  with 
a start.  For  tho  next  two  d.ays  he  took  wine  in  gradually  augmented  doses.  His  pulse  becaiiK!  more  feeble,  and  rose  to  90 
pulsations.  Respirations  13,  sighing.  On  Dec(‘mber  19th,  the  whole  fungous  mass  sloughed  away.  There  was  delirium  and 
subsultus  tendiuum.  The  other  symptoms  were  unchanged.  Death  took  place  on  December  23d,  18G3.  At  tlu?  autopsy,  an 
abscess  of  the  left  hemisjdiere,  and  diffused  arachnitis,  were  observed.  Tho  bayonet  had  ]H'nctrated  an  inch  or  more  into  the 
cerebrum.  The  calvaria  was  forwarded  to  the  Army  Medical  Museum  by  Assistant  Surgeon  C.  J.  Kipp,  U.  S.  Volunteers,  with 


American  Medical  Times^  June  10,  Vul.  VI.  p.  202. 


PUNCTUEED  WOUNDS  OF  THE  HEAD. 


33 


the  foregoing  notes  of  the  case.  It  is  rejn-esented  in  tlie  adjacent  wood-cut,  (Fig.  If)  It  shows  a perforation  of  the  left  parietal 
hehind  the  protuberance.  The  opening  is  egg-shaped ; but  tlie  edges  suggest  its  original  triangular  outline.  The  edges  are 
rounded,  and  the  texture  of  the  bone  near  the  solution  of  continuity  is  i)orous,  particularly  on  the  inner  table.  A slight  fissure 
exists  in  the  outer  table. 

H , John,  Private  of  the  Hospital  Guards  at  the  Lovell  Gena-al  Hospital,  Portsmouth  Grove,  Ehode  Island,  aged 

25  years,  was  conllned  four  hoprs  on  the  night  of  February  28th,  1863,  as  a punishment  for  bringing  spirits  into  the  camj)  and 
attempting  to  run  the  guard.  When  released  from  his  cell  by  order  of  the  officer  of  the  guard,  he  rushed  upon  the  latter  and 
struck  him  in  the  face,  whereupon  the  sergeant  drew  his  sword,  and,  stepping  hack  a pace,  put  himself  in  guard,  holding  the 
gi-ipo  of  his  sword  firmly  against  the  right  hip,  with  the  point  slightly  elevated.  While  in  this  position  the  prisoner  again  rushed 
upon  the  sergeant ; hut  the  ground  being  uneven,  and  the  grass  covered  with  a heavy  frost,  the  assailant  slipped  and  fell  on  the 
point  of  the  sword,  and  then  heavily  forwards  on  the  ground.  When  taken  up  he  was  insensible,  and  breathed  heavily.  On 
washing  from  his  face  the  blood,  which  had  flowed  copiously  from  a slight  wound  in  the  right  nostril,  the  otlicer  of  the  day,  an 
acting  assistant  surgeon,  who  was  immediately  summoned,  detected  no  other  injury  than  the  trivial  incision  of  the  right  ala  of 
the  nose.  The  man  had  been  drinking  freely,  and,  under  the  supposition  that  he  was  suffering  onlj-  from  the  stupefying  effects 
of  liquor,  increased  by  the  fall  upon  his  head,  the  surgeon  remanded  him  to  the  guard-house,  where  he  laid  in  a state  of  stujjor 
until  the  following  morning,  when  he  was  removed  to  one  of  the  wards  of  the  hospital.  He  was  found  to  be  still  unconscious, 
and  breathed  stertorously,  and  moaned  occasionally.  The  pulse  was  full  and  slow.  The  eyelids  were  closed,  showing,  when 
forcibly  opened,  the  pupils  dilated  and  immovable.  The  remedies  usually  employed  in  cases  of  apoplexy  wer(!  directed,  but 
consciousness  could  not  be  restored,  and  the  patient  died  on  the  succeeding  morning,  March  2d,  1863,  thirty-one  hours  after  the 
reception  of  the  injury.  An  autopsy  ivas  made  nine  and  a half  hours  after  death.  Eirjor  mortis  well  pronounced.  No  external 
mark  of  violence  was  perceptible,  except  a wound  five-eighths  of  an  inch  in  length  and  one-eighth  of  an  inch  in  depth  on  the 
external  edge  of  the  right  nostril.  The  nostril  was  filled  with  coagulated  blood.  There  was  no  sign  of  fracture  of  the  nasal 
bones.  On  removing  the  calvarium,  the  blood  vessels  of  the  membranes  of  the  brain  were  found  to  be  engorged,  and  upon 
reflecting  the  membranes,  the  convolutions  over  the  whole  of  the  right  hemisphere  were  found  to  be  covered  with  extravasated 
blood.  This  extravasation  extended  along  the  whole  of  the  base  of  the  right  side,  and,  to  a slight  degree,  on  the  left,  covering 
the  ■whole  surface  of  the  cerebellum,  increasing  at  the  base  and  towards  the  medulla 
oblongata.  The  brain  was  then  removed,  and  the  posterior  clinoid  process  of  the 
sphenoid  was  found  to  be  fractured  transversely,  and  the  middle  and  lowin’  part  of 
the  superior  turbinated  bone  was  pierced.  A small  indentation,  corresponding  with 
the  point  of  the  sword,  was  found  in  the  right  clinoid  process.  The  lungs  were 
considerably  engorged,  but  healthy  and  crepitant  throughout.  There  was  a slight 
adhesion  found  at  the  apex  of  the  posterior  part  of  the  left  lung.  A portion  of  the 
sphenoid  bone  was  removed  to  exhibit  this  very  rare  and  interesting  fracture. 

Unfortunately  it  was  somewhat  injured  during  maceration,  but  still  gives  a good 
illustration  of  this  unusual  form  of  injury.  The  portion  of  the  sword  which  inflicted 
the  injury  was  filed  off,  and  was  found  to  fill  exactly  the  perforations  of  the  ethmoid 
and  sjihenoid  bones.  The  sword  had  penetrated  about  four  inches  from  the  nasal 

spine.  The  history  of  the  case  was  carefully  compiled  by  Acting  Assistant  Surgeon  ge™ ‘j  a™m '^jr  oimsi.— .5/)ec.  nue, 

E.  Seyffarth,  and  the  specimen,  represented  in  the  accompanying  wood-cut,  (Fig. 

10,)  was  forwarded  by  Surgeon  L.  A.  Edwards,  U.  S.  A.,  in  charge  of  Lovell  Hospital,  to  the  Surgeon  General. 

Saundcr,  G.  JV.,  Private,  Co.  D,  7th  North  Carolina  Eegiment,  received  at  the  battle  of  Gaines’s  Mill,  Juno  26th,  186'2,  a 
bayonet  thrust  in  the  for(‘head,  which  probably  penetrated  the  frontal  bone.  He  was  conveyed  to  Eichmond,  and  admitted,  on 
Juno  -JTth,  into  Ward-No.  3 of  Chimborazo  Hospital.  He  died  on  July  5th,  1862.  Surgeon  E.  11.  Smith,  C.  S.  A.,  reports  the 
case. 

WOODBUIDGIC,  William  T.,  Musician,  Co.  F,  15th  Indiana  Volunteer.s,  received  on  October  15th,  1863,  a jmnetured 
wound  of  the  skull  from  a bayonet  thrust,  which  perforated  the  left  parietal  bone  near  its  posterior  superior  angle.  Two  days 
after  the  injury  he  was  received  into  the  City  Hospital  at  Indianapolis,  Indiana,  suffering  with  convulsions,  and  symptoms  of 
meningitis  and  inflammation  of  the  brain.  On  October  21st,  several  small  fragments  of  bone  were  extracted ; but  the  symptoms 
were  not  alleviated,  and  the  patient  died  on  October  27th,  1863,  from  abscess  of  the  brain.  Acting  Assistant  Surgeon  J.  M.  * 
Kitchen  reports  the  case. 

Of  the  six  patients  with  punctured  fractures  of  the  cranium,  one  survived,  though 
permanently  disabled  ; and  five  died,  with  extravasation  of  blood  in  one  case,  cerebral 
hernia  in  one,  encephalitis  in  one,  and  abscess  of  the  brain  in  two  cases. 

The  very  intractable  and  fatal  nature  of  such  injuries  is  well  known.  The  diagnosis 
is  commonly  difficult,  the  small  dimensions  of  the  external  wound  forbidding  satisfactory 
exploration.  If  the  external  table  only  is  punctured,  it  is  true  that  there  is  not  much  more 
danger  than  in  a wmund  of  the  soft  parts ; and  recoveries  take  place  when  both  tables  are 
pierced,  if  there  is  no  extravasation  of  blood,  or  wound  of  the  membranes  or  the  brain  by  the 
weapon,  or  by  depressed  splinters  of  fhe  vitreous  table.  But  when  the  puncture  is  small  and 


riG.  10. — Transverse  fracture  of  the  posterior 


WOUNDS  AND  INJURIES  OE  THE  HEAD, 


:H4 

narrow,  it  is  very  difficult  to  determine  its  depth.  Tlie  information  obtained  by  tiie  probe 
is  unsatisfactoiy,  and  its  use  is  not  unattended  by  danger.  When  the  lirain  is  wounded, 
symptoms  of  cerebral  mischief  are  frequently  delayed  until  extravasa- 
tion or  the  pent-up  products  of  inflammation  produce  pressure.  Thus 
the  surgeon  is  restrained  from  interference  until  a period  when  inter- 
ference is  likely  to  be  of  little  benefit. 

When  arrows  and  lances  were  commonly  used  in  warfare,  this 
class  of  injuries  were  not  uncommon,  and  many  interesting  examples 
of  them  are  reported  by  authors.^  The  Indian  hostilities  in  the  west- 
ern part  of  the  United  States  still  afford  exam})les  of  punctures  of  the 
cranium  by  arrows." 

In  the  late  war,  the  lance  was  not  used  to  any  extent,  and  no 
cases  were  reported  of  wounds  of  the  head  by  this  weapon.  Two 
regiments  were  armed  with  it ; but  the  nature  of  the  country  which 
was  the  theatre  of  war  was  regarded  as  ill  adapted  to  the  manoeuvres' 
of  lancers;  and,  after  serving  for  a while  on  escort  duty,  the  regiments 
changed  their  equipment, 
the  u.  s.  Lancers.  2.  Lance  ear-  vciy  giavo  complicatioii  of  punctuios  ot  tlio  crauium  coiisists 

ried  by  Gth  Pennsylvania  Cav-  • j i i i • fr  ^ i i ’ i • i • 

ahy.  Scale  one-tmth  to  me  inch.  Ill  tiic  breaking  olf  ot  tlie  penetrating  weapon,  which  is  sometimes  so 

From  specimens  furnished  the  ^ ^ ^ ^ ^ ^ 

ordnan^o^corp?^' fimily  weclgecl  that  its  removal  is  a matter  of  great  difficulty. 

The  treatment  of  punctures  of  the  cranium  will  consist  of  the  ordinary  simple 
dressing  of  wounds  of  the  scalp,  until  symptoms  of  cerebral  disorder  arise  demanding 
mechanical  interference.  Recognizing  the  great  probability  of  dangerous  complications, 
the  surgeon  will  insist  on  strict  precautionary  measures,  and  will  incise  the  scalp,  and 
expose  the  fracturQ,  and  remove  spiculai  or  foreign  bodies,  or  elevate  depressed  bone  as 
soon  as  he  is  satisfied  that  the  brain  or  its  membranes  are  injured. 

Besides  the  six  examples  of < puncture  of  the  cranium  by  sharp-pointed  weapons, 
reported  on  the  preceding  pages,  the  Army  Medical  Museum  has  specimens  of  punctures 
of  the  skull  by  arrows  and  tomahawks.^  These  preparations  will  be  fully  described  in 
the  next  edition  of  the  j\Iuseum  Catalogue. 


'See  Pare,  {Oeuvres  Completes,  ed.  Malg.aigne,  livre  8'’);  Morgagni,  {De  Causis  ct  Sedibus  Morhoriini,  Vol.  1);  Briot, 
{nisioire  de  I’Etat  ct  des  Progres  de  la  Chirurgie  Militaire,  Bc.san^on,  1817,  p.  Ill);  Percy,  {Manuel  da  Chirurgicn  d’Armee, 
I’aris,  1830,  p.  101) ; Desport,  {Trade  des  Places  d' Armes  d Feu,  Paris,  1749,  p.  374) ; Larrey,  {Relation  Med.  de  Camp,  ct  Voyages, 
Paris,  1841,  p.  381;  et  Clinique  C/nrurgiralc,  Paris,  1829,  T.  I,  pp.  156  et  192;  et  T.  V,  Paris,  1836,  p.  323);  llennen,  {Princi- 
ples of  Military  Surgery,  London,  1829,  p.  284);  Rogers,  Transactions  of  the  Royal  Medico- Chirurgical  Society,  \o\.  XIII); 
South,  {Chelius's  System  of  Surgery,  Ani.  ed.,  Vol.  I,  p.  437);  Hewett,  {Dublin  Med.  Jour.,  1851,  p.  347);  Legouest,  {Chirurgie 
d’Armee,  p.  277)  ; Bonnefous,  {Jour.de  Mkl.  de  Montpellier,  1860);  Bruns,  Die  Chirurgischen  Kranhheiten,  Tiihmgon,  1854, 
S.  32,  u.  s.  V.) ; Ilyrtl,  {IJandbueh,  S.  86) ; Veli)eau,  {Dictionnaire  de  Medecinc,  Paris,  1844,  2'^'"®  ed.,  T.  XXIX,  p.  559) ; Fritze, 
{Xassauisrhe  Jahrbw'her,  Ileft.  VII,  S.  64);  Sclineider,  {Die  Kopfvcrlctzungcn  in  Medkinisch-geriehtlkher  Ilinsicht,  Stuttgart, 
1848,  S.  58.) 

-For  a very  interesting  account  of  arrow  wounds,  with  numerous  illustrative  cases  aud  Judicious  suggestions  as  to  treat- 
ment, based  on  extensive  observation  of  such  injuries,  the  reader  is  referred  to  an  article  by  Assistant  Surgeon  [now  Surgeon 
and  Bvt.  Lieut.  Colonel]  .1.  II.  Bill,  U.  S.  Army,  in  the  Ameriean  Journal  of  the  Medical  Sciences,  N.  S.,  V’^ol.  XLIV,  p.  365. 

^No.  5528,  Section  I,  A.  M.  M.,  is  the  cranium  of  a Tonkaway  warrior,  with  two  punctures  in  the  right  parietal  by  the 
sharp  point  of  a tomahawk.  It  was  obtained  near  Fort  Cobb,  Washita  River,  I.  T.,  by  Dr.  E.  Palmer.  No.  5531,  is  a cranium 
j)onctrated  through  the  left  antrum  and  orb;t,  by  a stone-headed  arrow.  It  was  obtained  from  a grave  in  Alameda  county,  Cali- 
fornia, by  Dr.  C.  Yates.  No.  5644,  is  a segment  of  the  anterior  portion  of  the  skull  of  a Mexican  herder,  with  a jK'rfoi'ation  cf 
the  frontal,  above  the  left  superciliary  ridge,  by  an  iron  arrow  head,  which  had  been  driven  deeply  into  the  brain,  in  an  Indian 
fight,  seventy  miles  north  of  Fort  Concho,  in  the  summer  of  1863.  It  was  presented  by  Bvt.  M.T,jor  W.  M.  Notson,  Assistant 
Surgeon,  U.  S.  Army. 


CONTUSIONS  AND  LACERATED  WOUNDS  OF  THE  SCALP, 


35 


Section  II. 


MISCELLANEOUS  INJURIES. 


In  this  section  such  injuries  of  the  head  as  are  common  to  the  soldier  and  the  civilian 
will  be  considered.  These  comprise  the  results  of  railroad  accidents,  of  falls,  of  blows 
from  blunt  weapons,  of  kicks  from  horses  and  mules,  of  the  falling  of  trees  or  masonry, 
and  other  accidents. 

It  is  impracticable  to  determine  the  total  number  of  cases  that  should  have  been 
referred  during  the  war,  to  this  category.  On  the  monthly  reports  of  sick  and  wounded, 
the  contusions  and  lacerated  wounds,  and  simple  fractures,  were  entered  numerically, 
without  indication  of  the  seat  of  injury.  Cases  of  concussion  and  compression  of  the 
brain  were  returned  separately,  but  these  statistics  were  vitiated,  because  instances  of 
gunshot  wounds  were  oftentimes  included.  The  information  that  can  be  gleaned  from  this 
source  will  be  recorded  at  the  end  of  this  section.  Abstracts  of  a few  cases,  cited  ft-om 
special  reports,  or  from  the  histories  of  specimens  in  the  Army  Medical  Museum,  will 
illustrate  the  principal  varieties  of  injuries  of  this  class. 

In  movements  of  large  bodies  of  troops  by  rail,  the  men  crowded  upon  platforms 
and  roofs  of  cars,  contusions  and  lacerations  of  the  scalp,  concussions  of  the  brain,  and 
fracture  of  the  skull,  were  not  infrecpient. 

Railroad  Accidents. — The  following  are  examples  of  contusions  from  this  cause : 

Case. — Second  Lieutenant  John  H.  Masterson,  Co.  E,  lOOtli  U.  S.  C.  T.,  aged  38  years,  was  thrown  from  a I'ailroad  car 
and  received  a severe  contusion  of  tlie  scalp,  July  1st,  1834.  He  entered  the  Oificers’  Hospital  at  Nashville,  Tennessee,  the 
following  day;  recovered,  under  simple  treatment,  and  was  returned  to  duty  July  25th,  1834. 

Case. — Private  John  Jenkins,  Co.  G,  15th  U.  S.  C.  T.,  aged  28  years,  fell  from  a railroad  car  at  Nashville,  Tennessee, 
December  26th,  1834,  and  received  a severe  contusion  of  the  head.  He  was  ti’eated  at  Hospital  No.  1C,  at  Nashville,  by  cold 
applications,  and  was  returned  to  duty,  well,  on  January  4th,  1865. 

Case. — Private  Ganin  McCoy,  Co.  C,  16th  Veteran  Reserve  Corps,  aged  57  years,  received  at  Petersburg,  Virginia, 
August  14th,  1863,  a severe  contusion  of  the  forehead  and  right  side  of  the  head,  by  falling  from  a car  in  motion.  He  was 
admitted  to  York  Hospital,  Pennsylvania,  and  discharged  from  service  on  .January  8th,  1864,  on  account  of  persistent  ])ain  in 
the  head. 

Case. — Sergeant  .1.  C.  Williams,  Co.  R,  1st  Wisconsin  Heavy  Artillery,  aged  20  years,  received  in  a railroad  collision, 
on  August  19th,  1864,  a contused  wound  of  the  scalp.  He  recovered,  under  simjde  dressings,  at  the  hospital  at  Lexington, 
Kentucky,  and  returned  to  duty  August  22d,  1864. 

Case. — Private  L.  J.  Leai-ned,  Co.  15,  1st  Wisconsin  Heavy  Artillery,  aged  22  years,  was  similarly  injured  at  the  same 
time  and  place,  but  with  greater  severity.  He  was  transferred  to  Park  Hospital,  Milwaukie,  Wisconsin,  on  S(!j)teniber  18th, 
and  was  discharged  from  service  December  20th,  1864. 

Case. — Private  S.  Croyton,  Co.  G,  6th  West  Virginia  Cavalry,  aged  17  years,  received  near  Carlisle,  Illinois,  .lune  21st, 
1835,  several  severe  contused  wounds  of  the  seal]),  in  a railroad  accident.  He  was  treated  with  cold  local  api)lications  at  the 
Marine  Hospital,  Bt.  Louis,  Mi.ssouri,  and  recovered ; was  diseharg(‘d  from  service  .July  19th,  1865. 


36 


WOUNDS  AND  INJUKIES  OF  THE  HEAD, 


The  following  men  also  received,  in  railroad  accidents,  contusions  of  the  head,  of  a 
slight  nature,  probably,  as  all  were  speedily  returned  to  duty ; 


Cases. — Private  J.  Burns,  K,  71st  New  York  Volunteers,  near  Wilmington,  Delaware,  September  21st,  1854. 
Captain  D.  Cornelius,  C,  212tli  Pennsylvania  Volunteers,  near  Baltimore,  September  17th,  1854. 
Private  Peter  Daly,  G,  140tli  New  York  Volunteers,  near  York,  Pennsylvania,  January  7tli,  18G5. 
Private  L.  P.  Daniels,  I,  2cl  Ohio  Artillery,  near  Knoxville,  January  29th,  1855. 

Private  W.  Fogarty,  A,  21st  New  York  Cavalry,  near  Grafton,  W’^est  Virginia,  July  22cl,  1864. 
Private  J.  H.  Fritton,  A,  33cl  Illinois  Volunteers,  New  Orleans,  March  2(1,  1865. 

Pi  ivate  J.  Jaide,  E,  1st  Missouri  Militia,  near  St.  Louis,  April  29th,  1864. 

Private  D.  Jones,  A,  145th  Ohio  Volunteers,  near  W^ashington,  May  21st,  1884. 

Private  W.  Kennan,  E,  14th  Veteran  Eeserve  Corps,  near  Baltimore,  March  24th,  1864. 

J.  T.  Langston,  Military  Train,  near  Summit  Point,  Maryland,  November  16th,  1864. 

Private  J.  N.  Moore,  C,  100th  Pennsylvania  Volunteers,  near  Pittsburgh,  March  23d,  1864. 

Private  A.  Eussell,  I,  2d  Ohio  Heavy  Artillery,  near  Knoxville,  January  29th,  1865. 

Corporal  S.  Shipman,  F,  88th  Blinois  Volunteers,  near  Jeffersonville,  Indiana,  December  16th,  1864. 
J.  Slacher,  Unassigned  Eecruit,  near  Elmira,  New  York,  April  26th,  1865. 

Sergeant  F.  W^right,  B,  16th  New  York  Cavalry,  near  York,  Pennsylvania,  January  7th,  1865. 
Corporal  C.  Zuraff,  A,  33d  Illinois  Volunteers,  near  New  Orleans,  Louisiana,  March  3d,  1865. 


In  the  following  cases  of  contusions  of  the  head,  the  injuries  were  of  a severe  character, 
probably,  since  the  patients  were  discharged  from  service  for  disability : 

Cases. — Private  G.  A.  Campbell,  I,  2d  Ohio  Art’y,  near  Knoxville,  Tenn.,  January  29th,  1835.  Discharged  May  12th,  1865. 

Private  J.  Carney,  C,  43d  New  York  Volunteers,  near  Albany,  N.  Y.,  March  7th,  1865.  Discharged  July  6th,  1835. 

Private  P.  Coyne,  A,  1st  N.  Jersey  Artillery,  near  W’^ashmgton,  D.  C.,  June  13th,  1865.  Discharged  July  10th,  1835. 

Private  T.  Little,  F,  122d  Ohio  Volunteers,  near  W’'ashington,  December  3d,  1834.  Discharged  January  23d,  1865. 

Lacerations  of  the  scalp  were  produced  in  the  following  cases : 

Case. — Private  Philip  A.  Adams,  Co.  G,  8th  Indiana  Cavalry,  aged  39  years,  received  June  30th,  1864,  near  Chatta- 
nooga, Tennessee,  a severe  lacerated  wound  of  the  scalp,  by  falling  from  a railroad  car.  He  was  admitted  to  Hospital  No.  3, 
Nashville,  Tennessee,  on  June  30th,  and  on  January  11th,  1865,  he  was  transferred  to  Gallatin,  Tennessee.  He  was  discharged 
the  service  for  disability  on  June  5th,  1865. 

Case. — Private  Clifibrd  Alien,  Co.  I,  2d  Ohio  Heavy  Artillery,  aged  16  years,  received  a contused  and  lacerated  wound 
of  the  left  temporal  region  on  January  29th,  1865,  near  Knoxville,  Tennessee,  from  a railroad  accident.  He  was  admitted  to 
the  Asylum  Hospital,  at  Knoxville,  and  recovered,  under  simple  treatment,  and  was  returned  to  duty  on  February  16th,  1865. 

Case. — Private  Eichard  Bogles,  Co.  G,  20th  Pennsylvania  Cavalrj',  aged  21  j'ears,  received  on  April  11th,  1854,  a 
severe  lacerated  wound  of  the  right  side  of  the  scalp,  hy  falling  from  a railway  car,  and  was  admitted  to  Grafton  Hospital, 
West  Virginia,  on  the  same  day.  The  wound  did  well  under  cold  water  dressings,  and  he  was  returned  to  duty  on  June  2d,  1854. 

Case. — Private  Eobert  Boyd,  Co.  F,  8th  New  Jersey  Volunteers,  fell  from  a railway  car  near  Wilmington,  Delaware, 
on  June  21st,  1864,  and  received  a lacerated  wound  of  the  scalp.  He  was  immediately  conveyed  to  the  Tilton  Hospital. 
Simple  dressings  were  ajiplied,  and  he  was  returned  to  duty  July  8th,  1864. 

Case. — Private  Albert  Edgar,  Co.  G,  20th  Pennsylvania  Cavali’y,  aged  18  years,  was  wounded  on  the  same  occasion, 
and  the  preceding  history  applies  to  his  case. 

Case. — Private  L.  J.  Frence,  Co.  I,  2d  Ohio  Heavy  Artillery,  aged  21  years,  received  a severe  contusion,  with  a lacerated 
wound  of  the  scalp,  on  the  same  occasion  as  the  preceding,  and  returned  to  duty  at  the  same  date. 

Case. — Private  John  B.  Glynn,  Co.  II,  24th  Missouri  Volunteers,  received  a severe  scalp  wound  by  a fall  from  a i-ailway 
car,  on  March  1st,  1833.  He  was  admitted  to  Lawson  Hospital,  St.  Louis,  Missouri,  and  returned  to  duty  J une  1st,  1863. 

Case. — Piivate  G.  W.  Haines,  Co.  I,  2d  Ohio  Heavy  Artillery,  aged  36  years,  was  wounded  in  the  same  accident,  and 
was  treated  in  the  same  hospital.  He  had  a wound  of  the  scalp,  with  a very  severe  contusion,  and  recovered  slowly.  He  was 
discharged  from  service  on  !May  21st,  1865.  Surgeon  F.  !Meacham,  U.  S.  V.,  reports  the  case. 

Case. — Private  G.  W.  ^Marvin,  Co.  I,  2d  Ohio  Heavy  Artillery,  aged  20  3'ears,  was  wounded  at  the  same  time  and  place, 
receiving  a laceration  of  the  scalp,  extending  from  behind  the  left  ear  to  the  occipital  protuberance.  He  recovered,  under  simple 
treatment,  and  was  discharged  from  service  May  24th,  1865.  Surgeon  F.  Meacham  reports  the  case. 

The  following  were  returned  to  duty  after  receiving,  in  railroad  accidents,  slight  lacera- 
tions of  the  scalp: 


CONCUSSION  OF  THE  BRAIN  FROM  RAILROAD  ACCIDENTS. 


37 


C.YSliS. — Private  G.  W.  Francis,  C,  112th  Pennsylvania  Volunteers,  near  Philadelphia,  November  7th,  1864. 

Private  G.  Gormer,  K,  2d  Maryland  P.  II.  V.  B.,  near  Cumberland,  Maryland,  October  20th,  1864. 

Private  W.  Gunnin,  2d  Massachusetts  Volunteers,  near  Albany,  Now  York,  June  8th,  1864. 

Sergeant  J.  II.  Jackson,  G,  149th  Indiana  Volunteers,  near  Indianapolis,  Indiana,  August  25th,  1855. 

Sergeant  A.  Jlitchell,  27th  Michigan  Volunteers,  near  Cincinnati,  Ohio,  April  IJth,  186.6. 

Private  L.  H.  Palmer,  K,  97th  Illinois  Vohrnteers,  Algiers,  Louisiana,  November  1st,  1866. 

Private  T.  W.  Peverley,  A,  36d  Illinois  Volunteers,  near  New  Orleans,  Louisiana,  March  2d,  1885. 

Private  T.  Powers,  H,  97th  Illinois  Volunteers,  near  Algiers,  Louisiana,  November  1st,  1866. 

Private  D.  Swinger,  A,  19th  Veteran  Reserve  Corps,  near  Baltimore,  September  3d,  1864. 

Private  J.  Williams,  L,  193d  New  York  Volunteers,  near  Baltimore,  May  18th,  1865. 

The  following  were  discharged  from  service  on  account  of  lacerations  of  the  scalp  of 
a graver  description : 

Cases. — Private  J.  Fallon,  A,  1st  New  Jersey  L.  Artillery,  near  Washington,  June  13th,  1885.  Discharged  July  10th,  1835. 

Private  E.  S.  Harper,  A,  1st  Virginia  Artillery,  near  Columbus,  Ohio,  February,  1835.  Discharged  May  29th,  1885. 

Private  A.  Kimball,  G,  10th  Vermont  Volunteers,  near  Brattleboro,  Vt.,  June,  1835.  Discharged  July  14th,  1865. 

Private  M.  Rice,  G,  83th  New  York  Volunteers,  at  Bristol,  Pa.,  March  7th,  1835.  Discharged  June  7th,  1885. 

In  four  of  these  forty-nine  cases  of  contusions  and  lacerations  of  the  scalp,  erysipe- 
latous inflammation  supervened,  and  others  were  complicated  by  sloughing  and  burrowing 
of  pus.  The  patients  all  ultimately  recovered. 

In  the  following  cases,  concussion  of  the  brain  was  the  most  important  feature : 

Case. — Captain  W.  W.  Cushing,  Co.  I,  125th  Ohio  Volunteers,  aged  27  years,  was  admitted  to  the  Officers’ Hospital, 
Nashville,  Tennessee,  on  March  12th,  188.5,  laboring  under  concussion  of  the  brain,  resulting  from  a railroad  accident  on 
March  1st.  He  was  furloughed  on  ISIarch  13th,  1865,  and  did  not  report  subsequently. 

Case. — Private  A.  Faigue,  Co.  B,  153d  New  York  Volunteers,  received,  in  a railroad  accident,  near  Harper's  Ferry, 
Virginia,  April  20th,  1835,  a severe  contusion  of  the  head,  accompanied  by  concussion,  and  probably  laceration,  of  the  brain. 
He  was  admitted  on  the  same  day  to  the  Island  Hospital,  at  Harper's  Ferry,  and  survived  but  a few  hours.  Acting  Staff  Sur- 
geon N.  F.  Graham  reports  the  case. 

Case. — Joseph  M.  Grace,  unassigned  recruit,  aged  16  years,  jumped  from  the  cars  while  in  motion,  near  Bowling  Green, 
Kentucky,  on  November  4th,  1884.  He  was  admitted  to  Hospital  No.  3,  at  Nashville,  Tennessee,  on  November  5th.  There 
was  a severe  contusion  on  the  head,  and  signs  of  grave  concussion  of  the  brain.  He  recovered  from  the  head  symptoms,  but 
died  on  April  5th,  1865,  from  some  pulmonary  complication.  Surgeon  J.  R.  Ludlow,  U.  S.  V.,  reports  the  case. 

Case. — Patrick  King,  aged  23  years,  a laborer  in  the  employ  of  the  subsistence  department,  fell  from  a railroad  car  July 
22d,  1833,  and  was  admitted  to  the  General  Hospital  at  Frederick,  M.aryland,  on  the  following  day,  in  a semi-comatose  condi- 
tion, in  consequence  of  a severe  contusion  of  the  forehead,  with  concussion  of  the  brain.  As  the  stupor  passed  off,  there  was 
mild  delirium;  but  the  patient  gradually  improved  under  the  use  of  saline  cathartics  and  a low  diet,  and  was  returned  to  duty, 
August  14th,  1863. 

Case. — Corporal  T.  J.  Smith,  Co.  G,  6th  West  Virginia  Cavalry,  aged  20  years,  was  wounded,  on  the  night  of  June  21st, 
1865,  by  a collision  of  trains  on  the  Ohio  and  Mississippi  Railroad,  near  Carlisle,  Illinois.  The  regimental  surgeon.  Dr.  A.  H. 
Thayer,  reports  that  there  were  very  gi-ave  symptoms  of  concussion  of  the  brain.  The  patient  was  conveyed  to  the  Marine 
Hospital,  St.  Louis,  where  Assistant  Surgeon  E.  iM.  Horton,  U.  S.  A.,  reports  that  arteriotomy  was  performed  without  any 
beneficial  result.  The  patient  died  on  June  23d,  1865. 

Case. — Private  John  Taft,  Unassigned  Recruit,  received,  in  an  accident  on  the  Philadelphia  and  Baltimore  Railroad, 
March  30th,  1885,  near  Wilmington,  Delaware,  a severe  contusion  of  the  head,  with  concussion,  and  probably  laceration,  of  the 
brain.  He  was  conveyed  to  Tilton  Hospital,  at  Wilmington.  Every  eff'ort  to  bring  about  reaction  was  unavailing,  and  the  case 
terminated  fatally  on  the  following  day,  March  31st,  1865.  No  autopsy  was  held.  The  case  is  reported  by  Surgeon  E.  J. 
Bailey,  U.  S.  Aimy. 

Case. — Sergeant  T.  Wise,  Co.  K,  134th  Ohio  Volunteers,  aged  35  years,  received,  in  a railroad  accident,  June  6th,  1864, 
near  Point  of  Rocks,  Vij’ginia,  a sev’ere  concussion  of  the  brain.  He  was  admitted  to  Judiciary  Square  Hospital,  and  after 
reaction  had  taken  place,  he  was  treated  by  purgatives,  rest,  and  low  diet.  He  recovered,  and  was  furloughed  for  forty  days, 
and  failed  to  return,  but  joined  his  regiment  “ of  three  months’  men,”  on  October  20th,  1864,  to  be  mustered  out.  Assistant 
Surgeon  Alexander  Ingram,  U.  S.  A.,  reported  the  case. 

In  the  following  cases,  without  injury  to  the-  walls  of  the  cranium,  there  appeal's  to 
have  been  some  obscure  injury  to  its  contents: 

Case. — Private  James  Buckland,  Co.  H,  2d  Missouri  Artillery,  received,  in  a railroad  accident  near  St.  Louis,  August 
13th,  1864,  a severe  contusion  of  the  head.  He  was  received  into  Schofield  Barracks  Hospital  on  the  same  day,  with  symptoms 
of  severe  concussion  of  the  brain.  His  condition  was  relieved  in  a short  time,  but,  after  a few  days,  pai'alysis  of  the  motor 
nerves  of  the  lower  extremities  was  observed,  and  symptoms  indicative  of  softening  of  the  lirain  ensued.  The  case  terminated 
fatally,  September  14th,  1864,  from  ramollissement.  Assistant  Surgeon  E.  M.  Powers,  U.  S.  V.,  reports  the  case. 


38 


WOUNDS  AND  INJUEIES  OF  THE  HEAD 


C'ASU. — Lieutenant  William  Harrington,  29tli  Pennsylvania  Volunteers,  age{l  28  years,  tell  from  a railway  car  in  motion, 
near  Chester,  Pennsylvania,  March  1st,  1804.  lie  was  admitted  to  the  Citizens’  Volunteer  Hospital,  in  Philadelphia,  on  the 
following  d:iy.  'There  were  signs  of  severe  concussion  of  the  brain  ; hut  no  evidence  of  fracture  could  he  detected.  He  died 
on  March  4th,  1804.  'The  relatives  refused  to  permit  an  autopsy.  Surgeon  R.  S.  Kenderdine,  U.  S.  V.,  i-ej)orts  the  case. 

Case. — Private  Edward  McKeehy,  Co.  C,  19th  Illinois  Volunteers,  aged  00  years,  on  June  12th,  1864,  while  riding  on 

a railroad  car,  I’eceivcd  a contusion  of  the  light  side  of  tlie  occiput,  by  striking  violently  against  a bridge.  He  was  admittc'd, 
on  June  13th,  into  IIos]iital  No.  8,  Nashville,  'Tennessee,  at  which  time  there  were  no  external  marks  of  violence,  and  no  ))ain. 
Occasional  delirium  W'as  the  only  indication  of  mischief  to  the  contents  of  the  cranium.  On  the  third  day  the  symptoms  were 
greatly  aggravated.  Coma  supervened,  with  involuntary  discharges;  and  death  took  place  on  June  25th,  1834.  At  the  autopsy, 
there  was  found  upon  the  superior  surface  of  the  right  cerebral  hemisphere,  and  beneath  the  pia  mater,  a small  collection  of 
pus,  and  upon  the  left  side  a eoaguhnn  of  blood.  'The  inferior  surface  of  the  cerebellum,  medulla  oblongata,  pons  varolii,  and 
optic  commissure,  wer(!  covered  with  a thick  coat  of  pus.  The  i-ight  lateral  ventricle  and  choroid  plexus  were  likewise  covered 
with  pus.  A clot  of  blood  was  found  interposed  between  the  dura  mater  and  cranium,  below  the  right  lobe  of  the  cerehdlum. 
'There  was  a contusion,  with  extravasation  of  blood,  beneath  tlie  scalp  on  the  right  side  of  the  occiput.  No  fracture  could  bo 
detected.  The  tlioracic  and  abdominal  organs  wore  normal  in  appearance.  Surgeon  R.  R.  Taylor,  U.  S.  V.,  I'eports  tlie  case. 

Case. — Sergeant  S.  Warner,  Co.  C,  34th  New'  Jersey  Volunteers,  aged  31  j-ears,  near  Beverly,  New  Jei'sej’,  July  15th, 

1834,  fell  from  a railway  car  in  motion,  and  received  a very  severe  contusion  of  the  head.  lie  was  taken  to  the  Beverly  llosjiital, 

and  presented  the  symptoms  of  severe  concussion,  but,  in  addition,  the  pupils  were  quite  irresponsive  to  light,  and  vision  was 
extinct.  'The  symptoms  of  compression  were  speedily  relieved,  hut  vision  did  not  return.  On  April  4th,  1865,  the  patient  was 
transferred  to  Satterlee  Hospital,  Philadelphia,  and  evas  discharged  from  service  May  24th,  1865,  for  traumatic  amaurosis, 
completely,  and  jirobably  permanently,  blind.  Assistant  Surgeon  Dallas  Bache,  U.  S.  A.,  reports  the  case. 

The  following  cases  of  railway-  accidents  were  attended  by  fractures  of  the  skull : 

Case. — Sergeant  Charles  Dougherty,  Co.  C,  69th  l’enns3Tvania  Volunteers,  aged  38  3'ears,  while  in  an  intoxicated 
condition,  fell  from  a railroad  car,  on  April  16th,  1834,  receiving  a severe  contusion  of  the  left  temporal  region,  and  a compound 
fracture  of  the  right  humerus.  He  was  admitted  to  Cu3-ler  Hospital,  Germantoivn,  Penns3’lvania,  on  April  18th.  'The  arm  ^vas 
dressed  in  an  angular  splint,  and  stimulants  were  administered.  'There  was  much  ccchymosis  about  the  temple  and  oi-hit.  'The 
general  symptoms  approached  those  of  delirium  tremens.  There  was  apparent  improvement  foi-  the  first  twenty-four  hours, 
w'hen  obstinate  vomiting  began,  and  recurred  with  brief  intermissions.  On  the  morning  of  the  fifth  da3',  the  patient  was  in  a 
moribund  condition,  pulseless  at  the  ^vrist,  bathed  in  a cold  jierspiration,  and  delirious.  'There  was  a general  capillary 
congestion  amounting  to  c3'anosis  almost,  and  an  excessive  dilatation  of  both  pupils,  with  insensibility  to  light.  Coma  grad- 
uall3'  came  on,  and  d(!ath  on  April  20th,  1864.  'The  autopsy  revealed  extensive  congestion  of  the  membranes  and  substances 
of  the  brain,  softening  and  laceration  of  tlie  spleen,  with  extravasation  of  blood  in  the  abdominal  cavit3’,  congestion  of  the  base 
of  the  right  lung,  and  a multiple  fracture  of  the  right  humerus.  Assistant  Surgeon  H.  S.  Schell,  U.  S.  A.,  reports  the  case. 

Case. — Walter  Fitch,  in  the  employ  of  the  Quartermaster  Department,  aged  19  3-ears,  received  a fracture  of  the  vault 
of  the  cranium,  by  being  throw'n  from  a railroad  car  in  motion,  ila3-  18th,  1864.  He  was  admitted  to  the  field  hospital  at 
Bridgeport,  Alabama,  on  May  19th,  with  symptoms  of  compression  of  the  brain.  Death  took  jdace  on  Ma3-  2Cth,  1864.  As.sistant 
Surgeon  H.  T.  Legler,  U.  S.  V.,  reports  the  case. 

Ca.se. — Private  Edwin  French,  Co.  F,  3d  Delaware  Volunteers,  aged  18  3'ears,  was  thrown  from  a railway  car,  on 
.Tune  21st,  1832,  and  the  fall  produced  a linear  fracture  of  the  skull  near  the  vertex.  He  was  admitted  to  hospital  at 
Frederick,  IMaiwland,  August  22d,  1862.  Tlie  treatment  was  expectant.  He  was  transferred  to  Race  Street  Hospital,  I’hil- 
adclidiia,  on  September  27th.  The  case  is  entered  on  the  register  as  one  of  “general  debility.”  He  was  transferred  on 
Januar3-  14th,  18'J3,  to  Mower  Hospital,  Philadelphia,  and  complained  of  great  dizziness  and  pain  in  the  head.  On  Februar3- 
15th,  ho  had  a severe  chill,  due  apparently  to  malarious  influences,  since  quinine  prevented  the  recurrence  of  other  2iarox3-sms. 
In  lMa3',  ho  was  well  enough  to  perform  dut3'  as  a nurse  in  the  -ward.  Ho  was  transferred  to  the  Veteran  Reserve  Corps  on 
August  27th,  and  was  sent  to  modified  duty  on  September  3d,  1863. 

Case.— Private  George  H , Co.  I,  3d  Delaware  Volunteers,  fell  from  a railroad  car,  on  June  22d,  1862,  his  head 

striking  the  ground  with  great  violence.  He  was  taken  up  in  a stunned  and 
insensible  condition,  and  was  convc3-ed  to  the  neighboring  post  hos]iital  at 
Winchester,  Virginia.  Acting  Assistant  Surgeon  W.  Draino  found  a severe 
contusion  over  the  right  parietal  eminence,  and,  as  grave  symiitoms  of  com- 
pression of  the  brain  were  apparent,  he  made  a free  crucial  incision  through 
the  scalp,  with  the  expectation  of  finding  a depressed  fracture  of  the  skull. 

But,  although  the  skull  was  freoty  exposed  by  reflecting  the  flaps  of  intogu- 
ment,  no  evidence  of  fracture  was  observed.  'The  patient  lingereil,  comatose, 
for  a few  d.avs,  and  died  on  .June  26th,  1832.  At  the  autops3-,  a fissure  seven 
inches  in  length  wa.-?. discovered,  commencing  in  the  squamous  loortion  of  the 
right  temjioral  hone,  jjassing  through  the  right  jiarietal  protuberance,  crossing 
the  sagittal  suture  at  right  angles,  and  running  forward  on  the  left  ])arletal 
hone.  'The  specimen  (Fig.  12)  was  forwarded  by-  Dr.  Draine  to  the  Army 
^lodioal  Museum,  and  the  f.icts  aliove  recorded  were  reported  bv  Surgeon 
George  Suckle3',  H.  S.  V. 


FRACTUKES  OF  THE  SKULL  FROM  RAILROAD  ACCIDENTS. 


39 


Case. — ITivalo  A.  Jlitcliell,  Co.  E,  Ctli  Indiana  Cavalry,  agod  28  years,  received,  in  a railway  accident,  near  Murfreesboro, 
Tennessee,  on  October  SOtb,  1664,  a severe  lacerated  wound  of  the  bead,  with  fracture  of  the  right  parietal  bone.  He  also 
bad  a compound  fracture  of  the  light  fore-arni.  He  was  conveyed  to  Nashville,  and  subsequent!}'  w'as  transferred  to  .Teffersou 
Barracks,  St.  Louis,  on  December  Ctb,  1664.  There  had  not  been,  at  any  time,  signs  of  compression,  and,  on  his  arrival  at  St. 
Lonis,  the  cerebral  symptoms  had  disapjieared.  After  undergoing  an  amputation  at  the  arm,  he  recovered,  and  was  discharged 
from  service,  well,  on  April  Ctli,  1865. 

Case. — Private  G.  Spancell,  Co.  A,  105th  Illinois  Volunteers,  in  a railroad  accident,  near  Murfreesboro,  Tennessee,  Sep- 
tember 10th,  1883,  received  a compound  fracture  of  the  skull.  He  was  placed  in  hospital  under  the  care  of  Surgeon  W.  Threl- 
keld,  U.  S.  y.  The  case  was  comjdicated  by  laceration  of  the  brain,  and  extravasation  of  blDod  within  the  cranium,  and  death 
took  place  within  a few'  hours  after  the  accident,  September  10th,  1863. 

Case. — Private  Zachariali  Wai'd,  Co.  H,  139th  Indiana  Volunteers,  aged  17  years,  fell  from  the  cars  in  motion,  near 
!Muinfordsville,  ICentucky,  July  4th,  1864.  He  was  taken  to  the  military  hospital  at  Mumfordsvillc,  where  a sinqjle  linear 
fracture  of  the  frontal  bone  was  diagnosticated.  There  were  no  symptoms  of  compression,  and  the  treatment  was  of  the 
expectant  nature.  On  August  14tli,  he  was  transferred  to  Clay  Hospital,  at  Louisville,  Kentucky,  and  again,  on  Scjitember 
10th,  to  the  City  Hospital,  at  Indianapolis,  Indiana.  With  the  exception  of  slight  vertigo  and  headache,  he  had  quite  recovered 
at  this  date,  and  two  weeks  subsequently,  September  24th,  1864,  he  was  returned  to  duty  with  his  regiment. 

Case. — Private  Matthew  Young,  Co.  I,  1st  Ohio  Artillery,  aged  39  years,  received  a compound  fracture  of  the  left 
parietal  bone,  with  a terrible  laceration  of  the  scrotum,  on  November  29th,  1864,  in  a railroad  accident,  near  Knoxville, 
Tennessee.  He  was  taken  to  the  Asylum  Hospital,  at  Knoxville.  It  w'as  found  that  the  symptoms  did  not  justify  operative 
interference.  The  testes  had  been  quite  torn  away,  and  the  constitutional  depression  was  great.  The  patient  lingered  in  great 
suffering  until  December  16th,  when  he  died.  The  case  is  reported  by  Surgeon  B.  Barnum,  25th  Michigan  Volunteers. 

The  next  case  has  been  supposed  to  furnish  an  example  of  fracture  of  the  base  of  the 
cranium  by  contre-coup  : 

Case. — Private  Joscq)!!  Weber,  Co.  C,  Cth  New  York  Cavalry,  fell,  or  jumped,  from  a railroad  car  in  motion,  near 
Newark,  New  Jersey,  on  January  11th,  1865.  He  was  carried  to  the  Centre  Street  Branch  of  the  Ward  Hospital,  at  Newark. 
It  was  found  that  there  was  a compound  comminuted  fracture  of  the  frontal  bone.  He  was  sensible,  and  conversed  with 
readiness,  and  walked  uj)  stairs  to  his  bed.  Meningitis  soon  supervened,  indicated  by  nausea,  rigors,  contracted  pupils,  with 
intolerance  of  light,  and  severe  headache.  These  symptoms  were  unavailingly  combated  by  cold  applications  to  the  head, 
purgatives  and  i-evulsives.  The  case  terminated  fatally  on  January  15th,  1865.  At  the  autopsy,  it  was  found,  on  removing  the 
scalp,  that  the  frontal  bone  was  badly  fractured,  being  comminuted  near  the  right  frontal  eminence,  while  fissures,  penetrating 
both  tables,  extended  backwards,  nearly  to  the  coronal  suture,  and  downwards,  quite  into  the  right  oibit.  On  removing  the 
calvarium,  a large  clot  was  found  on  the  dura  mater,  below  the  right  frontal  eminence.  The  membranes  were  much  congested, 
and  were  covered  in  places  with  fibrinous  exudations,  and  elsewhere  were  strongly  adherent  to  the  calvarium.  The  cerebrum, 
and  particularly  the  right  hemisjjhere,  was  found  in  the  same  highly  congested  state.  The  removal  of  the  encephalon  disclosed 
a second  simple  fracture,  of  the  base  of  the  cranium,  extending  through  the  basilar  process  of  the  occipital  bone,  nearly  to  the 
foramen  magnum.  The  case  is  reported  by  the  late  Assistant  Surgeon  J.  T.  Calhoun,  U.  S.  A.,  the  report  of  the  post-mortem 
examination  being  furnished  by  Acting  Assistant  Surgeon  W.  S.  Ward. 

Falls. — Injuries  of  the  head  by  falls  were  not  uncommon,  especially  in  the  cavalry. 
The  following  are  examples  of  contusions  or  lacerations  of  the  scalp  from  this  cause  : 

CA.SE.S. — The  men  named  in  this  category,  by  being  thrown  from  their  horses,  or  falling  from  heights,  received  injuries 
of  the  scalp  of  sufficient  severity  to  be  admitted  into  General  Hospitals,  whence  they  were  returned  to  duty,  after  intervals  of 
from  tw'o  to  one  hundred  and  thirty-six  days : 

Private  F.  Albrecht,  Co.  F,  7th  Michigan  Cavalry,  Alexandria,  Virginia,  October  20th,  1863. 

Private  B.  F.  Alsop,  3d  Iowa  Cavalry,  near  Vicksburg,  ^lississippi,  March  10th,  1864. 

Private  F.  Andrews,  A,  12th  Ohio  Cavalry,  Lexington,  Kentucky,  April  15th,  1864. 

Private  R.  F.  Barton,  L,  1st  Kentucky  Cavalry,  near  Knoxville,  Tennessee,  July  6th,  1864. 

Private  F.  Beal,  1st  Provisional  Cavalry,  Washington,  D.  C.,  December  11th,  1885. 

Coi-poral  J.  Bletlume,  37th  Co.,  2d  Battalion  Veteran  Reserve  Corps,  near  Washington,  D.  C.,  January  31st,  1865. 

Private  S.  S.  Burridge,  E,  9th  New  York  Volunteers,  Alexandria,  Virginia,  September  28th,  1863. 

Private  F.  Campbell,  H,  6th  United  States  Infantry,  Hilthn  Head,  South  Carolina,  November  1st,  1865. 

Private  A.  B.  Chamberlain,  H,  4th  Vermont  Volunteers,  Philadelphia,  Pennsylvania,  March  13th,  1863. 

Private  P.  Crow,  C,  1st  Missouri  Artillery,  Eolla,  Missouri,  May  21st,  1833. 

Private  J.  Dailey,  F,  30tli  Massachusetts  Volunteers,  New  Orleans,  Louisiana,  September  19th,  1863. 

Private  H.  Egbert,  D,  7th  Illinois  Volunteers,  Fayetteville,  North  Carolina,  March  14th,  1865. 

Private  il.  Fesby,  F,  29th  U.  S.  C.  T.,  Point  of  Rocks,  Virginia,  March  31st,  1835. 

Private  J.  Haley,  18th  Massachusetts  Volunteers,  near  Boston,  Massachusetts,  December  11th,  1864. 

Sergeant  T.  Haley,  1st  Delaware  Volunteers,  Gettysburg,  Pennsylvania,  July  3d,  1863. 

Private  J.  A.  Hern,  E,  12th  New  York  Volunteers,  near  Alexandria,  Virginia,  December  26th,  1862. 

Lieutenant  D.  Hillis,  I,  3d  New  York  Artillery,  Newberne,  North  Carolina,  May  22d,  1834. 

Private  T.  Marin,  I,  3d  New  Jersey  Battery,  near  Fort  Jlonroe,  Virginia,  August  1st,  1864. 

First  Lieutenant  J.  D.  McBride,  H,  44th  ^Missouri  Volunteers,  Nashville,  Tennessee,  December  1st,  1864. 


40 


WOUKDS  AND  INJURIES  OE  THE  HEAD, 


Private  S.  McCarty,  B,  lOtli  New  Jersey  Volunteers,  near  Pliilaclelpliia,  Pennsylvania,  January  7th,  1864. 

Private  P.  McDougal,  (ilst  Massachusetts  Volunteers,  near  Galloup’s  Island,  Massachusetts,  January,  1865. 

Private  J.  McFarland,  K,  2d  New  Jersey  Cavalry,  Memphis,  Tennessee,  December  28th,  1864. 

Private  G.  L.  McKenzie,  A,  ICth  New  York  Cavalry,  Y'ork,  Pennsylvani.a,  July  6th,  1863. 

Private  G.  Meyers,  G,  41st  Missouri  Cavalry,  St.  Louis,  Missouri,  June  30th,  1865. 

Private  F.  Munch,  B,  11th  Indiana  Volunteers,  Colnmffla,  Tennessee,  January  14th,  1865. 

Private  P.  O’Donald,  F,  1.5th  New  Y’oik  Cavalry,  near  Alexandria,  Virginia,  June  30th,  1865. 

Private  P.  Palmer,  1, 1st  Veteran  Reserve  Corps,  Washington,  D.  C.,  February  13th,  1864. 

Private  W.  Pomperi,  F,  71st  New  York  Volunteers,  Shipboard,  February  2d,  1864. 

Private  J.  Regan,  C,  CCth  Pinnsylvcnia  Volunteers,  Harrisburg,  Pennsj  lvania,  April  11th,  1864. 

Private  M.  Rigel,  B,  20th  Pennsylvania  Cavalry,  Martinsburg,  Virginia,  June  2d,  1864. 

Private  B.  L.  Roberts,  K,  30th  Kentucky  Volunteers,  Lexington,  Kentucky,  June  12th,  1864. 

Private  S.  Smith,  C,  1st  Iowa  Cavalry,  Memphis,  Tennessee,  March  26th,  1865. 

Private  J.  Steves,  E,  91st  New  Y'ork  Y'olunteers,  Baltimore,  Maryland,  February  23d,  1865. 

Private  E.  Sullivan,  M,  11th  Kentucky  Cavalry,  Lexington,  Kentucky,  November  18th,  1864. 

Private  F.  Tarbox,  H,  14th  Pennsylvania  Cavalry,  HarpeFs  Ferry,  Virginia,  April  20th,  1865. 

R.  Taylor,  government  employ^,  near  Harper’s  Ferry,  Virginia,  June  10th,  1865. 

Private  J.  E.  Thomas,  G,  115th  Pennsylvania  Y'^olunteers,  near  Philadelphia,  Pennsylvania,  June  1st,  1863. 

Pi  ivate  L.  Turrier,  II,  29th  Illinois  Volunteers,  near  Mobile,  Alabama,  March  27th,  1865. 

Private  T.  Trempeman,  E,  16th  Illinois  Cavalry,  Camp  Butler,  Illinois,  Jidy  29th,  1863. 

Private  P.  Vincentio,  B,  Native  California  Cavalry,  San  Francisco,  California,  January  20th,  1864. 

Private  J.  N.  Wise,  B,  1st  Pennsylvania  Artillery,  Washington,  D.  C.,  May  4th,  1864. 

Private  E.  Y’ork,  G,  Sd  Ohio  Volunteers,  Columbia,  Tennessee,  January  14th,  1865. 

Private  J.  Y'orkman,  B,  23d  Michigan  Y^olunteers,  Columbia,  Tennessee,  November  26th,  1864. 

The  I'olloYvilig  are  exaniples  of  seY'erer  contusions  of  the'  head,  resulting  from  falls. 
Many  of  them  teiminated  in  such  disabilities  as  to  disqualify  the  patients  from  further 
actwe  service: 

Case. — Private  YV.  Alentharpe,  Co.  M,  9th  Indiana  Cavalry,  was  thrown  from  his  horse  at  Y'icksburg,  Mississippi,  May 
16th,  1665,  and  fell  upon  his  head.  He  was  admitted  to  McPherson  Hospital,  and  was  found  to  have  a severe  lacerated  wound 
of  the  right  paiietal  region,  with  grave  symptoms  of  concussion  of  the  brain.  He  partially  recovered,  and  was  discharged  from 
service  June  15th,  1865.  Assistant  Siugeon  J.  A.  White,  U.  S.  V.,  reports  the  case. 

Case. — Private  A.  Alteman,  Co.  G,  1st  Pennsylvania  Artillery,  aged  40  years,  fell  from  his  horse  July  1st,  1864,  striking 
his  head  on  the  left  temporal  region.  He  received  a severe  concussion  of  the  brain.  He  was  admitted  to  hospital  at  Chambers- 
burg,  Pennsylvania,  and  was  returned  to  duty  on  Seiitembcr  2d,  1864 ; but  instead  of  rejoining  his  regiment,  he  proceeded  to 
the  York  Hospital,  where  he  remained  until  January  18th,  1865,  when  he  was  transferred  to  the  military  hospital  at  Pittsburgh. 
Here  he  remained  until  June  £th,  1665,  when  he  W'as  transferred  to  Chester,  Pennsylvania,  whence  he  was  discharged  from 
service  for  disability  July  26th,  1865.  The  disability  appears  to  have  been  elite  to  chronic  rheumatism,  rather  than  the  efiects 
of  the  injury.  Surgeon  T.  II.  Bache,  U.  S.  V.,  reports  the  case. 

Case. — Private  J.  C.  Baumbach,  Co.  E,  65th  Ohio,  was  admitted  to  hospital  at  Camp  Chase,  Ohio,  December  23d,  1864. 
He  had  been  thrown  fiom  his  horse,  and,  falling  niton  the  left  side  of  his  head,  had  sufl'ered  a severe  concussion  of  the  brain. 
There  was  entire  lass  of  vision  of  the  left  eye,  and  the  vision  of  the  right  eye  was  impaired.  After  a time  deafness  of  the  right 
ear  supervened.  The  patient  was  discharged  from  service  May  17th,  1864,  for  disability.  Tbe  case  is  reported  by  Surgeon  S. 
S.  Schultz,  U.  S.  V. 

Case. — Private  Frank  Clune,  15th  New'  Y’ork  Cavalry,  was  thrown  from  his  horse  at  Louisville,  Kentucky,  July  20th, 
1865,  and  fell  violently  upon  his  head.  He  w’as  admitted  to  Crittenden  Hospital  immediately  after  the  accident,  and  died  in  a 
few  hours,  July  20th,  1865,  from  the  effects  of  concussion  and  probable  lacer’ation  of  the  brain.  No  fracture  or  extravasation  of 
blood  was  detected.  It  was  impossible  to  bring  about  reaction  from  the  condition  of  extreme  depression  resulting  from  the 
concussion.  Assistant  Surgeon  J.  C.  G.  Happersett,  FT.  S.  A.,  reports  the  case. 

Case. — Private  Dexter  Cole,  Co.  I,  25th  Michigan  Volunteers,  in  October,  1862,  received  a severe  blow  upon  the  head 
by  a fall,  and  was  admitted  into  Stanton  Hospital  at  YVashington,  on  February  1st,  1863,  completely  deaf,  in  consequence  of  the 
commotion  or-  concussion  of  the  brain.  Every  method  of  treatment  for  the  restoration  of  his  hearing  having  been  employed 
unavailingly,  he  was  discharged  from  service  February  26th,  1863,  on  the  certificate  of  Surgeon  .John  A.  Lidell,  of  his  total 
disability. 

Case. — Private  J.  D.  Davis,  Co.  F,  10th  Indiana  Volunteers,  aged  42  years,  was  admitted  to  Cumberland  Hospital, 
Nashville,  Tennessee,  December  6th,  1864,  on  account  of  a fall  fi-om  a horse  on  the  ju-evious  day.  He  had  a bad  contusion  of 
the  scalp  and  concussion  of  the  brain.  He  recovered,  and  was  sent  to  Jeffersonville  Hospital  on  January  7th,  1865.  He  was 
treated  for  chronic  rheumatism  till  February  22d,  when  he  was  transferred  to  Hosiiital  No.  15,  at  Nashville,  where  he  was 
treated  for  asthma  until  May  24th,  1865,  w'hen  he  was  finally  discharged  from  service.  The  case  is  reported  by  Surgeon  YV.  M. 
Chambers,  U.  S.  V. 

Case. — Private  Henry  Drimeyer,  Co.  C,  28th  Ohio  Volunteers,  aged  28  years,  a somnambulist,  fell  from  a second  story 
window  while  walking  in  his  sleep,  in  July,  1863,  and,  striking  on  his  head,  received  a severe  contusion  and  concussion  of  the 


CONTUSIONS  AND  CONCUSSIONS  FEOM  FALLS. 


41 


brain.  He  was  admitted  to  the  Marine  Hospital,  Cincinnati,  Ohio.  He  recovered  from  the  immediate  effects  of  the  accident, 
but  his  idiosyncrasy  was  regarded  as  such  a dangerous  one  for  a soldier,  that  he  was  discharged  from  service  August  16th,  1863. 
Acting  Assistant  Surgeon  John  Davis  reports  the  case. 

Case.— Sergeant  D.  H.  Gleason,  Co.  H,  1st  Massachusetts  Cavalry,  aged  28  years,  was  thrown  from  his  horse  in  a 
charge  at  Gettysburg,  July  1st,  1863,  and  received  a very  severe  concussion  of  the  brain.  He  was  sent  to  Ihe  hospital  at  the 
Cavalry  Depot  at  Camp  Stoneman,  Washington.  After  recovering  from  the  symptoms  of  concussion,  he  suffered  from  persistent 
pain  in  the  head,  and  on  March  7th,  1864,  he  was  sent  to  Finley  Hospital,  Washington.  He  recovered,  and  returned  to  duty 
October  1st,  1864.  The  case  is  reported  by  the  late  Surgeon  G.  L.  Pancoast,  U.  S.  V. 

Case.— Private  I’.  Goodman,  Co.  C,  13th  New  York  Cavalry,  aged  46  years,  received  a severe  injury  of  the  head,  by 
being  thrown  from  his  horse,  February  13th,  1864.  He  was  admitted  to  Campbell  Hospital,  and  was  discharged  from  service, 
with  complete  loss  of  vision  in  his  right  eye,  March  6th,  1864.  Surgeon  A.  F.  Sheldon,  U.  S.  V.,  reports  the  case. 

Case.— Corporal  J.  B.  Hefler,  Co.  D,  7th  Pennsylvania  Cavalry,  aged  25  years,  was  thrown  from  his  horse,  at  Louisville, 
Kentucky,  April  15th,  1864,  falling  between  his  own  horse  and  that  of  a comrade,  and  striking  upon  his  head.  His  injury  was 
supposed  to  be  of  a slight  character;  but  he  suffered  from  constant  headache  until  the  23th  of  August,  when  an  abscess 
commenced  to  form  over  the  right  parietal.  The  abscess  was  opened  on  November  30th.  The  patient  was  then  transferred  to  the 
hospital  at  Madison,  Indiana.  On  his  admission,  his  pulse  was  ninety,  his  skin  dry,  his  tongue  coated,  and  bowels  constipated. 
On  examining  the  seat  of  injury  the  parietal  bone  was  found  to  be  denuded,  and  externally  necrosed  for  a space  one  and  a half 
inches  in  width,  by  two  and  a half  inches  in  length.  On  December  21st,  the  scalp  w’as  freely  divided  and  the  flaps  reflected, 
with  a view  of  removing  the  necrosed  bone;  but  upon  examination  the  necrosed  portion  did  not  seem  to  be  sufficiently  separated 
to  justify  operative  interference.  On  January  1st,  1865,  very  marked  symptoms  of  compression  were  ushered  in  suddeidy, 
convulsions  recurring  in  rapid  succession  for  two  days,  when  a comatose  condition  supervened,  which  lasted  until  the  patient’s 
death,  on  January  13th,  1865.  At  the  autopsy,  a large  abscess  was  found  in  the  l ight  hemisphere  of  the  cerebrum  communicating 
with  the  lateral  ventricle,  and  containing  several  ounces  of  pus.  There  were  evidences  of  inflammation  of  the  cerebellum  and 
meninges  of  the  brain.  The  necrosed  portion  of  bone  was,  in  two  or  three  places,  perforated.  It  was  observed  that  the  walls 
of  the  cranium  were  very  thin.  The  thoracic  and  abdominal  viscera  were  normal  in  appearance.  The  notes  of  the  case  were 
furnished  by  Acting  Assistant  Surgeon  H.  F.  Bosworth. 

Case. — Lieutenant  J.  Hendrick,  Co.  H,  6th  Pennsylvania  Cavalry,  was  thrown  from  his  horse  in  August,  1863,  and  his 
head  struck  the  ground  with  such  violence  as  to  produce  a severe  concussion  of  the  brain.  He  was  admitted  to  the  Officers’ 
Hospital  at  Philadelphia,  with  partial  hemiplegia  of  the  right  side,  and  occasional  attacks  of  delirium.  With  rest  and  restricted 
diet,  these  symptoms  gradually  disappeared,  and  this  officer  was  returned  to  duty,  well,  on  February  5th,  1864.  Acting 
Assistant  Surgeon  W.  Camac  reports  the  case. 

Case. — Private  C.  S.  Miller,  Co.  I,  18th  Connecticut  Volunteers,  aged  30  years,  fell  from  a bridge  at  Harper's  Ferry, 
Virginia,  October  27th,  1834,  and  received  a severe  contusion  of  the  scalp  with  concussion  of  the  brain.  He  was  sent  to  the 
hospital  at  Sandy  Hook,  ilaryland,  on  the  following  day,  and  was  transferred  to  Frederick,  on  November  2d.  He  gradually 
recovered  his  physical  health,  but  dullness  of  intellect  persisted,  and  he  was  discharged  from  service  for  disability,  on  May  21st, 
1835.  Assistant  Surgeon  T.  H.  Helsby,  U.  S.  A.,  reported  the  case. 

Case. — Private  John  Miller,  Co.  E,  4th  Pennssylvania  Cavalry,  aged  31  years,  fell  from  a tree,  on  June  16th,  1883,  and 
struck  upon  the  left  side  of  his  head,  and  upon  his  shoulder,  fracturing  the  left  clavicle.  He  was  admitted,  a few  hours 
afterwards,  to  Lincoln  Hospital,  Washington,  in  a semi-conscious  condition,  partially  insensible,  the  surface  pale  and  cold,  with 
other  symptoms  of  severe  concussion  of  the  brain.  Stimulants  were  administered.  He  failed  to  react.  On  the  following  day 
his  respiration  hecame  more  Labored,  and,  failing  gradually,  he  died  on  June  18th,  1883.  Surgeon  G.  S.  Palmer,  LT.  S.  V., 
reports  the  case. 

Case. — Private  J.  P.  Schneider,  Co.  L,  1st  Missouri  Engineers,  aged  30  years,  was  tlirown  from  a wagon,  near  New 
Madrid,  in  November,  1883,  and,  striking  on  his  forehead,  was  badly  stunned,  and  received  a contused  and  lacerated  wound  of 
the  integuments.  He  was  treated  in  several  hospitals,  at  Chattanooga,  Cumberland,  and  Jeffersonville,  and  is  reported  as 
suffering  from  indigestion,  hernia,  neuralgia,  and  other  ailments,  and  finally,  at  Mound  City  Hospital,  Illinois,  on  December  1st, 
1834,  with  ulceration  of  the  frontal  bone  over  the  sinuses.  He  was  discharged  the  service  on  account  of  incurable  disease  of  the 
frontal  sinuses  and  turbinated  bones,  on  March  llth,  1865.  Surgeon  H.  Wardner,  U.  S.  V.,  reports  the  case. 

Case. — Private  Charles  Sherman,  Co.  A,  Todd's  Scouts,  was  thrown  from  his  horse,  on  August  18th,  1863,  and,  striking 
upon  the  right  side  of  his  head,  received  a severe  concussion  of  the  brain.  He  was  admitted  to  Camp  Dennison  Hospital,  Ohio, 
a few  hours  after  the  reception  of  the  injury,  at  which  time  respiration  was  almost  extinct,  pulse  soft  and  feeble,  and  extremities 
cold.  Complete  insensibility  existed,  although  he  could  swallow  stimulants  in  small  quantities.  Sinapisms  were  applied  to  the 
back  of  the  neck  and  to  the  extremities,  and  reaction  was  slowly  established.  On  August  19th,  he  remained  unconscious,  with 
irregular  and  labored  respiration,  j)ulse  60,  full,  slow,  and  incompressible,  with  involuntary  discharge  of  urine,  and  partial 
paralysis  of  the  right  arm.  During  the  evening  of  the  same  day  symptoms  of  improvement  and  returning  consciousness  were 
manifest.  At  9 j).  m.  the  pulse  was  110,  and  full.  He  was  bled,  and  the  judse  increased  in  frequency,  but  afterwards  fell  to  112. 
Upon  the  application  of  cold  to  the  head  the  respiration  became  natural.  On  August  20th,  he  opened  his  eyes  when  sharply 
spoken  to,  his  respiration  was  natural,  pulse  78,  and  compressible.  He  continued  in  this  condition  until  August  20th,  when  his 
symptoms  improved  still  more,  and  he  replied  to  questions  readily.  He  had  no  paralysis,  and  took  li(iuid  nourishment  freely. 
He  recovered  completely,  and  was  returned  to  duty  on  October  22d,  1863.  Surgeon  B.  Cloak,  U.  S.  V.,  reported  the  case. 

0 


42 


WOUNDS  AND  INJURIES  OE  THE  HEAD 


Case. — Priv^ate  F.  Tillotson,  Co.  B,  7tli  Kansas  Cavalry,  aged  25  years,  received  a severe  concussion  of  the  brain  by  a 
fall  from  bis  horse,  near  Memphis.  Tennessee,  and  was  transferred  from  a hospital  at  that  city  to  the  Marine  Ilosjiital  at  St. 
Louis,  on  September  IGth,  1834.  He  was  furloughed  on  November  20th,  and  on  December  24th,  1864,  he  deserted.  Sui’geou 
A.  Hammer,  U.  S.  V.,  reports  the  case. 

Case. — Private  T.  J.  Wittermodc,  Co.  I,  14th  Indiana  Volunteers,  was  admitted  to  Mower  Hospital,  Philadelphia, 
March  IGth,  1863,  with  a very  severe  contusion  of  the  scalp,  occasioned  by  a fall.  A puffy'tumor  of  the  scalp,  which  subsided 
under  the  use  of  evaporating  lotions,  while  persistent  pain  at  the  seat  of  injury  continued.  The  patient  was  transferred  to 
^IcDougal  Hospital,  New  York,  on  April  22d,  thence  to  Fort  W'ood,  thence  to  New  York  City,  where  he  was  transferred  to  the 
Veteran  Reserve  Corps,  on  July  27th,  1833,  in  accordatice  with  G.  O.  No.  235,  War  Department,  A.  G.  O.,  18G3. 

The  next  series  consists  of  abstracts  of  thirteen  cases  of  simple  or  compound  fractures  of 
the  cranium  produced  by  falls; 

Case.— Private  .John  W.  Anderson,  Co.  E,  19th  Michigan  Volunteers,  fell  down  stairs  in  the  court-house  at  McMinns- 
ville,  Tennessee,  February  2d,  1884,  and,  striking  his  head,  produced  a fracture  of  both  tables  of  the  left  temporal  bone.  He 
was  admitted  to  hospital  under  the  charge  of  Surgeon  John  Bennett,  19th  Michigan  Volunteers,  who  records  the  accident  upon 
his  regimental  monthly  report.  The  case  terminated  fatally  on  Februai-y  Gth,  18G4.  At  the  autopsy,  intense  congestion  of  the 
cerebral  vessels  was  observed,  with  effusion  of  serum  in  the  cavity  of  the  ventricles  ; but  no  extravasation  of  blood  was  observed. 


Case. — Private  J.  J.  Brooks,  Co.  G,  9th  Illinois  Cavalry,  aged  28  years,  was  thrown  from  his  horse  on  April  .5th,  1864, 
and  fell  upon  his  head.  A fracture,  involving  the  frontal,  temporal,  sphenoid,  ethmoid,  and  upper  maxillai-y  bones,  was  ju’o- 
duced.  The  p.atient  was  taken  to  the  Adams  Hospital  at  Memphis,  Tennessee.  He  died  a few  hours  after  his  admission,  and  it 
was  found  that  the  brain  had  been  extensively  contused  and  lacerated.  Acting  Assistant  Surgeon  F.  Inijtey  reports  the  case. 

Ca.si:. — Private  James  Carr,  Co.  G,  Gth  United  States  Cavalry,  aged  24  years,  fell  from  his  horse  on  July  Gth,  1863, 
receiving  a wound  of  the  frontal  region  with  fracture,  and  depression  of  the  inner  table  of  the  skull.  He  was  admitted  to 
Carver  Hospital,  Washington,  on  July  24th,  in  an  irritable,  morose,  and  restless  condition.  Three  days  subsequently  he  was 
slightly  delirious,  and  rcsj)iration  was  difficult.  In  the  afternoon  he  became  completely  unconscious,  with  insensible  pupils  and 
stertorous  breathing,  and  death  ensued  in  a fetv  hours,  on  July  27th,  1863.  The  autopsy  revealed  a depression  of  the  inner 
table  of  the  frontal  bone,  .and  an  abscess  immediately  beneath,  filled  with  sanious  pus,  and  surrounded  with  plastic  hunph. 
Many  of  the  sulci  were  adherent,  and  patches  of  lymph  were  distributed  on  the  anterior  and  middle  lobes  of  the  brain.  Surgeon 
O.  A.  Judson,  U.  S.  V.,  reports  the  case. 


Casio. — Pi-ivate  William  Day,  Co.  C,  .57111  Illinois  Volunteers,  aged  44  years,  an  epileptic  subject,  a deserter  from  his 
regiment,  had  a severe  fall,  April  1st,  1864,  and  was  admitted,  in  a delirious  state,  to  the  Marine  Hospital  at  Chicago,  Illinois. 
Acting  Assistant  Surgeon  E.  N.  Isham,  who  reports  the  case,  does  not  describe  the  symptoms,  or  the  appearances  at  the  autopsy  ; 
but  states  that  there  was  a fracture  of  the  base  of  the  cranium,  and  that  compression  of  the  brain,  consequent  upon  a large 
extravasation  of  blood  within  the  skull,  was  the  cause  of  death.  The  patient  died  April  3d,  1884. 


Case. — Private  Hugh  Donelly,  Co.  K,  38th  New  York  Volunteers,  received  at  the  battle  of  Williamsburg,  May  Gth,  18G2, 
a flesh  wound  of  the  shouldqr.  He  was  made  a prisoner.  While  confined  at  Eichmond  he  had  a fall  in  prison,  striking  his 
head,  and  producing  a depressed  fracture  of  the  right  jiarietal  bone.  Ho  was  exchanged,  and  received  into  hospital  at  Camp 
Parole,  Annapolis,  on  February  5th,  1833.  He  was  deaf,  and  his  mental  faculties  were  very  sluggish  and  obtuse.  He 'was 
discharged  from  service  for  total  disability  on  February  18th,  1863.  Surgeon  James  Norval,  79th  N.  Y.  S.  M.,  reports  the  case. 

Case. — Sergeant  Albert  K , Co.  A,  4th  Pennsylvania  Cavalry,  falling  violently  upon  his  head,  in  April,  1832,  in 

Washington,  D.  C.,  had  a fracture  of  the  left  side  of  the  occipital  bone,  attended 
with  laceration  of  the  brain.  He  entered  the  .ludiciary  Square  Hospital  in  an  in- 
sensible condition,  with  stertorous  breathing,  ddated  pupils,  slow  pulse,  and  relaxed 
sphincters.  Cold  applications  to  the  head,  purgatives,  and  derivatives,  were  em- 
ployed unavailingly.  The  patient  passed  into  a condition  of  jirofound  coma,  and 
died  April  28th,  1832,  from  compression  of  the  brain.  Acting  Assistant  Sur- 
geon C.  G.  Page  made  the  autopsy,  and  found  a partially  organized  coagulum 
in  the  substance  of  the  posterior  lobe  of  the  left  hemisphere,  and  in  the  cavity 
of  the  left  ventricle.  The  clot  is  not  recent,  and  the  brain  substance  in  the 
vicinity  is  firmly  contracted  around  it.  It  is  of  a dark  brownish-yellow  color, 
and  spongy  in  texture,  and  measures  one  inch  in  diameter  by  one-fourth  of 
.an  inch  in  thickness.  On  the  surface  of  the  brain  there  is  a more  recent  clot, 
black  in  color,  and  p.artialiy  disorganized,  measuring  nearly  the  same  as  the 
first.  The  specimen  was  contributed  b}'  Dr.  Page  to  the  Army  Medical  iSIu- 

seum.  A view  of  the  clot  in  the  ventricle  is  given  in  the  accompanying  wood-  containinsracoagulum.-AJiee..')05,  .^icet.l,  A.M.M. 
cut,  (Fig.  13.) 


Case. — Sergeant  .1.  .1.  Kent,  Co.  L,  1st  Wisconsin  Cavalry,  aged  29  years,  was  thrown  from  his  horse  February  18th, 
1834,  and  falling  on  his  head,  had  a depressed  fracture  of  the  left  parietal  bone  near  its  coronal  suture.  It  can  only  be  learned 
of  the  early  history  of  the  case  that  it  was  treated  on  the  expectant  plan.  The  patient  was  admitted  to  Harvey  Hor.pital,  at 
Madison,  Wisconsin,  on  .July  27th.  Ho  made  a very  good  recovoiy,  returning  to  duty  October  lOth,  1834. 

C.tSE. — Sergeant  Alexander  N , Co.  B,  13th  New  York  Cavalry,  was  thrown  from  his  horse  whiie  riding  in  the 

streets  of  Washington,  on  August  10th,  1865,  his  head  striking  violently  upon  the  pavement.  He  was  taken  to  the  hospital  at 


CONTUSIONS  AND  LACERATIONS  BY  BLOWS  FROM  MUSKETS. 


43 


Cnmp  Barry  in  an  insensible  condition,  and,  in  a few  hours,  became  delirious.  He  remained  so  until  his  death,  which  took  place 
on  August  14th,  1865.  There  was  no  external  evidence  of  depression  or  fracture  of  the  skull,  but  simply  a severe  contusion  of 
the  foreliead.  The  autopsy  revealed  a three-branched  linear  fracture  of  the  frontal 
bone.  Its  direction  is  indicated  in  the  accomp.anying  wood  cut.  (FiG.  14.) 

Externally  one  line  of  fracture  passes  from  the  centre  of  the  superior  border  of  the 
bone  downward  and  outward  through  the  right  frontal  eminence.  From  the  upper 
third  of  this  fissure  a second  fissure  passes  nearly  at  right  angles  downward  tlirough 
the  left  frontal  eminence.  This  last  fissure  involves  the  external  table  only.  The 
inner  table  is  fissured  to  correspond  with  the  first  line  of  fracture,  and  there  is  also 
a short  fissure  branching  upward.  The  inner  table  opposite  each  frontal  eminence 
is  reticulated,  and  in  the  centre  of  the  perforated  ])late  on  the  left  side  there  is  a 
small  nodule  of  bone  of  the  size  of  a gi'ain  of  wheat.  The  specimen,  with  a mem-  l-’io.  14.— Fracture  cf  the  frontal  bone  vithout 
orandum  of  the  case,  was  forwarded  to  the  Army  Jledical  Museum  by  Surgeon  <bsplaccment,  from  a fall  from  a horse.— ,Spcc.  2970, 
,1.  M.  Ilomiston,  3d  New  York  Provisional  Cav.alry. 

Case. — Lieutenant  J.  M.  Eagan,  Co.  E,  1st  Tennessee  Artillery,  aged  30  3'ears,  was  thrown  from  his  horse,  June  18th, 
1865,  and  was  admitted  into  the  Officers’  Hospital,  at  Knoxville,  Tennessee,  on  the  following  daj-,  laboring  under  very  grave 
sj’mptoms  of  compression  of  the  brain.  He  died  June  25th,  1865,  from  extravasation  of  blood,  consequent  upon  the  fracture  of 
the  skull.  Stirgeon  F.  Meacham,  IT.  S.  V.,,  reports  the  ease. 

Case. — Private  E.  G.  Stevens,  Co.  D,  8th  Vermont  Volunteers,  aged  18  j'ears,  fell  from  a second  story  window,  in  New 
Orleans,  on  .Tunc  10th,  1864,  his  head  striking  the  ground.  He  was  convej^ed  to  the  UniversiH  Hospital,  and  Surgeon  Samuel 
Kneeland,  U.  S.  V.,  recognized  the  usual  signs  of  fracture  of  the  base  of  the  cranium.  There  was  also  a contused  and  lacerated 
wound  of  the  vertex.  The  case  terminated  fat.ally  June  11th,  1864. 

Case. — Private  C.  Timbei-man,  Co.  C,  2d  New  .Jersej'  Cavaliy,  aged  19  years,  received,  Aiiril  22d,  1864,  a severe  fall. 
He  was  admitted  to  Gayoso  Hospital,  at  IMemphis,  Tennessee,  on  April  30th,  and  was  found  to  have  a compound  fracture  of 
the  occipital  bone.  There  were  no  sjunptoms  which  were  thought  to  justify  operative  interference,  and  the  treatment  consisted 
of  cold  applications  to  the  head,  and  purgatives.  Death  took  place  on  May  11th,  1864.  Surgeon  F.  N.  Burke,  U.  S.  V.,  reports 
the  case. 

The  two  following  were  believed  to  be  examples  of  fracture  by  contre-cowp  : 

Ca.sEj — Private  John  H.  Bowker,  Co.  A,  3d  Maine  Volunteers,  was  thrown  from  a horse,  March  26th,  1832,  at  Fort 
Monroe,  Virginia,  and,  falling  upon  his  head,  received  a fracture  of  the  base  of  the  skull.  He  was  immediately  conveyed  to 
the  Hygeia  Hospital,  with  marked  symptoms  of  compression  of  the  brain.  He  died,  March  27th,  1862.  Brigade  Surgeon 
E.  B.  Bontecou,  U.  S.  V.,  reported  the  case. 

Case. — Private  Peter  Flj'iin,  Co.  H,  2d  Ohio  Heavy  Artillery,  was  admitted  to  the  Post  Hospital  at  IMunfordsville, 
Kentucky,  January  3d,  1834,  with  a fracture  of  the  skull.  He  had  cveiy  symptom  of  grave  compression  of  the  brain,  and 
blood  was  passing  from  his  mouth  and  ears.  He  was  comatose,  and  died  two  hours  after  his  admission.  The  man  had  received 
a heavy  blow  upon  the  left  supra-orbital  ridge,  whether  by  a weapon,  or  fall,  could  not  bo  ascertained;  but  no  evidence  of 
fracture  could  be  discovered  at  this  j^oint.  Surgeon  S.  Albright,  2d  Ohio  Heavy  Artilleiy,  who  reports  the  case,  believed  that 
there  must  be.  a fracture  of  the  base  of  the  skull  by  contrc-coup.  The  mortoa  examination  proved  the  correctness  of  this 
diagnosis.  There  was  a fissure  running  across  the  petrous  bone,  diastasis  of  the  sutures  between  the  occipital  and  left  temporal, 
with  a large  coagulum  of  blood  in  the  loft  cranial  fossa. 

Blows. — Contusions  and  lacerations  of  the  scalp,  concussion  of  the  brain,  and  frac- 
tures of  the  cranium,  were  produced  by  a great  variety  of  blows.  When  received  in  action, 
such  injuries  were  commonly  inflicted  by  clubbed  muskets,  falling  trees  or  liranches  cut 
down  by  artillery,  or  by  kicks  from  horses  or  mules.  In  affrays  in  camp  or  on  the  street, 
similar  injuries  were  more  generally  produced  by  blows  from  clubs  or  axes,  slung  shot, 
and  various  other  blunt  weapons,  or  by  bricks  or  stones: 

Cases. — The  nineteen  following  named  patients  were  admitted  to  hospital  for  contusions  or  lacerations  of  the  scalp  by 
blows  from  muskets,  and  were  returned  to  duty,  the  average  duration  of  treatment  being  about  one  month  : 

Private  J.  W.  Anderson,  H,  19th  Massachusetts  Volunteers,  in  action,  at  Getfysburg,  July  2d,  1833. 

Private  D.  W.  Butler,  A,  92d  Illinois  Volunteers,  at  Nashville,  Tennessee,  November,  1864.  Deserted. 

Private  C.  Chamberlain,  A,  34th  New  Jersey  Volunteers,  November,  1833. 

Private  H.  W.  Jone.s,  K,  9th  New  Hampshire  Volunteers,  in  action,  near  Jackson,  iMississippi,  July  14th,  1863. 

Private  E.  Launtz,  C,  54th  Pennsjdvania  Volunteers,  in  action,  at  Piedmont,  Virginia,  June  5th,  1834. 

Private  P.  Leonard,  G,  2d  Michigan  Cavalry,  in  action,  near  Nashville,  ’Tennessee,  December  7th,  1864. 

Private  J.  Linebacker,  F,  13th  Missouri  Volunteers,  accidentally',  at  Eolla,  Missouri,  December  llth,  1864. 

Private  JI.  J.  Loud,  A,  9d  Ehode  Island  Volunteers,  in  action,  near  Appomattox,  Virginia,  April  6th,  1865. 

Private  J.  McCracken,  A,  5th  Tennessee,  accidentallv-,  Cincinnati,  Ohio,  January  22d,  1835. 

Private  H.  McLaughlin,  G,  16th  N(;w  York  Cavalry,  near  Alexandria,  Virginia,  July  Jlst,  1834. 

Private  W.  Magee,  L,  2d  Iowa  Cavalry,  in  action,  near  Nashville,  Tennessee,  December  18th,  1834. 


44 


WOUNDS  AND  INJUEIES  OF  THE  HEAD 


Private  Conrad  Osman,  Co.  1,  lOStli  Oliio  Volunteers,  Marietta,  Georgia,  November  13th,  1864. 

Private  W.  A.  Palmer,  A,  14Gtli  New  York  Volunteers,  in  action,  near  Spottsylvania,  Virginia,  May  5th,  1864. 

Corporal  T.  Robb,  A,  2d  District  of  Columbia  Volunteers,  Washington,  D.  C.,  August,  1865. 

Corporal  J.  Schinkel,  D,  28th  Ohio  Volunteers,  near  Beverly,  West  Virginia,  February  7th,  1864. 

Private  J.  Snowdon,  F,  30th  United  States  Colored  Troops,  in  action,  near  Petersburg,  Virginia,  July  30th,  1864. 

Private  J.  Sweeney,  G,  Second  Battalion,  14th  United  States  Infantry,  near  Annapolis,  Maryland,  June  9th,  1863. 

Private  W.  J.  True,  K,  2d  Blinois  Volunteers,  near  Memphis,  Tennessee,  IMarch  10th,  1865. 

Private  A.  Wolf,  D,  59th  New  York  Volunteers,  in  action,  at  Gettysburg,  July  2d,  1863.  Deserted. 

Cases. — The  twelve  following  received  injuries  of  the  head,  of  a more  severe  nature,  from  blows  from  muskets: 

Private  Andrew  Berry,  Co.  B,  14th  Pennsylvania  Cavalry,  aged  54  years,  at  Snicker’s  Gap,  Virginia,  April  1st,  1865,  in 
action.  Was  sent  to  Satterlee  Hospital,  Philadelphia;  thence  to  McClellan  Hospital,  July  16th;  thence  to  Mower  Hospital, 
July  20th,  and  was  discharged  from  service  August  24th,  1865,  in  accordance  with  G.  O.,  War  Department,  A.  G.  0.,  May  3d, 
1865. 

Private  M.  Brown,  B,  140th  New  Y'ork  Volunteers,  in  action,  at  Spottsylvania,  May  12th,  1864. 

Private  IT.  B.  Burns,  A,  22d  North  Carolina  Regiment,  was  admitted  to  Farmville  Hospital,  A'^irginia,  August,  1864,  and 
was  discharged  from  the  Confederate  service  for  total  deafness,  resulting  from  a blow  I'eceived,  in  action,  from  a musket. 

Private  J.  Hewett,  Co.  B,  2d  A'ermont  A^olunteers,  aged  28  years,  received.  May  5th,  1864,  a lacerated  ^vound  of  the 
scalp,  with  concussion  of  tlu!  brain,  by  being  struck  with  the  butt  of  a musket  at  the  battle  of  the  AVilderness.  He  was  treated 
at  the  University  Hosj)ital,  Baltimore,  and  at  the  Smith  Hos])ital  at  Brattleboro,  Vennont,  and  retunied  to  duty  July  29th,  1864. 

Private  AI.  Leisure,  173d  Ohio  A'^olunteers,  aged  30  years,  accidentally,  at  Nashville,  Tennessee.  Transferred  July  1st, 
1865.  Not  accounted  for. 

Private  Otis  J.  Libby,  Co.  H,  16th  Maine  A’’olunteers,  was  struck  on  the  head  by  a musket,  at  the  battle  of  Fredericks- 
burg, December  12th,  1862,  and  was  sent  to  Alexandria,  December  19th,  and  was  discharged  from  service,  totally  disabled,  on 
March  30th,  1863.  The  case  was  recorded  by  Surgeon  E.  Bentley,  U.  S.  Y. 

Private  J.  Loglm,  Co.  C,  6th  Maine  Volunteers,  aged  28  years,  received  a lacerated  wound  of  the  scalp,  July  21st,  1861, 
at  the  6rst  battle  of  Bull  Run.  He  was  treated  at  the  Mason  Hospital,  Boston,  and  returned  to  duty,  and  was  subsequently 
discharged  from  service  on  account  of  epileptic  fits,  Januaiy  11th,  1865. 

Private  J.  O’Donnell,  Co.  K,  12th  Maine  Volunteers.  Insubordination,  December  9th,  1862.  In  1883  and  1864,  he  was 
serving  out  his  sentence  by  Court  Martial,  at  Ship  Island,  Mississippi,  and  Tortugas,  Florida. 

Private  J.  Parker,  Co.  K,  2d  New  Hampshire  A^olunteers,  aged  23  years,  March  12th,  1864.  Partial  paralysis  of  left 
arm.  Recovery,  and  returned  to  duty.  May  6th,  1864. 

Private  Sampson  Turner,  Co.  F,  66th  Ohio  Volurrteers,  was  admitted  irrto  the  Twentieth  Army  Corps  Hospital,  on  July 
6th,  1864,  much  debilitated  by  malarious  attacks.  AVhile  in  hospital,  a musket  fell  uporr  his  head,  producirrg  a concussiorr  of 
the  brain,  and  almost  irrstant  death,  on  Augirst  26th,  1864. 

Private  AA'".  AAkalter,  3d  Pennsylvania  Reserve  Volunteers,  Juno  26th,  1864,  lacerated  wound  of  the  scalp,  at  the  battle  of 
Games’s  Mill,  1862.  Examined  for  44th  Reginrent,  V.  R.  C.,  Jarruary,  1867. 

Private  Robert  M.  A'ourtg,  Co.  D,  107th  Illinois  A’olunteers.  Laceration  of  the  scalp  by  a blow  from  the  butt  of  a gun. 
Admitted  to  Douglas  Hosjrital,  AA’^ashingtoir,  July  17th,  1863.  He  was  transferred  to  the  Invalid  Corps,  September  16th,  1863. 

The  seA'en  folloAving  abstracts  refer  to  examples  of  fracture  of  the  skull  resulting 
from  bloAvs  from  muskets: 

Case. — Private  Alichael  B , Co.  F,  9th  Massachusetts  Volurrteeers,  while  sleeping  orr  the  ground  after  the  battle  of 

Gettysburg,  Perrnsylvania,  July  4th,  1863,  was  struck  on  the  head  by  a musket  in  the  hands  of  a fellow  soldier.  The  hammer 
of  the  musket  inflicted  a wound  of  the  left  temple  and  a depressed  fracture  at 
the  middle  of  the  lower  border  of  the  left  parietal  and  adjoining  portion  of  the 
left  temporal  bone.  The  patierrt  was  conveyed  to  Baltimore.  He  was  adrrritted, 
orr  July  5th,  irrto  Jarvis  Hospital,  in  a comatose  condition.  There  was  a hernia 
of  the  brain  of  tire  size  of  a wahrut.  The  patierrt  retained  voluntary  motion  of 
the  lower  limbs.  The  pujrils  were  irregular  arrd  insensible  to  the  light.  Con- 
sciousrress  was  rrever  restored,  and  death  took  place  orr  July  6th,  1863,  forty- 
four  hours  after  the  reception  of  the  injury.  At  the  airtopsy,  made  fourteen 
hours  after  death,  the  left  side  of  the  calvarium  was  removed,  and  a rrunrber  of 
long  fragments  were  found  imbedded  in  the  nriddle  lobe  of  the  left  hemisphere, 
the  brain  tissue  being  broken  up  as  far  as  the  left  lateral  ventricle.  Two  frag- 
nrents,  orre  of  the  outer  and  one  of  the  inner  table  remained  attached;  the  latter 
and  one  of  the  former  having  their  free  edges  depressed  one^fourth  of  an  inch,  from  a mas\ict. —Spec.  1457,  Sect . I,  A.  M.  M. 

The  oval  openirrg  made  in  the  skull  is  represented  in  the  adjacent  wood-cut,  (Fig.  15.)  The  pathological  specimen  and  notes  of 
the  case  were  contributed  by  Assistant  Surgeon  D.  C.  Peters,  U.  S.  Army. 

Case. — Private  James  H.  Burns,  Co.  F,  9th  New  Hampshire  Volunteers,  was  struck,  at  Petersburg,  Virginia,  July  30th, 
1884,  with  the  butt  of  a musket,  and  received  a contused  wound  of  the  scalp,  with  fracture  and  depression  of  the  right  parietal 
bone,  two  and  a half  inches  anterior  to  the  lainbdoidal,  and  two  inches  external  to  the  sagittal  suture.  On  June  1st,  1865,  he 
was  transferred  to'  the  6th  New  Hampshire  A'^olunteers.  Cephalalgia,  upon  exposure  to  the  sun,  was  the  only  troublesome 
symptom.  He  was  mustered  out  of  service  on  July  17th,  1865. 


Fig.  15. — Section  of  craniam  fractured  by  a blow 


CONTUSIONS  AND  LACERATIONS  FROM  FALLING  TREES  OR  BRANCHES. 


45 


Case. — Private  Wni.  Alclntire,  Co.  K,  2d  Dela^val•o  Volunteers,  received  a blow  from  the  butt  of  a pistol  in  a street 
brawl,  at  Wilmington,  Delaware,  November  21st,  1863.  He  was  conveyed  to  Tilton  Hospital,  where  Surgeon  E.  J.  Bailey, 
U.  S.  Army,  who  reports  the  case,  found  that  there  was  a compound  fracture  with  depression  of  the  left  parietal,  causing  grave 
injury  to  the  brain.  Operative  interference  was  deemed  inexpedient,  and  the  patient  died,  November  25th,  1863. 

Case. — Private  Jarvis  Nunn,  Co.  A,  12th  Kentucky  Volunteers,  aged  18  years,  was  admitted  into  the  Old  Hallowell 
branch  of  the  military  general  hospitals  at  Alexandria,  Virginia,  February  1st,  1865,  with  a compound  fracture  of  the  skull  by 
a blow  from  the  muzzle  of  a musket  in  the  hands  of  a comrade.  The  wound  and  fracture  were  situated  a little  above  and  to 
the  outside  of  the  left  frontal  eminence.  There  was  no  disturbance  of  the  mental  faculties,  and  no  especial  derangement  of  the 
physical  functions  at  the  date  of  the  patient’s  admission,  except  slight  constipation,  which  was  overcome  by  a cathartic.  On 
February  4th,  a slight  febrile  movement,  with  a dull  frontal  headache  and  swelling  of  the  left  parotid  gland  was  observed  ; but 
there  was  no  obtuseness  of  intellect.  On  the  following  day,  the  left  side  of  the  face  was  oedematous.  The  eyes,  particularly 
the  left  eye,  being  watery.  The  bowels  were  soluble.  The  wound  had  now  commenced  to  suppurate,  the  discharge  being 
foetid.  Cold  applications  were  made  to  the  head.  On  the  7th,  the  pupils  were  dilated,  and  the  tongue  was  protruded  with 
difficulty.  On  February  8th,  the  patient  was  delirious,  deaf,  unable  to  articulate,  or  to  protrude  his  tongue.  He  could  be  roused 
with  difficulty  from  his  comatose  state.  The  respiration  was  at  44,  and  the  pulse  thready  at  115.  It  was  necessary  to  evacuate 
the  urine  by  a catheter.  On  the  9th,  the  coma  became  profound ; respiration  35 ; pulse  128 ; pupils  widely  dilated,  and 
irresponsive  to  light.  On  February  10th,  the  respiration  was  very  labored,  the  face  and  neck  oedematous;  the  eyelids  firmly 
closed ; but,  when  forcibly  separated,  revealing  the  pupils  dilated  to  almost  the  extent  of  the  iris.  The  urine  and  faces  were 
discharged  involuntarily.  The  surface  was  covered  by  a profuse  sweat.  The  radial  pulse  was  imperceptible.  Death  took 
place  at  three  o’clock  in  the  afternoon  of  February  10th,  1865.  At  the  autopsy  there  was  found,  on  the  left  side  of  the  sinciput, 
a wound  covered  with  yellow  pus,  and  beneath,  a depressed  fracture  of  the  frontal  bone;  and  on  removing  the  skull-cap  a dark, 
coagulum.  The  dura  mater  was  not  inflamed,  but  was  separated  from  the  bone  for  some  distance  around  the  fracture.  The 
anomaly  of  the  right  lung  being  divided  into  two  lobes  only  was  noticed.  This  lung  was  emphysematous,  and  the  bronchial 
mucous  membrane  on  this  side  was  tliickened  and  discolored.  The  tissue  of  the  left  lung  was  crepitant,  but  red  and  slightly 
softened.  The  structure  of  the  spleen  was  softened.  The  case  was  reported  by  Surgeon  E.  Bentley,  U.  S.  V. 

Case. — Private  Joseph  Richards,  Co.  G,  13th  Wisconsin  Volunteers,  aged  52  years,  received,  at  Paint  Rock,  Alabama, 
December  31st,  1864,  a lacerated  wound  of  the  scalp,  with  fracture  of  the  right  parietal,  by  a blow  from  a musket.  He  was 
sent  to  the  hospital  at  Huntsville,  where  he  recovered  from  the  symptoms  of  concussion  at  first  manifested,  and  was  so  far 
convalescent  that,  on  March  31st,  1865,  he  was  transferred  to  Nashville,  Tennessee.  On  April  13th,  he  was  sent  to  Crittenden 
Hospital,  at  Louisville,  Kentucky,  and  thence  to  Swift  Hospital,  at  Prairie  du  Chien,  Wisconsin.  He  recovered  from  his  injury, 
and  was  discharged  from  service,  on  June  30th,  1865. 

Case. — Private  David  Smith,  Co.  K,  113th  Ohio  Volunteers,  aged  23  years,  was  struck  on  the  head  by  a musket,  August 
4th,  1864,  in  a private  quarrel,  and  received  a partial  fracture  of  the  frontal  and  left  parietal  bones.  He  was  received  into 
Adams  Hospital,  at  Memphis,  Tennessee,  August  17th,  1864.  He  recovered  perfectly,  under  expectant  treatment,  and  was 
returned  to  duty  December  10th,  1864.  Surgeon  J.  G.  Keenon,  U.  S.  V.,  reports  the  case. 

Case. — Private  E.  J.  Tripp,  Co.  B,  77th  New  York  Volunteers,  aged  42  years,  in  the  battle  of  Spottsylvania,  May  10th, 
1834,  was  struck  upon  the  head  with  the  butt  of  a musket  which  produced  a severe  contusion  of  the  scalp,  and  a simple  fracture 
of  the  cranium.  These  injuries  seem  to  have  led  to  no  very  serious  derangement  of  the  cerebral  functions  since  the  patient  was 
able  to  return  to  duty  in  October,  and  to  go  into  action  at  the  battle  of  Cedar  Creek,  October  19th,  1864,  when  he  received  a 
flesh  wound  in  his  groin,  for  which  he  was  treated  in  the  field  hospital  of  the  Second  Division  of  the  Sixth  Corps,  and  afterwards 
at  Martinsburg,  Virginia,  whence  he  was  furloughed,  on  February  1st,  1865,  to  report  at  Ira  Harris  Hospital,  Albany,  New 
A'ork,  on  March  12th.  He  was  discharged  from  service  August  7th,  1865,  on  account  of  loss  of  power  in  the  lower  extremities, 
and  impairment  of  the  mental  faculties,  resulting  from  the  injury  of  the  head.  Assistant  Surgeon  James  11.  Armsby,  U.  S.  V., 
rated  his  disability  at  two-thirds. 

The  following  men  received  injuries  of  the  head  from  falling  trees  or  branches  : 

Cases. — The  sev.enteen  men  named  in  this  series  had  contusions  or  lacerations  from  the  above  cause  of  sufficient 
severity  to  require  treatment  in  general  hospitals.  They  were  all  returned  to  duty  after  a few  days  or  weeks  of  treatment,  with 
the  exception  of  a few  who  were  mustered  out  of  service,  or  who  deserted  : 

Private  W.  R.  Bradstreet,  Co.  B,  19th  Maine  Volunteers,  in  action.  Wilderness,  Viiginia,'May  9th,  1864. 

Drummer  D.  Cain,  Co.  H,  20th  Massachusetts  Volunteers,  Brandy  Station,  Virginia,  Jlay  2d,  1864. 

Corporal  G.  Chase,  Co.  H,  4th  Vermont  Volunteers,  March  23d,  1865. 

Private  J.  Cozzens,  14th  Co.  Unattached  Massachusetts  Volunteers,  June  22d,  1864. 

Private  F.  Freeman,  Co.  I,  25th  Wisconsin  Volunteers,  October  10th,  1864. 

Lieutenant  D.  B.  Greeley,  Co.  B,  11th  Iowa  Volunteers,  in  action,  at  Corinth,  Mississippi,  October  4th,  1862. 

Private  T.  Lee,  Co.  H,  20th  Indiana  Volunteers,  January  13th,  1865. 

Private  J.  McIntyre,  Co.  B,  157th  New  York  Volunteers,  Fillifinny,  South  Carolina,  December  0th,  1864. 

Private  J.  McNulty,  Co.  D,  26th  Massachusetts  Vohmtccrs,  August  23d,  1804. 

Private  J.  Maine,  Co.  K,  102d  New  York  Volunteers,  Winchester,  Virginia,  February  22d,  1805. 

Private  .1.  D.  Mansfield,  Co.  B,  10th  Maine  Volunteers,  February  7th,  1865. 

Private  J.  Miles,  Co.  C,  10th  Illinois  Volunteers,  February,  1865. 

Private  G.  11.  Miller,  Co.  B,  2.3d  United  States  Colored  Troops,  Petersburg,  Virginia,  October  27tb,  1864. 


46 


WOUNDS  AND  INJURIES  OE  THE  HEAD, 


Privale  E.  B.  Mitchell,  Co.  K,  15th  Virginia  Volunteers,  Cuinherland,  Maryland,  August  9th,  18G4. 

Pi'ivate  T.  Mount,  Co.  I),  77tli  Illinois  Volunteers,  March  27th,  1865. 

Private  J.  Naylor,  Co.  D,  52d  Illinois  Volunteers,  Pome,  Georgia,  November  1st,  18C4. 

Private  J.  Talbot,  Co.  I,  189th  New  York  Volunteers,  June  1st,  1865. 

C.t.SE.S. — The  fourteen  named  in  this  series  were  discharged  from  service  on  account  of  disabilities,  produced  by  more 
severe  injuries,  from  the  same  cause : 

Private  Edward  Harris,  Co.  H,  120th  New  York  Volunteers,  in  action,  at  Hatcher's  Pun,  Virginia,  February  8th,  1865. 

Private  Peter  Ilollahan,  Co.  G,  73d  New  York  Volunteers,  January  4th,  1865. 

Private  John  W.  Hudson,  Co.  A,  60th  Ohio  Volunteers,  June,  1865. 

Private  John  Larkin,  Co.  D,  88th  New  York  Volunteers,  April,  1865. 

Private  William  Loveland,  Co.  F,  21st  New  York  Cavalry,  March  23d,  1865. 

Corporal  Arthur  McCune,  Co.  I),  7th  Indiana  Volunteers,  January,  1865. 

Private  Patrick  Maloney,  Co.  D,  46th  New  York  Volunteers,  Petersburg,  Virginia,  November  3d,  1864. 

Private  Otto  Nestler,  Co.  B,  7th  New  York  Volunteers,  February  5th,  1865. 

Private  Joseph  W.  Newland,  Co.  G,  80th  New  Yoi’k  Volunteers,  Pochester,  New  York,  November  13th,  1864. 

Private  D.  Pogers,  29th  United  States  Colored  Troops,  Petersburg,  Virginia,  October  25th,  18154. 

Private  Christian  Smith,  Co.  E,  7th  New  Y^ork  Volunteers,  April,  1865. 

Private  Patrick  Sullivan,  Co.  H,  73d  New  York  Volunteers,  May,  1865. 

Private  Stephen  Twelves,  Co.  A,  116th  Pennsylvania  Volunteers,  Chancellorsville,  Virginia,  May  3d,  1863. 

Case. — Lieutenant  John  A.  Porter,  Co.  C,  36th  Illinois  Volunteers,  aged  23  years,  in  the  engagement  at  Pesaca, 
Georgia,  May  15th,  1864,  was  struck  on  the  head  by  a limb  of  a tree  whicli  h.ad  been  cut  off  by  a solid  shot.  He  fell,  senseless, 
the  blood  gushing  from  his  mouth  and  nostrils.  Ho  rimiained  in  an  unconscious  state  for  forty-eight  hours,  tvhen  he  was  con- 
veyed to  the  hospital  at  Chattanooga,  Tennessee.  On  admission,  he  was  speechles.s,  .and  completely  paralyzed  in  the  upper 
extremities  and  in  the  muscles  of  the  head  and  fiice..  On  June  18th,  he  was  transferred  to  Hospital  No.  1,  at  Nashville,  whence 
ho  was  furloughed  on  August  1st,  1864.  At  this  date  “ the  entire  upper  part  of  his  body  was  paralyzed.”  He  remained  at  his 
home  until  November  10th,  when,  having  regained  his  strength,  and,  in  a measure,  the  use  of  his  upper  extremities,  he  returned 
to  the  hospital,  and  thence  to  duty  with  his  regiment  at  Pulaski,  Tennessee.  He  participated  in  the  engagements  at  Spring  Hill 
and  Franklin,  Tennessee,  on  November  29th  and  30th,  hoping  that  the  excitement  would  restore  his  voice.  He  stated  that  the 
sound  of  musketry  and  artillery  firing  “ almost  burst  his  head.”  In  the  earl_y  part  of  December,  1864,  after  violent  and  repeated 
efforts  to  utter  a sound,  a copious  htemorrhage  took  ])lace  from  the  fauces,  and  possibly  the  upper  portion  of  the  larynx,  j)receded 
by  a feeling  of  •'•'cracking  and  bursting,”  and  a sense  of  ‘•  rushing  upward  in  the  head.”  The  hemorrhage  was  followed  by 
complete  return  of  his  voice,  seven  and  one-half  months  after  the  reception  of  the  injury.  During  this  period  tinnitus  aurium 
and  vertigo  existed,  at  times,  to  such  extent  as  to  dejn-ivc  him  of  sight  and  hearting.  He  was  mustered  out  of  service  on  October 
8th,  1835,  with  his  regiment.  On  June  13th,  1866,  he  was  iiensionod,  to  date  from  October,  1885.  The  examining  surgeon  report- 
ing a concussion  of  the  right  hemisphere  of  the  brain,  which  caused  “general  debility,  affecting  the  right  leg,  arm,  and  eye.” 
He  drew  his  pension  at  the  Quincy  Agency,  Illinois,  March  4th,  1869,  and  was  then  reported  as  permanently  disabled.  He 
resided  at  Little  York,  Warren  county,  Illinois,  and  wrote  thence,  in  the  spring  of  1866,  a very  detailed  account  of  his  acci- 
dent, from  which  the  above  abstract  is  partially  compiled.  He  stated  that  he  suff'ered  so  much  from  dizziness,  from  flow  of  blood 
to  the  head,  that  he  supposed  he  would  never  recover  his  health,  and  concluded:  “I  am  unable,  entirely,  for  manual  labor;  yet 
my  wound  was  received  in  a glorious  cause,  and  one  that  I was  willing  to  sacrifice  my  life  for.” 

Ill  the  next  two  cases,  falling  trees  produced  fractures  of  the  cranium  : 

Case. — Private  James  M.  Logan,  Co.  K,  106th  Illinois  Volunteers,  was,  in  .January,  1863,  struck  by  a falling  tree, 
which  fractured  the  cranium  at  the  vertex,  just  ])osterior  to  the  coron.al  suture,  involving  both  tables.  He  was  admitted  to  the 
hospital  at  the  provision.al  encampment  at  Fort  Pickering,  Tennessee,  where  he  remained  under  treatment  until  August  4th,  1863, 
when  he  was  discharged  from  the  service.  On  August  Sth,  1863,  Pension  Examining  Surgeon  Thomas  B.  Henning,  examined 
the  case,  and  reports  that  a portion  of  the  bone  was  lost,  and  that  the  pulsations  of  the  brain  were  visible.  An  abscess  had 
formed  in  the  left  temporal  region,  and  was  then  discharging.  The  man  was  debilit.ated,  and  when  exjwsed  to  the  sun,  or 
exertion,  would  sutt’er  from  vertigo  and  headache. 

Case. — Private  John  Tyler,  Co.  K,  30th  United  States  Colored  Troops,  was  injured,  on  December  27th,  1834,  by  a 
falling  tree,  which  produced  a linear  fracture  of  the  cranium,  extending  from  the  sagittal  suture  obliquely  through  the  left 
parietal  and  temporal  bones  to  the  middle  foramen  lacerum.  He  was  admitted  to  the  field  hospital  of  the  Twenty-fifth  Army 
Corps  on  the  same  day,  in  an  unconscious  condition,  from  which  he  nev'er  rallied.  His  pulse  was  slow  and  weak,  respiration 
stertorous,  and  pupils  insensible  to  light.  But  little  nourishment  could  be  given  in  consequence  of  impaired  deglutition.  With 
the  exception  of  slight  improvement  in  his  pulse,  he  continued  in  the  above  condition  until  his  death,  on  December  31st,  1864. 
At  the  autopsy,  effusion  of  blood  in  the  left  parietal  and  temporal  regions  beneath  the  sc.alp,  and  slight  effusion  internally  upon 
the  dura  mater.  Beneath  the  dura  mater,  on  the  right  side,  a thin  coagulnm  extended  from  the  iqiper  surface  of  the  hemisphere, 
down  into  the  middle  fossa  of  the  cranium,  where  it  was  one-fourth  of  an  inch  in  thickness.  The  convolutions  of  brain  were 
flattened  from  j^ressure.  The  inferior  portion  of  the  right  middle -lobe,  for  a space  of  one  and  a half  inches,  was  much 
ecchymosed  and  softened,  and  blended  with  the  coagula.  There  were  two  ounces  of  serum  in  the  sub-arachnoid  space,  and  in 
the  lateral  ventricles,  which  were  somewhat  distended.  The  left  hemisphere  was  normal;  no  other  organs  were  examined.  Sur- 
geon Norton  Folsom,  45th  United  States  Colored  Troops,  reports  the  case. 


FROM  CLUBS  AND  OTHER  BLUNT  WEAPONS. 


,47 


Kicks,  from  horses  and  mules,  were  a not  infrequent  cause  of  injuries  of  the  head: 

Cases. — The  ten  named  in  tlic  following  list  were  received  into  hospital  on  account  of  contusions  or  lacerations  of  the 
scalp  1)3'  hicks  from  horses  or  mules,  and  were  I'eturned  to  duU  after  a brief  interval : 

Private  William  Brown,  Co.  G,  '21st  Now  York  Cavahy,  November  1st,  1864. 

Teamster  E.  Brovden,  Quartermaster's  Department,  January  loth,  1865. 

Private  Alonzo  Cole,  Co.  G,  Cth  Pennsylvania  Reserves,  Juno  30th,  1863. 

Private  William  Deal,  Co.  I,  7th  Illinois  Cavahy,  July  28th,  1864. 

Sergeant  E.  S.  Dow,  Co.  C,  39th  Massachusetts  Volunteers,  October  15th,  1864. 

Bugler  Jacob  Horn,  Co.  K,  5th  United  States  Artillciy,  Buzzard  Boost,  Georgia,  May  9th,  1864. 

Private  Joshua  Lewis,  Co.  A,  5th  Michigan  Volunteers,  July,  1863.  Deserted,  September  3d,  1863. 

Private  Andrew  Peters,  Co.  G,  3d  LTiited  States  Colored  Troops,  St.  Louis,  December  4th,  1862. 

Private  Edward  T.  Simmons,  Co.  G,  1st  Delaware  Volunteers,  May,  1864. 

Private  Calvin  Starzman,  Co.  H,  12th  Illinois  Cavalry,  February  21st,  1865. 

Cases.- — The  three  following  are  reporled  as  discharged  from  service  on  account  of  severe  injuries  of  the  head,  without 
fracture,  from  kicks: 

Private  John  IV.  Forckers,  Co.  A,  3d  Maryland  Volunteers,  March,  1865. 

Pi’ivate  Andrew  Kerr,  Co.  G,  1st  Michigan  Cavalry,  November  25th,  1863. 

Private  Philip  Seton,  Co.  G,  169th  New  York  Volunteers,  July  25th,  1865. 

Cases. — The  four  following  are  reported  as  having  received  simple  fractures  of  the  skull  from  kicks;  but  the  accidents 
were  not  followed  by  any'  very  grave  symptoms,  since  the  men  w'ere  returned  to  duty,  or  discharged,  as  well : 

Private  IVilliam  N.  Elwood,  Co.  I,  29th  Pennsylvania  Volunteers.  Returned  to  duty,  Juno  22d,  1865. 

Private  Peter  Leiser,  Co.  C,  G7th  Ohio  Volunteers.  Discharged,  October  1st,  1863. 

Private  George  Styles,  Co.  B,  20th  New  York  Cavahy.  Returned  to  duty,  July  12th,  1865. 

Private  John  L.  Weigel,  Co.  I,  8th  Ohio  Cavalry.  Returned  to  duty,  October  29th,  1864. 

Case. — Private  George  A.  Teasdale,  Co.  G,  36th  New  York  Volunteers,  received  a severe  contused  wound  of  the  scalji, 
with  fracture  of  the  left  parietal  bone,  by  a blow  from  a horse’s  foot,  in  a cavahy  charge,  at  the  first  battle  of  Bull  Run,  July 
21st,  1831.  He  was  made  a i)risoner,  and  remained  in  confinement  until  the  termination  of  the  war,  in  the  spring  of  1865.  He 
was  then  I’eleased,  and  was  examined  at  Washington  for  admission  into  the  44th  Regiment  Veteran  Reserve  Corps.  He  was 
suffering  from  very  imperfect  vision,  resulting  from  the  injury  he  had  received.  • The  late  Assistant  Surgeon  W.  A.  Bradley,  U. 
S.  Army',  reported  the  case. 

Case. — Abraham,  a colored  teamster  of  the  Quartermaster’s  train  of  the  20th  Arm_y  Corps,  received,  September  14th, 
1883,  near  Stevenson,  Alabama,  a kick  from  a mule.  The  blow  was  found  to  have  produced  a depressed  fracture  of  the  left 
temporal  bone.  Surgeon  D.  J.  McKibben,  U.  S.  V.,  who  records  the  case,  states  that  the  patient  died  on  September  17th,  1863, 
from  compression  of  the  brain. 

These  cases  comprise  all  the  injuries  of  the  head  from  kicks  that  have  been  reported 
by  name,  with  the  exception  of  one,  which  will  be  cited  among  the  cases  of  trephining,  at 
the  conclusion  of  this  section. 

Injuries  of  the  head,  requiring  treatment  in  hospitals,  were  frequently  produced  in 
private  quarrels,  or  affrays,  by  blows  from  clubs  and  other  blunt  weapons ; 

Cases. — The  forty’-one  named  in  the  following  list  received  contusions  or  lacerations  of  the  scalp  from  blows  from 
clubs,  &c.,  and  were  returned  to  duty  after  a short  period  of  treatment  in  general  hosjiital; 

Private  Samuel  Biland,  Co.  L,  1st  Missouri  Artillery',  November  2Gth,  1833. 

Private  Abraham  Bow'en,  Co.  I,  IGth  Kentucky  Volunteers,  June  4th,  1864. 

Private  B.  F.  Boswell,  Co.  D,  1st  District  of  Columbia  Volunteers,  October  2d,  1864.  Deserted. 

Sergeant  Win.  Campbell,  Co.  E,  33d  Iowa  Volunteers,  March  31st,  1885. 

Private  F.  E.  Conn,  Co.  F,  1st  United  States  Artillery,  January'  5th,  1865. 

Private  S.  F.  Conway,  Co.  D,  1st  Virginia  Cavahy,  December  23d,  1864. 

Private  C.  C.  Daggart,  Veteran  Reserve  Corps,  December  13th,  1834. 

Private  John  Dowler,  Co.  G,  2d  District  of  Columbia  Volunteers,  October  10th,  1883. 

Private  S.  W.  Duvall,  Co.  D,  12th  Kentucky  Volunteei'S,  January,  1835. 

Private  James  English,  Co.  K,  3d  Massachusetts  Heavy  Artillery,  January  9th,  1865. 

Private  John  Fitzgibbons,  Co.  B,  13th  New  York  Artillery,  December,  1863. 

Thomas  Geary,  Quartermaster’s  Department,  July'  15,  1864. 

AV.  AV.  Hopkins,  Recruit,  5th  Michigan  Volunteers,  April  26th,  1865. 

Thomas  Jordan,  employ'6.  Quartermaster's  Department,  Alarch  31st,  1865. 

Private  AA’illiam  Jolmson,  10th  New  Ilamp.shire  Ahdunteer.s,  December,  1883.  Deserted. 

Sergeant  AA'.  Leroy,  Co.  G,  4th  United  States  Artillery,  October  25th,  1864. 

Private  Edward  Lowry,  Co.  E,  1st  Veteran  Reserve  Corps,  April  21st,  1834. 


48 


WOUNDS  AND  INJUETES  OP  THE  HEAD, 


Private  David  McBride,  Co.  A,  18tli  Iowa  Volunteers,  October  ITtli,  1863. 

Private  Michael  McCabe,  Co.  11,  4th  Wisconsin  Volunteer.s,  January  2'2d,  186.6. 

Private  Jerry  McCarty,  Co.  C,  8th  Illinois  Cavalry,  February  1st,  1864. 

Private  Daniel  McLaughlin,  Co.  E,  McClellan  Guard,  June  ’J/th,  1863.  Deserted. 

Private  Patrick  klarlin,  Co.  E,  88th  New  York  Volunteers,  May  24th,  1865. 

Sergeant  L.  iSIartindale,  Co.  G,  2d  Maine  Cavalry,  August  13th,  1865. 

Private  John  Moony,  Co.  II,  5th  Connecticut  Volunteers,  November  29th,  1863. 

Private  John  !Moore,  Co.  D,  First  Battalion  California  Volunteers,  December  12th,  1863. 

Private  Kenneth  Newton,  Co.  K,  38th  Illinois  Volunteers,  December  10th,  1864. 

Private  Edward  Ormsby,  Co.  1, 145th  New  Y’'ork  Volunteers,  November,  1863. 

Corporal  Daniel  Parker,  Co.  D,  73d  New  York  Volunteers,  February  7th,  1863. 

Sergeant  J.  D.  Place,  Co.  F,  75th  Illinois  Volunteers,  December  11th,  1864. 

Corporal  Jacob  Paul,  Co.  E,  16th  Illinois  Volunteers,  December  14th,  1864. 

Private  W.  E.  Redding,  Co.  G,  2d  Tennessee  Mounted  Infantry,  January  20th,  1865. 

Private  M.  J.  Rico,  Co.  I,  110th  Pennsylvania  Volunteers,  May,  1863. 

Private  Peter  Smith,  Co.  C,  1st  Missouri  Artillery,  December  22d,  1864. 

Private  James  E.  Shay,  Co.  F,  22d  Illinois  Volunteers,  May  24th,  1864. 

Private  John  Scott,  2d  Indiana  Battery,  January  27th,  1865. 

Private  Jacob  Smith,  110th  Ohio  Volunteers,  October  4th,  1864. 

Private  Silas  M.  Smith,  Co.  C,  15th  Illinois  Cavalry,  November  14th,  1863. 

Private  Charles  Trucksiss,  Co.  C,  10th  Veteran  Reserve  Corps,  September  11th,  1864. 

Private  Edward  Woodruff,  Ordnance  Corps,  January  1st,  1865. 

Private  Francis  Wirtz,  Co.  L,  1st  Missouri  Artillery,  November  20th,  1863. 

Private  John  Williams,  Ordnance  Corps,  January  1st,  1865. 

Cases. — The  seven  following  men  received  injuries  of  the  head  from  blows,  which  were  followed  by  grave  complications: 

Private  G.  II.  Cutting,  Co.  D,  8th  Delaware  Volunteers.  Blow  from  spade.  May,  1865.  Otorrhoea  followed.  Mustered 
out  July  22d,  1865. 

Private  Joseph  Edwards,  Co.  A,  28th  Illinois  Volunteers.  Laceration  of  forehead  by  a billet  of  wood.  May,  1864. 
Severe  erysipelas.  Duty,  June  30th,  1864. 

Private  Henry  Loughwell,  Co.  H,  15th  Ohio  Volunteers.  Contusion  of  frontal  region  by  a billet  of  wood,  November 
25th,  1864.  Discharged,  June  10th,  1865. 

Private  Michael  Miller,  27th  Co.,  7th  Regiment,  V.  R.  C.,  aged  52.  Severe  contusion  of  scalp  and  concussion  of  the 
brain  from  a blow  by  a whip  handle.  May  14th,  1865.  Discharged,  November  14th,  1865. 

Private  A.  Robinson,  6th  Michigan  Cavalry,  aged  24.  Laceration  of  forehead  by  a slung  shot.  May  23d,  1865.  Dis- 
charged, July  3d,  1865. 

Corporal  William  W'^arner,  Co.  F,  7th  Michigan  Volunteers,  aged  24.  Partial  paralysis  of  the  left  arm  from  a blow  from 
a fence  rail,  in  action,  Gettysburg,  July  3d,  1833.  Transferred  to  2d  Co.,  1st  Battalion,  V.  R.  C.,  September  4th,  1863. 

Private  James  Whissen,  Co.  F,  13th  Ohio  Cavalry,  aged  21,  was  struck  on  the  head  with  a pick-axe,  February  16th, 
1834.  October  1st  he  was  sent  to  a hospital  at  Alexandria,  with  violent  epileptic  convulsions.  These  continued  to  recur,  and 
he  was  discharged  from  service  March  18th,  1865. 

The  fourteen  following  abstracts  afford  examples  of  fractures  of  the  cranium  by  blows 
from  various  blunt  weapons : 

Case. — Seaman  James  R.  Connor,  U.  S.  Steamer  Arietta,  aged  19  years,  was  admitted  to  the  Post  Hospital  at  Beaufort^ 
North  Carolina,  October  31st,  1834,  on  account  of  a blow  upon  his  head  by  an  iron  stanchion  on  the  previous  day.  The  blow 
had  caused  a fracture  of  the  vault  of  the  cranium.  The  patient  died  November  1st,  1864.  Surgeon  N.  P.  Rice,  U.  S.  V.,  reports 
the  case,  without  particulars  of  the  treatment. 

Case. — Sergeant  J.  G.  Garrabrant,  Co.  C,  39th  New  Jersey  Volunteers,  aged  39  years,  was  admitted  to  the  Ward  Hos- 
pital, Newark,  New  Jersey,  on  January  8th,  1865,  in  an  insensible  condition,  with  a fracture  of  the  cranium  and  compression 
of  the  brain,  resulting  from  a blow  received  in  a street  affray  a few  hours  previously.  He  never  regained  consciousness,  and 
died  on  January  12th,  1865.  At  the  autopsy,  the  arachnoid  membrane  was  highly  congested,  and  the  smallest  vessels  were 
visible.  Upon  the  anterior  portion  of  the  right  lobe  of  the  cerebrum,  between  the  dura  mater  and  arachnoid,  there  was  a clot  of 
blood  several  inches  in  diameter.  The  other  portion  of  the  brain  was  normal.  The  internal  table  of  tlie  occipital  was  found  to 
be  fractured  in  two  places,  extending  from  the  torcular  Herophili  to  the  foramen  magnum.  The  case  is  reported  by  the  late 
Assistant  Surgeon  J.  Theodore  Calhoun,  U.  S.  A. 

Case. — Private  John  W.  Hogener,  Co.  E,  120th  Ohio  Volunteers,  received,  on  board  a transport  steamer,  a blow  from  an 
iron  bolt,  which  caused  a fracture  of  the  frontal  bone.  He  was  admitted  to  Hospital  No.  11,  at  New  Albany,  Indiana,  on 
November  18th,  1833,  and  died,  on  November  21st,  1863,  from  compression  of  the  brain.  Acting  Assistant  Surgeon  A.  M. 
Clapp  reports  the  case. 


Case. — David  H , U.  S.  ^Marine  Corps,  aged  35  years,  was  admitted  to  the  post  hospital  at  Vicksburg,  Missis- 

sippi, February  24th,  1836,  with  all  the  toes  frost-bitten.  This  seemed  to  constitute  the  only  trouble,  with  the  exception  of  a 
slight  headache,  which  was  attributed  to  tlie  constipated  condition  of  his  bowels  for  three  or  four  days  prior  to  admission.  An 


FRACTURES  FROM  VARIOUS  BLUNT  WEAPONS. 


49 


aperient  was  ordered,  witli  simple  dressings  to  the  feet.  Until  February  27tli,  there  was  a gradual  improvement  in  the  local 
lesion,  but  the  dull,  heavy  pain  in  the  head  continued,  with  poor  appetite,  and  costive  bowels.  On  February  28th,  the  patient 
was  found  comatose,  and  for  the  first  time  there  was  noticed  a .slight  par.alysis  of  the  right  side.  An  incised  wound  of  the  scalp, 
an  inch  or  more  in  length,  was  discovered  in  front  of  the  left  parietal  protu- 
berance. A crucial  incision  was  made,  and  the  flaps  were  reflected,  with  a 
view  of  trephining  in  the  event  of  a fracture  of  the  skull  witli  depression,  but 
as  no  lesion  of  the  skull  could  be  detected,  the  incision  was  closed.  No  other 
injury  of  the  scalp  was  found  after  careful  examination.  The  coma  and 
paralysis  were  ascribed  to  apoplectic  effusion.  The  patient  expired  at  three 
o’clock  on  the  morning  of  the  following  day.  Tlu;  antecedent  history  of  this 
patient  could  not  be  ascertained,  and  Acting  Assistant  Surgeon  G.  F.  Eock- 
• well,  who  attended  and  reported  the  case,  rem.arks  that  lie  was  restricted  to 
inferences  from  the  clinical  history  and  what  the  autopsy  revealed.  On  re- 
moving the  calvarium  he  found  a small  coaguhnn,  but  its  location  was  not 
under  the  site  of  the  external  wound,  but  a little  back  of  the  coronal  suture, 
on  the  left  side,  where  the  internal  table  was  slightly  depressed.  But  the 
chief  difficulty  was  on  the  right  side.  "When  the  skull-cap  was  lifted  between 
two  and  three  ounces  of  blood  escaped,  still  leaving  a coagulum  covering  the 
whole  henisphere.  There  was  a semicircular  fissure  of  the  external  table 
just  in  front  of  the  left  parietal  protuberance,  and  stellate  fissuring,  with  slight  depression  of  the  inner  table,  including  a surface 
one  inch  in  diameter.  From  this  point  a fissure,  involving  both  tables,  extended  to  the  centre  of  the  left  branch  of  the  lambdoidal 
suture.  There  were  no  traces  of  attempt  at  repair.  There  must  have  been  a rupture  of  some  of  the  larger  vessels  to  cause  such 
profuse  extravasation  of  blood.  There  was  no  external  wound  of  the  scalp  over  the  fracture  of  the  left  parietal.  The  specimen 
(Fig.  16)  was  contributed  to  the  Army  Medical  Museum  by  Dr.  Rockwell,  who  believed  that  the  weapon  employed  must  have 
been  a billet  of  wood,  or  something  of  that  nature. 


Fig.  16. — Fracture  of  the  left  parietal  by  a blow  from  a 
blunt  weapon. — Spec.  2876,  Sect.  I,  A.  M.  M. 


Case. — Private  William  Horan,  U.  S.  Marine  Corps,  aged  43  years,  was  admitted  to  Armory  Square  Hospital,  Washing- 
ton, May  14th,  1865,  with  a bruise  of  the  left  side  of  the  forehead,  received  in  a street  fight  a few  hours  previously.  The  injury 
was  regarded  as  a simple  contusion  of  the  scalp,  and  was  treated  as  such.  On  May  20th,  the  patient  suddenly  because  comatose, 
and  death  took  place  on  the  following  day.  May  21st,  1865.  The  post  mortem  examination  revealed  a slight  fissui’e  of  the  outer, 
and  a considerable  depression  of  the  inner  table.  An  abscess  of  considerable  size  extended  for  some  distance  beneath  the  frontal 
bone.  Surgeon  D.  W.  Bliss,  U.  S.  V.,  reports  the  case. 


Case. — Corporal  Michael  Lynch,  Co.  H,  45th  New  York  Volunteers,  aged  33  years,  was  struck  with  a club  July  1st, 
1864.  He  was  admitted  into  the  hospital  of  the  2d  Division,  2d  Corps  on  the  same  day,  and  was  transferred  to  Stanton  Hospital, 
in  Washington,  on  July  4th.  Surgeon  John  A.  Lidell,  U.  S.  V.,  who  reports  the  case,  found  that  there  was  a comminuted 
fracture  of  the  right  temporal  bone.  Cerebral  inflammation  supervened,  and  the  patient  died  July  14th,  1864. 


Case. — Private  E.  C.  M , Co.  D,  28th  Alabama  Infantry,  a prisoner  of 

war  at  Rock  Island,  Illinois,  was  killed  by  a fellow  prisoner,  August  14th,  1864,  by 
a blow  on  the  right  temporal  region  with  a board.  Death  was  almost  instantaneous. 

At  the  autopsy,  it  was  found  that  the  skull  was  remarkably  thin,  and  that  a nearly 
vertical  fissure  extended  through  the  squamous  portion  of  the  temporal,  the  great  wing 
of  the  sphenoid,  and  nearly  to  the  median  line  of  the  frontal  bone,  bifurcating  an  inch 
from  its  termination.  The  right  orbital  plate  of  the  frontal,  which  was  extremely 
thin,  was  fissured  either  by  contra  conp,  or  by  the  impulse  communicated  through  the 
cerebral  substance.  There  was  diastasis  of  the  squamo-sphenoid  suture.  Large 
branches  of  the  meningeal  arteries  were  ruptured,  and  death  resulted,  probably,  from 
Inemorrhage  in  the  cavity  of  the  cranium.  But  the  condition  of  the  brain  and  its 
membranes,  and  the  extent  of  the  intracranial  bleeding,  were  not  reported.  The  speci- 
men is  delineated  in  the  adjacent  wood-cut,  (Fig.  17.)  By  an  inadvertence  of  the  en- 
graver in  copying  the  photograph,  the  specimen  appears  reversed,  and  represents  a 

fracture  of  the  left  instead  of  the  right  side.  Fig.  17.— Fract  ure  of  the  temporal  by  a blow 

from  a board. — Spec.  2862,  Sect.  I,  A.  M.  M. 


Case. — Private  J.  M.  Munroe,  Co.  E,  26th  Massachusetts  Volunteers,  was  admitted  to  St.  James  Hospital,  New  Orleans, 
February  23d,  1863,  with  a fracture  of  the  skull,  produced  by  a blow.  He  recovered,  under  expectant  treatment,  and  was 
discharged  from  service  on  May  12th,  1863.  The  case  appears  on  the  report  of  Assistant  Surgeon  J.  Homans,  U.  S.  A. 


Case. — Private  John  Murray,  Co.  D,  6th  Illinois  Cavalry,  aged  23  years,  was  struck  on  the  head  by  a slung  shot,  in  the 
streets  of  Memphis,  Tennessee,  April  7th,  1864.  He  was  admitted,  on  the  same  day,  to  Adams  Hospital,  and  Ids  case  is  recorded 
on  the  register  of  that  hospital  as  a contused  wound  of  the  scalp.  He  was  furloughed  on  July  8th,  and  admitted  to  Knight 
Hospital,  New  Haven,  Connecticut,  on  August  24th.  He  was  furloughed  from  this  hospital  on  September  9th,  and  re-admitted 
as  unable  to  travel,  two  days  subsequently.  Ho  was  again  furloughed  on  November  2d,  1864,  and  ro-admitted  from  furlough 
November  15th,  and,  according  to  the  monthly  report  of  Surgeon  P.  A.  Jewett,  U.  S.  V.,  in  charge  of  Knight  Hospital,  was 
discharged  from  service  on  November  16th,  1864,  on  account  of  total  jihysical  disability,  resulting  from  fracture  of  the  skull. 
The  certificate  states  that  the  man  was  unfit  for  duty  in  the  Veteran  Reserve  Corps. 


7 


50 


WOUNDS  AND  INJURIES  OF  THE  HEAD: 


Case. — Private  Francis  ]\I.  Pettit,  Co.  G,  12tli  Kansas  Volunteers,  is  reported  by  Surgeon  C.  R.  Stuckslager,  12tli  Kansas 
Volunteers,  as  having  received  a compound  fracture  of  the  left  parietal  bone,  a little  in  advance  of  the  protuberance,  by  a blow 
from  the  handle  of  a table  foi-k.  There  was  depression  of  bone,  with  injury  of  the  membranes  of  the  brain,  and  the  patient 
died  a'few  days  after  the  injury.  May  7th,  18C3.  A post  mortem,  examination  was  made,  which  disclosed  indications  of  softening 
of  the  brain  and  meningitis. 

Case. — Private  Michael  Smith,  Co.  F,  7th  United  States  Infantrj',  arrived  at  Fort  Bascora,  New  Mexico,  August  10th, 
1863,  and,  on  August  20th,  he  applied  to  Acting  Assistant  Surgeon  S.  Rankin,  to  have  his  head  dressed.  Dr.  Rankin  found  a 
fistulous  opening  on  the  right  frontal  protuberance.  The  man  related  that,  six  months  previously,  at  Fort  Union,  he  had 
received,  in  an  afl'ray,  a blow  which  had  broken  his  head,  and  that  a little  matter  had  flowed  from  the  wound  ever  since.  A 
simple  dressing  was  applied,  and  the  man  did  not  report  again  on  the  sick  list  until  September,  1863,  when,  after  getting  on  a 
frolic,  he  was  attacked  with  grave  symptoms  of  cerebral  disorder,  and  died,  from  cerebritis,  September  20th,  1863.  At  the 
post  mortem  examination,  Dr.  Rankin  found  a piece  of  bone  two  inches  long  and  one  inch  wide,  consisting  of  the  inner  table, 
altogether  detached,  lying  pressing  upon  the  brain,  which  had  undoubtedly  been  in  the  same  situation  the  previous  spring  when 
he  received  the  injury. 

Case. — Alfred  Sypole,  Farrier,  Co.  M,  4th  West  Virginia  Cavalry,  on  February  26th,  1864,  was  knocked  down  by  a blow 
from  an  axe,  while  making  a furious  assault  upon  a non-commissioned  officer  of  his  company.  For  several  hours  afterwards  he 
was  insensible,  and  then  partially  recovered;  but  remained  moody  and  stupid.  On  March  2d,  he  was  admitted  into  the  post 
hospital  at  New  Creek,  West  Virginia,  under  the  care  of  Surgeon  S.  P.  Smith,  2nd  Potomac  H.  B.,  who  reports  the  case.  Dr.  Smith 
found  a small  wound,  suppurating  freely,  over  the  left  temporal  bone,  and  a fracture  without  depression.  The  mental  faculties  were 
confused.  The  patient  complained  of  severe  pain  on  the  opposite  side  of  the  head.  An  emollient  poultice  was  applied  to  the 
seat  of  injury,  and  a brisk  cathartic  was  ordered,  which  promptly  relieved  the  pain  in  the  head,  and  was  followed  by  a restora- 
tion of  clearness  of  intellect.  At  this  time  the  patient  seemed  to  convalesce  rapidly.  In  two  daj's,  he  walked  about  and  enjoyed 
himself,  entering  freely  into  general  conversation,  and  expressing  himself  with  ease  and  clearness.  On  the  evening  of  the  16th, 
he  became  sullen  and  depressed  in  spirits,  and  had  a recurrence  of  severe  pain  on  the  opposite  side  of  the  head  from  the  wound. 
On  the  following  morning,  the  patient  had  convulsions,  and  death  took  place  in  a short  time,  March  17th,  1864.  On  a post 
mortem  examination,  it  Avas  found  that  there  was  a fracture  of  the  temporal  bone,  triangular  in  shape,  an  inch  and  a half  in 
length,  and  about  one  inch  in  Avidth  at  the  base.  The  dura  mater  Avas  not  injured,  and  the  bone  Avas  not  depressed.  In  the 
middle  lobe  of  the  left  hemisphere  there  Avas  an  abscess  near  the  fracture  containing  an  ounce  and  a half  of  pus.  No  abnormal 
appearances  could  be  detected  on  the  opposite  side  of  the  brain,  Avhere  the  intense  pain  had  been  experienced.  There  Avas  but 
little  injection,  anywhere,  of  the  pia  mater. 

Case. — Private  James  Wiggins,  Co.  C,  1st  U.  S.  Cavalry,  was  admitted  to  the  Balfour  Hospital,  Portsmouth,  Virginia, 
April  pith,  1865,  Avith  compression  of  the  brain,  resulting  from  a fracture  of  the  frontal  bone  by  a bloAV  over  the  left  superciliary 
ridge,  received  a feAV  hours  before  admission.  The  roof  of  the  orbit  Avas  depressed,  as  Avell  as  the  loAver  part  of  the  skull,  over 
the  anterior  portion  of  the  left  hemisphere.  An  operation  Avas  deemed  inexpedient.  Cold  applications  to  the  head,  blisters  to 
the  nape  of  the  neck,  and  stimulants,  constituted  the  treatment.  Assistant  Surgeon  J.  H.  Frantz,  U.  S.  A.,  reported  the  case. 

Case. — Private  J.  B.  WUlinson,  Co.  B,  46th  Virginia  Regiment,  Avas  struck  on  the  head  by  an  iron  bar,  used  in  starting 
a steam  engine,  and  had  a fracture  of  the  right  parietal  bone.  He  Avas  treated  at  the  Farmville  Hospital,  Virginia,  on  the 
expectant  plan.  Epileptic  convulsions  ensued,  and  the  patient  Avas  discharged  from  service,  permanently  disabled,  on  Septem- 
ber 23d,  1864.  Surgeon  H.  D.  Taliaferro,  C.  S.  A.,  records  the  case  on  his  monthly  report. 

The  following  are  examples  of  contused  and  lacerated  wounds  of  the  scalp  produced 
by  stones,  bricks,  and  similar  missiles  : 

Cases. — An  officer  and  eight  men  of  the  6th  Massachusetts  Militia  received  contusions  or  lacerations  of  the  scalp,  by 
paving  stones,  bricks,  etc.,  on  the  occasion  of  the  memorable  attack  upon  that  Regiment  by  insiu-gents  in  Baltimore,  on  April 
19th,  1861 ; 

Privates  G.  Alexander,  C.  H.  Chandler,  and  Sergeant  W.  H.  Lamson,  of  Co.  D ; Sergeant  G.  G.  Durrell,  Co.  D ; Lieut. 
James  F.  RoAve,  of  Co.  L;  Privates  S.  Flanders,  J.  Porter,  J.  Pennell,  and  Charles  B.  Stinson,  of  Co.  C.  These  patients  Avere 
conveyed,  by  rail,  to  Washington,  and  were  treated  in  the  E Street  Infirmary,  under  charge  of  Surgeon  Norman  Smith,  6th 
Massachusetts  Volunteers,  and  the  late  Dr.  J.  Sim  Smith,  Assistant  Surgeon,  U.  S.  A. 

Cases. — The  tAventy-tAVo  men  named  below  are  reported  as  having  been  treated  in  vailous  hospitals  for  contused  or 
lacerated  scalp  Avounds,  produced  by  bricks  or  stones,  and  returned  to  duty,  after  a comparatively  brief  period  of  treatment : 

Private  James  Armstrong,  Co.  K,  7th  Pennsylvania  Reserves,  October  4th,  1863. 

Private  Anthony  Babano,  Co.  C,  46th  Indiana  Volunteers,  April  16th,  1865. 

Private  Wm.  BoAvles,  Co.  A,  1st  Michigan  C.  T.,  September  17th,  1864. 

Corporal  F.  B.  Cox,  I,  22d  Pennsylvania  Cavalry,  May  30th,  1865. 

Sergeant  F.  A.  Cullin,  D,  22d  Veteran  Reserve  Corps,  July  9th,  1864. 

Private  J.  R.  Davenport,  H,  84th  NeAv  York  Volunteers,  July  1st,  1863. 

Private  E.  Enghausen,  K,  1st  Ncav  York  Light  Artillery,  June  1st,  1865. 

Private  J.  Ginn,  C,  36th  Indiana  Volunteers,  November  27th,  1863. 

Private  F.  P.  Green,  D,  205th  Pennsylvania  Volunteers,  May  26th,  1865. 

Private  G.  W.  Hamilton,  K,  8Gth  Illinois  Volunteers,  July  1st,  1864. 

Private  R.  D.  Herron,  A,  23d  Michigan  Volunteers,  December  22d,  1864. 


FROM  UNSPECIFIED  CAUSES  OTHER  THAN  GUNSHOT. 


51 


Private  B.  Hockwortli,  I,  1st  West  Virginia  Infantry,  April  18th,  18C4. 

Private  T.  Kelley,  A,  14th  Tennessee  Cavalry,  December  20th,  18G4. 

Private  J.  Kennedy,  L,  1st  Missouri  Engineers,  August  16th,  1864. 

Private  W.  Locke,  G,  23d  Veteran  Reserve  Corps,  March  18th,  1865. 

Private  M.  Lope,  A,  22d  Ohio  Volunteers,  June  29th,  1865. 

Private  T.  Miniian,  Ordnance  Corps,  March  10th,  1865. 

Private  A.  Newhauser,  G,  1st  Illinois  Artillery,  April  29th,  1865. 

Private  P.  Rhodes,  D,  18th  Iowa  Volunteers,  October  1st,  1863. 

Private  W.  Sallee,  Ordnance  Corps,  January,  1865. 

Corporal  J.  W.  Smithers,  B,  27th  Massachusetts  Volunteers,  May  11th,  1864. 

Private  C.  H.  Winn,  I,  35th  Illinois  Volunteers,  May,  1864. 

The  three  following  are  cases  of  fractures  of  the  skull  from  the  causes  last  mentioned ; 

Case. — Private  John  Aldrich,  Co.  K,  176th  New  York  Volunteers,  aged  29  years,  in  an  attack  of  delirium,  struck  his 
head  with  a stone,  on  July  25th,  1864,  producing  a compound  fracture  of  the  cranium.  He  was  admitted  to  the  University 
Hospital,  at  New  Orleans,  Louisiana,  on  the  following  day.  An  abscess  formed  and  the  patient  died,  on  August  15th,  1864, 
from  inflammation  of  the  brain.  Surgeon  Samuel  Kneeland,  U.  S.  V.,  reports  the  case. 

Case. — Corporal  Adam  Gaslein,  Co.  B,  6th  Pennsylvania  Cavalry,  had  a simple  fracture  of  the  vault  of  the  cranium,  in 
April,  1863,  caused  by  a blow  from  a stone.  He  was  admitted  to  Columbian  Hospital,  Washington,  on  April  4th,  1863.  He 
had  a very  protracted  convalescence,  and  finally  recovered  perfectly,  and  returned  to  duty,  April  12th,  1864.  Surgeon  T.  E. 
Crosby,  U.  S.  V.,  reports  the  case. 

Case. — Private  Daniel  T.  Swartz,  7th  West  Virginia  Cavalry,  aged  35  years,  had  a laceration  of  the  forehead,  and  a 
compound  fracture  of  the  left  side  of  the  frontal  bone,  from  a blow  by  a brick-bat,  on  April  1st,  1865.  He  was  admitted  to 
Washington  Hospital,  Memphis,  Tennessee,  where  the  htemorrhage,  which  had  been  very  profuse,  was  arrested,  and  the  wound 
dressed  simply,  there  being  no  indications  of  depression  of  bone  or  of  intracranial  extravasation  of  blood.  On  May  15th,  the 
patient  was  transferred  to  Gayoso  Hospital.  On  May  24th,  he  was  considered  cured,  and  returned  to  duty.  Surgeon  Daniel 
Stahl,  U.  S.  V.,  reports  the  case. 

Unspecified  Causes. — Many  men  also  were  received  into  general  hospital  for  con- 
tusions or  lacerations  of  the  scalp,  or  for  concussion  of  the  brain,  or  fracture  of  the  skull, 
and  were  reported  by  name,  but  without  any  indication  of  the  precise  cause  of  their 
injuries: 

Cases. — The  one  hundred  and  twenty-one  men  enumerated  in  the  following  list  recovered,  and  were  returned  to  duty 
or  discharged  fi-om  service  at  the  conclusion  of  the  war  after  a brief  period  of  treatment  for  such  injuries  as  are  mentioned  above : 

Private  H.  Ackerman,  K,  18th  Wisconsin  Volunteers,  Nashville,  Tennessee,  January  11th,  1865. 

Private  W.  H.  Alexander,  C,  39th  New  Jersey  Volunteers,  Camp  Frelinghuysen,  New  Jersey,  October  24th,  1864. 

Private  J.  Anderson,  G,  4th  Tennessee  Cavalry,  Vicksburg,  Mississippi,  February  20th,  1865. 

Bugler  G.  W.  Ashland,  B,  12th  Pennsylvania  Volunteers,  Sandy  Hook,  Maryland,  May  12th,  1864. 

Teamster  C.  Barachi,  Indian  Expedition,  Fort  Eidgely,  Minnesota,  May  31st,  1864. 

Private  T.  Barber,  H,  118th  New  York  Volunteers,  Petersburg,  Virginia,  June  2d,  1865. 

Private  D.  Bon,  C,  2d  Missouri  Artillery,  Cape  Girardeau,  Missouri,  December  20th,  1863. 

Private  B.  S.  Boorman,  G,  41st  Ohio  Volunteers,  Nashville,  Tennessee,  December  13th,  1864. 

Private  W.  J.  Bro>vn,  E,  14th  Illinois  Cavalry,  Nashville,  Tennessee,  February  9th,  1865. 

B.  Busa,  Government  Employd,  Washington,  D.  C.,  February  17th,  1864. 

Recruit  J.  Cain,  Merrill’s  Horse,  St.  Louis,  Missouri,  November  8th,  1864. 

Lieutenant  H.  D.  Call,  A,  76th  New  York  Volunteers,  Georgetown,  D.  C.,  January  9th,  1864. 

Private  J.  Cantrell,  Schofield  Hussars,  St.  Louis,  Missouri,  December  8th,  1883. 

Private  W.  C.  Carroll,  B,  4th  Tennessee  Volunteers,  Louisville,  Kentucky,  March  30th,  1863. 

Private  M.  Casey,  L,  1st  Illinois  Artillery,  New  Creek,  West  Virginia,  November  10th,  1864. 

Private  A.  E.  Chapman,  C,  32d  Massachusetts  Volunteers,  Washington,  D.  C.,  May  23d,  1865. 

Private  J.  Chase,  G,  4th  Michigan  Cavalry,  Nashville,  Tennessee,  March  6th,  1864.  Deserted. 

Private  J.  Christie,  A,  18th  New  York  Cavalry,  New  Orleans,  Louisiana,  April  26th,  1865. 

Private  IF.  M.  Clare,  G,  20th  Missouri  Eegiment,  Farmville,  Va. 

Private  H.  W.  Cochran,  I,  17th  Indiana  Volunteers,  Louisville,  Kentucky,  November  30th,  1864. 

Private  B.  Cofflety,  G,  77th  Pennsylvania  Volunteers,  Nashville,  Tennessee,  December  15th,  1864. 

Private  J.  Cox,  A,  13th  New  York  Cavalry,  Washington,  D.  C.,  August  11th,  1884. 

Recruit  J.  E.  Cranfield,  G3d  New  York  Volunteers,  Alexandria,  Virginia,  May  8th,  1864. 

Private  W.  Daly,  A,  16th  United  States  Infantry,  Nashville,  Tennessee,  December  18th,  1865. 

Private  W.  Danekas,  E,  11th  Illinois  Volunteers,  Memphis,  Tennessee,  April  6th,  1865. 

Private  L.  L.  Davis,  C,  15th  New  Jersey  Volunteers,  Washington,  D.  C.,  May  11th,  1864. 

John  Dugan,  Government  Employd,  Quartermaster’s  Department,  Nashville,  Tennessee,  November  28th,  1864. 

Private  H.  Dunham,  I,  6th  Missouri  Volunteers,  Nashville,  Tennessee,  December  9th,  1864. 


52 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Coi’poral  S.  Eplar,  C,  2cl  Minnesota  Cavaliy,  Fort  Eidgely,  Minnesota,  April  13th,  1864. 

Private  J.  Erbay,  A,  10th  Michigan  Volunteers,  Knoxville,  Tennessee,  April  24th,  1864. 

Private  A.  C.  Ewing,  Q,  28th  Kentucky  Volunteers,  Louisville,  Kentucky,  June  15th,  1865. 

Private  C.  Farnsworth,  A,  3d  Ohio  Cavalry,  New  Albany,  Indiana,  April  10th,  1864. 

Private  J.  Fitzgerald,  21st  Wisconsin  Volunteers,  Nashville,  Tennessee,  November  2d,  1884. 

Private  M.  Flaherty,  C,  49th  Missouri  Volunteers,  St.  Louis,  Missouri,  November  17th,  1864. 

1st  Sergeant  A.  B.  Francisco,  F,  124th  New  York  Volunteers,  Chester,  Pennsylvania,  May  30th,  1864. 
Corporal  G.  Gamble,  A,  27th  Pennsylvania  Volunteers,  Nashville,  Tennessee,  May  13th,  1864. 

Private  P.  Gannon,  K,  39th  Massachusetts  Volunteers,  Boston,  Massachusetts,  May  9th,  1864. 

Sergeant  J.  N.  Gilchrist,  K,  5th  Alabama  Infantry,  Eichmond,  Virginia,  June  4th,  1864. 

Corporal  T.  Gleason,  E,  63d  New  York  Volunteers,  Nashville,  Tennessee,  September  7th,  1865. 

Private  J.  G.  Gossman,  B,  176th  Ohio  Volunteers,  Nashville,  Tennessee,  August  2d,  1864. 

Private  A.  Grant,  H,  59th  Indiana  Volunteers,  Tullahoma,  Tennessee,  September  1st,  1864. 

Private  J.  B.  Griffith,  I,  95th  Pennsylvania  Volunteers,  Washington,  D.  C.,  May  14th,  1864. 

Sergeant  C.  B.  Hadley,  B,  56th  Massachusetts  Volunteers,  Boston,  Massachusetts,  April  21st,  1864. 

Private  W.  Uatsell,  B,  6th  Kentucky  Eegiment,  Nashville,  Tennessee,  September  24th,  1863. 

Private  H.  Henning,  E,  8th  Iowa  Cavalry,  in  action,  Tuscaloosa,  Alabama,  April  3d,  1865. 

Private  J.  M.  Heevey,  A,  5Cth  Georgia  Infantry,  Nashville,  Tennessee,  February  16th,  1864. 

Private  J.  Hickey,  D,  23d  Indiana  Volunteers,  Louisville,  Kentucky,  June  25th,  1865. 

Private  E.  B.  Hieronymus,  B,  7th  Missouri  State  Militia  Cavalry,  St.  Louis,  Missouri,  March  30th,  1865. 
Private  M.  Higgins,  L,  2d  Massachusetts  Artillery,  Portsmouth,  Virginia,  July  1st,  1865. 

Private  F.  Howe,  G,  6th  Vermont  Volunteers,  January  6th,  1865. 

Private  J.  Hudson,  C,  2d  United  States  Infantry,  Elmira,  New  York,  January  7th,  1865. 

Private  J.  Jenks,  F,  51st  New  York  Volunteers,  Alexandria,  Virginia,  April  23d,  1864. 

Private  J.  James,  Unassigned  Substitute,  Elmira,  New  York,  May  7th,  1865. 

Sergeant  W.  A.  Johnson,  A,  15th  Indiana  Battery,  Washington,  D.  C.,  February  17th,  1865. 

Private  J.  Kanally,  K,  35th  Indiana  Volunteers,  Louisville,  Kentucky,  February  22d,  1864.  Erysipelas. 
Private  D.  Kelly,  K,  73d  Pennsylvania  Volunteers,  Philadelphia,  Pennsylvania,  July  8th,  1863.  Deserted. 
Private  E.  A.  Knapp,  I,  89th  Illinois  Volunteers,  Nashville,  Tennessee,  May  29th,  1864. 

A.  Kruse,  Contract  Nurse,  Washington,  D.  C.,  May  15th,  1864. 

Corporal  T.  Langley,  E,  10th  United  States  Colored  Troops,  Portsmouth,  Virginia,  May  27th,  1865. 

Private  A.  J.  Little,  H,  5th  Missouri  State  Militia  Cavalry,  Eolla,  Missouri,  July  4th,  1864. 

Private  J.  S.  Lockwood,  A,  17th  Connecticut  Volunteers,  St.  Augustine,  Florida,  June  11th,  1864. 

Private  J.  McAldee,  2d  Indiana  Battery,  Nashville,  Tennessee,  February  16th,  1865. 

Private  B.  McCarty,  B,  21st  Connecticut  Volunteers,  Portsmouth,  Virginia,  May  5th,  1865. 

Private  E.  McCarty,  B,  40th  Missouri  Volunteers,  St.  Louis,  Missouri,  November  0th,  1864. 

Private  C.  McDonald,  C,  19th  Massachusetts  Volunteers,  in  action,  Wilderness,  Virginia,  May  6th,  1864. 
Private  N.  SIcEnroe,  F,  2d  New  York  Volunteers,  Newark,  New  Jersey,  June  6th,  1834. 

Private  P.  McGevi,  B,  10th  Tennessee  Volunteers,  Nashville,  Tennessee,  November  0th,  1864. 

Private  M.  McKenney,  I,  1st  United  States  Artillery,  Gettysburg,  Pennsylvania,  July  3,  1863. 

Piivate  C.  McMahon,  I,  5th  Missouri  State  Militia  Cavalry,  St.  Louis,  Missouri,  January  1st,  1865. 

Private  P.  Mahon,  F,  20th  Connecticut  Volunteers,  Aquia  Creek,  Virginia,  May  4th,  1863. 

Private  F.  Man-ais,  7th  Massachusetts  Battery,  New  Orleans,  Louisiana,  March  18th,  1864. 

Private  J.  Marity,  G,  1st  Michigan  Engineers,  Louisville,  Kentucky,  March  15th,  1864. 

Private  M.  Miller,  C,  2d  Ohio  Heavy  Artillery,  Bowling  Green,  Kentucky,  October  22d,  1863. 

Private  5V.  Missor,  G,  87th  Illinois  Volunteers,  St.  Louis,  ^Missouri,  December  18th,  1862.  Deserted. 
Private  S.  W.  Morgan,  G,  1st  Indiana  ArtOlery,  New  Orleans,  Louisiana,  January  8th,  1864. 

Private  W.  J.  Mowry,  K,  11th  Illinois  Cavalry,  Vicksburg,  Mississippi,  February  24th,  1804. 

Sergeant  J.  Murphy,  D,  2d  Maryland  Cavalry,  Annapolis,  Maryland,  August  27th,  1863. 

Private  jSI.  Murray,  C,  6th  New  York  Heavy  Artillery,  Washington,  D.  C.,  August  16th,  1864. 

Private  J.  F.  Neal,  F,  55th  Kentucky  Volunteers,  Louisville,  Kentucky,  May  26th,  1865. 

Private  T.  Newell,  D,  0th  Kentucky  Cavalry,  Louisville,  Kentucky,  March  18th,  1804. 

Private  J.  O.  Barker,  H,  9th  United  States  Colored  Troops,  Portsmouth,  Virginia,  May  27th,  1865. 

Private  J.  O’Hara,  D,  2d  Massachusetts  Heavy  Artillery,  Boston,  Massachusetts,  September  12th,  1865. 
Private  7F.  Palmer,  B,  26th  Virginia  Infantry,  June  17th,  1864. 

Sergeant  A.  M.  Parmenter,  E,  29th  Michigan  Volunteers,  Louisville,  Kentucky,  October  11th,  1864. 

W.  Par-ker,  Substitute,  10th  Kentucky  Volunteers,  Nashville,  Tennessee,  December  9th,  1804.  Deserted. 
Orderly  Sergeant  T.  Pepper,  United  States  Army,  Covington  Kentucky,  June  18th,  1865. 

Private  W.  H.  Peiry,  K,  6th  Illinois  Volunteers,  Nashville,  Tennessee,  July  2Sth,  1885. 

Private  J.  M.  Pierce,  H,  6th  Indiana  Volunteers,  Chattanooga,  Tennessee,  November  25th,  1863. 

Private  L.  E.  Porter,  H,  109th  New  York  Volunteers,  Baltimore,  Maryland,  August  23d,  1864. 

Private  J.  KUey,  D,  4th  United  States  Infantry,  New  York,  August  30th,  1865. 

Private  J.  Ritchey,  H,  18th  Kentucky  Infantry,  Murfreesboro,  Tennessee,  September  26th,  1863. 

Private  M.  Rodgers,  D,  14th  United  States  Infantry,  Elmira,  New  York,  January  7th,  1865.  Deserted. 

A.  Eosa,  Blacksmith,  L,  1st  Illinois  Artillery,'  Vicksburg,  Mississippi,  ]\Iay  29th,  1864. 

Private  R.  Scerter,  G,  30th  Indiana  Volunteers,  Nashville,  Tennessee,  May  19th,  1884. 


FEOM  UNSPECIFIED  CAUSES  OTHER  THAN  GUNSHOT. 


53 


Private  J.  Scribner,  D,  lltli  Missouri  Cavalry,  St.  Louis,  Missouri,  December  28tlt,  1864. 

Corporal  L.  Seiper,  E,  4()th  Missouri  Volunteers,  St.  Louis,  Missouri,  November  7tb,  1884. 

Private  D.  Smallwood,  C,  15th  United  States  Colored  Troops,  Nashville,  Tennessee,  August  19th,  1865. 

First  Lieutenant  A.  Smith,  D,  51st  New  York  Volunteers,  Alexandria,  Virginia,  May  18th,  1865. 

Recruit  C.  Smith,  14th  New  York  Artillei-y,  Elmira,  New  York,  December  29th,  1863. 

Private  D.'  Smith,  D,  1st  Wisconsin  Cavalry,  Nashville,  Tennessee,  March  9th,  1864. 

Private  H.  Smith,  A,  68th  New  York  Volunteers,  Nashville,  Tennessee,  December  16th,  1864. 

Private  1.  Smith,  D,  31st  Maine  Volunteers,  Boston,  Massachusetts,  April  18th,  1864. 

Private  J.  Smith,  A,  9th  New  York  Volunteers,  New  York,  July  20th,  1863.  Deserted. 

Private  J.  Smith,  B,  18th  New  York  Cavalry,  Washington,  D.  C.,  F(!bruary  14th,  1864.  Deserted. 

Private  J.  Smith,  C,  10th  Tennessee  Mounted  Infantry,  Nashville,  Tennessee,  May  4th,  1864. 

Private  W.  A.  Smith,  F,  1st  Delaware  Volutiteers,  Wilderness,  Virginia,  May  5th,  1864. 

Private  J.  Spencer,  A,  179th  Ohio  Volunteers,  Louisville,  Kentucky,  October  6th,  1864. 

Private  T.  Sullivan,  F,  52d  Illinois  Volunteers,  Louisville,  Kentucky,  June  21st,  1865. 

Corporal  J.  Suter,  E,  7th  Veteran  Reserve  Corps,  Louisville,  Kentucky,  July  19th,  1864. 

Private  J.  Sutter,  K,  1st  Michigan  Cavalry,  Washington,  D.  C.,  March  2d,  1864. 

Private  IF.  C.  Swanson,  K,  12th  North  Carolina  Infantry,  Richmond,  Virginia,  April  28th,  1863. 

Private  E.  Sweat,  F,  93d  New  Y’’ork  Volunteers,  Wilderness,  Virginia,  M.ay  5th,  1864. 

Private  E.  Taylor,  F,  3d  Ohio  Cavalry,  Nashville,  Tennessee,  June  8th,  1864. 

Private  D.  7V.  Vicks,  C,  50th  Georgia  Regiment,  Richmond,  Virginia,  June  5th,  1863. 

Private  W.  Visser,  G,  82d  Illinois  Volunteers,  Ballesville,  Illinois,  December  18th,  1882.  Deserted. 

Private  J.  Walcott,  I,  50th  Ohio  Volunteers,  Baltimore,  Maryland,  February  4th,  1865. 

Corporal  P.  Walton,  I,  111th  Pennsylvania  Volunteers,  Savannah,  Georgia,  February  1st,  1865. 

Corporal  C.  Williams,  M,  2d  Massachusetts  Cavalry,  Winchester,  Virginia,  January  23d,  1865. 

Private  T.  Wilson,  ]\I,  3d  United  States  Cav.alry,  Little  Rock,  Ai’kansas,  February  19th,  1866. 

Private  H.  Wolf,  B,  9th  New  Y’’ork  Cavalry,  Washington,  D.  C.,  June  20th,  1865. 

Private  G.  B.  Young,  B,  04th  United  Slates  Colored  Ti’oops,  Vicksburg,  Mississippi,  July  31st,  1805. 

\ 

The  following  are  examples  of  graver  injuries  belonging  to  the  foregoing  category : 

Case. — Private  Frederick  Burling,  Co.  D,  23d  New  York  Volunteers,  aged  21  years,  received  a severe  injury  of  the 
head,  at  Upton’s  Hill,  Virginia.  Deafness  and  partial  paralysis  ensued,  and  he  was  discharged  from  service  on  March  1st,  1862. 

Case. — Private  O.  B.  Cook,  Co.  II,  14th  Vermont  Volunteers,  received  a severe  injury  of  the  head,  at  Fairfax  Court 
House,  Virginia,  January  4th,  1883,  and  was  discharged  for  disability,  rated  at  one-half,  on  March  24th,  1863.  Surgeon  A.  T. 
Woodward,  14th  Vennont  Volunteers,  records  the  case. 

Case. — Private  Milton  Crowell,  Co.  B,  84th  Illinois  Volunteers,  received  a contused  wound  of  the  head,  in  May,  1863, 
and  was  admitted  to  Gayoso  Hospital,  Memphis,  Tennessee,  June  1st.  Cerebral  complications  arose,  and  he  died  on  June  5th, 
1883.  Surgeon  D.  W.  Hartshom,  U.  S.  V.,  records  the  case. 

Case. — Private  Edward  Garnett,  Co.  B,  5th  Ohio  Volunteers,  at  Camp  Banks,  in  the  spring  of  1863,  received  an  injury 
of  the  head,  which  resulted  in  impairment  of  the  mental  faculties.  Complete  loss  of  memory  was  a remarkable  feature  of  the 
case.  The  patient  was  discharged  for  total  disability  by  order  of  Surgeon  R.  O.  Abbott,  U.  S.  Army,  the  Medical  Director  of 
the  Department  of  Washington,  Mai’cli  3d,  1863.  The  case  is  recorded  by  Surgeon  J.  H.  Wythes,  U.  S.  V. 

Case. — W.  F.  Kirkland,  a recruit  of  the  16th  New  Y’’ork  Cavalry,  aged  43  years,  received  a lacerated  wound  of  the 
scalp  in  the  fi-ontal  region.  May  4th,  1864,  and  was  admitted  to  Camden  Street  Hospital,  Baltimore.  Erysipelas  of  the  scalp 
supervened,  and  was  followed  by  meningeal  inflammation.  The  patient  died  on  IMay  13th,  1864.  Surgeon  Z.  E.  Bliss,  U.  S. 
V.,  records  the  case. 

Case. — Private  Thomas  Morrissey,  Co.  A,  2d  Vermont  Volunteers,  aged  26  years,  was  admitted  to  Lincoln  Hospital, 
Washington,  April,  1833,  under  the  charge  of  Sni-geon  H.  Bryant,  U.  S.  Volunteers,  on  account  of  a contusion  of  the  head. 
Symptoms  of  arachnitis  were  manifested;  but  the  patient  recovered  partially,  w.as  transferred  to  a convalescent  camp  near 
Alexandria,  on  March  10th.  He  was  discharged  from  service  on  JIarch  20th,  1883.  His  mental  faculties  were  much  impaired. 
His  disability  w’as  rated  at  two-thirds.  Surgeon  S.  B.  Hunt,  U.  S.  V.,  records  the  case. 

Case. — Sergeant  Richard  M.  Porter,  37th  Massachusetts  Volunteers,  aged  28  years,  received  a contusion  of  the  seal]),  in 
July,  1884.  He  wms  admitted  into  Augur  Hospital,  and,  on  August  2d,  he  was  transferred  to  the  3d  Division  Hos{)ital,  at 
Alexandria,  with  symptoms  of  incipient  cerebritis.  He  died,  August  28th,  1864.  Surgeon  E.  Bentley,  U.  S.  V.,  records 
the  case. 

Case. — Private  Thomas  Solomon,  Co.  F,  2d  Louisiana  Mounted  Infantry,  aged  50  years,  received,  in  camp,  near  Green- 
ville, Louisiana,  June  18th,  1864,  a contused  wound  of  the  scalp.  On' Juno  20th,  he  was  transferred  to  University  Hospital, 
New  Orleans,  and  on  December  21st,  1864,  he  was  transferred  to  the  Veteran  Reserve  Corps. 

The  following  arc  abstracts  of  cases  of  simple  or  compound  fractures  of  the  skull, 
produced  by  causes  not  specified,  save  that  it  is  statctl  that  they  were  not  inflicted  by 
gunshot : 


54 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Private  Robert  Bibb,  Co.  E,  4tli  Virginia  Regiment,  was  admitted,  March  31st,  1864,  into  the  hospital  at  the 
Old  Capitol  Prison,  Washington,  with  a simple  fracture  of  the  skull.  He  died,  April  6th,  1866. 

Case. — Private  James  Burns,  Co.  B,  S9th  Massachusetts  Volunteers,  aged  57  years,  was  admitted  to  Stanton  Hospital, 
Washington,  on  July  14th,  1863,  with  a fracture  of  the  cranium.  He  was  transferred  to  Sattcrlee  Hospital,  Philadelphia,  on 
May  10th,  1864,  and  returned  to  duty  October  18fh,  1864.  Siu'geon  I.  I.  Hayes,  U.  S.  V.,  records  the  case. 

Case. — Private  Peter  Cahill,  Co.  C,  79th  New  York  Volunteers,  aged  19  years,  received  an  accidental  compound  fracture 
of  the  external  table  of  the  frontal  hone,  June  14th,  1665,  while  serving  on  the  Provost  Marshal’s  Guard.  He  was  admitted  to 
Sickel  Hospital,  Alexandria,  on  June  14th,  and  discharged  from  service  well,  on  July  4th,  1865.  Surgeon  E.  Bentley,  U.  S. 
V.,  records  the  case. 


Case. — Private  W.  H.  Christ,  Co.  I,  126th  Ohio  Volunteers,  aged  24  years,  was  admitted  to  the  base  hospital,  at  City 
Point,  Virginia,  with  a lacerated  wound  of  the  scalp,  and  fracture  of  the  skull,  April  24th,  1865.  He  was  transferred  to 
Patterson  Park,  Baltimore,  May  18th,  to  Hick’s  Hospital,  convalescent,  June  8th,  and  discharged  from  service,  well,  June  17th, 
1865.  Surgeon  Thomas  Sim,  U.  S.  V.,  records  the  case. 

Case. — Private  Peter  Clofat,  Co.  E,  2d  Louisiana  Regiment,  was  sent  to  the  St.  James  Hospital,  New  Orleans,  on  Jlay 
10th,  1863,  by  the  Provost  Marshal,  with  fracture  of  the  skull.  He  died  on  the  following  day.  Assistant  Surgeon  J.  Homans, 
U.  S.  A.,  records  the  case. 


Case. — The  body  of  private  John  C , Co.  K,  2d  U.  S.  Infantry,  aged  30 

years,  was  brought  into  hospital,  at  Fort  Columbus,  New  York  Harbor,  on  January 
21st,  1865.  It  was  found  that  life  was  entirely  extinct.  There  was  a contused  and 
lacerated  wound,  three  inches  in  length,  behind  the  left  ear,  and  a depressed  fracture 
on  the  left  side  of  the  occipital.  No  clue  whatever  could  he  obtained  as  to  the  nature 
of  the  weapon  by  which  the  injury  was  inflicted;  nor,  indeed,  could  it  he  accurately 
determined  whether  it  was  due  to  a blow,  or  to  a fall.  At  the  autopsy,  it  was  found  that 
the  medulla  oblongata  was  torn  away  almost  completely  from  the  pons  Varolii.  There 
was  great  intracranial  extravasation  of  blood,  and  a fracture  extending  across  the 
occipital  and  temporal  bones  to  the  left  side  of  the  foramen  magnum.  A fissure 
proceeded  also  through  the  right  condyloid  foramen  into  the  mastoid  jtrocess  of  the  right 
temporal.  Assistant  Surgeon  P.  S.  Conner,  U.  S.  Army,  fonvarded  to  the  Army 
Medical  Museum  the  notes  of  the  case,  and  a section  of  the  skull,  which  is  represented 
in  the  accompanying  wood-cut,  (FiG.  18.) 


Fig.  18. — Section  of  base  of  cranium  show- 
ing depressed  fracture. — Spec.  4351,  Sect.  I, 
A.  M.  M. 


Case. — Captain  J.  B.  Forcum,  Co.  H,  4th  Noi’th  C.arolina  Infantry,  received,  at  Gettysburg,  July  1st,  1863,  a simple 
fracture  of  the  cranium.  Ho  was  admitted  to  Hospital  No.  4,  at  Richmond,  Virginia,  and  recovered,  and  was  furloughed, 
August  3d,  1863.  Surgeon  J.  B.  Read,  C.  S.  A.,  records  the  case. 

Case. — Bugler  Morris  Houlahan,  Co.  G,  5th  U.  S.  Cavalry,  was  admitted  to  the  Seminary  Hospital,  Georgetown, 
December  11th,  1862,  with  a fracture  of  the  skull,  and  died  the  same  day.  Acting  Assistant  Surgeon  Landon  Wells  records 
the  case. 


Case. — Private  John  Hines,  Co.  D,  3d  Michigan  Volunteers,  aged  39  years,  received  a fracture  of  the  right  side  of  the 
frontal  bone,  on  October  28th,  1834.  He  was  treated  at  Huntsville,  Alabama;  Nashville,  Tennessee;  Louisville,  Kentucky;  and 
recovered,  and  was  discharged  from  service,  June  9th,  1865.  Surgeon  B.  B.  Breed,  U.  S.  V.,  records  the  case. 


Case. — Sergeant  R.  TV.  Jones,  1st  Virginia  Artillery,  was  admitted  to  Chimborazo  Hospital,  Richmond,  Virginia,  on 
November  17th,  1863,  with  a fracture  of  the  skull.  He  recovered,  and  returned  to  duty,  December  13th,  1863.  Surgeon  E.  S. 
Smith,  C.  S.  A.,  records  the  case. 

Case. — Private  Michael  McNulty,  Co.  E,  77th  Pennsylvania  Volunteers,  aged  24  years,  received  a simple  fracture  of  the 
frontal  bone,  December  10th,  1864,  at  Nashville,  Tennessee.  He  was  transferred  to  Louisville,  thence  to  Camp  Dennison,  Ohio, 
and  recovered,  and  was  returned  to  duty,  January  7th,  1865.  Surgeon  J.  E.  Herbst,  U.  S.  V.,  records  the  case. 

Case. — Private  Andrew  Mader,  Co.  L,  3d  Pennsylvania  Artillery,  received  a simple  fracture  of  the  light  parietal, 
December  13th,  1864.  The  line  of  fracture  passed  across  the  middle  meningeal  artery,  which  was  ruptured,  and  gave  rise  to  a 
large  extravasation  of  blood.  He  was  admitted  to  Balfour  Hospital,  Portsmouth,  Virginia,  with  every  symptom  of  compression 
of  the  brain.  He  died,  December  16th,  1864.  An  autopsy  revealed  a large  coagulum  over  the  right  hemisphere.  Assistant 
Surgeon  J.  H.  Frantz,  U.  S.  A.,  records  the  case. 

Case. — Private  George  W.  Morey,  Co.  E,  10th  Michigan  Volunteers,  aged  23  years,  received  a contused  wound  on  the 
left  side  of  the  head,  at  Tunnel  Hill,  Georgia,  in  April,  1834.  The  existence  of  fracture  Avas  suspected,  but  not  clearly  diagnos- 
ticated. The  patient  was  treated  at  Hospital  No.  19,  Nashville,  Tennessee,  at  Louisville,  Kentucky,  and  at  St.  Mary’s  Hospital, 
Detroit,  Michigan.  He  had  frequent  epileptic  convulsions,  and  died  in  one  of  the  paroxysms.  May  25,  1864. 

Case. — Sergeant  John  Miller,  Co.  I,  2d  Illinois  Artillery,  Avas  admitted  to  Indianapolis  Hospital,  in  September,  1832, 
Avith  fracture  of  the  skull.  He  died,  September  17th,  1882.  Surgeon  J.  S.  Bobbs,  Brigade  Surgeon,  U.  S.  V.,  I'ecords  the  case. 

Case. — Private  Daniel  W.  Nash,  Co.  F,  31st  Ohio  Volunteers,  received  a simple  fracture  of  the  skull,  in  February,  1833. 
He  Avas  admitted  to  Hospital  No.  10,  at  Louisville,  Kentucky,  and  Avas  discharged  from  service,  February  28tb,  1863.  Acting 
Assistant  Surgeon  E.  O.  BroAvn  records  the  case. 


FEACTUEES  FEOM  UNSPECIFIED  CAUSES. 


55 


Case.— Teamster  Wasliiiigtoii  Odell,  Co.  I,  DStli  Illinois  Volniiteors,  received  aii  injury  of  tlie  skull  in  1863.  Ho  was 
admitted  to  Camp  Dennison  Hospital,  Ohio,  and  was  discharged  from  service  on  August  12th,  1863.  Surgeon  H.  C.  McAllister, 
98th  Illinois  Volunteers,  records  the  case. 

Case.— Private  Stephen  E.  Potts,  New  York  Marine  Artillery,  wtis  admitted  to  Foster  Hospital,  Newberne,  North 
Carolina,  August  23d,  1862,  with  a simple  fracture  of  the  skull.  He  recovered,  and  was  discharged  from  service,  December 
13th,  1833. 

Case.— Private  Dennis  Quinn,  Co.  F,  11th  Veteran  Eeserve  Corps,  received,  in  September,  1864,  a simple  fracture  of  the 
frontal  bone,  with  a slight  depression.  He  was  admitted  to  Judiciary  Square  Hospital,  Washington,  on  September  24th,  and 
recovered,  and  returned  to  duty  on  October  8th,  1884.  Assistant  Surgeon  P.  C.  Davis,  U.  S.  A.,  records  the  case. 

Case.— Private  William  Eussell,  26th  New  York  Battery,  was  admitted  to  the  St.  James’  Hospital,  New  Orleans, 
Louisiana,  on  March  11th,  18G3,  with  a simple  fracture  of  the  skull.  He  recovered,  and  was  discharged  from  service,  on  May 
11th,  1863.  Assistant  Surgeon  John  Homans,  U.  S.  A.,  records  the  case. 

Case. — Private  J.  C.  E , Pennsylvania  Artillery,  aged  22  years,  was  admitted,  on  September  oOth,  18o4,  to  Jarvis 

Hospital,  Baltimore,  Maryland,  in  an  inebriated  condition,  with  a contusion  of  the 
left  side  of  the  face,  and  a small  contused  wound  over  the  left  malar  bone.  No  history 
of  the  cause  or  circumstances  attending  his  accident  could  be  ascertained.  Cold 
applications  were  made  to  the  head,  and  he  was  kept  quiet  in  bed.  No  symptoms  of 
grave  cerebral  miscfiief  appeared  until  the  evening  of  October  5th,  ^vhen  he  became 
noisily  delirious.  He  became  comatose,  and  died  the  following  morning.  Scctio  cada- 
veris  twenty-four  hours  after  death.  There  was  ecehymosis  on  the  left  side  of  the 
face ; the  left  ramus  of  the  lower  jaw  bore  traces  of  an  old  gunshot  fracture.  There 
was  also  a gunshot  fracture  involving  the  right  shoulder.  On  removing  the  scalp, 
dark  blood  oozed  from  the  ruptured  veins,  and  on  removing  the  skull-cap  and  cere- 
brum, a clot  of  blood  of  from  one  and  a half  to  two  ounces  was  found  between  the 
frontal  bone  and  dura  mater  on  the  left  side,  adhering  to  the  membrane.  It  must, 
necessarily,  have  compressed  greatly  the  anterior  lobe  of  the  left  hemisphere.  Thei’e 
was  also  a clot  at  the  posterior  surface  of  the  posterior  lobe  of  the  i-ight  hemisjihere 
The  cerebral  substance  was  softened  at  this  point.  There  was  eflusion  of  serum  over 
the  pons  Varolii  and  in  the  third  and  fourth  ventricles.  The  arachnoid  membrane 
was  considerably  separated  from  the  sulci  by  effusion  into  the  subarachnoid  cavity. 

The  veins  of  the  pia  mater  were  everywhere  turgid.  The  fracture  commenced  on 
the  outer  part  of  the  left  superciliary  ridge,  and  passed  across  the  left  orbital  plate 
of  the  frontal,  fissuring  the  ethmoid,  and  the  body  of  the  sphenoid.  The  sphenoidal 
fissure  on  the  left  side  was  enlarged  as  though  by  absorption  from  without.  Acting 
Assistant  Surgeon  B.  B.  Miles  contributed  the  specimen,  (Fig.  19,)  with  the  notes  in  the  case. 

Case. — Private  Frederick  Seltzer,  5th  U.  S.  Artillery,  was  admitted  to  the  Seminary  Hospital,  Georgetown,  D.  C.,  J anuary 
8th,  1832,  with  a fracture  of  the  skull.  Ho  died  on  January  12th,  1862.  Surgeon  Joseph  E.  Smith,  U.  S.  A.,  records  the  case. 

Case.— Private  J.  M.  Sharp,  Co.  F.,  45th  North  Carolina  Eegiinent,  received  a simple  fracture  of  the  zygoma  of  the  right 
temporal,  without  injury  to  the  cranial  cavity.  Ho  was  admitted  to  the  Farmville  Hospital,  Virginia,  on  J une  2d,  1864.  He 
recovered,  and  was  fiuloughed  on  August  9th,  1834.  Surgeon  H.  D.  Taliaferro,  C.  S.  A.,  records  the  case. 

Case. — Private  Adolphus  Seymour,  Co.  F,  1st  New  York  Cavalry,  aged  21  years,  received  a simple  fracture  of  the  right 
side  of  the  frontal  bone,  at  Now  Market,  Virgini.a,  May  15th,  1864.  Ho  was  transferred  in  June  to  Frederick,  Maryland,  and 
in  October  to  Annapolis  Junction,  and  thence  to  Satterleo  Hospital,  Philadelphia,  .and  finally  to  Turner’s  Lane  Hospital,  whence 
ho  was  discharged  on  M.arch  16tli,  1835,  on  account  of  confirmed  epilepsy. 

C.\SE. — Private  Frederick  St.apley,  Co.  E,  92d  Illinois  Volunteers,  was  .admitted  to  Hospital  No.  19,  Nashville,  Tennessee, 
on  June  4th,  1833,  on  account  of  a simple  fracture  of  the  skull,  according  to  the  hospital  register.  If  the  diagnosis  was  correct, 
the  case  was  unusually  successful,  since  the  patient  returned  to  duty  on  June  18th,  1833.  Surgeon  .John  W.  Foye,  U.  S.  V., 
records  the  case. 

Case. — Private  Frank  Treber,  Co.  D,  10th  Tennessee  Volunteers,  aged  38  years,  was  admitted  to  Hospital  No.  19,  Nash- 
ville, Tennessee,  on  March  21st,  1835,  with  a simple  depressed  fracture  of  the  os  frontis.  He  w.as  transferred  to  Cund)erland 
Hospital  on  April  20th,  .and  returned  to  duty,  well,  on  April  29th,  1835.  Surgeon  B.  Cloak,  U.  S.  V.,  records  the  case. 

Removal  of  Feagments. — In  the  following  cases  of  fracture  of  the  skull,  from  falls 
or  blows,  depressed  fragments  of  bone  were  removed  by  the  forceps,  saw,  or  elevator: 

Case. — Seaman  Henry  Black,  of  the  United  States  Transport  S;  E.  Spalding,  fell  from  the  spar  deck  into  the  hold,  on 
June  20th,  1833,  a distance  of  twenty-four  feet,  striking  on  the  vertex  of  the  skull.  A large  scalp  wound,  four  inches  in  length, 
with  fracture  of  both  tables  of  the  skull,  with  depression,  having  a diameter  of  two  inches,  was  ])roducod.  On  his  admission  to 
the  military  hospital  at  Beaufort,  North  C.arolina,  the  man  was  i)ale,  his  pulse  imi)erceptible,  .and  he  lay  groaning  occasionally, 
his  lower  limbs  moving  sjtasmodically.  The  trephine  was  ap|)lied,  but  the  d('pressed  portion  of  bone  could  not  be  raised  by  the 
elevator.  A portion  of  the  fractured  skull  was  then  removed  by  Hey’s  saw ; after  which,  the  remiiiuing  portion  was  raised  to 
its  normal  position  by  the  elevator,  .and  the  periosteum,  which  had  been  carefully  ])reserved,  was  brought  back  over  the  solution 


Fig.  19. — Fracture  of  the  orbital  pl.ate  of  the 
frontal,  the  ethmoid,  and  sphenoid. — Spec.  3440, 
Sect.  I,  A.  M.  M. 


56 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


of  continuity  of  tlie  bone.  Tlie  wound  %vas  then  dressed  with  cold  water.  The  after  treatment  was  of  stimulant  and  tonic 
description,  with  careful  attention  to  the  bowels,  and  occasional  opiates.  At  the  date  of  the  report,  fifteen  days  after  the 
oiieration,  the'  patient  was  walking  about  the  ward.  The  wound  of  the  scali)  was  united,  and  the  small  portion  over  tlie  trephined 
part  was  healing  by  granulation.  The  case  appears  on  the  monthly  report  of  Beaufort  Hosjiital,  North  Carolina,  signed  by 
Surgeon  F.  S.  Ainsworth,  U.  S.  V. 

0^vsE. — Private  Edward  Connors,  Co.  A,  9th  Illinois  Cavalry,  aged  22  years,  received  in  a street  fight,  March  22d,  1864, 
a blow  from  a stone,  which  struck  .the  left  side  of  the  forehead.  He  was  admitted  into  the  Lawson  Hospital  at  St.  Louis, 
Illissouri,  on  the  same  day.  There  was  an  external  wound  throe  inches  in  length,  a depressed  fracture  involving  both  tables  of 
the  skull.  Several  small  sjiiculai  of  bone  were  removed,  and  the  depression  of  the  inner  table  was  raised  by  an  elevator.  A 
piece  of  the  broken  outer  table  was  missing,  having,  apparently,  been  torn  off  at  the  time  of  the  injury.  A saline  purgative 
was  administered  and  low  diet  was  prescribed,  with  cold  water  applications  to  his  head.  His  general  condition  at  this  time  was 
good  : the  pulse  was  natural,  the  pupils  were  sensible  to  light  and  normal  in  movement,  and  his  intellect  was  perfectly  clear. 
He  continued  thus  until  the  night  of  the  23d,  when  symptoms  of  concussion  and  compression  of  the  brain  were  manifested ; the 
symptoms  of  compression,  perhaps,  pi-edominating.  On  the  following  day,  there  was  evidently  compression,  as  indicated  by 
the  stertorous  breathing  and  insensibility,  dilated  pupils  and  slow  pulse.  Death  took  place  at  midnight  on  March  24th,  1864. 
An  autopsy  was  made  on  the  following  day.  The  external  table  of  the  frontal  bone  showed  the  loss  of  a fragment  of  the  size  of 
a quarter  of  a dollar.  A fissure  extended  backwards  an  inch  and  a half  into  the  left  parietal.  There  was  a stellate  fracture  of 
the  inner  table,  but  no  depression.  At  the  seat  of  injury  there  was  no  extravasation  of  blood.  The  brain  substance  around  this 
point  was  softened,  but  to  an  inconsiderable  degree.  The  specimen  was  preserved,  but  was  not  forwarded  to  the  Army  Medical 
Museum.  The  case  was  reported  by  Surgeon  C.  T.  Alexander,  U.  S.  A.,  in  charge  of  Lawson  Hospital. 

Case. — Private  Miles  P.  Hatch,  Co.  H,  161st  New  York  Volunteers,  aged  22  years,  was  admitted,  on  January  12th,  1865, 
to  St.  Louis  Hospital,  New  Orleans,  Louisiana,  with  twenty  other  wounded  men,  injured  on  the  occasion  of  the  collision  between 
the  United  States  transport  J.  H.  Dickey,  and  John  Pain,  on  the  Mississippi  River,  fifteen  miles  below  Vicksburg,  on  January 
9th,  1865.  Private  Hatch  W’as  found  to  be  still  laboring  under  the  efl'ects  of  concussion  of  the  brain.  He  had  received  a 
violent  blow,  causing  a wound  of  the  scalp  and  fracture  of  the  skull.  Symptoms  of  injury  to  the  brain  persisting,  the  wound  in 
the  scalp  was  enlarged,  and  the  fracture  was  exposed,  and  a fragment  of  depressed  bone  was  removed.  The  case  terminated 
fatally  on  January  14th,  1865.  This  imperfect  account  is  derived  from  the  monthly  report  of  the  161st  New  York  Volunteers,  for 
January,  1835,  and  from  tlie  hospital  register,  signed  by  Surgeon  A.  MciSIahon,  U.  S.  V. 

Case. — Private  Jonathan  Leet,  Co.  M,  22d  Pennsylvania  Cavalry,  aged  18  yeai-s,  received,  on  April  4th,  1835,  a com- 
minuted fracture  of  the  ci  anium,  by  a blow  from  a glass  bottle.  He  was  admitted  to  hospital,  at  Oumberland,  Maryland,  on  May 
14th,  from  his  regiment.  Fragments  of  bone  were  removed  on  the  following  day.  He  was  discharged  from  service  on  August 
15th,  1865.  Surgeon  J.  B.  Lewis,  U.  S.  V.,  records  the  case. 

Case. — Private  Conrad  Murphy,  Co.  E,  17th  Kentucky  Volunteers,  was  confined  for  misconduct  in  the  guard-house,  on 
February  15th,  1863.  He  was  insubordinate,  and  the  sentinel  struck  him  on  the  head  with  the  butt  of  a musket,  with  such 
violence  as  to  fracture  the  frontal  bone,  klurphy  was  taken  to  the  Post  Hospital,  at  Clarksville,  Tennessee,  under  the  charge 
of  Surgeon  A.  B.  Patterson,  102d  Ohio  Volunteers.  Stertorous  breathing,  dilated  pupils,  oppressed  pulse,  and  stupor,  indicated 
compression  of  the  brain.  An  incision  was  made  at  the  seat  of  injury,  and  the  depressed  bone  was  elevated,  and  detached 
spiculse  were  removed,  but  the  grave  sjTnptoms  were  not  modified,  and  death  took  place  on  February  16th,  1863.  At  the  autopsy, 
made  by  Assistant  Surgeon  S.  Hubbard,  17th  Kentucky  Volunteers,  it  was  found  that  there  had  been  an  extensive  extravasation 
of  blood  uj)on  the  brain. 


Case. — Private , 149th  New  York  Volunteers,  received  at  Stevenson,  Alabama,  January  23th,  1864,  a heavy  blow 

from  a glass  bottle,  in  a private  quarrel,  in  the  camp  of  the  Second  Division,  Twentieth  Army  Corps.  He  was  taken  to  the 
regimental  hospital,  and  Surgeon  J.  V.  Kendall,  149th  New  York  Volunteers,  ascertained  that  there  was  a fracture  of  the 
frontal  bone  over  the  right  frontal  sinus,  with  depression  of  the  vitreous  table.  The  patient  had  I’epeated  convulsions  and  in 

the  intervals  was  partially  comatose.  Surgeon  Kendall  extended  the  wound  in  the 
integument  so  as  to  freely  expose  the  bone,  and  removed  four  fragments  of  bone,  and 
also  raised  a depressed  portion  of  the  inner  plate,  which  was  not  detached.  The  scalp 
was  then  brought  together  by  sutures,  and  cold  water  dressings  were  applied.  The 
patient  was  rejiorted  as  doing  well  in  Februaiy,  the  symptoms  of  compression  being 
entirely  relieved,  but  it  has  been  imj)racticable  to  leai'ii  the  ultimate  result  of  the  case. 
The  fragments  of  bone  removed  are  represented  in  the  adjoining  wood-cut,  (FiG.  20,) 
and  comprise  about  half  a square  inch  of  the  inner  table,  and  a somewhat  larger  portion 
of  the  external  table. 


Fig.  20. — Four  frag-inents  removed  from  the 
right  side  of  the  frontal  bone,  fractured  by  a 
blow  from  a bottle ; natural  size.  2210, 

Sect.  I,  A.  JI.  M. 


Case. — PriAate  Charles  V.  Orton,  Co.  L,  1st  Tennessee  Cavalry,  in  an  engagement  at  Shoal  Creek,  Alabama,  October 
19th,  1864,  received  a wound  in  the  neck  from  a musket  ball,  which  lodged  under  the  sterno-cleido-mastoid  muscle,  and  also  a 
blow,  apparently  from  the  butt  of  a musket,  or  stone,  which  produced  a compound  fracture  of  the  frontal  bone.  The  regimental 
surgeon.  Dr.  W.  F.  Green,  reports  that  several  fragments  of  bone  were  removed  from  the  forehead,  and  the  signs  of  compression 
of  the  brain  being  thereby  relieved,  the  patient  was  sent,  by  way  of  Pulaski,  to  Nashville,  Tennessee,  and  was  admitted  to 
Hospital  No.  14,  on  November  23d.  He  was  subsequently  sent  to  the  West  End  Hospital,  at  Cincinnati,  Ohio,  and  was 
discharged  from  service  on  May  2d,  1865,  for  disability  rated  at  three-fourths.  He  was  allowed  a pension  of  six  dollars  per 
month  from  this  date,  and  Commissioner  H.  Van  Aernam  states  that  he  drew  his  pension  on  March  4th,  1889;  but  that  the 
particulars  of  his  condition  at  that  time  were  not  reported. 


REMOVAL  OF  FRAGMENTS  AND  TREPHINING. 


57 


Fig.  21. — Segment  of  right 
parietal,  showing  a fracture 
from  a blow  from  a spade. — 
Spec.  712,  Sect.  I,  A.  M.  M. 


Case.— At  Antictam,  Maryland,  September  17tb,  1862,  a soldier,  employed  in  entrenching, 
struck  another,  on  the  left  side  of  his  head,  with  the  edge  of  a spade.  The  wounded  man  fell, 
badly  stunned,  and,  on  examination,  it  was  found  that  the  blow  had  produced  a depressed  frac- 
ture of  the  left  parietal  bone.  The  patient  was  conveyed  to  the  Smoketown  Hospital,  and  was 
placed  under  the  care  of  Surgeon  B.  A.  Vanderkieft,  U.  S.  V.  He  breathed  with  stertor,  and  had  a slow 
pulse,  dilated  pupils,  and  the  other  signs  of  compression  of  the  brain.  The  scalp  was  shaved,  and  an 
incision  was  made,  through  which  a number  of  fragments  of  detached  bone  were  removed.  The 
patient  lingered,  in  a state  of  stupor,  until  November  8th,  1862.  The  particulars  of  the  case  are 
not  recorded  in  the  register  or  in  the  reports  from  Smoketown  Hospital;  but  the  only  death  in 
the  hospital  from  fracture  of  the  cranium,  at  the  date  referred  to,  is  that  of  Sergeant  Arthur  F. 
Hascall,  Co.  C,  61st  New  York  Volunteers.  The  fracture  extends  downwards  from  the  sagittal 
suture  three  inches,  and  it  is  an  inch  wide  at  its  lowest  part.  A few  fragments  are  adherent 
to  the  inner  table,  and  the  edges  of  the  orifice  are  carious.  The  specimen  is  represented  in  the 
adjoining  wood-cut,  (Fig.  21.)  The  contour  of  the  aperture  in  tlie  bone  represents,  with  exactness, 
the  outline  of  the  edge  of  the  spade.  The  specimen  was  forwarded  to  the  Army  Medical  Museum 
by  Surgeon  Vanderkieft,  by  Hospital  Steward  A.  Schafhirt,  U.  S.  A.  The  latter  states  that  a 
detailed  history  accompanied  the  specimen.  A careful  search  has  failed  to  discover  this  paper,  and 
the  registers  of  the  Museum  contain  no  indication  of  its  reception. 


Trephining. — The  following  eighteen  abstracts  of  cases  of  fracture  of  the  skull 
from  various  causes  other  than  gunshot  injury,  refer  to  instances  in  which  the  trephine 
was  formerly  applied: 

Case. — Private  Joseph  Bums,  Co.  C,  4th  Kentucky  Cavalry,  aged  23  years,  was  struck  on  the  head  at  8 o’clock  r.  m., 
February  22d,  1834,  by  a slung  shot,  which  produced  a fracture  of  the  skull,  extending  from  the  vertex  to  the  left  orbit,  through 
the  parietal,  frontal,  and  the  great  wing  of  the  sphenoid.  The  patient  was  taken  to  Clay  Hospital,  at  Louisville,  Kentucky,  on 
the  evening  of  the  accident,  with  symptoms  of  grave  compression  of  the  brain.  During  the  night  he  had  frequent  convulsions. 
Early  the  follorving  morning,  Acting  Assistant  Surgeon  John  E.  Crowe  applied  the  trephine,  and  elevated  the  depressed  bone. 
The  patient  had  previously  been  comatose  or  convulsed  every  five  or  ten  minutes;  but  in  ten  minutes  after  the  operation  he 
became  conscious,  and  spoke  rationally,  stating  the  circumstances  attending  his  injury  and  his  military  history.  In  a few  hours, 
however,  the  convulsive  paroxysms  returned,  and  continued  during  the  night.  The  patient  died  on  the  succeeding  day, 
February  24th,  1834.  Surgeon  Alexander  T.  Watson,  U.  S.  V.,  records  the  case. 

Case. — Private  Patrick  H.  Green,  Co.  H,  125lh  New  York  Volunteers,  while  on  furlough,  received  a blow  on  the  left 
side  of  the  head  from  a slung  shot,  on  the  night  of  May  23d,  1863.  He  was  treated  by  a private  physician  until  June  3d,  when 
he  was  admitted  into  the  Ladies’  Home  Hospital,  New  York  City.  Twenty-four  hours  after  his  admission  he  had  a spasm  of 
the  right  side  of  the  body,  and,  upon  examination,  there  was  found  to  be  a depressed  fracture  of  the  skull.  The  scalp  was  laid 
open  by  an  incision,  and  trephining  was  performed,  and  the  depressed  portions  of  bone  were  removed.  The  scalp.-wound  was 
united  by  sutures,  and  a compress  of  cloths  wet  with  tepid  water  wmre  applied.  Rest  and  quiet  were  enjoined.  The  convulsions 
ceased  after  the  operation,  and  the  wound  discharged  freely.  The  patient  progressed  favorably,  and  was  discharged  from  service 
on  September  21st,  1863,  for  hemiplegia.  Acting  Assistant  Surgeon  John  W.  Robie  reports  the  case. 

Case. — Private  Charles  H , Co.  G,  61st  Ohio  Volunteers,  aged  37  years,  was  found  lying  in  the  street,  at  Alex- 

andria, Vii'ginia,  on  September  27th,  1863,  in  a comatose  condition,  with  a wound  on  the  right  side  of  his  head.  He  was 
conveyed  to  the  New  Hallowell  branch  of  the  3d  Division  General  Hospital,  by 
the  provost  guard.  On  admission  his  breathing  was  stertorous,  laborious, 
slow;  his  pulse  was  at  48,  full  and  regular.  There  was  a punctured  wound 
over  the  lower  portion  of  the  right  parietal,  and  an  examination  by  the  probe 
showed  that  the  bone  rvas  fractured  and  depressed.  A crucial  incision  was 
made  through  the  scalp,  and  the  cranium  being  freely  exposed,  it  was  found 
that  the  fracture  was  much  more  extensive  than  had  been  supposed.  A disk 
of  bone  was  removed  by  the  trephine,  and  several  detached  pieces  were 
removed  by  the  elevator,  so  that,  altogether,  a portion  foui’  inches  in  length 
by  two  inches  in  width  of  the  skull-cap  was  taken  away.  The  flaps  of  the 
integument  were  then  brought  together  and  were  united  by  sutures.  Cold 
water  dressings  were  applied.  The  immediate  effects  of  the  operation  were 
very  remarkable.  Iii  less  than  three  minutes  after  the  removal  of  the  de- 
pressed fragments,  the  patient  opened  his  eyes,  and  appeared  to  awake  to 
consciousness,  and  in  less  than  a minute  more  he  spoke,  articulating  dis- 
tinctly. For  the  first  week  after  the  operation  his  diet  was  restricted  to  barley  water.  On  October  4th,  seven  days  after  the 
operation,  ho  was  reported  to  have  had  no  bad  symptom  and  he  complained  of  nothing  but  hunger.  The  sutares  had  been 
removed,  and  the  greater  portion  of  the  incision  had  united  by  first  intention.  lie  was  now  allowed  the  “extra  diet”  of  the 
hospital,  consisting  of  oyster  broth,  i-ice  [ludding,  and  the  like.  On  October  2()th,  the  patient  was  uj)  and  about  the  ward.  No 
untoward  symptoms  had  intervened  meanwhile,  and  the  treatment  had  been  nnclianged.  At  this  date  the  ptitient  was  ))Ut  < u 
“half  diet,”  and  the  nearly  cicatriiied  wound  was  dressed  with  simple  cerate.  lie  continued  to  do  well  until  November  2{.th, 
when  he  was  visited  by  his  brother,  who  brought  him  some  bad  news  from  home  which  disturbed  him  very  much,  and  he 
immediately  went  to  bed  and  became  stupid  and  sullen,  taking  no  notice  of  auvtiung.  Is  it  not  possible  that  his  brother  brought 
8 


Fig.  22. — Section  of  cranium  with  great  less  of  sub- 
stance  from  the  removal  of  dcprcHsecl  frag^ments. — Spec* 
2673.  Sect.  1,  A.  JI.  M. 


58 


WOUNDS  AND  INJUPJES  OF  THE  HEAD 


liini  some  stimulant  as  well?  On  October  27tli,  tlie  i)atient  bad  become  comatose,  with  every  sign  of  compression  of  the 
brain,  and  on  October  28th,  1863,  he  died.  At  the  autoj)sy,  twenty  hours  after  death,  there  was  found  to  he  an  abscess  in 
the  right  hemisphere  and  the  neighboring  brain  substance  was  softened.  The  thoracic  and  abdominal  viscera  were  healthy. 
The  edges  of  the  apcrtur(i  were  found  to  be  rounded  off  and  in  process  of  repair.  The  notes  from  which  the  abstract  is 
compiled  were  made  by  Acting  Assistant  Surgeon  S.  B.  Vf  ard,  and  the  specimen  was  forwarded  to  the  Army  Medical  Museum 
by  Surgeon  E.  Bentley,  U.  S.  V.  It  is  represented  in  the  wood-cut  (Fig  22)  on  the  preceding  page. 

Case. — Private  John  T.  Jcnl-ins,  .5th  Alabama  Eegiment,  was  received  into  a regimental  hospital  at  Union  Mills, 
Fluvanna  county,  Virginia,  in  October,  1861,  suffering  from  compression  of  the  brain,  produced  by  a blow.  The  skull  was 
extensively  fractured.  Trejihining  was  unsuccessfully  performed.  The  patient  died  on  October  26th,  1861.  The  case  is  noted 
on  a monthly  report  of  sick  and  wounded  signed  by  Surgeon  A.  Venable,  C.  S.  A.,  and  no  further  particulars  can  be  obtained. 

Case. — Private  William  11.  Lowery,  Co.  C,  6th  Tennessee  Cavalry,  aged  22  years,  was  wounded  in  an  affray  at  Slem- 
phis,  Tennessee,  October  3d,  186-1,  receiving  a punctured  fracture  of  the  right  parietal  bone,  near  its  superior  posterior  angle, 
produced  by  a blow  of  a musket,  the  hammer  passing  through  both  tables  of  the  cranium.  He  remained  in  the  regimental  hos- 
pital until  October  13th,  when  he  entered  Gayoso  Hospital.  He  was  somewhat  drowsy  and  stupid,  but  no  other  symptoms  of 
compression  existed.  On  the  following  day  he  Avas  put  under  the  influence  of  chloroform,  and  Acting  Assistant  Surgeon  Julius 
Broy  trephined  the  skull  and  removed  a circular  portion  of  the  outer  table  and  three  depressed  fragments  of  the  inner  table. 
The  tip  of  the  little  finger  could  be  introduced  through  the  opening  made  in  the  skull,  and  it  appeared  that  there  Avas  no  injury 
to  the  dura  mater.  Cold  Avater  dressings  Avere  applied  to  the  Avound.  The  patient  Avas  restless  for  several  days,  and  slightly 
delirious  at  night.  Symptoms  of  cerebral  disturbance  Avere  thought  to  be  favorably  modified  by  the  use  of  the  extract  of  Can- 
nabis Indica.  On  October  18th,  an  intcrcurrent  attack  of  pneumonia  supervened.  On  November  3d,  there  Avere  signs  of  cerebral 
hernia.  Protrusion  of  the  cerebral  substance  progressed  so  rapidly,  that  on  November  6th,  it  Avas  deemed  expedient  to  compress 
the  fungous  mass  by  a bladder  of  ice.  On  November  7th  paralysis  of  the  left  arm  Avas  observed.  On  the  16th,  the  cerebral 
hernia  Avas  still  further  compressed  by  a metallic  disk.  Coma  supervened,  and  the  patient  died,  November  17th,  186-1.  Surgeon 
T.  N.  Burke,  U.  S.  V.,  furnished  the  notes  of  the  case. 

Case. — Private  E.  Miller,  Co.  G,  6th  Virginia  Cavalry,  aged  17  years,  Avas  Avounded,  in  a railroad  collision  on  the  Ohio 
and  Mississippi  Railroad,  near  Carlisle,  Illinois,  June  21st,  1865.  He  Avas  taken  to  IllinoistoAvn,  under  the  care  of  his 
regimental  surgeon.  Dr.  A.  II.  Thayer,  and  Avas  thence  sent  to  the  Marine  Hospital,  St.  Louis,  Missouri,  Avhere  a depressed 
fractui’e  of  the  cranium  Avas  diagnosticated.  Assistant  Surgeon  S.  M.  Horton,  U.  S.  Army,  decided  that  the  symptoms  of 
compi’ession  of  the  brain  demanded  an  operation,  and  applied  the  trephine,  and  remoA’ed  several  fragments  of  bone;  but  the 
symptoms  Avere  not  relieved,  and  the  case  terminated  fatally  in  the  night  of  June  23d,  1865.  Surgeon  T.  F.  Azpell,  U.  S.  V., 
reports  the  case. 

Case. — Private  Sumner  H.  Needham,  Co.  I,  6th  Massachusetts  Militia,  on  April  19th,  1861,  during  the  attack  upon  his 
regiment,  by  riotous  insurgents  in  Baltimore,  Maryland,  was  struck  on  the  forehead  by  a brick,  Avhich  fractured  the  frontal 
bone.  He  AA'as  conveyed  to  the  Baltimore  Utiiversity,  Avhere  his  wound  Avas  examined  by  Dr.  William  A.  Hammond,  Avho 
found  symptoms  of  compression  of  the  brain  demanding  the  application  of  the  trephine.  The  operation  Avas  immediately 
performed  by  Dr.  Hammond,  but  the  symjitoms  Avere  not  relieved,  and  the  patient  died  in  a feAV  hours,  April  19th,  1861.  Mr. 
Needliam,  a I'esident  of  LaAvrence,  Massachusetts,  was  one  of  the  earliest  victims  of  the  rebellion.* 

Case. — ^A  negro,  Avhose  name  Avas  unknoAvn,  Avas  brought  into  the  E Street  Infirmary,  Washington,  D.  C.,  Avith  Avell 
marked  symptoms  of  compression  of  the  brain,  in  the  latter  part  of  February,  1864.  He  Avas  examined  by  Assistant  Surgeon 
J.  W.  S.  Gouley,  U.  S.  A.,  Avho  found  a Avound  over  the  right  parietal  pro- 
tuberance, caused  apparently  by  a bloAV  from  the  head  of  an  axe.  The  scalp 
Avas  shaved,  and  it  Avas  found  that  there  Avas  a depressed  fracture  of  both  tables 
of  the  skull,  Avith  detachment  of  a large  fragment.  It  Avas  not  practicable  to 
insert  the  elevator  to  raise  the  depressed  fragment;  to  allow  this  to  be  done,  a 
disk  of  bone  Avas  removed  by  the  trephine.  A triangular  fragment,  measuring 
an  inch  bj-  one  and  a (piarter  inches,  Avas  then  removed  and  the  flaps  of  the 
scalp  Avere  approximated.  The  symptoms  of  compression  Avere  relieved,  and 
the  patient  Avas  doing  Avell  three  days  subsequently,  Avhen  the  specimen,  rep- 
resented in  the  adjacent  Avood-cut,  (Fig.  23),  Avas  forivarded  to  the  Army 
Medical  Museum.  The  facts  above  noted  are  taken  from  a minute,  made  upon 
the  reception  of  the  specimen,  hy  Surgeon  John  H.  Brinton,  U.  S.  V.  It  has 
been  impracticable  to  learn  the  ultimate  result  of  the  case;  but  a letter  from 
the  late  Assistant  Surgeon  T.  G.  Mackenzie,  U.  S.  A.,  dated  March  25th,  1864, 
states  that  the  man  Avas  doing  Avell  at  that  date,  though  his  left  arm  Avas  paralyzed.  Dr.  Mackenzie  refers  to  an  escape  of  brain 
substance  at  the  time  of  the  injury;  and  Dr.  Gouley,  in  forwarding  this  letter,  states  that  at  least  half  an  ounce  of  brain  matter 
Avas  lost,  and  comments  on  the  singular  good  fortune  of  the  patient  in  recovering  Avithout  the  supervention  of  cerebral  hernia, 
and  Avithout  loss  or  ajiparent  impairment  of  the  mental  faculties. 

Case. — A.  B.  Parish,  Quartermaster’s  Department,  received  a lacerated  Avound  of  the  frontal  region,  Avith  fracture  and 
depression  of  the  frontal  bone,  by  a kick  from  a horse,  near  Natchez,  Mississippi,  September  13th,  1864.  He  Avas  admitted  to 
the  hospital,  at  Natchez,  on  the  same  day,  in  a semi-comatose  condition.  Soon  after  his  admission.  Acting  Assistant  Surgeon 
James  S.  King  administered  chloroform,  and  trephined  the  skull,  and  raised  the  depressed  portion  of  bone  Avith  the  elcA'atoi'. 
The  patient  soon  reacted.  Tonics,  stimulants,  and  loAV  diet,  Avere  ordered.  The  patient  gradually  improved,  and  Avas  discharged 
from  the  hospital,  entirely  cured,  on  October  13,  1865. 

* llecord  of  the  Massachusetts  Volunteers,  1801-1805.  I’ublishcd  hy  the  Adjutant  C5eneral,  under  a Kesolve  of  the  General  Court.  Quarto. 
Boston,  1868,  vp-  Vol-  I,  p.  ^4. 


TREPHINING. 


59 


Case. — Private  P , 14th  Tennessee  Confederate  Infantry,  aged  25  years,  small  in  stature,  but  muscular,  received, 

in  a quarrel,  a wound  on  the  anterior  portion  of  the  parietal  bone,  from  a stone  held  in  the  clenched  fist  of  his  adversary.  He 
was  stunned  by  the  blow.  Fearing  punishment,  he  did  not  report  at  sick  call  for  several  days,  when  he  was  compelled  to  do  so 
because  of  the  supervention  of  erysipelas.  He  was  soon  relieved  of  this  complication ; but  in  a few  weeks,  became  subject  to 
epileptic  paroxysms,  which  recurred  every  four  or  five  days.  He  was  discharged  for  disability,  and  went  to  his  home,  at 
Springfield,  Tennessee.  Convulsions  recurred  with  such  fi-equency  and  violence  that  he  went  to  Nashville  in  May,  1862,  to  be 
treated  by  Dr.  W.  T.  Briggs,  of  the  medical  school  in  that  city.  His  general  health  was  poor,  the  countenance  pale,  the  bowels 
torpid,  the  pulse  quick  and  irritable.  A depression  of  the  skull  corresponded  with  the  cicatrix  of  the  original  wound.  There 
was  no  pain  about  the  cicatrix ; but  a sense  of  pressure  on  the  whole  side  of  the  head.  After  ten  days  of  preparatory  treat- 
ment, Dr.  Briggs,  assisted  by  Drs.  Bowling  and  Buchanan,  removed  a disk  of  bone  with  the  crown  of  a very  large  trephine. 
The  inner  surface  of  the  disk  presented  a sharp  angle  at  the  union  of  the  edges  of  the  depressed  inner  table.  Special 
instructions  were  given  that  the  patient  should  rest  quietly  in  bed,  but  he  disregarded  these  instructions,  yet  the  wound  healed 
in  ten  days,  and  there  was  no  recurrence  of  the  convulsions.  He  reentered  the  Confederate  service,  as  a so-called  “ Bartizan 
Ranger,”  and  was  captured  and  sentenced  to  be  hung,  but  escaped  before  the  sentence  was  executed;  and,  under  these  exciting 
circumstances  had  no  return  of  epilepsy.  The  abstract  of  the  case  is  compiled  from  a report  by  the  operator.* 


Case. — Private  James  Rogers,  Battery  L,  4th  Ohio  Artillery,  was  struck  on  the  head  by  a stone  on  Jlay  3d,  18G5, 
receiving  a depressed  fracture  of  the  skull.  He  was  admitted  to  the  hospital  at  New  Creek,  Virginia,  on  May  7th,  in  a comatose 
state.  He  remained  in  this  condition  until  May  9th,  when  he  was  placed  under  the  influence  of  ether,  and  Assistant  Surgeon 
S.  IM.  Finley,  22d  Pennsylvania  Cavalry,  applied  the  trephine  and  elevated  the  depressed  bone.  The  patient  reacted  well,  and 
simple  dressings  were  applied.  Erysipelas  supervened,  but  was  successfully  combated  by  chloride  of  iron.  The  patient 
improved  rapidly,  the  wound  was  cicatrized,  and  he  returned  to  duty,  well,  on  June  29th,  1865. 

Case. — Private  John  R , Co.  H,  2d  Michigan  Volunteers,  aged  41  years,  was  wounded  on  July  17th,  1865,  in  a 

street  affray,  receiving  four  wounds  of  the  head  from  stones  thrown  at  him.  He  was  admitted  to  Armory  Square  Hospital,  Wash- 
ington, D.  C.,  on  the  following  d.ay.  He  was  perfectly  conscious,  yet  had  marked  contraction  of  the  pupils,  with  accelerated 
pulse,  and  a tremulous  voice.  There  was  considerable  ecchymosis  about  the  orbits.  The  first  wound  examined  was  over  the 
frontal  eminence,  and  penetrated  no  further  than  the  aponeurosis  of  the  occipito-front.alis  muscle.  The  second  was  in  the  centre 
of  the  coronal  suture,  and  slightly  denuded  the  pericranium.  The  third  was  in  the  right  temporal  region,  and  likewise  was  a 
scalp  wound.  The  fourth  was  on  the  right  parietal  eminence;  and,  upon  a close  examination,  it  was  discovered  that  a minute 
depression  of  the  bone,  half  an  inch  in  diameter,  existed,  evidently  produced  by  a blow  from  the  sharp  edge  of  the  stone.  The 
patient  was  a stout,  muscular  man,  in  good  health;  he  suffered  no  nausea,  and  little  pain.  He  was  immediately  placed  under 
the  influence  of  ether,  and  Surgeon  D.  W.  Bliss,  U.  S.  V.,  after  shaving  the  scalp,  made  a crucial  incision  three  inches  in 
length,  having  the  wound  at  the  intersection  of  the  incisions,  and  then,  reflecting  the  flaps,  applied  the  crown  of  a trephine  and 
removed  a disk  of  bone,  which  was  found  to  include,  with  remarkable  exactness,  a depressed  fragment  of  the  vitreous  plate. 
Between  the  diploe  and  depressed  lamina  there  was  a coagulum.  The  dura  mater  was  unmjured.  The  wound  was  partly 
closed  by  four  sutures,  an  opening  being  left  over  the  perforation,  into  which  a 
pledget  of  charpie  was  inserted.  The  patient  recovered  favorably  from  the  anes- 
thetic, and  was  jmt  to  bed  and  ordered  to  observe  perfect  quiet  and  strict  diet. 

The  case  proceeded  without  an  unfavoi-able  symptom.  On  July  23d,  the  sutures 
were  removed.  On  July  24th,  the  compress  of  charpie  was  taken  away,  and  a 
healthy  granulating  surface  appeared  beneath.  These  facts  in  regard  to  the  case 
were  reported  by  Assistant  Surgeon  Charles  A.  Leale,  U.  S.  V.  The  pathologi- 
cal specimen  was  presented  to  the  Army  Medical  iluseum  by  the  operator,  and 
is  represented  in  Photograph  No.  87  of  the  Surgical  Section  of  the  Army  Medical 
Museum,  and  in  the  accompanying  wood-cut,  (Fig.  24.)  The  disk  is  seven-eighths  of  an  inch  in  diameter,  and  is  slightly 
reduced  in  the  illustration.  On  August  24th,  1835,  the  patient  was  transferred  to  Harper  Hospital  at  Detroit,  Michigan.  The 
case  continued  to  progress  favorably,  and  the  man  recovered  without  a bad  symptom.  He  was  discharged  from  service  on 
September  8th,  1865. 


Fig.  t34. — External  and  infernal  views  of  a button  of 
bone  removed  for  a depressed  fracture  by  a blow  fi'oni 
a stone. — Spec.  1452,  Sect.  I,  A.  M.  II. 


Case. — Private  James  C.  Shedd,  Co.  D,  11th  New  York  Cavalry,  aged  19  years,  was  thrown  from  his  horse  to  the 
pavement,  while  riding  through  the  streets  of  New  Orleans,  Louisiana,  April  10th,  1834.  There  was  a compound  comminuted 
fracture  of  the  cranium,  confined  principally  to  the  external  table,  which  was  depressed  about  au  inch  and  a half  in  length  and 
half  au  inch  in  depth.  He  was  conveyed  to  the  University  Hospital,  being  in  a stupid  condition,  in  consequence  of  the  concussion 
and  the  influence  of  liquor;  but,  at  times,  he  was  restless,  and  could  be  aroused  for  brief  periods  only  by  determined  eflbrts. 
Shortly  after  admission  he  was  placed  under  the  influence  of  chloroform.  Surgeon  Samuel  Kneeland,  U.  S.  V.,  then  enl.arged 
the  wound  of  the  scalp,  which  was  found  much  torn  and  bruised,  and  trephined  the  skull  at  the  anterior  jiortion  of  the  right 
parietal  region,  removing  several  pieces  of  bone  and  elevating  others.  Cold  water  was  applied  to  the  wound,  rest  and  (luiet 
enjoined,  and  light  diet  ordered.  The  case  progressed  favorably,  with  very  little  cerebral  disturbance,  and  on  the  Itlth  of  June, 
1854,  the  patient  was  discharged  from  the  service,  .as  a long  time  would  be  necessary  for  the  exfoliation  of  the  bone,  extensively 
denuded  of  periosteum.  His  general  health  and  strength  were  excellent. 

Case. — Jesse  Smith,  Freedman,  aged  18  years,  employed  as  a cattle  driver,  rolled  olf,  in  his  sleep,  from  the  hay  in  a 
stable  loft,  and  fell,  some  twelve  feet  to  the  floor,  striking  his  head.  He  was  found  in  the  morning,  cold  and  insensible,  lying 
on  the  stable  floor,  near  the  horses.  Under  the  use  of  frictions,  hot  drinks,  and  other  restoratives  ho  revived,  and  was  carried 
to  the  Freedmen's  Hospital,  at  Ale.xandria,  Virginia.  Acting  As.5istant  Surgeon  Robert  N.  Atwood,  found  a wound  of  the  scalj) 
of  a crucial  form  over  the  right  parietal  eminence,  and  a depressed  fracture  of  the  bone;  but,  as  the  general  condition  of  the 


'The  Nashville  Jounial  of  Jledicine  and  Surgery,  New  Scries,  186(1,  Vol.  I,  p.  35. 


60 


WOUNDS  AND  IJUPJES  OF  THE  HEAD, 


Fig.  25. — Disk  and  depressed 
fi’ai^inent  of  bone  fn)m  right 
parietal. — Sjjec.  4817,  Sect.  I,  A. 
M.  M. 


patient  was  comfortable,  sensibility  being  restored,  and  the  mental  faculties  being  apparently  normal,  Dr.  Atwood  decided  to 
await  further  developments.  No  decidedly  bad  cerebral  symptoms  appeared  for  twelve  days  after  the  injury,  when  the  patient 
complained  of  increased  lieadaohe,  and  a few  hours  subserpiently  had  a severe  convulsion.  On  the  following  day,  the  patient 
was  much  the  same  as  usual,  except  that  his  headache  was  increased.  Dr.  Atwood,  in  considtation  with  Acting  Assistant 
Surgeon  A.  yV.  K.  Andrews,  decided  to  operate,  and  (;ther  having  been  administered,  enlarged  the  original  wound  and  applied 
the  treitbine,  and  i-emoved  a button  of  bone  to  which  the  greater  portion  of  the  depres.sed  fragments  were  unit(.‘d  by  the  inner 
table.  On  removing  the  bone,  pus  gushed  out  copiously.  At  the  upper  posterior  part  of  the  perforation  the  inner  table  was 
detached  three-fourths  of  an  inch  more  -than  the  outer.  This  fragment  was,  with  some  difficulty, 
removed  by  strong  forceps.  An  hour  afterwards,  the  patient  having  recovered  from  the  ether, 
was  highly  excited,  restless,  anil  complained  of  intolerable  pain.  He  was  ordered  a grain  of 
sulphate  of  morphia,  and  in  two  hours  slept  comfortably.  For  ten  days  subsequently,  the  morphia 
was  continued,  being  given  to  the  extent  of  two  or  three  grains  daily.  His  diet,  at  this  time,  was 
bread  and  milk,  in  small  quantities,  acidulated  with  vinegar,  wliich  he  craved  earnestly.  Pie  also 
had  vinegar  and  water  to  drink.  In  three  days  after  the  operation  the  brain  commenced  to 
protrude  through  the  opening  in  the  skull,  and  by  the  tenth  day  had  attained  the  size  and  shape 
of  half  of  a hen’s  egg.  Dr.  Atwood  decided  to  try,  by  gentle  compression,  to  reduce  the  protru- 
sion, and  applied  a compress  and  retentive  bandage  with  this  view;  but  immediately  violent 
convulsions  occurred ; and,  although  the  compress  was  instantly  removed,  violent  convulsive  paroxysms  recurred  during  the 
night,  not  less  than  fifteen  or  twenty  times.  The  next  day  the  patient  was  hovering  between  life  and  deatb,  but  he  gradually 
rallied,  and  str.ange  to  say,  after  the  subsidence  of  the  convulsions  he  had  no  more  pain  in  his  head.  His  bowels  bad  been 
regular  throughout  his  illness,  and  he  had  taken  no  medicine  except  the  morphia,  which  was  discontinued  as  soon  as  the  pain 
in  the  head  ceased.  Convalescence  proceeded  rapidly;  the  protrusion  subsided;  a firm  and  dense  cicatrix  covered  the 
aperture  in  the  .skull;  and  the  patient  recovered  without  any  impairment  of  his  mental  faculties  or  motor  powers.  Several 
months  after  his  recovery  he  was  brought  to  the  Army  Medical  Museum  to  be  photographed.  The  picture  is  numbered  185  in 
the  Surgical  Series.  The  boy  was  then  in  perfectly  good  health,  and  his  faculties  were  unimpaired.  The  specimen  of  the  disk 
and  depressed  fragment  of  the  parietal  was  presented  to  the  Museum  by  Dr.  Atwood,  and  is  figured  in  the  accompanying  wood 
cut,  (IHg.  25.) 

Case. — Private  W.  H.  South,  Co.  H,  lG8th  Pennsylvania  Volunteers,  while  quartered  in  a house,  at  Washington,  North 
Carolina,  fell  down  stairs.  May  13th,  1833,  and  struck  upon  the  left  side  of  his  head.  The  medical  officer  of  the  garrison, 
As.sistant  Surgeon  P.  E.  Hubon,  27th  Massachusetts  Volunteers,  was  summoned,  and  found  that  there  was  a stellated  fracture 
of  the  cranium,  one  fissure  running  over  the  occipital  bone,  another  fissure  through  the  petrous  portion  of  tbe  left  temporal,  and 
a third  e.xtending  to  the  left  orbit.  At  the  point  of  impact  the  left  parietal  was  much  depressed.  The  patient  was  unconscious, 
and  stertorous  breathing,  dilated  pupils,  and  other  evidences  of  comjiression  of  the  brain  existed.  Dr.  Hubon  api)lied  the 
trephine  and  elevated  the  depressed  bone.  The  patient  did  not  regain  consciousness,  and  died  thirty-nine  hours  after  the 
accident.  May  15th,  1863.  The  case  appears  on  the  monthly  report  of  the  Post  Hospital,  Washington,  North  Carolina,  for 
Jlay,  1863. 

Case. — Private  Charles  E.  Towns,  Co.  I,  9.th  New  Hampshire  Volunteers,  was  thrown  from  his  horse,  and  falling  upon 
his  head,  received  a fracture  of  the  cranium.  He  was  treated  in  the  regimental  hospital  until  February  1st,  1865,  when  ho  was 
admitted  to  the  hospital  of  the  Second  Division  of  the  Ninth  Army  Corps.  The  accident  is  not  recorded  on  the  regimental 
reports,  and  it  is  impracticable  to  ascertain  its  date.  Such  facts  as  are  known  are  derived  from  the  report  of  the  Corps  Hospital. 
On  tile  patient's  admission  it  was  decided  that  compression  of  the  brain  with  depressed  bone  existed;  and  the  operation  of 
trephining  was  performed  by  Surgeon  L.  W.  Bliss,  51st  New  York  Volunteers.  The  date  and  other  particulars  are  wanting. 
The  jiatient  died,  February  20tb,  1865.  The  case  was  reported  by  Surgeon  F.  N.  Gibson,  9th  New  Hampshire  Volunteers. 


Case.— Private  Charles  Williams,  Co.  B,  161st  New  York  Volunteers,  was  admitted  into  St.  Louis  Hospital,  New 
Oi'leans,  Louisiana,  January  12th,  1835,  with  an  extensive  fracture  of  the  cranium  and  compression  of  the  brain,  caused  by  a 
blow  received  in  a steamboat  collision,  January  9th,  1835,  between  the  U.  S.  Transport  J.  H.  Dickey  and  the  Transport  John 
Eain,  on  the  Mississippi  River,  fifteen  miles  below  Vicksburg.  The  trephine  was  applied  and  a portion  of  depressed  bone  was 
elevated,  and  another  portion  was  removed.  The  p.atient  died  on  January  18th,  1835.  Surgeon  A.  McMahon,  U.  S.  V., 
records  the  case  on  his  monthly  report  without  particulars  of  the  operation  or  after  treatment. 

Case. — Private  Charles  V , Signal  Corps,  received,  on  February  24th,  1832,  at  Georgetown,  D.  C.,  a kick  from  a 

horse;  the  sharp  cork  of  the  shoe  penetrating  the  cranium  at  the  anterior  inferior  angle  of  the  parietal  bone,  driving  frag- 
ments of  the  internal  table  inward,  penetrating  tbe  dura  mater  and  rupturing  the 
middle  meningeal  artery.  He  was  seen  by  Assistant  Surgeon  John  S.  Billings, 
six  hours  after  the  reception  of  the  injury.  He  was  comatose,  and  presented  the 
usual  signs  of  compression  of  the  brain  from  depressed  fractui-c.  Dr.  Billings 
applied  the  trephine  and  removed  the  depressed  fragments,  and  also  about  two 
ounces  of  coagulated  blood.  The  jiatient  immediately  came  to  his  senses,  and 
did  ■well  for  four  days,  when  symptoms  of  cerebro-meningitis  set  in.  The  patient 
was  then  transferi-ed  to  the  ITnion  Hotel  Hospital.  Active  treatment  was  unavail- 
ing, and  dc'atb  followed  in  two  days,  or  on  March  2d,  1862.  The  autopsy  showed 
effusion  of  lyinj)!!  over  the  whole  of  the  right  hemisphere  of  the  cerebrum.  A 
portion  of  the  cranium,  showing  the  extent  of  bone  removed,  was  contributed, 

with  a memorandum  of  thci  case,  to  the  Army  Medical  Museum  by  Dr.  Billings.  , , „ , 

ilepre.sscd  iracturc  from  the  kick  of  a horse. — i>pcc. 

It  is  represented  in  tbe  adjacent  wood  cut,  (I  IG.  26.)  345J,  Sect.  I,  A.  M.  M. 


ANALYTICAL  EEVIEW. 


61 


Five  hundred  and  eight  cases  of  injuries  of  the  head,  resulting  from  railroad  accidents, 
falls,  blows,  or  analogous  causes,  have  been  enumerated  in  the  foregoing  pages  of  this 
Section.  They  comprise  nearly  all  of  the  cases  of  this  nature  reported  by  name  during 
the  war ; all,  in  fact,  in  which  the  nature  and  seat  of  the  injury  could  be  satisfactorily 
verified.  A large  proportion  pertain  to  the  two  latter  years  of  the  war,  when  the  system 
of  reporting  had  been  perfected.  A few  cases,  about  eighteen  altogether,  have  been 
gleaned  from  the  Confederate  records.  Of  the  whole  number  of  five  hundred  and  eight 
cases,  three  hundred  and  thirty-one  were  contusions  or  lacerations  of  the  integuments, 
without  serious  primary  or  secondary  injury  to  the  skull  or  its  contents ; seventy-two  were 
examples  of  injury  of  the  head  affecting  the  brain,  but  without  fracture  of  the  skull ; and 
one  hundred  and  five  were  instances  of  fracture  of  the  skull.  In  the  first  class,  all  of  the 
patients  recovered,  though  there  were  many  instances  of  troublesome  complications  from 
heemorrhage,  abscesses  under  the  scalp,  erysipelas,  and  sloughing.  In  the  second  class, 
the  percentage  of  complete  recovery  was  small,  as  fourteen  of  the  cases  terminated  fatally, 
and  fifty-three  patients  were  discharged  for  disability.  In  the  third  class,  the  mortality 
was  large,  fifty-seven  of  the  one  hundred  and  five  patients  having  died. 

Of  the  five  hundred  and  eight  cases,  seventy  resulted  from  railroad  accidents,  seventy- 
eight  from  falls,  two  hundred  and  six  from  blows,  and  one  hundred  and  fifty-four  from 
unspecified  causes  other  than  gunshot,  the  sabre,  or  the  bayonet. 

Analyzing  the  seventy  cases  of  injuries  by  railway  accidents,  it  is  found  that  forty- 
nine  were  contusions  and  lacerations  of  the  integuments,  attended,  in  some  instances,  with 
the  temporary  effects  of  concussion,  or  by  erysipelas,  sloughing,  or  burrowing  of  pus. 
Thirty-five  of  these  forty-nine  men  were  returned  to  duty,  and  fourteen  were  discharged 
for  disability.  Eleven  were  cases  of  severe  concussion,  or  contusion,  or  laceration  of  the 
brain,  and  of  these  patients,  two  were  returned  to  duty,  one  was  furloughed  and  not  heard 
from  afterwards,  one  was  discharged  as  permanently  blind,  one  died  from  pulmonary  com- 
plications, and  six  died  from  the  effects  of  the  accident.  Ten  were  cases  of  fracture  of 
the  skull,  and,  of  these  patients,  one  was  returned  to  duty,  one  was  transferred  to  the 
Veteran  Reserve  Corps,  one  was  discharged,  and  seven,  including  one  who  had  been 
unsuccessfully  trephined,  died.  In  short,  of  the  seventy  patients  reported  with  injuries  of 
the  head  from  railroad  accidents,  thirty-nine  went  to  duty,  seventeen  were  discharged,'*’ 
and  fourteen  died. 

Of  the  seventy-eight  cases  of  injuries  of  the  head  from  falls,  forty-three  were  exam- 
ples of  contusions  or  of  contused  or  lacerated  wounds,  followed  ultimately  by  recovery. 
Seventeen  were  attended  by  grave  concussion  of  the  brain,  or  other  serious  complications, 
and  of  these  seventeen  patients,  three  were  returned  to  duty,  nine  were  discharged,  one  was 
transferred  to  the  Veteran  Reserve  Corps,  one  deserted,  and  three  died.  Eighteen  were 
cases  of  fracture  of  the  skull,  and  thirteen  of  them  were  fatal.  Five  of  the  eighteen 
patients  were  subjected  to  trephining,  or  the  removal  of  fragments,  or  the  elevation  of 
depressed  bone,  and  three  of  the  five  recovered.  In  brief,  forty-nine  of  the  seventy-eight 
patients  were  returned  to  duty,  twelve  were  discharged,  sixteen  died,  and  one  was  doing 
well  at  the  last  report,  fifteen  days  after  undergoing  an  operation  for  the  elevation  of 
depressed  bone. 

* In  the  summaries,  the  m(!n  transferred  to  modifiesd  duty  in  the  Veteran  Reserve  Corps,  are  included  with  fliose  returned 
to  duty,  and  the  furloughed  men,  not  heard  from,  and  the  deserters,  witli  those  discharged. 


62 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Of  the  two  hundred  and  six  cases  of  injuries  of  the  head  from  blows,  the  scalp  alone 
was  seriously  involved  in  one  hundred  and  eighteen  ; six  of  these  patients  deserted,  and  the 
remainder  were  returned  to  duty.  Thirty-six  cases  were  attended  by  cerebral  complications  ; 
of  these  men,  three  went  to  duty,  three  to  modified  duty  in  the  Veteran  Reserve  Corps, 
twenty-seven  were  discharged,  and  one  died,  while  in  two  cases,  the  ultimate  result  has  not 
been  ascertained.  Fifty-two  were  instances  of  fractures  of  the  skull,  and  of  this  series  of 
patients,  seven  recovered  and  were  returned  to  duty,  one  was  transferred  to  the  Veteran 
Reserve  Corps,  fourteen  were  discharged  for  disability,  twenty-eight  died,'^  and  in  two  cases 
the  result  is  undetermined.  Operative  interference  was  employed  in  twenty  of  the  fifty-two 
fractures.  One  of  the  patients  went  to  duty,  six  were  discharged,  and  eleven  died,  and  in  two 
casesf  the  ultimate  issue  has  not  been  ascertained.  The  results  of  the  two  hundred  and  six 
cases  may  be  thus  recapitulated : one  hundred  and  twenty-six  went  to  duty,  forty-seven 
were  discharged,  twenty-nine  died,  while  in  four  cases  the  results  are  undetermined. 

Of  the  one  hundred  and  fifty-four  cases  of  injuries  of  the  head  from  unspecified  causes, 
one  hundred  and  twenty-one  refer  to  uncomplicated  contusions  or  lacerations  of  the  scalp. 
One  hundred  and  thirteen  of  these  patients  returned  to  duty,  and  eight  deserted.  In  eight 
cases,  the  brain  or  its  membranes  were  involved,  and  four  of  these  patients  were  discharged 
on  account  of  deafness,  paralysis,  or  impairment  of  the  mental  faculties,  one  was  transferred 
to  the  Veteran  Reserve  Corps,  and  three  died.  Twenty-five  cases  are  reported  as  instances 
of  fracture  of  the  skull ; but  in  several  of  the  cases  the  diagnosis  is  not  beyond  suspicion. 
Six  of  these  patients  are  reported  as  returned  to  duty,  two  were  furloughed,  eight  were  dis- 
charged for  disability,  and  nine  died. 

In  brief,  of  the  five  hundred  and  eight  patients  with  wounds  and  injuries  of  the  head, 
three  hundred  and  thirty-four  were  returned  to  duty,  ninety-eight  were  discharged,  seventy- 
one  died,  and,  in  five  cases,  the  results  are  undetermined. 

The  Contusions  of  the  Scalp,  from  miscellaneous  causes,  may  be  conveniently  sub- 
divided into  those  in  which  there  was  laceration  of  small  vessels  in  the  areolar  tissue  and 
limited  effusion  of  blood ; those  attended  by  extensive  ecchymosis  ; and  those  in  which  the 
tissues  were  pulpified  and  disorganized. J 

The  uncomplicated  contusions  of  the  scalp,  without  external  breach  of  surface,  that  were 
treated  in  hospital,  generally  required  but  little  surgical  interference.  They  were  commonly 
dressed  with  a spirit  or  lead  lotion,  at  first,  or  by  an  ice  bladder,  or  the  frigorific  mixture  of 
hydrochlorate  of  ammonia,  saltpetre,  and  salt,  recommended  by  Hennen^  and  Schmucker,^ 
conjoined  with  elevation  of  the  head,  and  an  antiphlogistic  regimen.  No  instance  of  the 
application  of  leeches  is  mentioned.  When  a large  amount  of  effused  blood  remained  long 
unabsorbed,  bandaging,  with  moderate  compression,  stimulating  frictions,  and  general  treat- 
ment were  sometimes  employed.  In  a few  cases,  the  bad  practice  of  incising  the  tumor  and 
squeezing  out  the  coagulum,  is  reported  to  have  been  adopted,  with  the  result  of  inducing 
inflammatory  action  and  unhealthy  suppuration. 


* The  case  of  Wiggins,  on  page  50,  should  have  been  recorded  as  fatal.  He  died  on  April  14th,  1865. 
t Already  referred  to  among  the  fifty- two  fractures. 

iDupuytreu,  it  is  well  known,  classified  contusions  in  four  degrees,  {Logons  Oralcs,  T.  IV,  p.  267;)  but  even  the  French 
surgeons  admit  that  either  the  third  or  fourth  division  is  “unpeu  arbitraire.”  See  Follin,  Traite  de  Fathologie  Lxterne,  T.  I, 
p.  386,  Paris,  1869. 

‘ Hennen.  Principles  of  Militwnj  Surgery,  3d  ed.,  London,  1829,  p.  283. 

SCHMUCKEE,  J.  L.  Chirurgiseke  Wahrnehmungen.  Berlin  und  Stettin,  1774,  Erster  Theil,  S.  89. 


ANALYTICAL  REVIEW. 


63 


In  quite  a large  number  of  the  contusions  of  the  scalp,  there  was  great  extravasation 
of  blood  under  the  occipito-frontalis  tendon  ; and,  in  several  of  these  cases,  suppuration 
ensued.  They  were  judiciously  treated  by  free  incisions  at  the  most  depending  parts,  the 
courses  of  the  larger  arterial  branches  being  avoided,  and  by  the  subsequent  application  of 
warm  water  dressings.  Though  complicated,  in  a few  instances,  by  erysipelas  and  slough- 
ing, recovery  eventually  resulted  in  all  of  these  cases.  There  were  also  examples  of  bruises 
of  the  scalp,  with  effusion  of  blood  in  the  meshes  of  the  condensed  cellular  tissue  connecting 
the  common  integument  with  the  occipito-frontalis  aponeurosis,  producing  that  remarkable 
condition  in  which,  the  effused  blood  coagulating  imperfectly,  the  portion  in  the  centre 
remaining  fluid,  and  the  scalp  being  apparently  depressed  at  this  point,  a depressed  fracture 
is  closely  simulated.  These  circumscribed  bosses,  hard  at  the  circumference  and  soft  and 
depressible  in  the  centre,  were  more  frequently  observed  over  the  lateral  regions  of  the  skull. 
Fortunately,  there  were  no  symtoms  of  affection  of  the  brain  in  these  cases,  and  the 
attendants  wisely  refrained  from  cutting  down  upon  the  bone.  Resolvent  lotions  and  the 
popular  plan  of  compressing  the  bump  by  one  or  two  coins  or  a bit  of  folded  sheet  lead, 
appeared  to  expedite  absorption.  In  two  cases,  the  plan  proposed  by  Champion,^  of  sud- 
denly compressing  the  tumor  by  a blow  severe  enough  to  rupture  the  sanguineous  cyst  and 
to  cause  the  blood  to  be  infiltrated  into  the  neighboring  cellular  tissue,  was  employed  with 
good  results.  In  these  cases,  a peculiar  crepitation,  due  doubtless  to  broken  fragments  of 
fibrinous  coagula,  was  observed. 

There  were  a few  instances  in  which  the  surface  of  the  scalp  was  unbroken  while  the 
tissues  composing  it  were  crushed  so  as  to  be  irretrievably  disorganized.  These  cases  were 
treated  by  warm  emollient  applications,  until  the  gangrene  that  ensued  had  ceased,  and  the 
sloughs  had  separated,  and  granulation  began  ; when  the  usual  means  of  promoting  cicatriza- 
tion were  employed. 

The  Contused  and  Lacerated  Wounds  of  the  Scalp  will  be  so  fully  considered  in  the 
section  on  gunshot  wounds  of  the  head,  that  few  comments  will  be  required  in  this  place. 
In  examining  the  detailed  histories  of  the  several  hundred  cases  barely  enumerated  in  the 
foregoing  part  of  this-  Section,  examples  are  found  of  almost  every  variety  of  injuries  of  this 
nature,  from  slight  solutions  of  continuity,  resembling  incised  wounds,  to  nearly  complete 
denudations  of  the  calvarium.  As  a general  rule,  the  treatment  of  these  lesions  appears  to 
have  been  simple  and  judicious.  That  axiom  of  practical  surgery  which  forbids,  in  the 
treatment  of  scalp  wounds,  the  sacrifice  of  the  smallest  portion  of  damaged  integument,  was 
almost  universally  observed ; and  the  means  adopted  of  replacing  and  connecting  detached 
flaps  of  integument  were  usually  well  selected.  In  several  cases,  very  large  portions  of  the 
scalp  were  described  as  nearly  torn  away,  hanging  by  slender  pieces  of  skin.  Such  injuries 
were  caused,  in  two  instances,  by  blows  from  muskets ; but  more  frequently  by  falls,  or  by 
the  passage  of  the  wheels  of  heavy  wagons,  caissons,  or  gun-carriages,  over  the  side  of  the 
head.  In  these  cases,  after  suppressing  haemorrhage,  on  the  rare  occasions  in  which  it  was 
troublesome,  after  cleansing  the  pendulous  flaps  from  the  dirt,  gravel,  or  other  foreign  bodies 
adhering  to  them,  and  after  divesting  them  and  the  adjacent  scalp  of  hair,  it  was  customary 
to  replace  the  flaps,  and  maintain  them  in  position,  either  by  agglutinative  plasters,  or  by 
sutures.  In  most  cases,  the  dressing  was  completed  by  the  application  of  compresses  dipped 

' Archives  Generales  de  Medecine,  Premiere  S6rie,  1827,  T.  XV,  p.  139. 


64 


WOUNDS  AND  INJUPwIES  OF  THE  HEAD 


in  cold  water,  and  maintained  by  a bandage.  In  some  instances,  layers  of  raw  cotton, 
cbarpie,  or  iDicked  oakum,  were  arranged  as  graduated  compresses  upon  the  flaps.  A few 
surgeons  preferred  to  apply  poultices  or  warm-water  dressings,  if  the  scalp  was  much 
mangled.  In  all  of  the  cases  of  detachment  of  large  flaps,  it  would  app'ear  that  the  peri- 
cranium was  fortunately  left  entire ; and,  though  many  of  these  cases  were  complicated  by 
erysipelas,  sloughing,  or  by  the  bagging  of  pus,  the  wounds  granulated  after  awhile,  and -all 
eventually  cicatrized.  No  instance  was  reported  of  any  special  inconvenience  arising  from 
the  employment  of  stitches.  In  one  case,  a very  long  wound  was  sewed  up  by  the  continued 
or  Glover’s  suture,  without  bad  consequences.  Usually,  when  adhesive  plasters  were  con- 
sidered insufficient  to  approximate  the  edges  of  the  wounds,  the  interrupted  suture  with 
metallic  threads  was  employed.  Assistant  Surgeon  J.  S.  Billings,  U.  S.  A.,  reports  a 
lacerated  wound  of  the  scalp  neatly  approximated  by  tying  together  the  hairs  bordering 
the  retracted  edges  of  the  wound.  This  expedient  answered  a good  purpose,  cicatrization 
following  as  promptly  as  usual  under  more  methodical  dressings. 

In  scalp  wounds  with  little  separation  of  the  edges,  adhesive  plasters  were  the  ordinary 
dressing.  The  importance  of  adjusting  the  parts  with  the  nicest  accuracy,  and  of  leaving 
sufficient  intervals  between  the  strips,  with  the  lower  angles  of  the  wound  open,  was  gen- 
erally appreciated.  The  propriety  of  removing  the  dressings  as  infrequently  as  practicable 
was  commonly  recognized.  In  the  hospitals  about  Philadelphia,  the  gauze  and  collodion 
dressing  recommended  by  Dr.  P.  B.  Goddard  found  favor ; but  the  isinglass  and  resin 
plasters,  supplied  by  the  field  medicine-chests  and  knapsacks,  were  the  agglutinatives  com- 
monly employed.  In  a few  cases,  it  is  stated  that  the  old-fashioned  Friar’s  Balsam'-’'  was 
advantageously  employed. 

The  complications  arising  in  this  class  of  wounds  of  the  scalp  were  haemorrhage, 
erysipelas,  abscess,  and  sloughing.  Several  instances  of  troublesome  bleeding  from  the 
posterior  auricular,  occipital,  or  temporal  arteries,  or  their  branches,  are  reported ; but,  in 
every  case,  the  hemorrhage  was  controlled  by  compression,  either  by  the  clamp  tourniquet, 
or  the  common  tourniquet,  or  by  a circular  bandage  and  compress,  or  by  a compress  con- 
sisting of  a metallic  disk.  In  one  case,  a profuse  secondary  bleeding  from  the  temporal  was 
arrested  by  dividing  the  vessel  transversely,  and  suffering  it  to  retract.  Persulphate  of  iron, 
in  powder  or  solution,  was  employed  as  a styptic  in  several  cases ; but  not  with  advantage. 
In  a case  in  which  it  appeared  that  ligation  must  be  resorted  to,  acupressure  was  suggested 
as  peculiarly  appropriate ; and  preparations  to  use  this  resource  were  made,  when  the 
bleeding,  being  controlled  by  pressure,  ceased,  and  did  not  recur.  Erysipelas  was  not  a very 
frequent  complication,  being  reported  in  but  thirteen  of  the  four  hundred  and  three  cases 
unattended  by  fracture.  Nearly  all  of  the  cases  in  which  it  supervened  were  attended  by 
symptoms  of  affection  of  the  membranes  of  the  brain,  or  of  the  brain  itself ; yet,  with  one 
exception,  (Kirkland,  p.  53),  they  terminated  favorably,  under  the  supporting  and  stimu- 
lating treatment  uniformly  adopted.  There  were  numerous  instances  of  abscesses  under  the 
scalp,  due  apparently,  in  most  cases,  to  negligence  in  keeping  the  detached  scalp  in  apposition 
with  the  subjacent  parts  by  gentle  bandaging,  or  to  the  retention  of  clots  of  blood  under  the 
flaps.  Incisions,  followed  by  fomentations  and  poultices,  and  the  washing  out  of  the  cavity 
of  the  abscess  by  warm  detergent  solutions,  appears  to  have  been  the  ordinary  treatment. 
In  many  of  the  contused  and  lacerated  wounds,  there  was  slight  loss  of  tissue  from  gangrene, 


* Compound  Tincture  of  Benzoin,  or  Baume  du  Commandeur,  or  Teinturc  halsamique  of  the  French  Codex. 


ANALYTICAL  REVIEW. 


65 


and  in  two  cases,  very  large  portions  of  the  scalp  sloughed  away,  yet  the  exposed  surface 
was  soon  covered  with  florid  granulations,  and  rapidly  cicatrized.  ' Detergent  or  stimulating 
lotions  were  employed  in  these  cases,  and  solutions  of  the  salts  of  zinc  or  the  permanganate 
of  potassa  were  the  applications  commonly  selected. 

Concussion  of  the  Brain. — It  will  he  remembered  that  the  five  hundred  and  eight 
cases  of  injuries  of  the  head  from  miscellaneous  causes  were  classified,  on  page  61,  in  three 
divisions  ; the  first  comprising  three  hundred  and  thirty-one  cases  of  injuries  of  the  integ- 
uments chiefly  ; the  second,  seventy-two  cases  of  severer  injuries,  with  cerebral  complica- 
tions ; and  the  third,  one  hundred  and  five  cases  of  fractures  of  the  skull.  In  the  second 
class  were  placed  only  those  cases  which  terminated  fatally,  or  in  discharge  for  disability, 
or  in  return  to  modified  duty  after  protracted  disability.  But  concussion  of  the  brain, 
temporary  in  its  effects,  was  observed  in  a large  proportion  of  the  three  hundred  and  thirty- 
one  slighter  cases  enumerated  in  the  first  class ; and,  in  fifteen  of  them,  this  complication 
was  .attended  by  profound  insensibility  and  collapse  and  appeared,  at  first,  to  be  very  serious, 
though  speedily  followed  by  reaction  and  recovery.  Severe  commotion  or  concussion  of  the 
brain  was  observed  in  fifty-nine  of  the  seventy-two  cases  of  the  second  class,  or,  altogether, 
in  seventy-four  of  the  four  hundred  and  three  cases  of  miscellaneous  injuries  of  the  head 
without  fracture.  The  treatment  of  this  condition  usually  consisted  in  wrapping  the  patient 
in  hot  blankets,  and  applying  bottles  of  hot  water  to  the  extremities,  in  employing  frictions, 
and  sinapisms,  and  stimulating  enemata;  and,  after  reaction  was  established,  in  prescribing 
purgatives,  low  diet,  and  rest  in  bed.  The  precautions  suggested  by  authors  respecting  the 
use  of  volatile  salts,  cordials,  and  venesection  during  the  stage  of  collapse,  appear  to  have 
been  observed  uniformly.  The  management  of  the  stage  of  reaction  appears,  also,  as  a 
general  rule,  to  have  been  prudent  and  judicious ; but  many  exceptions,  due  sometimes  to 
the  exigencies  of  the  situation,  and  sometimes  to  the  negligence  or  officiousness  of  the 
attendants,  are  noticed,  in  which  quiet  and  abstinence  were  not  enjoined,  or  stimulants  and 
full  diet  were  ordered  in  obedience  to  false  therapeutic  dogmas  in  preference  to  the  lessons 
of  experience.  To  these  causes,  probably,  must  be  attributed  the  considerable  number  of 
instances  in  which  concussion  was  followed  by  cerebral  irritation  or  encephalitis,  complica- 
tions which  will  be  considered  further  on.  In  one  case  of  concussion,  (Sherman,  p.  41,) 
when  reaction  was  becoming  over-action,  venesection  was  practiced,  with  apparent  advantage. 
In  one  case,  concussion  produced  almost  instant  death,  (Turner,  p.  44 ;)  but  neither  this 
nor  the  thirteen  other  cases  which  resulted  fatally  from  the  direct  effects  of  concussion,  throw 
any  light  upon  the  functional  or  textural  alterations  of  the  brain  resulting  from  this  shock, 
but  leave  the  subject,  which  has  perplexed  pathologists  for  so  many  centuries,  as  inscrutable 
as  ever. 

As  has  been  intimated  at  the  beginning  of  this  Section,  the  value  of  the  numerical 
statistics  relative  to  concussion  and  compression  of  the  brain  derivable  from  “monthly 
reports  of  sick  and  wounded,”  would  have  been  greater,  if  the  cases  due  to  miscellaneous 
causes  had  always  been  separated  from  those  resulting  from  injuries  by  gunshot  projectiles. 
In  the  first  year,  and  in  a portion  of  the  second  year,^  of  the  war,  the  reporters  failed  some- 
times to  make  this  important  discrimination  ; but,  subsequently,  explicit  instructions  having 


9 


66 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Leeu  promulgated,  the  gunshot  injuries  were  separately  reported.  The  number  of  cases 
of  concussion  and  compression  of  the  brain  recorded  on  the  monthly  reports  is  given  in 
the  following  table  ; 


Table  I. 

Cases  of  Concussion  or  Compression  of  the  Brain,  generalhj  from  Causes  other  than  Gun- 
shot, recorded  on  the  Monthly  Reports  during  the  War. 


Year. 

Mayand  June, 
IHOl. 

Year  ending 
June  .30, 1862. 

Year  ending 
June  30, 1863. 

Year  ending 
June  30,1864. 

Year  ending 

J une  30, 1865. 

Aggregate. 

White  'I’roops. 

Mean  strength  in  Field  and  Garrison  . , 

“ “ “ General  Hospitals  . 

41,5r>6 

‘279,590 

9,548 

630,761 

45,630 

6‘2‘2,058 

55,710 

574,0‘2‘2 

71,484 

515,517 

4.5,593 

Cases. 

Deaths. 

Cases. 

Deaths. 

Cases. 

Deaths. 

(’ases. 

Deatlis. 

Cases. 

Deaths. 

Cases. 

Deaths. 

Concns.sion  of  Brain 

7 

1 

144 

60 

19 

17 

‘295 

(>2 

234 

52 

193 

60 

873 

61 

193 

17 

Colored  Titoors. 

Mean  strength  in  Fiehl  and  Garrison  .. 

46,020 

1,222 

86,660 

.5,572 

66,340 

3,397 

General  lloypitiils . 

Cases 

Deaths. 

Cases. 

Deaths. 

Cases. 

Deaths. 

18 

0 

31 

13 

49 

22 

This  table  indicates  that  in  the  year  ending  June  30th,  1862,  there  was  one  case  of 
concussion  of  the  brain  in  a mean  strength  of  2,008,  and  that  of  144  cases,  one  in  7.5  was 
fatal.  In  the  following  year,  when  the  concussions  from  gunshot  injury  may  be  supposed 
to  have  been  generally  excluded,  there  was  one  case  of  concussion  in  a jiiean  strength  of 
2,292,  and  a mortality  of  one  in  4.7  cases.  In  the  third  complete  year  there  was,  among 
the  wliite  troops,  one  case  of  concussion  in  2,896,  and  a mortality  of  one  in  4.5  ; and,  in 
the  colored  troops,  one  case  of  concussion  in  2,625  cases,  with  a mortality  of  one  in  2 cases. 
In  the  fourth  year,  the  cases  of  concussion  were,  among  the  white  troops,  one  in  3,344  mean 
strength,  with  a mortality  of  one  in  3.2,  and,  among  the  colored  troops,  one  in  2,975  mean 
strength,  with  a mortality  of  one  in  2.4. 

The  report  of  Surgeon  Thomas  41.  Williams,  0.  S.  A.,  Medical  Director  of  the  Con- 
federate Army  of  Northern  Virginia,  shows  that  the  consolidation  of  the  monthly  reports 
of  sick  and  wounded  for  nine  months,  from  July,  1861,  to  March,  1862,  inclusive,  furnish 
eighteen  instances  of  concussion  of  the  brain  in  a mean  strength  of  49,394.  During  the 

*The  consolidations  for  white  troops  are  taken  from  page  040  of  the  medical  volume  of  the  First  Part  of  the  Medical  and 
Surgical  History  of  the  Rebellion.  The  consolidations  for  the  colored  troops  are  furnished  me  in  manuscript  by  Brevet  Lient. 
Col.  J.  J.  Woodward,  Assistant  Surgeon  U.  S.  A.  After  183.2,-  “compression  of  the  brain”  was  e.'ccluded  from  the  nomencla- 
ture of  the  monthly  report  of  sick  and  wounded.  The  deaths  are  understood  to  be  included  among  the  cases  : c.  g.,  of  144 
patients  with  concussion  of  the  brain,  during  the  year  ending  J une  30,  1862,  10  died.  • 


ATJALYTICAL  REVIEW. 


67 


months  of  September,  October,  November,  and  December,  1862,  of  an  aggregate  of  48,543 
patients  in  the  General  Hospitals  under  the  supervision  of  Surgeon  T.  H.  Williams,  0.  S.  A., 
there  were  sixteen  examples  of  concussion  of  the  brain.  All  of  these  thirty-four  cases 
terminated  favorably.  From  the  absence,  in  these  reports,  of  any  fatal  results  from  con- 
cussion, it  may  be  inferred  such  were  probably  entered  under  other  headings.  Of  the 
Confederate  systematic  writers  on  military  surgery,  the  compilers  of  the  official  manual' 
advise,  in  the  early  treatment  of  concussion,  the  use  of  external  warmth,  frictions,  and  diffu- 
sible stimuli ; Surgeon  J.  J.  Chisolm^,  C.  S.  A.,  thinks  “ the  safest  practice  consists  in  doing 
as  little  as  possible,  the  indiscriminate  use  of  stimuli  on  the  one  hand,  or  bloodletting  on 
the  other,  being  especially  avoided;”  while  the  Surgeon  General  of  North  Carolina,  E. 
Warren,^  with  strange  confusion,  “ in  order  that  the  pathological  difference  between  con- 
cussion and  compression  of  the  brain  may  be  thoroughly  comprehended,”  ascribes  to  con- 
cussion the  signs  almost  universally  believed  to  attend  compression.  The  “Confederate 
States  Medical  and  Surgical  Journal,”  published  under  the  auspices  of  Surgeon  General 
S.  P.  Moore,  C.  S.  A.,  contains  no  reference  to  the  treatment  of  concussion  of  the  brain,  and 
the  reports  and  treatises  above  alluded  to  furnish  the  scanty  information  to  be  derived  from 
the  Confederate  records. 

Fractures  of  the  /Skull. — Of  the  one  hundred  and  five  cases  of  fracture  of  the  skull 
recorded  in  this  Section,  forty-six  were  instances  of  simple  and  forty-three  of  comjiound 
fracture ; while,  in  sixteen  cases,  the  reports  are  silent  regarding  this  distinction.  Fifty- 
seven  of  the  one  hundred  and  five  cases  terminated  fatally ; in  three  cases,  the  ultimate 
results  cannot  be  learned  ; and  forty-five  patients  are  reported  as  recoveries.  The  causes 
of  death  in  the  fifty-seven  fatal  cases  were  ; compression  of  the  brain  from  fragments  of 
bone,  in  sixteen  cases;  laceration  of  the  brain,  in  five  cases'*;  shock  and  concussion,  in  two 
cases ; extravasation  of  blood,  in  sixteen  cases ; encephalitis,  in  ten  cases ; abscess  of  the 
brain,  in  six  cases  ; epilej)sy,  in  one  case  ; cerebral  hernia,  in  one  case.  Each  of  the  three 
undetermined  cases  was  doing  well  several  weeks  after  the  reception  of  the  injury.  Of  the 
forty-five  patients  reported  as  returned  to  duty,  thirty  had  simple  and  fifteen  compound 
fractures,  and  four  of  the  simple  and  seven  of  the  compound  fractures  were  depressed.  Of 
these  forty-five  patients,  seventeen  recovered  wholly,  and  were  returned  to  duty ; one 
recovered  and  was  mustered  out  on  the  expiration  of  his  term  of  service  ; another  recovered 
I'rom  the  injury  of  the  head,  and  was  discharged  on  account  of  the  loss  of  an  arm ; and 
twenty-six  were  discharged  on  account  of  physical  disabilities  of  various  degrees.  Epilepsy, 
in  three  cases ; hemiplegia  or  paraplegia,  in  three  cases  ; impaired  intellectual  functions, 
in  two  cases  ; deafness,  in  two  cases  ; imperfecd  vision,  in  one  case  ; vertigo  and  cephalalgia 
on  exposure  to  the  sun,  in  five  cases,  are  the  disabilities  particularly  specified.  It  is  safe  to 
say,  that  nineteen  of  the  one  hundred  and  five  patients  with  fractured  skull  recovered  com- 
pletely, that  twenty-nine  recovered  partially,  and  that  fifty-seven  died. 


* A Manual  of  Military  Surgery,  prepared  for  the  Use  of  tlee  Confederate  States  Army,  by  Order  of  the  Surgeon  General. 
Richmond,  1863,  p.  7. 

'^Chisolm.  A Manual  of  Military  Surgery  for  the  Use  of  Surgeons  of  the  Confederate  States  Army.  Columbia,  S.  C., 
1864,  p.  275. 

^ Warren.  An  Epitome  of  Practical  Surgery  for  Field  and  Hospital.  Richmond,  1863,  p.  351. 

■*  In  one  of  the  cases  of  laceration  of  the  brain  (Michaei,  B , p.  44)  there  was  cerebral  hernia,  as  well  as  in  the  case  of 

Lowery  (p.  51),  cited  two  lines  further  on.  In  tlie  latter,  this  complication  was,  appiu-cntly,  the  proximate  cause  of  death. 


68 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


All  of  the  cases,  twenty-eight  in  number,  of  fracture  of  the  skull  without  injury  to  the 
brain  or  its  membranes  terminated  favorably,  with  the  exce})tion  of  the  case  of  Private 
M.  Young  (p.  39),  complicated  by  a terrible  laceration  of  the  testes.  Fifty-eight  cases  in 
which  symptoms  of  compression  of  the  brain  supervened  immediately  or  soon  after  the  recep- 
tion of  the  injury,  present  forty-six  deaths,  three  instances  of  favorable  progress  a few  weeks 
after  the  injury  with  the  ultimate  results  undetermined,  and  three  examples  of  complete, 
and  six  of  partial  recovery.  In  the  nineteen  remaining  cases,  cerebral  complications 
appeared  at  a later  date  ten  of  the  nineteen  were  fatal ; eight  ended  in  permanent  dis- 
abilities, through  impairment  of  the  mental,  sensory,  or  motor  functions ; while  only  one 
patient  completely  recovered. 

It  was  observed  that  fissures  or  long  linear  fractures  with  little  depression,  as  a 
general  rule  characterized  the  fractures  of  the  skull  from  falls  or  railroad  accidents,  while 
extensive  splintering  of  the  internal  table  was  a very  frequent  consequence  of  blows  from 
blunt  weapons. 

The  portion  of  the  cranium  injured  is  referred  to  in  seventy-eight  of  the  reports,  and 
is  indicated  in  the  following  tabular  statement : 

Table  II. 


Seat  of  Injury  in  One  Hundred  and  Five  Fractures  of  the  Skull  from  Falls,  Blows,  &c. 


The  far  greater  fatality  of  fractures  of  the  side  and  base  of  the  cranium  than  of  those 
implicating  the  anterior  and  upper  portions  of  the  vault,  is  well  illustrated  by  these  figures. 

There  were  no  instances  of  fracture  of  the  internal  table  alone ; but  the  case  of  Cahill 
(p.  64),  and  that  of  Sharp  (p.  55),  afford,  perhaps,  illustrations  of  fracture  implicating  the 
external  table  only,  over  the  frontal  sinus  and  at  the  base  of  the  zygoma.  The  case  of 
Schneider  (p.  41)  also,  reported  among  the  severe  contusions,  the  patient  having  been 
discharged  on  account  of  obstinate  ozsena  from  ulceration  of  the  frontal  sinus,  possibly 
belongs  to  the  category  of  fractures  of  the  external  table.  The  frequency  of  such  fractures 

‘ At  incipcre  fehrem  in  capitis  milnerc,  quarta  die  aut  septima  aut  undecima,  valde  lethale  cst.  Hippociiates,  De  Prwdict. 
Lib.  II,  Sect.  II.  Cap.  10. 


ANALYTICAL  REVIEW. 


69 


has  heeii  overestimated  by  Sir  Astley  Cooper*  and  other  eminent  surgical  writers.  In  rare 
instances,  blows  upon  the  mastoid  or  zygomatic  processes,  or  frontal  sinuses,  produce  such 
an  injury  ; but,  over  the  vault  of  the  cranium,  a depression  of  the  outer  table  upon  tlie  diploe, 
without  lesion  of  the  vitreous  lamina,  is  oftener  described  in  books  than  demonstrated  by 
pathological  preparations.® 

Of  the  eleven  cases  of  fracture  of  the  base  of  the  cranium,  two  were  accompanied  by 
that  peculiar  colorless  discharge  from  the  auditory  canal  which  excited  so  much  discussion 
among  surgeons  thirty  years  ago,  and  which  is  held  to  be  a positive  indication  of  fissure  ol 
the  petrous  bone.^  Three  cases  of  fracture  .of  the  base  were  believed  to  be  instances  of 
fracture  by  contre-coup.  This  subject  will  be  fully  considered  hereafter,  and  it  will  be  shown 
that  the  existence  of  such  fractures,  in  the  sense  understood  by  Grima^  and  Saucerotte,  may 
be  fairly  called  in  question. 

In  seventy-nine  cases  of  fracture  of  the  skull  treated  without  operative  interference, 
the  death-rate  was  54.4.  Of  twenty-six  cases  operated  upon,  the  ultimate  results  are 
ascertained  in  twenty-three,  in  which  the  mortality-rate  was  60.8. 

Removal  of  Fragments  ahd  Trephining . — Of  the  twenty-six  depressed  fractures 
treated  by  the  removal  of  fragments  and  trephining,  five  were  caused  by  falls,  three  by 
railroad  or  steamboat  accidents,  and  eighteen  by  blows.  Fourteen  of  the  patients  died. 
Three  undetermined  cases  were  progressing  favorably  fifteen  days,  three  weeks,  and  four 
weeks,  respectively,  from  the  date  of  injury.  Nine  patients  recovered,  of  whom  two  went 
to  duty,  two  were  discharged  though  entirely  well,  and  five  were  discharged  for  disabilities 
due  to  cerebral  disorders.  In  brief,  it  may  be  said  of  the  twenty-six  cases  in  which  operative 
interference  was  employed,  that  complete  recovery  took  place  in  four  cases,  partial  recovery 
in  eight  cases,  and  death  in  fourteen  cases. 

The  cases  recorded  in  this  Section  afford  instances  of  commotion,  contusion,  laceration, 
and  compression  of  the  brain,  of  rupture  of  the  meningeal  arteries,  of  cerebral  irritation, 
of  perversion  or  loss  of  the  sensory  or  intellectual  functions,  of  various  paralyses,  of  puffy 
tumor  and  persistent  pain  in  the  scalp ; but  general  observations  on  these  subjects,  all  of 
which  will  appear  again  in  the  succeeding  Section,  may  be  reserved  for  the  conclusion  of 
this  Chapter. 


* Astley  Cooper.  Lectures  on  Surgery,  London,  1842,  p.  130. 

Specimen  48.53,  Section  I,  A.  M.  M.,  represents  a segment  of  tlie  frontal  hone  of  a young  man  who  received  a blow  fi-om 
a fireman’s  iron  “spanner”  upon  the  left  superciliary  ridge.  Such  competent  observers  as  Drs.  Thomas  Miller  and  Robert  King 
Stone,  of  Washington,  diagnosticated  a depression  of  the  outer  table  of  the  frontal  sinus.  Several  months  subsequently,  the 
patient  died  from  inflammation  of  the  brain,  and  an  extensive  depression  of  the  inner  table  was  revealed.  Tbe  large  collection  of 
specimens  of  fractures  of  the  skull  in  the  Army  Medical  Museum  fails  to  afford  a single  example  of  fractui-e  of  the  outer  table 
singly,  if  the  groovings  by  shell  fragments  and  incisions  hy  cutting  weapons  are  excluded. 

^ Bereng.arius,  in  his  work  on  Fractures  of  the  Cranium,  published  at  Bologna,  in  1518,  first  called  attention  to  this  phe- 
nomenon, and  Stalp.art  Van  der  Weil,  {Obs.  rarior.  cent,  prima,  Obs.  XV,  Leyden,  1728,  p.  68,)  cited  an  example,  and  quoted 
another  from  Langelot;  but  Laugier,  in  his  note  to  the  French  Institute,  in  1839,  pointed  out  the  significance  of  this  discharge 
in  diagnosis. 

Guima,  tSar  les  Conire-coups  dans  Ics  Ldsions  di  la  Teti.  Memoires  sur  les  Sujets  proposds  pour  les  Prix  de  TAcaddmie 
Royale  de  Chirurgie.  Paris,  1819,  T.  IV,  p.  207;  Saucerotte,  in  the  same  work,  Vol.  IV,  p.  290.  Sabouraut,  loc.  cit,  p. 
337,  and  many  others. 


70 


WOUNDS  AND  INJURIES  OF  THE  HEAD. 


Section  III. 


GUNSHOT  WOUNDS. 


In  modern  times,  the  proportion  of  wounds  and  injuries  of  the  head  received  in  action 
has  always  been  large.  In  the  late  war,  the  ratio  of  such  injuries  to  the  total  number  of 
casualties  was  especially  great,  because  the  men  frequently  fought  under  cover,  and  many 
of  the  engagements  were  of  the  nature  of  siege  operations.  More  than  twelve  thousand 
gunshot  wounds  of  the  head  must  be  discussed.  They  will  be  classified,  with  many  sub- 
divisions, into  those  affecting  the  scalp  only,  those  attended  with  injury  to  the  skull,  and 
those  implicating  the  encephalon. 

Gunshot  Wounds  of  the  Scalp.— The  number  of  such  cases  is  so  great  that  it  is 
only  practicable  to  present  a numerical  statement,  supplemented  by  details  of  the  fatal  and 
complicated  cases. 

Table  TII. 


Hesults  of  Several  Thousand  Seven  Hundred  and  Thirty-nine  Cases  of  Gunshot  Wounds  of 
the  Scaljp  reported  during  the  War  of  the  Uchellion. 


Patient.s. 

P 

"5 

P 

V.  R.  C. 

1 

Resigned. 

Dismissed.* 

1 Leave  of  ab- 
1 sence. 

! Discharged. 

1 

Furloughed. 

1 

Deserted. 

Transferred  to  i 

Gen’l  Hospital. 

! 

Paroled. 

Exchanged. 

Released  on 
oath. 

Unknown. 

Total. 

11 

167 

10 

10 

97 

35 

7 

337 

1-2C 

3108 

127 

542 

76 

261 

1427 

958 

6625 

U.  S.  Enlisted  Men  (colored) 

7 

7.5 

13 

2 

4 

26 

11 

138 

Citizen  Employes,  U.  S 

1 

4 

5 

10 

1 

5 

3 

o 

6 

8 

25 

Confederate  Enlisted  Men 

17 

65 

3 

118 

7 

156 

6 

108 

10 

114 

604 

Total 

162 

3420 

127 

10 

10 

97 

593 

201 

275 

1609 

8 

114 

10 

1103 

7739 

* The  iut'erence  from  the  records  is  that  these  ten  officers  were  not  dismissed  dishonorably,  but  were  stricken  from  the  rolls 
for  failing  to  comply  with  orders  to  report  their  condition  while  on  leave  of  absence. 


GUNSHOT  WOUNDS  OF  THE  SCALP. 


71 


The  following  fifty-four  fatal  cases  of  gunshot  wounds  of  the  scalp  are  reported  as 
uncomplicated.  In  every  instance,  the  most  careful  scrutiny  has  heen  exercised  to 
determine  if  any  injury  of  the  cranium,  or  its  contents,  was  susj)ected  by  the  surgical 
attendants  ; 

Case. — Private  Thomas  Arnisti'ong,  Co.  1),  ‘id  Maryland  Volunteers,  aged  48  years,  received  a flesh  wound  of  the  head, 
in  an  engagement  before  Petersburg,  Virginia,  July  i,  1864,  from  a conoidal  l)all.  He  was  at  once  admitted  to  the  Hospital  of 
the  Second  Division,  Ninth  Corps,  thence  sent  to  City  Point,  and  conveyed  to  the  DeCamp  Hospital  at  David’s  Island,  New  York, 
where  he  arrived  on  July  6th.  He  died  on  the  14th  of  July,  1854. 

Case. — Private  James  Barry,  Co.  D,  2d  New  York  Mounted  Eifles,  aged  30  years,  received,  in  an  engagement  before 
Petersburg,  Virginia,  June  18,  1864,  gunshot  flesh  wounds  of  the  head  and  arm.  He  was  admitted  to  the  hospital  of  the  Second 
Division,  Eighteenth  Corps,  and,  on  June  19th,  was  sent  to  the  First  Division  Hospital  at  Anna))olis,  Maryland,  where  he  died, 
June  22d,  1864.  The  late  Surgeon  B.  A.  Vanderkieft,  U.  S.  V.,  recorded  the  case. 

Case. — Sergeant  Harvey  F.  Beals,  Co.  C,  59th  New  York  Volunteers,  was  struck,  at  the  battle  of  Cold  Harbor,  Virginia, 
June  3d,  1864,  by  a fragment  of  shell,  which  caused  a flesh  wound  of  the  head.  He  was  admitted,  on  June  8th,  to  the  Columbian 
Hospital,  Washington,  D.  C.,  where  simple  dressings  were  applied.  Death  occurred  on  June  12th,  1864. 

Case. — Private  Horace  Bellows,  Co.  G,  98th  New  York  Volunteei-s,  aged  34  years,  was  wounded,  in  an  engagement  at 
Chapin’s  Farm,  Virginia,  September  29th,  1864,  by  a conoidal  ball,  which  sevei'ely  injured  the  scalp  over  the  right  side?  of  head. 
He  was  admitted  to  the  liospital  of  the  First  Division,  Eighteenth  Corps.  On  October  2d,  he  was  transferred  to  the  hospital  at 
Fort  Monroe,  Virginia,  and  on  October  15th,  to  the  White  Hall  Hospital,  near  Bristol,  Pennsylvania.  He  died  on  October  20th, 
1864.  Assistant  Surgeon  W.  H.  Forwood,  TP  S.  A.,  reported  the  case. 

Case. — Private  Rupert  Carney,  Co.  C,  28th  Pennsylvania  Volunteers,  aged  38  years,  received,  in  an  engagement  near 
Dallas,  Georgia,  May  25th,  1864,  a slight  gunshot  scalp  wound  of  the  back  of  the  head.  He  was  admitted  to  the  hospital  of  the 
Second  Division,  Twentieth  Corps,  and,  on  June  "2d,  was  transferred  to  the  hospital  at  Chattanooga;  thence,  on  June  11th,  to 
Hospital  No.  1,  Nashville,  Tennessee,  where  he  died,  on  June  15th,  1864,  from  the  effects  of  the  wound. 

Case. — Corporal  Win.  G.  Carr,  Co.  G,  13th  New  Hampshire  Volunteers,  aged  40  years,  received,  in  a skirmish,  on  !May 
13th,  1864,  a wound  of  the  scalp,  from  a fragment  of  shell  striking  over  the  left  aye,  and  making  a ragged  wound  an  inch  and  a 
half  in  length.  He  was  sent  to  the  hospital  at  Point  Lookout,  Maryland,  and  died  on  June  22d,  1884. 

Case. — Private  Frank  Carter,  Co.  F,  17th  New  .York  Volunteers,  aged  18  years,  was  wounded,  in  an  engagement  before 
Petersburg,  Virginia,  June  17th,  1864,  by  a fragment  of  shell,  which  cut  the  scalp  near  the  vertex.  He  was,  on  the  same  day, 
admitted  to  the  hospital  of  the  Second  Division,  Ninth  Corps,  and,  on  June  19th,  sent  to  the  Hospital  at  Annapolis.  The  wound 
was  ilressed  with  dry  lint,  sprinkled  with  opium.  ’The  patient  died  July  7th,  1864. 

Case. — Lientemmt  John  K.  Clemm,  Co.  K,  3d  Maryland  Volunteers,  received  at  the  battle  of  Chancellorsville,  Virginia, 
May  3d,  1863,  a slight  gunshot  flesh  wound  of  the  head.  He  w'as  admitted  to  the  field  hospital  of  the  First  Division,  Twelfth 
Corps.  He  died  on  May  22d,  1863.  Surgeon  A.  Chapel,  U.  S.  V.,  recorded  the  case. 

Case. — Private  Jackson  Clifton,  Co.  D,  107th  Illinois  Volunteers,  aged  22  years,  received,  at  the  battle  of  Fraidilin,  Ten- 
nessee, November  29th,  1834,  a shell  wound  of  the  light  side  of  the  scalp.  Ho  was  admitted,  on  December  1st,  to  Hos|)ital  No.  3, 
Nashville,  Tennessee,  where  simple  dressings  were  applied.  On  December  2d,  he  was  transferred  to  the  Jefferson  Hospital,  Jeffer- 
.sonville,  Indiana,  where  he  died,  on  December  17th,  1864,  from  the  “effects  of  wound.” 

Case. — Private  William  Coakley,  Co.  K,  28th  Massachusetts  Volunteers,  aged  40  years,  received,  in  an  engagement  before 
Petersburg,  Virginia,  June  16th,  1864,  a lacerated  wound  of  the  scalp  from  a fragment  of  shell.  He  was  admitted  to  the  hospital 
of  the  First  Division,  Second  Corps,  and  thence  sent  to  the  First  Division  Hospital  at  Annapolis,  Maryland,  which  he  entered  on 
June  20th.  Simple  dressings  were  applied  to  the  wound.  The  patient  died  on  June  28th,  1864. . 

Case. — Private  Stephen  Colledge,  Co.  E,  2d  Pennsylvania  Aitillery,  aged  33  years,  received,  in  an  engagement  before 
Petersburg,  Virginia,  June  18th,  1864,  a gunshot  wound  of  the  right  side  of  the  scalp.  lie  was,  on  the  next  day,  admitted  to  the 
hospital  of  the  Eighteenth  Corps,  and  on  June  21st,  was  sent  to  the  Chesapeake  Hospital,  near  Fort  Monroe,  where  he  died  on 
July  17th,  1864.  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  records  the  case. 

Case. — Private  Martin  Cornell,  Co.  H,  7th  Rhode  Island  Volunteers,  aged  33  years,  received,  at  the  battle  of  Spottsyl- 
v'ania  Court  House,  Virginia,  May  l‘2th,  1864,  a gunshot  wound  of  the  integuments  of  the  forehead,  over  the  right  eye.  He  was, 
at  once,  admitted  to  the  hospital  of  the  Second  Division,  Ninth  Corps.  On  May  16th,  he  was  sent  to  the  Ilarewood  Hospital, 
Washington,  D.  C.,  and,  on  May'  18th,  was  transferred  to  the  First  Division  Hospital,  Annapolis,  Maryland,  where  he  died,  on 
June  1st,  1854.  Tlie  late  Surgeon  B.  A.  Vanderkieft,  U.  S.  V.,  recorded  the  case. 

Case. — Private  Albert  L.  Curtis,  Co.  D,  17th  Maine  Volunteers,  aged  ‘20  years,  was  .struck,  near  Petersburg,  Virginia, 
June  17th,  1834,  by  a fragment  of  shell,  which  caused  a flesh  wound  of  the  head.  He  was  admitted  to  the  hospital  of  the  Third 
Division,  Second  Corp.s,  and  thence,  on  the  21st,  conveyed  to  Wiushington,  D.  C.,  to  the  Lincoln  Hospital.  On  the  ‘27th,  he  was 
sent  to  Cony  Hospital,  at  Augusta,  Maine.  Death  occurred  on  August  l‘2th,  1864.  Surgeon  G.  Derby,  U.  S.  V.,  rejiorted  the 
case. 

Case. — Private  Van  Buren  Danner,  Co.  II,  87th  Pennsylvania  Volunteers,  aged  ‘26  years,  was  struck,  at  the  battle  of  Win- 
chester, Virginia,  September  19th,  1864,  by  a conoidal  bull,  which  produced  a lacerated  wound  of  the  scalp  over  the  left  frontal 


72 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


eminence.  He  was  admitted  to  the  depot  field  hospital  on  the  same  day.  On  the  25th,  he  was  sent  to  the  hospital  at  Sandy  Hook, 
Maryland,  and  on  the  2Gth,  he  was  transferred  to  the  Sixteentli  and  Filbert  Streets  Hospital,  Philadelphia,  lie  died  on  Novem- 
ber 10th,  1864.  Surgeon  T.  B.  Reed,  U.  S.  V.,  reported  the  case. 

Case. — Private  John  Duett,  Co.  E,  8th  Maine  Volunteers,  aged  26  years,  received  in  an  engagement  at  Drury’s  Bluff, 
Virginia,  May  16th,  1864,  a wound  of  the  scalp  in  the  occipital  region  from  a grape  shot.  He  was,  on  May  18th,  admitted  to  the 
hospital  at  Point  Lookout,  Maryland,  where  he  died  on  July  4th,  1864.  Surgeon  A.  Heger,  U.  S.  A.,  recorded  tlie  case. 

Case. — Eben  L.  Farrar,  Musician,  Co.  I,  96th  New  York  Volunteers,  aged  19  years,  was  wounded  in  an  engagment  before 
Petersburg,  Virginia,  June  23,  1864,  by  a conoidal  ball,  which  tore  the  scalp  over  the  parietal  bone.  He  was  at  once  admitted 
to  the  field  hospital  of  the  Eigliteenth  Corps,  and,  on  June  25th,  transferred  to  the  Hampton  Hospital,  Fortress  Monroe.  Simple 
dressings  were  applied  to  the  wound.  He  died  on  July  4th,  1864,  from  the  “effects  of  the  scalp  wound.” 

Case. — Private  William  Finke,  Co.  I,  13th  Indiana  Volunteers,  aged  25  years,  was  wounded  in  an  engagement  near 
Bermuda  Hundred,  Virginia,  on  May  20th,  1864,  by  a conoidal  ball,  which  toi’e  the  scalp.  He  was  admitted  to  the  hospital  of 
the  First  Division,  Tenth  Corps;  on  May  21st,  he  was  sent  to  flie  hospital  at  Foi't  Monroe,  and  on  June  1st,  1864,  transferred  to 
the  Ward  Hospital,  Newark,  New  Jersey,  where  he  died  on  June  15th,  1864.  'The  late  Surgeon  G.  Taylor,  U.  S.  A.,  recorded 
the  case. 

Case.— Private  Leroy  W.  Freeman,  Co.  H,  142d  Pennsylvania  Volunteers,  aged  18  years,  was  wounded  in  an  engage- 
ment at  the  South  Side  Railroad,  October  27th,  1864,  by  a conoidal  ball,  which  struck  over  the  right  parietal  bone.  He  was,  on 
October  29th,  admitted  to  the  hospital  steamer  Connecticut,  and  conveyed  to  Washington,  D.  C.,  where  he  entered  the  Emory 
Hospital  on  October  30th.  Simple  dressings  were  applied  to  the  wound.  Death  occurred  on  November  12th,  1864,  “from  hectic 
fever.”  Surgeon  N.  R.  Moseley,  U.  S.  V.,  reported  the  case. 

Case. — Private  L.  Garrett,  Co.  C,  56th  Alabama  Regiment,  was  admitted  to  the  prison  liospital  at  Nashville,  Tennessee, 
with  a gunshot  wound  of  the  scalp.  He  died  on  November  5th,  1863.  Acting  Assistant  Surgeon  T.  G.  Hickman  reported  the 
case. 

Case. — Private  W.  A.  Giles,  Co.  C,  98th  Ohio  Volunteers,  received  near  Atlanta,  Georgia,  August  6th,  1864,  a gunshot 
wound  of  the  scalp,  and  was  sent  to  the  hospital  of  the  Second  Division  of  the  Fourteenth  Corps.  He  was  transferred,  on  August 
24th,  to  Chattanooga,  Tennessee,  and  died,  at  Hospital  No.  1,  on  August  29th,  1864. 

Case. — Private  George  Graff,  Co.  E,  32d  Indiana  Volunteers,  was  struck  by  a conoidal  musket  ball,  near  Dallas,  Georgia, 
May  26th,  1864,  and  was  received  at  Chattanooga,  Tennessee,  on  June  3d,  with  a severe  lacerated  wound  of  the  scalp.  He  died 
June  5th,  1864.  Surgeon  E.  B.  Collins,  51st  Indiana  Volunteers,  records  the  case. 

Case. — Private  George  Hall,  Co.  D,  30th  United  States  Colored  Troops,  aged  20  years,  received,  in  an  engagement  before 
Petersburg,  Virginia,  J uly  30th,  1864,  a shell  wound  of  the  scalp.  He  was,  on  August  1st,  admitted  to  the  hospital  for  colored 
troops  at  City  Point,  and,  on  August  14th,  was  transferred  to  the  Summit  House  Hospital,  Philadelphia,  where  he  died  on  Sep- 
tember 5th,  1864.  Surgeon  J.  H.  Taylor,  U.  S.  V.,  reported  the  case. 

Case. — Private  O.  J.  Hardin,  Co.  K,  68th  Georgia  Regiment,  aged  23  years,  received  at  the  h.attle  of  Gettysburg,  Penn- 
sylvania, July  1st,  1863,  a gunshot  wound  of  the  scalp.  He  was  probably  treated  in  a field  ho.spital  until  July  20th,  when  he 
was  admitted  to  the  Chimborazo  Hospital,  Richmond,  Virginia,  where  he  died  on  August  7th,  1863. 

Case. — Private  Daniel  C.  Harrison,  Co.  C,  76th  Illinois  Volunteers,  received  during  the  siege  of  Fort  Blakely,  Alabama, 
April  8th,  1865,  a severe  guilshot  wound  of  the  scalp.  He  was  admitted  to  the  field  hospital  of  the  Second  Division,  Thirteenth 
Corps,  and,  on  April  11th,  was  ordered  to  be  transferred  to  the  St.  Louis  Hospital,  New  Orleans,  but  died  on  April  14th,  1865, 
on  tlie  journey.  Surgeon  O.  Peabody,  23d  Iowa  Volunteers,  records  the  case. 

Case. — Private  John  Holmes,  Co.  C,  98th  Ohio  Volunteers,  was  struck  over  the  occipital  region  by  a conoidal  ball,  at 
Atlanta,  Georgia,  August  6th,  1864.  At  the  hospital  of  the  Second  Division,  Fourteenth  Corps,  and  at  the  Chattanooga  Hospital, 
the  injury  was  regarded  as  a simple  laceration  of  the  scalp.  He  died  at  Chattanooga,  August  18th,  1864. 

Case.— Private  David  J.  Huganer,  Co.  K,  6th  New  York  Heavy  Artillery,  aged  42  years,  was  wounded,  at  Cold  Harbor, 
Virginia,  May  30th,  1864,  by  a conoidal  ball,  which  caused  a wound  of  the  scalp  on  the  back  of  the  head.  He  was  admitted  to 
the  hospital  of  the  Third  Division,  Fifth  Corps;  on  June  3d,  sent  to  the  Stanton  Hospital,  Washington,  D.  C.,  and,  on  June  21st, 
transferred  to  the  McDougall  Hospital,  New  York,  where  he  died,  on  October  5th,  1864,  from  “e.xhaustion  following  gunshot 
wound.”  Assistant  Surgeon  S.  H.  Orton,  U.  S.  A.,  reported  the  case. 

Case.  Private  James  Ireland,  Co.  K,  21st  Connecticut  Volunteers,  aged  18  years,  received  a gunshot  wound  of  the  scal)i 
at  the  battle  of  Cold  Harbor,  Virginia,  June  3d,  1864.  He  was,  on  June  6th,  admitted  to  the  Mount  Pleasant  Hospital,  Wash- 
ington, 1).  C.,  and,  on  June  12th,  transferred  to  the  McClellan  Hospital,  Philadelphia,  where  the  injury  is  diagnosed  as  gunsliot 
flesh  wound  of  right  cheek.  He  died  on  June  16th,  1864.  The  late  Surgeon  Lewis  Taylor,  IT.  S.  A.,  reported  the  case. 

Case.— Private  Andrew  Jackson,  Co.  G,  5th  Texas  Regiment,  was  wounded,  at  the  battle  of  Gettysburg,  Pennsylvania 
J uly  3d,  1883,  on  the  right  side  of  the  scalp,  by  a gunshot  projectile.  He  was  admitted  to  the  Seminary  Hospital,  where  he  died 
on  July  23d,  1863.  Surgeon  Henry  Janes,  U.  S.  V.,  recorded  the  case. 

Case.  Private  Jahez  Johnson,  Co.  A,  29th  Virginia  Regiment,  was  wounded  and  made  a prisoner  in  the  retreat  of  the 
Confederate  army  from  the  lines  of  Petersburg,  in  April,  1865.  He  was  admitted,  on  April  17th,  to  the  hospital  at  Point  of  Rocks, 
with  what  appeared  to  be  a lacerated  gunshot  wound  limited  to  the  scalp.  Ho  died  on  April  24th,  1865. 


FATAL  GUNSHOT  WOUNDS  OF  THE  SCALP. 


73 


Case. — Private  Wui.  A.  Johnson,  Co.  C,  24th  Kentucky  Volunteers,  was  wounded  in  tlie  scalp,  by  gunshot,  at  Resaca, 
Georgia,  May  14th,  1864.  He  was  sent  to  Chattanooga,  Tennessee,  and  died  on  the  day  of  liis  admission  to  Hospital  No.  1,  May 
20th,  1864.  Surgeon  Francis  Salter,  U.  S.  V.,  reported  the  case. 

Case. — Sergeant  Francis  M.  Jones,  Co.  F,  36th  Indiana  Volunteers,  aged  28  years,  I’eceived,  in  an  engagement  at  Marietta, 
Georgia,  June  23d,  1864,  a severe  gunshot  wound  of  the  scalp.  He  was  admitted  to  the  hospital  of  the  First  Division,  Fourth 
Corps,  and,  on  June  27th,  was  sent  northward.  On  July  1st,  1864,  he  entered  Hospital  No.  1,  Nashville,  Tennessee,  and  died, 
on  .July  12th,  1864,  “li’pm  wound.”  Surgeon  B.  B.  Breed,  U.  S.  V.,  reported  the  case. 

Case. — Private  Gideon  M.  Jones,  Co.  B,  25th  Ohio  Volunteeis,  aged  43  years,  was  wounded,  in  an  engagement  at  Honey 
Hill,  South  Carolina,  November  30th,  1864,  by  a musket  ball,  which  caused  a scalp  wound  of  the  occipital  region.  Fie  was,  on 
the  following  day,  admitted  to  the  hospital  at  Hilton  Head.  Simple  dressings  were  applied;  but  death  took  place  on  January 
14th,  1865,  “from  wound.”  Assistant  Surgeon  C.  T.  Reber,  U.  S.  V.,  reported  the  case. 

Case. — Private  Lewis  Kumpf,  Co.  D,  12th  Missouri  Vol«nteers,  aged  40  years,  received,  at  the  battle  of  Resaca,  Georgia, 
May  14th,  1864,  a gimshot  scalp  wound  of  the  left  side  of  the  head.  He  was,  on  the  same  day,  admitted  to  the  hospital  of  the 
First  Division,  F'ifteenth  Corps;  on  May  23d,  was  sent  to  the  fiield  hospital,  Chattanooga,  Tennessee,  and,  on  May  25th,  trans- 
ferred to  Hospital  No.  1,  Nashville,  Tennessee,  where  he  died  on  June  5th,  1864. 

Case. — Private  Chauncey  C.  Moore,  Co.  D,  42d  Illinois  Volunteers,  received,  at  the  battle  of  Chattanooga,  Tennessee. 
November  24th  and  25th,  1863,  a gunshot  wound  of  the  scalp  of  the  right  side  of  the  head.  He  was  treated,  for  a few  days,  in  a 
field  hospital,  and,  on  December  1st,  was  admitted  to  the  general  hospital  at  Chattanooga.  He  died  on  December  18th,  1863. 

Case. — Corporal  S.  B.  Mortes,  Co.  K,  1st  South  Carolina  Regiment,  was  admitted  to  the  Jackson  Hospital,  Richmond, 
Virginia,  May  15th,  1864,  Svith  a gunshot  wound  of  the  scalp.  He  died  on  May  24th,  1864.  Di'.  Wellford,  C.  S.  A.,  recorded 
the  case. 

Case.— Piivate  .John  Nicholson,  Co.  D,  56th  Massachusetts  Volunteers,  aged  18  years,  i-oceived,  at  the  battle  of  the  Wil- 
derness, May  6th,  1864,  a gunshot  wound  of  the  scalp,  over  the  frontal  bone.  He  was,  on  M.ay  14th,  admitted  to  the  Columbian 
Hospital,  Washington,  D.  C.,  where  simple  dressings  \vere  applied.  He  died  on  May  30th,  1864.  Reported  bj'  Surgeon  T.  R. 
Crosby,  U.  S.  V. 

Case. — Private  Lewis  Noble,  Co.  C,  73d  Ohio  Volunteers,  received,  at  the  engagement  at  Tunnel  Hill,  Georgia,  July  20th, 
1864,  a gunshot  fiesh  wound  of  the  head.  He  was  sent  from  the  hospital  of  the  Third  Division,  Twentieth  Corps,  for  transfer  to 
the  rear,  and  died  on  his  way  to  Chattanooga,  July  25th,  1864. 

Case. — Corporal  Lawrence  C.  Pepoon,  (10th  Sharpshooters,)  00th  Ohio  Regiment,  aged  21  years,  received  in  an  engage- 
ment before  Petersburg,  Virginia,  July  (ith,  1804,  a gunshot  wound  of  the  head,  obliquely  across  the  occipital  protuberance.  I'he 
bone  was  apparentlj^  uninjured.  He  was  admitted  to  the  hospital  of  the  Third  Division,  Ninth  Corps,  where  simple  dressings 
were  applied  to  the  wound.  On  July  15th,  he  was  sent  to  theFilbertStreetllospital,  Philadelphia,  when  death  occurred  on.Iidy 
24th,  1864,  from  “the  effects  of  the  wound.”  Assistant  Surgeon  S.  A.  Storrow,  IT.  S.  A.,  reported  the  case. 

Case. — Private  Michael  Raher,  Co.  D,  44th  Ohio  Volunteers,  was  struck  hy  a gunshot  projectile  at  Lewisburg,  Virginia, 
May  23d,  1862,  receiving  a wound  of  the  integuments  over  the  os  frontis  without  any  injury  to  the  bone.  He  was  admitted  to 
the  Washington  Park  Hospital,  Cincinnati,  Ohio,  on  June  16th,  and  died  on  .June  21st,  1862.  Reported  by  Dr.  ,J.  B.  Smith. 

Case. — Private  Chauncey  Reeves,  Co.  F',  19th  Michigan  Volunteers,  at  Resaca,  Georgia,  May  14th,  1864,  was  struck  by 
a musket  ball,  which  produced  a lacerated  wound  of  the  left  side  of  the  scalp.  He  was  treated  at  the  hospital  of  the  Third 
Division,  Twentieth  Corps.  He  died  on  klay  16th,  1864.  Recorded  by  Surgeon  W.  C.  Bennett,  U.  S.  V. 

Case. — Private  Albert  A.  Roaks,  Co.  H,  21st  Kentucky  Volunteers,  aged  36  years,  was  wounded  in  an  engagement  near 
Marietta,  Georgia,  June  26th,  1864,  by  a conoidal  musket  ball,  which  caused  a flesh  wound  of  the  head.  He  was  admitted  to  the 
hospital  of  the  First  Division,  F'ourth  Corps,  and,  on  the  1st  of  July,  w.as  sent  to  Hospital  No.  1,  Nashville,  Tennessee,  but  was 
transferred,  on  .July  6th,  to  the  .Jefferson  Hospital,  Jeffersonville,  Indiana.  Death  ensued  .July  20th,  1864. 

Case.— Private  James  Rowley,  Co.  C,  4th  New  York  Cavalry,  aged  17  yeai’s,  received  in  an  engagement  near  Charles- 
town, Virginia,  August  29th,  1864,  a gunshot  wound  of  the  scalp.  He  was,  on  the  following  day,  admitted  to  the  hospital  at 
Sandy  Hook,  Maryland,  where  simple  dressings  were  applied.  Death  occurred  on  Sejjtember  1st,  1864,  from  “effects  of  wound.” 

Case. — Private  Wm.  Sebring,  Co.  1,  14th  Ohio  Volunteers,  at  Chickamauga,  September  19th,  1863,  received  a lacerated 
gunshot  wound  of  the  left  side  of  the  scalp.  He  was  taken  to  the  hospital  of  the  T’hird  Division,  J'^ourteenth  Corps,  and  thence 
to  the  Chattanooga  Hospital,  where  he  died  on  October  9th,  1863.  Surgeon  Israel  Moses,  U.  S.  V.,  reported  the  case. 

Case. — Sergeant  Nelson  I'.  Steinhour,  Co.  H,  4th  New  Hampshire  Volunteers,  aged  23  years,  received  in  an  engagement 
before  Petei-sburg,  Virginia,  June  30th,  1864,  a gunshot  wound  of  the  scalp.  He  was  admitted,  on  .July  3d,  to  the  hospital  at 
J’ort  iMonroe.  Irritative  fever  followed,  and  the  patient  died  from  exhaustion,  on  July  10th,  1864. 

Case. — Corporal  William  A.  Stewart,  Co.  B,  15th  Ohio  Volunteers,  aged  21  years,  received  at  the  battle  of  Nashville, 
Tennessee,  December  15th,  1864,  a simple  flesh  wound  of  the  scalp.  He  was  admitted  to  the  hospital  of  the  Third  Division, 
J'^ourth  Corps,  was  thence  transferred  to  Hospital  No.  1,  Nashville,  Tennessee,  and,  on  December  20th,  sent  to  the  hospital  at 
Jeffersonville,  Indiana,  where  he  died  on  January  24th,  1865,  from  the  “effects  of  tlie  wounil.” 

10 


74 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Private  John  Stringer,  Co.  G,  Cth  U.  S.  Colored  Troops,  received,  at  Wilmington,  North  Carolina,  February  19th, 
180.5,  a slight  lacerated  wound  of  the  scalp  by  a musket  ball.  At  the  hospital  for  Colored  Troops,  the  injury  was  regarded  as 
trivial,  yet  death  followed  from  the  effects  of  the  wound  on  February  2Gth,  1805.  Recorded  by  Surgeon  D.  W.  Hand,  U.  S.  V. 

C!ase. — Private  William  Tait,  Co.  F,  100th  Pennsylvania  Volunteers,  aged  40  years,  received,  at  the  battle  of  Spottsyl- 
vania,  Vii’ginia,  May  12th,  1804,  a gunshot  wound  of  the  scalp.  He  was  admitted  to  the  hospital  of  the  First  Division,  Ninth 
Corps.  On  May  15th,  he  was  sent  to  the  Mount  I'leasant  Hospital,  Washington,  I).  C.,  and,  on  IMa}'  19th,  to  the  McClellan 
Hospital,  Pliiladelphia,  where  he  died  on  May  28th,  1804.  Surgeon  Lewis  Taylor,  U.  S.  A.,  reported  the  case. 

Case. — Private  David  Titus,  Co.  M,  1st  New  Jersey  Caviilry,  aged  19  years,  received,  at  the  battle  of  the  Wilderness, 
Virginia,  May  5th,  1804,  a gunshot  wound  of  the  scalp,  over  the  left  temporal  region.  On  May  12th,  he  was  admitted  to  Mount 
Pleasant  Hospital,  Washington,  D.  C.,  and  on  June  10th,  transfeiTod  to  DeCamp  Hospital,  New  York  Harbor,  where  he  died  on 
.Tune  21st,  1804.  Assistant  Surgeon  Warren  Webster,  II.  S.  A.,  reported  the  case. 

Case. — Lieutenant  John  Van  De  Sande,  Co.  B,  115th  New  York  Volunteers,  aged  31  years,  received,  in  an  engagement 
near  M.alvern  Hill,  Virginia,  August  ICth,  1804,  a severe  gunshot  wound  of  the  scalp.  He  was,  on  August  17th,  admitted  to  the 
hospital  at  Foit  Monroe,  Virginia,  where  he  died  on  September  3d,  1804.  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  reported 
the  case. 

Case. — Private  Jackson  IV.  Vorhees,  Co.  1,  27th  Michigan  Volunteers,  aged  38  years,  received,  at  the  b.attle  of  Cold  Har- 
bor, Virginia,  June  3d,  1804,  a gunshot  flesh  wound  of  the  left  tem]>le.  lie  was,  on  June  8th,  admitted  to  the  hospital  of  the 
Third  Division,  Ninth  Corps,  and  on  .Tune  14th,  to  the  Second  Division  Hospitiil  at  Alexandria.  Simple  dressings  were  .applied. 
Death  occurred  on  .Tune  28th,  1804.  Surgeon  T.  Rush  Spencer,  U.  S.  V.,  I’epoj'ted  the  c.ase. 

Case. — Private  James  Waller,  Co.  B,  1st  North  Carolina  Regiment,  received  a very  slight  gunshot  wound  of  the  scalji,  at 
the  battle  of  Gaines’s  Mills,  Virginia,  June  27th,  1602.  He  was  admitted  to  Ilow.ard  Grove  Hospital,  near  Richmond,  Virginia, 
and  died  July  1.5th,  1802.  Surgeon  C.  D.  Rice,  P.  A.  C.  S.,  recorded  the  case. 

Case. — Private  Ezekiel  Wimmer,  Co.  C,  30th  Illinois  Volunteers,  aged  22  years,  received,  at  the  battle  of  Fr.anklin,  Ten- 
nessee, November  30th,  1804,  a gunshot  wound  of  the  scalp.  Ho  was,  on  the  following  d.ay,  admitted  to  Hospital  No.  1.5,  Nash- 
ville, and,  on  December  3d,  sent  to  the  .lefferson  Hospital,  Jeffersonville,  Indiana,  where  he  died,  on  December  17th,  1804,  from 
“ fleets  of  wound.”  Surgeon  M.  Goldsmith,  U.  S.  V.,  recorded  the  case. 

Case.— Private  Win.  G.  Young,  Co.  G,  41th  Illinois  Volunteers,  aged  24  years,  receiv'ed,  at  Marietta,  Georgia,  .Tune  20th, 
1804,  a gunshot  W'ound  of  the  scalp.  He  w'as  admitt(‘d  to  the  hospital  of  the  Second  Division,  Fourth  Corps,  on  the  following 
day,  .and  transferred  to  Chattanooga,  on  .Tuly  2d,  and  di(‘d  on  .Julj'  3d,  1804.  Assistant  Surgeon  C.  C.  Byrne,  U.  S.  A.,  reported 
the  case. 

Case. — Sergeant  W.  H.  Zimmerman,  Co.  E,  11th  Pennsylvania  Volunteers,  .aged  25  ye.ars,  at  the  battle  oj'  the  Wilderness, 
Vii’ginia,  May  0th,  1864,  received  a scalp  wound  over  the  right  p.arietal  region,  from  a musket  ball,  which  lodged  beneath  the 
integument.  The  missile  was  extracted  on  the  field,  and  the  jiatient  was  sent  to  the  re.ar,  .and  conveyed  finally  to  Washington, 
D.  C.,  entering  Armory  Square  Hospital  on  May  26th.  He  died  on  June  20th,  1.864. 

Nine  patients,  witli  gunshot  wounds  of  the  sc<alp,  died  while  on  furlough,  and  it  has 
been  impossible  to  obtain  particulars  of  the  complications  which  led  to  the  fatal  results; 

Case. — Corporal  Selah  B.  Alden,  Co.  D,  13th  Massachusetts  Volunteers,  aged  32  j’cars,  received  at  the  battle  of  the  Wil- 
derness, Virginia,  May  8th,  1804,  a gunshot  wound  of  the  scalji.  He  was  admitted  to  the  regimental  hospital,  and  thence  sent 
to  the  Campbell  Hospital,  Washington,  D.  C.,  on  May  I’Jtb.  On  May  17th  he  was  furloughed,  and,  according  to  the  registers 
of  the  Pension  Bureau,  and  the  records  of  the  Adjutant  General  of  Massachusetts,  he  died  at  Natick,  May  25th,  1804. 

Case. — Private  Thomas  Bowles,  Co.  I,  28th  Kentucky  Volunteers,  aged  28  years,  received,  in  an  action  at  .Spring  Hill, 
Tennessee,  November  29th,  18(!4,  a wound  of  the  scalp  by  a conoidal  musket  ball.  He  was  admitted  into  the  field  hospital  of  the 
Second  Division,  Fourth  Arm}’  Corps,  and,  on  the  following  day,  was  sent  to  Nashville  and  admitted  into  the  No.  8 Hospital. 
Simple  dressings  were  used.  On  December  3d,  he  was  transferred  to  Jeffersonville,  Indiana,  and  admitted  into  the  general  hos- 
pital at  that  place.  The  report  of  the  Adjutant  General  of  Kentucky  states  that  he  died,  while  on  Airlough,  February  6th,  1805, 
“from  wounds  received  in  action.” 

Case.— Private  Thom.as  Bryant,  Co.  C,  118th  Pennsylvania  Volunteers,  aged  29  yeai's,  received,  at  the  battle  of  the  Wil- 
derness, Virgini.a,  May  7th,  1804,  a slight  wound  of  the  scalp  from  a fragment  of  shell.  He  was  admitted  to  the  hospital  of  the 
First  Division,  Fifth  Corps,  and,  ou  May  12th,  he  was  sent  to  the  Campbell  Hospital,  Washington,  1).  C.  On  May  27th  he  was 
furloughed,  and  died  while  on  furlough,  July  10th,  1864.  .Surgeon  A.  F.  Sheldon,  U.  S.  V.,  reports  the  case. 

Case. — Private  J.  11.  Chase,  Co.  I,  106th  New  York  Volunteers,  aged  42  years,  was  admitted  to  the  Lincoln  Hospital, 
Washington,  1).  C.,  on  August  19th,  1864,  with  a contused  gunshot  wound  of  the  scalp.  He  was  furloughed  on  November  4th, 
and  died  while  on  furlough,  December  12th,  1804. 

Case. — Private  H.  F.  lligbv,  Co.  H,  121st  New  York  Volunteei  s,  aged  25  j'ears,  was  wounded,  at  the  battle  of  Spottsyl- 
vania,  Virgiui<a,  May  11th,  1864,  by  a conoidal  ball,  wbieh  cut  the  sc.alp  at  the  superior  front.al  region.  He  was  admitted  to  the 
hospital  of  the  First  Division,  Sixth  Corps,  .and,  on  May  16th,  was  sent  to  the  Mount  Pleasant  Hospital,  Washington,  D.  C.  The 
W’ound  did  well,  and  the  patient  was  furloughed  on  May  21st.  He  died,  while  on  leave.  May  27th,  1804. 


COMPLICATED  GUNSHOT  WOUNDS  OF  THE  SCALP. 


75 


Case. — Pi-ivate  1*1.  F.  Hosmer,  Co.  A,  9tli  New  York  Heavy  Artilleiy,  aged  18  years,  received,  at  the  battle  of  Cedar 
Creek,  Virginia,  October  19th,  1864,  a severe  gunshot  wound  of  tlie  scalp.  He  was,  on  the  same  day,  admitted  to  the  hospital  of 
the  Third  Division,  Sixth  CorjjS-,  and  thence  was  sent  to  the  Cuyler  Hospital  at  Germantown,  Pennsylvania,  where  he  entered  on 
October  24th.  He  was  furloughed  on  November  Cth;  and  died,  while  on  furlough,  December  9th,  1804. 

Case. — Lieutenant  John  Jimgerich,  Adjutant  121st  Pennsylvania  Volunteers,  received,  at  the  battle  of  North  Anna  Diver, 
Virginia,  May  23d,  1864,  a slight  gunshot  flesh  wound  over  the  right  side  of  the  frontal  bone.  He  was  taken  to  the  hospital  of 
the  Fourth  Division,  Fifth  Corps,  and  thence  was  sent  to  Washington.  On  May  31st,  he  was  granted  leave,  and  died  on  June 
23d,  1864,  while  on  leave  of  absence. 

Case. — Private  Eobert  F.  Parkhill,  Co.  B,  9th  New  York  Artillery,  aged  27  years,  received,  at  the  battle  of  Cedar  Greek', 
Virginia,  October  19th,  1864,  a severe  .shell  wound  of  the  scalp.  He  was  admitted  to  the  hospital  of  the  Third  Division,  Sixth 
Corps.  On  October  24th,  he  was  sent  to  the  Sheridan  Hospital,  Winchester,  Virginia,  and  thence  to  the  hospital  at  York,  Penn- 
sylvania, which  he  entered  on  October  26th.  Under  simple  dressings  the  wound  was  doing  well,  and  on  November  7th,  the  patient 
was  furloughed.  He  died,  while  on  furlough,  November  12th,  1864. 

Case. — Private  William  F.  Small,  Co.  B,  7th  New  Hampshire  Volunteers,  received,  in  an  engagement  in  front  of  Peters- 
burg, Virginia,  on  May  10th,  1864,  a gunshot  wound  of  the  scalp,  inflicted  by  a conoidal  musket  ball.  He  was  admitted  into 
the  hospital  at  Hampton,  Virginia,  on  May  11th,  and,  on  June  8th,  was  transferred  to  De  Camp  Hospital,  David’s  Island,  New 
York.  On  November  1st,  1864,  he  was  considered  convalescent,  and  received  a furlougli,  and  died,  while  at  home,  on  .Tune 
29th,  1865. 

The  records  are  silent  regarding  the  causes  of  death  in  the  sixty -three  examples  of  gun- 
shot wounds  of  the  scalp  here  enumerated.  The  average  interval  between  the  reception  of 
the  injury  and  the  latal  termination  was  twciity-seven  days.  It  may  he  suspected  that  in 
most,  if  not  all,  of  these  cases,  there  was  some  undiscovered  primary  or  secondary  lesion  of 
the  skull  or  its  contents,  hut  precise  evidence  on  the  suliject  is  wanting.  The  seat  of  injury 
is  specified  in  twenty-seven  cases;  as  in  the  i'rontal  i-egion  in  seven,  the  temporal  in  two, 
the  parietal  in  twelve,  the  occipital  in  six. 

Gnimliot  Scalp  Wounds  followed  hy  Encephalitis. — In  the  following  cases  of  gunshot 
wounds  of  the  scalp,  which  terminated  fatally  from  inflammation  of  the  hrain  or  its  mem- 
branes, the  reports  indicate  that  the  injuries  were  carefully  examined,  and  that  the  observers 
were  convinced  that  there  were  no  primary  lesions  of  the  skull : 

Case. — Piivate  William  H.  Alliiigtou,  Co.  C,  141st  New  York  Volunteers,  aged  21  years,  received,  at  the  engagement 
before  Dallas,  Georgia,  Maj'  25th,  1864,  a gunshot  ilesli  wound  of  the  forehead,  from  a musket  ball.  He  was  admitted  into  the 
field  hospit.al  f)f  the  Twentietli  Corps.  Simple  dressings  were  used.  The  ]iatient  was  transferred  to  the  Cumberland  Hospital, 
Nashville,  Tennessee,  on  .Tune  2d.  Meningitis  set  in  soon  afterwards,  .and  resulted  fatally,  on  .June  11th,  1864.  The  case  is 
reported  by  Surgeon  C.  McDerinont,  U.  S.  V. 

Ca.se. — Private  Albert  E.  Ammon,  Co.  H,  27th  Indiana  Volunteers,  aged  21  years,  was  wounded,  in  the  engagement  near 
Dallas,  Georgia,  May  25th,  1864,  by  a conoidal  musket  ball,  which  caused  a slight  wound  of  the  scalp.  lie  was  admitted  to  the 
hospital  of  the  Fii  st  Division,  Twentieth  Corps,  and,  on  June  1st,  was  sent  to  the  field  hospital  at  Chattanooga,  Tennessee.  Mcn- 
ingitk  supervened,  and  death  took  place  on  .Tune  10th,  1864.  Assistant  Surgeon  C.  C.  Byrne,  U.  S.  A.,  rei)orts  tlu*  case. 

Case. — Pi  ivate  Simon  Birdsell,  Co.  I,  32d  Illinois  Volunteers,  received  a severe  gunshot  wound  of  the  integuments  of  the 
forehead,  at  the  battle  of  Shiloh,  April  6th,  1862.  He  was  tre.ated  by  Brigade  Surg(“on  William  Dickinson,  U.  S.  V.,  and  was 
conveyed  on  an  hospital  steamer  to  the  hospital  at  Benton  Barracks,  St.  Louis.  The  wound  progressed  very  favorably,  and,  on 
May  5th,  the  patient  was  considered  convalescent,  and  was  furloughed  to  go  to  his  home  at  latan,  Morgan  County,  Illinois. 
Inflammation  of  the  brain  supervened,  and  the  case  termimated  fatally  on  .Tune  2d,  1862.  The  attending  phj'sician,  George  M. 
Smith,  M.  D.,  of  latan,  reports  the  case. 

Case. — Private  Charles  Brown,  Co.  D,  23d  United  States  Colored  Troops,  received,  in  an  engagement  before  I’etersburg, 
Virginia,  July  13th,  1864,  a severe  gunshot  wound  of  the  scalp.  He  was  admitted  to  the  hospital  of  the  Fourth  Division,  Ninth 
Corps.  On  .July  31st,  he  was  sent  to  the  hospital  for  colored  troops  at  Citj'  Ikiint,  and,  on  August  17th,  he  was  placed  on  the 
steamer  Baltic  for  transportation  to  the  Satterlce  Hospital  at  Philadelphia.  Surgeon  1. 1.  Hayes,  IT.  S.  V.,  reports  that  convulsive 
fits  supervened,  and  that  death  took  place  aboard  the  steamer  on  August  18th,  18()4. 

Case. — Private  Thomas  Casey,  Co.  F,  11th  Illinois  Volunteers,  was  wounded,  at  Fort  Douelson,  Tennessee,  February  16th, 
1862,  by  a musket  ball,  which  glazed  the  left  side  of  the  head,  producing  a slight  scalp  wound,  which  was  considered  of  trivial 
importance.  The  man  was  sent  to  the  Academy  Hospital  at  Nashville,  Tennessee,  and  remained  in  a comfortable  condition  until 
Februai’j’  26th,  when  he  complained  of  violent  headache,  and  soon  aftei-wards  became  wildly  delirious.  He  was  freely  purged, 
and  a blister  was  ajiplied  to  the  nape  of  the  neck,  and  there  was  great  apparent  improvement,  until  March  10th,  when  a relapse 
took  place,  and  symptoms  of  compression  of  the  brain  supervened,  terminating  eventually  in  coma.  He  died  on  March  21st, 
1862.  Acting  Assistant  Surgeon  W,  P.  .Tones  recorded  the  case. 


76 


■WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Case. — Sergeant  Tliomas  Elliott,  Co.  E,  19tli  Wisconsin  'Volunteers,  aged  28  years,  received  a lacerated  gunshot  wound 
of  the  scalp,  near  Petersburg,  Virginia,  June  30th,  1864,  and  was  taken  to  the  corps  field  hospital.  He  was  transferred,  on  the 
following  day,  to  the  base  hospital  at  Point  of  Rocks,  and  thence,  on  July  4th,  to  Chesapeake  Hospital,  and  thence,  on  July  14th, 
to  the  McDougal  Hospital,  New  York  harbor.  He  died  on  August  11th,  1864,  of  subacute  encephalitis. 

Case. — Private  John  H.  Fridley,  Co.  K,  28th  Virginia  Regiment,  received,  at  the  battle  of  Gettysburg,  Pennsylvania,  July 
2d,  1863,  a gunshot  wound  of  the  head.  He  was,  on  the  same  day,  admitted  to  the  Seminary  Hospital  at  Gettysburg,  and,  on 
June  17th,  he  was  sent  to  the  hospital  at  Chester,  Pennsylvania.  Meningitis  set  in,  and  death  resiilted  on  August  13th,  1863. 
Surgeon  E.  Swift,  U.  S.  A.,  records  the  case. 

Case. — Private  David  Garrett,  Co.  A,  98th  Pennsylvania  Volunteers,  aged  20  years,  received,  at  the  battle  of  Cedar  Creek, 
Virginia,  October  19th,  1864,  a gunshot  scalp  wound.  He  was  taken  to  the  hospital  of  the  Second  Division,  Sixth  Corps,  and,  on 
October  23d,  he  was  admitted  to  the  Satterlee  Hospital,  at  Philadelphia.  The  injury  was  considered  slight,  as  the  patient  was 
furloughed  in  a short  time  after  his  admission.  While  at  home,  inflammation  of  the  brain  supervened,  and  he  died  on  November 
9tli,  1864.  The  case  is  reported  by  Surgeon  I.  I.  Hayes,  U.  S.  V. 

Case.— Private  Augustus  Ilether,  Co.  K,  98tli  Pennsylvania  Volunteers,  aged  46  years,  was  wounded  at  the  battle  of 
Spottsylvania  Court  House,  Virginia, 'May  12th,  1864,  by  a conoidal  musket  ball,  which  severely  lacerated  the  scalp.  He  was 
immediately  conveyed  to  the  hospital  of  the  Second  Division,  Sixth  Corps;  thence  transferred  to  the  First  Division  Hospital  at 
Alexandria.  Death  resulted  on  June  17th,  1864.  Surgeon  E.  Bentley,  U.  S.  V.,  reports  the  case. 

« 

Case. — Serge.ant  'William  P.  Holden,  Co.  G,  2d  Maine  Volunteers,  aged  26  years,  was  admitted  to  the  hospital  at  Annap- 
olis, Maryland,  on  November  15th,  1862,  with  a gunshot  wound  of  the  integuments  of  the  forehead.  The  wound  granulated 
kindly,  and  cicatrization  was  almost  complete,  and  the  patient  improved  sti'adily  until  May  5th,  1863,  when  he  was  attacked  by 
a severe  pain  in  the  head,  which  rapidly  increased  and  became  intense,  in  spite  of  counter  irritation  and  anodyne  applications. 
Death  took  place  on  May  5th,  only  six  hours  fi’om  the  time  that  the  pain  first  set  in.  At  the  autopsy,  the  anterior  lobe  of  the 
cerebrum  was  found  softened  and  disorganized.  There  were  four  ounces  of  pus  in  the  lateral  ventricle.  Surgeon  T.  A.  McPar- 
lin,  U.  S.  A.,  reported  the  case. 

Case. — Private  Celestas  Jenkins,  Co.  H,  9th  New  York  Artillery,  aged  22  years,  was  wounded  at  the  battle  of  Winchester, 
Virginia,  September  19th,  1864,  by  a fragment  of  shell,  which  caused  a severe  wound  of  the  right  temporal  region  without  injury 
of  bone.  He  was,  on  the  same  day,  admitted  to  the  hospital  of  the  Third  Division,  Sixth  Corps,  and  was  thence  conveyed  to 
Philadelphia,  and  admitted,  on  the  27th,  into  the  Filbert  Street  Hospital.  Death  resulted  on  the  9th  of  October,  1864.  Surgeon 
Thomas  B.  Reed,  U.  S.  V.,  records  the  case. 

Case. — I’rivate  U.  B.  Johnson,  Co.  G,  15th  Alabama  Infantry,  aged  19  years,  received,  at  the  battle  of  Fredericksburg, 
Virginia,  December  13th,  1862,  a gunshot  wound  of  the  scali>  in  the  left  parietal  region.  He  was  admitted  into  No.  12  hospital, 
at  Richmond,  on  December  Kith.  Symptoms  of  inflammation  of  the  Itrain  made  their  appearance,  and  several  convulsions  fol- 
lowed. The  scalp  was  shaved,  and  cold  lotions  were  applied,  and  mercurials  were  administered.  He  died  January  4th,  1863. 
Surgeon  W.  H.  Thom,  C.  S.  A.,  reports  the  case. 

Case. — Corporal  John  Kealey,  Co.  A,  99th  Pennsylvania  Volunteers,  aged  21  years,  received,  while  on  the  picket  line 
before  Petersburg,  Virginia,  September  12th,  1864,  a gunshot  scalp  wound  of  the  vertex,  from  a conoidal  musket  ball.  He  was 
admitted,  on  September  1.5th,  into  the  field  hospital  of  the  Third  Division,  Second  Corps.  On  September  19th,  the  patient  was 
sent  to  field  hospital  of  the  Second  Corps,  and,  on  the  same  day,  he  was  transferred  to  Washington,  where,  on  September  21st,  he 
was  admitted  into  Emory  Hospital.  Inflammation  of  the  brain  set  in,  and  death  followed,  October  3d,  1864.  Surgeon  N.  R. 
Moseley,  U.  S.  V.,  reported  the  case. 

Case. — Sergeant  Thomas  H.  Law,  Co.  K,  5th  New  Hampshire  Volunteers,  received,  at  the  battle  of  Antietam,  Maryland, 
September  17th,  1862,  a gunshot  wound  of  the  integuments  of  the  forehead.  He  was  admitted  to  the  hospital  of  the  Second 
Corps,  and,  on  October  5th,  w'as  sent  to  the  Ladies’  Home  Hospital  at  New  York.  An  abscess  of  the  scalp  formed,  and  menin- 
gitis ensued,  terminating  in  compression  of  the  brain,  coma,  and  death  on  October  11th,  1862.  Surgeon  A.  B.  Mott,  U.  S.  V., 
reports  the  case. 

Case. — Private  S.  Lawson,  Co.  E,  22d  Georgia  Regiment,  received,  at  the  battle  of  Gettysburg,  Pennsylvania,  .July  3d, 
1863,  a gunshot  wound  of  the  scalp,  and  was  t.aken  to  the  Seminary  Hospital.  On  July  25th,  he  was  transferred  to  the  West’s 
Building  Hospital,  Baltimore,  Maryland,  where  he  died  on  September  6th,  1863. 

Case. — Private  J.  A.  Murphy,  Co.  B,  49th  Virginia  Regiment,  aged  30  years,  received,  at  the  battle  of  Gettysburg,  Penn- 
sylvania, .July  3d,  1863,  a gunshot  wound  of  the  right  side  of  the  scalp.  He  was,  on  July  6th,  admitted  to  Hospital  No.  1,  Fred- 
ei  ick,  Maryland,  on  July  7th,  transfeiTcd  to  Annapolis,  probably  for  exchange,  and  on  August  1st,  1863,  he  was  admitted  to  a 
Confederate  hospital,  at  Petersburg,  Virginia,  where  he  died,  on  August  18th,  1863,  of  meningitis. 

Case. — Private  Hugh  O’Donnell,  Co.  C,  29tli  Pennsylvania  Volunteers,  aged  24  years,  received,  at  the  battle  of  Atlanta, 
Georgia,  .July  20th,  1864,  a severe  gunshot  wound  of  the  scalp.  He  was  admitted  into  the  hospital  of  the  Second  Division,  Twen- 
tieth Corps,  and  thence  sent  to  Hospital  No.  2,  at  Chattanoog.a,  Tennessee,- on  July  25th.  He  was  transferred,  about  the  1st  of 
August,  to  Nashville,  and  thence,  within  a few  wei'ks,  sent  to  the  Satterlee  Hospital  in  Philadelphia.  Death  supervened  on 
August  31st,  1864. 

Case. — Private  Duncan  Stone,  Co.  C,  1st  North  Carolina  Battery,  received  a wound  of  the  right  side  of  the  scalp  hy  a 
conoidal  musket  ball.  He  was  admitted  into  the  Pettigrew  Hospital,  Raleigh,  North  Carolina,  on  March  23d,  1865.  Simple 
dressings  were  used.  Meningitis  supervened,  and  the  case  terminated  fatally  on  March  29th,  1865.  Surgeon  E.  Burke  Hay- 
wood, C.  S.  A.,  records  the  case. 


COMPLICATED  GUNSHOT  WOUNDS  OF  THE  SCALP. 


77 

Case. — Private  Nicholas  Strayer,  Co.  C,  205th  Pennsylvania  Volunteers,  aged  30  years,  received,  in  an  engagement  before 
Petersburg,  Virginia,  April  2d,  1865,  a gunshot  wound  of  the  scalp  above  the  left  ear.  He  was  admitted  to  the  hospital  of  the 
Third  Division,  Ninth  Corps,  and,  on  April  4th,  was  sent  to  the  Lincoln  Hospital,  Washington,  D.  C.,  where  he  died  on  May 
12lh,  1865,  from  inflammation  of  brain.  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A.,  records  the  case. 

Case. — Private  Henry  IVarnei',  Co.  B,  1st  IMichigali  Volunteers,  aged  29  years,  was  wounded  near  Petersburg,  Virginia, 
July  24th,  1864,  by  a fragment  of  shell,  which  caused  a severe  wound  of  the  scalp.  He  was  admitted  to  the  hospital  of  tlie  First 
Division,  Fifth  Corps,  and  thence  sent  to  City  Point,  where  he  remained  under  treatment  until  the  6th  of  August.  He  was 
then  transferred,  by  steamer,  to  the  De  Camp  Hospital  at  David’s  Island,  New  York  Harbor,  where  death  residted  on  August 
20th,  1864. 

Case. — Private  John  Warner,  Co.  D,  4th  New  Jersey  Volunteers,  aged  26  years,  received,  at  the  battle  of  the  Wilderness, 
May  6th,  1864,  a gunshot  w ound  of  the  scalp,  by  a conoidal  musket  ball.  He  was  taken  to  the  hospital  of  the  First  Division  of 
the  Sixth  Corps,  and  transferred  to  the  Finley  Hospital,  at  Washington,  on  May  11th;  from  thence  he  was  sent  to  Philadelphia, 
and  admitted  to  the  Satterlee  Hospital  on  May  18th.  On  Blay  28th,  he  was  attacked  by  a chill,  attended  by  a violent  pain  in  the 
head,  and  symptoms  of  cerebral  iutlammation.  The  case  terminated  fatally  on  Blay  29th,  1864. 

Case. — Corporal  James  E.  White,  Co.  A,  3d  New  Hampshire  Volunteers,  aged  33  years,  received,  in  an  engagement  near 
James’s  Plantation,  Virginia,  Blay  20th,  1864,  a gunshot  wound  of  the  scalp  from  a conoidal  musket  ball.  He  was  admitted  into 
the  field  ho!  ]Ital  of  the  Tenth  Corps  on  the  same  day,  and  a day  later  was  transferred  to  the  Hampton  Hospital  at  Fort  Blonroe. 
On  June  li.t,  the  })atie!it  was  sent  to  the  Ward  Hospital,  at  Newark,  New  Jersey.  Congestion  of  the  brain  supervened,  and  death 
resulted  on  July  14th,  1864.  The  late  Assistant  Surgeon  J.  T.  Calhoun,  U.  S.  A.,  recorded  the  case. 

In  eight  fatal  cases  of  gunshot  wounds  of  the  scalp,  it  may  be  inferred,  froiii  the  nature 
of  the  prescriptions,  that  some  form  of  encephalitis  supervened  and  induced  fatal  results  ; but 
the  precise  features  of  the  secondary  complications  were  not  reported : 

Case.— Private  John  Aufterheide,  Co.  B,  6th  Ohio  Volunteers,  received,  at  the  battle  of  Chickamauga,  Georgia,  Septem- 
ber 19th,  1863,  a severe  gunshot  flesh  wound  of  the  head.  He  was,  at  once,  admitted  to  the  hospital  of  the  Second  Division, 
Twenty-first  Corps,  and,  on  the  next  day,  sent  to  the  General  Hospital  at  Chattanooga,  Tennessee,  where  he  died,  on  September 
22d,  1863.  Surgeon  A.  J.  Phelps,  U.  S.  V.,  recorded  the  case. 

Case.— Private  A.  L.  Cook,  Co.  E,  16th  Connecticut  Volunteers,  received,  in  the  engagement  at  Plymouth,  North  Caro- 
lina, April  20th,  1864,  a gunshot  wound  of  the  scalp.  He  died  on  May  9th,  1864.  Surgeon  D.  G.  Rush,  101st  Pennsylvania 
Volunteers,  recorded  the  case. 

Case.— Private  Isaac  Hamlin,  Co.  F,  101st  Illinois  Volunteers,  received,  near  Dallas,  Georgia,  May  25th,  1864,  a slight 
gunshot  wound  of  the  head.  He  was  admitted  into  the  field  hospital  of  the  Third  Division,  Twentieth  Army  Corps,  on  the  same 
day,  and,  on  Blay  30th,  he  was  sent  to  Chattanooga.  He  died  on  June  16th,  1864. 

Case. — Private  J.  TI.  Hatley,  Co.  D,  27th  North  Carolina  Infantry,  received,  in  action,  a gunshot  wound  of  the  scalp.  He 
was  admitted  into  the  Mooi-e  Hospital  at  Richmond,  Viiginia,  December  20th,  1863,  and  died  on  December  22d.  Surgeon  Otis 
F.  Blanson,  C.  S.  A.,  recorded  the  case. 

Case. — Private  J.  Hinton,  Co.  C,  28th  Alabama  Regiment,  was  wounded  and  made  a prisoner  at  the  battle  of  Chattanooga, 
and  was  admitted,  on  November  23d,  1863,  to  Hospital  No.  4,  Chattanooga,  Tennessee,  with  a gunshot  scalp  wound  over  the 
forehead.  He  died  on  December  15th,  1863.  Surgeon  Francis  Salter,  U.  S.  V.,  reports  the  case. 

Case.^ — Private  Clarence  R.  Smith,  Co.  A,  94th  New  York  Volunteers,  was  admitted  to  the  Patent  Office  Hospital,  Wash- 
ington, D.  C.,  on  September  21st,  1862,  with  a gunshot  wound  of  the  scalp.  He  died  on  October  1st,  1862.  Assistant  Surgeon 
J.  J.  Woodward,  U.  S.  A.,  recorded  the  case. 

Case. — Private  Hiram  Voiles,  Co.  F,  70th  Indiana  Volunteers,  received,  at  the  battle  of  Resaca,  Georgia,  May  15th,  1864, 
a slight  gunshot  wouml  of  the  right  side  of  the  scalp.  He  was  admitted  to  the  hospital  of  the  Third  Division,  Twentieth  Corps, 
and,  on  Blay  20th,  was  sent  to  the  general  fi  Id  hospital  at  Resaca,  where  he  died,  on  May  24th,  1864.  Assistant  Surgeon  BI.  C. 
Woodworth,  U.  S.  V.,  recorded  the  case. 

Case. — Private  Bladison  Wilman,  Co.  D,  15th  Iowa  Volunteers,  aged  26  years,  received,  at  the  battle  of  Shiloh,  Tennes- 
see, Aj)ril  6th,  1862,  a slight  gunshot  wound  of  the  scalp.  He  died  on  June  1st,  1862.  Surgeon  Samuel  B.  Dawes,  1.5th  Iowa 
Volunteers,  reported  the  case. 

Erysipelas. — The  proportion  of  cases  in  which  erysipelas  supervened  after  gunshot 
wounds  limited  to  the  integuments  of.  the  cranium,  was  by  no  means  large.  But  twenty- 
two  cases  were  reported,  of  which  eight  terminated  fatally.  It  is  highly  probable  that  this 
complication  was  present,  in  a mild  form,  in  many  of  the  cases  reported  without  commentary 
as  “returned  to  duty  but  was  seldom  of  such  gravity  as  to  be  made  the  subject  of  special 
report.  The  few  exceptions  are  here  noted : 


78 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Case. — J.  IS.  BrUloc,  Co.  C,  2titli  Virginia  liegimont,  aged  IW  years,  received,  on  July  17th,  18(54,  a gunshot  wound  of 
the  scalp,  just  above  the  right  eye.  During  the  progress  of  the  ease  erysipelas  supervened,  but  it  was  checked,  and,  on  July  30th, 
the  patient  was  reported  as  convalescing.  Surgeon  P.  F.  Brown,  C.  S.  A.,  I'ecords  the  case. 

Case. — I’l  ivate  Charles  Ferry,  Co.  B,  72d  New  York  Volunteers,  aged  37  years,  received,  in  the  Peninsular  campaign, 
at  JIalvern  Hill,  July  1st,  ISti’J,  a shell  wound  of  the  occipital  region  of  the  scalp.  He  was  adi^itted  to  Division  No.  1 
Hospital,  at  Annapolis,  IMaiyland,  from  the  Steamer  Kennebec,  July  5th,  18(5‘J.  A severe  attack  of  erysipelas  supervened,  from 
which  the  jiatient  recovered,  and  was  returned  to  duty  on  October  11th,  18(52.  Acting  Assistant  Surgeon  Arthur  Rich  recorded 
the  case. 

Case. — Pjivate  Henry  T.  Frazell,  Co.  15.  (ith  iMissouri  Volunteers,  received  in  front  of  Vicksburg,  Mississippi,  May  22d, 
18(53,  a gunshot  wound  of  the  scalp  in  the  right  teni[ioral  region.  He  was  received  on  board  the  hospital  steamer  K.  V.  Wood, 
from  Chickasaw  Bayou,  on  the  8th  of  June,  and  transferred  to  Memphis,  Tennessee,  whei  e,  on  the  same  day,  he  was  admitted  to 
llnion  Hospital.  On  the  morning  of  the  2yth,  the  wound  was  attacked  hy  erysipelas,  which  soon  extended  over  the  entire  scalp 
and  face.  The  disease  yielded  readily  to  ti-eatment,  and,  on  Jidy  7th,  the  patient  was  reported  as  very  neaily  free  of  the  disease. 
On  (he  22d  of  J uly,  he  had  so  completely  recovered  as  to  be  able  to  return  to  duty.  The  case  is  reported  by  Surgeon  J.  D.  Brum- 
ley,  U.  S.  V. 

Case. — Private  T.  A.  GaUayhcf,  Co.  C,  10th  Louisiana,  was  w ounded  at  the  battle  of  Gettysburg,  Pennsylvania,  July  3d, 
18(53,  by  a musket  ball,  which  entered  the  scalp  to  the  left  of  the  median  line,  near  the  suj)orior  lidge  of  the  occiput.  The  missile 
passed  forw  ard,  and  downward  behind  the  ear,  and  lodged  about  the  middle  of  the  lower  jaw.  He  also  received  a gunshot  wound 
of  the  ankle.  Tlie  wounds  w’ere  dressed  in  a held  hos|)ital,  and  thence  he  was  sent  to  Camj)  Letterman  Hospital  at  Gettysburg, 
where  he  was  admitted  on  July  27th.  Eiysipelas  supervened,  which,  hy  appropriate  treatment,  was  subdued,  and,  at  the  date  of 
his  transfer  to  Baltitnori‘,  the  patient  was  doing  well.  He  was  admitted,  on  October  (ith,  to  West’s  Building  Hospital,  at  Balti- 
more, Maryland,  where  ho  remained  until  November  12th,  1853,  on  which  date  he  was  paroled. 

Case. — Fiist  Sergeant  Samuel  B.  Gray,  Co.  I,  123d  Illinois  Volunteers,  in  an  engagement  near  Milton,  Tennessee,  March 
2(lth,  18(53,  received  a gunshot  scalp  wound.  He  was  admitted  into  Hospital  No.  1,  at  Murfreesboro,  March  21st,  and  transferred 
thence  to  Nashville,  and  admitted,  on  May  22d,  in  Hospital  No.  23.  He  remained  here  utitil  August  1st,  when  he  was  sent  to 
Louisville,  anil  adnutted  into  Hospital  No.  7.  On  September  3d,  he  was  sent  to  Hospital  No.  19,  where  erysipelas  supervened. 
Simple  dressings  were  used.  He  was  discharged  from  service  October  13th,  18(53,  on  account  of  a scrofulous  abscess.  The  case 
is  rejiorted  by  Assistant  Surgeon  E.  O.  Brown,  26th  Kentucky  Volunteers. 

Case. — Sergeant  K.  M.  Harris,  Co.  F,  3d  Tennessee  Infantry,  aged  24  years,  received  at  the  battle  of  Kenesaw  Mountain, 
Georgia,  June  30th,  1864,  hy  a conoidal  ball,  a wound  of  the  scalp  over  the  right  temple.  He  was  admitted,  on  July  llth,  to 
Holston  Hospital,  at  Knoxville,  Tennessee.  The  wound  became  affected  with  erysipelas,  which  was  subdued,  and  the  patient 
was  furloughed  on  the  26th  of  October.  On  November  18th,  he  was  admitted  to  Asylum  Hospital  at  Knoxville,  where  he 
remained  until  February  4th,  1865,  when  he  was  returned  to  duty.  The  case  was  reported  by  Acting  Assistant  Surgeon  S.  L. 
Herrick. 

Ca.se. — Sergeant  John  MePeake,  Co.  B,  82d  New  York  Volunteers,  received,  at  the  battle  of  Antietam,  Maryland,  Sep- 
tember 17th,  1862,  a gunshot  wound  of  the  iutegunients  of  the  forehead.  He  was  admitted  to  the  regimental  hospital,  and,  on 
November  21st,  was  sent  to  hospital  at  Camp  I’arole,  Annapolis,  Maryland.  Erysipelas  of  a severe  character  supervened,  but 
the  patient  recovered,  and  was  discharged  from  the  service  on  February  23d,  1863.  Surgeon  James  Norval,  79th  New  York 
State  Militia,  recorded  the  case. 

Ca.se. — Private  J.  L.  Means,  Texas  Regiment,  received,  in  the  assault  on  Fort  Douelson,  Tennessee,  February  15th,  1862, 
a sliglit  wound  of  the  scalp,  over  left  jiarietal  region,  by  a musket  ball.  He  was  conveyed  to  a Confederate  hospital  in  Nashville. 
Erysipelas  set  in,  on  the  tenth  day  lifter  the  reception  of  the  injury,  and  extended  over  the  entire  head  and  face.  Tincture  of 
iodine  was  applied  locally,  and  general  supporting  treatment  was  eni|)loyed.  He  rapidly  recovered,  and  was  discharged  from  the 
hospital  about  March  2()th,  1862,  for  duty. 

Ca.se. — Private  .7.  L.  Smiley,  Co.  E,  12th  Alabama  Infantry,  aged  19  years,  received,  in  the  assault  on  Fort  Steadman, 
Virginia,  March  25th,  1865,  a gunshot  wound  of  the  occipital  region,  by  a conoidal  musket  ball.  He  was  admitted  into  the  Wash- 
ington Street  Ilosiiital,  at  Petersburg,  Virginia,  on  the  same  day.  Erysipelas  sujiervened.  The  patient  was  made  a prisoner  and 
transferred  to  the  Hanijiton  Hospital,  at  Fort  Monroe,  May  17th,  and  on  May  25th,  1865,  he  was  sent  to  the  Military  Prison. 
Assistant  Surgeon  B.  F.  Pope,  10th  New  York  Artillery,  reports  the  case. 

Case. — Private  William  11.  Smith,  Co.  1,  99th  Pennsylvania  Volunteers,  aged  18  years,  received,  in  an  action  on  the  South- 
side  Railroad,  Virginia,  about  April  7th,  1865,  a gunshot  wound  of  the  right  parietal  region.  He  was  admitted  into  the  field  hos- 
pital of  the  Third  Division,  Second  Corps.  Simple  dressings  were  applied.  On  April  12th,  he  was  admitted  into  the  Second 
CoT’[)S  field  hospital,  at  City  Point,  whence  he  was  transferred,  on  April  18th,  to  Finley  Hosfiital,  Washington.  On  April  21st, 
erysipelas  attacked  the  scalp  and  face.  Tincture  of  iodine,  and  lead  and  opium  washes,  and  poultices  were  used.  He  was 
admitted  into  Mower  Hosjiital,  Philadelphia,  May  19th,  and  on  July  19th,  1865,  he  was  discharged  from  service. 

Case. — Private  F.  M.  Streeter,  Co.  G,  42d  Mississippi  Infanjry,  received  a gunshot  wound  of  the  scalp.  He  was  admitted, 
oil  .luly  23d,  1863,  into  the  Howard  Grove  Hospital,  Richmond,  Virginia.  Erysipelas  supervened.  On  September  16th,  1863, 
he  was  furloughed.  The  case  is  reported  by  Surgeon  C.  D.  Rice,  P.  A.  C.  S. 

Case. — Private  L.  H.  Taylor,  Co.  A,  46th  Virginia  Regiment,  was  admitted,  on  July  2d,  1864,  to  the  Howard  Grove  Hos- 
pital, Richmond,  Virginia,  with  a gunshot  wound  of  the  scalp.  Erysipelas  supervened;  but  otherwise  the  case  progressed  ftivor- 
ably,  and  the  patient  was  furloughed,  on  July  31st,  1864,  for  thirty  days.  Surgeon  C.  D.  Rice,  P.  A.  C.  S.,  recorded  the  case. 


COMPLICATED  GUNSHOT  WOUNDS  OF  THE  SCALP. 


79 


Another  case  of  erysipelas  of  the  scalp,  complicated  hy  heemorrhage,  will  be  recorded 
further  on  among  the  abstracts  of  seal}'  wounds  with  haemorrhage.  Still  another  affords  an 
instance  of  the  a}'}''lication  of  sutures  in  gunshot  lacerations  of  the  scalp: 

Case.— Private  .laiues  Paiclianaii,  Co.  C,  (itli  Iowa  Volunteers,  aged  35  years,  received  at  tlie  battle  of  Eesaca,  Georgia, 
May  14th,  lSfi4,  a lacerated  wound  of  the  vertex  of  the  scalp,  from  a fragment  of  shell.  T'he  cranium  was  laid  bare  for  a 
distance  of  two  and  a half  inches.  lie  was  admitted  to  the  field  ho?]rital  of  the  Fifteenth  Anny  Corps,  in  charge  of  M.  C. 
Woodworth,  Assistant  Surgeon  U.  S.  V.,  on  the  same  day,  and  the  wound  was  cleaned,  the  seal])  shaved,  and  its  edges  a])proxi- 
mated  by  sutures.  The  wound  was  then  covered  with  water  dressings.  The  next  re])ort  is  dated  May  20th,  when  it  is  stated 
that  the  wound  was  tumefied,  highly  infiamed,  sup])urating,  and  gaping,  the  sutures  having  broken  out.  The  wound  was 
cleaned  of  |)uruh*nt  matter,  and  was  dressed  tvith  stiips  of  isinglass  plaster,  and  covered  hy  a compress.  On  the  21st,  there 
was  erysi])elatous  inflammation  extending  fiom  the  vertex  over  the  forehead  nearly  down  to  the  eyelid.  The  wound  was 
dressed  with  plasters,  as  before,  and  strong  tincture  of  iodine  was  painted  over  the  entire  inflamed  surface  and  a border  of  the 
sound  skin  adjacent.  On  the  22d  the  erysipelas  extended  slightly  downwards  to  the  face.  On  the  25th,  the  inflammation  had, 
iti  a great  measure,  subsided.  The  jjatient  was  transferred  to  the  Cumberland  Hospital,  at  Nashville,  Tennessee,  under  the 
care  of  t^urgeon  C.  McDermont,  U.  S.  V.,  and  was  treated  by  simple  dressings  to  the  scalp  and  with  purgatives.  On  June  4th, 
he  was  transferred  to  the  Holt  IIosj)ital,  at  Jeflersonville,  Indiana,  in  charge  of  Surgeon  H.  P.  Stearns,  U.  S.  V.  It  is  stated 
on  the  register  of  this  hospital,  that  the  wound  was  inflicted  by  a conical  musket  ball.  The  patient  recovered  without  further 
complication,  and  was  returned  to  duty  August  19th,  18C4. 

Eight  cases  were  reported  which  terminated  fatally  in  consef}iience  of  the  meningeal 
inflammation  following  the  invasion  of  erysipelas  ; 

Case. — Private  Lewis  Alfiey,  Co.  K,  22d  Indiana  Volunteers,  received  in  an  engagement  at  Kenesaw  Mountain,  Georgia, 
.Tune  27th,  18G4,  a gunshot  wound  of  the  seal]).  He  was  admitted  to  the  hospital  of  the  Second  Division,  Fourteenth  Corps, 
and,  on  Jidy  1st,  was  transferred  to  the  Cumberland  Hospital  at  Nashville,  Tennessee.  He  died,  July  26th,  1864,  “of 
ery.sipelas,  following  gunshot  wound  of  scalp.”  Assistant  Surgeon  W.  15.  Trull,  U.  S.  V.,  records  the  case. 

Case. — Corporal  William  Cammire,  Co.  H,  73d  Illinois  Volunteers,  aged  22  years,  was  admitted  to  Hospital  No.  19, 
Nashville,  Tennessee,  on  December  1st,  1864,  with  a gunshot  wound  of  the  left  side  of  the  scalp.  Erysipelas  of  the  head  and 
face  supervened,  and  the  case  had  a fatal  termination  on  December  4th,  1864. 

Case.— Private  James  JS.  Fant,  Co.  B,  17th  Mississij)pi  Kegiment,  was,  on  May  9th,  1864,  admitted  to  the  Howard  Grove 
llos]iit;d,  Eiehmond,  Virginia,  with  a lacerated  wound  of  the  scalp  in  the  left  temporal  region,  caused  by  a gra])e  shot.  On 
July  8th,  erysipelas  attacked  the  wound,  and  death  resulted  on  July  29th,  1864.  iSurgeon  T.  M.  Palmer,  C.  S.  A.,  records 
the  case. 

Case. — Private  William  Jackson,  Co.  F,  16th  Ohio  Volunteers,  received,  at  the  siege  of  Vicksburg,  Mississij)])i,  Decem- 
ber 28tb,  1862,  a gunshot  wound  of  the  left  side  of  the  seal]).  He  was  conveyed,  on  the  steam  transport  C’ity  of  Memphis,  to 
Paducah,  Kentucky,  and  was  admitted,  on  January  8th,  1863,  into  IIos])ital  No.  2.  Erysipelas  of  the  seal])  supervened,  and 
death  resulted  from  exhaustion,  on  February  23d,  1863.  At  the  post  mortem  examination  the  liver,  spleen,  and  mesenteric 
glands  were  found  enlarged.  The  case  was  reported  by  Surgeon  II.  P.  Stearns,  U.  S.  V. 

Case. — Corporal  Francis  N.  Lewis,  Co.  E,  18th  North  Carolina  Eegiment,  leceivcd,  in  an  engagement  before  Petersburg, 
April  1st,  I860,  a gunshot  wound  of  the  scalp.  He  was,  on  A])i-il  4th,  admitted  to  the  hospital  at  Fort  Monroe,  wdiere  he 

died,  on  April  13th,  1865,  of  erysipelas.  Assistant  Surgeon  W.  D.  Wolverton,  U.  S.  A.,  records  the  case. 

Case. — Private  Eeinhold  Maywold,  Co.  G,  6th  Wisconsin  Volunteers,  aged  27  years,  was  wounded,  in  an  engagement 
at  the  Southside  Eailroad,  April  1st,  186.5,  by  a conoidal  ball,  which  struck  over  the  squamous  portion  of  the  left  temporal  bone. 
He  was,  on  the  following  day,  admitted  to  the  field  hospital  of  the  Fifth  Corps,  and,  on  April  4th,  was  sent  to  the  Lincoln  Hos- 
pital, Washington,  1).  C.,  where  he  died,  on  April  24th,  1865,  from  eiysipelas  following  gunshot  wound  of  scalp. 

Case. — Private  Fountain  McClarry,  Co.  E,  100th  U.  S.  Colored  Troo})s,  aged  24  years,  received,  at  the  battle  of 

Nashville,  December  ICth,  1864,  a gunshot  wound  of  the  scalp,  on  the  back  of  the  head.  He  was  admitted,  on  the  following 

day,  to  Hospital  No.  16.  Simple  dressings  were  applied.  Erysipelas  supervened,  and  death  followed,  on  J.anuary  14th,  1865. 

Case. — Private  John  Williams,  Co.  B,  12th  New  Jersey  Volunteers,  aged  30  years,  received,  in  the  attack  on  Peters- 
burg, Virginia,  June  17th,  1864,  a shell  wound  of  the  left  side  of  the  seal]).  He  was  admitted,  on  June  19th,  to  the  hospital  of 
the  Second  Corps  at  City  Point,  and,  on  June  25th,  was  sent  to  the  Lovell  IIosj)ital,  Portsmouth  Grove,  Ehode  Island. 
Erysipelas  supervened,  and  death  occurred  on  July  7th,  1864. 

Gangrene. — The  contused  wounds  of  the  scal}i  made  by  lialls,  til  ways  followed  by  llio 
death  of  a thin  layer  of  tissue,  sometimes  lead  to  spreading  gangrene,  a coiAiilication  more 
common  in  head  wounds  with  fracture  of  the  skull  than  in  those  limited  to  the  seal}).  In  the 
latter  class,  but  nine  cases  of  traumatic  gangrene  were  reported,  of  which  four  terminated 
fatally. 


80 


WOUNDS  AND  INJURIES  OF  THE  HEAD. 


Case. — Private  Josepli  H.  Clouse,  Co.  U,  ‘20tli  Iiuliana  Volunteers,  was  wounded  at  the  battle  of  Gettysburg,  Pennsyl- 
vaiua,  July  3d,  1863,  by  a coiioidal  ball,  which  entered  just  above  the  frontal  eminence  of  the  left  side,  and  made  a large  flesli 
wound.  He  was  sent  to  Philadelphia,  and,  on  July  5th,  admitted  to  the  Satterlee  Hospital.  Cold  water  dressings  were 
apjjlied  until  the  11th,  when  Hax-seed  poultices  were  used.  The  wound  did  comparatively  well  until  the  20th,  when  gangrene 
appeared.  Tincture  of  the  sesquichloride  of  iron  was  given,  and  applications  of  nitric  acid,  followed  by  emollient  dressings, 
were  made  for  a few  days,  when  the  sloughs  came  away,  and  the  wound  commenced  to  heal.  On,  the  24th,  the  edges  were 
ai)proximating.  About  a square  inch  of  the  bone  was  visible,  one-half  of  which  was  denuded  of  its  periosteum.  The  patient 
was  furloughed  on  August  2d,  1863;  returned  to  his  regiment,  and  wiis,  on  December  22d,  1863,  transfeiTed  to  Co.  F,  20th 
Indiana  Kegiment,  reorganized. 

Case. — Private  William  rad(jct,  Co.  B,  1st  Florida  Battery,  was  admitted,  on  J une  4th,  1864,  to  Howard  Grove  Hospital, 
Richmond,  Virginia,  with  a gunshot  wound  of  the  scalp  over  the  left  temponil  bone.  Gangrene  attacked  the  wound,  but  was 
readily  checked,  and  on  July  23d  the  patient  was  furloughed  for  sixty  days. 

Case. — Private  Horace  Garrcjuis,  Co.  E,  8th  Connecticut  Volunteers,  aged  20  years,  received,  in  an  engagement  before 
Petersburg,  Viiginia,  May  7th,  1864,  a gunshot  wound  of  the  scalp.  He  was,  on  May  9th,  admitted  to  the  Flampton  Hospital 
near  Fort  Monroe,  and,  on  May  18th,  transferred  to  the  Mower  Hospital,  Philadelphia.  On  May  30th,  the  wound  commenced 
to  slough.  Bromine  was  applied,  and  afterwards  fla.x-seed  poidtices,  and  on  June  15th,  healthy  granulations  set  hi.  On  July 
11th,  the  patient  was  sent  to  the  Knight  Hospital,  New  Haven,  Connecticut,  and  on  October  11th,  1864,  he  was  returned  to  duty. 

Case. — Private  John  K.  Kittredge,  Co.  1,  93d  New  York  Volunteers,  aged  20  years,  was  wounded  at  the  battle  of  the 
Wilderness,  Virginia,  May  5th,  1864,  by  a conoidal  ball,  which  passed  across  the  vertex  of  the  cranium  from  left  to  right, 
causing  a scalp  wound  two  inches  in  length.  He  was  admitted  to  the  hospital  of  the  Third  Division,  Second  Corps;  on  May 
lOth,  sent  to  the  Carver  Hospital,  Washington,  D.  C.,  and,  on  May  1.5th,  transferred  to  Mower  Hospital,  Philadelphia.  On 
.June  14th,  the  wound  began  to  slough;  poultices  were  applied,  and  on  June  18th  the  sloughing  had  ceased.  Kittredge  was 
returned  to  duty  on  October  4th,  1864. 

Case. — Private  W.  I.  Watson,  Co.  D,  26th  Georgia  Cavalry,  received,  on  October  27th,  1864,  a gunshot  wound  of  the 
scalp.  He  was  admitted  into  the  second  division  of  the  Jackson  Hospital,  Richmond,  on  the  same  day.  Gangrene  supervened. 
He  recovered,  and  was  furloughed  March  24th,  1865. 

The  following  cases  of  sloughing  after  gunshot  wounds  of  the  scalp,  terminated 
fatally  ; 

Case. — Private  Daniel  L.  Dougherty,  Co.  H,  55th  Pennsylvania  Volunteers,  aged  27  years,  was  wounded  before  Peters- 
burg, Virginia,  June  16th,  1864,  by  a conoidal  ball,  which  injured  the  scalp  and  the  left  shoulder.  He  was,  on  the  following 
ilay,  admitted  to  the  hospital  of  the  Eighteenth  Corps,  at  Point  of  Rocks,  Virginia,  and,  on  June  19th,  was  sent  to  the  Hampton 
Hospital,  Fort  Monroe,  where  simple  dressings  were  applied  to  the  wound.  Death  occurred  on  July  15th,  1864,  from  gangrene 
and  exhaustion.  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  recorded  the  case. 

Case. — Private  Patrick  Doyle,  Co.  D,  117th  New  York  Volunteers,  aged  36  years,  was  wounded  before  Petersburg, 
Virginia,  Juno  15th,  1864,  by  a fragment  of  shell,  which  caused  a wound  of  the  scalp.  He  was  treated,  for  some  days,  in  a 
lield  hospital,  and  thence,  on  June  24th,  transferred  to  the  Mount  Pleasant  Hospital,  Washington,  D.  C.,  and,  on  June  27th, 
sent  to  the  Satterlee  Hospital,  Philadelphia.  Gangrene  attacked  the  wound,  and  the  patient  died  on  July  30th,  1864. 

Case. — Private  Irvine  Hawkhis,  Co.  I,  2d  New  York  Artillery,  aged  19  years,  received,  in  an  engagement  at  Petersburg, 
Virginia,  June  16th,  1864,  a gunshot  wound  of  the  occipital  region,  by  a round  ball.  He  was  admitted,  on  the  same  day,  into 
the  held  hospital  of  the  First  Division,  Second  Army  Corps,  and,  on  the  21st,  was  sent  to  the  base  hospital  at  City  Point.  Simple 
dressings  were  used.  The  jjatient  was  subsequently  transferred  to  Washington,  and  was  received  into  the  Mount  Pleasant 
Hospital  on  June  27th.  He  was,  a few  days  later,  sent  to  the  Chester  Hospital  in  Pennsylvania.  The  wounds  fell  into  a 
sloughing  condition,  and  death  resulted  from  the  consequent  exhaustion,  July  28th,  1864.  Surgeon  Thomas  H.  Bache,  U.  S.  V., 
re]iorts  the  case. 

Case. — Corporal  William  Roth,  Co.  E,  119th  New  York  Volunteers,  aged  28  years,  received,  at  the  battle  of  Gettysbui'g, 
I’ennsylvanla,  July  3d,  1863,  a scalp  wound  in  the  left  parietal  region,  and  also  a wound  through  the  left  latissimus  dorsi 
muscle.  He  was  conveyed  to  Philadelphia,  and,  on  July  5th,  was  admitted  to  the  Satterlee  Hospital.  Both  wounds  were 
gangrenous.  Charcoal  poultices  were  applied,  after  cauterization  by  nitric  acid.  On  July  26th,  the  wounds  looked  healthy; 
but,  on  July  29th,  excessive  diarrhoea  supervened,  followed  by  chills  and  headache,  and  death  occurred  on  August  2d,  1863. 
The  case  is  reported  by  Acting  Assistant  Surgeon  N.  Hickman. 

llcemorrhage.—ln  gunshot  wounds  of  the  scalp,  primary  hiemorrhage  was  very 
infrequent,  but  secondary  hoemorrhage  was  not  uncommon,  and  proved,  when  it  occurred, 
a very  troublesome  complication.  Abstracts  will  be  given  of  all  the  cases,  twenty-one  in 
number,  reported  in  detail : 

Case. — Private  Thomas  Bell,  Co.  A,  9th  Pennsylvania  Volunteer  Reserves,  a paroled  prisoner,  was  admitted  to  hospital 
at  Annapolis,  Maryland,  on  January  11th,  1863.  He  had  been  wounded  by  a musket  ball,  which  entered  the  scalp  to  the  right 
of  the  occipital  protuberance,  and,  passing  forward  and  slightly  upward,  emerged  at  a distance  of  two  inches  above  the  ear. 
The  missile,  in  its  course,  cut  the  occipital  artery,  from  which  there  was  profuse  haemorrhage.  Sight  and  hearing  were  some- 


OOMPLICATEt)  GUNSHOT  WOUNDS  OF  THE  SCALP. 


81 


wliat  affected;  but,  on  the  date  of  liis  leaving  tbe  hospital,  the  patient  was  doing  well.  Tie  was  transferi’cd,  on  January  21st, 
1863,  to  Pittsburg,  Pennsylvania,  after  which  there  is  no  account  of  him.  Surgeon  T.  A.  JlcPai  liu,  U.  S.  A.,  records  the  case. 

Case. — Private  Burton  Fuller,  Co.  IT,  7th  Iowa  Volunteers,  was  wounded,  at  the  battle  of  Corinth,  Jlississippi,  October 
3d,  18G2,  in  the  right  temple.  The  missile  entered  on  a line  with  the  external  canthus  of  the  right  eye,  severing  the  temporal 
artery,  and  lodged.  He  was,  on  October  13th,  1862,  admitted  to  the  hospital  at  Mound  City,  Illinois,  where  the  temporal  artery 
was  ligated.  Fuller  was  discharged  from  the  service  on  January  13th,  1863. 

Case. — Private  John  Hearne,  Co.  E,  lG4th  New  York  Volunteers,  was  wounded,  in  an  engagement  near  Suffolk,  Virginia, 
A])ril  24th,  1863,  in  the  right  temporal  region,  the  missile  dividing  the  temporal  artery,  which  bled  freely.  The  hsemorrhage  was 
checked  by  compression,  and  the  patient  was  sent,  on  the  following  day,  to  the  hospital  at  Hampton,  Virginia.  On  Juno  22d, 
1863,  he  was  returned  to  duty. 

Case. — Lieutenant  A.  St.  Clair  Smith,  Co.  E,  12th  New  Hampshire  Volunteers,  was  wounded  at  the  battle  of  Cold  Har- 
bor, Virginia,  June  3d,  1864,  by  a conoidal  musket  ball,  which  cut  the  scalp  over  the  left  ear  and  severed  the  temporal  artery, 
which  was  secured  with  some  difficulty.  He  was  admitted,  on  June  5th,  to  the  field  hospital  of  the  Eighteenth  Corps,  and  thence 
sent  to  Washington,  D.  C.,  and  was  treated,  at  his  quarters,  at  the  Avenue  House.  He  was  furloughed,  on  June  11th,  1864,  and 
was  finally  mustered  out  with  his  regiment,  on  June  21st,  1865.  Acting  Assistant  Surgeon  G.  K.  Smith  recorded  the  case. 

Case. — Corporal  John  C.  Taylor,  Co.  D,  5th  New  Jersey  Volunteers,  aged  44  years,  received,  at  the  battle  of  Fair  Oaks, 
June  1st,  1862,  a gunshot  wound  of  the  scalp.  He  was  sent  to  the  Seminary  Hospital  at  Georgetown,  D.  C.,  and  admitted  on 
June  4th.  Profuse  limmorrhage  occurred,  on  the  same  day,  from  one  of  the  branches  of  the  temporal  artery.  The  main  trunk 
was  ligated,  just  above  the  zygomatic  process.  The  patient  was  returned  to  duty  on  August  19th,  1862.  The  case  is  reported  by 
Acting  Assistant  Surgeon  Josiah  F.  Kennedy. 

In  six  cases  of  secondary  lieemorrliage  from  gunshot  wounds  of  the  scalp,  the  bleeding 
was  controlled  by  pressure  and  by  styptics : 

Case. — Private  G.  A.  Arnold,  Co.  G,  2d  Vermont  Volunteers,  aged  21  years,  was  wounded,  at  the  battle  of  the  Wilderness, 
Virginia,  May  5th,  1864,  by  a conoidal  musket  ball,  wliich  caused  a wound  of  the  scalp  in  the  right  parietal  region.  He  was 
admitted  to  the  Harewood  Hospital,  Washington,  D.  C.,  and,  on  May  15th,  sent  to  Mower  Hospital,  Philadelphia.  On  the  fol- 
lowing day  hmmorrhage  occurred  fi'om  the  parietal  branch  of  the  temporal  artery,  which  was  controlled  by  compression.  On 
May  31st,  the  wound  had  nearly  healed,  but  the  patient  suffered  from  headache.  He  was  returned  to  duty  on  July  26th,  1864. 

Case. — Private  John  Gallager,  Co.  G,  5th  New  Jersey  Volunteers,  aged  25  years,  was  wounded  at  the  battle  of  the  Seven 
Pines,  Virginia,  June  1st,  1862,  by  a round  ball,  which  struck  in  the  right  parietal  region,  two  inches  from  vertex,  laying  the 
bone  bare.  He  was  conveyed  to  Washington,  and  admitted,  on  June  4th,  into  the  Seminary  Hospital,  Georgetown.  A haemor- 
rhage took  place  fi-om  the  tempor.al  artery  on  the  same  day.  The  patient  suffers  from  occasional  attacks  of  vertigo.  On  .July 
18th,  he  was  transferred  to  the  Union  Hotel  Hospital,  in  the  same  place,  and,  on  July  25th,  1862,  was  returned  to  duty.  Assist- 
ant Surgeon  Joseph  E.  Smith,  U.  S.  A.,  reports  the  case. 

Ca.se. — Private  Zachariah  Hancock,  Co.  I,  19th  Indiana  Volunteers,  was  wounded,  at  the  battle  of  Gettysburg,  Pennsyl- 
vania, July  2d,  1863,  by  a buckshot,  which  entered  behind  the  left  ear  and  lodged.  He  was,  on  the  same  day,  admitted  to  the 
Seminary  Hospital,  Gettysburg,  and,  on  July  11th,  sent  to  the  McClellan  Hospital,  Philadelphia.  Hajmorrhage,  amounting  to 
twelve  ounces,  occurred  on  the  following  day,  but  was  arrested  by  pressure  and  a solution  of  the  persulphate  of  iron.  The  patient 
was  discharged  on  Decembei*  3d,  1863.  Surgeon  Lewis  Taylor,  U.  S.  A.,  records  the  case. 

Case. — Private  John  Lowrey,  Co.  I,  2d  United  States  Infantry,  aged  29  years,  was  wounded,  at  the  battle  of  Antietam, 
ilaryland,  September  17th,  1862,  in  the  right  temporal  region.  He  was,  on  September  22d,  admitted  to  Hospital  No.  5,  Fred- 
erick, ^Maryland,  and,  on  October  10th,  sent  to  McDougall  Hospital,  Fort  Schuyler,  New  Yoik  Harbor.  On  October  16th, 
hmmoiThage  occurred  from  the  temporal  artery,  but  was  easily  controlled  by  compresses  and  styptic  preparations.  The  patient 
was  returned  to  duty  on  November  4th,  1862. 

Case. — Private  John  O'Connor,  Co.  I,  20th  Massachusetts  Volunteers,  aged  21  years,  received,  at  the  battle  of  Gettysburg, 
Pennsylvania,  July  2d,  1863,  a wound  of  the  scalp  near  the  vertex,  by  a fragment  of  shell.  He  was  admitted  into  a field  hosj)ital, 
and,  a few  days  later,  was  sent  to  Philadelphia,  and  admitted,  on  July  7th,  into  the  Mower  Hospital.  On  July  lltli,  a consid- 
erable haemorrhage  took  place,  which  was  controlled  by  a compress  and  styptics.  He  deserted  October  5th,  1863.  The  case  is 
reported  by  J.  Hopkinson,  Surgeon,  U.  S.  V. 

Case. — Private  Henry  Schumnghausen,  Co.  I,  Ist  Ohio  Light  Artillery,  aged  25  years,  was  woifnded  in  the  forehead,  by 
a buckshot,  in  the  engagement  at  Chantilly,  Virginia,  September  1st,  1862.  He  was  admitted  to  the  Master  Street  Hospital,  Phil- 
adelphia, on  September  3d,  1862.  The  injury  was  regarded  as  slight,  but  subsequent  sloughing  caused  hmmorrhage  from  the 
frontal  arteiw  on  September  10th.  The  bleeding  was  readily  arrested  by  continuous  pressure  and  Monsell’s  dry  salt.  The  wound 
healed,  and  the  patient  was  discharged  from  the  service  on  January  4th,  1865. 

In  eight  cases,  the  bleeding  was  successfully  treated  by  ligating  the  wounded  vessel : 

Case. — Lieutenant  Henry  Gilmore,  Co.  A,  17th  Vermont  Volunteers,  aged  32  years,  received,  at  the  battle  of  Spottsylva- 
ni.a,  Virginia,  May  12th,  1864,  a gimsliot  flesh  wound  of  the  he.ad.  Ho  was  treatial  in  a field  hospital  until  May  19th,  when  he 

n 


82 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


was  sent  to  the  Campbell  Hospital,  Washington,  D.  C.  On  admission,  the  wound  was  in  a bad  condition;  the  temporal  hone 
was  exposed  to  view,  and  the  tissues  were  sloughing  ami  inclined  to  gangrene.  On  iMay  21st,  limmorrhage  occurred  from  the 
tem])oral  artery.  Acting  Assistant  Surgeon  F.  W.  Kelly,  ligated  the  artery  in  its  continuity.  No  untoward  symptoms  occurred. 
On  August  15th,  Lieutenant  Gilmore  was  transferred  to  the  Olhcers’  Hospital,  at  Annapolis,  Maryland,  and,  on  St'ptemher  Gth, 
1864,  he  was  returned  to  duty.  Surgeon  A.  F.  Sheldon,  U.  S.  V.,  records  the  case. 

Case. — I’livate  F.  C.  Ihirtly,  Co.  G,  49th  Virginia  Regiment,  aged  21  years,  was  admitted  on  June  1st,  1864,  to  Chimbo- 
razo Hospital,  Richmcnd,  Virginia,  with  a gunshot  wound  of  the  scalp,  received  on  May  31st,  1864.  On  June  5th  ha-morrhage 
occurred  from  the  anterior  branch  of  the  temporal  artery,  which  was  ligated  near  the  expansion  of  the  temporal  muscle.  On  June 
39th,  the  patient  was  doing  well,  and,  on  July  1st,  he  was  furloughed  for  sixty  days. 

Case. — Piivate  Josiah  Mullen,  Co.  A,  ICOth  Pennsylvania  Volunteers,  was  wounded  during  the  .siege  of  Knoxville,  Ten- 
nessee, November  30th,  1863,  by  a conoidal  ball,  which  struck  the  left  side  of  the  head  and  severed  the  temporal  artery.  He  was 
at  once  admitted  to  Hospital  No.  5,  Knoxville,  where  Surgeon  George  B.  Coggswell,  29th  Massachusetts  Volunteers,  ligated  the 
temporal  artery  near  its  oiigin.  'I'he  ball  was  not  discovered  until  December  5th,  when  it  was  extracted  from  beneath  the  sterno- 
cleido-mastoid  muscle,  near  the  sternal  extremity.  The  patient  recovered,  was  fuiloughed  on  February  17th,  1864,  and  finally 
returned  to  duty.  The  case  is  reported  by  Surgeon  A.  M.  Wilder,  IT.  S.  V. 

Case. — I’rivate  Ileniy  Reese,  Co.  I,  53d  Pennsylvania  Volunteers,  aged  18  years,  was  wounded  at  the  battle  of  Gettys- 
burg, Pennsylvania,  July  2d,  1863,  by  a shell,  which  caused  a Hesh  wound  over  the  right  temple.  He  was,  on  July'5th,  admitted 
to  the  Siitterleo  Hospital,  Philadelphia.  On  July  ICth,  haemorrhage,  amounting  to  four  ounces,  occurred  from  the  temporal  artery, 
which  was  ligated  in  the  wound.  Haemorrhage  did  not  recur,  and  the  patient  was  returned  to  duty  on  December  7th,  1833.  The 
case  is  reported  by  Surgeon  I.  I.  Hayes,  LT.  S.  V. 

Case. — Corporal  A.  Talniadge,  Co.  E,  11th  New  Jersey  Volunteers,  aged  32  years,  was  wounded  at  the  battle  of  Gettys- 
burg, Pennsylvania,  July  Sd,  1863,  by  a conoidal  musket  ball,  which  tore  the  scalp  over  the  left  temple  for  a distance  of  one  by 
two  and  a half  inches.  He  was  admitted,  on  July  5th,  to  Satterloe  Hospital,  Philadelphia.  The  wound  became  gangrenous,  and 
was  treated  with  flaxseed  meal  and  porter  poultices.  The  pain  was  intense,  and  the  patient  was  unable  to  rest ; the  wound  began 
to  slough,  and  there  was  such  free  bleeding,  that  on  July  14tii  the  anterior  temporal  artery  was  ligated.  The  slough  was  grad- 
ually thrown  off,  and,  on  July  23d,  healthy  granulation  commenced.  A slight  hajmorrhage  occurred  on  July  27th,  but  was 
speedily  arrested  by  compression.  The  jiatient  was  furloughed  on  August  1st,  1833,  and  returned  to  duty  on  March  24th,  1834. 
The  case  is  reported  by  Surgeon  I.  I.  Hayes,  U.  S.  V. 

The  following  patients  recovered,  also,  from  secondary  haemorrhage  treated  by  ligation, 
and  they  were  discharged  on  account  of  the  expiration  of  their  terms  of  service : 

Case. — Corporal  Henry  Kullman,  Co.  I,  27th  Wisconsin  Volunteers,  aged  25  years,  was  wounded  in  an  engagement  before 
Petersburg,  Virginia,  July  30th,  1864,  by  a conoidal  musket  ball,  which  entered  anteriorly  to  the  light  ear,  passed  through  the 
pavilion,  and  emerged  just  behind  the  concha.  He  was  at  once  admitted  to  the  hospital  of  the  First  Division,  Ninth  Corps,  and, 
on  August  1st,  was  sent  to  the  Harewood  Hospital,  Washington,  D.  C.  On  August  14th,  haemorrhage,  amounting  to  four  ounces, 
occurred  from  the  temporal  artery,  which  was  ligated  in  its  continuity  by  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  a ligature  being 
jdaced  above  and  below  the  wound.  Hamiorrhage  did  not  recur.  On  September  3d,  1864,  the  patient  was  sent  to  the  Mower 
Hospital,  Piiiladelphia,  and,  on  May  30th,  1865,  was  mustered  out  of  service.  The  case  is  reported  by  the  operator.  Surgeon  R. 
B.  Bontecou,  U.  S.  V. 

Case. — Private  Richard  Norris,  Co.  C,  1st  United  States  Cavalry,  aged  32  years,  was  wounded  at  the  battle  of  the  Wil- 
derness, Virginia,  May  8th,  1864,  by  a conoidal  musket  ball,  which  entered  in  front  of  the  right  ear  and  emerged  two  inches  back 
of  the  right  mastoid  ))rocess.  He  was  admitted  into  Finley  Hos])ital,  Washington,  D.  C.,  on  Slay  11th,  1864.  On  Miiy  25th, 
haiuiorrhage  occurred  from  the  occipital  arteiy,  which  was  ligated  by  Acting  Assistant  Surgeon  F.  G.  H.  Bradford.  The  man 
recovered,  and  was  discharged  on  July  20th,  1864,  on  account  of  the  expiration  of  tenn  of  service.  Surgeon  G.  L.  Pancoast,  U. 
S.  V.,  reported  the  case. 

In  the  following  case,  recovery  ensued  after  ligation  for  secondary  hsemorrhage,  and 
the  patient  deserted  from  hospital : 

Case. — Private  David  Jones,  Co.  B,  1st  Massachusetts  Volunteers,  aged  26  years,  was  wounded  at  the  battle  of  Spottsyl- 
vania,  Virginia,  May  9th,  1864,  by  a conoidal  musket  ball,  wliicli  entered  above  and  to  the  left  of  the  left  eye,  passed  in  a direct 
line  through  the  integuments  over  the  temporal  region,  and  emerged  four  inches  from  the  point  of  entrance.  He  was  conveyed 
to  the  Second  Division  Hospital  at  Alexandria,  and,  on  May  21st,  was  transferred  to  Mower  Hospital,  Philadel])hia.  The  wound 
was  swollen  and  painful,  and  bled  freely.  On  May  24th,  the  temporal  artery  was  ligated  in  its  continuity,  in  front  of  the  ear, 
and  half  an  inch  below  the  wound,  by  Acting  Assistant  Surgeon  S.  D.  Mar-shall.  An  attack  of  erysipelas  was  checked  by  local 
applications  of  iodine  and  of  lead  water.  The  patient  recovered,  and  was,  on  July  7th,  1864,  sent  to  the  hospital  at  Beverly,  New 
Jersey,  whence  he  deserted  on  July  23d,  1864. 

Two  cases  of  gunshot  wound  of  the  scalp,  complicated  by  hsemorrhage,  had  a fatal 
termination  : 

Case. — Private  Alexander  Brown,  Co.  B,  14th  New  York  State  Militia,  aged  33  years,  was  wounded  at  the  battle  of 
the  Wilderness,  Virginia,  May  8th,  1864,  by  a conoidal  musket  ball,  which  entered  in  front  of  the  left  ear,  pass(!d  do\vnward 
and  backward,  and  emerged  about  one  inch  below  the  occiput.  He  was  admitted  into  the  field  hospital  of  the  Fourth  Division, 


COMPIJCATKD  GUNSHOT  WOUNUS  OF  THE  SCALP. 


83 


Fifth  Amiy  Corps,  on  tho  sanip  day,  and  a few  days  later  sent  to  Alexandria,  and  was  admitted,  on  May  12tli,  to  the  Second 
Division  Hospital.  Siinj)]e  dressings  were  used.  On  May  19th,  hatmoi'rhage  took  plaec!  from  the  occipital  ai'tery,  and,  though 
tempoi'iwily  checked,  the.  arterial  bleeding  recuiTi'd  on  the  20th,  and,  on  the  21st;  about  thirty-eigbt  ounces  of  blood  were 
believed  to  have  been  lost  altogether.  Compression  and  astringents  were  the  measures  unavailingly  employed.  The  patient 
died  on  May  21st,  1864.  The  case  is  reported  by  Surgeon  T.  Eush  Spencer,  U.  S.  V. 

Case. — Private  Lewis  Jones,  Co.  C,  115th  New  York  Volunteers,  aged  23  years,  received,  in  an  engagement  at  Olustee, 
Florida,  February  20th,  1864,  a gunshot  wound  of  the  seal]).  lie  was  conveyed  to  Jacksonville,  and  thence  to  Hilton  Head, 
South  Carolina,  where  he  entered  the  hospital  on  February  25th.  On  February  27th,  haemorrhage  amounting  to  six  ounces, 
occurred  from  the  anterior  temporal  artery.  The  vessel  was  ligated,  and  h.asmonhage  did  not  recur.  On  April  20th,  he  was 
sent  to  the  hospital  at  Fort  Monroe;  on  April  2Gth,  to  the  DeCamp  Hospital,  New  York  Harbor;  and,  on  September  27th,  1864, 
to  Albany,  New  Yoik,  where  he  died  on  October  15th,  1864,  from  the  effects  of  the  wound.  Assistant  Surgeon  M.  F.  Cogswell, 
LI.  S.  V.,  records  the  case. 

Tetanus. — In  five  of  the  fatal  cases  of  gunshot  wounds  of  the  scalp,  tetanus  was  the 
cause  of  death.  In  every  instance,  the  invasion  of  this  comjilication  was  ascribed  to 
exposure  to  dampness,  with  sudden  depression  of  the  temperature  of  the  atmosphere  ; 

Case. — Corporal  Charles  G.  Carpenter,  Co.  F,  19th  Iowa  Volunteeis,  aged  about  32  years,  received  a wound  of  the 
scalp,  in  the  engagement  at  Morganzia,  Louisiana,  September  29th,  1863,  by  a conoidal  ball.  He  was  admitted,  from  the  field  to 
St.  Louis  General  Hospital,  at  New  Orleans,  on  October  4th,  1863,  where  he  was  treated  by  application  of  simple  dressings,  and 
the  administration  of  saline  cathartics,  and  the  free  use  of  morphia.  On  the  night  of  October  7th,  the  weather  became  cold  and 
damj),  and,  on  the  following  morning,  the  patient  manifested  symptoms  of  trismus.  The  phenomena  of  acute  tetanus  rapidly 
ensued,  and  the  case  terminated  fatally,  on  October  11th,  1863.  At  the  autopsy,  an  extravasation  of  blood  was  found  beneath 
the  skull,  at  a point  corresponding  with  the  wound  of  the  scalp.  The  case  is  reported  by  Surgeon  F.  Bacon,  U.  S.  V. 

Case. — Private  A.  J.  Cook,  Co.  B,  92d  Ohio  Volunteers,  by  the  accidental  discharge  of  a pistol  in  his  own  hands, 
received,  on  November  2d,  1862,  a slight  bullet  wmund  of  the  integuments  of  the  forehead,  over  the  right  superciliary  ridge. 
He  was  admitted  to  hospital  at  Charlestown,  Virginia.  The  wound  at  first  granulated  kindly;  but,  on  November  10th,  the 
j)atient  having,  in  spite  of  the  protestations  of  his  nurse,  removed  the  dressings,  and  gone  out  of  doors  on  a cold,  damp  day, 
tetanic  spasms  of  great  severity  set  in,  and  the  case  terminated  fatally  within  tw'enty-four  ho^irs.  Acting  Assistant  Sm-geon 
McEwen  reports  the  case. 

Case. — Private  Wilson  Miller,  Co.  C,  116th  United  States  Colored  Troops,  aged  26  years,  was  wounded,  in  an  engage- 
ment before  Petersburg,  April  2d,  1865,  by  a conoidal  ball,  which  lodged  two  inches  above  the  left  ear.  He  was  taken  to  the 
hospital  of  the  Second  Division,  Twenty-fifth  Corps,  where  the  ball  was  removed.  On  April  5th,  1865,  he  was  admitted  to  the 
hospital  at  Fort  Monroe.  He  was  placed  in  a hosj)ital  tent,  and  unavoidably  exposed  to  dampness  owing  to  inclement  weather. 
On  April  14th,  trismus  commenced,  and  spasms  gradually  extended  to  the  muscles  of  the  chest,  abdomen,  and  extremities. 
Active  purgatives  were  given,  until  the  bowels  w'cre  thoroughly  evacuated,  after  which  opium  was  prescribed  without  effect. 
Subsequently,  ether  and  chloroform  were  administered,  with  but  temporary  benefit;  assafoetida  also,  was  ineffectually  administered 
per  anum  in  large  and  repeated  doses.  Death  occurred  on  April  20th,  1865.  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  reports 
the  case. 

Case. — Lieutenant  Patrick  Morris,  Co.  M,  62d  Pennsylvania  Volunteers,  aged  30  years,  received,  at  the  battle  of 
Gettysburg,  Pennsylvania,  July  2d,  1863,  a gunshot  scalp  wound  of  the  occipital  region.  On  July  3d,  he  was  admitted  to  the 
hospital  of  the  Fifth  Corps.  On  July  7th,  tetanus,  in  the  form  of  trismus,  made  its  appearance.  Chloroform  was  administered 
by  inhalation,  and  free  incisions  were  made  through  the  scalp  near  the  seat  of  injury.  These  measures  appeared,  for  a time, 
greatly  to  alleviate  the  symptoms,  but  after  a temporary  remission,  these  recurred  with  increased  severity,  and  death  took  place, 
on  July  11th,  1863. 

Case. — Private  Thomas  J.  Severance,  Co.  F,  2d  New  Hampshire  Volunteers,  aged  25  years,  was  wounded,  at  the  battle 
of  Gettysburg,  Pennsylvania,  J uly  2d,  1833,  by  a fragment  of  shell,  which  caused  a wound  of  the  right  side  of  the  scalp, 
j)Osterior  aspect.  He  was,  at  first,  admitted  to  the  Seminary  Hospital,  and,  on  July  8th,  was  transferred  to  Turneris  Lane 
Hospital,  Pluladelphia.  The  general  health  of  the  patient  was  good.  The  edges  of  the  wound  were  inflamed,  and  cold  water 
dressings  were  therefore  applied,  and  continued  until  July  16th,  when  the  patient  complained  of  stiffness  of  the  jaws.  The 
throat  was  rubbed  with  strong  ammoniacal  liniment.  On  the  following  day,  there  was  confirmed  trismus,  and,  in  addition  to 
this,  emprosthotonos  occurred  during  the  night.  Warm  cataplasms  were  a])[)lied  to  the  wound,  and  anodynes  were  administered 
internally.  On  July  18th,  the  anodynes  were  continued,  and  as  the  wound  was  found  to  bo  suppurating  freely,  a supporting 
course,  consisting  of  milk  punch,  and  injections  of  beef  tea,  was  resorted  to.  On  July  19th,  tlie  patient  appeared  to  be  much 
the  same,  manifesting  a great  indisposition  to  be  disturbed.  The  treatment  of  the  preceding  day  was  continued,  together  with 
the  apj)lication  of  powerful  rubefacients  along  the  spine.  Death  resulted  on  the  morning  of  the  20th  of  July.  The  api)arent 
cause  of  the  inva-sion  was  damp  weather,  as  it  occurred  during  a very  damj),  rainy  period.  The  case  is  recorded  by  Assistant 
.Surgeon  C.  H.  Ahlen,  U.  B.  A. 

The  following  case  was  regarded  as  an  insttince  of  recovery  from  traumatic  tetanus,  hut 
the  evidence  is  anything  hut  satisfactory  : 


84 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Private  Conrad  Wentzell,  Co.  E,  75tli  Penneylvauia  Volunteers,  aged  34  j-ears,  received,  at  the  battle  of  Gettys- 
burg, July  1st,  18C3,  gunshot  wounds  of  the  left  side  of  the  head  and  of  the  upper  third  of  the  left  arm.  He  was  at  once 
admitted  into  Seminary  Hospital,  Gettysburg,  and  thence,  on  July  13th,  sent  to  Satterlee  Hospital,  Philadelphia.  There  were 
indications  of  trismus  or  tetanus;  but  upon  chloroform  being  inhaled,  no  spasms  or  pain  recurred.  On  the  ICth,  the  jiatient 
complained  of  burning  pain  in  the  wound,  but  on  the  25th,  he  was  doing  well.  The  wound  looked  healthy,  and  no  further 
complication  ensued.  He  was  furloughed  on  September  28th,  1863,  and  transferred  to  Veteran  Reserve  Corps  on  Febniary 
29th,  1864. 

Pyoemia. — The  reports  specify  five  cases  of  gunshot  wounds  of  the  scalp  in  which 
pytemia  supervened : 

Case. — Private  T.  D.  Biggs,  Co.  I,  Anthorn’s  Regiment,  was,  on  July  5th,  1863,  admitted  to  the  hospital  steamer  R.  C. 
W^ood,  with  a gunshot  wound  on  the  left  side  of  the  scalp.  On  July  7th,  he  was  transfened  to  the  Overton  Hospital,  Memphis, 
Tennessee,  and,  on  July  31st,  he  was  sent  to  the  Church  Hospital  of  the  same  city,  where  he  died,  on  September  3d,  1863,  of 
septica?mia,  accompanied  by  embolic  obstructions  in  some  of  the  smaller  arteries. 

Case. — Private  George  Gold,  Co.  I,  155th  Pennsylvania  Volunteers,  aged  £3  years,  was  admitted  to  Harewood  Hospital 
on  October  7th,  1864.  He  had  been  wounded  at  Poplar  Grove  Church,  on  September  30th,  by  a musket  ball,  which  struck  the 
scalp,  passing  from  before  backwards,  tearing  up  a portion  about  three  inches  in  length  by  one  inch  in  breadth,  laying  bare  the 
skull  and  denuding  it  of  its  pericranium  for  the  space  of  three  inches  in  length  and  one  inch  in  breadth,  through  the  middle  of 
which  space  the  sagittal  suture  passed,  meeting  the  coronal  at  the  anterior  border.  The  patient  was  carefully  watched  for  symp- 
toms indicative  of  cerebral  or  meningeal  inflammation ; but  none  were  manifested  up  to  the  moment  of  his  death,  unless  a slight 
drowsiness,  which,  at  tho  time,  was  attributed  to  the  administration  of  eight  grains  of  Dover’s  powder,  might  be  so  regarded. 
Ho  was  u])  and  about  the  ward,  complaining  of  nothing  except  the  wound  in  the  scalp,  and  receiving  no  treatment,  except 
simple  dressings,  until  the  morning  of  October  18th,  when  he  spoke  of  a slight  pain  in  the  left  side  of  the  chest,  over  the  lower 
lobe  of  the  lung.  There  was  some  dullness  on  percussion  over  the  part  complained  of,  but  no  marked  physical  signs  of  inflam- 
matory mischief.  On  October  19th,  the  patient  was  worse.  The  pain  in  the  left  chest  was  mot:e  severe,  resembling  that  of 
pleurisy;  the  pulse  was  full  and  frequent;  the  tongue  brown  and  rather  dry ; there  was  very  little  cough,  and  no  expectoration. 
On  percussion,  the  right  side  was  very  dull  over  the  lower  lobe,  less  so  over  the  upper  lobe.  The  respiratory  murmurs  were 
nearly  if  not  quite  normal,  over  the  whole  of  the  right  lung.  Examination  by  auscultation  unsatisfactory,  on  account  of  the 
turbulent  action  of  the  heart  and  the  catching  character  of  the  respiration.  There  was  no  cephalic  or  nervous  symptoms.  On 
October  20th,  the  patient  appeai'cd  more  comfortable  in  the  early  part  of  the  day,  the  respiration  less  labored,  and  pulse  more 
quiet,  and  tongue  more  moist;  towards  the  latter  part  of  the  day,  howevei’,  the  symptoms  increased  in  severity.  Great  dullness 
over  whole  of  left  side  of  chest  W'as  noticed,  and  greatly  diminished  resonance  on  the  right  side.  The  vesicular  murmur  was 
heard  over  a small  portion  of  the  superior  lobe  of  the  left  lung  only.  Moist  friction  sounds  over  nearly  the  whole  of  the  left  lung 
could  be  heard,  together  with  bronchial  respiration,  and,  at  some  circumscribed  parts,  a very  coarse  crepitation.  On  the  right 
side  the  vesicular  murmur  was  rather  faint,  and  greatly  obscured  by  bronchial  respiration.  On  October  21st,  there  was  less 
pain  and  dyspnoea,  very  little  cough,  with  a soft  infrequent  pulse,  pale  countenance,  and  increasing  dullness  on  percussion  over 
the  right  side.  Towards  the  latter  part  of  the  day  there  was  less  drowsiness.  The  patient  died  at  half-past  eight  o’clock,  on 
October  22d,  1864.  He  was  perfectly  sensible  and  rational  within  ten  minutes  of  his  death.  A post  mortem  examination  was 
made  three  hours  afterwards.  Cadaveric  rigidity  was  strongly  marked;  the  skin  of  the  chest  and  face  was  of  a deeply  jaundiced 
hue.  On  making  an  opening  into  the  chest,  about  twenty  ounces  of  yellow  serum  was  found  in  the  left  pleura,  none  in  the 
right.  The  pleural  cavities  of  both  sides,  but  jiaiticularly  the  left,  were  covered  to  a considerable  extent  with  coagulablo  lymph 
of  considerable  firmness.  The  left  costal  and  pulmonary  pleurte  were  bound  strongly  together  by  broad,  thick  bands,  the  r('sult 
of  some  foiiner  disease.  There  were  also  a few  much  less  firm  attachments  on  the  right  side.  The  lower  lobe  of  the  left  lung 
was  in  a state  of  gray  hepatization,  the  upper  lobe  in  that  of  red  hepatization,  and  in  both,  at  various  points,  were  found  circum- 
scribed deposits  of  pus,  containing  from  one-half  a drachm  to  a drachm  each.  The  lower  lobe  of  the  right  lung  was  in  a state 
of  red  hepatization,  and  the  middle  and  upper  lobes  were  greatly  congested.  In  the  lower  lobe  were  found  two  or  three  purulent 
deposits,  which  appeared  to  form  centres  of  inflammation,  or  metastatic  foci.  The  wound  along  the  scalp  appeai-ed  as  during 
life.  Pus  was  found  along  the  coronal  and  sagittal  sutures,  throughout  the  whole  extent,  dissecting  the  scalp  from  the  bone,  to 
the  breadth  of  one  inch.  The  skull  was  roughened,  and  deprived  of  })ericranium  to  that  extent.  The  portion  of  the  wound 
which  had  been  originally  denuded  had  begun  to  exfoliate,  a line  of  separation  being  visible  around  it.  On  removing  the 
calvaria,  a thin  layer  of  pus  wms  found  between  the  hone  and  dura  mater,  extending  along  the  sagittal  and  coronal  sutures  to 
the  same  e.xtent  as  on  the  external  surface,  the  amount  of  pus  within  the  skull  being  less  than  one  drachm.  There  w'as  a 
narrow  strip  of  the  dura  mater  each  side  of  these  sutures  which  was  inflamed;  at  other  j)arts  this  membrane  was  healthy.  The 
arachnoid  and  pia  mater  were  perfectly  normal.  The  brain  and  its  ventricles,  the  cerebellum,  medulla  oblongata,  and  roots  of 
all  the  cerebral  nerves  were  carefully  examined,  and  no  lesions  were  discovered.  The  heart  and  its  valves,  the  vena  cava  and 
azygos,  the  pulmonary  veins  and  arteries,  the  jugulars,  and  the  blood-vessels  of  the  brain,  were  in  a normal  condition.  The 
liver  was  apparently  healthy.  Acting  Assistant  Surgeon  Cobb  recorded  the  case. 

Case. — Private  Rufus  Hedges,  Co.  G,  10th  Michigan  Volunteers,  received,  in  the  engagement  at  Peach  Tree  Creek, 
Georgia,  July  21st,  1864,  a slight  gunshot  wound  of  the  scalp.  He  was  admitted  into  the  field  hospital  of  the  Second  Division, 
Fourteenth  Army  Corps,  on  the  same  day.  On  the  following  day,  he  was  conveyed  to  Hospital  No.  2,  at  Chattanooga, 
Tennessee.  On  August  7th,  he  was  transferred  to  the  Sherman  Hospital,  at  Nashville.  A supporting  diet  was  given,  and 
simple  dressings  used.  The  patient  died,  on  August  30th,  1864,  of  pyaemia.  Surgeon  William  Threlkeld,  U.  S.  V.,  reports 
the  case. 


COMPLICATED  GUNSHOT  WOLNDS  OF  THE  SCALP. 


85 


Case. — Private  Gilmer  P.  Rook,  Co.  B,  9tli  Maine  Volunteers,  aged  18  years,  received,  at  the  siege  of  Petersburg,  Vir- 
ginia, July  8th,  1834,  a gunshot  wound  of  the  scalji.  He  was  admitted  to  the  hospital  of  the  Second  Division,  Tenth  Corps,  and 
was  thence  sent  to  the  McDougall  Hospital,  at  Fort  Schuyler,  which  he  entered  on  July  27th.  He  died,  on  July  31st,  of  double 
pneumonia  and  icterus,  and  other  signs  of  pyaemia. 

Case. — Private  A.  Russell,  Co.  K,  53d  North  Carolina  Regiment,  received,  at  the  battle  of  Gettysburg,  Pennsylvania,  July 
3d,  1833,  a gunshot  wound  of  the  scalp.  He  was  admitted  to  the  Seminary  Hospital,  and,  on  July  17th,  was  transferred  to  the 
De  Camp  Hospital  at  David’s  Island,  New  York.  Pyaemia  supervened,  and  death  occurred  on  September  20th,  1863.  Surgeon 
Charles  Gr.ay,  11th  New  York  Cavalry,  reports  the  case. 

Complications  from  Intercurrent  Diseases. — In  twelve  cases  of  gunshot  wounds  of 
the  scalp,  the  fatal  results  are  ascribed  to  typhoid  fever.  This  term  was  often  employed 
in  a very  loose  sense  by  some  of  the  medical  officers,  being  applied  not  infrequently  to  a 
state  of  exhaustion  resulting  from  irritative  or  traumatic  fever  ; 

Case. — Private  George  W.  Beisel,  Co.  K,  55th  Pennsylvania  Volunteers,  aged  29  years,  was  wounded,  while  on  picket, 
]\lay  20th,  1834,  by  a musket  ball,  which  tore  the  scalp  on  the  left  side.  He  was  admitted,  on  May  23d,  to  the  hospital  at  Point 
Lookout,  Maryland,  furloughed  June  24th,  and  readmitted  on  August  17th,  1864.  Typhoid  fever  then  set  in,  and  death  occurred 
on  October  27th,  1834. 

Case. — Private  Chai’les  W.  Hapenstall,  Co.  G,  36th  Illinois  Volunteers,  aged  18  years,  was  wounded,  at  the  battle  of 
Franklin,  Tenn<!ssee,  November  30th,  1834,  by  a conoidal  ball,  which  injured  the  scalp.  He  was  treated  in  a regimental  hospital 
at  first,  and  transferred,  on  December  2d,  to  Hospital  No.  19,  at  Nashville;  but,  on  the  same  day,  he  was  returned  to  modified 
duty  at  the  Convalescent  Camp.  On  December  4th,  he  was  admitted  to  the  Clay  Hospital,  Louisville,  Kentucky,  on  account  of 
the  same  injury.  On  December  25th,  he  was  transfeiTed  to  Hospital  No.  5,  at  Quincy,  Illinois,  where  he  died,  on  December  26th, 
1864,  of  “typhoid  fever.” 

Case. — Private  Lewis  Hicks,  Co.  K,  6th  New  Yoi’k  Heavy  Artillery,  was  wounded,  in  an  engagement  before  Petersburg, 
Virginia,  June  18th,  1834,  by  a conoidal  ball,  which  struck  the  left  temporal  region,  inflicting  a laceration  of  the  integunient.  He 
also  received  a shell  wound  of  the  second  fing(!r  of  the  left  hand.  He  was  admitted  to  the  hospital  of  the  Second  Division,  Fifth 
Corps,  ■where  the  terminal  phalanx  was  removed.  On  July  2d,  he  was  sent  to  the  Slough  Hospital,  Alexandria,  Virginia,  where 
cold  water  dressings  were  applied  to  the  scalp  wound.  Death  occuiTed,  from  enteric  fever,  on  July  10th,  1864.  The  autopsy 
revealed  the  pathognomonic  ulceration  of  Peyer’s  glands,  and  extensive  inflammation  of  the  intestinal  canal. 

Case. — Private  Thomas  Jorman,  Co.  A,  35th  North  Carolina  Regiment,  was  admitted  to  the  hospital  transport  De  Molay, 
with  a gunshot  wound  of  the  scalp.  Typhoid  fever  supervened,  and  the  patient  died,  on  August  28ih,  1864. 

Case. — Private  John  Leach,  Co.  I,  11th  Iowa  Volunteers,  aged  26  years,  received,  at  the  battle  of  Shiloh,  Tennessee,  April 
6th,  1862,  a gunshot  wound  of  the  scalp.  He  subsequently  contracted  typhoid  fever,  from  which  he  died,  on  May  22d,  1862,  at 
Monterey,  Tennessee.  Assistant  Surgeon  A.  R.  Derby,  20th  Missouri  Volunteers,  reports  the  case. 

Case. — Private  Otis  Packard,  Co.  I,  3d  Maine  Volunteers,  aged  18  years,  received,  at  the  battle  of  Spottsylvania,  Virginia, 
May  12th,  1834,  a gunshot  wound  of  the  scalp,  over  the  left  eye.  He  was  admitted  to  the  hospital  of  the  Third  Division,  Second 
Corps,  and,  on  May  14th,  sent  to  the  Harewood  Hospital,  Washington,  D.  C.,  where  he  died,  on  July  9th,  1864,  of  “typhoid 
fever.” 

Case. — Private  John  O’Ragan,  Co.  C,  1st  Maine  Infantry,  aged  41  years,  received,  at  the  battle  of  Cedar  Creek,  Virginia, 
October  19th,  1864,  a gunshot  wound  of  the  scalp.  He  was  admitted,  on  the  same  day,  to  the  hospital  of  the  Second  Division, 
Sixth  Coi-ps,  and,  on  October  23d,  was  sent  to  the  Haddington  Hospital,  Philadelphia,  where  he  died,  “of  typhoid  fever,”  Decem- 
ber 11th,  1864. 

Case. — Private  George  A.  Raush,  Co.  B,  108th  Illinois  Volunteers,  received,  in  the  engagement  at  Arkansas  Post,  January 
11th,  1833,  a slight  gunshot  wound  over  the  eye.  He  was  treated  in  a field  hospital,  and,  on  March  8th,  was  discharged  from 
the  service,  on  account  of  chronic  diarrhoea  and  hernia.  He  died  “of  typhoid  fever,”  on  board  of  the  steamer  Nashville,  on  March 
12th,  1833,  while  in  transit  for  his  home. 

Case. — Private  Barney  Riley,  Co.  F,  1st  New  York  Dragoons,  aged  26  years,  was  wounded  in  the  engagement  at  Tre- 
vilian  Station,  Virginia,  on  June  11th,  1864,  by  a conoidal  musket  ball,  which  caused  a wound  of  the  left  side  of  the  scalp.  He 
was  immediately  admitted  to  the  field  hospital  of  the  Cavalry  Corps,  and,  on  June  21st,  he  was  transferred  to  Mount  Pleasant 
Hospital,  Washington,  D.  C.  Typhoid  fever  supervened,  and  the  patient  died  on  August  11th,  1864.  The  case  is  reported  by 
Assistant  Surgeon  C.  A.  McCall,  U.  S.  A. 

Case. — Private  Alfred  B.  Smith,  Co.  F,  1st  Massachusetts  Heavy  Artillery,  aged  26  years,  was  wounded,  in  an  engage- 
ment before  Petersburg,  Virginia,  June  15th,  1864,  by  a conoidal  ball,  which  lacerated  the  scalp  severely.  He  was  admitted  to 
the  hospital  of  the  Third  Division,  Second  Corps,  and  thence,  on  July  17th,  was  sent  to  the  Finley  Hospital,  Washington,  D.  C. 
He  died,  on  July  27th,  1834,  “of  typhoid  fever.” 

Case. — Private  George  F.  Stetson,  Co.  E,  23d  Massachusetts  Volunteers,  aged  23  years,  was  wounded,  at  the  battle  of 
Cold  Harbor,  Virginia,  June  3d,  1834,  by  a fragment  of  shell,  which  caused  a scalp  wound  of  the  left  side  of  the  head.  He  was 
admitted  to  the  field  hospital  of  the  Eighteenth  Corps,  and,  on  June  9th,  sent  to  the  First  Division  Hos])ital,  at  Alexandria. 
Typhoiil  fever  suj)ervened,  and  death  occurred  on  .July  8th,  1834. 


86 


WOUNDS  AND  INJURIES  OP  THE  HEAD 


Case. — Private  Charles  Tennis,  Co.  K,  7th  Pennsylvania  Cavalry,  aged  25  years,  received,  in  a skirmish,  near  Dallas, 
Georgia,  klay  27th,  18G4,  a severe  gunshot  wound  of  the  left  side  of  the  head.  lie  was  sent  to  Kingston,  Georgia,  and  in  May 
sent  north.  On  June  3d,  he  was  admitted  to  Hospital  No.  8,  Nashville,  Tennessee,  and,  on  June  27th,  transferred  to  the  Third 
Division  Hospital,  at  Murfreesboro,  Tennessee,  where  he  died,  on  September  16th,  1834,  of  typhoid  fever. 

In  four  cases  of  gunshot  wounds  of  the  scalp,  the  fatal  terminations  were  attributed  to 
incidental  malarial  attacks.  But,  as  the  symptoms  were  not  minutely  described,  and  the 
necroscopic  appearances  were  not  observed,  suspicion  arises  that,  in  some  of  the  cases  at  least, 
the  chills  may  have  been  symptomatic  of  internal  suppuration,  or  a part  of  the  characteristic 
phenomena  of  pyaemia. 

Case. — Private  John  A.  Boyle,  Co.  A,  105th  Ohio  Volunteers,  received,  in  an  engagement,  near  Chattanooga,  Tennessee, 
September  23d,  1803,  a gunshot  wound  of  the  head.  He  was  admitted  to  Hospital  No.  15,  Nashville,  where  he  died,  on  October 
19th,  1863,  of  typho-malarial  fever. 

Case. — Private  Daniel  Meyers,  Co.  C,  110th  Pennsylvania  Volunteers,  aged  40  years,  received,  at  the  battle  of  the  Wil- 
derness, Vh’ginia,  May  5th,  1834,  a gunshot  wound  of  the  scalp,  caused  by  a fragment  of  shell.  He  was,  on  May  26th,  admitted 
to  the  Carver  Hospital,  Washington,  D.  C.,  and,  on  June  2d,  transferred  to  the  hospital  at  Brattleboro’,  Vermont.  Fever  of  a 
mahmial  character  supervened,  and  death  occurred  on  June  13th,  1834. 

Case. — Private  Lewis  Price,  Co.  A,  73d  Illinois  Volunteers,  received,  at  the  battle  of  Chickamauga,  Georgia,  September 
19th,  1833,  a slight  gunshot  wound  of  the  scalp,  over  the  left  eyebrow. ' He  was  admitted  to  the  hospital  of  the  Third  Division, 
Twentieth  Corps,  on  September  24th;  was  sent  to  an  hospital  at  Nashville,  and  on  February  7th,  1864,  was  returned  to  the  hos- 
pital at  Chattanooga,  Tennessee,  where  he  died,  on  March  14th,  1834,  of  congestive  fever. 

C.\SE. — Private  Jeremiah  R.  Putnam,  Co.  B,  1st  Massachusetts  Heavy  Artillery,  aged  42  years,  received,  in  an  engage- 
ment before  Petersburg,  Virginia,  June  ICth,  1834,  a gunshot  wound  of  the  scalp.  A coiioidal  ball  struck  over  the  parietal  bones 
in  the  line  of  the  sagittal  suture.  He  was  admitted  to  the  hospital  of  the  Third  Division,  Second  Corps,  and  thence  sent,  by  City 
Point,  to  the  Broad  and  Cherry  Streets  Hospital,  Philadelphia,  which  he  entered  on  June  30th.  He  was,  on  .July  2d,  trans- 
ferred to  the  Haddington  Hospital.  When  admitted  the  patient  suffered  from  intermittent  fever  and  chronic  diarrhcea,  and  was 
extremely  anaemic  and  emaciated.  He  died,  on  July  7th,  1834,  “undoubtedly  in  consequence  of  serous  eflusion  in  brain,  causing 
general  paralysis.” 

In  thirteen  cases  of  gunshot  Wounds  of  the  scalp,  pneumonia  is  reported  as  the  cause 
of  death ; but,  in  several  of  them,  it  is  cpiestionable  if  the  pulmonary  complications  were 
not  embolic  phenomena,  indicating  th-e  formation  of  metastatic  foci,  and  whether  these  cases 
would  not  have  been  more  properly  classified  under  the  head  of  pysemia : 

Case. — Private  Benjamin  D.  Cargill,  2d  Vermont  Volunteers,  aged  19  years,  received,  at  the  battle  of  Spottsylvania  Court 
House,  Virginia,  May  8th,  1834,  a gunshot  wound  of  the  anterior  portion  of  the  scalp.  lie  was  admitted  to  the  hospital  of  the 
Second  Division,  Sixth  Corps,  and,  on  May  23th,  sent  to  the  Lincoln  Hospital,  Washington,  D.  C.  Furloughed  on  May  24th, 
he  was  readmitted  on  June  23d,  and  died  on  August  8th,  1864,  of  acute  bronchitis. 

Case. — Private  James  E.  Coulter,  Co.  E,  95th  Ohio  Volunteers,  aged  38  years,  received,  during  the  siege  of  Vicksburg, 
Mississippi,  June  20th,  1863,  a gunshot  wound  of  the  scalp,  right  side,  and  also  a flesh  wound  of  the  right  forearm.  He  was  admitted 
to  the  hospital  of  the  Third  Division,  Fifteenth  Corps,  where  he  is  reported  as  recovered  for  duty.  On  November  5th,  1864,  he 
was  admitted  to  the  Adams  Hospital,  Memphis,  Tennessee,  with  pneumonia,  and  died  on  November  9th,  1834. 

Case. — Sergeant  Richard  Decker,  Co.  K,  1st  New  Jersey  Cavalry,  aged  22  years,  received,  at  the  affair  at  Salem  Church, 
Virginia,  May  28th,  1834,  a wound  from  a conoidal  musket  ball,  which  tore  up  the  scalp  over  the  vertex  for  the  length  of  an  inch. 
No  injury  to  the  bone  could  bo  detected.  The  patient  was  sent  to  Washington,  and  admitted  to  Mount  Pleasant  Ilosjiital  on  J une 
4th,  1834.  Pneumonic  complications  supervened,  and  the  patient  sank  into  a typhoid  condition,  which  terminated  fatally  on  June 
11th,  1834.  Assistant  Surgeon  H.  Allen,  U.  S.  A.,  recorded  the  case. 

Ca.se. — Private  Samuel  Healey,  Co.  C,  25th  klassachusetts  Volunteers,  aged  28  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  Virginia,  June  3d,  1834,  by  a fragment  of  shell,  which  caused  a wound  of  the  scalp.  He  was  at  once  admitted  to  the 
hospital  of  the  Eighteenth  Corps,  on  June  7th  transferred  to  the  Second  Division  Hospitabat  Alexandria,  and,  on  June  12th,  sent 
to  the  hospital  at  Chester,  Pennsylvania.  Warm  applications  were  made  to  the  wound  to  j)romote  discharge,  but  on  the  19th 
pleuro-pneumonia  set  in,  and  death  occurred  on  June  23d,  1834.  Surgeon  E.  Bentley,  U.  S.  V.,  records  the  case. 

Ca.se. — Private  John  A.  Hutf,  Co.  E,  5th  ^Michigan  Cavalry,  aged  48  years,  received,  in  an  engagement  near  Cold  Har- 
bor, Virginia,  May  28th,  1864,  a severe  gunshot  wound  of  the  scalp  from  a conoidal  ball.  He  was  admitted  to-the  Cavalry  Corps 
Hospital,  and,  on  June  3d,  sent  to  the  Campbell  Hospital,  Washington,  D.  C.,  whence  ho  was  furloughed  on  June  17th,  1834. 
He  died  while  on  furlough,  June  23d,  1834,  from  Wound  and  jrneumonia.  Surgeon  A.  F.  Sheldon,  U.  S.  V.,  records  the  case. 


COMPLICATED  GUNSHOT  WOUNDS  OF  THE  SCALP. 


87 


Case. — Private  C.  W.  Johnson,  Co.  I,  31st  Maine  Volunteers,  aged  25  years,  received,  at  Spottsylvania  Court  House, 
Virginia,  May  12th,  1864,  a shell  wound  of  the  scalp.  Ho  was  admitted  to  Harewood  Hospital,  Washington,  on  May  16th, 
transferred  to  Patterson  Park,  Baltimore,  INlay  18th,  thence  to  David's  Island,  Now  York  Harbor,  May  24th,  and,  finally,  to 
Cony  Hospital  at  Augusta,  Maine,  on  .June  3d,  where  pneumonia  supervened,  and  the  patient  died,  on  June  11th,  1864. 

Case. — Pi  ivate  Allen  H.  Moore,  Co.  E,  1st  Ohio  Volunteers,  aged  26  years,  received,  in  an  engagement  near  Dallas, 
Georgia,  May  27th,  1834,  a gunshot  scalp  wound  of  the  left  side  of  the  head.  He  was  admitted  to  the  hospital  of  the  Third 
Division,  Fourth  Corps,  and,  on  June  1st,  was  sent  to  the  Cumberland  Hospital,  Nashville,  Tennessee,  where  he  died,  on 
.June  15th,  1664,  of  typhoid  pneumonia.  Assistant  Surgeon  W.  B.  Trull,  U.  S.  V.,  records  the  case. 

Case. — Private  John  Portei',  Co.  D,  35th  Indiana  Volunteers,  aged  32  years,  received,  in  an  engagement  at  Marietta, 
Georgia,  Juno  18th,  1864,  a gunshot  wound  of  the  scalp.  He  was  admitted  to  the  hospital  of  the  First  Division,  Fourth  Corps, 
and,  on  June  23d,  he  was  transferred  to  Hosjiital  No.  2,  Chattanooga,  and,  on  Juno  30th,  thence  sent  to  the  Cumberland 
Hospital,  Nashville,  Tennessee.  Simple  dressings  were  applied  to  the  wound,  but  the  patient  was  attacked  by  pleuro- 
jmeumonia,  and  died  on  .July  13th,  1864.  Assistant  Surgeon  W.  B.  Trull,  U.  S.  V.,  records  the  case. 

Case. — Private  James  Reardon,  Co.  B,  6th  Missoini  Volunteers,  received,  before  Vicksburg,  Mississippi,  in  the  latter 
part  of  December,  1862,  a scalp  wound.  He  was  taken  on  board  the  Steamer  City  of  ^Memphis,  and,  on  January  13th,  1863, 
was  admitted  to  the  hospital  at  1‘aducah,  Kentucky,  where  he  died  of  wound  of  the  scalp,  with  pneumonia,  on  January  18th,  1863. 

Case. — Captain  F.  W.  Sabine,  Co.  G,  11th  Maine  Volunteers,  aged  25  years,  received,  in  an  engagement  at  Deep 
Bottom,  Virginia,  August  14th,  1864,  a gunshot  wound  of  the  scalp.  He  was,  on  the  following  day,  admitted  to  the  Chesapeake 
Hospital,  at  Fort  Monroe,  Virginia.  Pneumonia  of  the  right  lung  existed  at  time  of  admission,  and  terminated  fatally  on 
September  15th,  1864.  Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  records  the  case. 

Case. — Private  Jam(>s  Shields,  Co.  I,  69th  New  Yoilc  Volunteers,  received,  at  the  battle  of  Fredericksburg,  Virginia, 
December  13th,  1862,  a gunshot  wound  of  the  scalp.  He  was  admitted  to  the  hospital  of  the  Third  Division,  Ninth  Corps,  on 
Decemher  14th,  was  sent  to  the  Armory  Square  Hospital,  Washington,  D.  C.,  and,  on  December  19th,  transferred  to  the  De 
Camj)  Hospital,  New  York  Harbor,  where  he  died,  on  January  9th,  1853,  of  pneumonia.  Surgeon  J.  Simons,  U.  S.  A., 
recorded  the  case. 

Case. — Private  George  51.  Snow,  Co.  D,  25th  Wisconsin  Volunteers,  aged  23  years,  received,  at  the  battle  of  Eesaca, 
Georgia,  51ay  14th,  1864,  a shell  wound  of  the  scalp.  He  was,  at  once,  admitted  to  the  hospital  of  the  Sixteenth  Corps.  On 
51ay  19th,  he  was  sent  to  the  field  hospital  at  Chattanooga,  on  5Iay  21st,  was  transferred  to  Hospital  No.  1,  Nashville,  and 
thence,  on  May  24th,  was  sent  to  the  Brown  Hospital,  Louisville,  Kentucky.  He  died,  on  June  9th,  1864,  of  pleuro-pneumonia. 

Case. — Private  William  Spencer,  Co.  F,  51st  Ohio  Volunteers,  received,  at  the  battle  of  Kenesaw  5Iountain,  June  22d, 
1864,  a shell  wound  of  the  scalp.  He  was  conveyed  to  Nashville,  Tennessee,  and  admitted  to  the  Cumberland  Hospital,  on 
June  26th.  Typhoid  pneumonia  supervened,  and  the  patient  died,  on  July  3d,  1864. 

Three  fatal  cases  of  gunshot  scalp  wounds  were  complicated  by  the  supervention  of 
variola : 

Case. — Corporal  Edgar  Calkins,  Co.  D,  5th  5Iichigan  Voluntefh's,  'received,  at  the  battle  of  Fredericksburg,  Virginia, 
December  13th,  1862,  a gunshot  wound  of  the  right  side  of  the  scalp.  He  was  admitted  to  the  hospital  of  the  First  Division, 
Third  Corps,  and,  on  December  19th,  was  sent  to  5Iansion  House  Hospital,  Alexandria,  and,  on  April  10th,  1863,  symjitoms  of 
small-pox  being  manifested,  he  was  transferred  to  hospital  for  eruptive  diseases,  at  Kalorama,  Washing-ton,  D.  C.,  where  he 
died,  on  5Iay  27th,  1863,  of  varioloid  with  cerebral  symptoms. 

Case. — Private  John  Crandall,  Co.  K,  04lh  New  York  Volunteers,  aged  33  years,  received,  at  the  engagement  at  North 
Anna,  Virginia,  5Iay  18th,  1864,  a scalp  wound  of  the  occipital  region,  from  a musket  ball.  He  was  sent  to  Washington,  and 
entered  Carver  Hospital  on  the  24th,  and,  on  the  27th,  was  transferred  to  the  Summit  House  Hospital,  Philadelphia.  Here  he 
had  variola.  When  partially  convalescent  he  was  removed,  July  14th,  to  Turner’s  Lane  Hospital;  again,  on  October  10th,  to 
Filbert  Street  Hospital,  and  again,  on  Fobruaiy  16th,  1865,  to  Islington  Lane  Hospital.  Here  he  died,  on  February  24th,  from 
the  effects  of  the  wound,  and  of  the  sequela?  of  small  pox. 

Case. — Sergeant  Charles  Harbstrutt,  Co.  D,  74th  Pennsylvania  Volunteers,  received,  at  the  battle  of  Gettysburg,  .July 
2d,  1863,  a shell  wound  of  the  integuments  on  the  back  of  the  head.  Ho  was  admitted,  on  the  same  day,  to  the  Seminary 
Hospital,  at  Gettysburg,  to  be  transferred  on  the  18th,  to  the  hospital  at  York,  Pennsylvania.  On  October  8th,  variola  super- 
vened, and  the  patient  died,  November  6th,  1863,  from  the  conjoined  effects  of  tlie  wound  and  fever.  » 

In  one  case  of  gunshot  scalp  wound  hepatitis  is  adduced  as  the  cause  of  death  ; 

Case. — Private  Edward  5IcDole,  Co.  G,  7th  New  York  Heavy  Ar  tillery,  received,  irr  an  engagement  before  Petersburg, 
Virginia,  June  16th,  1864,  a scalp  wound,  caused  by  a fragment  of  shell.  He  was  admitted  to  the  hosjiital  of  the  First  Division, 
Second  Army  Corps;  on  June  21st,  he  was  sent  to  the  Lincoln  Ho.sjiital,  Washingtorr,  D.  C.,  and,  on  Jurre  28th,  to  the 
Satteriee  Hospital,  I’hiladeljihia,  where  he  died,  on  July  9th,  1864,  “of  hejratitis.” 

Diarrhoea  is  reported  as  a fatal  complication  in  four  cases : 

Case. — Private  Joseph  Coad,  Co.  F,  3d  Mairre  Volunteers,  aged  35  years,  was  wourrded,  at  the  b.attle  of  the  Wildcraress, 
Virginia,- 5Iay  8th,  1864,  by  a conoiilal  ball,  which  lacerated  the  right  side  of  the  scaljr.  He  was  sent  to  Washington,  and 
admitted,  orr  May  27th,  to  Cai-ver  Hospital,  where  simple  dressings  were  ajiplied  to  the  wound.  De.'ith  occurred  oir  June  18th, 
1864,  from  “chrorric  diarrhoea.”  Surgeon  O.  A.  Judsorr,  U.  S.  V.,  recorded  the  case. 


88 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Case. — Private  A.  F.  Dana,  Co.  E,  United  States  jMarine  Coi’ps,  aged  22  years,  was  wounded,  at  the  assault  on  Fort 
Fisher,  January  15th,  1865,  by  a fragment  of  shell,  which  lacerated  the  right  side  of  the  scalp  and  caused  a transitory  concussion 
of  the  brain.  He  was  made  a prisoner,  but  was  shortly  afterwards  exchanged,  and,  on  February  3d,  186.5,  admitted  to  the 
hospital  at  Point  Lookout,  Maryland.  Here  he  died,  on  July  18th,  1865,  of  “chronic  diarrhoea.”  Surgeon  G.  L.  Sutton, 
U.  S.  V.,  records  the  case. 

Case. — Private  Alvah  B.  Small,  Co.  C,  20th  Maine  Volunteers,  received,  at  Gettysburg,  Pennsylvania,  July  3d,  1863,  a 
gunshot  wound  of  the  scalp.  He  was,  at  once,  admitted  to  a field  hospital,  and,  on  July  8th,  was  transferred  to  the  Satterlee 
Hospital,  at  Philadelphia.  Sunple  dressings  were  applied  to  the  wound,  and  tonics  and  astringents  were  administered  internally. 
Chronic  diarrhoea,  fi’om  which  he  was  suffering,  persisted,  and  death  ensued  August  28th,  1863. 

Case. — Corporal  Richard  H.  Van  Devine,  Co.  K,  1st  New  Jersey  Infantry,  aged  28  years,  received,  at  the  battle  of 
Spottsylvania,  Virginia,  May  12th, '1864,  a gunshot  wound  of  the  scalp.  He  was  admitted,  on  June  11th,  to  the  Mount  Pleasant 
Hospital,  Washington,  D.  C.,  and,  on  June  20th,  transferred  to  the  Summit  House  Hospital,  Philadelphia.  At  the  period  of 
his  admission  he  was  very  much  reduced,  and  he  died,  on  July  10th,  1864,  “of  diarrhoea.”  Surgeon  J.  H.  Taylor,  U.  S.  V., 
records  the  case. 

Privation  in  prison  is  assigned  as  the  cause  of  death  in  one  case : 

Case. — Private  John  A.  Brown,  Co.  B,  73d  Blinois  Volunteers,  was  wounded,  at  the  battle  of  Chickamauga,  September 
19th,  1863,  by  a musket  ball,  which  produced  a lacerated  wound  of  the  scalp.  He  was  made  a prisoner,  and  was  sent  to 
Andersonville,  Georgia,  where  he  died,  on  August  17th,  1864. 

The  following  case  terminated  fatally  in  consequence  of  the  supervention  of  diph- 
theritis  : 

Case. — Private  Julius  McKnight,  Co.  D,  27th  U.  S.  Colored  Troops,  aged  23  years,  received,  on  July  30th,  1864,  at  the 
siege  of  Petershurg,  yirginia,  a gunshot  wound  of  the  scalp.  He  was  sent  to  the  hosjiital  for  Colored  Troops,  a few  miles  in 
the  rear,  at  City  Point.  Here  little  importance  was  attached  to  the  wound  of  the  head,  and  the  patient  was  entered  on  the 
register  as  suffering  fi-om  remittent  fever.  On  August  14th,  he  was  sent  to  Philadelphia,  to  the  Summit  House  Hospital,  where 
the  scalp  wound  was  regarded  as  serious.  As  it  was  progi’cssing  favorably,  light,  simple  dressings  were  apjilied.  In  Septem- 
ber, symptoms  of  diphtheria  were  manifested,  and  the  disease  making  very  rapid  progress,  the  patient  died,  on  Se])tember  2ffth, 
1864.  At  the  autopsy,  the  mucous  coat  of  the  fauces  and  trachea  appeared  to  be  ulcerated  and  disorganized.  A tough  tuhular 
membrane  lined  the  larynx,  trachea,  and  bronchi,  even  to  the  smaller  ramifications;  and  in  the  larger  air  passages,  this 
pseudo-membrane  was  detached.  It  was  of  a yellowish  gray  or  ash  colored  hue.  The  lungs  were  much  engorged.  An  abscess 
containing  half  an  ounce  of  pus  was  found  in  the  right  lung.  Entangled  among  the  columnaj  earner  of  the  right  ventricle  of 
the  heart  was  a concretion,  half  an  ounce  in  weight,  very  similar  in  appearance  to  the  membranous  exudation  in  the  lung.  It 
was  very  unlike  the  ordinary  fibrinous  coagula  or  heart  clots  so  frequently  observed  in  autopsies,  and,  under  the  microscojie, 
presented  the  same  histological  elements  as  the  exudations  in  the  air  passages.  Surgeon  J.  H.  Taylor,  U.  S.  V.,  records  the  case. 

In  another  of  the  one  hundred  and  sixty-two  fatal  gunshot  scalp  wounds,  the  fatal 
result  was  probably  due  to  delirium  tremens  : 

Case. — Corporal  William  Quinn,  Co.  A,  95th  New  York  Volunteers,  aged  29  years,  received,  at  the  battle  of  Gettysburg, 
July  2d,  1863,  a gunshot  scalp  wound  of  the  frontal  region.  After  a few  days  treatment  in  field  hosj)ital,  he  was  sent  to  Phila- 
delphia, and  admitted  into  Satterlee  Hospitid  on  July  11th.  He  died  “from  mania  a potu”  on  August  23d,  1863.  At  the 
autopsy,  an  extensive  discoloration  of  the  forehead  and  face  was  observed;  but  no  fracture  of  the  cranium  or  injury  of  the 
brain  could  be  detected  after  the  most  careful  exploration.  There  was  cirrhosis  of  the  liver;  but  the  other  viscera  showed  no 
organic  alteration.  Surgeon  I.  I.  Hayes,  U.  S.  V.,  records  the  case. 

The  five  following  cases  are  reported  as  slight  gunshot  wounds  of  the  head.  From  the 
evidence  derived  from  prescription  books,  hospital  registers,  monthly  reports,  and  other 
sources,  it  is  inferred  that  the  injuries  were  diagnosticated  as  gunshot  wounds  of  the  scalp 
only,  and  that  no  lesions  of  the  bony  walls  of  the  skull  were  discovered  after  death : 

Case. — Corporal  Isaac  Foster,  Co.  H,  98th  New  Y'ork  Volunteers,  aged  23  years,  received,  at  the  battle  of  Cold  Harbor, 
Virginia,  June  3d,  1864,  a gunshot  wound  of  the  head.  He  was  admitted  to  the  hospital  of  the  First  Division,  Eighteenth 
Corps,  and  was  thence  transferred  to  hospital  Division  No.  2,  Alexandria,  Virginia,  where  he  died,  on  June  21st,  1864,  from 
wound.  Surgeon  E.  Bentley,  U.  S.  V.,  records  the  case. 

Case. — Corporal  Henry  French,  Co.  I,  173d  New  York  Volunteers,  received,  on  May  12th,  1863,  a gunshot  wound  of 
the  head.  He  was  admitted  to  the  Alexander  Hospital,  Brashear  City,  Louisiana,  where  he  died,  on  Slay  25th,  1863.  Surge  on 
C.  Powers,  160th  N.  Y.  Vols.,  reports  the  case. 

Case. — Private  W.  B.  Griffith,  Co.  H,  20th  Virginia  Regiment,  was  brought  to  the  Chimborazo  Hospital,  Richmond, 
Virginia,  on  December  10th,  1864,  with  a gunshot  wound  of  the  head.  1 le  died  on  December  25tb,  1864.  Assistant  Surge  on 
J.  B.  Wily,  C.  S.  A.,  records  the  case. 


GUNSHOT  WOUNDS  OF  THE  SCALP. 


89 


Case. — Private  Charles  Bussell,  Co.  B,  37th  Massachusetts  Volunteers,  was  wounded  at  the  battle  of  Winchester,  Septem- 
ber 19th,  1864,  and  is  reported  by  Assistant  Surgeon  Elisha  M.  White,  37th  Massachusetts  Volunteers,  as  “killed  in  battle.”  He 
was  not  killed,  however,  but  was  conveyed  to  the  general  field  hospital  of  the  Sixth  Coi’ps,  whence  the  case  is  reported  by  Sur- 
geon S.  A.  Holman,  U.  S.  V.,  as  a flesh  wound  of  the  scalp,  produced  by  a fi-agment  of  shell.  On  October  4th,  the  patient  was 
transferred  to  Sheridan  Hospital,  where  the  diagnosis  is  recorded  by  Surgeon  F.  V.  Hayden,  U.  S.  V.,  as  a gunshot  wound  of 
the  scalp,  involving  the  integument  only,  and  by  Surgeon  W.  A.  Barry,  98th  Pennsylvania  Volunteers,  as  a gunshot  wound  of 
the  head  with  injury  of  the  skull.  The  patient  died  on  October  7th,  1864. 

Case. — Private  Edward  Wilmore,  Co.  K,  1st  Missouri  Volunteers,  received,  at  the  battle  of  Wilson’s  Creek,  Missouri, 
August  10th,  1861,  a gunshot  wound  of  the  head  and  the  face.  He  was,  on  the  same  day,  admitted  to  the  hospital  at  Springfield, 
where  he  died,  on  August  25th,  1861. 

As  contused  or  lacerated  wounds  of  the  scalp  are  rarely  fatal,  unless  followed  by 
secondary  disease  of  the  cranium  or  its  contents,  or  by  hsemorrhage,  sloughing,  pyaemia, 
or  tetanus,  numerical  estimates  of  the  results  of  gunshot  injuries  of  the  integuments  of  the 
head  can  teach  us  little  more  than  the  relative  frequency  and  fatality  of  such  complications. 
The  foregoing  brief  abstracts  of  two  hundred  cases  include  thirty-eight  recoveries  and  one 
hundred  and  sixty-two  fatal  cases.  The  tabular  statement,  on  page  70,  of  7,739  cases  of 
gunshot  scalp  wounds  gives  a near  approximation  to  the  truth  regarding  the  results  of  such 
injuries,  every  allowance  being  made  for  errors  in  diagnosis  and  imperfection  in  the  returns.”' 
The  histories  of  3,420  cases  have  been  traced  from  hospital  to  hospital  until  the  complete 
recovery  of  the  patients'  and  their  return  to  duty  was  ascertained.  In  like  manner,  the 
histories  of  132  Confederates  who  recovered  and  were  exchanged,  released,  or  paroled,  and 
of  127  United  States  enlisted  men  who  were  sent  to  modified  duty,  have  been  followed  to 
their  termination.  The  terminations  of  1,186  cases  in  resignation,  discharge,  dismissal, 
failure  to  return  from  leave  or  furlough,  or  in  desertion,  have  been  ascertained.  1,609 
patients  have  been  followed  through  successive  transfers  to  hospitals  or  convalescent  camps  ; 
though  the  records  do  not  furnish  evidence  of  the  ultimate  disposition  made  of  them,  it  may 
be  inferred  that  they  recovered,  since  their  names  do  not  appear  upon  the  alphabetical 
registers  of  deaths.  Finally,  1,103  cases  are  derived  from  the  field  casualty  lists,  and, 
although  they  are  entered  as  cases  in  which  the  terminations  are  “unknown,”  it  may  be 
inferred,  as  the  names  do  not  reappear  on  any  of  the  hospital  registers,  that  the  injuries  in 
these  cases  were  slight,  and  that  the  patients  were  returned  to  duty  almost  immediately. 
Grouping  those  sent  to  active  or  modified  duty,  those  transferred,  paroled,  or  exchanged, 
and  those  who  did  not  enter  permanent  hospitals,  in  one  class,  and  in  another  those  who 
were  discharged,  or  dismissed,  or  reported  as  deserters,  the  7,739  cases  are  accounted  for 
as  follows : 162  patients  died,  1,186  were  discharged,  and  6,391  recovered.  But,  as  1,186 
patients  discharged  include  many  who  were  mustered  out  on  the  expiration  of  their  term  of 
service,  or  who  failed  to  return  from  furlough,  or  who  deserted,  a nearer  approximation  to 
exact  truth  is  attained  by  the  statement  that  162  died,  522  were  discharged  on  certificates 
of  physical  disability,  and  7,055  probably  recovered.  The  death-rate  of  gunshot  wounds 
of  the  integuments  of  the  cranium  during  the  late  war  was,  therefore,  about  2.09,  or  nearly 
one  fatal  case  in  48. 


* I am  anxious  to  point  out  how  far  each  numerical  estimate  may  be  relied' upon,  and  to  indicate  the  sources  of  error.  The 
reports  of  each  of  the  seventy-seven  hundred  and  thirty-nine  cases  of  gunshot  wounds  of  the  scalp  recorded  in  Table  III,  were 
separately  examined  and  were  entered  upon  the  register  of  gun.shot  wounds  of  the  scalp,  when  the  evidence  indicated  the  proba- 
bility that  the  injury  was  hmited  to  the  integument.  Jhe  tabular  statement  is  a correct  transcript  from  the  official  records,  and 
an  index  of  the  average  results  of  the  injuries  to  which  it  relates.  To  suppose  that  no  cases  of  contusion  of  the  skull  or  injury  to 
the  brain  were  included  in  the  statement,  would  imply  a precision  in  diagnosis  and  perfection  in  returns  that  are  unattainable. 
In  a final  revision  of  the  reports,  I have  set  aside  twenty-one  cases,  including  eleven  that  were  fatal,  recorded  among  the  scalp 
wounds  as  probably  examples  of  contusion  of  bone,  and  have  transposed  about  an  equal  number  from  the  register  of  contusions 
and  partial  fractures  of  the  skull. 

12 


90 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


The  Surgical  History  of  the  British  Army  in  the  Crimea,  compiled  by  Staff  Surgeon 
T.  P.  Mattliew,''’  contains  a record  of  668  gunshot  wounds  of  the  head  designated  “ simple 
flesh  contusions  and  wounds;”  8 of  these  patients  died,  73  were  invalided,  and  587  were 
returned  to  duty,  a mortality -rate  of  1.02,  or  one  in  83.  The  surgical  report  of  the  French 
army  in  the  Crimea,  by  M.  Chenu,^  presents  a tabular  statement  of  1,633  gunshot  wounds 
of  the  head  distinguished  from  fractures  of  the  cranium  and  wounds  of  an  undetermined 

O 

nature,  and  designated  “ plaies  simples. et  contusions.”  Of  these  patients,  157  died,  17  were 
pensioned,  and  1,459  returned  to  duty  ; a death-rate  of  nearly  ten  per  cent.  In  the  Eeport 
on  the  Italian  AVar  of  1859,  the  same  author J enumerates  308  cases  of  gunshot  wounds  of 
the  head  as  “ contusions  et  plaies  contuses.”  Of  these  patients  19  died,  4 were  invalided, 
and  285  returned  to  duty,  or  about  one  death  in  16.  These  discrepancies  are  quite 
explicable.  M.  Chenu’s  returns  are  very  incomplete,  the  slight  cases  being  omitted.  The 
British  returns  include  contusions  by  spent  balls  and  trivial  injuries ; but  exclude  fatal 
results  from  intercurrent  diseases.  The  American  returns  comprise  a large  series  of  both 
slight  and  severe  cases,  and  include  the  fatal  results  due  to  diseases  contracted  in  hospitals. 

The  danger  of  injuries  of  the  skull  varies  greatly,  according  to  the  part  involved ; but 
in  wounds  limited  to  the  integument  little  difference  is  observed,  save  that  those  of  the 
temporal  and  occipital  regions  are  more  liable  to  hsemorrhage.  In  5,246  cases  of  gunshot 
wounds  of  the  scalp,  the  precise  location  of  the  wound  is  not  specified.  In  the  remaining 
2,493  cases  the  seat  of  injury  is  reported  as  follows ; 

Table  IV. 


Seat  of  Injury  in  Two  Thousand  Four  Hundred  and  Ninety-three  Cases  of  Gunshot 

Wounds  of  the  Scalp. 


The  gunshot  wounds  of  the  scalp  presented  many  varieties.  There  were  mere 
scratches  of  the  skin  made  by  the  sharp  angles  of  shell  fragments,  solutions  of  continuity 
resembling  incised  wounds,  superficial  injuries  analogous  to  ordinary  contusions  with 
abrasion  of  the  cuticle  furrows  or  cleanly  cut  grooves  made  by  balls  moving  with  great 
velocity,  lacerations  with  flaps  or  with  much  loss  of  tissue,  long  fistulous  tracks  or  tunnel- 
like passages  styled  by  French  surgeons  plaies  en  seton,  and  wounds  with  lodgment  of  the 
missile. 

* Medical  and  Surgical  History  of  the  British  Army  which  served  in  Turkey  and  the  Crimea  during  the  War  against 
Russia,  in  the  years  18.j4-’55-’5G,  London,  1858,  Vol.  II,  p.  28G. 

+ Eapport  au  Conscil  de  Sante  dfs  Armees  sur  les  llcsuUats  du  Service  Medico-Chirurgkal pendant  la  Campapne  d’ Orient  en 
1854-’r).5-’.5G.  Par  J.  C.  CnENU,  Paris,  1855,  p.  1.34. 

t Statistique  Mcdico-CJururqicale  de  la  Campapnc  d’ltalie  en  18.59  et  1800.  Par  J.  C.  CiucNU,  Paris,  1809,  Tome  II,  ]).  424. 


GUNSHOT  WOUNDS  OF  THE  SCALP. 


91 


The  abrasions  and  superficial  cuts  require  no  other  comment  than  the  Hippocratic 
aphorism,  that  no  injury  of  the  head  is  too  slight  to  he  despised ; the  furrowed  wounds, 
because  of  the  rounded  form  of  the  head,  are  usually  very  limited  in  length  ; the  extended 
lacerations  are  commonly  produced  by  shell  fragments  or  by  elongated  musket  balls  striking 
sideways ; long  fistulous  tracks  are  made  by  both  round  and  yylindro-conical  small-arm 
projectiles  deflected  by  the  dense  tissues  of  the  scalp,  but  the  longest  occur  when  a round 
ball  strikes  obliquely  and  runs  around  the  head,  such  cases  being  rare  unless  attended  by 
contusions  of  bone ; the  wounds  resembling  incisions  are  not  exempt  from  slight  loss  of 
tissue  and  consequent  inevitable  suppuration.  The  wounds  with  lodgment  of  missiles  will 
be  noticed  presently,  after  adverting  to  the  relative  frequency  of  wounds  from  the  different 
varieties  of  gunshot  projectiles. 

In  the  returns  of  4,002  cases,  the  nature  of  the  gunshot  projectile  inflicting  the  injury 
is  specified  in  the  reports,  and  in  3,737  cases  this  particular  is  not  referred  to,  or  was 
undetermined : 

Table  V. 


Nature  of  Missile  in  Four  Thousand  and  Two  Cases  of  Gunshot  Wounds  of  the  Scalp. 


NAME  OF  MISSILE. 

No.  OF  Wounds. 

Conoidal  Musket  Ball  

2,G12 

384 

Explosive  Musket  Ball - 

2 

Buck  Shot 

94 

Pistol  Ball - 

25 

Solid  Canon  Ball 

3 

Shell  Fragments 

861 

Grape  Shot 

9 

Case  and  Canister  Shot  and  Shrapnel 

6 

Torpedo  Fragments - 

4 

Piece  of  Iron 

2 

Total, 

4,002 

This  statement  indicates  that  72.6  per  cent.,  or  nearly  three-fourths  of  the  gunshot 
wounds  of  the  scalp,  were  caused  by  small-arm  missiles,  and  that,  without  any  attendant 
injury  to  the  skull  or  concussion  of  the  brain,  the  scalp  may  be  wouuded  by  the  largest 
projectiles  from  artillery.  The  form,  size,  and  velocity  of  missiles  have  very  important 
relations  to  the  nature  and  extent  of  fractures,  wounds  of  the  great  cavities,  and  some 
classes  of  flesh  wounds ; but  the  soft  parts  covering  the  skull  are  so  thin,  that  distinctions 
referable  to  the  nature  of  the  projectil^  causing  flesh  wounds  of  this  region  are  not  well 
marked,  and  suggest  few  considerations  of  interest.  The  varieties  in  gunshot  scalp  wounds 
depend  more  upon  the  velocity  than  the  dimensions  or  shape  of  the  missile.  Cleanly  cut 
furrows  were  made  both  by  musket  balls  and  fragments  of  shell  in  rapid  flight,  and  very 
ragged  wounds  were  inflicted  not  only  by  shell  fragments,  but  by  nearly  spent  or  glancing 
musket  balls. 


92 


WOUNDS  AND  INJUEIES  OF  THE  HEAD 


In  sixty-five  cases,  or  less  than  one  per  cent,  of  the  gunshot  wounds  of  the  scalp, 
foreign  bodies  lodged,  and  were  extracted  from  beneath  the  integument.x  They  were  chiefly 
small-arm  projectiles,  either  nearly  spent  or  diminished  in  velocity  by  deflection  that  made 
no  exit  wounds ; but  small  fragments  of  shells,  iron  balls  from  spherical  case,  and  buttons 
and  bits  of  metal,  torn  from  the  soldier’s  uniform  or  equipment,  were  occasionally  extracted. 
A few  illustrative  cases  will  not  be  uninteresting : 


Case. — Private  Diedridi  Dasenbuck,  Co.  C,  151st  Pennsylvania  Volunteers,  was  wounded,  at  the 
battle  of  Gettysburg,  July  1st,  18G3,  by  a battered  conoidal  musket  ball,  which  struck  the  scalp  an  inch 
and  a half  behind  the  right  ear,  and,  passing  forward  beneath  the  integument,  lodged  in  the  right  cheek. 

He  I'cceived  another  wound,  the  entrance  being  on  the  right  side  of  the  neck,  at  the  border  of  the 
trapezius,  two  inches  within  and  above  the  acromio-clavicular  articulation,  the  missile  passing  subcutane- 
ously and  lodging  above  the  middle  of  the  right  clavicle,  whence  it  was  removed  through  a button-hole 
incision,  on  July  Sd.  He  was  treated  for  a few  days  in  the  Seminary  field  hospital,  at  Gettysburg,  Penn- 
sylvania, and  was  then  sent  to  Philadelphia,  and  admitted,  on  July  11th,  to  the  hospital  in  Turner’s  Lane. 

On  July  17th,  the  position  of  the  larger  foreign  body  was  ascertained,  and  it  was  removed  from  the  cheek, 
by  an  incision  through  the  inner  or  huccal  surface,  fi-om  its  lodgment  immediately  below  the  orifice  of  the 
duct  of  Steno.  Both  wmunds  cicatrized  promptly,  and  the  patient  was  returned  to  duty  perfectly  well,  on 
August  17th,  1863.  The  ball  removed  from  the  cheek  was  very  much  battered,  and  included  in  its  folds  a 
tuft  of  hair.  The  other  missile  extracted  was  a flattened  piece  of  lead,  not  improbably  a fragment  of  the 
projectile  just  described.  This,  a cylindro-conical  ball  of  English  manufacture,  had  apparently  struck 
and  split  upon  some  hai’d  surface  before  inflicting  the  wound  in  the  scalp.  The  two  projectiles  were  con- 
ti-ibuted  to  the  Army  Medical  Museum  by  Acting  Assistant  Surgeon  Charles  Carter,  and  are  represented  in 
the  adjacent  wood-cut,  (Fig.  27).  The  notes  of  the  case  were  furnished  by  Assistant  Surgeon  C.  H. 

Alden,  U.  S.  A. 

A ball  lodged  under  the  scalp  is,  usually,  very  readily  detected  ; but,  in  rare  instances 
of  lodgment  in  the  temporal  fossa  or  occipital  region,  there  may  be  some  obscurity.  The 
next  abstract  suggests  the  utility,  in  such  cases,  of  the  probe  invented  by  M.  bT^laton  ; 


Fig.  27. — Projec- 
tiles extracted  from 
a patient  with  a 
wound  of  the  scalp. 
— Spex.  4520  and 
Spec.  4527,  Sect.  I, 
A.  M.  M. 


Case. — A soldier  of  the  First  Brigade,  First  Division,  Fifth  Corps,  was  wounded,  on  May  20th, 
1854,  in  the  advance  from  Spottsylvania  towards  the  North  Anna  river,  by  a musket  hall,  which 
entered  the  left  cheek  over  the  canine  fossa  of  the  left  superior  maxillary,  and  passed  outward  and- 
backward  eight  inches,  without  apparent  injury  to  the  bone,  and  lodged  under  the  scalp  above  the 
nucha.  The  discoloration  of  the  porcelain  tip  of  a N61aton  probe  passed  through  the  long  fistulous 
Fig.  28.— Elongated  track,  revealed  the  exact  location  of  the  ball,  which  was  immediately  extracted,  on  the  field,  by  Surgeon 
neafh’^tjie'^^ocoipTtTl  14Cth  New  York  Volunteers.  The  notes  of  the  case,  together  with  the  specimen,  repre- 

gion  of  the  scalp.— ^pec.  sented  in  the  wood-cut  (Fig.  28),  were  forwarded  by  Assistant  Surgeon  J.  Sim  Smith,  U.  S.  Anny.  In 
3153,  Sect.  I,  A.  Jt.  M.  letter  from  Dr.  Flandrau,  dated  Borne,  New  York,  February,  1870,  he  refers  to  this  case,  and  mentions 
that,  “in  a careful  examination  of  the  wound,  several  surgeons  were  unable  to  decide  whether  bone  or  ball  was  touched,  until 
the  porcelain-tipped  probe  promptly  settled  the  question.” 


Very  rarely  a fragment  of  shell  may  lodge  under  the  scalp  without  injuring  the  bone, 
as  in  the  following  instance  : 


Case. — Private  G , Co.  F,  41st  New  York  Volunteers,  in  the  assault  on  the  works  on 

John’s  Island,  South  Carolina,  February  11th,  1864,  was  wounded  in  the  right  temple.  He  walked 
from  the  battle-field  to  the  field  hospital,  several  hundred  yards  in  the  rear,  and  presented  himself  to 
Surgeon  Samuel  Brillantowski,  of  his  regiment.  A crucial  wound  was  found  in  the  temporal  region, 
three-fourths  of  an  inch  from  the  external  angle  of  the  right  orbit.  An  irrcgulaily  triangular  frag- 
ment of  a shell  was  found  beneath  the  integument,  and  was  speedily  extracted.  Under  approjiriate 
treatment  the  wound  healed  perfectly  in  six  weeks,  the  patient  recovering  without  any  impairment  of 
vision.  The  specunen,  contributed  by  Surgeon  Brillantowski  to  the  Museum,  with  the  foregoing 
notes,  is  represented  in  the  adjacent  wood-cut.  (Fig.  29.) 


Fig.  29. — .Small  cast-iron 
fragment,  apparently  from 
tlio  base  of  a cylindrical 
shell. — Spec.  234.5,  Sect..  I, 
A.  M.  M. 


Brevet  Lieutenant  Colonel  0.  H.  Laub,  Surgeon  U.  S.  Army,  lately  informed  the 
writer  that,  during  the  hostilities  with  the  Seminoles  in  Florida,  the  lodgment  of  small 
rifle  balls  under  the  scalp  was  not  an  infrequent  occurrence.  Surgeon  Laub  cited  three 
instances  of  removal  of  such  missiles  from  beneath  the  frontal  integument,  in  the  cases  of 
soldiers  wounded  near  Fort  Miller.  The  short  incisions  necessary  for  the  removal  of  the 
Vialls  healed  within  two  weeks,  and  there  were  no  unpleasant  consequences. 


GUNSHOT  WOUNDS  OF  THE  SCALP. 


93 


Gunshot  contusions  of  the  head  witliout  breach  of  surface,  of  sufficient  severity  to 
cause  ecchymosis,  were  invariably  attended  by  . commotion,  concussion,  or  intracranial 
extravasation,  and  are  classified,  and  will  he  described,  in  connection  with  injuries  of  the 
encephalon. 

Among  the  cases  reported  as  gunshot  wounds  of  the  scalp,  were  many  followed  by 
vertigo,  headache,  persistent  pain  at  the  point  struck,  impairment  of  the  special  senses — 
amaurosis  and  deafness  being  especially  frequent — by  mental  imbecility,  by  epilepsy,  and 
various  forms  of  paralysis ; but,  as  in  all  of  these  cases  the  ulterior  effects  indicated  that 
there  must  have  been  some  injury  to  the  cranium  or  its  contents,  they  were  nearly  all 
excluded  from  the  return  on  page  70,  and  will  be  considered  in  the  next  subsection. 

It  has  not  been  practicable  to  ascertain  the  nature  of  the  disabilities  for  which  one 
hundred  and  twenty-seven  enlist^xl  men  were  transferred  to  the  Veteran  Reserve  Corps, 
after  receiving  gunshot  wounds  of  tlie  scalp.  The  reports  to  this  Office  afford  no  information 
on  the  subject.  The  surgeons’  certificates,  under  which  the  men  were  transferred,  were 
forwarded  to  the  Provost  Marshal  General,  and  duplicates  were  sent  to  the  Adjutant  General; 
but  these  certificates  only  state  the  seat  of  injury,  without  detailing  its  consequences,  and 
the  degree  of  disability,  without  specifying  its  nature. 

A critical  examination  of  the  returns  constrains  me  to  disagree  with  Reudorfer,^ 
Denonvilliers,"  and  other  modern  authorities,  in  regard  to  the  comparative  infrequency  of 
gunshot  wounds  limited  to  the  integuments  of  the  cranium.  In  gunshot  wounds  of  the  head, 
the  fractures  and  penetrating  and  perforating  wounds  of  the  brain  undoubtedly  exceed  in 
number  the  lesions  of  the  exterior  soft  parts  ; but  so  many  of  the  wounded  of  the  first  class 
are  left  dead  on  the  field,  that  it  may  be  safely  asserted  that  of  the  cases  brought  under 
surgical  treatment,  the  scalp  wounds  are  more  numerous  than  the  fractures. 

The  return,  on  page  70,  of  7,739  cases  of  gunshot  wounds  of  the  scalp,  unquestion- 
ably includes  some  instances  complicated  by  injury  to  the  skull  or  its  contents ; as,  for 
example,  the  case  of  Corporal  Carpenter,  of  which  an  abstract  is  given  on  page  83.  But 
such  examples  are  few,  so  that  in  a final  revision  of  the  registers  of  gunshot  injuries  of 
the  head,  made  since  the  preceding  pages  were  printed,  I have  found  but  twenty-one  cases 
in  which  the  evidence  furnished  by  the  reports  indicated  the  probability  of  any  lesion  of  the 
cranium  or  brain.  There  is  great  difficulty,  no  doubt,  in  distinguishing  the  various  classes 
of  gunshot  wounds  of  the  head,  both  in  practice,  and  in  the  analysis  of  brief  and  often 
imperfect  reports.  But,  from  the  evidence  offered,  it  would  appear  incontestable,  that  in 
the  cases  of  gunshot  injuries  of  this  region  which  come  under  the  care  of  the  surgeon,  the 
wounds  of  the  soft  parts  outnumber  the  fractures. 

The  divisions  here  established  in  classifying  gunshot  wounds  of  the  head,  are,  of 
course,  in  a measure,  arbitrary  and  artificial,  and  are  only  justified  by  the  necessities  of 
analysis  and  of  study.  For  these  purposes,  it  is  requisite  to  separate  these  lesions,  and  to 
present  particular  descriptions  of  each ; but  the  practical  surgeon  will  never  lose  sight  of 
the  fact  that,  in  examining  patients,  he  will  constantly  encounter  complications  of  disorders 
of  every  variety. 

* Neudorfer.  “Iin  Kriege  kommen  derlei  Verletzungen  dcr  Scliadelbedeckungen  viol  soltcmer  vor,  als  iniiii  glauboii 
sollte,  weil  die  ineiston  Scbussverletzungen  des  Kopfes  sicli  nur  ilussorst  solten  aiif  die  Woiclitlieile  bescbiaiikon/’  u.  s.  \v.,  in 
Uandhuch  der  KrieijscMrunjie,  Leipzig,  1837.  Zweite  Ilalftc,  I'lrstcs  S.  6. 

’^Denonvilliers  et  Gosselin.  "Rareinent  lea  coups  de  feu  boniont  leiir  action  aux  parties  inolles.”  Compendium  dc 
Chirurrjic  Pratique,  Art.  Lesions  Traumatiques  du  Crane,  T.  11,  p.  570,  I’aii.s,  1851. 


94 


WOUNDS  AND  INJUEIES  OF  THE  UEAD, 


In  discussing,  on  page  89,  the  ratio  of  fatality  of  gunshot  wounds  of  the  scalp,  deaths 
from  intercurrent  diseases  have  been  included  in  the  estimates,  in  conformity  with  the  system 
of  reports  in  the  medical  department  of  the  United  States  Army.  In  one  hundred  and 
twenty-two  of  the  one  hundred  and  sixty-two  fatal  cases,  death  would  appear,  beyond 
question,  to  have  resulted,  either  directly  or  indirectly,  from  the  effects  of  the  wound  ; some 
form  of  encephalitis  being  the  proximate  cause  in  ninety-eight  cases,  and  such  complications 
as  erysipelas,  gangrene,  hsemorrhage,  tetanus,  and  pyaemia,  in  twenty-four  cases.  The 
remaining  forty  fatal  cases  include  twenty-nine  deaths,  attributed  to  typhoid  and  malarial 
fevers,  and  jmeumonia,  in  regard  to  which  it  is  difficult  to  determine  how  far  the  febrile  or 
pulmonary  symptoms  were  symptomatic  only,  and  eleven  deaths,  due  to  variola,  diphtheritis, 
hepatitis,  privation,  and  delirium  tremens^  the  original  injury  having  little,  if  any  connection 
with  the  fatal  event.  The  duration  of  life  after  the  reception  of  the  injury,  of  the  one 
hundred  and  sixty-two  fatal  cases,  taking  an  average  from  them  all,  was  forty  days.  The 
mean  interval  in  the  cases  in  which  the  fatal  terminations  were  due  to  encephalitis,  was 
twenty-four  days.  Some  of  the  patients  who  succumbed  to  secondary  diseases  less  directly 
dependent  on  the  injuries  received,  survived  many  months. 

As  other  examples  of  the  more  common  complications  of  gunshot  wounds  of  the  scalp, 
as  hsemorrhage,  erysipelas,  sloughing,  and  abscess,  will  be  offered  in  the  next  subsection,  it 
will  be  more  convenient  to  defer  the  consideration  of  these  subjects.  Some  observations  on 
cerebral  irritation  and  on  traumatic  encephalitis  will  be  presented  at  the  close  of  the  chapter. 
Uemarks  upon  the  cases  of  tetanus  and  pyaemia  will  more  appropriately  find  a place  in  the 
chapters  specially  devoted  to  the  discussion  of  these  important  affections. 

The  Army  Medical  Museum  has  only  a single  anatomical  preparation^  illustrating 
gunshot  wounds  of  the  scalp  ; but  possesses  a large  collection  of  photographs  of  patients  with 
such  injuries.^  The  majority  of  cases  selected  for  illustration  were  severe  lacerations,  or 
were  complicated  by  erysipelas,  or  sloughing,  or  injury  to  the  skull.  Four  of  these  photo- 
graphs are  faithfully  copied  in  Plate  III,  (opp.  page  105.) 

The  ordinary  primary  treatment  of  gunshot  w'ounds  limited  to  the  scalp,  consisted  in 
washing  the  parts  with  a warm  sponge,  shaving  the  scalp  in  the  vicinity  of  the  wcnmd, 
removing  foreign  bodies,  and  suppressing  liEemorrhage,  when  necessary,  and  covering  the 
part  with  a compress  dipped  in  cold  water.  Many,  perhaps  the  majority,  of  the  surgeons 
were  accustomed  to  approximate  the  edges  of  the  wounds  by  adliesive  strips,  and  a few 
even  used  stitches.  It  is  hardly  possible  that  they  anticipated  union  by  first  intention ; 
but  they  probably  hoped  to  abbreviate  the  stage  of  granulation  by  these  methods  of 
dressing.  Other  surgeons  applied,  in  place  of  water  dressing,  a strip  of  muslin  or  lint 
spread  with  simple  cerate,  and  kept  in  place  by  adhesive  plaster,  and  thus  avoided  the 

' Specimen  1302,  Section  I. — A wet  preparation  of  a portion  of  the  scalp  from  the  right  parietal  region,  perforated  by  a 
musket  ball  which  fractured  the  cranium.  The  opening  made  by  the  ball  has  been  enlarged  by  two  incisions  and  by  the  slough- 
ing of  the  contused  edges.  Sergeant  J.  F , Co.  K,  14th  Maine  Volunteers,  aged  34  years,  wounded  at  Port  Hudson,  Lou- 

isiana, May  27tli,  admitted  into  hospital  at  New  Orleans,  29th  May;  died,  June  7th,  1833.  The  specimen  was  contributed  by 
Assistant  Surgeon  P.  S.  Conner,  IT.  S.  Ai-my.  See  Catalogue  of  the  Surgical  Section  of  the  Army  Medical  Museu  n,  p.  38. 

-See  Card  PnoTOGRAPiiS,  A.  M.  M.,  Vol.  Ill,  p.  1,  (Case  of  Sergeant  Coletrap;)  Vol.  Ill,  p.  3,  (Case  of  Private  Fol- 
som)— for  illustrations  of  lacerations  of  the  integuments  of  frontal  and  parietal  regions,  without  in  jury  to  the  skull.  See  ITioto- 
GRARIIS  Olf  SURGICAR  C.\SKS,  Vol.  Ill,  ]).  7,  (Case  of  Ferris,)  p.  9,  (Case  of  Van  Valkenberg,)  p.  10,  (Case  of  Shatter,)  Vol. 
VII,  p.  1,  (Case  of  Wheeler,)  ]>.  3,  (Case  of  Scott,)  ji.  4,  (Case  of  Scluller,)  p.  5,  (Case  of  Bean,)  p.  7,  (Case  of  Kinchelow,)  p.  9, 
(Case  of  Ilendei'son,)  Vol.  I,  p.  33,  (Case  of  Dougherty)— for  a few  of  the  many  illustrations  of  comj)licated  gunshot  injuries  of 
the  scalp. 


GUNSHOT  CONTUSIONS  OE  THE  CEANIAL  BONES. 


95 


necessity  of  a retentive  bandage.  It  was  not  customary  to  lay  open  the  long  fistulous  wounds 
where  there  was  an  aperture  of  exit ; hut  injections  were  used  to  cleanse  them  from  the 
hairs,  bits  of  clothing,  or  other  foreign  bodies  that  might  have  lodged  in  the  sinuses.  The 
blind  fistulous  wounds  with  a missile  at  the  closed  end,  were  treated  by  a counter-opening 
for  the  extraction  of  the  foreign  body,  and  were  thus  assimilated  to  the  variety  just  men- 
tioned. In  some  of  these  “ seton  wounds  ” the  whole  track  was  laid  open  by  sloughing ; 
in  others,  suppuration  was  so  abundant  that  the  apertures  of  entrance  and  exit  aftbrded 
insufficient  space  for  the  elimination  of  eschars  and  pus,  and  it  was  necessary  to  make  one 
or  more  incisions  along  the  track  of  the  sinus.  When  wounds  of  the  scalp  became  inflamed, 
cataplasms  of  flaxseed  meal  were  commonly  applied,  or  sometimes  bread  and  water  poultices, 
or  compresses  saturated  with  warm  water.  These  emollient  applications  were  occasionally 
medicated  by  solutions  of  chlorinated  soda,  permanganate  of  potassa,  spirits  of  camphor, 
and  infusions  of  belladonna.  Ointments  of  the  iodide  of  lead,  sulphate  of  zinc,  and  nitrate 
of  mercury  are  among  the  other  local  applications  reported.  In  a number  of  cases  where 
cerebfal  symptoms  impended,  besides  resorting  to  general  treatment,  ice  bladders  were 
applied  to  the  head.  This  method  was  adopted  with  advantage  in  numerous  cases  at  the 
Stanton  Hospital,  at  Washington,  under  the  direction  of  Surgeon  John  A.  Lidell,  U.  S.  V. 
From  the  Confederate  Hospital  No.  12,  at  Richmond,  Virginia,  a number  of  cases  of 
inflamed  scalp  wounds,  successfully  treated  by  continuous  irrigation,  were  reported  by  Sur- 
geon W.  A.  Thom,  C.  S.  A. 

Gunshot  Contusions  of  the  Cranial  Bones. — Among  cases  returned  as  gunshot 
wounds  of  the  scalp  were  many  in  which  exfoliations  from  the  outer  table  of  the  skull, 
persistent  pain  at  the  point  struck,  secondary  disorders  of  the  brain,  pysemia,  and  other  grave 
results  indicated  that  there  had  been  contusion  of  the  skull  without  fracture. 

The  following  forty-seven  cases  of  gunshot  contusion  of  the  bones  of  the  skull  recovered 
without  serious  disability,  and  the  men  were  returned  to  duty  after  intervals  varying  from 
thirty-five  days  to  forty-three  weeks ; 

Beax,  J.  W.,  Lieutenant,  Co.  I,  5th  New  Hampshire  Volunteers.  Gunshot  contusion  of  the  temporal  hone.  Fredericks- 
burg, Virginia,  December  13th,  1862.  Returned  to  duty  January  9th,  1863. 

Bowe,  John,  Corporal,  Co.  K,  1st  Maryland  Volunteers.  Denudation  of  fi’ontal  hone  by  a conoidal  musket  ball.  Peters- 
burg, Virginia,  August  20th,  1864.  Returned  to  duty  December  1st,  1864. 

Cheesboro,  Her.Max,  Private,  Co.  G,  46th  Pennsylvania  Volunteers,  aged  23  years.  Gunshot  contusion  of  the  right 
parietal  bone.  Marietta,  Georgia,  June  15th,  1864.  Returned  to  duty  October  2d,  1864. 

Clark,  John,  Private,  Co.  B,  116th  Pennsylvania  Volunteers.  Gunshot  contusion  of  the  frontal  bone.  Fredericksburg, 
Virginia,  December  13th,  1862.  Returned  to  duty  June  18th,  1863. 

CociiR.\.NE,  John,  Private,  Co.  H,  141st  New  York  Volunteers,  aged  19  years.  Gunshot  contusion  of  the  bones  of  the 
cranium.  Resaca,  Georgia,  May  15th,  1864.  Returned  to  duty  August  19th,  1864. 

Collins,  T.  J.,  Sergeant,  Co.  A,  22d  Kentucky  Volunteers.  Gunshot  contusion  of  right  parietal  bone.  June  4th,  1863. 
Returned  to  duty  July  22d,  1863. 

Crouch,  James  N.,  Sergeant,  131st  Pennsylvania  Volunteers.  Gunshot  contusion  of  the  left  side  of  the  occipital  bone. 
Fredericksburg,  Virginia,  December  13th,  1862.  Returned  to  duty  May  12th,  1863. 

CORMAN,  Elisha,  Private,  Co.  A,  5th  United  States  Colored  Troops,  aged  34  years.  Denudation  and  contusion  of  the 
cranial  bones  at  the  vertex  by  a fragment  of  shell.  Deep  Bottom,  Virginia,  September  29th,  1864.  Returned  to  duty  December 
10th.  1834. 

Crosby,  .1.  W.,  Major,  61st  Pennsylvania  Volunteers.  Contusion  and  denudation  of  the  right  parietal  bone  by  a conoidal 
musket  ball.  Wilderness,  May  5th,  1864.  Returned  to  duly  July  6th,.  1834. 

Dablaux,  Charles,  Private,  Co.  D,  42d  Illinois  Volunteers.  Gunshot  contusion  of  the  temporal  bone.  Chickamauga, 
Georgia,  September  19th,  1833.  Returned  to  duty  January  1st,  1864. 


96 


WOUNDS  AND  INJUEIES  OF  THE  HEAD 


Diesze,  August,  Private,  Co.  H,  47th  Pennsylvania  Volunteers,  aged  25  years.  Contusion  and  denudation  of  the  cranial 
bones  by  a conoidal  musket  ball.  Cedar  Creek,  Virginia,  October  19th,  1864.  Eeturned  to  duty  January  19tb,  1865. 

Dollmeyer,  Henry,  Private,  3d  Independent  Ohio  Cavalry,  aged  26  years.  Gunshot  contusion  of  the  cranium  by  a 
conoidal  musket  ball.  Point  Pleasant,  Virginia,  March  30th,  1863.  Eeturned  to  duty  July  5th,  1864.  lie  recovered  rapidly 
from  tlie  wound,  but  remained  in  hospital  on  account  of  distressing  attacks  of  asthma. 

Dul-e,  Hiram,  Private,  Co.  D,  14th  Alabama  Eegiment.  Gunshot  contusion  of  the  occipital  region.  Eeturned  to  duty 
September  3d,  1862. 

Elwood,  Solomon,  Private,  Co.  A,  8th  New  York  Cavalry,  aged  25  years.  Contusion  and  denudation  of  the  frontal 
bone  by  a conoidal  musket  ball.  Fisher’s  Hill,  Virginia,  October  7th,  1864.  Eeturned  to  duty  March  15th,  1865. 

Foote,  G.  W.,  Corporal,  Co.  E,  51st  Pennsylvania  Volunteers.  Gunshot  contusion  and  denudation  of  the  right  parietal 
bone.  Antietam,  September  17th,  1862.  Eeturned  to  duty  June  17th,  1863. 

Foster,  S.  M.,  Private,  Co.  E,  13th  North  Carolina  Eegiment.  Gunshot  contusion  of  the  skull.  Chanccllorsville,  Virginia, 
May  3d,  1863.  Eeturned  to  duty. 

Funk,  John,  Corporal,  Co.  I,  54th  Pennsylvania  Volunteers,  aged  39  years.  Contusion  of  the  parietal  bone  by  a musket 
ball.  Newmarket,  Virginia,  May  15th,  1864.  Eeturned  to  duty  June  29th,  1834. 

Gallutia,  a.  M.,  Private,  Co.  H,  53d  Pennsylvania  Volunteers,  aged  26  years.  Contusion  of  the  left  parietal  region  by 
a fragment  of  shell.  Spottsylvania,  May  11th,  1864.  Eeturned  to  duty  August  26th,  1864. 

Gardnter,  "William,  Private,  Co.  B,  18th  Indiana  Volunteers.  Gunshot  contusion  of  the  left  parietal  bone.  Vicksburg, 
Mississippi,  June  1st,  1833.  Eeturned  to  duty  August  17th,  1863. 

Glynn,  Joun,  Private,  Co.  G,  57th  New  York  Volunteers,  aged  35  ycais.  Gunshot  contusion  of  the  cranium.  Peters- 
burg, Virginia,  June  16th,  1864.  Eeturned  to  duty  October  13th,  1864. 

Hadeield,  Michael  E.,  Private,  Co.  F,  8th  Ohio  Cavalry,  aged  23  years.  Contusion  of  the  left  parietal  bone  by  a 
conoidal  musket  ball.  Bunker  Hill,  Virginia,  September  5th,  1864.  Eeturned  to  duty  October  28th,  1864. 

Hamilton,  Wji.  S.,  Private,  Co.  D,  14th  New  Hampshire  Volunteers,  aged  21  years.  Contusion  and  denudation  of  the 
right  parietal  bone  by  a conoidal  musket  ball.  Winchester,  Virginia,  September  19th,  1864.  Eeturned  to  duty  November 
28th,  1864. 

Hyde,  Thomas,  Private,  Co.  F,  1st  Vermont  Cavalry,  aged  18  years.  Contusion  of  the  bones  of  the  cranium  by  a frag- 
ment of  shell.  Appomattox  Court-house,  Virginia,  April  8th,  1865.  Eeturned  to  duty  June  29th,  1865. 

Jones,  Henry,  Private,  Co.  E,  26th  United  States  Colored  Troops.  Contusion  of  the  parietal  bone  by  a conoidal  musket 
ball.  John’s  Island,  South  Carolina,  July  7th,  1864.  Eeturned  to  duty  February  17th,  1885. 

Kelley,  C.  T.,  Sergeant  Major,  20th  Kentucky  Volunteers.  Gunshot  contusion  of  the  bones  of  the  cranium.  Atlanta, 
Georgia,  J uly  10th,  1864.  Eeturned  to  duty  September  21st,  1864. 

Lakeman,  William,  employed  on  the  Gunboat  Carondelet.  Collision  of  tlie  bones  of  the  skull  by  a fi-agment  of  shell. 
Fort  Henry,  Tennessee,  February  0th,  1862.  Eeturned  to  duty  May  0th,  1862. 

Lennon,  John  A.,  Private,  Co.  A,  32d  Massachusetts  Volunteers,  aged  23  years.  Gunshot  contusion  of  the  bones  of  the 
cranium  by  a conoidal  musket  ball.  Deep  Bottom,  Virgiida,  August  14th,  1864.  Eeturned  to  duty  September  22d,  1834. 

Madore,  Edward,  Private,  Co.  M,  11th  Vermont  Volunteers,  aged  17  years.  Gunshot  eontusion  of  the  right  parietal 
bone  by  a conoidal  musket  ball.  Cold  Harbor,  Virginia,  June  4th,  1834.  Eeturned  to  duty  August  31st,  1864. 

Martin,  Jacob  W.,  Corporal,  Co.  K,  101st  Ohio  Volunteers,  aged  30  jmars.  Contusion  of  the  right  parietal  bone  by  a 
conoidal  musket  ball.  Franklin,  Tennessee,  November  30th,  1864.  Eeturned  to  duty  February  1st,  1835. 

Monroe,  D.  S.,-  Corporal,  Co.  H,  20th  Michigan  Volunteers,  aged  24  years.  Gunshot  contusion  of  the  occipital  bone  by  a 
musket  ball.  Petersburg,  Virginia,  October  28th,  1864.  Eeturned  to  duty  December  20th,  1864. 

Osgood,  Charles  E,  Co.  A,  40th  Massachusetts  Volunteers,  aged  32  years.  Gunshot  contusion  of  the  left  parietal  bone. 
Cold  Harbor,  Virginia,  June  3d,  1834.  Eeturned  to  duty  March  11th,  1835. 

Ean,  C.  C.,  Private,  Co.  B,  114th  Pennsylvania  Volunteers,  aged  27  years.  Gunshot  eontusion  of  the  left  temporal  bone, 
with  lodgment  of  the  baU,  which  was  extracted  soon  after  the  reception  of  the  injury.  Gettysburg,  July  3d,  1863.  Eeturned  to 
duty  May  Gth,  1864. 

Eobinson,  William,  Private,  Co.  E,  0th  United  States  Infantry.  Gunshot  contusion  of  the  left  temporal  bone  by  a 
pistol  ball.  Gettysburg,  July  3d,  1803.  Eeturned  to  duty  September  4th,  1863. 

Eoth,  Peter,  Private,  Co.  E,  4th  United  States  Artillery,  aged  35  years.  Gunshot  contusion  of  left  frontal.  Peters- 
burg, Virginia,  March  31st,  1835.  Eeturned  to  duty  July  26th,  1865. 

Euggles,  S.  N.,  Private,  Co.  B.,  157th  New  York  Volunteers,  aged  23  years.  Gunshot  contusion  of  the  left  parietal. 
Chancellorsville,  May  3d,  1803.  Eeturned  to  duty  January  21st,  1804. 

Eussell,  George  G.,  Private,  Co.  E,  15th  Blaine  Volunteers,  aged  18  years.  Contusion  and  denudation  of  the  left  tem- 
poral by  a conoidal  musket  ball.  Lline  Eun,  Virginia,  November  30th,  1863.  Eeturned  to  duty  April  19th,  1864. 

Eussell,  Joseph,  Piivate,  Co.  G,  27th  Michigan  Volunteers,  aged  21  years.  Gunshot  contusion  of  the  parietal  by'a 
conoidal  musket  ball.  I’etcrsburg,  Virginia,  July  23d,  1864.  Eeturned  to  duty  January  11th,  1805. 


GUNSHOT  CONTUSTONR  OF  TTTF  CFANTAL  P.ONRS.  97 

Sally,  Ciiaiiles  IL,  Private,  4th  Maine  Battery.  Contusion  of  the  frontal  bone  by  a fragment  of  shell.  Cedar 
Mountain,  Virginia,  August  9th,  1862.  Returned  to  duty,  April  3d,  1863. 

SatterlA',  MHlliam,  Corporal,  Co.  G,  137th  New  York  Volunteers,  aged  43  years.  Contusion  of  the  right  parietal  by 
a conoidal  musket  ball.  Resaca,  Georgia,  May  15th,  1864.  Returned  to  duty,  June  27th,  1864. 

Selba',  Harlow  E.,  Sergeant,  Co.  G,  78th  Illinois  Volunteers.  Gunshot  contusion  of  the  cranium.  Chickamauga, 
Georgia,  September  19th,  1863.  Returned  to  duty,  December  1st,  1863. 

Shattuck,  C.  H.,  Private,  Co.  H,  142d  New  York  Volunteers,  aged  44  years.  Contusion  of  the  bones  of  the  skull  by 
a conoidal  musket  ball.  Petersburg,  Virginia,  June  30th,  1864.  Returned  to  duty,  September  22d,  1864. 

Shaw,  William,  Private,  Co.  G,  100th  Illinois  Volunteers,  aged  21  years.  Gunshot  contusion  of  the  skull  by  a 
fragment  of  shell.  Kenesaw  Mountain,  Georgia,  June  27th,  1864.  Returned  to  duty,  December  6th,  1864. 

SiiUEA’’,  D.AXIEL,  Private,  Co.  C,  148th  Pennsylvania  Volunteers,  aged  26  years.  Gunshot  contusion  and  denudation  of 
the  mastoid  process  of  the  temporal  bone.  Gettysburg,  July  2d,  1863.  Returned  to  duty,  September  11th,  1863. 

Stalmaker,  M.  W.,  Sergeant,  Co.  E,  10th  West  Virginia  Volunteers,  aged  33  years.  Gunshot  contusion  of  the  frontal 
by  a musket  ball.  Cedar  Creek,  Virginia,  October  13th,  1884.  Returned  to  duty,  November  7th,  1864. 

Stephens,  J.  N.,  Private,  Co.  K,  30th  Georgia  Regiment.  Gunshot  contusion  of  left  temporal.  Gettysbui'g,  Pennsyl- 
vania, July  3d,  1863.  Returned  to  duty,  August  24th,  1864. 

SUMXER,  Jacob,  Private,  Co.  D,  67th  New  York  Volunteers,  aged  31  years.  Gunshot  contusion  of  right  parietal 
by  a conoidal  musket  ball.  Cold  Harbor,  June  1st,  1884.  Returned  to  duty,  August  9th,  1834. 

Titus,  George  S.,  Sergeant,  Co.  F,  9th  New  Jersey  Volunteers,  aged  24  years.  Gunshot  contusion  of  the  skull 
by  a fragment  of  shell.  Cold  Harbor,  June  3d,  1884.  Returned  to  duty,  December  13th,  1864. 

Twenty-two  cases  are  reported  of  gunshot  contusion  of  the  cranial  bones,  in  which 
the  patients  were  discharged  or  mustered  out  at  the  expiration  of  their  terms  of  service 
without  any  serious  physical  disability.  Brief  notes  of  the  particulars  of  these  cases  are 
appended : 

Beateridge,  j.  G.,  Captain,  Co.  F,  2d  Rhode  Island  Volunteers.  Gunshot  contusion  of  frontal  bone  over  the  right  eye. 
Wilderness,  May  7th,  1864.  Mustered  out  of  service,  June  17th,  1864. 

Browx,  Charles,  Sergeant,  Co.  G,  58th  New  York  Volunteers.  Gunshot  contusion  of  the  skull.  Cross  Keyes, 
Virginia,  June  8th,  1^62.  Discharged  from  service,  July  13th,  1862. 

Browx,  Patrick,  Private,  Co.  H,  6th  Pennsylvania  Volunteers.  Gunshot  contusion  of  the  cranial  bones.  Second 
Bull  Run,  August  29th,  1862.  Discharged  from  service,  December  20th,  1862. 

Creasea',  Johx  F.,  Private,  Co.  I,  124th  Illinois  Volunteers.  Gunshot  contusion  of  left,  parietal  by  a fragment  of  shell. 
Vicksburg,  June  23th,  1833.  Treated  at  ^lemphis,  by  Surgeon  J.  D.  Brumley,  U.  S.  V.  Returned  to  duty,  and  subsequently 
mustered  out  of  service.  Became  a pensioner  June  29th,  1835,  on  account  of  chronic  diarrhoea.  He  died  about  the  20th  of 
August,  1835,  having  had,  according  to  the  report  to  the  Pension  Office  of  his  attending  physician,  W.  D.  Yargan,  M.  D.,  no 
head  symptoms. 

Doolittle,  Hexry,  Private,  Co.  H,  2d  Michigan  Volunteers.  Gunshot  contusion  of  cranium,  with  denudation  of 
bone.  Near  Knoxville,  Tennessee,  November  16th,  1863.  Mustered  out  of  service,  July  20th,  1864. 

Gaa',  5Villiam,  Private,  Co.  A,  2d  Ohio  Cavalry,  aged  20  years.  Contusion  of  the  frontal  bone  by  a conoidal  musket 
ball.  Petersburg,  July  30th,  1864.  Treated  at  Mount  Pleasant  and  Mower  Hospitals.  Discharged  June  13th,  1865.  General 
Order,  A.  G.  O.,  No.  77,  1865. 

Head,  Albert,  Captain,  Co.  F,  10th  Iowa  Volunteers,  aged  24  years.  Gunshot  contusion  of  right  parietal  by  round 
musket  ball.  Champion  Hills,  May  16th,  1863.  Treated  at  Officers’  Hospital,  Memphis,  Tennessee.  Mustered  out  on  expiration 
of  term  of  service,  December  17th,  1864. 

Hexsler,  Charles,  Sergeant,  Co.  F,  6th  Wisconsin  Voluiiteers,  aged  23  years.  Denudation  of  right  parietal  by 
conoidal  musket  ball.  Southside  Railroad,  Virginia,  March  31st,  1885.  Treated  at  Lincoln  and  Harvey  Hospitals.  Mustered 
out  of  service,  J uly  10th,  1865. 

Houtz,  James,  Private,  Co.  K,  111th  New  York  Volunteers,  aged  19  years.  Contusion  of  the  frontal  bone  by  a 
conoidal  musket  ball.  Petersburg,  Virginia,  April  2d,  1865.  Discharged  from  service,  June  8th,  1865. 

Kxox,  E.  B.,  Major,  44th  New  York  Volunteers.  Denudation  and  contusion  of  occipital  bone  by  shell.  Spottsylvania, 
May  8th,  1864.  Treated  at  Fifth  Corps  Hospital,  and  at  Washington,  by  Surgeon  T.  Antisell,  U.  S.  V.  LeaA^e  of  absence 
granted.  May  17th,  1864,  and  mustered  out  Avith  his  regiment,  October  11th,  1864. 

Lloyd,  William,  Private,  Co.  G,  122d  Ohio  Volunteers,  aged  23  years.  Contusion  of  os  frontis  by  conoidal  ball 
denuding  the  bone.  Accidental,  April  15th,  1865.  Entirely  recovered  when  discharged,  June  9th,  1865. 

McConnell,  James,  Private,  Co.  A,  9th  New  York  Volunteers,  aged  25  years.  Gunshot  contusion  of  skull  by  a 
buckshot.  Antietam,  Maryland,  September  17th,  1832.  Discharged  at  expiration  of  term  of  service,  April  24th,  1863. 

1.} 


98 


WOUNDS  AND  INJUKIES  OF  THE  HEAD, 


Mouiiian,  James,  I’l-ivate,  Co.  C,  llOtli  1‘oiiiisylvaiiia  Volunteers,  aged  20  years.  Denudation  and  contusion  of  frontal 
bone  by  fragment  of  shell.  I’etersburg,  June  lOtli,  18u4.  Treated  at  Harewood.  Mustered  out  of  service,  June  21st,  1804. 

Morton,  D.  J.,  IJentenant,  Co.  O,  143d  Pennsylvania  Volunteers.  Gunshot  contusion  of  the  bones  of  the  skull. 
Wilderness,  May  (ith,  1804.  T'reated  at  the  Fifth  Corps  Hospital,  and  at  Washington.  Mu.st(‘red  out  with  his  regiment,  Juno 
12th,  1805. 

Murphy,  D,VNIEL,  Private,  Co.  A,  21)th  Massachusetts  Volunteers,  aged  54  years.  Contusion  of  the  temporal  by  a 
fragment  of  shell.  Fort  Steadman,  Virginia,  March  25th,  1865.  Treated  at  DeCamj)  and  Dale  Hospitals.  Mustered  out  of 
service,  September  11th,  1835.  Surgeon  C.  N.  Chamberlain,  U.  S.  V.,  records  the  case. 

Plymesser,  Samuel  J.,  Sergeant,  Co.  G,  Gth  Iowa  Volunteers.  Gunshot  contusion  of  the  skull.  Konesaw  Mountain, 
Georgia,  June  27th,  1804.  Recovered,  and  was  promoted  to  a lieutenantcy,  and,  finally,  mustered  out  with  his  regiment,  July 
21st,  1865. 

Sands,  E.  M.,  Private,  Co.  I,  1st  Maryland  Cavalry,  aged  34  years.  Contusion  of  cranial  bones  by  a conoidal  musket 
ball.  Treated  at  City  Point  and  Beverly  Hospitals.  Discharged  on  expiration  of  term  of  service,  September  28th,  1834. 

Sprague,  Thomas  C.,  Sergeant,  Co.  C,  155th  Pennsylvania  Volunteers,  aged  45  years.  Contusion  of  frontal  bone  by 
a conoidal  musket  ball,  the  bone  being  slightly  denuded  of  periosteum.  Hatcher's  Run,  Virginia,  March  25th,  1865.  Treated 
at  Lincoln,  Satterlee,  and  McClellan  Hospitals.  Discharged  from  service,  August  14th,  1865. 

Van  Valkenberg,  E.  P.,  Co.  C,  39th  Illinois  Volunteers,  aged  26  years.  Gunshot  contusion  of  left  parietal.  Peters- 
burg, April  1st,  1865.  Treated  at  Harewood  and  Harvey  Hospitals.  Discharged  July  18th,  1865. 

Waite,  Benjajiin,  Sergeant,  Co.  B,  198th  Pennsylvania  Volunteers,  aged  25  years.  Contusion  of  frontal  by  a conoidal 
musket  ball.  Southside  Railroad,  Virginia,  March  31st,  1885.  Mustered  out  of  service.  May  27th,  1865. 

Walker,  Hugh,  Private,  Co.  L,  5th  Iowa  Cavalry,  aged  19  years.  Gunshot  contusion  of  the  skull.  Fort  Donelson, 
Tennessee,  February  15th,  1832.  Discharged  from  service,  April  1st,  1863. 

Way,  A.  M.,  Major,  1st  New  Jersey  Volunteers.  Denudation  of  right  tempoi-al  by  a musket  ball.  Wilderness,  May 
Gth,  1834.  Treated  by  Surgeon  Antisell,  U.  S.  V.  Mustered  out  with  regiment  June  23d,  1834,  and  pensioned  from  that  date. 
Pension  E.xaminer  A.  D.  Newell  state.s,  September  1st,  1834,  that  “The  blow  was  so  shocking  that  he  cannot  stand  excitement  or 
go  out  in  the  sun.  He  is  not  able  to  do  any  -work,  but  ivill  soon  improve.  His  disability  is  total,  and  likely  to  continue  about 
six  months.”  E.xamiuing  Surgeon  J.  G.  Stearns  reports  to  th§  Pension  Bureau,  December  12th,  1834,  that  “The  patient  is 
one-fourth  incapacitated,  though  less  every  month.” 

Ill  twenty-eight  cases  of  gunshot  contusion  of  the  cranium,  the  patients  were  furloughed 
when  convalescent,  and  no  further  accounts  of  them  appear  : 

Allen,  C.  A.,  Private,  Co.  E,  18th  North  Carolina  Regiment.  Gunshot  contusion  of  the  cranium.  Chancellorsville,  May 
3d,  1833.  Treated  in  Hospital  No.  23,  Richmond,  Virginia.  Furloughed  June  2d,  1863. 

Aihens,  L.,  Lieutenant,  Co.  I,  9th  Georgia  Infantry.  Gunshot  contusion  of  the  right  temporal  region.  July  4th,  1864. 
Furloughed  July  14th,  1834.  Surgeon  J.  B.  Read,  C.  S.  A.,  reports  the  case. 

Bryan,  J.  L.,  Sergeant,  Co.  E.,  11th  Florida  Regiment.  Gunshot  contusion  of  the  frontal  bone.  Treated  at  Howard 
Grove  Hospital,  Richmond.  Furloughed  August  9th,  1864. 

Collins,  J.,  Private,  Co.  A,  1st  Minnesota  Battery,  aged  27  years.  Gunshot  contusion  of  the  frontal  bone.  October 
10th,  1884.  Furloughed  November  1st,  1834. 

Cooper,  M.  A.,  Private,  Co.  E,  4th  Alabama  Infantry.  Gunshot  contusion  of  the  temporal  bone.  Wilderness,  May  5th, 
1864.  Treated  at  Howard  Grove  Hospital,  Richmond.  Furloughed  June  3d,  1884. 

Corsey,  William,  Private,  Co.  I,  47th  Alabama  Regiment.  Gunshot  contusion  of  the  skull.  Treated  at  Howard  Grove 
Hospital,  Richmond.  Furloughed  June  6th,  1834. 

Cowart,  J.  L.,  Corporal,  Co.  E,  10th  Georgia  Battalion.  Gunshot  contusion  of  the  frontal  bone.  Farmville,  Virginia, 
May  27th,  1864.  Furloughed  June  14th,  1864. 

De  Gray,  Jame.s,  Lieutenant,  Co.  G,  1st  Minnesota  Volunteers.  Gunshot  contusion  of  the  cranial  bones.  Gettysburg, 
July  3d,  1833.  Leave  of  absence  granted  him  on  August  15th,  1833. 

Edwards,  D.  R.,  Private,  Co.  A,  12th  Georgia  Regiment.  Gunshot  contusion  of  the  skull.  Chancellorsville,  May  3d, 
1833.  Furloughed  June  6th,  1833. 

Fannin,  A.  B.,  Lieutenant,  Co.  F,  Gist  Alabama  Infantry.  Gunshot  contusion  of  the  cranium.  Winchester,  Virginia, 
September  19th,  1834.  Treated  at  Hospital  No.  4,  Richmond,  Virginia.  Furloughed  September  29th,  1864. 

Foley,  John  W.,  Sergeant,  Co.  C,  124th  New  York  Volunteers.  Gunshot  contusion  of  the  cranium.  Chancellorsville, 
May  3d,  1883.  Furloughed  July  10th,  1833. 

Forbes,  S.  F.,  Private,  Co.  K,  7th  Tennessee  Regiment,  aged  21  years.  Gunshot  contusion  of  the  frontal  bone.  Wilder- 
ness, May  6th,  1884.  Furloughed  May  8th,  1834. 

Gilbucl-,  J.  M.,  Pi'ivate,  Co.  K,  43d  Alabama  Regiment.  Gunshot  contusion  of  the  skull.  Wilderness,  May  7th,  1864. 
Furlouglied  May  26th,  1864. 


GUNSHOT  CONTUSIONS  OF  THE  CRANIAL  BONES. 


99 


llarpcr,  E.  F.,  I’rivate,  Co.  F,  IGtli  Georgia  Regiment.  Gunshot  contusion  of  the  skull.  Chancellorsville,  May  3d,  1833. 
Furloughed  July  1st,  1863. 

Hensley,  John  C.,  Captain,  Co.  G,  59th  Alabama  Infantry.  Gunshot  contusion  of  temporal  bone.  Wilderness,  May  Gth, 
1864.  Furloughed  from  Howard  Grove  Hospital,  Richmond,  Virginia,  May  23th,  1864. 

Hutchinson,  R.  M.,  Private,  Co.  F,  24th  Virginia  Cavalry,  aged  30  years.  Contusion  of  the  right  parietal  by  a conoidal 
musket  ball,  October  7th,  1834.  Treated  at  Chimborazo  Hospital,  Richmond.  Furloughed  October  20th,  1864. 

Jones,  J.  J.,  Lieutenant,  Co.  B,  13th  Virginia  Regiment.  Gunshot  contusion  of  the  cranium.  Treated  at  Jackson  and 
Howard  Grove  Hospitals,  Richmond.  Furloughed  J une  2d,  1864. 

Knijht,  Jeff.,  Private,  Co.  D,  8th  South  Carolina  Infantry.  Gunshot  contusion  of  the  frontal  bone.  Treated  at  Howard 
Grove  Hospital,  Richmond.  Furloughed  August  7th,  1863. 

Lucas,  B.,  Private,  Co.  H.  17th  North  Carolina  Regiment.  Gunshot  contusion  of  the  frontal.  Petersburg,  Virginia,  J une 
18th,  1864.  Treated  in  hospital  at  Farmville.  Furloughed  July  1st,  1864. 

McLear,  D.  B.,  Lieutenant,  Co.  I,  24th  North  Carolina  Regiment.  Gunshot  contusion  of  the  bones  of  the  skull.  Trt'ated 
at  Howard  Grove  Hospital,  Richmond.  Furloughed  May  25th,  1864. 

Mansell,  S.  V.,  Private,  Co.  E,  6th  Florida  Regiment.  Gunshot  contusion  of  the  skull.  Treated  at  Howard  Grove  Hos- 
pital, Richmond.  Furloughed  June  10th,  1864. 

Saunders,  E.  P.,  Private,  Co.  D,  12th  Mississippi  Regiment.  Gunshot  contusion  of  the  parietal.  Furloughed  June  20th, 
1864.  Surgeon  F.  M.  Palmer,  P.  A.  C.  S.,  recorded  the  case. 

Shcaley,  J.  M.,  Private,  Co.  K,  1st  South  Carolina  Regiment.  Gunshot  contusion  of  frontal  bone.  Fuiloughed  from  Jack- 
son  Hospital,  Richmond,  Virginia,  October  29th,  1864,  for  sixty  days. 

Sherwood,  J.  J.,  Private,  Co.  E,  3d  Alabama  Regiment.  Gunshot  contusion  of  skull.  Wilderness,  May  5th,  1864.  Fur- 
loughed May  25th,  1884,  from  Howard  Grove  Hospital,  Richmond. 

Sydnor,  T.  IF.,  Lieutenant,  Co.  G,  4th  Virginia  Cavalry.  Gunshot  contusion  of  right  temporal  bone,  August  13th,  1884. 
Furloughed  from  No.  4 Hospital,  Richmond,  August  25th,  1864.  Surgeon  J.  B.  Read,  C.  S.  A.,  recorded  the  case. 

Walker,  A.,  Private,  Co.  A,  43d  Alabama  Regiment.  Gunshot  contusion  of  the  frontal.  , Treated  at  Howard  Grove  Hos- 
pital, Richmond.  Furloughed  August  11th,  1884. 

Whitley,  J.  J.,  Private,  Co.  C,  8th  Alabama  Regiment.  Gunshot  contusion  of  the  parietal.  Wilderness,  Virginia,  May  5th, 
1864.  Furloughed  May  30th,  1864,  for  sixty  days. 

Wiley,  Jacob  S.,  Corporal,  Co.  K,  18th  South  Carolina  Infantry.  Gunshot  contusion  of  right  parietal.  Petersburg,  May 
20th,  1864.  Furloughed  June  13th,  1884. 

Six  patients  recovered  without  serious  disability,  and  were  transferred  to  the  Provost 
Marshal,  or  exchanged,  or  were  paroled  or  released. 

Bodman,  Hardy,  Private,  Co.  K,  2d  North  Carolina  Regiment,  aged  21  years.  Contusion  of  the  occipital  by  a conoidal 
ball,  which  entered  near  the  upper  portion  of  the  left  ear,  and  ploughed  under  the  scalp  for  three  inches.  Kelly’s  Ford,  Novem- 
ber 7th,  1863.  Treated  at  Lincoln  Hospital,  Washington,  till  December  7th,  thence  transferred  to  Old  Capitol  Prison  for  exchange. 

Bullock,  N.  B.,  Private,  Co.  G,  5th  Alabama  Regiment.  Contusion  of  right  parietal  bone  by  a conoidal  musket  ball.  Win- 
chester, Virginia,  September  19th,  1864.  Transferred  for  exchange,  October  25,  1864. 

Galloway,  J.  T.,  Private,  Co.  E,  25th  North  Carolina  Regiment,  aged  34  years.  Contusion  of  frontal  bone  by  a conoidal 
musket  ball.  Hatcher’s  Run,  Virginia,  April  1st,  1885.  Released  June  14th,  1865. 

Glenn,  Wade  M.,  Private,  Co.  A,  14th  Tennessee  Infantry,  aged  25  years.  Gunshot  contusion  of  occipital  bone.  Peters- 
burg, Virginia,  April  2d,  1865.  Transferred  to  Old  Capitol  Prison  for  exchange,  April  17th,  1885. 

Fisher,  John  H.,  Private,  Co.  E,  33th  North  Carolina  Regiment.  Contusion  of  the  frontal  bone  by  a fragment  of  shell. 
Fort  Fisher,  North  Carolina,  January  15,  1885.  Transferred  to  Provost  Jlarshal,  April  8th,  1865. 

Woodburn,  IF.,  Private,  Co.  K,  43d  North  Carolina  Regiment.  Gunshot  contusion  of  the  skull.  Gettysburg,  July  3d, 
1863.  Treated  at  DeCamp  Hospital,  New  York  Harbor.  Paroled  September  5th,  1863. 

Nine  patients,  with  gunshot  contusions  of  the  cranium,  deserted  from  hospital,  and  it 
may  be  inferred  that  their  disabilities  were  not  of  a serious  nature. 

Diffexbacu,  P.,  Private,  Co.  A,  7th  New  York  Volunteers,  aged  33  years.  Contusion  of  the  occipital  by  a six-pound 
k’on  ball.  Antietam,  September  17th,  1832.  Treated  at  Camden  Street,  Baltimore.  Deserted  December  4th,  1862. 

Eddy,  Axoxzo  F.,  Private,  Co.  1, 18th  Massachusetts  Volunteers,  aged  25  years.  Gunshot  contusion  of  the  skull.  Wil- 
derness, May  5th,  1864.  Treated  at  Corps,  Campbell,  and  Beverley  Hospitals.  Deserted  October  15th,  1864. 

Glenx,  Jacob,  Private,  Co.  K,  1st  Pennsylvania  Rifles,  aged  35  years.  Contusion  of  the  occipital  bone  by  a fragment 
of  shell.  Petersburg,  Virginia,  June  17th,  1864.  Treated  at  Division,  Mount  Pleasant,  ainl  York  Hospitals.  De.sorted  October 
20th,  1864. 


100 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Hasselriss,  William,  Private,  Co.  C,  93th  Penn.sylvatiia  Volunteers,  aged  30  years.  Contusion  of  the  frontal  bone  by 
a fragment  of  shell.  Cedar  Creek,  Virginia,  October  19th,  1834.  Treated  at  Division  and  Cuyler  Hospitals.  Deserted  January 
8th,  1865. 

Hoffm.an,  Henry,  Private,  Co.  K,  7th  Ohio  Volunteers,  aged  23  years.  Contusion  of  right  temporal  by  a conoidal  mus- 
ket ball.  Chancellorsville,  May  3d,  1833.  Treated  at  Douglas  and  Cincinnati  Hospitals.  Deserted  November  16th,  1863. 

McCall,  James,  Private,  Co.  A,  147th  Pennsylvania  Volunteers.  Contusion  of  the  temporal  by  a fragment  of  shell. 
Gettysburg,  July  3d,  1833.  Treated  at  Seminary  and  Satterlee  Hospitals.  Deserted  September  15th,  1833. 

McElroy,  James,  Private,  Co.  F,  33th  Wisconsin  Volunteers,  aged  40  years.  Contusion  of  the  frontal  bone  by  a conoidal 
musket  ball.  Petersburg,  Virginia,  June  24th,  1834.  Treated  at  Division,  Lincoln,  and  York  Hospitals.  Deserted  September 
20th,  1864. 

Eyan,  Thomas,  Private,  Co.  H,  58th  Massachusetts  Volunteers,  aged  35  years.  Contusion  of  left  temporal  by  a conoidal 
musket  ball.  Cold  Harbor,  June  3d,  1834.  Treated  at  Ninth  Corps  Field,  Harewood,  and  Mower  Hospitals.  Suffered  on 
exposure  to  the  sun.  Deserted  Deccnnber  2d,  1864. 

WiSPERT,  Adaji,  Private,  Co.  H,  91st  Pennsylvamia  Volunteers,  aged  23  years.  Gunshot  contusion  of  the  occipital. 
Petersburg,  Virginia,  June  18th,  1834.  Treated  at  Division,  Lincoln,  and  Satterlee  Hospitals.  Deserted  August  9th,  1864. 

Ill  ten  instances,  men  in  whom  this  form  of  injury  had  been  diagnosticated,  recovered 
and  were  returned  to  modified  duty  in  the  Veteran  Reserve  Corps,  in  accordance  with  a 
General  Order  from  the  Adjutant  General’s  Office.  On  their  discharge,  at  the  close  of  the 
war,  four  of  them  were  pensioned,  and  six  had  no  disabilities.  The  disabilities  of  the 
four  pensioners  appeared  to  have  been  of  a sliglit  nature,  limited  to  pain  and  headache  on 
exposure. 

Barnes,  John  K.,  Private,  Co.  C,  23d  Illinois  Volunteers,  aged  27  years.  Contusion  of  the  skull  by  a conoidal  musket 
ball.  Winchester,  Virginia,  July  24th,  1834.  Treated  at  Jarvis  and  Mower  Hospitals.  Transferred  to  Co.  118,  2d  Battalion  of 
the  Veteran  Eeserve  Corps,  January  19th,  1865.  Not  on  Pension  Roll. 

Hastings,  T.  J.,  Private,  Co.  E,  3d  Vermont  Volunteers,  aged  18  years.  Contusion  of  the  frontal  bone  by  a fragment  of 
shell.  Cold  Harbor,  Virginia,  June  3d,  1834.  Treated  at  Lincoln,  McKim’s,  and  Brattleboro’  Hospitals.  Transferred  to  Co.  G, 
2d  Veteran  Eeserve  Corps,  November  23th,  1864.  Discharged  July  18th,  1865.  Pension  Examiner  C.  S.  Cahoon,  of  Lynden, 
Vermont,  reported,  on  February  17th,  1837,  that  this  man  then  complained  of  giddiness  and  pain  in  the  bead. 

Heeler,  William  C.,  Corporal,  Co.  E,  2d  Pennsylvania  Heavy  Artillery,  aged  20  years.  Contusion  of  tbe  frontal  by  a 
fragment  of  shell.  Petersburg,  Virginia,  August  2d,  1834.  Treated  at  Field  and  Satterlee  Hospitals.  Transferred  to  the  Vet- 
eran Eeserve  Corps,  2d  Battalion,  January  IGth,  1865.  Mustered  out  November  21st,  1865,  and  pensioned  in  April,  1867.  Pen- 
sion Examining  Surgeon  E.  Simington  reported  that  this  pensioner  suffered  from  congestion  of  the  brain  on  slight  exposure  to  the 
sun  or  fire  beat,  and  rated  his  disability  at  one  half,  and  probably  not  permanent. 

AIcCarthy,  J.,  Private,  Co.  A,  42d  New  York  Volunteers,  aged  20  years.  Contusion  of  the  frontal  by  a fragment  of 
shell.  Gettysburg,  July  2d,  1833.  Treated  at  Field  and  Satterlee  Hospitals.  Transferred  to  Veteran  Eeserve  Corps,  December 
13th,  1833.  Mustered  out,  on  expiration  of  term,  June  27th,  1864.  Pension  Examining  Surgeon  E.  A.  Smith  reported,  Decem- 
ber 6th,  1865,  that  this  man  was  a pensioner  and  suffered  from  headache. 

McLarney,  P.,  Private,  Co.  G,  G9th  New  York  Volunteers,  aged  40  years.  Contusion  of  the  right  temporal  by  a conoidal 
musket  ball,  destroying  the  sight  of  the  right  eye.  Cold  Harbor,  Virginia,  June  3d,  1864.  Treated  at  Fairfax  Seminary  and 
Mower  Hospitals.  Transferred  to  the  Veteran  Eeserve  Corps,  January  28th,  1865.  Discharged  July  8th,  1865,  and  pensioned. 
Died  in  1868. 

Oberholtzer,  S.  W.,  Private,  Co.  G,  55th  Ohio  Volunteers,  aged  33  years.  Contusion  of  the  parietal  by  a conoidal 
musket  ball.  Chancellorsville,  Virginia,  May  3d,  1883.  Treated  at  Field,  Alexandria,  Satterlee,  Patterson  Park,  and  Camp 
Dennison  Hospitals.  Transferred  to  the  Veteran  Eeserve  Corps,  November  17th,  1863.  Discharged  for  disability,  October  27th, 
1834,  and  pensioned  from  that  date. 

Eingwald,  W.  a..  Private,  Co.  E,  24th  Michigan  Volunteers,  aged  19  years.  Gunshot  contusion  of  the  occipital.  North 
Anna,  Virginia,  May  23d,  1834.  Treated  at  Field,  Fairfax  Seminary,  Haddington,  and  St.  Mary’s  Hospitals.  Transferred  to 
the  2d  regiment  Veteran  Ee.serve  Corps,  August  31st,  1834.  Discharged  July  17th,  1885,  and  name  not  found  on  Pension  Roll. 

Egberts,  E.  A.,  Private,  Co.  E,  20tb  Indiana  Volunteers,  aged  15  years.  Contusion  of  the  left  parietal  by  a fragment  of 
shell.  Petersburg,  Virginia,  June  16th,  1834.  Treated  at  Division  and  Lincoln  Hospitals.  Transferred  to  the  9th  regiment 
Veteran  Reserve  Corps,  December  8th,  1884.  Not  on  Pension  Roll. 

Sharpie,  Francis,  Private,  Co.  B,  60th  New  York  Volunteers,  aged  19  years.  Contusion  of  tbe  occipital  by  a conoidal 
musket  ball,  which  lodged  in  the  back  of  the  neck.  Gettysburg,  July  2d,  1833.  Treated  at  Satterlee  Hospital,  where  the 
missile  was  extracted  on  September  18th.  Transferred  to  the  9tli  regiment  Veteran  Reserve  Corps,  December  31st,  1863.  Not 
pensioned. 

Walsh,  Michael,  Private,  Co.  K,  5th  Connecticut  Volunteers,  aged  21  years.  Contusion  of  the  right  parietal  bone  by 
a conoidal  musket  ball.  Cedar  Mountain,  Virginia,  August  9th,  1832.  Transferred  to  Co.  21,  2d  Battalion  Veteran  Reserve 
Corps,  September  1st,  1833.  Mustered  out,  on  expiration  of  term  of  service,  July  22d,  1864. 


GUNSHOT  CONTUSIONS  OF  THE  CRANIAL  BONES. 


101 


The  patients  named  in  the  following  list  were  discharged  from  service  on  account  of 
serious  disabilities,  the  nature  of  which  was  not  specified : 

He:mpton,  E.  JI.,  Co.  B,  3(1  New  Hampshire  Volunteers.  Gunshot  contusion  of  the  parietal  region.  Morris  Island,  South 
Carolina.  Discharged  from  s'ervdce  November  11th,  1833.  Surgeon  A.  J.  H.  Buzzell,  3d  New  Hampshire  Volunteers,  regarded 
the  disability  as  total. 

Noyes,  Samuel  G.,  Sergeant,  Co.  A,  40th  Massachusetts  Volunteers,  aged  22  years.  Gunshot  contusion  of  left  temporal 
bone,  by  a conoidal  musket  ball.  Cold  Harbor,  Virginia,  June  3d,  1834.  Treated  at  Field,  Slough,  York,  Boston,  and  Read- 
ville  hospitals.  Discharged  fi-om  the  latter,  Novemher  17th,  1834,  for  disability  resulting  from  injury  to  skull. 

O’Brien,  J.,  Private,  Co.  C,  28th  Massachusetts  Volunteers.  Gunshot  contusion  of  the  skull.  Treated  at  Carver  Hos- 
pital. Discharged  from  service  March  14th,  1833.  Disability  considered  as  total. 

Many  of  the  cases  of  gunshot  contusion  of_  the  cranial  bones  were  followed  by  very 
grave  symptoms.  Hsemorrhage,  erysipelas,  and  gangrene  were  the  early  complications  of 
the  superficial  portions  of  the  wounds  ; periostitis,  caries,  and  exfoliation  often  resulted  from 
the  injury  to  the  bone ; and,  in  some  instances,  the  mischief  extended  to  the  membranes  or 
to  the  brain  itself.  The  remote  effects  included  persistent  pain  in  the  point  struck,  vertigo, 
chronic  irritation  of  the  brain,  mental  imbecility,  epilepsy,  and  impairment  of  the  special 
senses,  especially  by  amaurosis  and  deafness. 

Hcemorrhage. — Of  the  cases  belonging  to  this  category,  one  was  complicated  by  primary, 
one  by  secondary  hoemorrhage,  and  a third,  by  haemorrhage  in  connection  with  extensive 
sloughing.  The  brief  notes  of  these  cases  are  as  follows  ; 

Newco.mbe,  John  S.,  Private,  Co.  E,  50th  New  York  Volunteers.  Contusion  of  the  left  temporal  by  a ball  accidentally 
discharged  from  his  own  musket  on  the  Battery  at  New  York  City,  September  18th,  1831.  The  temporal  artery  was  partly 
divided  and  there  was  profuse  haimorrhage.  When  taken  to  the  hospital  he  was  insensible.  The  artery  was  still  bleeding.  It 
was  ligated  near  the  zygoma.  He  died  September  21st,  1831,  from  intiammation  of  the  brain. 

White,  John  F.,  Lieutenant,  Co.  C,  134th  Pennsylvania  Volunteers.  Contusion,  by  a shell  fragment,  of  the  right  pari- 
etal bone,  near  the  sagittal  suture.  Fredericksburg,  December  13th,  1832.  Treated  at  Field,  Point  Lookout,  and  Philadelphia 
Officers’ hospitals.  Free  haemorrhage,  on  two  occasions,  from  branches  of  the  temporal.  The  bleeding  was  arrested  by  com- 
pression. There  was  burrowing  of  pus  and  an  abscess  formed  near  the  ear.  The  wound  healed  bj'  the  end  of  January,  and  the 
patient  returned  to  duty  on  February  17th,  1833. 

Brooks,  John,  Private,  Artillery,  aged  37  years.  Gunshot  contusion  of  the  temporal.  Admitted,  August  11th,  1833, 

to  the  Louisiana  Hospital  at  Richmond,  under  the  care  of  Assistant  Surgeon  II.  N.  Young,  C.  S.  A.  The  scalp  wound  was  in  a 
gangrenous  condition,  and  soon  after  a profuse  hajmorrhage  took  place  from  the  posterior  auricular  artery.  This  recurred  repeat- 
edly, though  temporarily  controlled  by  pressure,  and  death  took  place  on  September  15th,  1833. 

Erysipelas. — Six  of  the  cases  of  gunshot  contusion  of  the  skull  are  reported  to  have 
been  complicated  by  erysipelas.  Two  of  these  cases  were  fatal  : 

Baker,  John  C.,  Private,  104th  Ohio  Volunteers,  aged  22  years,  was  wounded,  at  the  battle  of  Franklin,  Tennessee, 
November  30th,  1884,  by  a conoidal  ball,  which  caused  a flesh  wound  of  the  left  side  of  the  head.  He  was  conveyed  to  Nash- 
ville, and  thence  sent  to  Jeffersonville,  Indiana,  on  January  11th,  183.5,  suffering  from  erysipelas.  On  February  23d,  he  was 
transferred  to  Lincoln  Hospital,  Washington,  D.  C.,  and,  on  June  17th,  1885,  was  mustered  out  of  service. 

Gildersleeve,  Wai.,  Corporal,  Co.  D,  40th  New  York  Volunteers,  aged  23  years,  was  wounded,  in  the  engagement  near 
Petersburg,  Virginia,  March  25th,  1835,  by  a conoidal  musket  ball,  which  entered  the  scalp  over  the  lamboidal  suture  and  cross- 
ing the  occipital  bone  obliquely,  emerged  three  inches  from  the  wound  of  entrance,  grazing  the  bone  in  its  passage.  Ho  received, 
at  the  same  time,  a wound  of  the  little  finger  of  the  left  hand.  He  was,  on  the  following  day,  admitted  to  the  hospital  of  the  2d 
division.  Second  Corps,  and,  on  March  27th,  was  transferred  to  the  Finhiy  Hospital,  Washington,  D.  C.  On  admission,  the  symp- 
toms were  favorable;  but,  on  March  31st,  coma,  with  stertorous  breathing,  supervened.  S-inapisms  were  applied  to  nape  of  luick, 
wrists,  and  ankles,  and,  on  the  following  day,  consciousness  returned,  and  the  patient  felt  much  improved.  On  April  4th,  erysip- 
elas of  the  scalp  set  in,  and  on  April  18th,  symptoms  of  pneumonia  appeared;  but  from  April  26th,  he  gradually  recovered  and 
was  returned  to  duty  on  December  8th,  1835.  He  was  pensioned  for  one  year.  Pension  Exam'ming  Surgeon  M.  D.  Benedict 
reported,  August,  183-5,  that  his  disabilities  would  not  be  permanent. 

King,  George  D.,  Private,  Co.  I,  21st  Michigan  Volunteer.s,  was  wounded,  at  the  battle  of  Stone  River,  December  31st, 
1862,  by  a musket  ball,  which  struck  behind  the  left  ear  and  lodged  under  the  scalp,  lying  against  the  bone.'-  He  was  sent  to 
Hospital  No.  7,  Louisville,  Kentucky.  On  January  1.5th,  1833,  erysipelas  supervened.  He  gradually  recovered,  and  on  April 
1.5th,  he  was  transferred  to  Hospital  No.  19.  On  the  27th,  he  was  readmitted  to  Hospital  No.  7.  Four  months  after  the  reception 
of  the  injury  the  ball  was  e-xtracted.  The  sense  of  hearing  was  entirely  do.stroyed.  lie  was  di.scharged  from  service  for  disability 


102 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


rated  at  oue-lialf,  on  Jilay  16th,  1863.  Surgeon  J.  L.  Teed,  38th  Illinois  Volunteers,  and  the  Adjutant  General  of  Michigan,  and 
Acting  Assistant  Surgeon  W.  W.  Goldsmith  report  the  ease.  A year  subsequently,  Pension  Examining  Surgeon  Geo.  W.  Hears, 
reports  that  the  wound  was  still  discharging  slightly.  There  was,  probably,  a scale  of  the  outer  table  detached. 

Thompson,  Jacob,  Cook,  11th  Illinois  Cav.alry,  aged  26  years,  was  wounded  at  Fort  Pillow,  Tennessee,  April  12th,  1864, 
by  two  musket  balls,  one  of  which  crossing  the  vertex  of  the  cranium,  inflicted  a scalp  wound  and  contused  the  bone.  He  was 
conveyed  to  Mound  City  Hospital,  Illinois,  on  April  16th.  Erysipelas  of  the  head  supervened  and  an  abscess  formed  under  the 
integuments,  which  caused  much  pain  and  febrile  reaction.  The  abscess  having  been  opened,  the  patient  steadily  improved,  and 
on  May  20th,  1864,  Surgeon  Horace  Wardner,  U.  S.  V.,  reports  that  he  was  returned  to  duty  entirely  cured. 

Whitlock,  George  H.,  Private,  Co.  G,  109th  Illinois  Volunteers,  aged  37  years,  was  wounded  befoi-e  Petersburg,  July 
30th,  1864,  by  a musket  ball,  which  tore  up  the  scalp  in  the  temporal  region,  and  denuded  the  skull.  First  treated  at  the  field 
hospital  of  3d  division  of  the  Ninth  Corps,  he  was  transferred,  on  August  2d,  to  the  Mount  Pleasant  Hospital  at  Washington. 
Tlie  register  of  this  hospital  states  that  the  outer  table  was  indented  but  not  fractured.  Erysipelas  of  the  scalp  set  in,  and  the 
case  termin.ited  fatally  on  December  1st,  1864. 

Wright,  S.  C.,  Private,  Co.  G,  8th  Florida  Regiment,  Was,  on  October  2d,  1863,  admitted  to  Cliimborazo  Hospital  at  Rich- 
mond, Virginia,  with  a gunshot  wound  of  the  scalp  with  contusion  of  the  skull.  An  attack  of  erysipelas  supervened;  but  tliis 
was  readily  subdued.  After  this,  the  patient  sufl'ered  from  acute  dysentery.  He  died  from  tliis  complication  on  December  5th, 
1863.  Surgeon  J.  B.  McCaw,  P.  A.  C.  S.,  reports  the  case. 

Gangrene. — Two  cases  of  gunshot  contusion  of  the  cranium  were  complicated  by 
sloughing  of  the  scalp  ; both  ultimately  recovered  : 

Allen,  George  H.,  Sergeant,  Co.  G,  146th  New  York  Volunteers,  aged  20  years,  was  wounded,  at  the  battle  of  Gettys- 
burg, Pennsylvania,  July  2d,  1863,  by  a piece  of  shell,  which  tore  the  scalp  over  the  right  pai’ietal,  to  the  extent  of  two  inches, 
denuding  the  bone  of  periosteum.  He  was  admitted  to  the  field  hospital  of  the  2d  division  of  the  Fifth  Corps,  and,  on  the  10th, 
transferred  to  the  Satterlee  Hospital  at  Philadelphia,  Pennsylvania.  Phagedenic  action  in  the  wound  was  promptly  arrested  by 
a lotion  of  nitric  acid.  Some  exfoliation  of  the  bone  occurred  in  the  progress  of  the  case.  The  patient  recovered  and  was  returned 
to  duty  on  the  23d  of  September,  1863.  His  name  does  not  appear  on  the  Pension  List.  The  case  was  reported  by  Acting  Assist- 
ant Surgeon  J.  B.  Trenor. 

Smith,  J.  W.,  of  Captain  Randolph’s  Company  of  Louisiana  Infantry,  was  wounded,  at  the  battle  of  Chancellorsville, 
May  2d,  1863,  by  a gunshot  projectile  which  lacerated  the  scalp  and  contused  the  skull.  He  was  conveyed  to  Richmond  and 
placed  in  the  Louisiana  Hospital.  Erysipelas,  followed  by  gangrene,  supervened.  Detergent  lotions  were  applied,  and  after  a 
while  the  wound  presented  a healthy  granulating  surface,  and  eventually  cicatrized.  The  patient  Vv^as  furloughed  on  June  3d, 

1863. 

Periostitis. — In  a few  instances  protracted  inflammation  of  the  contused  pericranium 
was  observed : 

Coffey,  Patrick,  Prlv'ate,  Co.  E,  37th  New  York  Volunteers,  received,  at  the  battle  of  Williamsburg,  Virginia,  May  5th, 
1862,  a gunshot  wound  of  the  scalp  with  injury  to  the  occipital  bone.  He  was,  on  May  11th,  admitted  to  the  Mill  Creek  Hospital, 
and,  on  May  22d,  was  sent  to  the  Ladies’  Horae  Hospital,  New  York,  whence  he  was  returned  to  his  regiment.  He  was,  how- 
ever, readmitted  on  June  12th,  1863,  and  was  discharged  from  the  service  on  June  23d,  1863.  The  injury  to  the  bone  was  trivial 
probably.  No  application  for  pension  appears  on  the  rolls  of  the  Interior  Department. 

Harrick,  Charles,  Private,  Co.  D,  94th  New  York  Volunteers,  aged  25  years,  received,  at  Gettysburg,  July  3d,  1863, 
a contusion  of  the  right  parietal  bone  at  the  lower  posterior  angle,  by  a conoidal  musket  ball  which  lodged  under  the  integuments. 
He  was  admitted  to  Satterlee  Hospital,  Philadelphia,  on  July  10th,  and,  on  the  following  day,  the  position  of  the  ball  was  detected 
by  a probe  and  the  missile  was  extracted.  A slight  scale  of  the  outer  table  necrosed,  and  the  pericranium  was  inllamed  for  a 
while;  but  the  wound  ultimately  did  well,  and  the  soldier  was  returned  to  duty  December  3d,  1863.  His  name  is  not  found  on 
the  Pension  List. 

Lusk,  S.\muel  R.,  Sergeant,  Co.  E,  137th  New  York  Volunteers,  aged  28  years,  received,  in  the  engagement  on  the 
Wauhatchie  River,  Tennessee,  October  28th,  1863,  a gunshot  contusion  of  the  right  portion  of  the  occipital  bone.  He  was,  on 
the  following  day,  admitted  to  Hospital  No.  3,  Chattanooga.  He  probably,  shortly  afterwards,  returned  to  duty,  as  in  June,  1864, 
he  was  again  admitted  to  the  field  hospital  of  the  2d  division.  Twentieth  Corps,  suffering  from  the  old  injury.  He  was,  on  June 
18th,  sent  to  Hospital  No.  2,  Chattanooga,  Tennessee,  on  June  20th,  to  the  Cumberland  Hospital,  Nashville,  on  June  27th,  to  the 
Brown  Hospital,  Louisville,  Kentucky,  and  on  July  1st,  to  Camp  Dennison,  Ohio,  whence  he  was  returned  to  duty  on  July  18th, 

1864.  He  was  discharged  on  June  28th,  1865.  Examining  Surgeon  J.  G.  Orton  reports,  April  19th,  1869,  that  this  pensioner 
Was  nervous,  sleepless,  depressed  in  spirits,  and  able  to  work  but  little. 

Pr.\tt,  Thomas  D.,  Private,  Co.  D,  18th  Massachusetts  Volunteers,  received,  at  the  battle  of  Fredericksburg,  Virginia, 
December  13th,  1862,  a gunshot  wound  of  the  head.  He  was  admitted  to  the  hospital  of  the  3d  division.  Second  Corps,  and,  on 
December  16th,  was  sent  to  the  hospital  at  Point  Lookout,  Maryland.  Here  it  was  ascertained  that  the  right  temporal  bone  had 
become  necrosed.  On  May  1st,  1863,  the  patiimt  was  sent  to  the  West’s  Buildings  Hospital,  Baltimore,  Maryland,  and,  on  May 
18th,  to  the  Lovell  Hospital,  Portsmouth  Grove,  Rhode  Island,  where  he  was  transferred  to  the  Veteran  Reserve  Corps,  on  July 
18th,  1863.  His  name  is  not  on  the  Pension  Rolls. 


GUNSHOT  CONTUSIONS  OF  THE  CEANIAL  BONES. 


103 


Exfoliation. — This  was  frequently  observed  in  gunshot  contusions  of  the  skull.  Many 
examples  are  noticed  in  the  categories  of  other  complications.  The  following  twenty-seven 
cases  were  also  reported  : 

Brown,  C.,  Private,  Co.  F,  11th  South  Carolina  Battery,  received,  on  July  SOth,  18G4,  a gunshot  -vvound  of  the  scalp, 
with  probable  contusion  of  the  bone.  He  was  admitted  into  the  Jackson  Hospital  at  Bichmond,  Virginia,  on  Sei)tember  16th. 
Exfoliation  resulted,  and,  after  the  separation  of  a scale  of  bone,  he  recovered. 

Ckinyan,  James,  Private,  Co.  H,  14th  Connecticut  Volunteers?,  aged  48  years,  received,  at  the  battle  of  the  Wilderness, 
May  5th,  1884,  a contusion  of  the  skull,  by  a conoidal  musket  ball.  He  had  already  been  wounded  at  Chaucellorsville,  in  the 
left  hand,  and  at  Gettysburg,  over  the  left  knee,  and  he  was  somewhat  lame  from  the  latter  injury,  while  the  former  had  caused 
luxation  of  the  thumb.  He  was  sent  to  Washington,  on  May  11th,  having  been  treated  meanwhile  at  the  field  hos]ntal  of  the 
2d  divusion  of  the  Second  Corps.  He  was  removed,  on  June  28th,  to  Summit  House  Hospital,  Philadelphia,  on  July  17th, 
to  Knight  Hospital,  New  Haven,  and,  on  October  17th,  to  the  hospital  at  Eeadville,  Ma.ssachusetts,  whence  he  was  discharged 
on  March  10th,  1865.  During  his  sojourn  at  Eeadville,  an  exfoliation  of  the  outer  table  of  the  skull  took  place.  He  was 
pensioned,  and  in  June,  1835,  Pension  Examining  Surgeon  J.  Cumminskey,  reported  that  he  suflered  from  headache  and 
dizziness,  and  was  unfit  for  the  Veteran  Eeserve  Corps. 

DiEitL,  George,  Private,  Co.  E,  100th  New  York  Volunteers,  aged  27  years,  received,  in  the  engagement  at  Chester 
Station,  Virginia,  May  12th,  1834,  a gunshot  contusion  of  the  left  parietal  near  the  temporal  suture.  On  May  15th,  he  was 
admitted  to  Hampton  Hospital,  and,  on  May  18th,  he  was  sent  to  the  hospital  at  Point  Lookout,  thence,  on  July  12th,  to 
Judiciary  Square  Hospital  at  Washington,  and,  on  July  18th,  to  the  Sisters  of  Charity  Hospital,  Buffalo.  The  outer  table  of  the 
bone  had  exfoliated,  and  the  w'ound  was  granulating  and  looking  well,  when,  on  August  16th,  typhoid  fever  set  in,  and  the  case 
terminated  fatally  on  August  23d,  1864. 

Dur/ffins,  JR.,  Private,  Co.  C,  11th  South  Carolina  Eegimeut,  received,  on  June  18th,  1864,  a gunshot  contusion  of  the  left 
parietal  bone.  He  was  admitted  to  the  Confederate  hospital  at  Farmville,  Virginia,  on  June  21st.  The  external  table  of  the 
parietal  bone  exfoliated;  otherwise  the  case  did  well,  and  the  patient  was  furloughed  on  July  8th,  1864,  for  sixty  days. 

Fauck,  Albert,  Private,  Co.  K,  94th  Pennsylvania  Volunteers,  aged  20  years,  was  wounded,  in  a skirmish  near  the 
Eappahannock,  by  a buckshot,  which  entered  the  scalp  over  the  vertex  of  the  cranium  and  lodged  near  the  skull.  The  missile 
w'as  extracted  on  the  same  day.  On  September  1st,  he  was  admitted  to  the  Camden  Street  Hospital,  Baltimore.  Some  slight 
exfoliation,  not  involving  the  entire  thickness  of  the  outer  table,  took  place;  and  then  the  w'ound  healed  kindly,  and,  on 
October  11th,  1862,  the  patient  was  sent  to  the  Convalescent  Camp  at  Fort  McHenry,  Baltimore,  for  duty.  The  case  is  reported 
by  Acting  Assistant  Surgeon  Edmund  G.  Waters.  His  name  does  not  appear  on  the  Pension  Eolls. 

Georr/e,  J.  JR.,  Private,  Co.  B,  9th  Louisiana  Eegiment,  received  on  April  SOth,  1863,  a gunshot  wound  of  the  head.  He 
was  admitted  to  the  Louisiana  Hospital,  Eichmond.  The  external  table  of  the  bone  was  contused  and  exfoliated,  yet  the 
case  progressed  favorably,  and,  on  June  10th,  1863,  the  patient  was  furloughed. 

Goldey,  James  H.,  Private,  Co.  A,  90th  Pennsylvania  Volunteers.  Supposed  gunshot  scalp  wound  ov(!r  occipital. 
Antietam,  September  17th,  1832.  Entered  hospital  at  Washington,  September  23d.  Transferred  to  Fort  Schuyler  Hospital, 
New  York,  October  7th.  Transferred  to  Fort  Hamilton,  December  1st.  On  December  13th,  he  entered  the  Satterlee  Hospital, 
Philadelphia,  complaining  of  pain  hi  the  occipital  region.  The  .wound  was  closed,  but  it  reopened  on  DecemlKu-  18th.  On 
Jannary  18th,  1863,  a circular  portion  of  dead  bone,  an  inch  in  diameter,  was  detected  by  a probe.  The  patient  had  no  pain  or 
derangement  of  the  mental  faculties,  and  walked  actively  about  the  ward.  About  February  2d,  the  discharge  from  the  wound 
was  profuse,  and  the  necrosed  bone  had  not  separated.  There  was  no  change  in  his  condition  until  February  25th,  when  the 
exfoliation  was  observed  to  be  loose,  and  it  was  removed  by  Acting  Assistant  Surgeon  J.  N.  ilooi’e,  through  a crucial  incision. 
The  exfoli.ation  consisted  of  a portion  of  the  external  table,  an  inch  in  diameter,  and  several  smaller  pieces.  On  March  3d,  yet 
another  piece  of  the  external  table  was  removed.  On  March  17th,  the  wound  was  nearly  healed.  The  patient  felt  entirely 
well;  and  on  May  22d,  1863,  he  was  discharged  from  service.  He  aj>pears  to  have  had  no  subsequent  trouble,  since  his  name 
does  not  appear  on  the  list  of  applicants  for  pension. 

Haxdletox,  George  W.,  Private,  Co.  D,  95th  Pennsylvania  Volunteers,  aged  30  years,  was  wounded  at  the  battle 
of  Cold  Harbor,  Virginia,  June  2d,  1864,  by  a conoidal  musket  ball,  which  contused  the  frontal  bone.  He  was  conveyed  to 
Alexandria,  and  admitted  into  the  3d  Division  Hospital  on  .June  6th,  and  from  there  sent  to  the  York  Hospital,  I’ennsylvania, 
on  .June  14th,  1864.  He  recovered,  .and  was  discharged  from  service  on  .January  12th,  186.5.  In  a communication  dated 
.January,  1868,  the  Commissioner  of  I’ensions  states  that  Handleton  receives  a pension  of  foiu-  dollars  per  month,  his  disability 
being  rated  one-half  and  temporary.  On  December  20th,  1865,  Examiniiug  Surgeon  Z.  Eeed  reported  that  portions  of  the 
outer  table  of  the  frontal  bone  had  exfoliated,  and  that  a profuse  ill-conditioned  pus  continued  to  be  discharged  from  the 
wound.  The  patient’s  general  health  was  much  impaired,  and  about  one-half  the  time  he  was  incapacitated  from  obtaining  his 
subsistence  by  manual  labor. 

Kinxe,  Charles,  Private,  Co.  G,  108th  New  York  Volunteers.  Contusion  of  right  p.ariettd  by  a musket  ball.  Antietam, 
September  17th,  1862.  Treated  at  the  field  hospital  of  the  3d  division  of  the  Second  Corps,  until  the  20th,  and  then  sent  to 
the  Mount  Pleasant  Hospital  at  Washington.  On  November  2d,  he  was  furloughed,  and  subsequently  returned  to  duty.  He 
was  discharged  from  service  at  the  regimental  hospital  on  December  24tli,  1802.  Disability  reported  as  “total,”  by  Assistant 
Surgeon  Williams  Ely,  108th  New  York  Volunteers.  He  was  pensioned,  and  reported  by  Pension  Examining  Surgeon  II.  M. 
Montgomery,  of  Eochester,  New  York,  Janu.ary,  1863,  .as  having  load  a series  of  pieces  of  bone  exfoliated.  Doctor  Montgomery 


104 


WOUNDS  AND  INJUlllES  OE  THE  HEAD 


stales  that  the  wound  was  then  discharging  pus,  hut  that  the  patient  would  probably  be  free  from  disability  in  a few  months, 
and  that  he  appeared  “fat  and  hearty.”  In  November,  18G5,  Pension  Examining  Surgeon  J.  K.  H3  de  reported  that  this 
pensioner  complained  of  increase  of  pain  and  dizziness  on  attempting  to  labor,  and  that  he  had  applied  for  an  increase  of  his 
pension,  in  a letter  from  Lancaster,  Wisconsin;  but  no  disabilty  except  dizziness  is  certified  to.  In  the  army  such  applicants 
are  regarded  as  malingerers ; but  in  the  civil  service  a greater  latitude  prevails. 

Lir/r/itt,  W.  B.,  Private,  Co.  G,  18th  Mississippi  Infantry,  received  a gunshot  wound  of  the  scalp  in  the  right  parietal 
region.  He  was  admitted  into  the  Howard  Grove  Hospital,  Eichmond,  May  2~th,  1864.  Exfoliation  of  the  outer  table  of  the 
bone  resulted.  On  July  4th,  he  was  furloughed. 

Lipscomb,  IF.  A.,  Sergeant,  Co.  C,  5th  South  Carolina  Eegiment,  was  admitted,  on  June  23d,  1864,  to  the  Confederate 
Hospital  at  Farmville,  Virginia,  with  a gunshot  injury  of  the  right  supra  orbital  region.  Gradual  exfoliation  of  the  external 
table  followed.  The  patient  was  furloughed  on  Jul^^  8th,  1864. 

Maksh,  George  H.,  Private,  Co.  I,  14th  New  York  Artillery,  aged  18  years.  Contusion  of  left  pari(4al,  near  lamb- 
doidal  suture,  denuding  bone  of  periosteum.  Petersburg,  March  25th,  1865.  Treated  at  Mount  Pleasant  Hospital,  Washington; 
White  Hall,  Pennsylvania;  and  was  discharged  from  service  June  19th,  1865.  In  November,  1869,  Pension  Examining 
Surgeon  J.  G.  Pitts  reports  that  a fragment  of  the  external  table  had  been  exfoliated,  and  the  pensioner  alleged  that  he  suffered 
dizziness  when  he  stooped  at  work,  and  he  suffered  a stinging  sensation  in  hot  weather.  Dr.  Pitts  rated  the  disability  at 
one-quarter,  and  probably  temporary. 

Maxwell,  Thomas,  Private,  Co.  K,  5th  Michigan  Volunteers,  received,  at  the  battle  of  Fredericksburg,  Virginia, 
December  13th,  1862,  a gunshot  injury  of  the  right  side  of  the  cranium,  anterior  portion.  He  was,  on  December  19th,  1862, 
admitted  to  the  Third  Division  Hospital  at  Alexandria.  A portion  of  the  outer  table  exfoliated,  otherwise  the  case  progressed 
favorably,  and  the  patient  was  returned  to  duty  on  May  29th,  1863.  His  name  does  not  appear  on  the  Pension  List. 

klcGuiRE,  JoHX,  Private,  Co.  G,  65th  New  York  Volunteers.  Gunshot  contusion  of  the  frontal  bone.  Antietam, 
September  17th,  1882.  Troated  at  Carver  Hospital,  Washington.  Exfoliation  of  both  tables  of  the  frontal  resulted,  and  the 
patient  suffered  from  neuralgia.  He  was  discharged  from  service  on  October  21st,  1862.  His  name  does  not  appear  on  the 
Pension  Rolls. 

McNicitols,  William,  Private,  Co.  K,  69th  Pennsjdvania  Volunteers,  aged  28  years.  Contusion  of  the  left  parietal 
by  a fragment  of  shell,  which  lacerated  the  scalp  for  three  inches  or  more.  Gettj’sburg,  July  2d,  1863.  Treated  at  Mower 
Hospital,  Philadelphia.  On  August  14th,  an  exfoliation  of  the  outer  table  was  removed,  and  the  patient  recovered  and  was 
returned  to  duty  on  December  16th,  1833.  Case  reported  by  Acting  Assistant  Surgeon  R.  II.  Lougwill.  The  man’s  name  is 
not  on  the  Pension  Roll. 

Pattersox,  Elias,  Private,  Co.  I,  7th  Kentucky  Volunteers,  received,  in  the  engagement  before  Vicksburg,  ^Mississippi, 
May  22d,  1863,  a gunshot  contusion  of  the  cranium.  He  was  taken  to  a field  hospital,  and,  on  June  3d,  ^vas  admitted  to  the 
hospital  steamer  E.  C.  Wood.  On  June  8th,  he  was  sent  to  the  Union  Hospital,  Memphis,  Tennessee.  Three  or  four  small 
pieces  of  the  external  table  of  the  cranium  came  away  by  exfoliation.  He  was  returned  to  duty  by  Surgeon  J.  D.  Brumley, 
U.  S.  V.  On  August  20th,  he  was  sent  to  Fort  Pickering,  Tennessee,  and  was  there  discharged  from  service,  on  September 
21st,  1863,  his  disability  being  rated  at  one-half;  Surgeon  Daniel  Stahl,  7th  Illinois  Cavalry,  certifying  that  the  portion  of  the 
occipital  removed  was  two  inches  long  and  half  an  inch  wide,  and  th.at  dimness  of  sight  .and  various  nervous  affections  followed 
the  injury,  and  that  the  soldier  was  not  fit  for  the  Veteran  Reserve  Corps.  Patterson  is  pensioned  at  four  dollars  per  month. 

SCAXLAX,  Jonx,  Private,  Co.  D,  164tli  New  York  Volunteers,  aged  33  years,  was  hit,  .at  the  battle  of  North  Anna, 
M.ay  18th,  1864,  by  a fragment  of  shell,  over  the  middle  of  the  left  lambdoidal  suture.  Treated  at  field  hospital  of  3d 
division.  Second  Army  Corps,  Carver  Hospital,  Washington,  and  Mower  Hospital,  Philadelijhia.  At  the  latter  hospital  the 
wound  reopened,  and  several  exfoliations  of  the  outer  table  came  away.  On  August  25th,  this  soldier  was  returned  to  duty  by 
Surgeon  J.  H.  Hopkinson,  U.  S.  V.  He  was  discharged  July  17th,  1865,  and  pensioned  from  that  d.ate.  On  J.anu.ary  16th, 
1866,  Pension  Examining  Surgeon  J.  E.  King  reported  that  his  dis.ability  was  permanent,  and  that  he  had  dizziness  and  pain 
in  the  head,  especially  when  in  a stooping  posture,  and  that  he  could  not  endure  the  sunlight. 

Sheffler,  Johx,  Priv.ate,  Co.  D,  45th  Pennsylv.ania  Volunteers,  aged  44  years,  received,  at  the  battle  of  Cold  Harbor, 
Virginia,  June  3d,  1864,  a gunshot  flesh  wound  of  the  head.  He  was  on  the  same  day  admitted  to  the  hospit.al  of  the  2d 
division.  Ninth  Corps,  on  June  10th,  1864,  sent  to  the  Emory  Hospital,  Washington,  D.  C.,  on  April  9th,  sent  to  the  Cuyler  Hos- 
pital, Philadelphia,  and,  on  Jlay  10th,  transferred  to  the  Mower  Hospital,  where  he  was  disch.arged  from  the  service  on  June22d, 
1865,  on  account  of  gunshot  contusion  of  the  cranium.  Pension  Examining  Surgeon  Edward  Smitli  reports,  July  20th,  1865, 
that  the  ball  injured  the  frontal  and  right  p.arietal  bones,  and  tlnat  several  exfoli.ations  of  bone  had  been  removed;  that  the 
patient  complained  of  constsint  headache  and  dizziness,  .and  the  ex.aminer  rated  his  disability  at  “three-fourths,  .and  probably 
permanent.” 

Soloman,  TF.  S.,  Private,  Co.  G,  66th  North  Carolina  Regiment,  wms,  on  June  20th,  1864,  admitted  to  the  Confederate 
Hospital  at  Farmville,  Virginia,  with  a gunshot  injury  of  the  frontal  bone,  received  on  June  18th,  1864.  Gradual  exfoliation 
of  the  outer  table  took  place,  but  the  patient  did  well,  and  was,  on  July  8th,  1854,  furloughed. 

Stafford,  Bexjamix,  Private,  Co.  I,  26th  New  York  Volunteers,  w'as  admitted  to  the  Fairfax  Seminary  Hospit.al, 
Virgini.a,  September  29th,  1862,  with  a gunshot  wound  over  the  right  side  of  the  frontal  bone,  received  at  Antietam.  He  was 
returned  to  duty  May  8th,  1863.  It  was  found,  however,  that  the  outer  table  of  the  os  front  is  was  exfoliating,  and  the  man  was 
discharged  from  the  service  on  May  28th,  1863.  He  was  examined  at  Utica  for  a pension,  by  Dr.  H.  B.  Day,  April  22d,  1864. 
It  was  found  th.at  two  fi'agments  of  bone  had  exfoliated,  and  that  there  was  a fistulous  sinus  through  which  detached  bone 
could  still  be  felt. 


4* 


Med, a Surs.  of  Ihc  War  of  t]ie  Rebenioii,  Pfjrt  1.  Vol 


1 CoTj).  A.H.  Beam , ( See  page  121.  • 

2. 1*1  W.Wlieeler,(  Seepage  225.)  4-  Ft . D. SuUhmn , ( Seepage  148.)  3.Pt.  P.  Scott, ( Seepage  105.) 

PLATE  III.  GUNSHOT  SCALP  WOUNDS  AND  CONTUSIONS  OFTHE  SKULL. 


GUNSHOT  CONTUSIONS  OF  THE  CHANIAL  BONES. 


105 


Scott,  Pembroke,  Private,  Co.  D,  198tli  Pennsylvania  Volunteers,  aged  25,  was  wounded,  in  an  engagement  at  Gravelly 
Run,  Virginia,  March  29th,  1835,  by  a conoidal  ball,  which  inllictcd  a wound  in  the  scalp,  three  inches  in  length,  across  the  left 
temporal  and  edge  of  the  left  parietal  bone,  and  contused  the  outer  table  of  the  latter.  He  was  conveyed  to  the  field  hospital  of 
the  1st  division.  Fifth  Corps,  and  thence  was  transferred  to  City  Point,  Virginia,  where  he  remained  in  the  depot  field  hospital 
of  the  Ninth  Corps  until  the  2d  of  April,  when  he  was  transferred  to  the  Harewood  Hospital,  Washington,  D.  C.  By  April  29th, 
the  wound  was  doing  well  and  healing  kindly,  and  there  were  no  indications  of  depression  nor  compression.  On  May  15th,  he 
was  transferred  to  the  Satterlee  Hospital,  Philadelphia,  Pennsylvania.  On  June  IGth,  several  small  pieces  of  the  outer  table  of 
the  skull  were  removed.  The  patient  improved  gradually,  and  was,  on  the  6th  of  July,  1835,  discharged  from  service.  The 
appearance  of  the  wound,  while  the  man  was  at  Harewood  Hospital,  is  exhibited  in  the  third  figure  of  Plate  HI.  Scott  was 
pensioned  to  date  from  July  5th,  1835.  In  April,  1836,  Pension  Examining  Surgeon  Wilson  Jewell  reported  that  the  man’s 
nervous  system  was  much  affected,  and  that  loss  of  memory  and  partial  aphasia  were  especially  noticeable.  Dr.  Jewell  regarded 
the  disability  as  permanent. 

Tree,  Fr.vnklix,  Private,  Co.  A,  20th  Maine  Volunteers.  Contusion  and  denudation  of  the  vault  of  the  skull  for  one 
inch  by  a musket  ball.  Gettysburg,  July  3d,  1833.  Treated  at  Seminary  and  Satterlee  Hospitals.  A scale  of  bone  exfoliated. 
The  wound  then  healed,  and  the  man  was  returned  to  duty  October  23d,  1833.  His  name  is  not  on  the  Pension  Roll. 


Whitmer,  B.  M.,  Captain,  Co.  G,  3d  South  Carolina  Battalion,  received,  at  the  battle  of  Gettysburg,  Pennsylvania,  July 
2d,  1863,  a gunshot  scalp  wound,  with  contusion  of  the  cranium.  He  was  admitted  to  the  Confederate  Hospital  No.  10, 
Richmond,  Virginia,  Exfoliation  of  the  external  table  of  the  bone  took  place.  Captain  Whitmer  was  furloughed  on  July 
20th,  1833. 


Wilson,  J.  P.,  Lieutenant,  Co.  B,  9th  Virginia  Regiment,  received,  at  the  battle  of  Spottsylvania  Court-house,  Virginia, 
May  10th,  1834,  a gunshot  injury  of  the  left  parietal  bone.  The  wound  of  the  scalp  was  about  two  inches  in  length.  He  was,  on 
May  24th,  admitted  to  the  Confederate  hospital  at  Farmville,  Virginia.  An  exfoliation  of  the  bone  took  place,  otherwise  the  case 
progressed  favorably,  and  the  patient  was  furloughed  on  July  1st,  1834.  He  was  readmitted  on  October  1st,  1864,  suffering  from 
acute  dysentery  and  icterus,  and  returned  to  duty  on  October  29th,  1864,  by  Surgeon  H.  D.  Taliaferro,  C.  S.  A.,  the  medical 
officer  in  charge  of  the  general  hospital  at  Farmville.  The  injury  of  the  head  gave  no  further  trouble. 


mi 


WiLSOX,  Jarvis  C.,  Sergeant,  Co.  I,  10th  Wisconsin  Volunteers,  aged  21  years.  Contusion  of  the  occipital  by  a conoidal 
musket  ball,  which  lodged  beneath  the  scalp  below  the  semi-circular  ridge.  Kenesaw  Mountain,  Georgia,  June  29th,  1864.  The 
missile  was  extracted  on  the  field  by  Assistant  Surgeon  R.  G.  James,  lOth  Wisconsin  Volunteers.  Treated  at  Totten  Hospi- 
tal, Louisville,  till  August  26th,  at  Harvey  Hospital,  Madison,  Wisconsin,  till  October  25th,  and  then  sent  to  Milwaukie  to  be 
mustered  out.  Pension  Examiner  C.  F.  Falley  reports.  May  24th,  1839,  that  there  had  been  exfoliation  of  the  external  plate  of 
the  occipital,  and  that  the  muscles  inserted  into  the  curved  lines  of  the  occipital  were  indurated  and  contracted.  The  head  was 
drawn  backward  somewhat,  and  the  pensioner  alleged  that  bending  it  forward  caused  dizziness  and  pain.  He  was  totally  dis- 
abled for  manual  labor;  but  Doctor  F'alley  thought  that  he  would 
ultimately  improve.  [In  October,  1873,  Examiner  C.  F.  Falley,  of  Ja 

Lancaster,  Wisconsin,  reported  a slight  depression  at  the  seat  of 
injury,  and  that  the  patient  suffered  from  vertigo  and  cephalalgia.] 

Gilkey,  Francis  W.,  Private,  Co.  K,  10th  Pennsylvania 
Reserves,  was  wounded  in  one  of  the  earlier  battles  of  the  war,  and 
made  a prisoner.  In  January,  1863,  he  was  exchanged,  and  received 
at  the  Annapolis  General  Hospital.  He  had,  to  the  right  of  the 
vertex,  a large  ulcer,  resulting  from  a gunshot  wound  of  the  scalp, 
extending  over  the  sagittal  suture.  Tlie  skull  was  necrosed,  and 
probably  there  had  been  denudation,  with  contusion  of  the  bone. 

Erysipelas  supervened,  followed  by  gangrene.  When  this  was 
arrested,  exfoliation  took  place,  and  the  brain  was  exposed.  The 
fragment  of  the  skull  exfoliated  is  represented  in  the  adjoining  wood- 
cuts  (Figs.  30  and  31),  copied  at  natural  size  from  the  specimen  for- 
warded by  the  attending  physician.  Dr.  A.  V.  Cherbonnier.  Granu- 
lations sprang  up,  the  wound  closed,  and  the  patient  recovered  without 
any  further  complications.  He  was  discharged  from  service  on  Jan- 
uary 29th,  1863.  His  name  does  not  appear  on  the  Pension  Rolls. 


Jill 


Fig  30. — Exfoliation  from 
the  parietals  following  gunshot 
contusion.  Spec.  5587,  Sect.  I, 
A.  M.  M.  a 


Fig  31. — Interior  view  of  the 
foregoing  specimen. 


Hay,  John  W.,  Private,  Co.  D,  61st  Pennsylvania  Volunteers,  aged  29  years,  was  wounded,  at  the  battle  of  Spottsyl- 
vania, Virginia,  May  11th,  1834,  by  a conoidal  ball,  which  struck  obliquely  about  the  middle  of  the  forehead.  He  was  admitted 
to  the  hospital  of  the  2d  division.  Sixth  Corps,  but  the  injury  must  have  been  considered  slight,  as  no  record  of  the  case  was 
found  until  July  12th,  when  the  patient  was  admitted  to  5Iount  Pleasant  Hospital,  on  account  of  a gunshot  scalp  wound  near 
the  occipital  protuberance,  subsequently  received  in  General  Early’s  demonstration  against  the  diTences  of  Washington,  the  day 
of  the  patient’s  admission.  Gangrene  attacked  this  later  wound.  Bromine,  nitric  acid,  yeast,  and  charcoal  poultices  were  suc- 
cessively applied  to  the  gangrenous  wound.  The  sloughing  was  checked,  and  the  wound  soon  assumed  a healthy  appearance. 
The  wound  on  the  forehead  was  not  affected  by  gangrene,  and  was  supposed  to  bo  trifling,  and  was  treated  witli  simple  dress- 
ings. A month  after  his  admission,  the  man  complained  of  some  pain  in  the  forehead.  Ice  water  was  applied,  and  morphia  was 
given  internally.  Death  occurred  a few  hours  afterwards.  On  August  7th,  1831,  at  \lvi  post  mortem  examination,  the  brain  was 

14 


106 


WOUNDS  AND  INJUKIES  OF  THE  HEAD, 


found,  to  be  slightly  congested,  but  no  pus  was  observed  between  the  skull  and  dura  mater;  yet  the  latter  was  detached  from  the 

inner  table  of  the  skull, 
which  was  carious  over  a 
surface  nearly  as  large  as 
the  surfaceof  the  incijjient 
exfoliation  on  the  outer 
table.  The  scale  of  dead 
bone  of  the  outer  table 
remained  in  situ.  The 
dura  mater  opposite  the 
diseased  inner  table  was 
thickened  and  had  depos- 
its of  lymph  on  the  surface 
next  the  cranium;  other- 
wise, the  encephalon  was 
normal  in  appearance. 

The  specimen  was  con- 
tributed by  Assistant  Sur- 
geon C.  A.  McCall,  U.  S. 

A.,  and  is  represented  in 
• the  foregoing  wood-cuts. 

Fig.  32. — .Segment  of  os  fronfis,  showing  necrosis  fol-  EiGS.  3'2  and  3.3.  The  FIG.  33. — Internal  view  of  the  same  specimen,  showing  the 
lowing  a gun-shot  contusion.  .Sjocc.  29G4,  Sect.  I,  A.  M.  M.  yp  fpg  were  <i's®a6ed  dura  mater  and  the  ulceration  of  the  inner  table. 

furnished  by  Acting  Assistant  Surgeon  F.  J.  Kern.  [Indeed  the  report  is  recorded  almost  in  his  precise  language.] 


Caries. — Gunshot  contusions  of  the  cranial  hones  were  succeeded,  in  three  instances, 
by  caries.  This  complication,  common  enough  in  tertiary  syphilis,  mercurio-syphilis,  and 
scrofula,  rarely  occurs  as  a result  of  injury,  unless  there  is  some  constitutional  taint.  There 
is  no  evidence,  however,  that  any  such  vice  of  system  existed  in  the  cases  of  which  abstracts 
are  subjoined.  The  energetic  treatment  advised  by  authors,*  such  as  applications  of  the 
rugine  or  trepan,  the  actual  cautery,  or  chloride  of  zinc,  red  oxide  of  mercury,  and  other 
potent  escharotics,  were  not  employed  in  any  of  these  cases. 

Price,  William,  Priv.ate,  Co.  H,  8th  Tennessee  Inflmtry,  aged  39  years,  received,  in  the  engagement  near  Atlanta, 
Georgia,  August  8th,  18o4,  a slight  injury  of  the  left  pai’ietal  bone,  and  also  a flesh  wound  of  the  leg.  He  was  taken  to  the 
field  hospital  of  the  23d  Corps,  and,  on  August  15th,  was  admitted  to  the  Asylum  Hospital,  Knoxville,  Tennessee.  No  aecount 
of  the  treatment  is  recorded.  He  was  discharged  from  the  service  on  June  20th,  1865,  and  pensioned  from  that  date.  On 
March  1st,  1839,  Pension  Examining  Surgeon  E.  P.  Mitchell  reports  that  this  man  was  living  at  Eogersville,  Hawkins  County, 
Tennessee;  that  he  had  caries  of  the  skull,  bits  of  bone  passing  out  in  the  purulent  discharge.  The  wound  was  still  open  and 
suppurating  five  years  subsequent  to  the  injury,  and  the  man  was  utterly  unable  to  perform  manual  labor,  or  to  bear  exposure  to 
the  sun’s  r.ays. 

Itohhison,  J.  A.,  Private,  Co.  B,  7th  South  Carolina  B.attalion,  received,  on  June  18th,  1864,  a gunshot  contusion  of  the  right 
parietal  and  right  side  of  the  frontal  bone.  He  was  admitted,  on  June  20th,  to  the  hospital  at  Farmville,  Virginia.  The  wound 
resulted  in  extensive  ulceration  of  bone.  The  patient  was  furloughed  July  19th,  1864,  by  Surgeon  11.  D.  Taliaferro,  C.  S.  A. 

Vaughan,  George  TV.,  Assistant  Surgeon,  Tennant’s  Battery,  received,  at  the  siege  of  Atlanta,  Georgia,  August  19th,  1864 
a wound  of  the  head  from  a fragment  of  shell.  The  scalp  was  lacerated  and  the  cranium  contused,  and  caries  of  the  occipital 
resulted.  This  patient  was  recommended  for  furlough,  October  11th,  1864,  by  a medical  examining  board. 

Persistent  Pain  in  the  Head. — Ten  instances  are  found  in  the  reports  of  cases  of  gun- 
sliot  contusions  of  the  skull,  in  which  persistence  of  pain,  either  in  the  cicatrices  or  in  distinct 
spots  of  the  cranium,  constituted  the  prominent  symptom.  Some  of  them  belong  to  the 
class  of  cases  described  by  Quesnay.f  All  of  these  patients  were  spared  incisions  of  the 
scalp,  or  the  application  of  the  rugine  or  trephine ; and  five  recovered  and  went  to  duty, 
while  five  were  discharged  for  disability,  two  of  whom  were  subsequently  pensioned. 

* Boyer,  Dictionaire  des  Sciences  Medicahs^  T.  vii,  p.  283,  Paris,  1813;  PiRRiE,  The  Principles  and  Practice  of  Surgery,  London,  18fi0,  p.  381; 
SfeDiTAOT,  Train  de  Midecine  Operatoire,  Paris,  1805.  T.  ii,  p.  3;  Faxo,  Traite  H^ienzntaire  dt  Chiriirgie,  Paris,  1869,  T.  i,  p.  C84.  The  latter  author 
even  advises  the  ablation  of  the  entire  bone,  citing  Lapeyronie’s  case  of  removal  of  the  whole  frontal,  and  suggests  the  gouge  and  chisel  and  mallet  as 
suitable  instruments. 

t Quesxay.  Mimoircs  dc  V Academic  Royale  de  Chirurgic.  Nouv.  ed.,  Paris,  1819,  T.  I,  p.  169. 


GUNSHOT  CONTUSIONS  OF  THE  CKANIAL  BONES. 


107 


Bruxxeli-O^  Pietro,  Private,  Co.  F,  55tli  New  York  Yoliintccrs.  Gmisliot  contusion  of  tlie  vertex  of  the  cranium  by  a 
fragment  of  sliell,  with  much  laceration  ot  the  scal]>.  Malvern  Hill,  Viiginia,  July  1st,  18G2.  Treated  at  Carver  Hospital, 
Washington,  and  returned  to  duty  August  13th,  1862.  On  November  12th,  1862,  he  was  admitted  to  Episcopal  Hospital, 
Philadelphia,  under  the  care  of  Doctor  W.  S.  Forbes.  He  was  suffering  from  severe  local  paili  at  the  seat  of  injury.  He  was 
discharged  from  the  service  on  February  25th,  1863.  His  name  does  not  appear  on  the  Pension  Roll. 

Ereneter,  Charles  J.,  Captain,  7th  United  States  Colored  Artillery,  received,  at  the  capture  of  Fort  Pillow, 
Tennessee,  April  12th,  1864,  a gunshot  wound  of  the  anterior  portion  of  the  temporal  ridge  of  the  right  parietal  bone.  At  the 
end  of  four  months  the  wound  had  closed,  but  it  opened  again  spontaneously  several  times.  There  was  always  more  or  less 
pain  extending  backwards  from  the  seat  of  injury,  nearly  parallel  with  the  median  line.  With  every  change  to  bad  weather 
the  pain  would  become  intolerable,  and  exposure  invariably  aggravated  it.  Captain  Epeneter  resigned  on  March  16th,  1865. 

Hants,  Enoch  W.,  Private,  Co.  C,  GthNew  Jersey  Volunteers,  aged  23  years,  was  wounded,  at  the  battle  of  Kinston, 
North  Carolina,  December  14th,  1862,  by  a conoidal  musket  ball,  which  apparently  only  involved  the  scalp.  He  was  admitted 
to  the  Stanlej'  Hospital  at  Newberne  on  the  20th,  whence  he  was  furloughed  and  sent  north  in  February,  1864.  On  the  8th  of 
April,  1864,  he  was  admitted  into  the  Balfour  Hospital,  Portsmouth,  Virginia,  still  sufiering  from  the  wound  in  the  head.  In 
the  latter  })art  of  April  he  was  ti'ansferred  by  steamei-  to  the  De  Camp  Hosjiital,  in  New  York  Harbor,  where  the  case  is 
reported  as  a contusion  of  the  skull.  He  was  returned  to  duty  on  May  27th,  1864,  but  was  again  admitted  to  the  Hampton 
Hospital,  at  Fort  Monroe,  on  June  11th,  1864,  suffering  from  cephalalgia.  On  June  21st,  he  was  transferred  to  the  Mower 
Hospital  at  Philadelphia,  and  finally  sent  to  Trenton,  New  Jersey,  on  September  22d,  1864,  to  be  mustered  out  of  service.  His 
name  does  not  appear  on  the  Pension  List. 

Hayes,  William  A.,  Private,  Co.  A,  28th  ISIassachusetts  Volunteers,  received  a slight  wound  of  the  scalp  by  a fragment 
of  shell,  with  contusion  of  the  skull  over  the  sagittal  suture.  Fredericksburg,  December  13th,  1862.  Treated  at  Point  Lookout 
till  May  1st,  1863,  West's  Building,  Baltimore,  till  May  9th,  Lovell  Hospital,  Rhode  Island,  till  October  7th,  1863,  when  he  was 
transferred  to  the  2d  Battalion  of  the  Veteran  Reserve  Corps.  He  suffered  greatly  from  pain  in  the  cicatrix,  which,  on  May 
13th,  1867,  was  reported  bj^  the  pension  examiner  to  be  very  sensitive  on  pressure.  It  was  paiticularly  painful  in  warm 
weather  and  after  exposure  to  the  sun. 

King,  Samuel,  Private,  Co.  H,  49th  Pennsylvania  Volunteers,  aged  33  years,  received,  at  the  battle  of  Cold  Harbor, 
Virginia,  June  4th,  1864,  a severe  wound  of  the  left  side  of  the  scalp  by  a conoidal  musket  ball.  He  was  admitted  into  the 
Soldiers’  Rest  Hospital  at  Alexandria,  June  6th,  and  a few  days  later  sent  to  Philadel])hia,  and  admitted,  on  June  16th,  into 
the  16th  and  Filbert  streets  Hospital.  On  July  16th,  he  was  sent  to  the  Satterlee  Hospital.  He  suffered  from  constant  pain  in 
his  head.  The  wound  healed  gradually.  On  September  29th,  he  was  transferred  to  Camp  Curtin  at  Harrisburg,  and,  on 
October  6th,  1864,  returned  to  duty.  The  case  is  reported  by  Surgeon  I.  I.  Hayes,  U.  S.  V. 

Lacoste,  S.  D.  M.,  Sergeant,  Co.  K,  23d  South  Carolina  Regiment,  wms  admitted  to  the  South  Carolina  Hos]iital, 
Charlottesville,  Virginia,  September  6th,  1862,  with  a gunshot  injury  a little  to  the  left  of  the  median  line  and  midway  between 
the  eye  and  the  root  of  the  hair.  There  was  an  indentation  of  the  bone,  but  no  perceptible  fracture.  The  periosteum  w'as 
gone  to  the  extent  of  about  one  square  inch.  No  operation  was  performed.  In  July,  1863,  the  man  was  at  his  home,  not  yet 
recovered,  and  suffering  constantly  with  intense  pain  in  the  head,  regretting  that  he  had  not  been  opei-ated  upon.  The  case  is 
reported  by  Assistant  Surgeon  B.  W.  Allen,  P.  A.  C.  S. 

Marshall,  James,  Private,  Co.  H,  28tli  Pennsylvania  Volunteers,  received,  at  the  battle  of  Antietam,  Maryland, 
September  17th,  1862,  a gunshot  injury  of  the  frontal  bone.  He  was,  on  October  30th,  1862,  admitted  to  the  Carver  Hos[)ital, 
Washington,  D.  C.,  and,  on  January  6th,  was  transferred  to  the  Patterson  Park  Hospital,  Baltimore.  He  was  treated  in  the 
hospitals  of  the  latter  city  for  cephalalgia  and  neuralgia,  until  August  29th,  1863,  when  he  was  returned  to  duty. 

Rate,  Edivard,  Private,  Co.  C,  17th  New  York  Volunteers,  aged  21  years,  was  wounded,  at  the  battle  of  Fredericks- 
burg, Virginia,  December  13th,  1862,  by  a fragment  of  shell  about  two  inches  in  length,  which  produced  a wound  of  the  scalp 
on  the  left  side  of  the  head.  He  was  prostrated,  and,  in  this  condition,  immediately  conveyed  to  a field  hospital,  where  his 
wounds  were  dressed.  After  the  troops  reerossed  tlie  river,  he  was  sent  to  Point  Lookout,  Maryland,  where  he  was  admitted 
to  Hammond  Hospital,  on  December  16th.  He  suffered  for  one  month  from  a severe  pain  at  the  point  struck,  and  also,  after 
his  entering  the  hospital,  from  a malarial  fever,  to  which  was  attributed  the  slow  manner  in  which  the  wound  healed.  He  was 
transferred,  on  February  13th,  1863,  to  New  York,  and  there  admitted  on  the  17th,  to  Ladies’  Home  Hospital,  where  he 
remained  until  returned  to  duty  on  March  30th,  1863. 

Eussell,  TT.  P.,  Private,  Co.  L,  6th  Alabama  Regiment.  Gunshot  contusion  of  the  left  parietal,  received  at  the  battle 
of  1'  air  Oaks,  May  31st,  1862.  Nenralgia  supervened,  and  constant  pain  in  the  cicatrix  for  a long  period  after  the  injury.  The 
patient  was  examined  by  Surgeons  Wolford,  Thom,  and  Cabell,  of  the  Confederate  service,  and  for  a long  time  he  was  unfit  for 
duty.  He  finally  recovered,  and  returned  to  duty  March  5th,  1833. 

Young,  Thomas,  Private, _Co.  F,  17th  United  States  Infantry,  received,  at  the  battle  of  Antietam,  September  17th,  1862, 
a gunshot  contusion  of  the  vertex.  Treated  at  Washington  and  Baltimore,  and  discharged  February  14th,  1863.  He  was 
pensioned,  and,  in  September,-  1886,  Pension  Flxamining  Surgeon  F.  I’.  Fitch,  of  Milford,  New  Hampshire,  reported  that  ho 
had  continuous  pain  in  the  cicatrix,  a very  irritable  temper,  and  impaired  memory. 

Vertigo. — Dizziness,  giddiness,  or  vertigo,  are  among  the  commonest  complaints  of  the 
pensioners  who  liave  recovered  from  contusions  of  the  skull.  The  cases  of  Hastings  (p.  100), 
ot  Kinnc  (p.  103),  of  Marsh,  Scanlan,  Shefller  (p.  101),  and  of  Wilson  (p.  105),  have  been 


108 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


already  cited.  In  the  following  cases,  also,  this  result  is  specially  commented  on  by  the 
surgeons  from  whose  reports  the  abstracts  have  been  compiled  : 

Blood,  J.  C.,  Private,  Co.  G,  27tli  Missouri  Volunteers,  received  a contusion  of  the  right  frontal  eminence  by  a conoiJal 
musket  ball,  at  the  siege  of  Vicksburg,  June  17th,  18G3.  He  was  discharged  from  service  July  9th,  1865,  and  pensioned.  On 
January  19th,  1866,  he  was  reported  by  Doctor  J.  T.  White,  at  Edina,  Missouri,  as  suffering  greatly  from  vertigo,  being 
entirely  un6t  to  labor  at  his  trade  of  brick-laying. 

Galmish,  George,  Private,  Co.  H,  150th  Pennsylvania  Volunteers.  Gunshot  contusion  of  the  right  parietal,  at 
Gettysburg,  July  2d,  1883.  Treated  at  Gettysburg  and  Philadelphia,  and  discharged  from  service  September  28th,  1863,  and 
pensioned.  At  this  date.  Pension  Examining  Surgeon  H.  Lenox  Hodge  reports  that  during  his  treatment  this  man  had  suffered 
from  convulsions,  with  much  cerebral  disturbance,  and  was  then  troubled  with  impaired  vision  and  hearing,  and  had  an  unsteady 
gait  and  constant  dizziness  and  vertigo,  and  rated  his  disabilities  at  three-fourths,  and  probably  temporary. 

Kellogg,  L.  M.,  Private,  Co.  B,  14th  New  York  State  Militia,  aged  29  years,  received,  at  the  battle  of  Gettysburg, 
Pennsylvania,  July  1st,  1863,  a gunshot  wound  of  the  left  occipital  region  by  a musket  ball.  He  was  admitted  into  the  field* 
hospital  on  the  same  day,  and  subsequently  transferred  to  New  York,  and  admitted,  on  July  27th,  into  the  Central  Park 
Hospital.  He  suffered  from  headache  and  vertigo.  Simple  dressings  were  used.  He  gradually  recovered,  and  was  returned 
to  duty,  November  29th,  1863. 

Leighton,  Charles  W.,  Corporal,  Co.  E,  11th  New  Hampshire  Volunteers,  aged  23  years,  was  wounded  at  the  battle 
of  Petersburg,  Virginia,  June  16th,  1864,  by  a conoidal  musket  ball,  which  contused  the  occipital  bone.  He  was  admitted  to  the 
hospital  of  the  2d  division.  Ninth  Corps,  and  thence  conveyed  to  Annapolis,  Maryland,  and  admitted,  on  the  20th,  into 
the  First  Division  Hospital.  After  several  transfers,  ho  was  admitted  into  the  Webster  Hospital,  in  New  Hampshire,  on 
December  2d.  On  May  27th,  1865,  he  was  discharged  from  service.  In  March,  1868,  the  Commissioner  of  Pensions  reported 
that  this  man’s  disability  was  rated  at  one-half  and  permanent,  and  that  he  had  been  greatW  troubled  with  vertigo  since  the 
reception  of  the  wound. 

Magness,  W.  a..  Musician,  Co.  B,  5th  Maryland  Volunteers,  aged  29  years,  was  wounded  in  front  of  Petersburg, 
July  6th,  1864,  by  a conoidal  musket  ball,  which  tore  up  the  pericranium  over  the  right  p.arietal  protuberance.  Treated  at 
field  hospital  of  the  Eighteenth  Corps,  Balfour  Hospital,  Lovell  Hospital,  Patterson  Pai'k  Hospital,  and  Hicks  Hospital,  and 
discharged  from  service  June  27th,  1865,  and  pensioned.  On  August  29th,  1869,  Pension  Examining  Surgeon  A.  W.  Dodge 
reported  him  as  totally  disabled,  his  suffering  from  vertigo  and  cephalalgia  being  aggravated  by  chronic  diarrhoea ; but  his 
disabilities  were  not  regarded  as  permanent. 

Shuler,  D.  A.,  Corporal,  Co.  K,  2d  South  Carolina  Infantry,  received  a gunshot  contusion  of  the  cranium.  He  was 
admitted  into  the  Chimborazo  Hospital,  No.  3,  Richmond,  on  February  22d,  1863.  Vertigo  and  general  debility  resulted  from 
the  injury.  On  February  26th,  he  w.as  furloughed. 

WOODBORNE,  George  W.,  Sergeant,  Co.  B,  13th  Ohio  Cavalry,  aged  31  years.  Contusion  of  the  right  parietal,  near 
the  sagittal  suture,  by  a conoidal  musket  ball.  Deep  Bottom,  Virginia,  August  IGth,  1864.  Treated  at  Ninth  Corps  Field, 
Beverley,  and  White  Hall  Hospitals.  Discharged  May  19th,  1865.  In  April,  1868,  he  was  a pensioner,  and  his  disability  was 
regarded  as  permanent.  Pension  Examining  Surgeon  W.  F.  Sharp  reported  that  he  was  much  troubled  with  vertigo,  pain  in 
the  head,  and  partial  loss  of  memory. 

Headache. — Ten  cases  are  reported,  in  which,  after  gunshot  contusions  of  the  skull, 
headache  was  the  most  troublesome  symptom.  To  these  might  he  added  the  cases  of 
McCarty  (p.  100),  and  Crinyan  (p.  103)  : 

England,  Samuel,  Sergeant,  Co.  C,  9th  Pennsylvania  Reserves,  was  wounded  at  the  battle  of  Gettysburg,  Pennsylvania, 
July  2d,  1863,  by  a buckshot,  which  entered  about  the  centre  of  the  occipital  region.  He  was  admitted  to  the  field  hospital 
of  the  3d  division.  Fifth  Corps,  on  the  day  of  the  receipt  of  injury,  and,  on  the  following  day,  was  sent  to  the  field  hospital  at 
Gettysburg,  whence  he  was  transferred,  on  the  7th,  to  Satterlee  Hospital  at  Philadelphia.  Although  the  patient  stated  that  the 
ball  was  still  in  the  wound,  it  healed  kindly.  Dnring  the  progress  of  the  case,  he  complained  of  headache.  He  remained  in 
hospital  until  April  27th,  1864,  when  he  was  returned  to  duty. 

Haynes,  Owen,  Private,  Co.  C,  28th  Massachusetts  Volunteers,  aged  27  years,  was  wounded  at  the  battle  of  Gettysburg, 
Pennsylvania,  July  2d,  1863,  by  a conoidal  musket  ball,  which  divided  the  scalp  in  the  right  occipital  region  for  a distance  of 
two  and  a half  inches,  grazing  the  skull.  He  was  at  once  admitted  to  the  hospital  of  the  1st  division,  Second  Corps,  and,  on 
June  11th,  sent  to  the  Turner’s  Lane  Hospital,  Philadelphia.  His  general  health  was  good,  but  he  suffered  considerable  pain 
in  the  head.  The  wound,  which  gaped  very  much,  healed  gradually,  the  headache  ceased,  and,  on  September  11th,  1863,  the 
patient  was  returned  to  duty.  The  case  is  reported  by  Acting  Assistant  Surgeon  David  Burpee. 

Heljireich,  Peter,  Private,  Co.  A,  44th  Illinois  Volunteers,  aged  29  years,  received,  at  the  battle  of  Peach  Tree 
Creek,  Georgia,  .July  20th,  1864,  a gunshot  contusion  of  the  right  parietal  region.  He  was  admitted  into  the  field  hospital  of 
the  2d  division.  Fourth  Corps,  on  the  same  day,  and,  a few  days  later,  was  sent  to  the  general  field  hospital.  On  July  27th, 
the  patient  was  sent  to  Nashville,  and  admitted  into  the  Cumberland  Hospital.  On  August  6th,  he  was  transferred  to  Louisville, 
and  admitted  into  the  Brown  Hospital,  and,  subsequently,  to  the  Mound  City  Hospital,  in  Illinois.  The  wound  was  discharging, 
and  he  had  occasional  headache.  On  September  24th,  he  was  admitted  into  the  general  hospital  at' Quincy.  He  was 
discharged  from  service,  June  10,  1865.  The  case  is  reported  by  Surgeon  Horace  Wardner,  U.  S.  V.  The  name  of  this  patient 
does  not  appear  on  the  Pension  List. 


GUNSHOT  CONTUSIONS  OF  THE  CEANIAL  BONES. 


109 


Lake,  Joshua,  Sergeant,  Co.  B,  2(1  Delaware  Volunteers,  aged  19  years,  received,  at  tlie  battle  of  Antietam,  Maryland, 
September  17tli,  1862,  a gunshot  contusion  of  the  right  parietal.  He  was  admitted,  on  Se])tember  24th,  to  Walnut  Street  Hosj>i- 
tal,  at  Harrisburg,  and,  from  there,  transferred  on  the  27th,  to  Philadelphia,  where  he  was  first  admitted  to  Race  Street  Hospital, 
and  there  remained  until  January  14th,  1833,  when  he  w'as  transferred  to  Mower  Hospital.  During  the  progress  of  the  case,  the 
patient  complained  of  headache,  the  cause  being  attributed  to  the  wound.  On  February  2d,  a part  of  the  ball,  still  remaining 
lodged,  was  removed,  after  which  he  did  well,  and,  on  the  25th  of  the  same  month,  was  able  to  do  light  duty,  in  the  performance 
of  which  he  was  engaged  at  the  latest  report. 

Laughlin,  Josiah  D.,  Private,  Co.  G,  91st  Ohio  Volunteers,  aged  16  years,  was  wounded  in  an  engagement  at  Win- 
chester, Vir^nia,  J^.ily  20,  1834,  by  a revolver  ball,  which  contused  the  skull  at  the  junction  of  the  sagittal  and  lambdoidal 
sutures.  He  was  admitted  into  the  hospital  at  Cumberland,  Maryland,  July  23d.  There  was  cephalalgia  and  slight  impair- 
ment of  audition.  The  wound  healed  rapidly  under  the  application  of  simple  dressings,  and  the  patient  was  returned  to  duty, 
August  18,  1864. 

McCletng,  George  W.,  Private,  Co.  G,  12th  West  Virginia  Volunteers,  aged  22  years,  was  wounded,  March  0th,  1804, 
by  a pistol  ball,  which  entered  the  scalp  near  the  intersecting  angle  of  the  frontal,  parietal,  and  temporal  bones  on  the  left  side, 
and  made  its  exit  four  inches  above  the  meatus  auditorious  externus,  two  inches  from  point  of  entrance,  and  contused  the  skull. 
Admitted  to  hospital  at  Cumberland  Maryland,  He  had  headache  and  i-inging  in  the  ear,  which  continued  for  some  days.  He 
was  returned  to  duty,  May  26th,  1804. 

Moakly,  E.,  Private,  Co.  A,  14th  New  York  State  Militia,  aged  26  years,  received,  at  the  battle  of  Gettysburg,  Pennsyl- 
vania, July  lst-3d,  1863,  a gunshot  contusion  of  the  skull.  He  was,  on  July  0th,  admitted  to  the  Cuyler  Hospital,  Germantown, 
Pennsylvania.  The  injury  was  painful  and  caused  much  headache,  and  at  times  the  patient  was  delirious.  In  a few  weeks  the 
wound  began  to  heal,  and  in  September  it  had  closed.  The  patient  was  returned  to  duty  on  February  10th,  1804,  but  he  still 
complained  of  much  headache  after  exertion.  The  case  is  reported  by  Acting  Assistant  Surgeon  C.  E.  Prall. 

Nason,  Alexander,  Corporal,  Co.  C,  1st  Alabama  Artillery,  aged  28  years,  was  wounded  at  the  capture  of  Fort  Pillow, 
Tennessee,  April  12th,  1834,  by  a conoidal  musket  ball,  which  struck  the  right  side  of  the  head,  immediately  above  the  ear,  con- 
tusing but  not  fracturing  the  bone.  He  was,  on  April  14th,  admitted  to  the  hospital  at  Mound  City,  Illinois,  and  for  weeks  he 
suffered  from  headache,  restlessness,  and  fever.  On  May  18th,  he  had  entirely  recovered,  and,  June  22d,  1864,  He  was  returned 
to  duty. 

Spurr,  William  E.,  Sergeant,  Co.  A,  56th  Massachusetts  Volunteers,  aged  23  years,  received,  in  an  engagement  before 
Petersburg,  Virginia,  June  17th,  1834,  a gunshot  contusion  of  the  skull.  He  w'as  taken  to  the  hospital  of  the  1st  division.  Ninth 
Corps,  and,  on  June  30th,  sent  to  the  Mount  Pleasant  Hospital,  Washington,  where  he  was  treated  for  concussion  of  the  brain. 
On  July  22d,  he  was  transferred  to  the  Mower  Hospital,  Philadelphia,  Pennsylvania.  He  was  then  suffering  from  headache. 
He  was  discharged  from  the  service  on  January  30th,  1865,  on  account  of  phthisis  pulmonalis.  His  name  does  not  appear  on 
the  Pension  List. 

Weiss,  Francis  S.,  Private,  Co.  F,  54th  Pennsylvania  Volunteers,  aged  27  years,  was  wounded,  in  an  engagement  near 
Piedmont,  Virginia,  June  5th,  1864,  by  an  explosive  musket  ball,  which  tore  a triangular  flap,  horizontally,  about  two  inches  in 
length  and  one  inch  above  the  occipital  protuberance,  and  contused  the  bone.  The  wound  was  first  dressed,  on  June  7th,  by 
Assistant  Surgeon  Reuben  Hunter,  54th  Pennsylvania  Volunteers,  who  extracted  five  or  six  fragments  of  the  ball,  which  were 
imbedded  beneath  the  integument,  and  applied  cold  water  dressings.  He  was  admitted  into  hospital  at  Cumberland,  Maryland, 
on  June  20th,  and  on  June  23d  the  wound  was  nearly  cicatrized;  suppuration  had  ceased,  and  the  general  symptoms  were  good, 
with  the  exception  of  an  occasional  headache.  The  patient's  appetite  and  digestive  powers  were  unimpaired.  On  July  20th,  he 
left  the  hospital  on  furlough,  but,  not  returning,  was  reported  as  a deserter,  August  3d,  1864.  His  name  does  not  appear  on  the 
Pension  Rolls. 

Chronic  Irritahilitij  of  the  Brain. — The  cases  of  Hefler  (p.  100),  and  of  Lusk  (p.  102), 
and  several  of  those  of  which  abstracts  are  given  further  on,  under  the  heading  Mental 
Aberration,  were  examples  of  that  condition  described  as  cerebral  irritation,  characterized 
at  the  outset  by  restlessness  and  a general  tendency  to  persistent  flexion  of  the  voluntary 
muscles,  with  contraction  of  the  pupils,  cool  surface,  feeble  and  slow  pulse,  and  mental 
irritability,  and,  subsequently,  by  mental  decay  or  complete  fatuity,  by  paralysis  or 
epilepsy.  This  condition  has  been  supposed  to  be  associated  with  lacerations  of  the  gray 
matter  of  the  brain.  The  following  case  was  regarded  as  an  example  of  this  pathological 
condition  at  the  time,  though  the  autopsy  proved  that  it  was  accompanied  liy  grave  structural 
lesions  : 

Farniiam,  Noah  L.,  Colonel,  lltli  New  York  Volunteers  (1st  Fire  Zouaves),  was  wounded,  at  the  battle  of  Manassas, 
July  21st,  1861,  by  a musket  ball,  which  made  a superficial  forward  wound  over  the  left  p.arietal.  lie  was  much  stunned,  and 
fell  from  his  horse.  He  was  conveyed  to  the  E Street  Infirmary,  Washington,  and  placed  under  the  care  of  Assistant  Surgeon 
W.  .1.  H.  White,  U.  S.  .V.  The  wound  Inialed  promptly,  and  his  condition  was  hopeful  until  August  10th,  when  gr.ave  cerebral 
symptoms  appeared,  terminating  in  liemipl(!gi;i,  follnwod  by  coma  and  death  on  August  lltli,  1861.  At  the  autojisy,  made  by 


no 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Assistant  Surgeon  J.  W.  S.  Gouley,  U.  S.  A.,  an  abscess,  the  size  of  an  English  walnut,  was  found  at  the  seat  of  injury,  with 
extravasation  of  blood  in  the  neighboring  sulci  of  the  brain.  The  following  description  of  this  case  was  prepared  by  Surgeon 
John  A.  Lidell,  U.  S.  V.  U 

* * * “It  cannot  be  doubted  that,  in  at  least  some  instances,  this  ecchymosis,  this  extravasation  of  blood  beneath  the 

visceral  arachnoid  membrane  into  the  meshes  of  the  i)ia  mater  (connective  tissue),  denotes  a genuii^e  contusion  of  the  brain  or 
spinal  cord,  as  the  case  may  be;  and  that,  in  this  way,  a positive  pathological  lesion,  perceptible  to  the  unaided  vision,  is  super- 
added  to  the  concussion.  These  cases  of  concussion,  complicated  with  contusion  of  the  nerve  tissue,  when  the  cerelirum  happens 
to  be  tbo  part  involved,  exhibit  a marked  tendency  to  the  occurrence  of  meningo-cerebral  inflamination  and  cerebral  abscess.  The 
following  case  strongly  corroborates  this  statement:  * * Colonel  Farnham,  of  the  New  York  City  Fire  Zouaves,  was 

wounded,  at  the  battle  of  Manassas,  July  21st,  1881,  by  a spent  ball,  which  hit  his  head  and  knocked  him  off  his  horse.  He  was 
picked  up  insensible.  The  wound  was  small  in  size,  superficial  in  character,  and  situated  on  the  left  side  of  the  head,  three  inches 
above  thFmeatus  auditorius.  It  healed  without  any  difficulty.  The  principal  symptoms  in  his  case,  until  near  the  close,  were 
referable  to  concussion  and  irritation  of  the  brain.  He  died  on  the  evening  of  August  14th,  twenty-four  days  subse(iuent  to  the 
inlliction  of  the  injury.  It  was  thought  that  he  would  recover,  until  about  four  days  before  death.  He  was  p?irtially  para- 
lyzed on  the  right  side  (hemiplegia)  toward  the  last.  He  was  comatose  in  the  last  moments.  At  the  autopsy,  made  August  15th 
by  Doctor  Gouley,  U.  S.  A.,  we  found  that  the  external  wound  was  superficial;  that  the  skull  was  not  injured;  that  there  was 
copious  subarachnoidian  effusion;  that  there  was  an  unusual  quantity  of  yellow-colored  serum  in  the  ventricles,  and  that  there  was 
an  abscess  of  the  cerebrum,  situated  directly  beneath  the  wound  of  the  scalp.  This  abscess  was  about  the  size  of  an  English  wal- 
nut, superficial  in  situation,  and  surrounded  by  softened  cerebral  tissue.  The  visceral  and  parietal  arachnoid  over  the  abscess 
were  glued  together,  to  some  extent,  by  adhesive  inflammation,  so  that,  in  endeavoring  to  turn  back  the  dura  mater  while  making 
the  autopsy,  though  it  was  carefully  done,  the  abscess  was  torn  open.  There  were  also  traces  of  an  extravasation  of  blood,  three 
or  four  weeks  old,  in  the  sulci  of  the  bruin,  beneath  the  visceral  arachnoid  membrane  over  the  seat  of  the  abscess,  and  likewise  at 
the  anterior  extremity  of  the  left  cerebral  hemisphere.  There  was  a flattened  clot  of  blood,  black  in  color,  and  apparently  three 
or  four  weeks  old,  in  the  fossa,  at  the  base  of  the  middle  lobe  of  the  left  cerebral  hemisphere.  The  dura  mater,  in  relation  with 
it,  was  somewhat  thickened,  roughened,  and  opacified.”  * * * 

Medical  Inspector  F.  H.  Hamilton,  U.  S.  A.,  has  described  this  case  as  follows : f 

“First,  I would  remark,  that  you  may  have  an  injury  of  the  scalp  of  an  exceedingly  trivial  character,  which  may,  in  the 
end.  prove  fatal.  A ball  may  simply  tear  off  the  hair  of  the  scalp,  and  create  a very  slight  abrasion  of  the  skin,  yet,  the  bone 
being  so  near,  and  the  brain  so  close  to  the  bone,  it  is  very  probable  that  serious  mischief  has  been  done.  The  bone  in  that  situ- 
ation may  be  so  injured  as  to  lead  to  necrosis,  or  a sufficient  shock  may  be  given  to  the  brain  and  its  envelopes  to  biing  on  inflam- 
mation. I will  mention  a very  remarkable  illustration  of  this  fact.  Colonel  Farnham,  after  the  death  of  Colonel  Ellsworth,  took 
command  of  the  1st  Zouave  Regiment.  At  the  battle  of  Bull  Run,  July  21st,  1861,  he  received  an  injury  of  the  character  referred 
to,  and  which  I e.xamined  myself.  It  was  a very  slight  and  supei-ficial  wound,  which  seemed  to  have  taken  off  very  little  more 
than  the  hair.  He  was  transferred  from  the  field  to  the  Washington  Infirmary,  where  he  was  reported  as  doing  very  well,  the 
wound  being  considered  as  a very  slight  and  insignificant  one;  but,  notwithstanding  all  this,  he  kept  his  bed.  He  did  actually 
seem  to  be  improving  until  about  the  ninth  day  after  the  reception  of  the  wound,  when  grave  symptoms  suddenly  supervened, 
and,  in  a day  or  two  after,  he  died.  I should  notice  that,  during  all  the  time  he  was  in  the  hospital,  he  was  very  easily  disturbed 
by  visitors,  and  it  was  his  desire  to  be  left  alone,  showing  that  there  was  some  cerebral  disturbance.  I ought  also  to  mention 
that  he  was  ill  before  he  received  the  wound,  and  was  unfit  to  perform  duty  at  the  time  the  battle  took  place;  but,  being  a gallant 
officer,  he  was  determined  to  lead  his  regiment  to  the  charge.  But  his  previous  condition  I do  not  think  had  much,  if  anything, 
to  do  witii  his  death,  which,  in  my  opinion,  and  in  the  opinions  of  many  other  surgeons  who  saw  him,  was  due  dii’ectly  to  the 
apparently  slight  wound  which  he  received  during  the  fight.”  * * “Next,  I called  your  attention  to  those  injuries  of  the  scalp 

proiluced  by  smaller  missiles;  for  example,  where  a rifle  ball  had  slightly  impinged  upon  the  surface  of  the  scalp,  producing  a 
slight  abrasion  of  the  integument,  which  accident  is  usually  accompanied  by  some  degree  of  concussion,  either  to  the  skull,  to  the 
meninges  of  the  brain,  or  to  the  brain  itself  and  which  I have  said  you  are  not  to  regard  as  trivial  accidents.  Although  the 
patient  may  not  seem  to  have  suffered  any  severe  injury,  you  are  to  anticipate  that  sooner  or  later  there  may  be  an  ulceration 
along  the  track  of  the  ball,  or  that  there  may  result  necrosis,  or  meningitis,  or  cerebritis,  and  that  the  patient  may  ultimately  die. 
And  I cited,  as  an  illustration  of  injuries  of  this  class,  the  case  of  Colonel  Farnham,  who  assumed  command  of  the  Ellsworth 
Zouaves  after  the  death  of  Colonel  Ellsworth.  He  received  an  injury  of  such  a character,  which  was  exceedingly  slight  and 
superficial.  I saw  him  myself,  and  examined  him  particularly,  and  all  that  was  visible  was  a very  trivial  scalp  wound.  He 
was  taken  into  a hospital  in  Washington,  and  there  I saw  him  again,  at  the  expiration  of  seven  or  eight  days.  He  was  then 
very  irritable,  and  had  been  quite  ill,  but  still  his  friends  all  thought  that  his  recovery  was  certain.  Throe  or  four  days  after 
this,  if  I remember  correctly,  the  synqjtoms  became  more  grave,  and  he  died,  evidently  from  the  injuries  which  his  brain  had 
received.”  * * * 

Meningitis. — This  formidable  affection  was  one  of  the  most  common  causes  of  deatli 
after  gunshot  contusion  of  the  cranium  : 

Cutting,  A.  H.,  Private,  Co.  K,  13th  Massachusetts  Volunteers,  was  wounded,  at  the  battle  of  Gettysburg,  July  2d, 
1863,  by  a conoidal  musket  ball,  which  caused  a contusion  of  the  frontal  bone,  just  above  and  external  to  the  right  parietal 
eminence.  He  was  admitted  to  Camp  Letterman,  and  thence  was  sent  to  the  McDougall  Hospital,  New  York,  on  July  12th. 
Meningitis  supei-vened,  and  death  ensued  on  July  30th,  1863,  twenty-seven  days  from  the  reception  of  the  injury.  The  specimen 


AtMrican  Journal  of  the  Medical  Sciences,  vol.  xlviii,  p.  323. 


t Americafi  Medical  Times,  vol.  viii,  pp.  711-85. 


GUNSHOT  CONTUSIONS  OF  THE  CRANIAL  RONES. 


Ill 


is  copiwl  in  the  adjacent  wood-cut  (Fig.  34).  The  injiiml  portion  of  the  externa! 
table  is  porous  and  spongy,  and  a small  scale  of  bone  was  evidently  in  process  of 
exfoliation.  The  internal  table  shows  no  trace  of  injury  beyond  the  most  trivial 
discoloration.  The  specimen  and  notes  of  the  case  were  contributed  by  Acting  Assist- 
ant Surgeon  A.  E.  M.  Purdy. 

Johnson,  C.  K.,  Captain,  Co.  F,  IGth  Massachusetts  Volunteers,  received,  at 
Gettysburg,  July  ‘Jd,  1863,  a scalp  wound  from  a mini6'  ball,  which  produced  a con- 
tusion of  the  cranium.  He  was  taken  to  the  field  hospital  of  the  2d  division  of  the 
Third  Corps,  when  meningitis  supervened,  and  he  died  on  Jidy  17th,  1863. 

Larkins,  Daniel,  Private,  Co.  H,  188th  Pennsylvania  Volunteers,  aged  It) 
years,  received,  at  the  battle  of  Cold  Harbor,  Virginia,  June  3d,  1864,  a gunshot  scalp 
wound,  with  contusion  of  the  left  parietal.  He  was  can  ied  to  the  hospital  of  the 
Eighteenth  Corps,  and,  on  June  6th,  was  transferred  to  the  Ilarewood  Hospital  at 
Wasliington,  and  thence,  on  June  11th,  to  the  convalescent  hospital,  Philadelphia,  where  ho  died,  on  June  26th,  1864,  from 
meningitis,  following  the  wound  of  head. 

Morris,  James,  Private,  Co.  I,  IbOth  Pennsylvania  Volunteers,  was  admitted,  on  July  12th,  1863,  to  the  McDougall 
Hospital,  Fort  Schuyler,  New  York,  with  compression  of  the  brain,  following  a gunshot  wound  of  the  scalp,  with  contusion  of 
the  skull.  He  died  on  July  18th,  1863. 

Thurman,  C.,  Private,  Co.  E,  42d  Pennsylvania  Volunteers,  was,  on  Jlay  30th,  1863,  admitted  to  a hospital  in  Richmond, 
Virginia,  with  a gunshot  wound  of  the  scalp,  involving  the  cranium.  He  died  on  January  7th,  1864,  of  pneumonia  and 
meningitis. 

Waterman,  William  A.,  First  Sergeant,  Co.  H,  1st  Michigan  Cavalry,  aged  27  years,  was  wounded,  in  the  action  at  Salem 
Church,  Virginia,  May  28th,  1864,  by  a conoidal  musket  ball,  which  struck  the  frontal  region  and  laid  the  bone  bare  for  one 
inch.  He  was  admitted  into  the  field  hospital  of  the  1st  division,  cavalry  corps,  on  the  same  day.  The  patient  was  transferred 
to  the  Mt.  Pleasant  hospital,  Washington,  on  June  1st.  Simple  dressings  were  used.  Meningitis  supervened,  and  death 
resulted  June  14th,  1864.  Assistant  Surgeon  C.  A.  McCall,  U.  S.  A.,  reported  the  case. 

Wright,  Harrison,  employed  in  the  Quartermaster’s  Department,  aged  45  years,  was  wounded,  July  15th,  1864,  by  a 
fragment  of  shell,  which  injured  the  scalp  and  contused  the  skull.  He  was,  on  August  15th,  admitted  to  the  hospital  for 
colored  troops  at  City  Point,  Vii’ginia,  and,  on  August  17th,  was  transferred  to  the  Satterlee  Hospital,  Philadelph.ia,  where 
meningitis  supervened,  from  which  he  died  on  August  26th,  1864. 


Fig.  34. — Results  of  contusion  of  the  frontal 
bone  bj’  a conoidal  ball,  twenty-seven  days 
after  the  injury.  Spec.  1660,  Sect.  I,  A.  3M.  M. 


Encephalitis. — The  following  cases  were  recorded,  in  which  the  fatal  results  were  due 
to  inflammation  of  the  brain  following  gunshot  contusions  of  the  skull.  Other  examples 
will  be  found  among  the  cases  classified  further  on  : 


Bowdle,  Charles  W.,  Co.  K,  1st  Ohio  Volunteers,  received,  at  the  battle  of  Stones  River,  Tennessee,  December  29th, 
1862,  a gunshot  wound,  with  contusion  of  the  vault  of  the  skull.  He  was  admitted  into  the  No.  1 Hospital,  Nashville,  on 
January  9th.  Death  resulted  April  2d,  1863,  from  inflammation  of  the  brain. 


KENNTtDY,  Thomas,  Private,  Co.  M,  1st  Massachusetts  Heavy  Artillery,  aged  30,  was  wounded,  at  the  battle  of 
Petersburg,  Virginia,  June  16th,  1884,  by  a conoidal  pistol  ball,  which  contused  the  right  parietal  bone,  near  the  right  descending 
branch  of  the  lambdoidal  suture.  He  was  conveyed  to  Washington,  and  admitted,  on  the  21st,  into  the  Lincoln  Hospital. 
Simple  dressings  were  applied,  as  the  injury  was  considered  slight.  He  was_furloughed  on  July  16th,  but  returned  on  the  29th 
of  the  same  month.  He  stated  that  during  his  absence  from  the  hospital  he  had  suffered  from  ague,  and,  for  the  last  ten  days, 
had  experienced  a chill  daily.  A careful  examination  of  the  wound  was  now  made,  and  a roughness  of  the  external  table  of 
the  skull  was  detected.  He  was  much  prostrated,  but  complained  of  no  pain  or  uneasiness  about  the  head.  His  pulse  was 
frequent  and  feeble,  tongue  dry  and  red,  and  the  abdomen  tympanitic  and  painful.  Three  grains  of  calomel,  with  one-fourth  of 
a grain  of  opium,  were  ordered  every  three  hours,  until  the  third  dose  had  been  taken ; meantime,  tonics  and  stimulants  were 
given,  and  afterwards  contuiued  in  liberal  doses.  Sinapisms  were  applied  to  the  epigastric  region  and  extremities.  No 
perceptible  improvement  in  his  condition,  however,  was  obtained.  He  died  on  the  afternoon  of  the  31st,  remaining  fully  sensible 

and  able  to  answer  questions  intelligently  until  within  two  or  three  hours  of 
his  death.  At  the  autopsy,  the  seat  of  injury  was  found  to  bo  near  the  middle 
of  the  posterior  edge  of  the  light  parietal  bone.  The  missile  had  glanced 
downward  and  forward,  and  was  found  lying  against  the  skull,  two  inches 
from  the  point  of  injury.  The  pericranium  was  S(;parated  a distance  of  three 
and  three-quarter  inches  along  the  track  of  the  missile,  and  beneath  it  the 
bone  was  spongy  and  porous.  The  line  of  separation  from  healthy  bone  was 
well-marked.  Upon  the  removal  of  the  skull-cap,  a slight  sponginess  of  the 
internal  table,  beneath  the  pointof  impact,  was  observed.  (See  Fig.  35.)  The 
meninges,  for  some  distance  around  the  seat  of  injury,  were  very  much 
thickened  and  blackened,  and  firmly  adherent  to  the  calvaria.  The  brain 
substance  was  softened,  and  the  vesscds  very  much  congested.  The  heart, 
liver,  and  spleen  were  flabby.  The  case  is  reported  by  Acting  Assistant 
Surgeons  Dean  and  Atwater. 


Fig.  35. — .Showing  the  extent  of  necrosis  in  a calvaria 
six  weeks  after  a gunshot  contusion.  Spec.  2320,  .Sect. 
I,  A.  M.  M. 


112 


W0UN1>S  AND  INJUEIES  OF  TIT]':  IIl'lAD 


Eeiimek,  William,  Private,  Co.  B,  16th  New  York  Heavy  Artillery,  aged  44  years,  was  wounded  at  Fort  Fisher, 
North  Carolina,  January  15th,  1865,  by  a-conoidal  musket  ball,  which  contused  the  frontal  and  temporal  bones.  He  ^vas  taken 
on  board  an  hospital  steamer,  and  conveyed,  on  January  ‘Jdth,  to  the  McDougall  Hospital,  New  York  Harbor,  where  he  died, 
on  February  9th,  1835,  from  inflammation  of  the  brain. 

SiiEERON,  Tiiojias,  Private,  Co.  A,  15th  Virginia  Volunteers,  aged  20  years,  I'eceived,  at  the  battle  of  Hatcher’s  Run, 
Virginia,  March  31st,  1865,  a gunshot  contusion  of  the  cranium.  He  was  admitted  to  the  hospital  of  the  2d  division  of  the  Ninth 
Corps,  and,  on  April  3d,  was  sent  to  the  hospital  at  Fort  Monroe,  Virginia.  Death  occurred  on  April  16th,  1865,  from 
meningitis  and  encephalitis. 

StTNDAY,  Jacob  C.,  Cm-poral,  Co.  C,  34th  Illinois  Volunteers,  was,  on  May  9th,  1864,  admitted  to  hospital  No.  1, 
Chattanooga,  Tennessee,  with  a gunshot  contusion  of  the  skull.  He  died  on  June  18th,  1804,  from  cerebritis. 

WELCn,  CiLAT.LES,  Private,  Co.  D,  8th  Maine  Volunteers,  aged  21  years,  was  wounded,  at  the  battle  of  Cold  Harbor, 
Virginia,  June  5th,  1864,  in  the  forehead,  by  a conoidal  musket  ball,  which  denuded  the  os  frontis,  though  producing  no 
apparent  fracture.  He  was  admitted  to  the  hospital  of  the  Eighteenth  Corps,  and  thence  conveyed  to  Washington,  and 
admitted,  on  the  10th,  into  Harewood  Hospital.  Tlie  case  seemed  to  bo  progressing  favorably.  The  patient  was  sent,  on  .Tune 
10th,  to  New  York  City,  but,  having  stopped  at  Philadelphia  on  his  way,  he  died  suddenly'  at  a refreshment  saloon,  on  June 
21st.  1864. 

Intracranial  Extravasation. — The  cases  of  Colonel  Farnham,  on  p.  109,  Private 
Rea,  on  p.  120,  and  that  of  Private  Foster,  recorded  among  the  instances  of  trephining, 
afford  illustrations  of  haemorrhage  within  the  cranium  following  gunshot  contusions  of  the 
skull. 

Intracranial  Abscess. — The  following  are  instances  of  suppuration  following  gunshot 
contusions  of  the  cranium,  and  other  illustrations  will  he  found  among  the  cases  of 
trephining : 

Crane,  Etiian  A.,  Musician,  Co.  K,  44th  New  York  Volunteers,  was  wounded,  at  the  battle  of  Cold  Harbor,  Virginia, 
June  3d,  1864,  by  a conoidal  musket  b.all,  which  struck  the  frontal  bone  on  the  right  side,  near  the  median  line,  and  glanced, 
apparently  causing  only  a flesh  wound;  the  bone  was  barely  bruised.  He  was  admitted  to  the  hospital  of  the  Fifth  Corps, 
and,  on  June  10th,  was  sent  to  the  Carver  Hospital  at  Washington.  The  case  progressed  favorably  until  June  20th,  when 
grave  cephalic  symptoms  came  on.  The  patient  bec.ame  comatose,  and  died  on  June  22d,  1864,  from  cerebral  complications. 
The  autopsy  revealed  a large  abscess  in  the  right  anterior  lobe  of  the  brain,  with  meningitis  beneath  the  seat  of  injury.  The 
external  table  of  the  bone  was  slightly  discolored  and  cribriform,  while  the  internal  presented  a faint  attempt  at  the  formation  of 
a circumscribed  area  of  the  effects  of  osteitis.  The  diploe  w.as  found  of  a dark  yellowdsh  gray  color,  as  in  cases  of  osteomyelitis 
in  long  bones.  The  pathological  specimen  was  sent  to  the  Army  Jtledical  Museum,  and  is  numbered  1393,  in  Section  I.  The 
specimen  and  history  were  contributed  by'  Assistant  Surgeon  IT.  Allen,  U.  S.  Army. 

Smith,  William,  Private,  Co.  G,  4th  New  York  Heavy  Artillery',  aged  18  years,  was  wounded,  at  the  battle  of  Hatcher’s 
Run,  Virginia,  March  31st,  1885,  by  a conoidal  ball,  which  caused  a contusion  of  the  left  parietal  bone.  He  was,  on  the 
following  day,  admitted  to  the  hospital  of  the  Second  Corps.  On  April  5th,  he  was  transferred  to  the  Emory  Hospital,  Wash- 
ington, D.  C.,  and  on  April  9th,  sent  to  the  Cnyler  Hospital,  Philadelphia,  Pennsylvania.  On  admittance  no  osseous  lesions 
could  be  detected.  The  case  progressed  favorably  until  April  16th,  when  the  patient  had  two  or  three  slight  convulsive  pai'oxysms, 
lying  in  a somewhat  soporose  condition  during  the  intervals.  He  afterw'ards  became  delirious,  and  finally  almost  completely 
comatose.  The  muscles  of  the  left  side  of  the  body  were  observed  to  be  in  a state  of  spasmodic  contraction  and  a large 
collection  of  pus,  formed  beneath  the  left  side  of  tlie  scalp,  anterior  to  the  wound,  and  was  opened  on  April  29th.  The  pathologi- 
cal condition  was  supposed  to  be,  that  an  abscess,  resulting  from  the  original  shock  to  the  brain  substance,  was  exciting  irrita- 
tion, and  would  probably  eventually  burst  into  one  of  the  lateral  ventricles.  Mercurials,  tartarized  antimony,  and  the  fluid 
extract  of  veratrum  viride  were  exhibited  internally,  while  the  head  was  kept  somewhat  elevated.  Death  ensued  on  the  night 
of  April  30th,  1835,  one  month  from  the  reception  of  injury'.  An  autopsy  was  made  about  fourteen  hours  after  death,  with  the 
following  results : there  was  no  fracture  of  the  skull  to  bo  detected  when  the  scalp  was  removed,  and  the  bone  was  not  bared 
beneath  the  abscess,  which  has  been  described  as  having  formed  a few  hours  before  death,  but  was  manifestly  necrosed  just 
below  the  origin.al  wound.  On  removing  the  skull  cap  it  was  found  that  a jdate  of  bone,  about  one  inch  long  and  three-quarters 
of  an  inch  broad,  had  been  separated  by  exfoliation  from  the  inner  table,  and  was  adherent  to  the  dui'a  mater  immediately 
beneath  the  position  of  the  original  scalp  wound.  The  brain  was  removed  with  the  membranes  entire,  but  a moderate  quantity 
of  blood  and  serum  being  found  beneath  the  dura  mater  and  the  skull.  On  reflecting  the  dura  mater  of  the  right  hemisphere, 
the  arachnoid  ovei-  the  middle  lobe  of  the  cerebrum  was  found  to  be  acutely  inflamcM,  presenting  an  abundant  deposit  of  soft 
coagulable  lymph.  The  membranes  of  the  left  side  presented  merely  a slight  pearliness,  and  the  adhesion  of  the  dura  mater 
to  the  sequestrum,  already  referred  to.  The  brain  substance  on  the  right  side  was  healthy ; on  the  left  side,  it  was  softened 
beneath  the  position  of  the  wound,  and,  at  the  depth  of  about  three-quarters  of  an  inch,  was  a small  abscess,  not  larger  than  a 
small  hickory-nut.  All  other  parts  of  the  body  ex’amined  appeared  normal.  The  muscular  contraction  on  the  same  side  of  the 
body  as  the  wound  was  now  accounted  for  by  the  existence  of  intracr.ani.al  disease  upon  the  opjmsite  side.  The  c.ase  is  reported 
by  Henry  S.  Schell,  Assistant  Surgeon  U.  S.  Army-. 


GUNSHOT  CONTUSIONS  OF  THE  CRANIAL  BONES. 


113 


Epilepsy,  mental  imbecility,  derangements  of  the  special  senses,  and  various  paralyses 
were  the  not  infrequent  results  of  gunshot  contusions  of  the  cranium. 

Paralysis. — Twenty-three  cases  are  referred  to  as  attended  by  this  complication  ; 

Adams,  J.  E.,  Corporal,  Co.  F,  15th  Massacliusetts  Volunteers,  received,  at  the  battle  of  Ball’s  Bluff,  Virginia,  October 
2lst,  1831,  a gunshot  wound  of  the  scalp,  with  contusion  of  the  right  parietal  bone.  A report  of  a medical  examining  board, 
dated  February  20th,  1802,  states  that  there  is  atrophy  of  the  left  arm,  with  partial  paralysis  of  the  sensory  nerves  and  diminu- 
tion of  the  temperature.  He  was  discharged  from  the  service,  March  8th,  1862.  His  name  is  not  upon  the  Pension  Rolls. 

Arend,  Johx,  Private,  Co.  F,  46th  New  York  Volunteers,  received,  at  the. battle  of  South  Mountain,  Maryland,  Septem- 
ber 14th,  1832,  a gunshot  wound  of  the  scalp,  with  contusion  of  the  frontal  bone.  He  was  admitted  toNo.  1 Hospital  at  Frederick, 
on  the  17th,  and  from  there,  on  the  20th,  was  transferred  to  Stewart's  Mansion  Hospital  at  Baltimore.  He  was  discharged  from 
the  service,  March  17th,  1833,  on  which  date  Assistant  Surgeon  Ue  Witt  C.  Peters,  U.  S.  A.,  reports  him  as  being  greatly  debili- 
tated, and  suffering  from  spinal  irritation,  with  partial  paralysis  of  the  lower  extremities,  for  which,  treatment  had  aflbrded  very 
little  benefit.  His  name  does  not  appear  on  the  Pension  List. 

Bootii,  John,  Private,  Co.  E,  55th  Pennsylvania  Volunteers,  aged  29  years,  received,  at  the  battle  of  Drury’s  Bluff,  Vir- 
ginia, May  16th,  1834,  a gunshot  wound  of  the  upper  and  posterior  right  parietal  region,  by  a conoidal  musket  ball.  He  was 
taken  prisoner,  but  subsequently  exchanged,  and  admitted,  on  August  14th,  into  the  First  Division  Hospital  at  Annapolis,  Mary- 
land. The  patient  wa.s  afterwards  sent  to  Camp  Parole,  and,  on  November  5th,  transferred  to  the  general  hospital  at  Pittsburgh. 
Paralysis  of  the  left  log  resulted,  and  he  was  discharged  from  service.  May  20th,  1865,  and  pensioned.  The  case  is  reported  by 
Assistant  Surgeon  H.  R.  Silliman,  U.  S.  A.  In  August,  1837,  Pension  Examining  Surgeon  G.  McCook  reported  that  this  pen- 
sioner was  totally  incapable  of  earning  a living  by  manual  labor,  on  account  of  partial  hemiplegia,  and  that  his  disabilities  were 
j)ermanent. 

Brown,  Presley  I.,  Corporal,  Co.  B,  102d  Pennsylvania  Volunteers,  aged  24  years,  received,  at  the  battle  of  the  Wil- 
derness, Virginia,  ISIay  6th,  .1864,  a gunshot  wound  of  scalp,  a conoidal  ball  entering  at  middle  of  left  parietal  bone,  passing  back- 
wards, making  a flesh  wound  two  inches  in  length,  denuding  the  bone.  He  was  admitted  to  Lincoln  Hospital,  Washington,  D. 
C.,  on  May  11th,  and,  on  May  16th,  was  transferred  to  Patterson  Park  Hospital,  Baltimore,  Maryland;  thence,  oti  May  21st,  to 
hospital  at  York,  Pennsylvania.  Acting  Assistant  Surgeon  H.  S.  Smyser,  under  whose  care  the  patient  came  at  the  latter  hospi- 
tal, reports  that  the  patient  stated  that  there  was  loss  of  sensation  in  right  arm  and  hand  from  the  moment  he  was  struck  by  the 
ball.  On  June  10th,  the  arm  was  recovering,  and,  on  June  13th,  the  patient  was  transferred  to  the  hospital  at  Pittsburg,  Penn- 
sylvania, whence  he  was  returned  to  duty  on  May  9th,  1865. 

Busii,  Aaron  C.,  Lieutenant,  4th  Wisconsin  Cavalry,  was,  in  February,  1864,  shot  in  the  head,  the  ball  inflicting  a scalp 
wound  and  contusion  of  the  right  parietal,  and  concussion  of  brain.  He  fell  from  his  horse,  and  was  conveyed  to  the  I’egimental 
hospital  very  much  depressed,  but  otherwise  doing  well.  The  regimental  report  for  March,  1864,  states  that  “Bush  is  in  a fair 
way  of  recovery,  although  a long  time  will  elapse  before  he  will  be  able  to  return  to  duty.”  He  was  discharged  on  August  30th, 
1334,  and  pensioned  for  partial  hemiplegia  of  the  left  side. 

Carson,  J.  M.,  Captain,  Co.  A,  25th  South  Carolina  Regiment,  aged  27  years,  received,  at  the  assault  on  Fort  Fisher, 
North  Carolina,  January  15th,  1865,  by  a conoidal  ball,  a wound  of  the  scalp,  with  contusion  of  the  skull,  causing  a paralysis  of 
the  right  arm.  He  was  admitted,  on  the  22d,  to  Chesapeake  Hospital,  near  Fort  Monroe,  and,  on  January  30th,  was  trans- 
ferred to  military  prison,  after  which  all  trace  of  him  is  lost.  The  case  was  reported  by  Assistant  Surgeon  Ely  McClellan, 
U.  S.  A. 

Coohe,  B.  n.,  Private,  Co.  D,  12th  Alabama  Regiment,  was  examined,  on  July  24th,  1862,  by  Surgeon  John  G.  Moore, 
93d  Alabama  Regiment.  He  was  suffering  from  an  unhealed  gunshot  wound  of  the  scalp,  and  probably  the  skull  had  been 
severely  contused.  He  complained  of  numbness  of  the  left  leg.  He  was  reported  as  unfit  for  duty. 

Curry,  John,  Private,  Co.  A,  142d  Pennsylvania  Volunteers,  was  wounded,  at  the  battle  of  Fredericksburg,  Virginia, 
December  13th,  1832,  by  a buckshot,  which  injured  the  left  parietal  bone.  He  was  treated  in  a field  hospital;  on  December  23d, 
admitted  to  the  Lincoln  Hospital,  Washington,  D.  C.,  and  discharged  from  the  service  on  February  21st,  1863.  His  right  side 
and  limbs  were  paralyzed.  His  name  is  not  on  the  Pension  Rolls. 

Douglas,  Alfred  F.,  Private,  Co.  I,  6th  Vermont  Volunteers,  aged  19  years,  received,  at  the  battle  of  the  Wilderness, 
Virginia,  May  6th,  1864,  a wound  of  the  right  side  of  the  scalp,  by  a conoidal  musket  ball,  with  contusion  of  the  parietal.  He 
was  admitted  into  the  Finley  Hospital  at  Washington,  May  11th.  Partial  paralysis  of  the  lower  extremities  resulted.  On. 
August  11th,  the  patient  was  sent  to  the  Smith  Hospital  at  Brattleboro’,  Vermont,  and,  on  September  11th,  wfis  transferred  to  the 
BaxtPi’  Hospital  at  Burlington.  He  was  returned  to  duty,  November  21st,  1864.  The  case  is  reported  by  Assistant  Surgeon  S. 
W.  Thayer,  U.  S.  V. 

Garland,  James  W.,  Corporal,  Co.  G,  5th  Wisconsin  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of  Cold  Har- 
bor, Virginia,  .June  1st,  1834,  by  a fragment  of  shell,  which  grazed  the  top  of  the  head,  on  the  median  line,  about  five  and  a half 
inches  from  the  margin  of  the  hair  on  the  forehead,  inflicting  a severe  wound  of  the  sealp,  about  two  inches  in  length  by  one  inch 
in  width,  and  contusing  the  cranium.  He  was  unconscious  for  about  ten  minutes,  the  control  of  the  lower  e.xtremities  was  lost, 
and  sensation  was  impaired.  S|)asms  and  temporary  partial  paralysis  of  the  U])per  extremities  supervened.  On  June  6th,  he 
was  admitted  to  First  Division  Hosj)ital  at  Alexandria,  Virginia.  On  .June  28th,  he  was  transferred  to  McClellan  Hospital,  Phila- 
delphia, and  thence,  on  .July  6th,  to  Turner's  Lane  Hospital.  At  the  latter  date,  the  patient  sufl'ered  from  severe  headache,  and 
the  power  of  motion  of  the  left  leg  was  still  impaired,  though  his  general  health  was  good.  On  July  20th,  a small  piece  of  bone 

15 


114 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


exfoliated,  and  was  removed.  Patient  was  gradually  regaining  the  use  of  left  leg.  On  November  15th,  the  wound  was  reported 
as  being  healed.  During  the  treatment,  he  had  three  paroxysms  of  intermittent  fever.  The  patient  was  transferred  to  the  Vet- 
eran Reserve  Corps  on  March  17th,  1835.  The  case  is  repot  ted  by  Surgeon  Robert  A.  Christian,  U.  S.  V.  He  was  discharged 
from  service,  September  26th,  1835.  In  1866,  Pension  Examining  Surgeon  J.  H.  Gallagher  reported  that  he  had  slight  paraly- 
sis of  the  left  leg,  and  lieadache  and  ftiintness  on  exposure  to  the  sun.  Any  excitement  or  study  aggravated  these  symptoms. 
The  examiner  regarded  these  symptoms  as  likely  to  increase  in  severity. 

Renslcy,  H.  S.,  Sergeant,  Co.  C,  loth  North  Carolina  Regiment,  aged  24  years,  was  wounded,  on  May  22d,  1864,  by  a 
conoidal  ball,  winch  inflicted  a severe  wound  of  the  scalp,  and  probably,  a contusion  of  the  skull.  Paralysis  of  the  lower  extremi- 
ties ensued.  He  was  admitted  to  the  field  hospital  of  the  1st  division.  Fifth  Corps,  and,  on  May  29th,  was  transferred  to  Mount 
Pleasant  Hospital,  Washington;  thence,  on  July  14th,  to  Lincoln  Hospital,  whence  he  was  transferred  to  Old  Capitol  Prison  on 
August  30th,  1864,  and  finally  exchanged. 

Ingersoix,  Fr.\nk  D.,  Private,  Co.  E,  26th  New  York  Volunteers,  was,  on  September  24th,  1862,  admitted  to  the  Carver 
Hospital,  Washington,  D.  C.,  with  a shell  wound  of  the  head,  lacerating  the  scalp  and  contusing  the  outer  table  of  the  skull. 
He  was  discharged  on  January  12th,  1863,  on  account  of  debility  and  deranged  innervation.  His  name  does  not  appear  on  the 
Pension  List. 

Keser,  Wallace,  Private,  Co.  F,  126th  New  York  Volunteers,  aged  25  years,  received,  in  the  engagement  at  Harper’s 
Ferry,  Virginia,  September  13th,  1832,  a gunshot  wound  in  the  head,  at  the  junction  of  the  occipital  with  the  parietal  bones. 
He  was,  on  December  29th,  admitted  to  Camp  Parole,  Maryland.  He  was  subject  to  vertigo,  and  suffered  from  partial  paralysis 
of  the  right  lower  limb.  He  was  discharged  from  service  on  Januaiy  7th,  1863.  He  is  not  reported  as  being  an  applicant  for  a 
pension. 

McFoley,  James,  Private,  Co.  A,  11th  Pennsylvania  Reserves,  aged  35  years,  was  wounded  at  the  battle  of  Spottsylva- 
nia,  Virginia,  May  10th,  1834,  by  a conoidal  ball,  which  passed  through  the  scalp,  grazing  the  left  parietal  bone  near  the  sagittal 
suture.  He  was  conveyed  to  the  Mount  Pleasant  Hospital,  Washington,  and,  on  May  19th,  was  sent  to  the  Camden  Street  Hos- 
pital at  Baltimore.  Hemiplegia  of  the  right  side  had  supervened.  He  was  transferred  to  Annapolis,  June  22d,  and,  on  August 
10th,  to  Pittsburgh,  where  he  was  discharged  from  the  service,  December  24th,  1864.  Paralysis  of  the  right  arm  still  existed. 
He  has  not  applied  for  a pension. 

McKendrick,  John  P.,  Co.  I,  12th  New  Hampshire  Volunteers,  received,  at  the  battle  of  Chancellorsville,  Virginia, 
May  3d,  1883,  a gunshot  contusion  of  the  skull,  posterior  aspect.  He  was  admitted  to  the  field  hospital  of  the  3d  division.  Third 
Corps,  on  the  following  day,  and  from  there  sent  to  Alexandria,  where  he  was  admitted,  on  June  14th,  to  Mansion  House  Hos- 
pital, whence  he  was  tiansferred,  on  the  16th,  to  hospital  at  Concord,  New  Hampshire.  Paralysis  of  both  lower  extremities 
ensued,  and  the  patient  suffered  from  constant  uneasiness  and  pain  in  the  head.  He  was  examined  by  Surgeon  J.  W.  Buckman, 
5th  New  Hampshire,  ani  discharged  from  the  service  on  the  12th  of  August,  1863.  His  name  does  not  appear  on  the  Pen- 
sion List. 

Miles,  Levi,  Private,  Co.  C,  52d  Indiana  Volunteers,  aged  50  years,  was  wounded  at  Fort  De  Russy,  Louisiana,  March 
14th,  1864,  by  a conoidal  ball,  which  entered  through  the  lobule  of  the  left  ear,  and  emerged  at  the  nape  of  the  neck,  below  the 
occipital  bone,  contusing  in  its  course,  but  not  fracturing,  the  temporal  bone.  He  was  sent,  on  March  16th,  to  the  hospital  steamer 
Woodford,  and,  on  April  30th,  was  transferred  to  the  hospital  steamer  R.  C.  W’ood.  On  May  8th,  he  was  sent  to  New  Orleans, 
and  thence  to  the  Overton  Hospital  at  Memphis,  Tennessee.  He  was  returned  to  duty  on  September  5th,  1864.  On  February 
13th,  1835,  he  was  admitted  to  the  Washington  Hospital  at  Memphis,  suffering  from  frequent  attacks  of  trembling,  and  other 
symptoms  of  paralysis.  The  wound  had  not  yet  healed.  He  was  discharged  from  service  on  April  20th,  1865. 

Pope,  Theodore,  Piivate,  Co.  C,  9th  Ohio  Volunteers,  received,  at  the  battle  of  Chickamauga,  Georgia,  September  19th, 
1833,  a gunshot  contused  wound  of  scalp.  He  was  admitted  into  Hospital  No.  1,  Nashville,  Tennessee,  on  September  25th,  and, 
on  September  27th,  was  sent  to  Louisville,  and  admitted  into  Hospital  No.  4,  where  his  wound  was  found  to  be  complicated  by 
contusion  of  tbe  left  parietal  bone.  On  December  30th,  1863,  he  entered  Washington  Park  Hospital,  Cincinnati,  and,  on  Jan- 
uary 8th,  1834,  was  sent  to  Camp  Dennison,  where  he  was  discharged  from  service  by  reason  of  partial  hemiplegia  of  the  right 
side  of  the  body.  His  name  does  not  appear  on  the  list  of  pensioners.  The  case  is  reported  by  Surgeon  William  Varian, 
U.  S.  V. 

Remick,  Martin,  Private,  Co.  I,  79th  Illinois  Volunteers,  aged  19  years,  was  wounded,  at  the  battle  of  Murfreesboro’, 
Tennessee,  December  31st,  1832,  by  a round  musket  ball,  which  struck  about  the  junction  of  the  occipital  and  parietal  bones,  and 
passed  laterally  through  the  integument,  making  a furrow  nearly  three  inches  in  length,  and  touching  and  bruising,  without  frac- 
turing, the  bone.  He  was,  on  January  25th,  1833,  admitted  to  Hospital  No.  5,  Murfreesboro’;  on  February  16th,  he  was  sent  to 
Hospital  No.  8,  Nashville;  on  March  1st,  to  Hbspital  No.  13,  Louisville,  Kentucky;  and,  on  ISIarch  8th,  to  the  hospital  at  Quincy, 
Illinois.  He  suffered  occasionally  from  tremors,  more  or  less  paroxysmal,  but  in  February,  1864,  the  wound  had  healed.  He 
still  complained  of  pain  in  the  head,  and  was  subject  to  many  nervous  symptoms.  He  was  discharged  from  the  service  ou  May 
18th,  1835.  He  is  not  an  applicant  for  a pension. 

Snyder,  Joseph,  Colonel,  7th  West  Virginia  Volunteers,  received,  at  the  battle  of  Fredericksburg,  Virginia,  December 
I3th,  1862,  a severe  gunshot  contusion  of  the  skull.  The  bone  was  denuded  of  periosteum,  and  slight  paralysis  of  the  left  arm 
supervened.  The  patient  was  treated  in  private  qu.arters,  was  furloughed  on  December  18th,  1862,  and  finally  discharged  from 
the  service  on  September  7th,  1833.  His  name  does  not  appear  on  the  Pension  List. 

Stanley,  J.  D.,  Private,  Caskie’s  Virginia  Battery,  was  admitted  into  Confederate  Hospital  No.  1,  Richmond,  Virginia, 
with  a gunshot  wound  of  the  scalp,  with  contusion  of  the  cranium,  received  on  September  24tli,  1833.  Hemiplegia  resulted  from 
the  injury,  and  the  patient  was  furloughed  for  sixty  d.ays  on  November  24th,  1833. 


GUNSHOT  CONTUSIONS  OF  THE  CHANIAL  BONES. 


115 


Sterling,  William,  Private,  Co.  B,  44fli  Illinois  Volunteers,  aged  32  years,  was  wounded,  at  the  battle  of  Kenesaw 
Mountain,  Georgia,  June  27th,  1864,  by  a fragment  of  shell,  which  struck  the  right  suiiraorbital  ridge,  injuring  the  frontal 
bone  and  destroying  the  right  eye.  He  had  previously  received,  at  the  battle  of  Cliickamauga,  Tennessee,  September  19th,  1863, 
a flesh  wound  of  the  right  arm.  He  was,  on  November  29th,  1864,  admitted  to  the  hospital  steamer  E.  C.  Wood,  and,  on 
December  1st,  transferred  to  the  hospital  at  Mound  City,  Illinois.  Chronic  neuralgia  of  the  right  supraorbital  nerve  followed. 
The  patient  was  discharged  from  the  service  on  February  ICth,  1865.  The  strength  and  usefulness  of  the  right  arm  were 
impaired.  His  name  does  not  appear  on  the  Pension  Eolls. 

Sherid.\N,  Thom.vs,  Pi-ivate,  Co.  B,  3d  United  States  Cavalry,  aged  27  years,  was  wounded,  near  Little  Eock, 
Arkansas,  October  16th,  1884,  in  the  head  by  a conoidal  ball,  which  lodged  beneath  the  scalp,  near  the  right  ear.  He  was 
admitted,  on  October  23d,  to  the  hospital  at  Little  Eock.  Convulsions  supervened,  and  death  occurred  on  December  23d,  1864. 

Thompson,  Kuxd,  Private,  Co.  I,  82d  Illinois  Volunteers,  aged  30  years,  received,  at  the  battle  of  Chancellorsville, 
Virginia,  May  3d,  1863,  a wound  by  a pistol  ball,  which  struck  the  head  and  denuded  the  left  parietal  of  periosteum.  He  was 
admitted  to  the  field  hospital  of  the  3d  division  of  the  Eleventh  Corps  on  May  4th,  1863,  and  transferred  to  Douglas  Hospital 
at  Washington  on  July  21st.  During  the  progi’ess  of  the  case,  paraplegia  ensued.  Tiie  patient  also  suffered  from  a general 
and  constant  pain  in  the  head.  He  Mas  transferred  to  Christian  Street  Hospital  at  Philadelphia  on  September  15th,  1863. 
Acting  Assistant  Surgeon  W.  W.  Keen,  jr.,  reports  that,  on  the  date  of  his  dischai’ge,  although  sufi'ering  from  an  evident 
disease  of  the  brain,  he  had  so  far  improved  as  to  be  able  to  walk.  Discharged  February  17th,  1864.  His  name  does  not 
appear  on  the  Pension  Eolls. 

Wagoner,  Jeremiah,  Private,  Co.  G,  85th  Illinois  Volunteers,  aged  25  years,  was  wounded,  in  an  engagement  at 
Peach  Tree  Creek,  Georgia,  July  19th,  1864,  by  a musket  ball,  which  entered  at  the  upper  part  of  the  frontal  region,  and, 
passing  directly  backward  over  the  vertex,  grazing  the  bone  in  its  passage,  made  its  exit  at  a distance  of  three  inches  from  the 
point  of  entrance.  He  was  received,  on  July  23d,  into  No.  2 Hospital  at  Chattanooga,  Tennessee,  and  from  there  successively 
transferred  to  Nashville,  Jeffersonville,  St.  Louis,  and  Mound  City,  Illinois.  He  was  admitted  to  the  hospital  at  the  latter 
place  on  September  4th,  1864,  at  which  time  the  wound  was  discharging  freely,  but  gradually  healing.  There  was  also 
paralysis  of  the  right  arm,  which  the  patient  stated  had  began  on  receipt  of  injury,  and  gradually  increased  until  the  limb  had 
become  useless.  He  was  transferred  on  September  23d,  and,  on  the  following  day,  admitted  to  hospital  at  Quincy,  Illinois, 
■where  he  remained  until  returned  to  duty,  April  12th,  1865. 

Jjoss  or  Impairment  of  Vision. — Many  forms  of  impairment  of  vision  resulted  from 
gunshot  scalp  wounds,  with  contusion  of  bone  and  lesions  of  the  nerves,  or  secondary 
disorders  of  the  brain.  Conjunctivitis,  ptosis,  amblyopia,  and  amaurosis  were  the  consecutive 
eye  diseases  most  commonly  observed.  The  following  cases  and  those  of  McLarney  (p.  100), 
and  Patterson  (p.  104),  belong  to  this  class  : 

Art,  James,  Private,  Co.  E,  2d  Pennsylvania  Volunteers,  aged  19  years,  was  wounded,  in  an  engagement  before 
Petersburg,  Virginia,  June  18th,  1864,  by  a conoidal  musket  ball,  which  struck  the  frontal  region  one  and  one-half  inches  above 
the  left  eye,  contusing  the  bone.  He  was  admitted  into  the  field  hospital  on  the  19th,  and,  a few  days  later,  sent  to  the  Chesapeake 
Hospital  at  Fort  Monroe.  On  July  4th,  the  patient  was  transferred  to  Philadelphia,  and  admitted  into  the  McClellan  Hospital. 
On  August  8th,  he  was  sent  to  Turner’s  Lane  Hospital.  There  was  ptosis  of  the  eyelids  of  both  eyes,  and  loss  of  vision  for 
some  days.  On  May  10th,  he  was  again  received  jnto  the  McClellan  Hospital,  and  on  July  13th,  1865,  was  mustered  out  of 
service.  The  case  is  reported  by  Surgeon  Lewis  Taylor,  U.  S.  A.  The  name  of  this  patient  does  not  appear  on  the  Pension  List. 

Buzzell,  Hiram  H.,  Private,  Co.  G,  40th  Massachusetts  Volunteers,  aged  38  years,  received,  in  an  engagement  before 
Petersburg,  Virginia,  in  June,  1864,  a contusion  of  the  skull,  by  a fragment  of  shell.  He  was  admitted  into  the  hospital  of  the 
Eighteenth  Army  Corps  on  July  1st.  On  July  2d,  he  was  transferred  to  the  general  hospital  at  Fort  Monroe,  Virginia. 
Conjunctivitis  supervened.  He  was  returned  to  duty,  July  29th,  1864. 

Cole,  Jacob,  Private,  Co.  I,  64th  Illinois  Volunteers,  aged  24  years,  received,  at  the  battle  of  Nashville,  Tennessee, 
December  13th,  1864,  a gunshot  wound  of  the  scalp,  with  contusion  of  the  bone.  He  was  admitted,  on  the  following  day,  to 
hospital  No.  1,  Nashville,  and,  on  May  3d,  1865,  transferred  to  hospital  No.  2,  of  the  same  city.  For  a time  he  suffered  from 
chronic  conjunctivitis,  but  he  recovered  and  was  returned  to  duty  on  July  16th,  1865. 

Emerick,  Jacob,  Private,  Co.  A,  148th  Pennsylvania  Volunteers,  aged  23  years,  received,  at  the  battle  of  Chancellorsville, 
Virginia,  May  3d,  1863,  a contusion  of  the  right  parietal  bone,  by  a fragment  of  sliell.  He  was  admitted  into  the  field  hospital 
of  the  1st  division  of  the  Second  Corps  on  the  following  day,  and,  about  June  13th,  was  sent  to  the  hospital  at  Point  Lookout, 
Maryland.  On  September  29th,  he  ivas  transfen’ed  to  the  Mower  Hospital  at  Philadelphia.  Vision  was  much  impaired.  On 
December  22d,  1863,  he  was  returned  to  duty. 

Gr.viiaji,  Michael,  Corporal,  Co.  H,  103d  Ohio  Volunteers,  aged  23  years,  received,  during  the  siege  of  Knoxville, 
Tennessee,  November  18th,  1863,  a gunshot  contusion  of  the  right  parietal.  lie  was  admitted  on  the  same  day  to  hospital  No. 
3,  Knoxville ; on  March  8th,  1864,  he  was  sent  to  the  hospital  at  Cleveland,  Ohio,  and,  on  April  7th,  1864,  transferred  to  the 
Veteran  Eeserve  Corps.  On  July  0th,  he  was  admitted  to  the  Satterlee  Hospital,  Philadelphia,  suffering  from  granular  con- 
junctivitis. He  "(vas  discharged  from  the  service  on  July  6th,  1835,  on  account  of  impaired  vision,  the  result  of  gunshot  wound 
of  the  head.  His  name  is  not  upon  the  Pension  Eoll. 

Hays,  E.  B.,  Private,  Co.  II,  2l8t  Mississippi  Eegiraent,  was  admitted  into  Jackson  Hospital,  Eichmond,  Virginia,  with 
a gunshot  wound  of  left  temporal  region,  received  March  25th,  18‘!5.  Vision  was  impaired. 


116 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Hagax,  Thomas,  Captain,  Co.  G,  71st  Pennsylvania  Volunteers,  received,  at  tlio  battle  of  Antietam,  September  17tb, 
18G2,  a gunshot  wound  over  left  paiietal  bone,  causing  amaurosis  of  both  eyes.  He  was  unable  to  do  duty  until  November  Kith, 
when  be  joined  his  regiment,  but  was  compelled  to  apply  for  sick  leave  again  on  December  19th,  1802.  He  resigned  on 
February  7tli,  1833.  The  loss  of  vision  was  almost  complete  in  the  left  eye,  and  the  right  eye  Avas  only  impaired.  In  April, 
1835,  Pension  Examiner  T.  F.  Smith,  of  New  York,  reports  that  the  left  iris  w;ib  very  much  dilated;  that  he  cmdd  not  read 
other  than  the  very  largest  type. 

James,  W.  J.,  Sergeant,  Co.  F,  83d  Ohio  Volunteers,  was  wounded  at  the  battle  of  Arkansas  Post,  Arkansas,  January 
lltb,  1833,  by  a conoidal  musket  ball,  which  struck  against  the  left  frontal  eminence,  and  glanced  backwards  as  far  as  the 
central  portion  of  the  left  parietal,  denuding  the  bone  to  the  extent  of  three  inches.  The  vision  became  impaired,  and  was,  for 
a short  time,  nearly  lost.  He  was  taken  to  the  hospital  steamer  D.  A.  January,  on  January  13th,  and  conveyed  to  Memphis, 
Tennessee,  where  he  was  admitted,  on  the  23d  of  the  month,  into  Hospital  No.  3.  In  the  course  of  two  or  three  days,  he  was 
seized  with  convulsions,  which  recurred  at  intervals  of  three  or  four  weeks.  The  vision  of  the  right  eye  was  more  affected  than 
that  of  the  left,  and  seemed  to  vary  with  the  condition  of  the  wound.  He  was  discharged  from  service  on  the  4th  of  April. 
The  wound  had  healed  to  some  ■extent,  and  looked  healthy.  Thus  far,  no  exfoliation  of  bone  had  taken  place.  The  patient 
walked  with  a feeling  of  giddiness  and  insecurity,  the  cerebral  symptoms  not  being  in  any  degree  alleviated,  though  his  general 
health  was  good.  In  July,  1838,  James  was  a pensioner  at  six  dollars  per  month,  his  disability  being  rated  at  three-fourths. 

LanIgan,  James,  Priv.ite,  Co.  E,  25th  Massachusetts  Volunteers,  received,  in  an  engagement  before  Petersburg,  Virginia, 
June  23d,  1834,  a gunshot  contusion  of  the  skull.  He  was  admitted  to  hospital  at  Hampton,  Virginia,  on  June  25th,  and,  on 
.1  uly  4th,  sent  to  Filbert  Street  Hospital,  Philadelphia.  On  July  24th,  he  was  transferred  to  Summit  House  Hospital;  thence, 
on  August  24th,  to  Satterlee  Hospital,  M'here,  on  May  20th,  1835,  he  was  discharged  from  service,  by  reason  of  impaired  vision. 
His  name  does  not  appear  on  the  Pension  List.  The  case  is  reported  by  Surgeon  John  E.  MacDonald,  U.  S.  V. 

Moore,  J.  C.,  Sergeant,  Co.  H,  99th  Pennsylvania  Volunteers,  aged  37  years,  received,  at  the  battle  of  the  Wilderness, 
Virginia,  May  5th,  1834,  a wound  of  the  frontal  region  by  a conoidal  musket  ball,  which  scraped  the  bone.  He  was  admitted 
into  the  field  hospital  of  the  3d  division.  Second  Army  Corps,  and,  a few  days  later,  sent  to  Washington,  and  admitted,  on  May 
11th,  into  the  Finley  Hospital.  Simple  dressings.  The  patient  was  transferred  to  Philadelphia  on  May  IStli,  and  was  admitted 
into  the  South  Street  Hospital.  On  May  IGth,  1835,  he  was  sent  to  the  Summit  House  Hospital,  and,  on  .July  5th,  1865,  he 
was  discharged  from  the  service.  The  case  is  reported  by  Surgeon  St.  I.  W.  Mintzer,  U.  S.  V.  He  was  pensioned  July  6th,  1885, 
and,  in  May,  1837,  Pension  E.xaminer  T.  B.  Reed  reported  that  his  eyesight  was  much  impaired,  and  that  he  suffered  fi'om 
giddiness  and  headache,  and  ho  thought  the  pensioner’s  disabilities  permanent,  though  some  amelioi'ation  might  be  anticipated. 

Neil,  Wm.  IL,  Captain,  Co.  D,  26th  New  Y'ork  Volunteers,  was  wounded  at  Fredericksburg,  Virginia,  December  13th, 
1832,  by  a conical  ball,  which  passed  across  his  forehead  about  an  ineb  above  his  eyebrows,  making  a very  slight  wound,  hardly 
sufficient  to  draw  blood,  but  j)robably  contusing  the  os  frontis.  He  was  instantly  rendered  totally  blind ; at  the  same  time,  the 
motor  nerves  near  the  eye  were  paralyzed,  so  that  the  lids  drooped,  notwithstanding  every  effort  he  made  to  raise  them.  The 
eye-balls  were  entirely  devoid  of  cx]iression.  He  was  admitted  to  regimental  hospital,  and  thence  sent  to  general  hospital. 
Surgeon  W.  B.  Coventry,  who  reports  the  case,  states  that  he  incidentally  beamed  afterwards  that  the  patient  commenced  to 
recover  the  sight  of  one  eye.  This  officer’s  name  does  not  appear  on  the  roUs  of  the  Pension  Bureau. 

Newson,  John  G.,  Sergeant,  Co.' B,  30th  North  Carolina  Regiment,  aged  18  years,  was  wounded  in  an  engagement  at 
Kelly’s  Ford,  Virginia,  November  7th,  1833,  by  a conoidal  musket  ball,  on  the  back  and  upper  part  of  the  scalp,  contusing  the 
skull.  He  became  unconscious,  and  remained  so  until  the  next  day.  On  November  9th,  he  was  admitted  to  the  Douglas 
Hospital,  Washington,  D.  C.  He  was  weak  and  giddy,  his  eyes  were  red  and  injected,  and  very  sensitive  to  light.  He  had 
no  appetite,  felt  stupid,  and  had  constant  inclination  to  vomiting.  These  symptoms  continued  for  some  days,  but,  on  November 
23d,  he  was  free  from  pain  and  able  to  walk  about.  His  appetite  had  improved,  and  the  discharge  from  the  wound  looked 
healthy.  He  was  transferred  to  the  Lincoln  Hospital,  and,  on  December  7th,  1863,  sent  to  the  Old  Capitol  Prison.  The  case  is 
reiiorted  by  Acting  Assistant  Surgeon  Carlos  Carvallo. 

Ploti',  Litwis,  Sergeant,  Co.  A,  71st  Ohio  Volunteers,  .aged  25  years,  was  wounded  in  an  engagement  in  front  of  Nashville, 
Tennessee,  December  15th,  1834,  by  a conoidal  musket  ball,  which  contused  the  frontal  bone,  and  destroyed  the  vision  of  the 
right  eye.  He  was  admitted,  on  the  17th,  into  Hospit.al  No.  1,  Nashville,  .and,  on  the  22d,  transferred  to  Hospital  No.  15,  of  the 
same  city.  On  the  4th  of  January,  1865,  he  was  sent  to  the  Brown  Hospital  at  Louisville,  Kentucky,  and,  in  March,  transferred 
to  Camp  Dennison,  Ohio.  Simple  dressings  constituted  the  main  treatment.  He  recovered,  and  was  discharged  from  service 
on  the  13th  of  June,  1835.  The  Commissioner  of  Pensions  reports,  December  11th,  1839,  th.at  Plott  is  a pensioner  at  four  dollars 
|)er  month.  The  sight  of  the  right  eye  is  destroyed,  and  the  hearing  impaired  as  well. 

Souder,  Axdrew,  Private,  Co.  C,  3d  Michigan  Volunteers,  aged  30  years,  in  the  action  at  GroVeton,  Virginia,  August 
27th,  1832,  received  a gunshot  contusion  of  the  left  temporal  region.  He  was  admitted  into  the  Georgetown  College  Hospital, 
D.  C.,  on  December  13th,  and,  on  .January  2d,  was  transferred  to  Philadelphia,  and  admitted  into  the  Mower  Hospital.  Loss 
of  vision  of  the  left  eye  resulted.  He  was  discharged  from  service,  February  21st,  1833,  and  pensioned.  The  wound  caused 
arthritis  of  the  temporo-maxillary  articulation,  ending  in  partial  .anchylosis,  so  that,  according  to  the  report  of  Pension 
Examining  Surgeon  Wilson  Jewell,  the  patient  was  unable  to  open  his  mouth  more  than  half  an  inch. 

Deafness.— The  cases  of  KiNG'(p.  101),  Laughlin  (p  109),  and  of  Chamberlain  (p. 
119),  and  those  detailed  in  the  fourteen  following  abstracts,  are  examples  of  deafness  follow- 
ing gunshot  contusions  of  the  skull : 

iD  o 

Artus,  Charles,  Private,  Co.  I,  15th  New  York  Artillery,  aged  30  years.  Contusion  of  the  left  tempor.al  by  a piece 
of  shell.  Weldon  Railroad,  August  20th,  1834.  Treated  at  held  hospital  of  Fifth-Corps,  .and  Mount  Pleasant,  Washington. 


GUNSHOT  CONTUSIONS  OF  THE  CKANIAL  BONES.  117 

Discliarged  from  service,  June  20tli,  1865,  on  account  of  deafness  of  the  left  ear  and  facial  neuralgia,  by  Assistant  Surgeon  II. 
Allen,  U.  S.  A.  His  name  docs  not  appear  on  the  Pension  List. 

Bexson,  Stephex  D.,  Sergeant,  Co.  A,  31st  Maine  Volunteers,  aged  20  years,  was  wounded  at  the  battle  of  Spottsyl- 
vania  Court  House,  Virginia,  May  12th,  1864,  by  a conoidal  ball,  which  entered  the  left  side  of  the  head,  one  inch  behind  the 
meatus  auditorious  externus,  on  a line  with  its  opening,  and  emerged  close  to  the  acromion  process  of  the  right  scajiula.  He 
was  entirely  unconscious  for  several  hours,  but  had  some  realization  of  pain  in  the  evening,  when  he  made  an  ineffectual  effort 
to  get  on  his  feet.  He  was  admitted  to  the  hospit.al  of  the  2d  division  of  the  Ninth  Corps,  and,  on  May  24th,  was  sent  to  the 
Harewood  Hospital,  Washington.  For  about  three  w'eeks  there  was  much  mental  aberration,  especially  at  night.  Aetg.  Asst. 
Surgeon  Sumner  A.  Patten,  who  reports  the  case,  examined  the  patient  on  June  20th,  1864.  The  wounds  of  entrance  and  of  exit 
discharged  freely.  There  was  numbness  of  the  left  side  of  the  head,  and  deafness  of  the  left  car.  The  scalj)  in  the  vicinity 
of  the  wound  was  much  swollen.  On  rising  to  his  feet,  he  was  so  dizzy  that  ho  was  compelled  to  lay  hold  of  something  to  avoid 
falling.  Occasionally  small  pieces  of  necrosed  hone  were  discharged  from  the  left  ear.  Sergeant  Benson,  commissioned  as 
lieutenant,  on  August  1st,  returned  to  his  regiment,  but,  on  December  5th,  1864,  resigned.  On  April  2d,  1853,  Doctor  I’atten  wrote 
that  this  officer  had  not  been  able  to  labor  since  the  reception  of  the  injury;  that  there  was  a constant  feeling  (ft'  weakness, 
although  his  appetite  was  generally  good.  Confusion  of  thought  and  impairment  of  memory  were  also  well-marked  effects 
of  the  injury.  His  general  health  was  deteriorated,  and  he  weighed  but  144  pounds,  having  weighed  103  when  he  enlisted.  In 
September,  1868,  Examining  Surgeon  E.  F.  Sanger  reported  that  this  pensioner,  residing  in  Bangor,  Maine,  had  tbtal  deafness 
of  the  left  ear,  and  that  his  general  health  w’as  very  poor,  and  his  disabilities  total.  In  a previous  communication.  Pension 
Examiner  J.  C.  Weston  reported  that  frequent  abscesses  formed  about  the  mastoid  process,  due  probably  to  caries. 

Bevelheimer,  George  W.,  Private,  Co.  A,  19th  Indiana  Volunteers,  was  wounded  at  the  second  battle  of  Bull  Run, 
Virginia,  August  30th,  1832.  The  missile  entered  over  the  inferior  curved  line  of  the  occipital  bone,  two  inches  to  the  left  of  the 
median  line;  it  then  passed  forward,  immediately  below  the  auditory  foramen,  and  produced  a largo  lacerated  exit  wounil  in 
front  of  the  ear.  He  was  admitted  on  September  0th  to  Judiciary  Square  Hospital,  at  Washington,  D.  C.  At  the  end  of  the 
third  week,  although  his  wounds  had  nearly  closed,  there  tvas  an  entire  loss  of  hearing  on  that  side,  the  recovery  of  which  the 
probabilities  were  very  unfavorable.  He  was  discharged  from  the  service,  December  16th,  1802.  His  name  does  not  apjiear  on 
the  Pension  List.  This  case  is  reported  in  the  Boston  Medical  and  Surgical  Journal,  volume  07.  page  493. 

Duxgax,  T.  J.,  Private,  Co.  F,  46th  Pennsjdvania  Volunteers,  received,  in  an  engagement  at  Cedar  Mountain,  Vhyinia, 
August  9th,  1832,  a gunshot  wound  of  the  right  tenlple.  The  bone  near  the  auditory  foramen  was  contused,  and  the  facial  nerve 
was  implicated.  He  was  admitted,  on  August  13th,  to  the  2d  division  hospital,  at  Alexandria,  and,  on  August  31st,  transferred 
to  the  .Judiciary  Square  Hospital,  Washington,  whence  he  was  discharged  from  the  service  on  November  Pith,  1862.  The  sense 
of  hearing  was  impaired,  and  theri  ght  side  of  the  face  paralyzed.  In  March,  1863,  Pension  E.xaminer  G.  McCook,  of  Pittsburgh, 
Pennsylvania,  reported  this  man’s  disabilities  permanent  and  incurable.  In  November,  1807,  Pension  Examiner'  E.  Swift 
reported  that  the  sense  of  hearing  on  tlie  right  side  was  almost  entirely  lost,  and  that  facial  paralysis  existed,  together  with  an 
inability  to  close  the  right  eyelids. 

Goodrich,  James  D.,  Private,  Co.  F,  124th  Ohio  Volunteers,  aged  21  years,  received,  at  the  battle  of  Buzzard  Roost, 
Georgia,  Ulay  9th,  1834,  a contusion  of  the  left  parietal  by  a conoidal  musket  ball.  He  w'as  treated  in  a field  hospital  until 
Ulay  10th,  when  he  was  transferred  to  Nashville,  Tennessee,  and  remained  in  Hospital  No.  19,  until  May  19th,  when  he  was 
sent  to  Clay  Hospital,  Louisville,  Kentucky,  and  thence,  on  June  29th,  to  Camp  Dennison,  Ohio,  from  whence  he  was  discharged 
from  the  service,  August  27th,  1804,  by  reason  of  deafness  and  impaired  mind.  His  name  does  not  appear  on  the  Pension  List. 
Surgeon  W.  Varian,  U.  S.  V.,  reports  the  case. 

Gregory,  Adam,  Corporal,  Co.  H,  18th  Ohio  Volunteers.  Shell  contusion  of  the  skull.  Chickamauga,  September  19th, 
1863.  Treated  at  Cumberland  nospit.al,  Nashville.  Slight  deafness  resulted.  Returned  to  duty  September  28th,  1803.  lie 
does  not  appear  to  be  a pensioner. 

Havexs,  Charles  P.,  Private,  Co.  F,  144th  New  York  Volunteers,  aged  28  years.  Contusion  of  the  left  temporal 
region  by  a conoidal  musket  ball.  Honey  Hill,  South  Carolina,  November  30th,  1834.  Treated  at  regimental,  Hilton  Head, 
IiIcDougall,  and  Elmira  Hospitals,  and  discharged  from  service  May  25th,  1805,  and  pensioned.  In  September,  1808, 
Examining  Surgeon  John  S.  Pfouts  reports  that  this  man  had  complete  deafness  of  the  left  ear. 

IaROESEX,  Cyrus,  Private,  Co.  A,  77th  Illinois  Volunteers,  was  wounded  at  the  battle  of  Arkansas  Post,  January  11th, 
1833,  by  a round  ball,  which  struck  the  left  side  of  the  head,  contusing  the  frontal  bone,  passed  backwards  above  the  base  of 
the  ear,  making  a track  three  inches  in  length  beneath  the  scalp.  He  was  conveyed  to  Memphis,  Tennessee,  by  the  hospital 
steamer  D.  A.  .January,  and  admitted,  on  January  22d,  to  the  Adams  Hospital.  Audition  of  the  left  ear  was  entirely  destroyed  ; 
that  of  the  right  ear  is  perfect.  The  wound  healed  without  any  untoward  symptom.  He  was  returned  to  duty  .July  2d,  1803. 
His  name  does  not  appear  on  the  Pension  Rolls. 

Peppers,  Martix,  Private,  Co.  D,  3d  Iowa  Volunteers,  was,  on  November  4th,  1832,  admitted  to  the  hos])ital  .at  Keokuk, 
Iowa,  suffering  partial  deafness  and  disease  of  the  frontal  sinus,  right  side,  caused  by  an  explosion  of  a shell  in  the  engagement 
at  Big  Hatchie,  Tennessee,  October  5th,  1832.  The  injury  was  followed  by  abscess  of  the  frontal  sinus.  The  patient  was 
disch.arged  from  the  service  on  March  30th,  1803.  His  name  does  not  .appear  on  the  Pension  List. 

Pulliam,  Eli.JAH  C.,  Private,  Co.  H,  32d  Illinois  Volunteers,  received,  at  the  battle  of  .Shiloh,  Tennessee,  A|)ril  (ith, 
1832,  a wouijd  of  the  scal[)  in  the  occipital  region,  with  contusion  of  bone,  by  a buckshot.  His  hospital  history  iirevious  to 
Aug«st  0th,  the  date  on  which  he  was  admitted  to  House  of  liefuge  Hospital  at  >St.  Jjouis,  Missouri,  is  w.ai'.’ing.  Erysii)elas 
supervened.  The  patient  suffered  several  relapses  of  the  disease,  which  finally  terminated  in  abscesses  behind  l)otli  ears, 
causing  temporary  deafness  on  tlie  left  side.  He  was  discharged  from  tlie  service  on  October  15th,  1832.  His  name  is  not 
recorded  on  tlie  Pension  Rolls. 


118 


WOUNDS  AND  IN  JUDIES  OF  THE  HEAD, 


Rawdon,  James,  Corporal,  Co.  K,  34tli  IMassachusetts  Volunteers,  aged  18  year.s,  was  wounded,  at  the  battle  of  New 
Market,  Virginia,  May  15tli,  1834,  by  a fragment  of  shell,  which  lacerated  the  scalp  over  the  posterior  border  of  the  left  parietal 
bone  to  the  extent  of  two  inches,  and  contused  the  bone.  He  was  conveyed  to  the  hospital  at  Cumberland,  Maryland.  The 
wound  healed  favorably,  but  the  patient  suffered  for  two  months  with  pain  and  partial  deafness.  On  October  25th,  the  headache 
ceased  and  the  hearing  was  restored,  and,  on  October  23th,  1834,  the  man  was  returned  to  duty.  His  name  does  not  appear 
upon  the  list  of  pensionei’s. 

liisa^  A.  JL,  Private,  Co.  I,  11th  North  Carolina  Infantry,  received,  July  1st,  18G3,  a gunshot  scalp  wound  of  the 
temporal  region,  with  contusion  of  the  bone.  He  was  admitted  into  the  Moore  Hospital  No.  24,  Richmond,  October  26th. 
Audition  impaired.  On  November  4th,  1833,  he  was  furloughed  for  sixty  days. 

Thurston,  Willi.am  F.,  Surgeon,  1st  Rhode  Island  Artillery,  was  wounded,  at  the  battle  of  Fair  Oaks,  June  28th, 
1832,  by  a ball  from  a sphei-ical  case  shot,  which  struck  his  left  parietal  bone,  contusing  but  not  fracturing  it.  Notwithstanding 
his  injury,  he  continued  to  attend  the  wounded  of  his  regiment  till  a few  days  after  the  battle,  when  he  had  a leave  of  absence 
for  twenty  days.  Deafness  came  on  gradually,  and  Surgeon  Thurston  finally  became  incapable  of  performing  duty  in  the  field. 
On  April  Gth,  1833,  he  was  mustered  out  of  service,  and  pensioned.  In  April,  1839,  Pension  Examining  Surgeon  C.  Hoppiu 
reported  that  he  was  completely  deaf,  and  a great  sufferer  from  vertigo. 

WiNSOU,  W.  H.,  Captain,  Co.  F,  18th  Massachusetts  Volunteers,  received,  at  the  battle  of  Fredericksburg,  Virginia, 
December  13th,  1832,  a gunshot  wound  of  the  head.  He  was  admitted,  on  the  same  day,  to  the  field  hospital  of  the  1st  division 
of  the  Fifth  Corps.  On  December  17th,  1832,  he  reported  to  Surgeon  Thomas  Antisell,  at  Washington,  D.  C.,  who  reported 
the  injury  as  a scalp  wound,  with  contusion  of  the  left  temple,  with  loss  of  hearing  on  that  side.  He  was  furloughed  on 
December  19th  for  twenty  days.  Resigned  March  15th,  1833.  His  name  is  not  found  on  the  Pension  Rolls. 

Aphasia. — This  obscure  and  curious  affection  was  observed  in  three  cases,  as  a sequence 
of  gunshot  contusions  of  the  skull.  One  instance  is  cited  on  p.  105  : 

Chapman,  II.  V.,  Private,  Co.  A,  Gth  Virginia  Cavalry,  aged  29  years,  received  a wound,  by  a pistol  ball,  on  October 
11th,  1833,  above  the  left  superciliary  ridge.  The  wound  was  contused,  and  the  ball  passed  out  from  under  the  ligaments  about 
the  left  jaw,  after  causing  a concussion  of  the  brain,  resulting  in  aphasia.  He  was  admitted  to  the  Chimborazo  Hospital, 
Richmond,  October  23d,  1883,  and  was  furloughed  on  the  17th  of  the  following  month,  his  speech  being  partially  regained, 
though  he  could  not  formulate  sentences  in  his  mind. 

Hclrnes,  J.  C.,  Private,  Co.  F,  48th  North  Carolina  Infantry,  received  a gunshot  wound  of  the  scalp,  contusing  the  skull. 
He  was  admitted  into  the  No.  8 Hospital,  Richmond,  on  September  28th,  1882.  Aphasia  resulted.  On  November  1st  he  was 
furloughed. 

Epilepsy. — Nine  cases  are  reported  to  have  resulted  in  epilepsy,  as  a remote  effect  of 
gunshot  contusions  of  the  cranium  : 

Anderson,  Alexander,  Private,  Co.  I,  24th  Massachusetts  Volunteers,  was  discharged  from  the  service  on  October 
19th,  1882,  .at  Camp  Conv<alescent,  Fort  McHenry,  Maryland.  He  had  been  wounded  in  the  he.ad  in  March,  1882,  near 
Newberne,  North  Carolina,  by  a fragment  of  shell,  which  Lacerated  the  scalp  and  contused  the  left  p.arietal.  Twice  .afterwards, 
he  was  attacked  by  epileptiform  convulsions.  He  was  pensioned  and,  December  27th,  1852,  Pension  Examining  Surgeon 
G.  S.  Jones  reported  that  he  suffered  from  convulsion,  that  his  memory  was  impaired,  .and  that  he  was  unable  to  labor. 

Davis,  William  E.,  Private,  Co.  C,  28th  Kentucky  Volunteers,  aged  21  years,  was  wounded  in  the  engagement  before 
Marietta,  Georgia,  June  27th,  1884.  The  missile  entered  just  .above  the  left,  and  escaped  above  the  right  superciluuy  ridge, 
contusing  the  frontal.  He  w.as  admitted  to  the  field  hospital  of  the  Fourth  Corps,  .and,  on  the  next  d,ay,  sent  to  the  general 
field  hospital  at  Big  Shanty  ; on  .July  18th,  to  hospital  No.  2,  Chattanooga,  Tennessee ; on  July  20th,  to  the  Cumberland  Hospital, 
Nashville ; on  August  3d,  to  the  Foundry  Hospital,  Kentucky ; and,  on  October  12th,  to  the  Brown  Hospit.al,  Louisville,  Kentucky, 
whence  he  was  returned  to  duty  on  March  8th,  1835.  In  the  various  hospitals,  he  is  reported  as  suffering  from  epilepsy.  His 
name  does  not  appear  on  the  Pension  Rolls. 

Harmon,  Gilbert  J.,  Sergeant,  Co.  F,  1st  New  York  Cavalry,  aged  18  years,  was  admitted  into  the  hospital  at 
Parkersburg,  Virginia,  September  28th,  1884,  with  a gunshot  contusion  of  the  skull.  He  was  pale,  emaciated,  and  weak,  and 
subject  to  epileptic  convulsions.  He  had  not  done  duty  for  sixteen  months,  and  being  unfit  for  the  Veteran  Reserve  Corps,  he 
was  discharged  from  the  service  on  November  18th,  1884.  His  name  is  not  on  the  Pension  List. 

Miller,  Noah,  Private,  Co.  H,  91st  Pennsylvania  Volunteers,  aged  33  years,  received,  in  the  battle  of  Fredericksburg, 
Virgini.a,  December  13th,  1882,  a gunshot  wound  of  the  scalp,  with  denudation  of  the  cranium.  He  was  conveyed  to  Wash- 
ington, and  admitted,  on  the  17th,  into  the  Mt.  Pleasant  Hospital.  On  January  Gth,  1883,  the  patient  was  transferred  to  the 
Mower  IIospit.al,  Philadelphia.  On  May  2d,  he  was  seized  with  .an  epileptic  convulsion,  which  continued  two  hours.  He  also 
suffered  from  rheumatism.  Discharged  from  service,  September  21st,  1833.  Surgeon  Joseph  Hupkinson,  U.  S.  V.,  reports  the 
case.  The  n.ame  of  the  patient  is  not  upon  the  records  of  the  Pension  Office. 

PreiS-S,  Charles,  Sergeant,  Co.  A,  40th  New  York  Volunteers,  was  wounded  at  the  battle  of  Getty.sburg,  Pennsylvania, 
July  2d,  1833,  by  a conoidal  ball,  which  caused  a gunshot  scalp  wound  over  the  occipital,  with  contusion  of  the  outer  table. 
He  was  taken  to  the  hospital  of  the  1st  division.  Third  Corps,  and,  on  September  Gth,  1833,  was  admitted  to  the  Ladies’  Home 
Hospital,  New  York.  He  was  discharged  from  the  service  on  December  12th,  1863,  suffering  from  epilepsy.  His  name  is  not 
on  the  recor<ls  of  the  Pension  Olfico. 


GUNSHOT  CONTUSIONS  OF  THE  CRANIAL  BONES. 


119 


Stroud,  n.  M.,  Private,  Co.  F,  4th  South  Carolina  Infantry,  aged  23  years,  received,  on  May  20th,  1864,  a gunshot  wound 
of  the  left  side  of  the  head.  He  was  admitted  into  the  Jackson  Hospital,  Richmond,  Virginia,  on  the  24th.  _ Frequent  attacks  of 
epilepsy  followed,  and  he  was  retired  upon  a surgeon's  certificate  of  disability,  March  25th,  1865. 

Sullivan,  Timothy,  Private,  Co.  D,  2d  ^Massachusetts  Cavalry,  wa»  admitted  to  the  field  hospital  at  Sandy  Hook, 
Maryland,  after  the  battle  of  Cedar  Creek,  Virginia,  October  19th,  1884,  where  he  was  treated  for  epilepsy.  From  here,  he  was 
transferred,  successively,  to  Jarvis  Hospital  at  Baltimore;  Cuyler  Hospital  at  Germantown,  Pennsylvania;  Turners’  Lane  Hos- 
pital at  Philadelphia ; and  finally,  on  May  10th,  1865,  to  McClellan  Hospital.  Here  the  cause  of  the  disease  was  attributed  to  a 
gunshot  wound  of  the  scalp,  with  contusion  of  the  skull,  but  as  his  name  does  not  appear  on  the  list  of  casualties,  and  as  his 
wound  is  not  mentioned  in  the  reports  of  the  hospitals  in  which  he  had  been  previously  treated,  it  is  not  certain  that  his  disease 
can  be  traced  to  this  cause.  He  was  discharged  from  service,  June  25th,  1865,  and  pensioned.  Pension  Examiner  G.  S.  Jones 
reports,  in  July,  1865,  that  this  pensioner  had  depressed  cicatrices  on  the  top  of  the  head,  and  suffered  gveatly  from  epilepsy,  and 
that  his  disabilities  were  probably  permanent. 

Wallace,  William,  Private,  Co.  A,  23d  Ohio  Volunteers,  received,  at  the  battle  of  Antietam,  Maryland,  September 
17th,  1862,  a gunshot  scalp  wound,  implicating  the  pericranium.  He  was  admitted,  on  September  21st,  into  the  Capitol  Hos- 
pital, Washington,  and,  on  the  25th  of  the  same  month,  transferred  to  the  Ward  Hospital,  Newark,  New  Jersey.  He  is  reported 
as  returned  to  duty  on  March  26th,  1863  ; but,  on  July  25th,  he  was  admitted  into  the  general  hosi)ital  at  Gallipolis,  Ohio.  Epi- 
leptiform convulsions  supervened  upon  long-continued  exertion.  He  was  transferred  to  the  Veteran  Reserve  Corps,  October  30th, 
1863.  The  case  is  reported  by  Acting  Assistant  Surgeon  James  R.  Beel.  The  name  of  this  patient  is  not  upon  the  Pension 
Rolls. 

Walters,  George  IF.,  Private,  Co.  C,  51st  Virginia  Infantry,  aged  24  years,  received,  at  the  affair  at  Fayetteville,  Virginia, 
September  10th,  1862,  a wound  at  the  anterior  and  superior  portion  of  the  right  temporal  region  by  a fragment  of  shell.  Epi- 
lepsy resulted,  and  he  was  discharged  from  the  service  upon  a certificate  of  disability,  February  14th,  1865.  The  case  is  reported 
by  Surgeon  James  Thomas  Cropp,  51st  Virginia  Infantry. 

Mental  Aberration. — In  the  following  cases,  gunshot  contusions  of  the  cranial  bones 
produced  such  lesions  of  the  brain  as  led  to  insanity  : 

Chamberlain,  Cornelius  W.,  Corporal,  Co.  B,  10th  New  Hampshire  Volunteers,  aged  28  years,  in  an  action  near 
Fort  Harrison,  Virginia,  September  30th,  1864,  received  contused  wounds  of  the  head,  trunk,  and  upper  extremities,  by  frag- 
ments of  shell.  He  was  admitted  into  the  general  hospital  of  the  Eighteenth  Corps,  at  Point  of  Rocks,  Virginia,  on  October 
9th,  and,  on  October  26th,  sent  to  the  hospital  at  Fort  Monroe.  On  November  4th,  he  was  furloughed,  and,  on  the  18th, 
examined  for  discharge,  at  Concord,  New  Hampshire.  Pai’tial  paralysis  of  the  right  side  resulted.  There  was  a purulent  dis- 
charge from  the  right  ear,  and  audition  was  impaired.  There  was,  likewise,  constant  aberration  of  the  mind.  He  was  dis- 
charged from  service,  January  16th,  1865,  with  a degree  of  disability  rated  total.  He  receives  a pension  of  eight  dollars  per 
month. 

Colvin,  Perry,  Private,  Co.  C,  47th  Pennsylvania  Volunteers,  aged  30  years,  received,  at  the  battle  of  Cedar  Creek, 
Virginia,  October  19th,  1864,  a contusion  of  the  left  parietal  by  a fragment  of  shell,  about  an  inch  from  the  median  line.  He 
was  admitted  into  the  Mower  Hospital,  Philadelphia,  from  the  field,  on  October  23d.  About  two  weeks  after  the  reception  of 
the  injury,  a htemorrhage  of  blood,  which  afterwards  became  purulent,  took  place  from  the  right,  and,  subsequently,  from  the 
left  ear.  Two  months  later,  a piece  of  bone,  about  five-eighths  of  an  inch  in  diameter,  came  away  from  the  external  table. 
Simple  dressings  were  used.  On  January  24th,  the  patient  was  transferred  to  the  Satterlee  Hospital.  The  wound  was  healed, 
but  deafness  remained.  He  was  discharged  on  June  14th,  1665,  by  reason  of  impairment  of  the  ment.al  faculties.  He  was 
pensioned  on  this  account.  He  is  quite  incapacitated  from  transacting  business,  according  to  the  account  of  Pension  Examiner 
Wm.  II.  Cornell. 

Crawford,  Quimby  H.,  Private,  Co.  D,  4th  Michigan  Volunteers,  aged  21  years,  was  wounded,  at  the  battle  of  Gettys- 
burg, Pennsylvania,  July  3d,  1863,  in  the  scalp,  by  a conoidal  musket  ball,  which  entered  the  right  temple  and  ‘emerged  behind 
the  ear.  His  mental  powers  were  deranged  for  two  days  after  the  reception  of  the  injury.  He  was,  on  July  5th,  1863,  admitted 
to  the  Satterlee  Hospital,  Philadelphia,  Pennsylvania,  and  returned  to  duty  on  January  22d,  1864. 

Erwin,  Henry,  Private,  Co.  D,  7th  Connecticut  Volunteers,  was  wounded,  in  the  action  at  Pocotiiligo,  South  Carolina, 
October  22d,  1862,  and  was  admitted,  on  the  following  day,  to  the  hospital  at  Hilton  Head,  with  a gunshot  lacerated  wound  over 
the  left  parietal  bone.  He  was  afterwards  sent  to  Fort  Wood,  New  York  Harbor,  and,  on  February  6th,  1863,  discharged  from 
the  service  on  account  of  gunshot  wound,  involving  a contusion  of  the  skull.  He  was  pensioned  from  this  date.  Long  subse- 
quently, Pension  Examiner  E.  R.  Bardin,  of  Fairfield  county,  Connecticut,  reported  that  the  pensioner’s  mind  was  greatly  de- 
ranged, that  he  was  totally  and  permanently  incapacitated  for  labor,  and  recjuired  constant  supervision. 

Fullard,  Andrf.w,  Private,  Co.  D,  78th  New  York  Volunteers,  aged  31  years,  received,  at  the  battle  of  Gettysburg, 
Pennsylvania,  July  3d,  1883,  a gunshot  contusion  of  the  frontal  bone,  fi-om  a fragment  of  shell.  He  was  admitted  to  a field  hos- 
pital, and,  on  July  11th,  was  sent  to  the  Satterlee  llo.spital,  Philadelpliia.  He  sufiered  from  violent  headache  and  vertigo,  and 
was  much  debilitated  in  body  and  mind.  He  was  discharged  from  the  service  on  November  27th,  1863.  His  name  does  not 
appear  on  the  Pension  Rolls. 

Palmer,  Franklin  L.,  Private,  Co.  C,  146th  New  York  Volunteers,  aged  36  years,  received,  at  the  battle  of  the 
Wilderness,  Virginia,  May  5th,  1834,  a wound  of  the  right  side  of  the  scalp,  involving  the  j)eriostoum,  by  a conoidal  musket 
ball.  He  was  admitted  into  the  field  hospital  of  the  1st  division.  Fifth  Corps,  and,  about  May  24lh,  sent  to  Washington,  and 
admitted  into  the  Carver  Hospital.  Simple  dressings  were  used.  On  the  151st,  the  patient  was  transferred  to  the  Mower 


120 


AVOUNDS  ANJA  INJURIES  OF  THE  HEAD, 


Hospitai,  Pliiladclpliia.  On  August  5tli,  a largo  spicula  of  necrosed  bone  was  removed.  The  wound  gradually  healed,  and  he 
was  discharged  from  service,  October  20th,  18G4,  and  pensioned.  In  June,  1866,  his  pension  was  doubled.  Pension  Examiner 
S.  Rhoades  reported  that  there  was  great  impairment  of  memory,  sight,  and  hearing,  and  that,  though  he  had  no  bad  habits,  this 
pensioner  was  vo7-y  much  debilitated  and  unlit  fo^  any  mental  or  bodily  labor. 

Re.\,  Robert  S.,  Private,  Co.  E,  31st  Ohio  Volunteers,  aged  22  years,  received,  at  the  battle  of  Chickamauga,  September 
10th,  1833,  a gunshot  contusion  of  the  head.  The  wound  of  the  scalp  was  slight.  After  a month’s  treatment  at  Hospital  No.  1, 
Nashville,  this  man  was  r<!turned  to  duty.  Six  months  subsequently,  he  was  sent  to  Camp  Chase,  Ohio,  insane.  He  died  on 
April  30di,  1834.  The  autopsy  revealed  a clot,  the  size  of  a lilbert,  and  two  small  abscesses  on  the  surface  of  the  brain.  The 
skull  was  not  fractured. 

SiiAXD,  Jonx  L.,  Corporal,  Co.  B,  03d  Pennsylvania  Volunteers,  was  admitted  to  the  Ladies’  Home  Hospital,  New  York, 
August  2d,  1832,  with  a gunshot  contusion  of  the  skull.  His  mental  faculties  were  impaired,  and  he  was  discharged  from  the 
service  on  September  17th,  1832,  and  pensioned.  Pension  Examiner  W.  51.  Guilford  reported,  April  23d,  1883,  that  the  wound 
had  healed  with  a depressed  cicatrix,  and  that  there  was  a constant  dull  and  heavy  pain  in  the  head. 

Sweet,  Oscar  F.,  Private,  8th  United  States  Infantry,  was  examined  for  a pension  on  A])ril  loth,  1864,  by  Pension  Ex- 
amining Surgeon  H.  B.  Day.  He  had  received  a gunshot  wound  t>f  the  cranium  near  the  vertex,  tearing  the  scalp  and  con- 
tusing the  cranium.  There  was  much  mental  aberration. 

The  following  cases  of  gunshot  wounds  of  the  head,  with  contusion  of  the  hones  of  the 
cranium,  terminated  fatally  : 

Caraker,  J.  V.,  Corporal,  Co.  D,  Pith  Alabama  Infantry,  received  a wound  of  the  frontal  region,  with  injinw  <if  the  bone. 
He  was  admitted,  on  October  14th,  1864,  into  the  Howard  Grove  Hospital,  Richmond,  Virginia.  There  was  much  cerebral  ilis- 
turbance,  and  death  took  place,  October  23th,  1864.  The  case  is  reported  by  Surgeon  S.  M.  Palmer,  P.  A.  C.  S. 

Carter,  Joseph,  Private,  Co.  A,  39th  Illinois  Volunteers,  received,  in  an  engagement  on  klorris  Island,  August  25th, 
1833,  a gunshot  wound  of  the  scalp.  The  missile,  a conoidal  ball,  grazed  the  right  parietal  bone,  and  removed  the  periosteum. 
He  was,  on  the  following  day,  admitted  on  board  of  the  steamer  Cosmopolitan,  where  he  died  on  August  26th,  1863. 

Eli.iott,  Estes  E.,  Private,  Co.  G,  36th  Massachusetts  Volunteers,  aged  21  years,  received,  at  the  battle  of  Cold  Harboi’, 
Virginia,  June  3d,  1864,  a wound  in  the  left  parietal  region,  denuding  the  bone  of  its  periosteum,  by  a conoidal  musket  ball.  He 
was  admitted  into  the  field  hospital  of  the  3d  division.  Ninth  Corps,  and,  a few  days  later-,  sent  to  Washington,  and  admitted  into 
Ihe  Carver  Hospital.  Simple  dressings  were  used.  He  died  from  concussion  of  the  brain,  Juite23d,  1864. 

Fixk,  Ira,  Private,  Co.  C,  6th  Maine  Volunteers,  received,  in  an  engagement  at  Charlestown,  Virginia,  August  21st,  1864, 
a gunshot  wound  of  the  scalp,  with  contusion  of  the  skull.  He  was  sent  to  the  hospital  at  Sandy  Hook,  klaryland,  but  died  in 
transit,  August  22d,  1864. 

George,  D.,  Private,  Co.  K,  1st  klichigan  Sharpshooters,  aged  26  years,  received,  at  the  battle  of  Spottsylvania  Court- 
house, Virginia,  5Iay  12th,  1864,  a wound  of  the  head,  with  contusion  of  the  bone,  in  the  riglit  parietal  region,  by  a conoidal 
musket  ball.  He  was  admitted  into  the  field  hospital  of  the  3d  division.  Ninth  Corps,  and  transferred  thence  to  Washington,  and 
admitted,  on  May  25th,  into  the  Emory  Hospital.  He  died  comatose  on  the  following  day.  The  case  is  reported  by  Surgeon  N. 
R.  Mosely,  U.  S.  V. 

Gibbs,  Fr^vxk  L.,  Private,  Co.  I,  21st  Connecticut  Volunteers,  aged  26  years,  was  wounded,  in  an  engagement  before 
Petersburg,  Virginia,  August  1st,  1864,  by  a conoidal  musket  ball,  which  severely  injured  the  scalp  and  contused  the  bone.  He 
was  admitted  to  the  hospital  of  the  1st  division.  Eighteenth  Corps,  and,  on  August  4th,  was  sent  to  the  hospital  at  Fort  Monroe. 
The  treatment,  so  far  as  recorded,  was  of  an  expectant  nature.  Death  resulted  from  the  injury  on  August  12th,  1864. 

Hodges,  W.  T.,  Sergeant,  Co.  D,  6Gth  Georgia  Regiment,  was  admitted  into  Pettigrew  Hospital,  Raleigh,  North  Carolina, 
on  March  11th,  1865,  with  a gunshot  wound  of  the  scalp,  with  contusion  of  the  right  parietal  bone.  The  patient  died  on  JIarch 
13th,  1835. 

Loxg,  C.  H.,  Private,  Co.  C,  1st  klaine  Heavy  Artillery,  aged  19  years,  was  wounded,  in  front  of  Petersburg,  Virginia, 
June  18th,  1834,  by  a conoidal  musket  ball,  which  produced  a severe  scalp  wound,  with  contusion  of  bone.  He  was  sent,  June 
22d,  to  the  hospital  of  the  3d  division.  Second  Corps,  at  City  Point,  and  thence  conveyed  to  Washington,  and  admitted,  on  June 
24th,  to  Mount  Pleasant  Hospital.  On  June  27th,  he  was  sent  to  the  Cony  Hospital  at  Augusta,  Maine,  where  he  died  on  July 
16th,  1864. 

Martix,  Sajiuel,  Private,  Co.  I,  15th  Veteran  Reserve  Corps,  was  brought  to  the  hospital  at  Camp  Douglas,  Illinois, 
on  December  27th,  1864,  from  his  regiment,  with  a gunshot  scalp  wound  over  the  occiput.  He  died  on  December  30th,  1864. 
There  was  contusion  of  the  bone  externally.  The  encephalon  was  not  examined. 

Palmer,  J.  H.,  Corporal,  Co.  K,  10th  Connecticut  Volunteers,  aged  26  years,  was  wounded,  in  an  assault  on  the  lines 
before  Petersburg,  Virginia,  April  2d,  1865,  by  a conoidal  musket  ball,  in  the  temporal  region,  the  bone  being  contused,  but  not 
fractured.  He  was  admitted  to  the  hospital  of  the  1st  division,  Twenty-fourth  Corps,  and,  on  April  5th,  was  sent  to  the  hospital 
at  Fort  Monroe.  He  died  on  April  11th,  1835,  from  compression  of  the  brain. 

PiiiLLirs,  Albert  S.,  Lieutenant,  Co.  I,  1st  Delaware  Volunteers,  received,  at  the  battle  of  Fredericksburg,  Virginia, 
December  13th,  1862,  a contused  wound  of  the  head  by  a fragment  of  shell.  He  was  admitted  into  the  field  hospital  of  the  3d 
division.  Second  Aiiny  Corps,  on  the  same  day.  Simple  dressings  were  used.  He  subsequently  went  on  leave  of  absence  to 
b)s  homo,  where  he  died,  on  January  14th,  1863.  The  case  i.s  rejiorted  by  Surgeon  D.  W.  Maull,  1st  Delaware  V(diiiiteei-s. 


GUNSHOT  CONTUSIONS  OF  THE  CRANIAL  BONES. 


121 


Rose,  Augustus,  Corporal,  Co.  B,  143(1  Now  York  Volunteers,  received,  in  tlie  actioji  at  Atlanta,  Georgia,  .Inly  20th, 
1864,  a severe  wound  of  the  scalp,  with  contusion  of  the  cranium,  and  concussion  of  the  brain.  He  was  admitted,  on  the  same 
day,  to  the  hospital  of  the  1st  division.  Twentieth  Corps,  and  on  the  26th,  sent  to  Hospital  No.  3,  at  Lookout  Mountain,  Ten- 
nessee. Death  resulted  on  the  1st  of  August,  1864. 

Ruff,  Lf.WIS  F.,  Private,  Co.  C,  13th  Ohio  Volunteers,  received,  during  the  campaign  around  Athant.a,  Georgia,  a gun- 
shot wound  of  the  scalp,  with  contusion  of  the  skull.  He  was,  on  September  2d,  admitted  to  the  hospital  of  the  3d  division. 
Fourth  Corps,  and  thence  sent  to  the  field  hospital  at  Chattanooga,  which  lie  entered  on  September  8th.  On  September  17th, 
he  was  transferred  to  Hospital  No.  14,  Nashville,  where  he  died,  on  October  1st,  1864,  from  concussion  of  the  brain. 

Smithson,  J.  D.,  Private,  Co.  B,  130th  Indiana  Volunteers,  aged  28  years,  was,  on  May  17th,  1864,  admitted  to  Hospital 
No.  1,  Chattanooga,  Tennessee,  with  a gunshot  scalp  wound.  He  died  on  May  18th,  1864,  and,  at  the  autopsy,  the  brain  was 
found  contused  near  the  seat  of  injury. 

Weber,  Andrew  .1.,  Colonel,  11th  Jlissouri  Volunteers,  wounded,  opposite  Vicksburg,  Mississippi,  by  a fragment  of 
shell,  which  took  effect  on  the  crown  of  the  head,  laying  bare  the  periosteum  for  an  inch  square.  No  fracture  of  the  bone  was 
perceptible.  He  never  returned  to  consciousness,  and  died,  on  June  30th,  1863,  twenty  hours  after  the  receipt  of  the  injury, 
with  symptoms  of  compression  rather  than  of  concussion.  The  case  was  reported  by  Assistant  Surgeon  T.  S.  Hawley,  11th 
Missouri  Volunteers. 

Weld,  S.,  Corporal,  Co.  K,  19th  Maine  Volunteers,  aged  31  years,  was  wounded,  at  the  battle  of  the  Po  River,  Virginia, 
May  13th,  1364,  by  a conoidal  musket  ball,  which  struck  at  the  vertex  of  the  head,  producing  an  open  wound  three  inches  in 
length  and  one  in  breadth,  and  denuding  a portion  of  bone  of  its  periosteum.  Ho  was  admitted  into  the  Mount  Pleasant 
Hospital,  Washington,  from  the  field.  May  16th,  and  thence  transferred,  on  the  19th,  to  the  hospital  at  Annapolis.  Death 
resulted  on  June  5th,  1864.  The  case  is  reported  by  Surgeon  B.  A.  Vanderkieft,  U.  S.  V. 

Yaw,  Andrew  J.,  Private,  Co.  B,  157th  New  York  Volunteers,  received,  at  the  battle  of  Gettysburg,  Pennsylvania, 
July  1st,  1863,  a gunshot  contusion  of  the  head,  without  fracture.  He  was  admitted  to  the  Seminary  Hospital,  Gettysburg, 
and,  on  July  25th,  sent  to  the  McDougall  Hospital,  New  York  Harbor.  Death  occurred  from  apoplexy  on  August  22d,  1863. 

The  eight  following  cases  of  gunshot  contusions  of  the  skull  should  probably  be  referred 
to  the  category  of  cases  resulting  in  chronic  irritability  of  the  brain ; but  the  details  given 
in  the  reports  are  insufficient  to  determine  their  nature  precisely  : 

Baker,  Charles  C.,  Major,  39th  New  York  Volunteers,  was  wounded,  at  the  battle  of  North  Anna  river,  Virginia,  May 
18th,  1834,  by  a fragment  of  shell,  which  caused  a contusion  of  the  right  side  of  the  head.  He  had  bleeding  from  the  nose  and 
ears,  and  subsequently  great  vascular  excitement,  headache,  and  other  cerebral  derangements.  He  was  treated  at  the  hospital  of 
the  1st  division  of  the  Second  Corps,  and  thence,  on  May  21st,  was  sent  to  Washington,  where  he  was  examined  by  Acting  Assistant 
Surgeon  J.  C.  Nelson,  who  thought  that  the  disabilities  were  likely  to  continue.  On  May  30th,  this  officer  was  mustered  out  of 
service.  His  name  does  not  appear  on  the  Pension  List.  t 

Beam,  Ansell  H.,  Corporal,  Co.  I,  26th  Michigan  Volunteers,  aged  21  years,  was  wounded  in  the  engagement  at 
Farmville,  Virginia,  April  6th,  1835,  by  a conoidal  ball,  which  made  a ragged  scalp  wound  to  the  right  of  the  sagittal  .suture, 
with  contusion  of  the  pariet.al  bone.  He  was  admitted  to  the  hospital  of  the  1st  division.  Second  Corps,  and  on  April  15th 
was  sent  to  the  Harewood  Hospital,  Washington,  where  a photograph  was  made  of  his  injury.  On  May  18th  he  was  transferred 
to  the  Satterlee  Hospital,  Philadelphia.  He  had  many  symptoms  of  disturbance  of  the  brain.  The  scalp  wound  healed  up 
favorably,  and  on  July  fith,  1865,  he  was  discharged  from  the  service  for  disability.  A photograph  of  the  case,  taken  a few 
days  after  the  reception  of  the  injury,  is  preserved  in  the  seventh  volume  of  Surgical  Photographs  of  the  Army  Medical  Sluseum, 
at  page  five.  It  is  copied  in  figure  1 of  Plate  III,  (opposite  p.  105.)  It  is  probable  that  he  completely  recovered,  since  his  name 
is  not  found  on  the  list  of  applicants  for  pension. 

Burke,  Eli,  Sergeant,  Co.  A,  lS3d  Pennsylvania  Volunteers,  aged  26  years,  received  a contusion  of  the  skull  from  a 
fr.agraent  of  shell  which  inflicted  a large  scalp  wound  and  caused  a grave  contusion  of  the  skull.  He  was  removed  from  a field 
hospital  to  the  Second  Division  Hospital  at  Alexandria  on  .lune  7th,  and  thence  to  the  South  Street  Hospital,  Philadelphia,  on 
June  13th,  1864.  He  suffered  from  cerebr.al  trouble,  and  was  discharged  from  service  on  May  30th,  1865.  There  is  no  record 
of  his  case  at  the  Pension  Office. 

Couch,  James  A.,  Sergeant,  Co.  D,  131st  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Fredericksburg, 
Virginia,  December  13th,  1832,  by  a conoidal  musket  ball  which  struck  the  upper  part  of  the  left  occipital  bone.  He  w.as  stunned 
for  a few  moments,  and  was  hardly  able  to  stagger  from  the  field.  He  was  admitted  to  the  Armory  Square  Hospital  on  December 
20th,  complaining  of  pain  in  the  head;  he  was  easily  confused;  otherwise  his  condition  was  normal.  He  was  returned  to  duty 
on  May  12th,  1863.  His  name  does  not  appear  upon  the  Pension  List. 

Derr,  Jacob,  Private,  Co.  A,  82d  Pennsylvania  Volunteers,  aged  20  years,  received,  at  the  battle  of  Cold  Harbor,  Virginia, 
June  3d,  1864,  a gunshot  wound  of  the  left  side  of  the  scalp.  He  was  conveyed  to  the  Second  Division  Hospital,  Alexandria, 
Virginia;  on  June  12th,  sent  to  the  hospital  at  Chester,  Pennsylvania,  and  on  July  11th,  1864,  returned  to  duty.  On  July  18th, 
1864,  he  was  admitted  to  the  Lincoln  Hospital,  Washington,  D.  C.,  with  secondary  symptoms  of  concussion  of  brain.  He 
recov(!red,  and  was  returned  to  duty  on  February  7th,  1865.  He  is  not  recorded  as  an  applicant  for  pension. 

Engelhart,  Louis,  Private,  Co.  E,  .59th  New  York  Volunteers,  received  a gunshot  wound  of  the  scalj),  grazing  and 
bruising  the  cranium.  He  was  admitt((d  to  Douglas  Hospital,  Washington,  on  December  12tli,  1863,  suffering  from  concussion 
of  the  brain.  He  recovered,  and  was  sent  to  the  Provost  Marshal  on  Februarv  6th,  1864. 

IG 


122 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Kyle,  John  W.,  Private,  Co.  F,  12th  Pennsylvania  Eeserve  Corps,  received  a gunshot  wound  of  the  scalp^bove  the 
riglit  eye,  with  contusion  of  the  frontal  bone  and  concussion  of  the  brain.  He  was  admitted  into  Carver  Hospital,  Washington, 
September  1st,  18C2,  and  was  discharged  from  tlie  service,  November  5th,  1862.  His  name  is  not  upon  the  Pension  Eolls. 

Wiley,  Jacob  S.,  Co.  K,  18th  South  Carolina  Eegiment,  received,  in  an  engagement  before  Petersburg,  Virginia,  May  20th, 
1864,  a gunshot  wound  of  the  right  parietal  bone.  He  was  admitted,  on  May  23d,  to  the  Confederate  hospital  at  Petersburg, 
Virginia,  and  furloughed  on  June  13th,  1864,  suffering  from  congestion  of  the  brain. 


Pycemia. — Theoretical  considerations  would  lead  to  the  belief  that  purulent  infection, 
with  metastatic  foci  or  visceral  abscesses,  would  be  common  in  gunshot  contusions  of  the 
skull,  in  consequence  of  the  entrance  of  pus  into  the  veins  of  the  diploe  in  the  vicinity  of 
exfoliations.  But  the  returns  do  not  sustain  this  supposition,  and  present,  indeed,  but  a 
single  case  in  which  the  existence  of  pyaemia  is  distinctly  alleged  : 


Buower,  G.,  Sergeant,  Co.  F,  16th  Ohio  Volunteers,  received,  at  the  siege  of  Vicksburg,  Mississippi,  December  28th, 
1862,  a gunshot  wound  of  the  scalp,  in  the  right  occipital  region,  with  contusion  of  the  bone.  He  was  conveyed  to  Paducah, 
Kentucky,  on  the  hospital  steamer  City  of  Memphis,  and  admitted,  on  January  13th,  into  the  St.  Mark’s  Hospital.  There  was 
paralysis  of  the  left  leg.  Pyaemia  supervened,  and  death  took  place,  February  21st,  1863.  The  case  is  reported  by  Surgeon  H. 
P.  Stearns,  U.  S.  V. 


Tetanus. — But  one  instance  of  the  occurrence  of  this  complication  is  reported  among 
the  gunshot  contusions  of  the  cranium  : 

Krall,  Christian,  Private,  Co.  K,  130th  Pennsylvania  Volunteers,  was  wounded,  at  the  battle  of  Fredericksburg, 
Virginia,  December  13th,  1862,  by  a musket  ball  which  caused  a contusion  of  the  outer  table  of  the  right  parietal  bone  above 
and  behind  the  protuberance.  The  concussion  was  slight,  not  even  knocking  him  down,  or  causing  any  disturbance  of  his 
mental  faculties.  Excessive  haemorrhage  followed  the  injury,  which  was  not  arrested  for  five  hours.  He  was,  on  December 
17th,  admitted  to  the  Patent  Office  Hospital,  Washington,  D.  C.,  and  on  December  19th,  sent  to  the  Jarvis  Hospital  at  Baltimore, 
Jlaiyland.  On  admission,  the  wound  looked  healthy,  and  discharged  normal  pus.  No  fracture  could  be  detected,  but  the 
bone  was  denuded  of  periosteum.  On  December  24th,  symptoms  of  tetanus,  confined  chiefly  to  the  muscles  of  the  neck,  super- 
vened, followed  by  nausea  and  vomiting.  January  1st,  1863,  tetanus  was  general  and  well-mai’ked.  The  wound  was 
e.xtremely  sensitive,  and  the  scalp  around  it  puffed,  indicating  a burrowing  of  pus.  The  pains  in  the  head  become  intolerable, 
and,  (luring  the  intervals  of  the  spasmodic  throes  he  would  scream  and  groan.  A free  incision  of  the  scalp  was  made,  and  the 

fresh  wound  allowed  to  bleed  unchecked  for  some  time.  Instantaneous  relief  followed, 
the  pain  in  the  head  abated,  and  the  spasms  did  not  recur  the  following  morning.  Still 
no  fracture  could  be  detected,  but  the  parietal  bone  was  somewhat  roughened,  and 
was  evidently  exfoliating.  On  the  following  day  the  symptoms  had  returned.  Opium 
was  given,  and  afterward,  cannabis  indica  was  substituted,  with  some  benefit.  Death 
occurred  on  January  4th,  1863.  At  the  autop.sy,  a film  of  pus  was  found  under  the 
dura  mater,  beneath  the  point  of  injury,  amounting  to  a half  drachm.  The  dura  mater' 
was  bruised  and  discolored ; the  substance  of  the  brain  was  normal,  but  a small  quantity 
of  bloody  serum  existed  in  the  lateral  ventricles.  The  pathological  specimens  were 
sent  to  the  Army  Medical  Museum.  One  of  them  is  represented  in  the  adjacent  wood- 
cut,  (Fig.  36.)  It  consists  of  the  vault  of  the  cranium,  showing  incipient  caries  and 
necrosis  of  the  outer  table  of  the  right  parietal  bone.  The  scale  of  bone,  around  which 
the  line  of  demarcation  has  formed,  is  elliptical  in  shape,  measuring  one  inch  by  one 
and  a half.  The  inner  table  presents  no  pathological  appearance.  The  second  specimen 
is  a wet  preparation  of  the  dura  mater,  thickened,  inflamed,  and  having  a deposit  of  pus 
upon  its  inner  surface.  Tlie  specimens  and  history  were  contributed  by  Assistant  Sur- 
geon D.  C.  Peters,  U.  S.  A. 


Fig.  36. — Exfuliation  from  the  right  parie- 
tal, from  gunshot  contusion.  Spec.  613,  Sect. 
I,  A.  M.  M. 


Trephining . — There  were  sixteen  cases  of  gunshot  contusion  of  the  cranial  bones,  in 
which  necrosed  fragments  were  removed  by  formal  operations  : 


Abbott,  Henry,  Private,  Co.  B,  32d  Maine  Volunteers,  aged  21  years,  was  wounded,  at  the  battle  of  Tolopotomy  Creek, 
Virginia,  May  31st,  1884,  by  a conoidal  ball  which  struck  the  right  parietal  bone,  passed  forward  and  downward,  exposing 
the  squamous  suture,  and  lacerating  the  scalp  for  a distance  of  three  inches.  He  was  at  once  admitted  to  the  hospital  of  the 
2d  division.  Ninth  Corps,  and,  on  June  4th,  was  sent  to  the  Stanton  Hospital,  Washington.  On  the  7th,  diarrhoea  set  in,  but 
soon  yielded  to  treatment.  His  general  health  continued  good,  and  by  the  17th  the  wound  had  neai-ly  healed.  On.  July  12th, 
a piece  of  necrosed  bone  from  the  outer  portion  of  the  temporal  suture  and  the  diploe,  one  inch  in  length  and  half  an  inch  in 
breadth,  was  removed,  and  on  the  14th,  another  portion,  corresponding  to  the  first,  and  consisting  of  the  inner  table,  was 
removed.  He  was  transferred  on  July  18th,  enttu'ing  Grant  Hospital,  Willet’s  Point,  New  York  Harbor,  on  the  21st,  whence 
ho  was  retui'iied  to  duty  on  the  21st  of  December,  1864.  The  case  is  reported  by  Surgeon  John  A.  Didell,  U.  S.  V.  The 
r((cov(Ty  app((ars  to  have  been  complete,  as  the  man’s  name  does  not  appear  on  the  list  of  apjdicants  for  pensions. 


GUNSHOT  CONTUSIONS  OF  THE  CRANIAL  BONES. 


123 


37. — Exfoliations  resulting  from  gun- 
shot ccmtusion  of  the  cranium.  Spec.  4943, 
Sect.  I,  A.M.  M. 


Pio.  39. — External  and  intcnial  *yiew  of  an 
exfoliation  of  the  cranium  following  gunshot 
contusion.  Spec.  2623,  Sect.  I,  A.  M.  M. 


Unknown.  An  infantry  soldier,  on  the 
Peninsula,  in  June,  1862,  received  a scalp  wound 
from  a glancing  musket  ball,  on  the  side  of  the 
head,  with  contu.sion  of  the  parietal  bone.  He 
was  treated  by  Assistant  Surgeon  Wm.  Thom- 
son, U.  S.  A.  There  were  very  grave  head  symp- 
toms, yet  the  case  was  treated  on  the  expectant 
plan.  After  a while,  it  was  noticed  that  the 
external  table  of  the  skull  was  necrosed,  and, 
subsequently,  the  two  fragments,  one  com- 
prising the  whole  tliickness  of  the  bone,  the 
other  the  outer  tablff  and  diploe  only,  were 
loosened  and  detached.  These  being  removed, 
the  patient  recovered  without  any  impairment  of  the  mental  faculties  or  physical  dis- 
ability. The  specimens,  represented  of  natural  size  in  the  adjoiningwood-cuts,  (Fig.  37 
and  Fig.  38,)  were  sent  to  the  Army  Medical  Museum  by  Assistant  Surgeon  W.  Thomson, 
U.  S.  A.,  who  lost  his  notes  of  the  case  in  the  retreat  from  the  Peninsula. 

Unknown.  A soldier,  wounded  in  one  of  the  battles  between  the  Wilderness 
and  Petersburg,  in  May,  1864,  receiving  a laceration  of  the  scalp,  with  contusion  of 
the  vault  of  the  cranium,  by  a musket  ball.  He  was  sent  to  an  hospital  in  Philadel- 
phia. The  bone  at  the  point  at  which  the  pericranium  was  denuded,  necrosed  and 
exfoliated,  and  was  removed  by  operation.  The  specimen  was  received  at  the 
Army  ISIedical  Museum,  without  an  history,  on  June  22d,  1864.  It  is  figured  at 
natural  size  in  the  adjacent  wood-cut,  (Fig.  39.)  Compare  Catalogue  of  the  Surgical 
Section,  1866,  p.  11. 


Pig.  38. — Internal  view  of  the  foregoing 
specimens. 


Yetter, 
November  10th, 


Fig.  40. — Frag- 
ments of  necrosed 
bone  from  the  left 
parietal.  Spec. 
4178.  Seet.  I,  A. 
M.  M. 


John,  Private,  Co.  A,  11th  New  Jersey  Volunteers,  aged  21  years,  was  wounded  near  Petersburg,  Virginia, 
1864,  by  a conoidal  ball  which  lacerated  the  scalp,  and  contused  the  anterior  portion  of  the  left  parietal  bone. 
He  was  admitted  to  the  field  hospital  of  the  3d  division.  Second  Corps,  and  thence  transferred  to  City  Ptfint, 
and  thence  sent  by  the  hospital  steamer  Connecticut  to  the  Stanton  Hospital,  Washington,  where  he  arrived  on 
November  26th.  There  was  a necrosis  of  the  cranium,  one-fourth  of  an  inch  in  diameter.  Low  diet  and  gentle 
purgatives  were  prescribed,  and,  as  suppuration  became  tolerably  well  established,  emollient  poultices  were 
applied  to  the  wound.  On  the  21st  of  December,  the  contused  bone  had  become  loosened  by  the  process  of 
absorption  and  suppuration.  The  patient  was  placed  under  the  influence  of  chloroform,  and  Surgeon 
Benjamin  B.  Wilson,  U.  S.  V.,  made  a crucial  incision,  and  removed  a piece  of  the  external  table  of  the 
parietal  bone,  half  an  inch  in  diameter,  and  another,  from  the  internal  table,  one-foui'th  of  an  inch  in  diameter. 
On  the  29th,  another  piece  of  bone,  including  a small  portion  of  both  tables,  was  removed  from  the  inferior 
margin  of  the  wound.  Water  dressings  were  applied.  The  patient  made  a rapid  recovery,  without  any 
untoward  symptom;  but  it  was  thought  inexpedient  to  return  him  immediately  to  active  service  in  the  field. 
He  did  efficient  service  for  some  months  as  a nurse  in  the  hospital.  When  discharged,  on  the  general  muster- 
out  of  troops,  June  15th,  1865,  he  was  in  excellent  health.  His  name  does  not  appear  on  the  list  of  applicants 
for  pension.  The  specimen  (see  FiG.  40)  and  notes  of  the  case  were  contributed  by  Surgeon  B.  B.  Wilson, 
U.  S.  V.  Compare  the  Catalogue  of  the  Surgical  Section,  same  page  as  in  the  preceding  case. 


Altman,  Samuel,  Private,  Co.  A,  50th  Georgia  Regiment,  was  wounded  at  the  battle  of  Antietam,  September  17th, 
1862,  by  a musket  ball  which  laid  b.are  the  frontal  bone  to  the  extent  of  two  inches  in  length  by  three-fourths  of  an  inch  in 
width,  but  not  depressing  or  fracturing  the  bone.  He  was  admitted  into  the  Convalescent  Hosjiital,  Philadelphia,  September 
27th,  1862.  The  wound  granulated  rapidly,  and  the  patient  was  apparently  doing  well,  exhibiting  no  symptoms  of  injury 
to  the  brain,  except  that  he  was  sullen  and  stupid,  which  was  attributed  to  other  causes.  On  October  6th,  he  complained 
of  headache,  chills  and  fever,  and,  on  the  8th,  cerebral  symptoms  app<!ared,  and  rapidly  increased  until  the  11th,  when 
indications  of  approaching  dissolution  were  unmistakable,  the  pulse  being  rapid  and  small,  puj)ils  natural,  but  insensible 

to  light.  The  patient  was  etherized,  and  the  operation  of  trephining 
performed,  to  evacuate  an  abscess  supposed  to  exist.  A ]uece  of  bone 
was  removed,  and  the  brain  punctured,  giving  exit  to  six  or  seven  ounces 
of  offensive  sero-purulent  fluid,  containing  fragments  of  broken  down 
brain  tissue,  with  such  a force  as  to  throw  it  three  feet  from  the  patient. 
The  effect  of  the  operation  was  favorable;  the  skin  became  warm,  the 
pulse  gained  strength  and  was  less  rapid,  the  breathing  was  easier,  and 
the  i>atient  appeared  in  every  way  better.  The  wound  was  closed,  and 
stimulants  were  administered,  but  exhaustion  followed,  and  death 
occurred  on  October  11th,  1862.  At  the  autopsy,  it  was  found  that  the 
ball  had  struck  the  os  frontis  on  the  left  side,  near  the  sagittal  suture, 
two  and  a half  inches  from  the  middle  line  of  the  cranium.  'J'ho  inner 
table  was  necrosed  over  an  irregular  circular  si)ace,  one  and  a half 
inches  in  diameter,  the  dij)lo(!  between  the  outer  and-  inner  tallies  at 


Fig.  41. — Calvaria  trephined  in  the  left  frontal  region  for 
gunshot  contusion.  Spec.  1199,  Sect.  I,  A.  M.  M. 


124 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


this  point  l)eing  carious.  There  was  an  abscess,  with  greenisli  indurated  walls,  three  inches  in  diameter,  in  the  anterior 
lobe  of  the  left  cerebral  hemisphere.  It  had  opened,  and  its  contents  had  filled  the  cavities  of  the  brain.  There  was  no  pus 
under  the  diseased  bone  upon  the  surface  of  the  brain,  nor  did  there  seem  to  be  any  immediate  communication  between  the 
diseased  bone  and  the  abscess.  The  pathological  specimen  is  figured  in  the  foregoing  wood-cut,  (Fig.  41.)  It  shows  the  vault 
of  the  cranium,  with  the  disk  in  place.  The  internal  table  is  cribriform.  The  outer  taWe  is  poroas,  and  discolored  to  a slight 
degree.  The  specimen  and  history  were  contributed  by  Acting  Assistant  Surgeon  G.  E.  Morehouse. 


Attig,  IVilgiaji,  Private,  Co.  A,  49th  Pennsylvania  Volunteers,  aged  25  years,  was  wounded  near  Eappahannock 
Station,  Virginia,  November  7th,  1863,  by  a conoidal  musket  ball  which  struck  the  forehead  near  the  left  frontal  eminence, 

denuding  the  bone  of  its  periosteum  for  about  one  inch.  He  was  conveyed  to 
Washington,  and  admitted  into  Harewood  Hospital  on  the  9th,  complaining  of  slight 
headache  over  the  region  of  the  eyes.  His  pulse  was  normal,  and  his  appetite  poor. 
On  the  17th,  chills,  with  vomiting,  supervened,  and  the  eyes  became  lachrymose. 
These  symptoms  continued  until  the  19th,  when  he  was  anaesthetized,  and  Surgeon 
E.  B.  Bontecou,  U.  S.  V.,  made  a crucial  incision  through  the  scalp,  when  pus  was 
found  issuing  through  the  denuded  bone.  The  trephine  was  then  applied  near  the 
left  fi-ontal  eminence,  giving  exit  to  a small  quantity  of  pus,  which  was  found 
between  the  dura  mater  and  the  skull.  After  the  operation  the  patient  became  free 
from  pain.  During  the  night  of  the  20th,  he  became  delirious,  and  lay  in  a stupor 
nearly  all  the  time,  but  answered  questions  correctly.  The  next  morning  the  fore- 
head and  right  eye-lids  were  oedematous,  and  the  pulse  was  75,  and  feeble.  On  the 
23d,  low  muttering  delirium  followed,  coma  ensued,  the  alvine  evacuations  became 
involuntary,  and  his  breathing  stertorous.  At  eleven  o’clock  A.  M.  of  the  24th,  the 


Fio.  42. — Perforation  of  the  left  os  frontis  for 
.1  pfiinshot  confusion,  followed  by  symptoms  of 
compression.  Spec.  2024,  Sect.  I,  A.  M.  JI. 


dura  mater  was  incised,  giving  exit  to  a small  quantity  of  pus,  but  no  relief  was  afforded,  and  death  occurred  two  hours 
subsequently.  The  pathological  specimen  was  sent  to  the  Army  Medical  Museum,  and  is  represented  in  the  wood-cut  (Fig.  42). 
It  was  forwarded,  with  its  history,  by  Surgeon  E.  B.  Bontecou,  U.  S.  V. 


B.vker,  Charles  K.,  Private,  Co.  D,  27th  lilassachusetts  Volunteers,  aged  25  years,  was  wounded  at  the  battle  of 
New  Berne,  North  Carolina,  Jlarch  14th,  1862,  by  a conoidal  musket  ball  which  made  a long  furrowed  wound  of  the  right 
parietal  region,  lacerating  the  scalp,  and  denuding  the  pericranium.  He  was  treated  at  a field  hospital  by  his  regimental 
surgeon.  The  right  side  of  the  scalp  was  shaven,  and  a compress,  dipped  in  cold  water,  was  secured  over  the  wound  by  a 
bandage.  The  patient  was  required  to  keep  his  bed  in  the  log  hut  used  as  an  hospital,  and  to  observe  a strict  diet.  He  had  no 
headache,  nor  any  symptom  of  disturbance  of  the  brain.  Careful  exploration  revealed  no  injury  of  the  bone.  On  March  20th, 
the  wound  of  the  scalp  was  fixirly  cicatrizing,  and  the  patient  was  sent  on  an  hospital  transport,  up  the  Neuse  river,  to  the 
Craven  Street  Hospital  at  New  Berne,  five  miles  distant.  Two  days  subsequently,  through  the  inadvertence  of  an  hospital 
steward,  this  man’s  name  was  included  in  the  list  of  wyimded  to  be  sent  northward  on  the  hospital  transport  steamer  New 
York.  Surgeon  .1.  B.  Upham,  in  charge  of  the  transport,  reports  that  he  had  no  ceiebral  symptoms  on  the  passage.  He 
proceeded  to  his  home  in  Amherst,  Massachusetts.  On  April  3d,  he  complained  of  headache,  and  the  following  day  sjuiiptoms 
of  compression  of  the  brain  were  manifested.  On  April  7th,  he  was  trephined  by  two  of  the  local  practitioners,  and  died  a 
few  hours  after  the  operation.  Assistant  Surgeon  D.  B.  N.  Fish,  27th  Massachusetts  Voluntoeu-s,  a resident  of  Amherst,  writes, 
in  1833,  that  the  two  surgeons  who  performed  the  operation  had  died  and  loft  no  notes  of  the  case;  but  thinks  it  certain,  from 
the  report  of  one  of  the  witnesses  of  the  operation,  that  a clot  of  blood  was  found  underneath  the  cranium,  at  the  point  of 
impact. 


Chapman,  S.  D.,  Private,  Co.  H,  92d  Ohio  Volunteers,  received,  at  the  battle  of  Chickamauga,  September  23d,  1863,  a 
gunshot  wound  of  the  scalp,  near  the  upper  posterior  angle  of  the  right  parietal,  with  a contusion  of  the  bone.  He  was  sent 
to  Nashville,  and  admitted  to  Cumberland  Hospital  on  the  25th.  The  wound  produced  little  inconvenience  until  October  4th, 
when  grave  head  symptoms,  such  as  delirium  and  convulsions,  supervened.  There  was  hemiplegia  also.  On  October  5th, 
the  patient  was  in  a comatose  condition,  and  trephining  was  resorted  to.  When  the  skull  was  perforated,  exit  was  given  to 
a quantity  of  pus,  which  had  formed  between  the  dura  mater  and  cranium.  Consciousness  was  restored  almost  immediately,  and 
apparent  steady  improvement  for  the  next  twenty-four  hours ; but  symptoms  of  compression  then  recurred,  and  the  patient  died 
on  October  9th,  1863.  At  the  autopsy,  the  right  hemisphere  was  found  partially  disorganized,  and  covered  with  a layer  of  pus, 
which  extended  to  the  longitudinal  fissure.  The  operator.  Surgeon  C.  McDermont,  U.  S.  V.,  reported  the  case. 


Chap.pel,  Beniamin  F.,  Sergeant,  Co.  II,  8th  New  York  Cavalry,  aged  27  years,  was  wounded,  before  Petersburg, 
Virginia,  April  1st,  1865,  by  a pistol  b.all  which  entered  one  inch  above  and  one  and  a half  inches  to  the  left  of  the  occipital 
protuberance  and  emerged  just  below  it  on  the  opposite  side,  denuding  the  bone  of  pericranium.  He  was  admitted  to  the 
hospital  of  the  3d  division.  Cavalry  Corps,  and  on  the  3d,  was  sent  to  Washington,  where  he  entered  Harewood  Hospital  on  the 
5th.  Until  the  14th,  the  patient  seemed  to,  bo  improving,  hut  on  that  day  a slight  haemorrhage  from  the  occipital  artery 
occurred,  causing  the  loss  of  about  six  ounces  of  arterial  blood.  The  haemorrhage  was  arrested  by  means  of  eompression,  and 
the  case  apparently  progressed  rapidly.  On  the  evening  of  the  18th,  the  patient,  however,  complained  of  considerable  pain 
in  the  region  of  the  cerebellum.  On  the  following  day  considerable  gastric  irritation  manifested  itself,  and,  at  intervals,  there 
was  slight  delirium.  Ether  was  administered,  and  Surgeon  E.  B.  Bontecou,  U.  S.  V.,  made  an  incision  two  and  a half  inches  in 
length,  just  below  and  parallel  to  the  lambdoidal  suture,  retracted  the  scalp,  applied  the  trephine,  and  removed  a disk  of  bone, 
giving  exit  to  a (]nantity  of  ])us.  The  patient  reacted  promptly,  after  the  operation,  and  s<!emed  to  bo  much  relieved,  but  in  the 


GUNSHOT  CONTUSIONS  OF  THE  CRANIAL  BONES. 


125 


ovc'niir!r  lie; 


bugan  to  sink,  and  died  on  the  morning  of  April  21st,  1865.  The  autopsy  revealed  a large  abscess  in  the  left  lobe  of 
the  cerebellum,  which  contained  four  or  five  ounces  of  pus.  The  medulla  oblongata 
was  implicated.  The  pathological  specimen  is  represented  in  the  adjacent  wood-cut, 
(Fig.  43,)  and  shows  the  occipital  bone  perforated  by  a trephine,  with  the  disk  restored 
to  its  position.  The  surrounding  portion  of  the  external  table  is  slightly  discolored 
and  cribriform.  The  specimen  was  contributed  by^he  operator.  A photograph  of  the 
case  will  be  found  in  the  Photographic  Surgical  Series  of  the  Army  Medical  Museum, 
Volume  I,  page  40. 


FoSTEjt,  James  B.,  Private,  Co.  F,  5th  Missouri  Militia,  was,  on  August  25th, 
18G3,  admitted  to  the  hospital  at  Kansas  City,  Missouri,  with  concussion  of  the  brain. 
The  skull  was  not  fractured,  but  there  were  symptoms  of  compression.  The  trephine 
was  applied  to  the  seat  of  injury,  and  a button  of  bone  removed.  The  operation 
revealed  a rupture  of  the  middle  meningeal  artery,  with  copious  Inemorrhage.  A clot  of  blood  was  removed  from  under  the 
j)ia  mater,  when  clear  blood  escaped  for  a few  minutes.  Death  occurred  on  August  27th,  1863,  thirty  hours  after  the  operation. 
The  autopsy  revealed  extravasation  of  blood  over  the  entire  surface  of  the  brain.  The  report  is  signed  by  Dr.  Joshua  Thorne. 


Fig.  43. — Segment  of  n cranium,  showing 
the  occipital  perforated  for  the  evacuation  of 
pus.  Spec.  4iM8,  Sect.  I,  A.  M.  M. 


Gaj/,  J.,  Private,  Co.  A,  44tli  Georgia  Infantry,  received  a gunshot  wound  of  the  scalp.  lie  was  admitted  into  tlie 
Jackson  Hospital  at  Richmond.  Paralysis  supervened,  and  trephining  was  resorted  to  on  June  2d,  1864.  Death  took  place  on 
June  4th.  The  case  is  reported  by  Surgeon  J.  S.  Welford,  C.  S.  A. 


Mokton,  Darius,  Private,  Co.  F,  9th  New  York  Cavalry,  was  wounded 
in  a skirmish  during  General  Pleasonton’s  raid  into  Virginia,  and  was  admitted, 
on  November  12th.  1862,  to  the  Armory  Square  Hospital,  Washington,  with  a 
gunshot  wound  of  the  scalp,  with  contusion.  No  particulars  of  the  treatment  are 
recorded.  Compression  of  the  brain  supervened,  and  the  operation  of  trephining 
was  performed  by  Surgeon  D.  W.  Bliss,  U.  S.  V.  The  symptoms  of  compression 
were  not  relieved,  and  the  patient  died  on  November  ISth,  1862.  The  pathological 
specimen  was  forwarded  to  the  Army  Medical  Museum.  It  consists  of  a segment 
of  the  right  parietal  bone,  of  a very  thin  calvaria,  trephined  near  the  coronal  suture. 
The  outer  table  of  the  bone  surrounding  the  perforation  is  porous  and  cribriform, 
and  there  are  traces  of  contusion  of  the  disk  removed.  There  are  no  pathological 
appearances  on  the  inner  table.  The  specimen,  which  is  represented  in  the 
adjacent  wood-cut,  (Fig.  44,)  was  contributed  by  the  operator.  Surgeon  D.  W. 
Bliss,  U.  S.  V. 


Pickard,  George,  Private,  Co.  F,  111th  New  York  Volunteers,  aged  43  years,  was  wounded  in  the  head  at  the  battle 
of  Gettysburg,  Pennsylvania,  July  2d,  1333,  by  a piece  of  sliell.  He  was  taken  to  the  regiment.al  hospital,  transferred  to  the 
Seminary  Hospital  at  Gettysburg,  Pennsylvania,  and  thence  sent  to  the  McDougall  Hospital,  Fort  Schuyler,  New  York  Harbor, 
where  he  was  admitted  on  the  12th.  Cold  water  dressings  were  applied,  and  an  antiphlogistic  treatment  ordered.  The  patient 
complained  of  headache  and  of  stiffness  in  the  cervical  region.  On  July  19th,  he  became  comatose,  with  fixed  pupils,  and 
stertorous  breathing.  On  the  20th,  Acting  Assistant  Surgeon  Henry  Sanders  applied  the  trephine,  giving  exit  to  a small  quantity 
of  pus,  after  which  the  patient  rallied  a little,  but  sank  again  at  night,  notwithstanding  the  free  use  of  stimulants,  and  died  on 
July22d,  1863.  The  autopsy  revealed  inflammation  of  the  membranes  of  the  brain,  and  several  ounces  of  pus  beneath  them. 
There  was  pus  also  on  the  external  surface  of  the  dura  mater.  The  tissue  of  the  brain  itself  was  normal.  The  case  was  reported 
by  the  operator. 


Resixger,  Joseph,  Private,  Co.  E.,  151st  New  York  Volunteers,  aged  21  years,  received,  at  the  demonstration  on  Mine 
Run,  Virginia,  November  27th,  1863,  a gunshot  wound  of  the  scalp,  over  the  right  parietal.  He  was  conveyed  to  Fairfax 
Seminary  Hospital.  There  was  no  cerebral  disturbance  at  the  time  of  his  admission.  The  pericranium  was  not  removed,  and 
it  was  hoped  that  the  skull  had  escaped  uninjured.  He  was  allowed  to  be  up  and  about  the  wards,  and  no  symptoms  of  any 

grave  injury  appeared  until  December  13th,  1863,  when  he  was  suddenly 
seized,  while  seated  at  the  supper  fable,  with  convulsions,  and  became 
immediately  unconscious.  He  was  taken  to  his  bed,  and  Surgeon  D.  P. 
Smith,  U.  S.  V.,  laid  bare  the  calvarium  at  the  seat  of  injury,  and  applied  the 
trephine.  Pus  was  found  immediately  beneath  the  bone,  and  oozed  from  the 
diploc.  It  was  thought  expedient  to  make  live  perforations  with  the  trephine, 
in  order  to  remove  the  diseased  bone,  and  to  give  free  exit  to  pils.  Convul- 
sions did  not  recur,  but  the  comatose  condition  continued,  and  the  case 
terminated  fatally  twelve  hours  after  the  operation.  The  autopsy  revealed 
diffuse  inflammation  of  the  arachnoid  and  of  the  dura  mater.  The  dura 
mater  was  not  incised,  as  it  did  not  bulge  into  the  perforations  made  by  the 
trephine.  The  pus  pi’oceeded  altogether  fi’om  the  diploe  and  from  between 
the  dura  mater  and  the. skull.  The  specimen  was  contributed  by  the  operator  to  the  Army  kledical  Museum,  and  is  figiu’ed  in 
the  adjoining  wood-cut,  (Fig.  45.) 

Spradley,  L.  D.,  Private,  Co.  H,  45th  Georgia  Regiment,  was  wounded,  at  the  battle  of  the  Wilderness,  May  5th,  1834, 
by  a colloidal  musket  ball  which  produced  a wound  of  the  head,  with  denudation  of  the  bone  of  the  vault  of  the  cranium.  He 


Fig.  4.5. — Section  of  a cranium,  e.vhibiting  five  trephine 
Perf  )ration3  for  the  evacuiition  of  pus,  the  result  of  a gun- 
shot contusion  of  the  right  parietal.  Spec.  2000,  Sect.  I, 
A.  M.  M. 


126 


WOUNDS  AND  INJURIES  OF  TUB  HEAD, 


was  conveyed  to  the  general  Confederate  hospital  at  Chailottesville,  Virginia.  On  May  12th,  symptoms  of  compression  of  the 
brain  appeared,  and,  on  the  following  day,  trephining  was  resorted  to.  The  patient  died  May  13th,  1864,  a few  hours  after 
the  operation.  The  case  is  recorded  in  his  monthly  report  for  May,  1864,  by  Surgeon  J.  L.  Cabell,  C.  S.  A. 

WiLi-iAMSON,  L.  B.,  Corporal,  Co.  G,  100th  Pennsylvania  Volunteers,  aged  23  years,  was  wounded,  before  Petersburg, 
Virginia,  April  2d,  1835,  by  a conoidal  musket  ball  which  injured  the  cranium.  He  was  admitted  on  the  same  day  to  the 
hospital  of  the  first  division.  Ninth  Corps,  and  thence  was  sent  to  the  hospital  at  Fairfax  Seminary,  which  he  entered  on  April 
0th.  On  April  12th,  the  operation  of  trephining  was  performed.  No  particulars  in  regard  to  the  operation  and  the  after- 
treatment  are  recorded.  Death  ensued  on  April  20th,  1865. 

Thus,  of  sixteen  cases  of  operative  interference,  four  only  had  a favorable  termination, 
and  these  were  examples  of  the  secondary  removal  of  exfoliated  fragments.  Art  serving  as 
the  handmaid  of  Nature,  who  had  already  nearly  effected  a cure.  In  the  twelve  remaining 
fatal  cases,  in  which  formal  trejohining  was  resorted  to,  pus  was  found  between  the  skull  and 
dura  mater  in  four  instances,  beneath  the  dura  mater  in  one  case,  and  in  the  substance  of 
the  brain  in  one.  In  two  instances,  it  is  alleged  that  intra-cranial  extravasation  was 
observed ; in  another  that  arachnitis  was  present ; in  three  cases  the  causes  of  the  symptoms 
of  compression  were  not  specified.  Its  symptoms  we're  manifested  earliest  in  those  cases  in 
which  hsemorrhage  in  the  cranial  cavity  was  observed.  In  the  six  cases  in  which  pus  was 
found,  the  symptoms  of  compression  arose  from  the  sixteenth  to  the  twenty-fourth  day. 
The  patients  survived  the  operations  on  an  average  about  three  days. 

Of  the  whole  number  of  three  hundred  and  twenty-eight  patients  with  gunshot  contu- 
sions of  the  cranial  bones,  whose  cases  have  been  reported,  fifty-five  died,  one  hundred  were 
returned  to  duty,  and  one  hundred  and  seventy-three  were  discharged.  Forty-eight  of  the 
last  category  were  pensioned. 

In  the  fifty-five  fatal  cases,  the  proximate  causes  of  death  were  external  haemorrhage 
in  two  cases  ; tetanus,  pyaemia,  intercurrent  typhoid  fever,  and  acute  dysentery  respectively 
in  four  cases  at  least,  compression  of  the  brain  from  extravasated  blood  or  from  intra-cranial 
abscess  in  seventeen  cases,  and  various  secondary  lesions  of  the  encephalon  in  thirty-two 
cases. 

The  wounds  were  inflicted  by  small-arm  projectiles  in  one  hundred  and  twenty-four 
instances,  by  shell  fragments  in  forty-four  cases,  and  in  one  hundred  and  sixty  cases,  the 
nature  of  the  missile  could  only  be  conjectured.  Lodgment  of  the  missile  beneath  the  scalp 
is  mentioned  in  eight  instances. 

The  seat  of  injury  was  specified  in  two  hundred  and  twenty-one  instances.  In  fifty- 
four,  the  frontal  bone  was  struck  ; in  thirty -three,  the  temporal ; in  ninety-five,  the  parietal ; 
in  thirty-three,  the  occipital ; and  in  six  cases,  the  contusion  involved  more  than  one  of  the 
cranial  bones.  The  fatality  in  contusions  of  the  frontal  and  temporal  bones  was  nearly 
fifteen  per  centum  ; in  contusions  of  the  parietals,  thirteen  ; and  in  contusions  of  the  occipital, 
nine  per  centum ; results  corroborating  the  observations  of  Guthrie  on  the  relative  danger 
of  injuries  of  the  different  regions  of  the  skull.* 

In  the  classification,  the  cases  have  been  grouped  under  the  headings  representing  the 
most  prominent  symptoms,  or  the  causes  of  discharge  or  death  which  they  illustrated. 
Thus,  though  three  cases  only  are  entered  under  the  heading  of  Hcemorrhage  (p.  101,) 
there  were  at  least  two  others,  (cases  of  Krall,  p.  122,  and  Chapped,  p.  124,)  in  which 


* Gctiirle.  Commentaries  on  the  Surgery  of  the  War  in  Portugal,  Spain,  France,  and  the  Netherlands,  from  the  Battle  of 
lloliga,  in  1808,  to  that  of  Waterloo,  in  1815,  with  Additions  relating  to  those  in  the  Crimea,  in  1854-55.  Gth  London  ed.,  1855, 
p.  293. 


GUNSHOT  CONTUSIONS  OF  THE  CRANIAL  BONES. 


127 


bleeding  from  the  arteries  of  the  scalp  was  an  important  complication.  The  five  were  all 
instances  of  hsemorrhage  from  direct  injury  of  the  occipital  or  temporal  arteries  or  of  the 
principal  branches.  The  bleeding  was  primary  in  two  cases,  and  secondary  in  three  cases. 
The  observations  on  page  64,  on  hsemorrhage  after  scalp  wounds,  would  be  applicable  to 
these  five  cases,  save  that  in  one  of  them  it  was  necessary  to  ligate  the  temporal  artery. 

Erysipelas  appears  to  have  been  neither  a frequent  nor  fatal  complication.  In  only 
four  cases,  [Smith,  p.  102,  Gilkey  and  Hay,  p.  105,  Pulliam,  p.  107,)  in  addition  to  the 
six  cases  recorded  under  the  heading  on  page  101,  is  it  reported  as  a . serious  intercurrent 
afiection,  and  only  two  of  the  aggregate  of  ten  cases  terminated  fatally.  Sloughing  of  the 
scalp  was  seldom  observed. 

Burrowing  of  pus  in  the  scalp  or  beneath  the  aponeuroses  of  the  occipito-frontalis  or 
crotaphite  muscles  was  reported  in  only  six  of  the  three  hundred  and  twenty-eight  cases. 
Pour  of  the  six  cases  had  a favorable  issue  ultimately,  after  the  elimination  of  dead  bone ; 
in  two,  the  abscesses  were  associated  with  other  lesions  which  proved  fatal.  Early  incision, 
followed  by  warm  emollient  applications,  and  subsequent  gentle  compression  by  bandages, 
constituted  uniformly  the  treatment. 

Periostitis  following  gunshot  contusions  of  the  cranium  resulted  occasionally  in  caries, 
not  infrequently  in  necrosis,  rarely  in  hyperotosis  and  induration,  sometimes  in  persistent 
pain  at  the  point  struck.  There  were  several  examples  of  inflammation  of  the  pericranium 
in  which  the  wounds  reopened  at  intervals  and  suppurated,  yet  no  exfoliation  followed. 
There  were  ten  cases  in  which  persistence  of  pain,  either  in  the  cicatrices  or  in  distinct 
spots  of  the  cranium,  constituted  the  prominent  symptom.  Three  of  them  belong  to  the 
class  of  cases  described  by  Quesnay.*  All  of  these  patients  were  spared  the  incisions  of  the 
scalp  or  the  application  of  the  rugine  or  trephine,  and  five  recovered  and  went  to  duty,  while 
five  were  discharged  for  disability,  two  of  whom  were  subsequently  pensioned.  I have 
carefully  examined  more  than  forty  crania  contused  by  gunshot  projectiles  without  finding 
an  example  of  the  local  hyperostosis  of  the  skull  which  authors  describe  as  a frequent 
result  of  this  form  of  injury.  There  were  two.  instances  in  which  there  was  abnormal 
thickening,  [Spec.  1199  and  1660  A.  M.  M.,)  but  the  subjects  who  furnished  these  specimens 
died. in  twenty-one  and  twenty-seven  days  respectively  after  the  reception  of  their  wounds, 
and  it  is  scarcely  possible  that  the  pathological  conditions  of  the  skulls  were  due  to  such 
recent  injuries.*}*  The  induration  or  eburnation  of  the  outer  table  mentioned  by  BokitanskyJ 
as  a consequence  of  contusion,  was  observed  in  six  or  seven  of  the  fatal  cases.  It  is  very 
well  illustrated  in  Specimens  1568,  2523,  and  3406,  of  the  Surgical  Section  of  the  Army 
Medical  Museum.  A few  specimens  showed  traces  of  the  velvety  osteophyte  described  by 
Lobstein.|I 

The  contusions  of  the  skull  by  gunshot  projectiles  were  followed  by  exfoliations  in 
thirty-seven  cases.  Five  of  these  terminated  fatally.  Eight  cases  of  this  category  were 
those  of  Confederate  soldiers,  who  so  far  recovered  as  to  be  furloughed  or  discharged.  Of 
the  twenty-five  Union  soldiers  who  recovered,  twelve  had  their  names  on  the  jiension  list 

* Quksxay,  Mcinoires  de  I’ Academic  lioyale  de  Chirurgie.  Nouv.  ed.  Paris,  1819,  T.  1,  p.  109. 

t Specimens  5135,  and  5481,  Section  I,  A.  M.  M.,  are  good  examples  of  chronic  thickening  of  the  skull  from  external 
violence,  and  specimen  55  of  Section  IV,  is  another  fine  illustration.  But  the  bruises  which  were  the  starting  point  o)  the  morbid 
alterations  in  these  cases  were  from  blows  or  falls. 

t Rokitansky,  Lehrhuch  dcr  Pathohgischen  Anatomic.  Wien,  1856,  Zweiter  Band,  S.  144. 

II  Lob.STEIN,  Traifd  d’ Anatomic  Pathologigue.  Paris,  1833. 


128 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


in  1870.  In  six  of  tlie  thirty-seven  cases,  the  exfoliation  included  both  tables  of  the  skull, 
in  thirty  cases  the  outer  plate  only,  and  in  one  (Smith,  p.  112)  the  inner  table  only.  It  is 
questionable  if  the  latter  case  should  not  be  regarded  as  a fracture  of  the  inner  table. 

In  the  few  cases  of  caries  observed,  the  disease  soon  followed  the  injury,  there  being  no 
instance  of  its  tardy  apparition,  as  described  by  Sir  Charles  Bell.f 

Of  the  one  hundred  and  seventy-three  patients  in  this  category  discharged,  ninety-eight 
were  discharged  for  serious  physical  disabilities,  such  as  protracted  headache  and  vertigo, 
persistent  pain  at  the  point  struck,  epilepsy,  paralysis,  impairment  of  the  special  senses  or 
mental  faculties.  Forty-eight  of  these  patients  remain  on  the  pension  list.  Some  were 
discharged  on  account  of  other  wounds  or  mutilations  more  serious  than  the  head  injuries, 
and  others  at  the  expiration  of  their  terms  of  service.  It  may  be  stated  as  a near  approx- 
imation to  truth,  that  of  three  hundred  and  twenty-eight  examples  of  gunshot  contusions  of 
the  cranial  bones,  fifty-five,  or  seventeen  per  centum,  died,  ninety-eight,  or  thirty  per 
centum,  were  disabled  from  causes  referable  to  the  injuries  of  the  head,  and  one  hundred 
and  seventy-five,  or  fifty-three  per  centum,  recovered. 

Gunshot  Fractures  of  the  External  Table  of  the  Cranium  alone. — AVith 
the  exception  of  instances  of  fracture  of  the  outer  wall  of  the  frontal  sinus,  or  of  the  mastoid 
and  zygomatic  processes  of  the  temporal,  and  of  grooving  of  the  outer  table  of  the  vault  of 
the  skull  by  the  sharp  angles  of  shell  fragments,  the  specimens  of  the  Army  Medical 
Museum  exhibit  no  satisfactory  examples  of  this  form  of  injury.  Though  the  reports  contain 
many  cases  returned  under  this  heading,  there  are  few  in  which  the  evidence  of  the  nature 
of  the  injury  is  conclusive.  The  following  are  reported  as  examples  of  fractures  of  the 
external  wall  of  the  frontal  sinus  : 

Case. — Private  George  Armstrong,  Co.  E,  1.56111  New  York  Volunteers,  received,  before  Port  Hudson,  Louisiana,  on  June 
1-ltli,  1833,  a gunshot  wound  over  the  right  eye.  The  missile  struck  over  the  right  frontal  sinus,  causing  a small  wound.  He 
was  admitted  to  St.  Louis  Hospital,  New  Orleans,  on  June  17th,  1863,  a slight  exfoliation  causing  no  inconvenience  or  complaint. 
On  the  night  of  Septemher  16th,  stupor  supervened,  but  passed  otf  in  about  thirty  minutes.  It  recurred  on  the  following  day, 
and  the  patient  died  on  September  18th,  1863.  At  the  autopsy,  tiie  whole  anterior  half  of  the  right  hemisphere  was  replaced  by 
a large  abscess,  which  was  divided  only  by  the  dura  mater  from  the  carious  opening  consequent  upon  the  wound. 

Case. — Private  William  S.  Dingman,  Co.  F,  10th  Vermont  Volunteers,  aged  26  years,  was  wounded  at  the  battle  of  Win- 
chester, Virginia,  September  19th,  1864,  by  a fragment  of  shell  which  fractured  the  outer  table  of  the  frontal  sinus.  He  was 
admitted  to  the  3d  division,  Sixth  Corps,  hospital,  and  on  the  24th,  sent  to  the  Frederick  hospital,  Maiyland,  but  shortly  after- 
wards transferred  to  the  Sloan  Hospital,  in  Vennont.  The  wound  healed  and  the  patient  ^vas  discharged  from  service  on  May 
22d,  1865,  at  Brattleboro’.  In  September,  1867,  he  was  in  receipt  of  a pension.  In  March,  1869,  Dr.  O.  F.  Fossett  reported 
that  this  pensioner,  having  had  .a  fracture  involving  the  frontal  sinus,  had  ulceration  with  a discharge  of  fetid  sanious  matter  in 
the  nose,  with  partial  loss  of  vision  and  much  pain  and  dizziness,  incapacitating  him  for  labor,  and  producing  a disability  rated 
at  throe-fourths,  without  likelihood  of  improvement. 

Case. — Sergeant  Major  Edwin  A.  Gordon,  57th  Ohio  Volunteers,  was  wounded  near  Vicksburg,  Mississippi,  December 
23th,  1832,  by  a gunshot  missile  which  fractured  the  external  table  of  the  frontal  bone  over  the  right  eye.  He  was  on  the  same 
day  admitted  to  the  hospital  steamer  City  of  Memphis.  He  recovered  rapidly,  w.as,  on  January  17th,  1833,  admitted  to  the  Law- 
son  Hospital,  St.  Louis,  Missouri,  and  returned  to  duty  on  April  2d,  1863.  His  pension  claim  is  reported  as  pending. 

* Williamson  informs  us  that : “Eleven  cases  of  this  description  of  injury,  (detachment  of  pericranium  by  gunshot  injuries), 
were  admitted  from  India,  of  whom  six  were  sent  to  duty  and  five  invalided  for  other  diseases.  In  all  of  them  small  portions  of 
the  external  table  of  the  skull  came  away  necrosed.  The  scalp  was  not  adherent  to  the  bone  in  any  of  them.”  See  Specimens 
2895,  2893,  and  3626,  Netlej^Museum.  Military  Surgery,  London,  1863,  p.  19. 

.t  Sir  CTiaules  Bell,  A System  of  Operative  Surgery,  2d  ed.  London,  1814.  Vol.  I,  p.  381 : “ The  surgeon  should  be 
aware  of  the  slow  progress  and  gradual  effect  of  caries  of  the  skull  after  contusion.  When  the  bone  has  been  injured,  but  not 
deadened,  it  falls  slowly  into  disease ; it  becomes  carious  and  spongy,  and  admits  the  oozing  out  of  matter.  The  dura  mater  does 
not  separate  from  the  bone,  as  in  the  more  common  case  of  death  of  the  bone  from  injury;  but  being  the  internal  periosteum  of 
the  bone,  it  partakes  of  its  disease,  and  grows  into  its  carious  cells.  This  is  a disease  of  the  skull,  like  to  the  common  diseases  of 
bones,  where  the  external  and  internal  periosteum,  and  substance  of  the  bone,  is  diseased  with  decay  of  internal  parts,  and  the 
fonnation  of  exostosis.” 


GUNSHOT  FRACTURES  OF  THE  OUTER  TABLE  OF  THE  SKULL. 


129 


Case. — ^Private  William  Gritzmacher,  Co.  C,  5th  Wisconsin  Volunteers,  aged  19  years,  was  wounded  at  the  battle  of 
Sjiottsylvania,  Virginia,  May  12th,  186-1,  by  an  explosive  musket  ball  which  struck  the  frontal  bone  at  the  left  supra-orbital 
ridge  and  fractured  the  outer  table.  He  was,  on  the  same  day,  admitted  to  the  hospital  of  the  1st  division,  Sixth  Corps,  and 
on  the  17th  sent  to  Washington,  U.  C.,  and  admitted  into  the  Emory  Hospital.  On  June  6th  he  was  transferred  to  tin; 
Patterson  Park  Hospital,  Baltimore,  and  on  August  16th  to  the  Chester  Hospital.  The  treatment  so  far  consisted  of  sim])le 
dressings.  He  recovered,  and  was  transferred  on  May  16th,  1865,  to  the  Veteran  Reserve  Corps,  and  discharged  the  service  of 
the  United  States  July  22d,  1835.  Pension  Examining  Surgeon  John  Phillips  reports,  on  May  9th,  1867,  that  this  pensioner’s 
wounds  were  still  discharging,  and  that  the  right  upper  eyelid  was  so  contracted  as  to  prevent  closure  of  his  eye,  and  that  his 
vision  was  impaired.  [The  field  report  was  from  Surgeon  L.  W.  Oakley,  ‘2d  New  Jersey.] 

Case. — Corporal  D.  Hagerty,  Co.  F,  69th  Pennsylvania  Volunteers,  aged  33  years,  was  wounded  at  the  battle  of  Gettys- 
burg, Pennsylvania,  July  3d,  1833,  by  a conoidal  musket  ball  which  fractured  the  external  table  of  the  frontal  bone.  He  was 
conveyed,  on  July  6th,  to  the  Cuyler  Hospital.  He  recovered,  and  was  transferred  to  the  Veteran  Reserve  Corps  on  May  12th, 
1864,  but  was  readmitted  into  the  hospital  on  May  22d,  and  finally  discharged  from  service  on  August  24th,  1864.  A fistulous 
opening  in  the  frontal  sinus  still  existed.  The  case  is  reported  by  Assistant  Surgeon  H.  S.  Schell,  U.  S.  A.  The  name  of  this 
patient  is  not  upon  the  list  of  applicants  for  a pension. 

Case. — Private  E.  B.  Johvson,  Co.  F,  1st  North  Carolina  Infantry,  received  a wound  of  the  frontal  region,  directly  over 
the  sinus,  with  fracture  of  the  external  table  of  the  bone,  by  a fragment  of  shell.  He  was  admitted  into  the  No.  3 Chimborazo 
Hospital,  Richmond,  on  June  4th,  1833,  and  on  June  27th  transferred  to  Weldon,  North  Carolina.  The  case  is  reported  by 
Surgeon  E.  H.  Smith,  P.  A.  C.  S. 

Ca.SE. — Private  Henry  Koelling,  Co.  C,  47th  Illinois  Volunteers,  was  wounded  at  the  battle  of  Shiloh,  Tennessee,  April 
7th,  1832,  by  a fragment  of  shell  which  struck  in  the  left  supra-orbital  region,  causing  a comminuted  fracture  of  the  external 
table  of  the  frontal  bone,  and  opening  the  frontal  sinus.  He  was  conveyed  on  the  hosjaital  steamer  D.  A.  January,  to  St.  Louis, 
and  admitted,  on  April  14th,  into  the  new  House  of  Refuge  Hospital.  There  was  occasional  vertigo  and  constant  headache.  A 
large  depressed  cicatrix  was  visible  at  the  seat  of  injm-y.  He  was  discharged  from  the  service  on  August  30th,  1862,  with  a 
disability  rated  one-h.alf.  The  case  is  reported  by  Surgeon  A.  Hammer,  U.  S.  V.  Drs.  E.  H.  Henry  and  J.  N.  Means,  of 
Washington  County,  Illinois,  report,  October  29th,  1832,  that  a portion  of  tlie  superciliary  ridge  was  removed,  and  that  the 
pensioner  was  unfit  for  manual  labor  or  any  employment  that  produced  cerebral  excitement. 

Case. — Private  A.  McDonald,  of  the  Palmetto  Sharpshooters,  was  admitted  to  the  South  Carolina  Hospital,  at  Charlottes- 
ville, Virginia,  on  September  6th,  1832,  with  a gunshot  wound  of  the  head,  received  a few  days  prior  to  admission.  The  os 
frontis  at  the  outer  extremity  of  the  left  frontal  sinus  was  fractured  to  a considerable  extent.  The  outer  wall  of  the  sinus  was 
I’iJmoved;  the  inner  table  was  uninjured.  The  case  progressed  favorably,  and  on  November  11th,  186‘2,  the  patient  was 
furloughed,  being  nearly  well.  The  case  is  recorded  by  Assistant  Surgeon  B.  W.  Allen,  P.  A.  C.  S. 

Case. — Private  Albert  J.  Miller,  Co.  B,  26th  Illinois  Infantry,  aged  30,  was  wounded  at  Jonesboro’,  Georgia,  August 
31st,  1884,  by  a piece  of  shell  which  fractured  and  slightly  depressed  the  outer  table  of  the  frontal  bone  above  the  left  eye. 
He  was?,  on  September  5th,  admitted  to  the  field  hospital  of  the  Fifteenth  Corps,  and  on  September  20th  he  was  furloughed. 
No  recor-d  of  the  case  can  be  found  until  December  3d,  when  he  was  admitted  to  the  hospital  at  Jeffersonville,  Indiana.  He 
stated  that  several  pieces  of  bone  had  come  away.  On  December  5th  he  was  sent  to  the  hospital  at  Quincy,  Illinois,  and 
thence  furloughed  on  December  24th,  1864.  He  was,  on  February,  1865,  promoted  to  a lieutenantcy  in  the  147th  Illinois 
Volunteers,  and  was  mustered  out  oir  January  20th,  1866.  His  name  does  not  appear  on  the  Pension  List. 

Case. — Private  Johrr  Miller,  Co.  I,  12th  New  Jersey  Volunteers,  aged  45  years,  was  wounded  at  the  battle  of  the 
Wilderness,  Virginia,  May  6th,  1864,  by  a conoidal  musket  ball  which  fractured  the  external  orbital  prrocess  of  the  frontal  borre. 
He  was  admitted  to  the  hospital  of  the  2d  division.  Second  Corps,  and  thence  conveyed  to  the  Mount  Pleasant  Hospital, 
Washington,  where  he  was  admitted  on  May  29th,  1834.  Death  resulted  on  the  22d  of  June. 

Case. — Private  George  Mills,  Co.  M,  8th  Illinois  Cavalry,  aged  33  years,  at  Beverly  Ford,  Virginia,  June  9th,  1863, 
was  struck  in  the  forehead  by  a carbine  ball  which,  passing  from  left  to  right,  fractured  the  outer  table  of  the  frontal  bone  over 
the  left  eye,  near  the  external  angle.  He  was  conveyed  to  Washington  and  admitted  into  the  Lincoln  Hospital  on  the  following 
d.ay,  suffering,  from  time  to  time,  severe  pain  and  vomiting.  Ic(!  water  dressings  were  applied  to  the  head,  and  a resti'icted 
diet  ordered;  anodynes  being  employed  to  relieve  the  pain.  In  a few  days  the  severity  of  the  pain  subsided.  He  improved 
rapidly,  and  was  returned  to  duty  on  August  6th,  1833.  The  case  is  reported  by  Acting  Assistant  Surgeon  Win.  Cannifi’.  In 
May,  1867,  Pension  Examining  Surgeon  J.  B.  Lyman  reported,  that  this  pensioner  had  a permanent  enlargement  of  the  jmpil  of 
the  left  eye,  and  immobility  of  the  iris,  and  that  he  considered  the  functions  of  the  retina  permanently  impaired. 

Case. — Private  James  Murphy,  Co.  K,  96th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Spottsylvania, 
Virginia,  May  12th,  1864,  by  a conoidal  ball  which  entered  behind  the  right  temporal  fossa,  passed  forward  and  fractured  the 
outer  table  of  the  frontal  bone  at  the  supra-orbital  ridge.  He  was  conveyed  to  Washington,  D.  C.,  and  on  May  18th  admitted 
to  Douglas  Hospital.  There  was  no  depression,  but  the  right  pupil  was  widely  dilated  and  vision  impaired.  No  brain  symp- 
toms occurred  at  any  time.  Poultices  were  applied  and  portions  of  bone  subsequently  removed.  The  patient  recovered,  and 
on  June  18th  was  sent  to  Haddington  Hospital,  and  on  July  23d,  1864,  returned  to  duty.  He  is  not  a pensioner. 

Case. — Private  Constantine  O’Donnell,  Co.  G,  184th  Pennsylvania  Volunteers,  aged  34  years,  was  wounded  at  the 
battle  of  Cold  Harbor,  Virginia,  June  3d,  1864,  receiving  a fracture  of  the  external  table  of  the  frontal  sinus  by  shell.  He  was 
admitted  to  the  2d  division,  Second  Corps,  field  hospital,  and  on  the  7th  was  conveyed  to  the  Carver  Hospital  at  Washington 
Several  sequestra  were  removed,  and  simple  dressings  were  applied.  On  the  11th  he  was  transferred  to  the  Haddington 
Hospital,  Philadelphia,  and  on  June  26th  death  supervened  from  compression  of  the  brain.  [There  was  no  autopsy.] 

17 


130 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Case. — Privato  James  B.  Perkins,  Co.  11,  20th  Connecticut  Volunteer.s,  aged  23  years,  was  wounded  at  tlie  battle  of 
' Chancellorsville,  Virginia,  May  3d,  1803,  by  a musket  ball  which  fractured  the  frontal  bone  an  inch  above  the  right  eye  and 
lodged  in  the  frontal  sinus.  Ho  was  taken  prisoner,  but  was  paroled  on  May  10th,  and  admitted  two  days  snbseejuently  into 
the  Held  hospital  of  the  Twelfth  Corps.  He  was  transferred  to  Fairfax  Seminary  hospital  on  June  14th,  and  thence  to  Phila- 
delphia on  the  17th,  and  admitted  into  Mower  Hospital.  On  the  28th  an  examination  of  the  wound  revealed  the  external 
table  denuded  and  sliglitly  depressed.  On  July  10th  the  wound  was  discharging  healthy  pus,  and  on  August  5th  had  closed, 
except  an  opening  half  an  inch  wide.  On  November  23d  he  had  sufficiently  recovered  to  be  placed  on  guard  duty  in  the 
hospital.  On  December  8th  a slight  swelling  over  the  right  frontal  protuberance  was  observed.  The  probe  detected  small 
loose  fragments  of  bone.  Acting  Assistant  Surgeon  J.  M.  McGrath  made  a straight  incision  an  inch  in  length,  extending  from 
the  fistulous  orifice  over  the  superciliary  ridge.  The  outer  table  of  the  skull  was  found  destroyed,  and  a musket  ball  almost 
completely  divided  through  its  centre  and  spread  open,  was  discovered  partially  imbedded  in  the  frontal  sinus.  The  missile, 
together  Avith  several  fragments  of  bone,  was  removed  by  forceps.  The  wound  was  closed  by  adhesive  strips,  and  cold  watiu’ 
dressings  were  applied.  The  patient  improved  gradually,  and  by  January  18th,  1864,  the  wound  had  healed  except  at  a small 
opening  through  which  there  was  a slight  discharge  of  healthy  pus.  On  March  31st  he  was  transferred  to  New  Haven  to  the 
Knight  Hospital,  whence  he  was  returned  to  duty  on  May  7th,  1864.  The  case  is  I'eported  by  Surgeon  Joseph  Hopkinson, 
U.  S.  V.  The  name  of  this  patient  is  not  upon  the  rolls  of  the  Pension  Office. 

Case. — Private  Henry  E.  Snap,  Co.  I,  18th  Kentucky  Volunteers,  was  wounded  at  the  battle  of  Chickamauga,  Georgia, 
September  19th,  1833,  by  a conoid.al  musket  ball  which  penetrated  the  external  table  of  the  frontal  bone  at  the  left  superciliary 
ridge  and  lodged  in  the  frontal  sinus.  The  missile  was  extracted,  and  the  wound  suitably  dressed  at  the  field  hospital  where 
the  patient  remained  until  November  27th,  when  he  was  sent  to  Lexington,  Kentucky.  He  was  returned  to  duty  December 
28th,  but  being  found  unfit  for  service  was  again  admitted  into  a general  hospital  at  Murfreesboro’,  Tennessee,  January  23d, 
1884.  He  now  fully  recovered  and  was  returned  to  duty  on  March  14th,  1834.  He  is  not  reported  as  an  applicant  for  pension. 

Case. — Private  Orrin  C.  Spencer,  Co.  F,  11th  Connecticut  Volunteers,  aged  18  years,  was  w'ounded  at  the  battle  of 
Antiet.am,  Maryland,  September  17th,  1862,  by  a musket  ball  which  fractured  the  outer  table  of  the  frontal  bone  at  its  superior 
portion  and  to  the  left  of  the  median  line.  He  was  stunned,  but  after  reaction,  endeavored  to  walk,  but  was  too  faint  and  giddy 
to  go  far.  With  the  assistance  of  two  comrades  he  retired  to  a field  hospital  where  cold  water  was  applied  to  the  wound.  He 
was  transferi'ed  to  Frederick,  and  thence  to  Washington,  entering  Capitol  Hospital  on  the  22d.  On  the  24th  he  was  sent  to 
the  DeCamp  Hospital,  David’s  Island,  New  York  Harbor,  where  he  arrived  on  the  28th.  The  wound  was  discharging  freely. 
At  the  expiration  of  a week  erysipelatous  action  set  in,  which  was,  however,  readily  combatted  by  a purge  and  the  local 
application  of  iodine.  On  October  26th  two  pieces  of  tlie  outer  table  of  the  frontal  bone  were  removed.  At  times  he  suffered 
severe  p.ain  over  his  eyebrows  which  extended  over  the  left  side  of  his  head,  and  occasionally  he  was  so  dizzy  that  he  could 
not  walk  across  the  ward.  He  was  discharged  from  the  service  on  November  12th,  1862.  Tlie  wound  had  healed,  but 
dizziness  occasionally  recurred.  On  .January  3d,  1863,  the  Commissioner  of  Pensions  stated  that  Spencer  was  a pensioner, 
that  his  disability  was  rated  at  one-third,  and  the  pi-ognosis  of  its  duration  doubtful.  Surgeon  S.  W.  Gross,  U.  S.  V.,  reports 
the  early  history  of  the  case. 

Case. — Sergeant  Paul  P.  Starke,  Co.  H,  95th  Pennsylvania  Volunteers,  aged  21  years,  received,  at  the  battle  of  Spott- 
sylvania  Court-house,  Virginia,  May  12th,  1864,  a gunshot  fracture  of  the  external  table  of  the  frontal  bone,  at  the  external 
edge  of  the  left  orbit.  He  was  immediately  admitted  to  the  hospital  of  the  1st  division.  Sixth  Corps,  and  on  the  19th  trans- 
ferred to  the  Carver  Hospital.  Sequestra  were  i-emoved  from  the  wound  and  simple  dressings  applied.  The  patient  recovered, 
was  furloughed  on  May  27th,  1864,  and  returned  to  the  hospital  June  29th.  He  was  pensioned,  and  on  October  15th,  1866, 
Pension  Examining  Surgeon  J.  Cummiskey,  reported  his  disability  as  one  quarter,  and  its  duration  doubtful. 

Case. — Private  Leonard  H.  Washburn,  Co.  E,  1st  Maine  Heavy  Artillery,  aged  21  years,  was  wounded  at  the  battle  of 
Spottsylvania  Court  House,  Virginia,  May  19th, -1834,  by  a conoidal  ball  which  fractured  the  outer  table  of  the  frontiil  bone. 
He  remained  in  the  field  hospital  until  May  24th,  when  he  was  conveyed  to  Washington  and  admitted  to  the  Carver  Hospital. 
On  June  1st  he  was  sent  to  the  Mower  Hospital,  Philadelphia.  The  patient  recovered  and  was  returned  to  his  regiment  for 
duty  December  27th,  1864.  He  served  in  the  field  until  the  middle  of  March,  1885,  when  he  was  again  admitted  to  the  field 
hospital  and  sent,  on  April  10th,  to  the  Armory  Square  Hospital,  with  aphonia  and  partial  amaurosis,  the  latter  a consequence 
of  the  old  wound.  He  was  discharged  on  June  9th,  1865.  On  August  3d,  1839,  Pension  Examining  Surgeon  E.  A.  Thompson 
reports  that  this  patient  had  a constant  discharge  of  pus  from  the  wound,  and  severe  headache  after  exertion  or  exposure;  that 
he  was  unable  to  perform  any  labor  that  requires  exertion  or  mental  eftbrt,  and  that  the  severe  pain  affected  his  general  health. 

Case. — Private  Charles  F.  B , Co.  D,  101st  Ohio  Volunteers,  received,  at  the  battle  of  Murfreesboro’,  Tennessee, 

December  31st,  1862,  a gunshot  fracture  of  the  outer  table  of  the  frontal  bone  over  the  right  eye  by  a conoidal  musket  ball.  He 
was  treated  at  the  hospital  of  the  1st  division  of  the  Fourteenth  Corps  until  January  7th,  1863,  when  he  was  sent  to  hospital 
No.  14,  at  N.ashville,  whence  he  was  discharged  from  service  on  April  23th,  1833,  and  pensioned.  The  pension  examiner  reports 
that  the  missile  lodged  in  the  frontal  sinus  whence  it  was  extracted,  and  that  the  pensioner  suffers  from  persistent  pain  in  the 
head  and  vertigo  with  loss  of  sight,  and  that  he  is  unable  to  perform  any  manual  labor. 

Next  in  frequency  to  the  fractures  of  the  outer  plate  of  the  frontal  sinus,  among  the 
cases  of  gunshot  fracture  reported  as  limited  to  the  external  table,  were  those  of  the  mastoidal 
region  of  the  temporal.  In  nine  cases,  in  which  the  injuries  are  described  with  precision, 
the  mastoid  process  was  detached  or  seriously  fractured  in  seven,  and  the  outer  lamina  of 
the  contiguous  portion  of  the  temporal  in  two.  One  case  was  fatal.  Five  of  the  patients 


GUNSHOT  FRACTURES  OF  THE  OUTER  TABLE  OF  THE  SKULL. 


131 


were  discharged  or  mustered  out,  and  three  of  these  were  subsequently  pensioned.  Three, 
recovered  and  were  returned  to  duty.  Permanent  deafness  in  three  instances,  and  trouble- 
some caries  in  two,  are  reported  in  the  cases  of  those  who  recovered. 

Case. — Private  Albert  Bradley,  Co.  E,  13tli  New  Jersey  Volunteers,  was  wounded  at  the  battle  of  Antietam,  September 
17th,  1862,  by  a musket  ball  which  chipped  off  a portion  of  the  exterior  lamina  of  the  left  temporal  bone,  and  lodged  behind  the 
ramus  of  the  lower  jaw.  On  September  24th  he  was  sent  to  the  South  Street  Hospital,  Philadelphia,  and  on  the  2Gth  the  missile 
was  extracted.  In  the  course  of  the  treatment  the  wound  reju'atedly  reopened,  but,  ultimately,  healed  fii'inly,  and  the  patient 
was  returned  to  duty,  December  22d,  1832.  The  case,  thus  far,  was  reported  by  Surgeon  P.  B.  Goddard,  U.  S.  V.  The  j)atient 
was  discharged  on  May  26th,  1833,  and  pensioned.  On  June  lOtli,  1839,  his  pension  was  increased.  Pension  Examiner  A.  W. 
Woodlmll  having  reported  that  he  was  entirely  deaf  in  the  left  ear;  that  the  cicatrix  was  constantly  tender  and  painful;  that  he 
had  severe  attacks  of  headache  and  vertigo,  induced  by  exposure  to  the  sun  or  by  changes  of  temperature. 

Case. — Corporal  John  C.  B , Co.  K,  .3th  Mary laiul  Volunteers,  aged  33  years,  was  'wounded  at  the  battle  of  Antietam, 

Maryland,  September  17th,  1832.  The  missile  entered  the  posterior  pai't  of  the  neck,  one  and  one-half  inches  below  the  occipital 

protuberance  just  forward  of  the  ligamentum  nuchm,  passed  ujiward  and  forward, 
and  emerged  above  the  right  ramus  of  the  lower  jaw.  He  was  sent  to  Washing- 
ton, and  admitted  to  Columbian  College  hospital  on  September  20th.  No  fracture 
could  be  discovered.  He  complained  of  difficulty  in  mastication,  and  there  was 
evidently  some  injury  of  the  facial  nerve.  In  a few  days  the  wound  began  to  sujv 
purate,  and  the  patient  walked  about  the  ward  appai’ently  doing  well.  October 
8th,  suppuration  suddenly  ceased.  Chills  occurred;  the  frequency  of  recurrence 
increased  until  October  Pith,  when  there  was  heavy  deep  breathing,  and  tnany 
symjUoms  of  meningitis.  Drowsiness  and  stupor  followed,  and  coma  and  death 
took  ])lace  October  14th,  1862.  At  the  autopsy  it  was  found  that  the  ball  had 
detached  the  mastoid  process,  denuded  the  occipital  and  temj)oral  bones  of  perios- 
teum in  the  vicinity  of  the  fracture.  There  was  some  redness  and  congestion  of 
the  blood  vessels,  but  no  traces  of  inflammation  could  be  found  in  the  brain  itself- 
The  specimen  was  sent  to  the  Army  Medical  Museum  by  Surgeon  A.  VanDerveer, 
68th  New  York  Volunteers,  and  is  represented  in  the  adjacent  wood-cut,  (Fjg.  43.) 
The  pu’oeess  is  entirely  detached  at  the  base,  the  mastoid  cells  are  opened,  of  course, 
but  there  is  no  fissuring  or  other  lesion  of  the  inner  table  and  no  attempt  at  repair. 
Dr.  Van  Derveer’s  report  does  not  refer  to  any  impairment  of  the  sense  of  hearing 
prior  to  the  supervention  of  coma.* 

Case. — Private  John  Burke,  Co.  K,  9th  Illinois  Volunteers,  was  wounded  at  the  battle  of  Corinthj  Mississippi,  October 
3d,  1862,  by  a conoidal  musket  ball  which  perforated  the  middle  portion  of  the  left  ear,  and  passing  under  the  integuments,  across 
the  mastoid  process,  fractured  the  outer  lamina  of  the  bone.  He  was  admitted  to  the  hospital  of  the  2d  division  of  the  Army  ot 
the  Tennessee,  and  on  October  13th  was  sent  to  the  hospital  at  Mound  City,  Illinois.  Simple  dressings  only  were  employed. 
Burke  was  returned  to  duty  on  October  2Sth,  1862.  Ilis  name  is  not  upon  the  list  of  pensioners. 

Case. — Private  William  H.  Bush,  Co.  F,  27th  Massachusetts  Volunteers,  aged  26  years,  was  wounded  before  Petersburg, 
June  18th,  1834,  by  a piece  of  shell  which  contused  the  left  temporal  bone.  He  was,  on  the  following  day,  admitted  to  the  field 
hospital  of  the  Eighteenth  Corps.  The  injury  was  considered  slight,  and  the  man  returned  to  his  regiment  for  duty.  No  further 
record  of  the  case  can  be  found  until  January  27th,  183.5,  when  he  was  admitted  to  the  Foster  Hospital,  at  New  Berne,  with 
ulceration  of  the  scalp.  He  was  again  returned  to  duty  on  March  8th,  1885,  but  on  March  31st  was  admitted  to  the  DeCamp 
Hospital,  at  David’s  Island.  On  April  4th  he  was  transferred  to  the  Dale  Hospital,  Worcester,  and  now  it  was  definitely  ascer- 
tained that  the  right  temporal  bone  was  fi-actured,  though  no  depression  existed.  The  man  was  mustered  out  of  service  on  June 
17th,  1875.  He  afterwards  made  a claim  for  a pension,  but  withdrew  it,  without  awaiting  a decision.  The  report  to  the  Pension 
Office  by  Examining  Surgeon  J.  H.  Watei-man,  states  that  the  patient  had  a fracture  of  the  outer  table  of  the  left  temporal  bone, 
portions  of  which  had  been  removed  by  caries.  In  October,  1865,  the  wound  was  healing  and  the  disability  was  not  considered 
permanent. 

Case. — Private  Alexander  J.  Clark,  Co.  D,  63d  Pennsylvania  Volunteers,  was  wounded  at  Charles  City  Cross  Roads  on 
J uno  30th,  1862.  The  missile  entered  behind  the  left  ear,  and  injured  the  mastoid  jmocess  of  the  temporal  bone.  He  was  admitted, 
on  August  17th,  to  the  hospital  at  Point  Lookout,  Maryland,  and  discharged  from  the  service  and  pensioned  on  December  25th, 
1862.  The  wound  had  healed  with  an  irregular  cicatrix,  and  the  hearing  was  somewhat  affected.  He  re-enlisted  on  February 
8th,  1864,  in  Co.  F,  Pennsylvania  Light  Artillery,  and  was  mustered  out  on  June  26th,  1865.  On  July  Jlst,  1866,  Pension 
Examiner  G.  McCook,  of  Pittsburg,  reported  that  the  hearing  was  affected,  and  there  was  a purulent  discharge  from  the  ear,  and 
pain  in  its  vicinity. 

Case. — Private  Daniel  Clymer,  Co.  B,  38th  Ohio  Volunteers,  received,  in  an  engagement  near  the  Chattahoochie  River, 
Georgia,  July  20th,  1864,  a gunshot  partial  fracture  of  the  left  mastoid  process.  He  was  admitted  into  the  field  hospital  of  the 
3d  division.  Fourteenth  Corps,  and  a few  days  later  sent  to  the  No.  2 hospital,  Chattanooga,  Tennessee.  He  was  returned  to 
duty  September  20th,  1864.  His  name  does  not  appear  on  the  Pension  List. 

* Sec  Catalogue  of  the  Surgical  Section  A.  M.  M.,  p.  11,  and  Circular  No.  fi,  S.  G.  O.,  18C5,  p.  12.  The  history  of  the  specimen  was  procured 
subsequently  to  the  date  of'thosc  publications.  * 


132 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Case. — Lieutenant  Joseph  H.  Heston,  Co.  D,  4th  New  Jersey  Volunteers,  was  wounded  at  the  battle  of  the  Wilderness, 
Virginia,  May  5th,  1864,  by  a buckshot  which  injured  the  mastoid  ju’ocess  of  the  temporal  bone.  He  was  admitted  to  the  hospi- 
tal of  the  1st  division  of  the  Sixth  Corps,  but  returned  to  his  regiment  in  a short  time.  He  was  mustered  out  with  his  regiment, 
June  9th,  1865.  His  name  is  not  upon  the  Pension  Rolls.  [Surgeon  L.  W.  Oakley,  2d  New  .Jersey,  reporter.] 

Case. — Private  Henry  Meixner,  Co.  F,  Gist  Pennsylvania  Volunteers,  aged  23  j'ears,  was  wounded  in  the  defences  of 
Washington,  D.  C.,  on  July  12th,  1834,  by  a conoidal  ball  which  fractured  the  outer  plate  of  the  mastoid  process  of  the  temporal 
bone.  He  was,  on  the  same  day,  admitted  to  the  Mount  Pleasant  Hospital.  The  wound  became  gangrenous,  and  on  July  30th 
hatmorrhage  to  the  amount  of  ten  ounces  occurred  from  a branch  of  the  occipital  artery.  On  the  following  day  haemorrh.ag(! 
recurred,  but  was  arrested  by  compression.  On  September  8th  Meixner  was  furloughed,  and  on  November  8th  he  was  admitted 
to  the  hospital  at  Pittsburg,  and  on  May  22d,  1835,  discharged  from  the  service.  His  name  is  not  upon  the  Pension  List. 

Case. — Pi-ivate  Samuel  N.  Morse,  Co.  A,  74th  Illinois  Volunteers,  aged  27  years,  was  wounded  in  an  engagement  at 
lUngston,.  Georgia,  klay  17th,  1834,  by  a couoidal  musket  ball  which  entered  near  the  right  ear,  detaching  a scale  from  the  mas- 
toid process  of  the  right  temporal  bone,  and  passed  through  the  cheek.  He  was,  on  the  same  day,  admitted  to  the  hospital  of  the 
2d  division.  Fourth  Corps,  and  thence  sent  to  Chattanooga  and  Nashville,  and  to  the  Jefferson  Hospital  in  Indiana.  On  July 
26th  he  was  sent  to  Camp  Butler,  Illinois;  furloughed  on  September  2d,  and  on  November  2d  admitted  to  the  hospital  at  Quincy, 
Illinois.  He  was  finally  discharged  from  service  on  the  29th  of  May,  1865.  At  this  date.  Pension  Examiner  J.  Robbins  reports 
that  the  patient  was  deaf  in  the  right  ear,  and  that  his  system  was  enfeebled  by  long-continued  suppuration. 

In  the  four  following  cases,  it  was  believed,  after  careful  exploration,  that  the  outer 
table  alone  of  the  parietal  was  fractured : 

Case. — Private  O.  G.  Ayres,  Co.  A,  22d  Virginia  Infantry,  aged  24  yeai’s,  received,  at  the  action  at  Mine  Run,  Virginia, 
November  27th,  1863,  a gunshot  fracture  of  the  outer  table  of  the  right  parietal  bone.  He  was  admitted  to  the  Chimbor.azo  Hos- 
pital, Richmond,  on  November  30th.  He  had  slight  fever  with  coma,  and  the  pulse  was  slow,  leading  to  the  supposition  th.at 
both  tables  were  fractured;  but,  on  closer  examination  it  was  discovered  that  the  outer  table  only  was  fractured  to  the  extent  of 
one  and  one-half  inches.  The  bowels  were  well  opened  with  calomel,  gamboge,  and  castor  oil,  and  the  coma  abated.  Cold  appli- 
cations were  constantly  applied  to  the  wound,  and  calomel  was  pushed  to  ptyalism.  Tlie  patient  became  rational  and  the  coma 
dis.appeared.  On  December  5th  erysipelas  developed  itself  over  the  head  and  fiice.  The  parts  were  painted  with  iodine  and 
tincture  of  sesqui-chloride  of  iron  ^vas  administered  internally.  On  the  15th  the  patient  had  almost  entirely  recovered,  and  was 
furloughed  on  December  25th,  1833.  He  appeared  before  a medical  examining  board  of  General  Heth’s  division,  September  8th, 
1864,  and  was  retired  on  account  of  cerebral  disturbance  accompanied  by  convulsions. 

Case. — Private  George  Atkinson,  Co.  E,  7th  W^'isconsin  Volunteers,  aged  24  years,  was  wounded  at  the  battle  of  the  W^il- 
derness,  Virginia,  May  5th,  1864,  by  a conoidal  musket  ball  which  injured  the  outer  table  of  the  skull.  He  was  sent  to  the  hos- 
pital of  the  4th  division.  Fifth  Corps,  thence  on  Slay  12th  to  the  2d  division  hospital  at  Alexandria,  thence  on  the  22d  to  the  Sat- 
terlee  Hospital,  Philadelpliia,  where  the  injury  is  reported  as  a wound  of  scalp.  Having  recovered,  he  was  returned  to  duty  on 
the  17th  of  September,  1864.  He  was  discharged  on  .July  3d,  1865,  and  pensioned.  On  November  12th,  1868,  Pension  Exam- 
iner G.  W.  Eastman  reported  that  there  then  had  been  fracture  of  the  outer  table  of  both  parietals,  and  that  the  patient  complained 
of  numbness  of  the  extremities. 

Case. — Assistant  Surgeon  Levi  Jewett,  14th  Connecticut  Volunteers,  aged  20  years,  while  attending  upon  the  wounded 
at  the  battle  of  Ream’s  Station,  Virginia,  Augus^  25tti,  1884,  was  struck  upon  the  left  side  of  the  head  by  a fr.agraent  (»f  shell 
which  fractured  the  outer  table  of  the  parietal  bone,  and  the  zygomatic  process  of  the  temporal,  denuding  the  skull  over  an  equi- 
lateral triangular  sui-firce  of  four  inches  a side.  For  a few  days  he  was  treated  in  the  hospital  of  the  Second  Corps,  then  trans- 
ferred to  Washington,  and  on  the  29th  admitted  into  the  Emory  Hospital.  So  far  as  recorded,  cold  water  dressings  formed  the 
main  treatment.  On  September  1st  he  was  transferred  to  the  Seminary  Hospital  in  Georgetown,  and  thence  on  December  3d  to 
the  Officer’s  Hospital  at  Annapolis,  Maryland.  He  remained  under  general  treatment  until  January  Gth,  1865,  when  he  was  dis- 
charged from  service.  He  still  complained  of  a fullness  of  tlie  head  and  of  imperfect  vision  of  the  left  eye,  though  there  was  no 
perceptible  difference  in  the  organs  of  vision.  He  was  naturally  shoi  t sighted.  The  general  condition  of  the  patient,  however, 
was  good.  The  case  is  reported  by  Acting  Assistant  Surgeon  J.  Longenecker.  This  officer  has  not  aj)plied  for  a pension. 

Case. — Private  JF.  B.  Taylor,  Co.  G,  38th  Alabama  Infantry,  received,  at  the  Rattle  of  Dalton,  Georgia,  Api’il  9th,  1864, 
a gunshot  fracture  of  the  external  table  of  the  right  parietal  bone.  He  was  admitted  into  the  hospital  at  Dalton  on  the  same  day. 
Exfoliation  of  bone  took  place.  On  June  23d,  1864,  he  was  furloughed. 

A number  of  cases  of  simple  grooving  of  the  outer  plate  and  diploe  are  reported,  in 
which  the  injury  appears  not  to  have  implicated  the  inner  table : 

Case. — Private  John  Anderson,  Co.  A,  77th  Illinois  Volunteers,  was  wounded  at  the  battle  of  Arkansas  Post,  January 
11th,  1863,  by  a conoidal  musket  ball  which  struck  at  the  junction  of  the  frontal  and  left  parietal  bones,  and  passed  backward 
near  the  sagittal  suture  almost  as  far  as  the  lambdoidal,  denuded  the  bone  and  grooved  the  outer  table  for  a length  of  two  and 
one-half  inches.  He  was  carried  on  board  the  hospital  steamer  D.  A.  January,  and  conveyed  to  Memphis,  Tennessee,  where 
he  was  admitted,  on  the  23d,  into  Hospital  No.  3.  No  fracture  or  depression  was  observed,  but  exfoliation  shortly  took  place, 
and  several  pieces  of  the  external  table  were  removed.  The  inner  tafele,  also,  was  found  to  be  necrosed,  and  a month  after  the 
reception  of  the  injury  a detached  piece  of  the  inner  plate,  three-fourths  of  an  inch  in  diameter,  was  extracted,  leaving  the 


GUNSHOT  FRACTURES  OF  THE  OUTER  TABLE  OF  THE  SKULL. 


133 


pulsation  of  the  brain  clearly  visible.  Subsequently,  other  small  portions  of  the  external  plate  were  remove<l  as  they  became 
loose.  The  sight  of  the  left  eye,  though  not  at  first  affeote:!  by  the  injury,  bec.ame,  in  the  course  of  two  or  three  weeks,  to  use 
the  expression  of  the  patient,  feeble  ami  glimmering,  so  that,  for  instance,  a printed  page  would  appear  blurred.  He  was 
discharged  from  service  and  pensioned  on  the  3d  of  April,  1863.  The  wound  had  not  fully  healed,  but  was  gradually 
contracting;  the  vision  remained  impaired.  The  case  is  reported  by  Assistant  Surgeon  Thomas  T.  Smiley,  U.  S.  V.*  On 
October  1st,  1853,  Pension  Examiner  H.  S.  Hurd  reported  that  this  man  had  partial  loss  of  sight  of  theneft  eye.  On  August 
6th,  1867,  Pension  Examiner  J.  W.  Spalding  reported  that  the  ball  penetrated  the  right  parietal,  “ remaining  some  time  in  the 
brain,  which  sloughed  considerably a statement  so  at  variance  with  previous  reports  that  it  was  probably  derived  from 
hearsay. 

Case. — Private  John  Boylan,  Co.  I,  1st  Michigan  Volunteers,  aged  26  years,  was  wounded  at  the  battle  of  Gaines’s 
Mill,  Virginia,  June  27th,  1862,  by  a conoidal  musket  ball  which  struck  the  right  parietal  bone  at  its  superior  posterior  angle, 
carried  away  a piece  of  the  scalp  larger  than  a half  dollar,  and  grooved  the  bone  for  a distance  of  three-fourths  of  an  inch.  He 
was  unconscious  for  nearly  thirty  minutes  after  the  reception  of  the  injury,  was  then  taken  prisoner,  and 
conveyed  to  Richmond,  where  the  wound  was  dressed  for  the  first  time,  on  June  30th,  with  cold  water 
dressings.  The  left  arm  had  become  paralyzed  and  devoid  of  sensation,  and  continued  so  for  about  a 
week.  He  remained  in  Richmond  about  three  weeks,  when  he  was  exchanged  and  sent  to  the  De  Camp 
Hospital,  David’s  Island,  New  York  Harbor.  The  wound  had  cicatrized  but  slightly,  and  was  discharging 
very  offensive  pus,  and  the  bone  was  found  to  be  necrosed.  On  July  28th  a portion  of  the  external  table, 
and  on  the  following  day  the  coiTesponding  portion  of  the  diploe  and  vitreous  table  were  removed, 
exposing  the  dura  mater  to  the  extent  of  an  inch  and  a half.  Cold  water  dressings  were  applied  and  the 
patient  recovered  rapidly.  At  the  time  of  his  discharge,  November  16th,  1862,  the  wound  had  healed 
perfectly,  the  cicatrij^  presenting  a depression  sufficiently  large  to  receive  the  index  finger.  The  parts 
were  very  tender,  and  pressure  would  produce  a sensation  of  dizziness.  Excepting  a slight  intermittent 
headache,  no  symptoms  of  br.ain  complication  occurred  at  any  time.  The  pathological  specimen  was 
contributed  to  the  Army  Medical  Museum,  and  consists  of  two  exfoliations.  The  smaller,  one  inch  in 
length,  consists  mainly  of  diploe ; the  other,  which  measures  three-fourths  of  an  inch  by  one  and  a half 
inches,  is  blackened  and  perforated  in  the  centre.  It  is  i-epresented  in  the  adjacent  wood-cut,  (Fig.  47.) 
The  history  was  contributed  by  Surgeon  S.  W.  Gross,  U.  S.  V.  Boylan’s  name  is  not  upon  the  Pension  List. 

Case. — Private  Noah  Frey,  Co.  I,  54th  Pennsylvania  Volunteers,  aged  22  years,  received,  at  the  battle  of  New  Market, 
Virginia,  May  15th,  1864,  a gunshot  wound  of  the  right  parietal  region,  about  two  and  one-half  inches  above  the  ear,  with 
partial  fracture  of  the  cranium.  He  was  sent  to  the  hospital  at  Cumberland,  Maryland,  on  May  18th.  There  was  a longitudinal 
superficial  furrow  about  two  inches  in  length  running  in  an  antero-posterior  direction.  Some  fragments  of  bone  came  away  in 
the  progress  of  the  case.  Simple  dressings  were  used.  The  wound  gradually  healed,  and  he  w,as  returned  to  duty  October 
26th,  1864.  The  case  is  reported  by  Surgeon  J.  B.  Lewis,  U.  S.  V.  The  name  of  the  patient  is  not  upon  the  I’ension  List. 

Case. — Private  J.  M.  Hardin,  Co.  B,  27th.  North  Carolina  Infantry,  received,  at  the  battle  of  the  Wilderness,  Virginia, 
May  6th,  1864,  a gunshot  wound  of  the  scalp  in  the  line  of  the  coronal  suture,  with  loss  of  a portion  of  the  outer  table  of  the 
bone.  He  was  admitted,  on  May  11th,  into  the  hospital  at  Farmville,  and  he  was  furloughed  June  3d,  1864. 

Case. — Private  Thomas  Mahoney,  Co.  E,  89th  Illinois  Volunteers,  aged  23  years,  was  wounded  in  the  engagement 
near  Dallas,  Georgia,  May  27th,  1864,  by  a conoidal  musket  ball  which  struck  the  upper  pai  t of  the  right  parietal  bone, 
grooving  it  slightly.  He  was  admitted  to  the  hospital  of  the  Fourth  Corps  on  June  5th,  and  sent  to  No.  19,  Nashville ; 
on  June  17th,  to  No.  5,  New  Albany;  on  June  27th,  to  Jefferson  Barracks,  St.  Louis,  Missouri ;'  and  on  July  9th,  1864,  to  the 
hospital  at  Quincy,  Illinois,  whence  he  was  returned  to  duty  on  August  23d,  1864.  His  name  does  not  appear  as  an  applicant 
for  a pension. 

Case. Private  Wilkie  Martin,  Co.  H,  6th  Pennsylvania  Cavalry,  aged  25  yeai’s,  was  wounded  at  the  battle  of  the 
Wilderness,  Virginia,  Jlay  6th,  1864,  by  a conoidal  musket  ball  which  struck  at  the  vertex,  laid  bare  the  scalp,  and  grooved  the 
bone  for  a small  distance.  He  was  admitted  into  the  field  hospital  of  the  Cavalry  Corps  on  the  following  day,  and  on  the  23d 
sent  to  the  3d  division  hospital,  Alexandria.  Simple  dressings  were  used.  On  June  6th  the  patient  was  transfemxl  to  the 
Mower  Hospital,  Philadelphia,  and  on  November  7th,  1864,  he  was  discharged  from  the  service.  The  case  is  reported  by 
Surgeon  Edwin  Bentley,  U.  S.  V.  He  is  not  a pensioner. 

Case. — Private  .John  Michael,  Co.  E,  67th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  the  Wilderness, 
Virginia,  May  6th,  1834,  by  a conoidal  ball  which  entered  the  scalp  at  the  vertex  and  ploughed  out  a poition  of  the  scalp 
about  three  inches  in  length  and  one  inch  in  width,  and  grooved  the  outer  table  of  the  skull.  He  was  admitted  to  the  hospital 
of  the  1st  division  of  the  Sixth  Corps,  and  on  May  11th  was  sent  to  the  Columbian  Hospital  at  Washington,  and  May  15th  to 
the  Patterson  Park  Hospital,  Baltimore,  and  on  May  21st  to  the  hospital  at  York,  Pennsylvania.  On  May  31st  erysipelas 
appeared,  and  extended  rapidly  over  the  forehead  and  left  side  of  the  face,  and  the  j)arts  around  the  eye  became  much  swollen. 
Ice  water,  tincture  of  iodine,  and  acetate  of  lead  to  the  eye,  were  employed.  On  June  3d,  the  wound  had  healed  and  the  patient 
was  nearly  well.  He  was  returned  to  duty  on  September  29th,  1834.  The  case  is  reported  by  Surgeon  Henry  Palmer,  U.  S.  V. 
The  name  of  this  patient  does  not  appear  upon  the  Pension  List. 


*Scc  Boston  Medical  and  SargicalJournal,  Vol.  LXIX,  p.  15J,  September,  1803. 


Fio  47. — Exfolia- 
tion  resulting  from 
the  prooviiifT  of  the 
parietal  bone  by  a 
musket  ball.  Spec. 
974,  Sect.  I,  A.  M.  M. 


134 


WOUNDS  AND  INJURIES  OF  THE  'HEAD, 


Cask. — Private  James  W.  Slater,  Co.  C,  49th  Ohio  Volunteers,  aged  16  years,  was  wounded  in  an  engagement  at  Lost 
Mountain,  Tennessee,  June  14th,  1834,  by  a fragment  of  shell  which  grooved  the  external  table  of  the  frontal  bone.  He  was 
conveyed,  on  .June  22d,  to  the  Cumberland  Hospit.al  at  Nashville,  Tennessee,  where  he  remained  until  the  9th  of  August,  when 
he  was  transferred  to  the  Joe  Holt  Hospital,  at  Jelfsrsonville,  Indiana.  On  November  23th,  1834,  he  was  returned  to  duty,  and 
discharged  June  3d,  1865.  He  has, a pension  claim  pending.  Pension  Examiner  W.  W.  Cake  reports,  September  22d,  1866, 
that  portions  of  the  outer  wall  of  the  frontal,  above  the  right  eye,  had  been  removed,  and  th.at  the  applicant  suffered  from  cerebral 
disorder  on  exposure,  and  that  his  disability  might  be  rated  at  two-thirds  and  permanent. 

Case. — Corporal  Hendrick  J.  Smith,  Co.  E,  137th  New  York  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of 
Chancellorsville,  Virginia,  May  3d,  1863,  by  a fragment  of  shell  which  fractured  the  central  portion  of  the  right  parietal  bone, 
apparently  grooving  the  outer  table  only.  He  was  partially  insensible  for  the  first  three  days  after  the  reception  of  the 
injury,  and  remained  upon  the  field  for  eleven  days.  When  admitted  to  the  hospital  of  the  Twelfth  Corps,  May  14th,  1863,  he 
was  greatly  exhausted  from  privation  and  exposure,  and  his  countenance  presented  a wild  and  excited  appeai'ance.  Cold 
applications  were  applied  to  the  wound,  the  bowels  freely  opened  and  generous  diet  ordered.  On  May  20th  the  wound  was 
closing  and  the  patient  had  much  improved,  looking  well,  except  the  same  wild  expression  ; he  talked  rationally  but  the  memory 
was  lost.  He  was  returned  to  duty  on  June  1st,  1863.  He  is  not  reported  as  an  applicant  for  a pension. 

Case. — Private  L.  V.  Stewart,  Co.  A,  20th  Massachusetts  Volunteers,  aged  35  years,  was  wounded  at  the  battle  of 
Gettysburg,  Pennsylvania,  July  1st,  1833,  by  a fragment  of  shell  which  fractured  the  outer  table  of  the  parietal  bone  one  inch 
above  the  right  ear.  In  the  same  engagement  he  received  a wound  of  the  back.  He  was  treated  at  the  Seminary  Hospital 
until  the  10th  of  July,  and  then  sent  to  the  McKim  Mansion  Hospital,  Baltimore,  at  which  time  he  was  suffering  considerable 
pain  in  the  head,  left  eye,  and  face.  On  the  25th  paralysis  of  the  right  side  of  the  face  supervened,  by  which  the  mouth  was 
drawn  to  the  left  side._  In  connection  with  local  applications,  acetate  of  opium  in  camphor  water  was  employed,  by  which  the 
degree  of  pain  was  lessened,  though  the  paralysis  continued  the  same.  On  November  8th  he  was  furloughed,  and  on  the  30th 
transferred  to  the  Jarvis  Hospital.  He  recovered  and  was  transferred  to  the  Veteran  Reserve  Corps,  March  21st,  1864.  Acting 
Assistant  Surgeon  E.  H.  Sterling  reports  the  case.  The  name  of  the  patient  does  not  appear  on  the  Pension  Rolls. 

Case. — Private  Frederick  Strouse,  Co.  I,  26th  Michigan  Volunteers,  aged  31  years,  received,  in  the  engagement  at  Deep 
Bottom,  Virginia,  August  16th,  1834,  a gunshot  scalp  wound  at  the  vertex  with  fracture  of  the  outer  table  of  the  cranium.  He 
was  taken  prisoner,  but  subsequently  paroled  and  admitted  into  the  hospital  at  Camp  Parole,  Annapolis,  on  September  22d. 
On  February  21st,  he  was  admitted  to  the  Harper  Hospital,  Detroit,  Michigan,  and  on  June  7th,  1865,  discharged  from  service. 
Acting  Assistant  Surgeon  W.  H.  Chandler  certifies,  on  the  certificate  of  disability,  that  there  was  a gunshot  wound  of  the  crown 
of  the  head  fracturing  the  outer  table  of  the  skull. 

Ca.se. — Private  Willi.am  H.  Voss,  Co.  G,  5th  Delaware  Volunteers,  aged  35  years,  was  wounded  in  the  engagement  at 
the  South  Side  Railroad,  Virginia,  April  1st,  1865,  by  a fragment  of  shell  which  cut  the  scalp  and  furrowed  the  occipital 
protuberance.  He  was  admitted  to  the  hospital  of  the  2d  division  of  the  Fifth  Corps,  and  on  April  7th  was  sent  to  the  Finley 
Hospital,  Washington.  He  was  returned  to  duty  on  July  8th,  1835.  He  does  not  appear  to  have  been  an  applicant  for  a 
pension. 

Case. — Private  Jacob  Welsh,  Co.  A,  lOJ'th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Getty.sburg,  Penn- 
sylvania, .July  2d,  1833,  by  a fragment  of  shell  which  fractured  the  external  table  of  the  right  parietal,  the  bone  being  driven 
upon  the  diploeic  structure.  He  was  conveyed  to  the  hospital  at  York,  Pennsylvania,  on  July  12th.  No  ill  result  ensued  from 
the  injury.  On  October  Ist  small  portions  of  bone  were  removed.  Having  recovered,  he  was  returned  to  duty  on  November 
16th,  1863.  The  case  is  I’eported  by  Acting  Assistant  Surgeon  H.  L.  Smyser.  The  name  of  the  patient  is  not  upon  the 
Pension  List. 

Case. — Private  George  L.  Wood,  Co.  I,  5th  New  York  Volunteers,  was  wounded  at  the  battle  of  Gaines’s  Mill,  June 
27th,  1862,  by  a conoidal  musket  ball  which  struck  the  back  of  the  head  obliquely,  making  a long  scalp  wound  and  gi-ooving 
the  outer  table  of  the  occipital  bone.  He  wiis  treated  at  Ira  Harris  Hospital,  Albany,  New  York,  and  discharged  from  service 
on  December  15,  1862,  and  pensioned.  Pension  Examiner  S.  D.  Willard  reports,  June  18th,  1863,  that  this  pensioner  was 
much  disabled,  but  likely  to  recover  in  the  course  of  a few  years. 

Four  instances  are  reported  of  fracture  of  the  external  lamina  of  the  occipital  near  its 
protuberance  or  semicircular  ridges  : 

Case. — Private  C.  J.  Adams,  Co.  H,  21st  North  Carolina  Regiment,  aged  19  years,  was  wounded  at  the  battle  of 
Winchester,  Virginia,  September  19th,  1864,  by  a conoidal  ball  which  fractured  the  outer  table  of  the  occipital  bone.  Frag- 
ments of  the  bone  were  removed  at  the  hospital  of  the  Nineteenth  Corps  at  Winchester,  where  he  rem.ained  until  the  20th  of 
November,  when  he  was  conveyed  to  Martinsburg,  and  thence  sent  to  Baltimore,  Maryland,  entering  West’s  Buildings  Ho.spital 
on  December  11th.  On  January  8th,  1835,  he  was  sent  to  the  Prisoner’s  Camp,  Point  Lookout,  but  on  the  27th  was  admitted 
to  the  hospital  at  the  latter  place,  suffering  from  the  effects  of  the  wound.  Death  from  apoplexy  supervened  April  15th,  1 865. 

Case. — Private  Charles  D.  Fairbanks,  Co.  E,  2d  United  States  Sharpshooters,  aged  18  years,  was  wounded  in  front  of 
Petersburg,  Virginia,  November  20th,  1834,  by  a conoidal  ball  which  fractured  the  external  table  of  the  occipital  bone.  He 
was  conveyed  to  a field  hospital,  and  on  December  4th  was  admitted  to  Armory  Square  Hospital.  Simple  dressings  were 
ap]died  to  the  wound  until  April  1st,  1835,  when  a piece  of  tlie  outer  table,  an  inch  square,  was  removed.  The  p.aticnt  was 
returned  to  duty  April  22d,  18'3.5,  suffering  no  disturbance  of  his  cerebral  functions  from  the  injury.  His  name  is  not  upon  the 
Pension  List. 


GUNSPIOT  FRACTURES  OF  THE  OUTER  TABLE  OF  THE  SKULL. 


135 


Case. — Private  A.  McDonald,  Co.  E,  42d  Illinois  Volunteers,  aged  28  years,  was  wounded  at  the  battle  of  Eesaca, 
Georgia,  May  14th,  18(34,  by  a round  musket  ball  which  fractured  the  external  table  of  the  occipital  bone  near  the  junction  of 
the  lambdoidal  and  sagittal  sutures.  He  also  received,  in  the  same  engagement,  a fracture  of  the  spinous  process  of  the  third 
lumbar  vertebra,  the  ball  lodging,  and  being  cut  out  from  the  muscles  on  the  left  of  the  spine.  He  was  admitted,  on  the 
following  day,  into  the  hospital  at  Chattanooga,  '^'^nnessee,  and  on  the  17th  sent  to  the  Cumberland  Hospital  at  Nashville, 
where  he  remained  until  transferred  on  the  lOtn  of  July  to  Jefferson  Barracks,  Missouri.  He  was  subsequently  sent  to 
Keokuk  Hospital  in  Iowa,  where  he  arrived  on  July  28th,  18G4.  He  was  finally  sent  to  Springfield,  Illinois,  on  August  22d, 
and  mustered  out  of  service  October  3d,  1864.  From  the  report  of  Pension  Examining  Surgeon  T.  S.  Hening,  dated 
November  4th,  1864,  information  is  obtained  that  the  patient  then  suffered  from  vertigo  and  defective  vision,  and  that  these  were 
increased  by  any  exposure  to  the  heat  of  the  sun.  The  fracture  of  the  spinous  process  of  the  vertebra  produced  an  iiTitation 
at  the  neck  of  the  bladder  and  weakness  in  the  back.  There  had  also  been  a ffesh  wound  of  the  lower  part  of  the  right  leg 
which  had  sloughed  and  left  a painful  cicatrix  near  the  ankle.  The  pension  examiner  regarded  the  disabilities  of  this  pensioner 
as  total,  but  likely  to  diminish  in  a few  years. 

Case. — Private  George  Statwood,  Co.  K,  4th  New  Hampshire  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of 
Cold  Harbor,  Virginia,  June  4th,  1864,  by  a conoidal  Imll  which  fractured  the  outer  table  of  the  occipital  protuberance.  He 
was  at  once  admitted  to  the  hospital  of  the  Eighteenth  Corps,  thence  sent  to  the  Harewood  Hospital,  Washington,  D.  C.,  and 
on  June  16th  transferred  to  the  Knight  Hospital,  New  Haven,  Connecticut.  On  July  18th  he  was  sent  to  the  Ward  Hospital, 
Newark,  New  Jersey.  On  January  18th,  1865,  denuded  and  carious  boire  was  discovered  through  a lai’ge  gangrenous  opening 
in  the  scalp.  The  patient  was  placed  under  the  influence  of  chloroform  and  ether,  and  Acting  Assistant  Surgeon  W.  S.  Ward, 
removed  the  carious  bone.  Simple  dressings  were  applied  and  the  wound  healed  rapidly.  Statwood  was  discharged  from  the 
service  on  the  29th  of  May,  1865,  by  reason  of  disability  resulting  from  the  wound.  He  does  not  appear  to  have  made 
application  for  a pension. 

Many  cases  appear  on  the  reports  as  gunshot  fractures  of  the  external  table  of  the  skull, 
in  which  the  appearances  and  symptoms  are  not  defined  with  sufficient  precision  to  permit 
a satisfactory  judgment  as  to  the  accuracy  of  the  diagnosis.  Of  these,  twenty  are  alleged 
examples  of  gunshot  fracture  of  the  outer  plate  of  the  frontal  bone.  One  was  a fatal  case, 
and  the  diagnosis  was  probably  verified  after  death.  Two  were  cases  of  Confederate 
soldiers,  who  recovered  and  were  furloughed,  ami  unaccounted  for  subsequently.  One 
patient  deserted.  The  remaining  sixteen  cases  were  of  Union  soldiers,  of  whom  nine  were 
returned  to  duty,  one  to  modified  duty  in  the  Veteran  Reserve  Corps,  and  six  were  discharged 
for  disability.  The  Veteran  Reserve  soldier  and  one  of  the  discharged  men  are  on  the 
Pension  Roll.  The  fractures  are  reported  to  have  been  inflicted  by  conoidal  musket  balls 
in  eleven  instances,  by  round  musket  balls  in  two,  and  by  shell  fragments  in  two,  while  in 
five  cases  the  nature  of  the  missile  was  unknown  : 

Case. — Sergeant  Major  L.  M.  Andrews,  8th  Georgia  Regiment,  was,  on  June  3d,  1864,  admitted  to  the  Confederate 
hospital  at  Farmville,  Virginia,  with  a gunshot  fracture  of  the  external  table  of  the  frontal  bone.  He  was  very  much  debilitated 
from  dysentery  of  three  weeks’  standing,  but  he  gradually  improved,  and  was,  on  June  17th,  1864,  furloughed  for  forty  days. 

Case. — Corporal  Francis  Atwood,  Co.  B,  48th  New  York  Volunteers,  aged  30  years.  Fort  Wagner,  South  Carolina, 
July  18th,  1863.  Round  musket  ball.  Treated  at  Beaufort,  McDougal,  and  DeCamp  hospitals.  Discharged  from  service 
August  25th,  1864.  Not  on  Pension  List. 

Case. — Corporal  Hudson  Austin,  Co.  G,  12th  Connecticut  Volunteers,  aged  23  years.  Cedar  Creek,  Virginia,  October 
19th,  1864.  Conoidal  musket  ball.  Treated  at  Jarvis  and  Mower  hospitals.  Returned  to  duty  January  25th,  1865.  Not  on 
Pension  List. 

Case. — Sergeant  Benjamin  F.  Ball,  Co.  K,  127th  Illinois  Volunteers,  aged  25  years.  Atlanta,  Georgia,  August  25th, 
1864.  Conoidal  musket  ball.  Treated  at  field,  corps,  and  Nashville  hospitals.  Returned  to  duty  November  21st,  1864.  Not 
on  Pension  List. 

Case. — Private  Nelson  W.  Chase,  Co.  A,  6th  Vermont  Volunteers,  aged  21  years.  Cold  Harbor,  Virginia,  June  7,  1864. 
Treated  at  corps.  Carver,  and  Brattleboro’  hospitals.  Returned  to  duty  August  30th,  1864.  Not  on  Pension  List. 

Case. — Captain  .lames  Cross,  Co.  A,  99th  Pennsylvania  Volunteers.  Fredericksburg,  Virginia,  December  13th,  1862. 
Treated  at  Officers’  Hospital,  Washington.  Discharged  from  service  January  14th,  1864.  Not  on  Pension  List. 

Case. — Private  Charles  Dickel,  Co.  D,  72d  Pennsylvania  Volunteers.  Fiiedericksbiirgh,  Virginia,  December  13th,  1862. 
Trt^ated  at  Carver  Hospital,  Washington.  Discharged  from  service  February  IGth,  1883.  Not  on  Pension  List. 

Case. — Private  Martin  Everett,  Co.  B,  I24th  New  York  Volunteers,  aged  37  years.  Spottsylvania  Court-house,  May 
10th,  1864.  Conoidal  musket  ball.  Treated  at  corp.s,  Alexiuidria,  Mower,  and  DuCainp  hospitals.  Discharged  from  service 
October  3d.  1834.  Not  on  Pension  List. 


136 


WOUNDS  AND  INJUEIBS  ON  THE  HEAD 


Cask. — Private  G.  Gerbaner,  Co.  F,  19th  Wisconsin  Volunteers,  aged  52  years.  Pefer.sburg,  Virginia,  June  16th,  1864. 
Colloidal  musket  ball.  Treated  at  Ilainpton  and  Mower  hospitals.  Deserted  January  6th,  1865.  Not  on  Pension  List. 

Case. — Sergeant  George  A.  Keeler,  Co.  A,  20th  Connecticut  Volunteers.  Fredericksburg,  Virginia,  May  3d,  1863, 
Fragment  of  shell.  Treated  at  corps.  Carver,  and  Knight  hospitals.  Returned  to  duty  December  9th,  1863. 

Case. — Private  Ji  F.  Key,  Co.  C,  1st  South  Carolina  Regiment.  September  30th,  1864.  Treated  at  Jackson  Hospital, 
Richmond.  Furloughed. 

Case. — Private  .James  L.  McMahan,  Co.  F,  87th  Indiana  Volunteers,  aged  20  years.  Chickainauga,  Georgia,  Septeia.- 
ber  19th,  1863.  Conoidal  musket  ball.  Treated  in  hospitals  at  Nashville.  Returned  to  duty  April  18th,  1864.  Not  on 
Pension  List. 

C.'VSE. — Corporal  George  Metzger,  Co.  I,  125th  New  York  Volunteers,  aged  18  years.  Gettysburg,  July  3d,  1833. 
Shell  fragment.  Treated  at  field  and  Newark  hospitals.  Transferred  to  Second  Battalion  Veteran  Reserve  Corps  February 
4th,  1864.  Discharged  June  29th,  1865,  and  pensioned.  Pension  Examiner  W.  S.  Searle,  Troy,  New  York,  reports  that  there 
is  a depression  over  the  left  orbit,  headache  and  giddiness,  and  rates  the  disability  of  the  pensioner  at  “two  thirds  and 
permanent.” 

Case. — Corporal  S.  H.  Polley,  Co.  H,  4th  New  York  Heavy  Artillery,  aged  21  years.  Petersburg,  Virginia,  June  23d, 

1834.  Conoidal  musket  ball.  Treated  at  Harewood  and  Rochester  hospitals.  Discharged  July  7th,  1865.  Pensioned. 
Pension  Examiner  Eli  F.  Hendrich  reports,  March  25th,  1887,  that  there  was  an  exfoliation  from  the  right  side  of  the  frontal 
bone,  that  the  vision  of  the  right  eye  was  impaired,  and  that  dizziness  and  headache  was  caused  by  slight  exposure  or  exertion. 

Case. — Private  John  L.  Pounds,  Co.  E,  100th  Pennsylvania  Volunteers,  aged  20  years.  Spottsylvania,  Virginia,  May 
12th,  1864.  Conoidal  musket  ball.  Treated  at  corps,  Harewood,  Chester,  and  Pittsburg  hospitals.  Returned  to  duty  October 
3d,  1864.  Not  on  Pension  List. 

Case. — Colonel  Richard  Rowett,  7th  Illinois  Volunteers,  aged  35  years.  Allatoona,  Georgia,  October  5th,  1864.  Conoidal 
musket  b.all.  Treated  at  corps  field  hospital  and  Officers’  Hospital  at  Nashville.  Returned  to  duty  and  mustered  out  July  9th, 

1835.  Not  on  Pension  List. 

Case. — Corporal  Dwight  C.  Rose,  Co.  C,  11th  Maine  Volunteers,  aged  34  years.  Deep  Run,  Virginia,  August  16th, 
1834.  Conoidal  musket  ball.  Treated  at  Fort  Monroe,  DeCamp,  and  Webster  hospitals.  Returned  to  duty  January  2d,  1865. 
Not  on  Pension  List. 

Case. — Private  James  Smith,  Co.  C,  5th  New  Hampshire  Volunteers,  aged  22  years.  Cold  Harbor,  Virginia,  June  1st, 
1834.  Buckshot.  Treated  at  Alexandria  and  Chester  hospitals.  Returned  to  duty  July  8th,  1864.  Not  on  Pension  List. 

Case. — Private  James  M.  Thompson,  Co.  A,  70th  Ohio  Volunteers,  aged  24  years.  Atlanta,  Georgia,  July  28th,  1864. 
Conoidal  musket  ball.  Treated  at  corps,  Fairfax  Seminary,  and  Camp  Dennison  hospitals.  Discharged  from  service  July 
9th,  1835.  Not  on  Pension  List. 

C.ASE.— Private  Daniel  Well,  Co.  A,  31st  Indiana  Volunteers,  aged  19  years.  Buzzard’s  Roost,  Georgia,  May  lllh,  1864. 
Conoidal  musket  ball.  Treated  at  Chattanooga,  Cumberland,  and  Jeffersonville  hospitals.  Died  June  27th,  1834. 

Of  seven  alleged  cases  of  fracture  of  the  outer  table  of  the  temporal  bone,  reported 
without  sufficient  details  to  remove  all  doubt  of  the  accuracy  of  the  diagnosis,  four  occurred 
to  Union  and  three  to  Confederate  soldiers.  All  of  the  patients  recovered.  Of  the  three 
Confederates,  two  were  furloughed  and  one  was  exchanged.  Of  the  Union  soldiers,  three 
went  to  duty,  one  of  them  subsequently  died  a prisoner,  and  one  deserted.  Four  were 
wounded  by  musket  balls,  one  by  a fragment  of  shell,  and  in  two  instances  the  nature  of  the 
missile  is  not  stated  : 

Case. — Corporal  Johu  Birdsill,  Co.  I,  101st  Illinois  Volunteers,  Resaca,  Georgia,  May  15th,  1864.  Right  temporal,  hy 
colloidal  musket  ball.  Treated  at  corps,  Cumberland,  Brown,  and  Quincy  hospitals.  Returned  to  duty  January  27th,  1865.  ’ 
Not  on  Pension  List. 

Case.— Private  Jacob  Boyer,  Co.  E,  11th  Pennsylvania  Volunteers,  aged  33  years,  was  wounded  at  the  battle  of  Fred- 
ericli;,sburg,  Virginia,  December  13th,  1832.  The  missile  entered  just  in  front  and  above  the  external  meatus,  passed  a little 
upward  and  inward,  and  then  glanced  downward  to  the  mastoid  portion  of  temporal  bone,  fracturing  in  its  course  the  external 
table,  and  lodging  over  the  mastoid  process.  He  was  admitted  to  the  hospital  of  the  2d  division.  First  Corps,  and  on  December 
18th  was  sent  to  Harewood  Hospital,  Washington,  where,  in  January,  1863,  a conoidal  musket  ball  was  removed  through  an 
incision.  On  January  20th  the  wound  had  nearly  healed,  and  on  M.ay  Cth,  1863,  the  patient  was  returned  to  duty.  This 
soldier  was  subsequently  made  a prisoner,  and  according  to  the  certificate  of  Assistant  Adjutant  General  S.  Breck,  died  at 
Salisbury,  Noi-th  Carolina,  January  31st,  1835,  the  cause  of  death  not  being  stated.  In  the  application  for  pension  by  the 
wido^Y,  it  is  stated  that  he  died  “by  reason  of  scurvy  and  diarrhoea.” 

Case. — Private  D.  IF.  Dslridye,  Co.  G,  11th  Mississippi  Regiment.  Gunshot  fracture  of  outer  table  of  right  temporal. 
Treated  at  Howard  Grove  Hospital,  Richmond,  in  August,  1834.  Furloughed. 

Case.— Priv.ate  A.  Easley,  Co.  I,  32d  Virginia  Regiment.  Gunshot  fracture  of  outer  table  of  temporal  bone.  Treated 
at  Chimborazo  IIosi)ital,  Richmond.  Furlouglied  July  14th,  1834. 


GUNSHOT  FRACTURES  OF  THE  OUTER  TABLE  OF  THE  SKULL. 


1 ‘^'7 

lo/ 

Case. — Private  Louis  FreJenburger,  Co.  D,  55th  New  York  Volunteers.  Fair  Oaks,  Virginia,  May  31st,  18G2.  Left 
temporal,  by  a fragment  of  shell.  Treated  at  held  and  McKim’s  hospitals.  Deserted  August  loth,  1862.  Not  on  Pension  List. 

Case.- — Private  John  S.  Haley,  Co.  I,  3d  North  Carolina  Regiment,  aged  20  years,  was  wounded  at  the  battle  of  Gettys- 
burg, Pennsylvania,  July  2d,  1833,  by  a conoidal  ball  which  fractured  the  external  table  of  the  temporal  bone  just  above  the 
right  ear.  Ho  was  admitted  into  the  Seminary  hospital,  and  the  tvound  properly  dressed.  No  head  symptoms  followed  the 
injury.  By  the  4th  of  October  the  wound  had  entirely  healed,  and  the  patient  was  transferred  to  the  general  hospital  at  Point 
Lookout,  Maryland.  On  March  3d,  1864,  he  was  exchanged,  being  at  that  time  in  excellent  health.  The  case  is  reported  by 
Acting  Assistant  Surgeon  E.  N.  Wright. 

Case. — Private  Willi.am  Schueble,  Co.  E,  32d  Indiana  Volunteers.  Chickamauga,  Georgia,  September  19th,  1883. 
Conoidal  musket  ball.  Treated  at  Chattanooga,  Stevenson,  New  Albany,  and  Evansville  hospitals.  Returned  to  duty  March 
4th,  1864.  Not  on  Pension  List. 

In  twenty-five  alleged  fractures  of  the  external  table  of  the  parietals,  in  twelve 
instances,  the  patients  returned  to  duty  after  from  four  to  six  months’  hospital  treatment ; 
three  patients  were  exchanged,  one  deserted,  eight  were  discharged  for  disability  and  four 
of  this'  class  are  now  on  the  Pension  List,  and  one  case  terminated  fatally.  Twenty-one 
were  Union  and  four  were  Confederate  soldiers.  In  fifteen  cases  the  injury  was  inflicted 
by  conoidal  musket  balls,  in  three  by  shell  fragments,  in  one  by  a grape  shot,  and  in  six 
instances  the  nature  of  the  missile  is  not  mentioned : 

Case.— Private  William  T.  Atkins,  Co.  K,  3d  Alabama  Regiment,  aged  21  years.  Chancellorsville,  May  3d,  1863. 
Conoidal  musket  ball.  Treated  at  Lincoln  Hospital.  Exchanged  and  treated  at  Farmville  Hospital.  Retired  August  12th,  1864. 

Case. — Private  Smith  Bailey,  Co.  E,  9th  United  States  Colored  Troops,  aged  22  years.  Deep  Bottom,  Virginia, 
September  29th,  1884.  Conoidal  musket  ball.  Treated  at  corps  and  Fort  Monroe  hospitals.  Returned  to  duty  March  13th, 
1865.  Not  on  Pension  List. 

Case. — Sergeant  John  T.  Bane,  Co.  C,  23d  Virginia  Battalion.  Winchester,  Virginia,  September  19th,  1864.  Conoidal 
musket  ball.  Treated  at  field  and  West’s  Building  hospitals.  Exchanged  October  25th,  1834. 

Case. — Corporal  Thomas  Beisty,  Co.  A,  43d  New  York  Volunteers,  aged  22  years.  Wilderness,  Virginia,  May  5th, 
1834.  Conoidal  musket  ball.  Treated  at  corps.  Mount  Pleasant,  Jarvis,  and  Ira  Harris  hospitals.  Returned  to  duty  October 
13th,  1834.  Not  on  Pension  List. 

Case. — Corporal  Francis  Bessell,  Co.  L,  25th  New  York  Cavalry,  aged  29  years.  Middletown,  Virginia,  November  12th, 

1864.  Conoidal  musket  ball.  Treated  at  corps  and  Mower  hospitals.  Deserted  May  23th,  1865.  Not  on  Pension  List. 

Case. — Private  Richard  Donovan,  Co.  G,  7th  Rhode  Island  Volunteers,  aged  28  years.  Fort  Sedgwick  near  Petersburg, 
April  2d,  1865.  Conoidal  musket  ball.  Treated  at  field.  Mount  Pleasant,  and  Lovell  hospitals.  Discharged  June  29th,  1865. 
Not  on  Pension  List. 

Case. — Private  Edward  Doyle,  Co.  D,  19th  Massachusetts  Volunteers,  aged  28  years.  Antietam,  Maryland,  September 
17th,  1862.  Treated  at  regimental  and  Annapolis  hospitals.  Discharged  from  service  April  14th,  1884.  Not  on  Pension  List. 

Case. — Private  William  H.  Elder,  Co.  B,  1st  Pennsylvania  Cavalry,  aged  23  years.  ’White  House,  Virginia,  June  21st, 
1834.  Conoidal  musket  ball.  Treated  at  Carver,  Cuyler,  and  Mower  hospitals.  Discharged  June  3d,  1865.  Pensioned  at  six 
dollars  per  month. 

Case. — Private  A.  Harris,  Co.  A,  12th  Alabama  Regiment.  Gunshot  fracture  of  external  table  of  parietals  at  the 
vertex.  Treated  at  Howard  Grove  Hospital,  Richmond.  Furloughed  May  26th,  1864. 

Case. — Corporal  Ansell  Hartwell,  Co.  I,  6th  Missouri  Volunteers,  aged  25  years.  Fort  McAllister,  Georgia,  December 
13th,  1834.  Conoidal  musket  ball.  Treated  at  corps,  and  Hilton  Hoad  hospitals.  Returned  to  duty  March  1st,  1865.  Not  on 
Pension  List. 

Case. — Bugler  Amos  D.  Hitchcock,  Co.  M,  3d  Michigan  Cavalry.  Holly  Springs,  Mississippi,  December  20th,  1862. 
Treated  in  hospital  at  Keokuk,  Iowa.  Transferred  to  Veteran  Reserve  Corps  December  llth,  1863.  Pensioned,  but  died  of 
pneumonia  early  in  1885. 

Case. — Lieutenant  Albert  Ivers,  Co.  C,  82d  Pennsylvania  Volunteers.  Cold  Harbor,  Virginia,  June  1st,  1884.  Tr(>ated 
at  corps  and  Washington  hospitals.  Returned  to  duty.  Not  on  Pension  List. 

Case. — Private  Benjamin  .Jerrough,  Co.  G,  2d  Vermont  Volunteers,  aged  34  years.  Cold  Harbor,  Juno  3d,  1864. 
Conoidal  musket  ball.  Treated  at  Lincoln  and  York  hospitals.  Returned  to  duty  July  27th,  1864.  Not  on  Pension  List. 

Case. — Sergeant  James  Kay,  Co.  C,  83d  Indiana  Volunteers.  Gunshot  fracture  of  outer  table  of  the  vault  of  the 
cranium.  Jonesboro’,  Georgia,  August  30th,  1864.  Treated  at  field  hospital,  where  he  dicid  on  August  31st,  1864. 

Case.— Privmte  James  McCarty,  Co.  F,  105th  Pennsylvania  Volunteers,  aged  37  years.  -Petersburg,  Virginia,  April  2d, 

1865.  Fragment  of  shell.  Treated  at  corps  and  Carver  hospit.als.  Mustered  out  of  service  .Tidy  lllh,  1865.  Not  on 
Pen.sion  List. 

18 


138 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Case. — Sergeant  Daniel  McDougall,  Co.  E,  17th  New  York  Volunteers,  aged  26  years.  Jonesboro’,  Georgia,  September 
1st,  1834.  Fragment  of  shell.  Treated  at  corps,  Atlanta,  and  Nashville  hospitals.  Eeturned  to  duty  November  29th,  1864. 
Not  on  Pension  List. 

Case. — Captain  David  McGauhey,  5th  Pennsylvania  Eeserves.  Spottsylvania,  May  9th,  1864.  Treated  at  corps  and 
Officers’  hospitals,  Washington.  Mustered  out  of  service  July  13th,  1864.  Not  on  Pension  List. 

Case. — Private  Thomas  Maley,  Co.  F,  7th  Missouri  Volunteers,  Vicksburg,  Mississippi,  May  12th,  1863.  Conoidal 
musket  ball.  Treated  at  field  and  Lawson  hospitals.  Ti-ansferred  to  the  Veteran  Eeserve  Corps  December  10th,  1863.  Not 
on  Pension  List. 

Case.- — Private  E.  F.  Maples,  Co.  G,  12th  Alabama  Eegiment,  aged  21  years.  Winchester,  Virginia,  September  19th, 
1864.  Conoidal  musket  ball.  Treated  at  Winchester,  West’s  Building,  and  Point  Lookout  hospitals.  Sent  to  Provost  Marshal 
for  exchange  February  11th,  1865. 

Case. — Corporal  David  Phillips,  Co.  D,  149th  Pennsylvania  Volunteers,  aged  20  years.  Spottsylvania,  Virginia,  May 
8th,  1884.  Conoidal  musket  ball.  Treated  at  Douglas  and  Pittsburgh  hospitals.  Eeturned  to  duty  September  23d,  1864.  Not 
on  Pension  List. 

Case. — Adjutant  John  S.  Eiehl,  26th  Pennsylvania  Volunteers,  aged,34  years.  Mine  Eun,  Virginia,  November  27th, 

1833.  Fragment  of  shell.  Treated  at  Wolfe  street,  Alexandria,  and  Officers’,  Philadelphia,  hospitals.  Eeturned  to  duty 
March  4th,  1864.  Not  on  Pension  List. 

Case. — Sergeant  George  Eoll,  Co.  A,  122d  Ohio  Volunteers,  aged  25  years.  Petersburg,  Virginia,  March  25th,  1865. 
Conoidal  musket  ball.  Treated  at  corps,  Lincoln,  and  Satterlee  hospitals.  Mustered  out  of  service  May  31st,  1865.  Not  on 
Pension  List. 

Case. — Private  Charles  W.  Eutherford,  Co.  B,  60th  Illinois  Volunteers,  aged  25  years.  Jonesboro’,  Georgia,  September 
1st,  1864.  Grape  shot.  Treated  at  corps,  Nashville,  and  Louisville  hospitals.  Eeturned  to  duty  December  27th,  1864.  Not  a 
pensioner. 

Case. — Private  Henry  Sheets,  Co.  H,  13th  Pennsylvania  Cavalry,  aged  20  years.  Deep  Bottom,  Virginia,  August  13th, 

1834.  Conoidal  musket  ball.  Treated  at  corps,  Emory,  and  South  street  hospitals.  Discharged  from  service  May  20th,  1865. 
Pensioned  at  four  dollars  per  month. 

Case. — Corporal  G.  B.  Smith,  Co.  B,  2d  United  States  Sharp-shooters,  aged  32  years.  Spottsylvania,  Virginia,  May 
16th,  1884.  Conoidal  musket  ball.  Treated  at  Carver  and  Mower  hospitals.  Transferred  to  Veteran  Eeserve  corps  January 
24th,  1865.  Pensioned  at  eight  dollars  per  month. 

Sixteen  alleged  fractures  of  the  outer  table  were  of  the  occipital  region,  eleven  of  the 
patients  were  Union  and  five  were  Confederate  soldiers,  of  whom  five  returned  to  duty,  five 
were  discharged,  and  three  died.  One  was  exchanged,  one  furloughed,  and  in  one  case  the 
ultimate  result  is  not  reported.  The  nature  of  the  projectile  is  reported  in  eleven  cases: 
musket  balls  in  seven,  pistol  ball  in  one,  and  shell  fragments  in  three : 

Case. — Private  S.  A.  Cai-lin,  Co.  A,  70th  New  York  Volunteers.  Gettysburg,  July  3d,  1863.  Treated  at  corps  and 
Seminary  hospitals.  Died  July  21st,  1863. 

Case. — Corporal  David  A.  Chandler,  Co.  B,  126th  Ohio  Volunteers,  aged  22  years.  Spottsylvania,  Virginia,  May  12th, 
1864.  Conoidal  musket  ball.  Treated  at  corps,  Emory,  Summit  House,  Satterlee,  Camp  Chase,  and  Tripler  hospitals. 
Transferred  to  Veteran  Eeserve  Corps  March  15th,  1865.  Not  on  Pension  List. 

Case. — Private  Henry  C.  Cross,  Co.  G,  24th  New  York  Volunteers,  aged  18  years,  was  wounded,  at  the  second  battle  of 
Bull  Eun,  August  29th,  1862,  by  a fragment  of  shell  which  fractured  the  external  table  over  the  occipital  protuberance.  The 
wound  in  the  scalp  was  nearly  two  inches  long.  He  was  conveyed  to  Washington,  and  on  September  1st  was  admitted  into 
the  Unitarian  Church  hospital.  Slight  paralysis  of  the  left  arm  and  leg  existed,  and  the  wound  was  painful.  Cold  water 
dressings  were  applied,  an  ounce  of  sulphate  of  magnesia  was  administered  and  a restricted  diet  ordered.  The  patient  was 
more  or  less  delirious  for  two  days.  On  September  30th  he  had  so  far  recovered  as  to  be  able  to  walk  about  the  ward,  and  the 
wound  had  nearly  healed.  He  experienced  no  inconvenience  from  the  injury  except  on  exposure  to  the  sun.  The  case  is 
reported  by  Surgeon  A.  Wynkoop,  U.  S.  V.  The  patient  was  discharged  October  2d,  1862,  and  pensioned.  Pension  Examining 
Surgeon  C.  E.  Clark  reports,  on  February  3d,  1833,  that  this  was  a “fracture  of  the  skull,  carrying  away  a portion  of  its 
substance.”  The  wound  was  nearly  healed,  and  the  patient  suffered  from  throbbing  pain  and  giddiness  on  active  exertion.  His 
disability  was  rated  as  total,  but  probably  temporary. 

Case. — Private  Eiley  A.  Davidson,  Co.  F,  1st  Vermont  Volunteers,  aged  30  years.  Cedar  Creek,  Virginia,  October 
19th,  1864.  Conoidal  musket  ball.  Treated  at  corps,  Satterlee,  and  Brattleboro’  hospitals.  Eeturned  to  duty  December  13th, 
1834.  Not  on  Pension  List. 

Case. — Private  C.  F.  Dervey,  Co.  H,  1st  New  Jersey  Cavalry,  aged  24  years.  Amelia  Springs,  Virginia,  April  5th,  1865. 
Pistol  ball.  Treated  at  field,  Annapolis,  West’s  Building,  and  York  hospitals.  Mustered  out  of  service  June  19th,  1865.  Not 
on  Pension  List. 


GUNSHOT  FEACTUIIES  OF  THE  OUTER  TABLE  OF  THE  SKULL. 


139 


Cask.— Sergeant  Alexander  Hayes,  Co.  I,  84tli  Indiana  Volunteers,  aged  32  years.  Knoxville,  Tennessee,  December 
17tli,  1834.  Colloidal  musket  ball.  Treated  at  Nashville,  Jeffersonville,  and  Indianapolis  hospitals.  Discharged  from  service 
May  13th,  1865.  Not  on  Pension  List. 

Cask. — Private  Joseph  Maries,  14th  North  Carolina  Regiment,  aged  40  years.  Fort  Fisher,  North  Carolina,  January  7th, 
1865.  Treated  at  Point  Lookout  hospital.  Died  April  5th,  1865. 

Case. — Private  John  C.  Martin,  Co.  E,  3d  New  Jersey  Volunteers,  received,  at  the  battle  of  Gettysburg,  July  3d,  18G3, 
a gunshot  fracture  of  the  outer  table  of  the  occipital  bone.  He  was  treated  at  regimental,  corps,  and  general  hospitals,  and  was 
discharged  from  service  on  June  23d,  1864,  and  pensioned  at  four  dollars  per  month.  Pensioner  Examiner  F.  F.  Burmeister 
reports,  March  2d,  1866,  that  this  pensioner  suffers  fi-om  constant  pain,  and  partial  loss  of  memory,  and  rates  his  disability  at 
one-half  and  permanent. 

Case. — Private  W.  H.  Parmar,  Co.  A,  23d  Ohio  Volunteers,  aged  43  years.  Cedar  Creek,  Virginia,  October  13th,  1864. 
Fragment  of  shell.  Treated  at  Sheridan  and  Cumberland  hospitals.  Returned  to  duty  November  28th,  1864.  Not  on  Pension 
List. 

Case. — Private  W.  A.  Potts,  Co.  K,  53d  Georgia  Regiment.  Gunshot  fracture  of  outer  table  of  occipital.  Treated  at 
Howard  Grove  Hospital,  Richmond.  Transferred  to  Macon,  June  4th,  1864. 

Case.— Private  George  Prior,  Co.  K,  83d  United  States  Colored  Troops,  aged  29  years.  February,  1865.  Conoidal 
musket  ball.  Treated  at  St.  John’s  Hospital,  Little  Rock,  Arkansas.  Returned  to  duty  September  26th,  1865.  Not  on 
Pension  List. 

Case. — Private  George  W.  Reed,  Co.  H,  12th  Ohio  Volunteers,  was  wounded  near  Laurel  Creek,  West  Virginia, 
November  12th,  1861.  One  ball  passed  through  the  scalp  at  the  back  of  the  head  and  lodged  in  the  diploic  structure  of  the 
occipital,  not  perforating  the  bone ; another  struck  on  the  outside  of  the  left  foot,  about  an  inch  below  the  external  malleolus, 
passed  forward  and  made  its  exit  about  two  inches  from  point  of  entrance.  He  was  admitted  to  the  hospital  at  Gauley,  West 
Virginia,  and  was  doing  well  when  seen  by  Surgeon  G.  G.  Shumard,  U.  S.  V.,  who  reports  the  case.  Reed  was  discharged 
from  the  service  on  December  28th,  1862.  His  name  is  not  upon  the  Pension  Rolls. 

Case. — Sergeant  H.  C.  Rinalder,  Co.  K,  5th  Alabama  Regiment,  aged  26  years.  Cedar  Creek,  Virginia,  October  19th, 
1864.  Conoidal  musket  ball.  Treated  at  West’s  Building  and  Point  Lookout  hospitals.  Sent  to  Provost  Marshal  for  exchange 
April  8th,  1865. 

Case. — Private  J.  W.  B.  Eobinson,  Co.  G,  1st  Virginia  Cavalry.  Spottsylvania,  May  7th,  1864.  Fragment  of  shell. 
Treated  at  hospital  at  Farmville,  Virginia.  Furloughed  August  9th,  1864. 

Case. — Private  David  Simpson,  Co.  A,  1st  North  Carolina  Volunteers,  aged  35  years.  Olustee,  Florida,  February  20th, 
1864.  Conoidal  musket  ball.  Treated  at  Beaufort  hospital.  Returned  to  duty  March  24th,  1864.  Not  on  Pension  List. 

Case. — Private  A.  Young,  Co.  C,  31st  Virginia  Regiment.  Gunshot  fracture  of  external  table  of  the  occipital.  Treated 
at  hospital  at  Farmville,  Virginia.  Died  June  13th,  1864. 

Twenty  alleged  cases  of  fracture  of  the  external  table  of  the  skull  are  reported,  without 
defining  the  location  of  the  injury,  as  follows  : 

Case. — Corporal  W.  T.  Bird,  Co.  B,  11th  Alabama  Regiment.  Gunshot  fracture  of  external  table  of  the  skull.  Treated 
at  Howard  Grove  Hospital,  Richmond.  F'urloughed  May  13th,  1864. 

Case. — Private  Napoleon  Bombard,  Co.  K,  11th  Vermont  Volunteers,  aged  21  years.  Cedar  Creek,  Virginia,  October 
19th,  1864.  Fragment  of  shell.  Treated  at  corps,  Filbert  street,  and  Baxter  hospitals.  Returned  to  duty  January  6th,  1865. 
Not  on  Pension  List. 

Case.— Lieutenant  Charles  H.  Briggs,  Co.  A,  1st  Connecticut  Cavalry.  Hanover  Court-house,  Virginia,  June  1st,  1864. 
Treated  at  corps  and  Officers’  hospitals.  Discharged  January  20th,  1865.  Not  on  Pension  List. 

Case. — Corporal  A.  P.  Cook,  Co.  H,  37th  Massachusetts  Volunteers,  aged  22  years.  Cold  Harbor,  Virginia,  June  3d, 
1864.  Conoidal  musket  ball.  Treated  at  corps,  Alexandria,  and  Satterlee  hospitals.  Returned  to  duty  September  17tli,  1864. 
Not  on  Pension  List. 

Case.— Private  Hugh  H.  Cormack,  Co.  H,  27th  Iowa  Volunteers,  aged  18  years.  Nashville,  Tennessee,  December  Kith, 
1864.  Conoidal  musket  ball.  Treated  at  Cumberland  and  Jeffersonville  hospitals,  and  returned  to  duty  February  25th,  1865. 
His  name  does  not  appear  on  the  list  of  pensioners. 

Case. — Lieutenant  7?.  F.  Felder,  Co.  I,  25th  South  Carolina  Cavalry.  Gunshot  fracture  of  outer  table  of  tlie  skull,  Juno 
18th,  1864.  Treated  at  No.  4 Hospital,  Richmond.  Furloughed  July  14th,  1864. 

Ca.se. — Private  Theodore  Kestler,  Co.  F,  17th  Ohio  Voluntci'r.s,  aged  18  years.  Chickamauga,  Georgia,  September  20tli, 
1863.  Conoidal  musket  ball.  Treated  at  corps,  Stevenson,  and  Nashville  hospitals.  Returned  to  duty  February  5th,  1864. 
Not  on  Pension  List. 

Case. — Priv.ate  A.  B.  McLain,  Co.  M,  12th  South  Carolina  Regiment.  Gunshot  fracture  of  outer  table  of  the  skull. 
Treated  at  Jackson  Ilo.^pital,  Richmond.  Furloughed  September  21th,  1864. 

Case. — Private  Charles  V.  klai-slj,  Co.  C,  Ibih  Massachusetts  Volunteers,  aged  28  years.  Gettysburg,  .July  3d,  1863. 
Treated  at  Corps  and  Mower  hosjiitals.  Returned  to  diilv  December  22d,  186'’.  Ills  name  is  not  upon  the  Pension  List. 


140 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Case. — Sergeant  Allen  F.  Miller,  Co.  G,  34th  Ohio  Volunteers,  aged  22  years.  Winchester,  Virginia,  September  19th, 
1864.  Conoidal  musket  ball.  Treated  at  division,  Sandy  Hook,  and  Satterlee  hospitals.  Eeturued  to  duty  December  2d,  1864. 
Not  on  Pension  List. 

Case. — Sergeant  Milton  Nash,  Co.  F,  130th  Indiana  Volunteers,  aged  24  years.  Atlanta,  Georgia,  August  6th,  1864. 
Conoidal  musket  ball.  Treated  at  field,  Knoville,  and  Louisville  hospitals.  Discharged  from  service  May  15th,  1865.  Not  a 
pensioner. 

Case.— Private  Louis  Nelty,  Co.  D,  149th  New  York  Volunteers,  was  wounded,  at  the  battle  of  Gettysburg,  Penn- 
sylvania, July  3d,  1863.  He  was  admitted  to  a field  hospital,  where  the  injury  was  treated  as  a scalp  wound.  On  July  16th, 
he  was  transferred  to  the  Carver  Hospital,  Washington,  where  it  was  diagnosticated  that  the  outer  table  of  the  cranium  was 
fractured.  He  was  returned  to  duty  on  October  19th,  1863.  His  name  is  not  upon  the  Pension  Eolls. 

Case. — Private  Leon  Eheims,  3d  New  York  Artillery.  Lee’s  Mill,  Virginia,  April  16th,  1862.  Treated  at  Christian 
street  and  Fifth  street  hospitals,  Philadelphia.  Eetui-ned  to  duty  August  8th,  1862.  Not  a pensioner. 

Case. — Corporal  Lloyd  Seville,  Co.  F,  1st  New  Jersey  Volunteers.  September  14th,  1862.  Treated  at  Judiciary  Square 
Hospital,  Washington.  Discharged  from  service  December  13th,  1862.  His  name  does  not  appear  on  the  Pension  Eolls. 

Case.— Private  B.  J.  Smoot,  Co.  G,  4th  North  Carolina  Eegiment.  Gunshot  fracture  of  outer  table  of  the  skull.  Treated 
at  Chimborazo  Hospital,  Eichmond.  Transferred  to  Salisbury,  North  Carolina,  June  '6th,  1864. 

Case. — Private  F.  M.  Stricklin,  Co.  F,  33d  Alabama  Eegiment.  Dallas,  Georgia,  May  27th,  1864.  Gunshot  fracture  of 
outer  table  of  the  skull.  Treated  at  hospital  at  Dalton.  Furloughed  May  30th,  1864. 

Case. — Corporal  F.  L.  Tarleton,  Co.  I,  10th  Alabama  Eegiment.  Gunshot  fracture  of  outer  table  of  the  skull.  Treated 
at  Howard  Grove  Hospital,  Eichmond.  Fuiloughed  May  24th,  1864. 

Case. — Private  Moses  Tonier,  Co.  K,  47th  New  York  Volunteers,  aged  32  years.  Petersburg,  Virginia,  July  24th,  1864. 
Conoidal  musket  ball.  Treated  at  corps.  Fort  Monroe,' and  Whitehall  hospitals.  Discharged  from  service  February  20th,  1865. 
Not  a pensioner. 

Case. — Private  John  Toi’borg,  Co.  K,  Purnell’s  Legion.  Cold  Harbor,  Virginia,  June  3d,  1864.  Treated  at  corps, 
Alexandria,  and  Satterlee  hospitals.  Mustei'ed  out  of  service  October  27th,  1864.  Not  on  Pension  List. 

Case. — Private  S.  E.  Wood,,  Co.  F,  21st  Virginia  Eegiment.  Winchester,  Virginia,  September  19th,  1864.  Conoidal 
musket  ball.  Treated  at  field  and  West’s  Building  hospitals.  Transferred  for  exchange  October  17th,  1864. 

Of  these  patients,  thirteen  were  Union  and  seven  Confederate  soldiers.  Seven  went 
to  duty,  five  were  discharged,  and  six  were  furloughed.  One  was  exchanged,  and  one  is 
unaccounted  for.  None  were  pensioned.  The  nature  of  the  missile  is  referred  to  in  eight 
of  the  cases  only,  being  a shell  fragment  in  one,  and  conoidal  musket  balls  in  seven  cases. 

Of  the  whole  number  of  one  hundred  and  thirty-eight  cases  of  alleged  gunshot  fracture 
of  the  external  table  only  of  the  skull,  one  hundred  and  eleven  appear  in  the  Union,  and 
twenty-seven  in  the  Confederate,  reports.  There  were  twelve  deaths,  two  of  which  were 
not  due  to  the  injuries,  but  to  intercurrent  diseases.  Of  the  Union  men  forty-five  were 
discharged,  fifty-six  went  to  duty,  three  recovered  and  deserted,  and  seven  died.  The  names 
of  twenty-six  of  the  Union  men  who  recovered  are  found  on  the  Pension  Eolls.  Those 
wounded  in  the  supra-orbital  region  frequently  suffered  from  impairment  of  the  senses  of 
vision  or  of  smell,  and  those  struck  in  the  mastoid  region,  from  injury  or  destruction  of  the 
sense  of  hearing.  One  suffered  from  numbness  of  the  lower  extremities,  another  from  con- 
vulsions, and  several  from  vertigo  and  dizziness.  Of  the  twenty-seven  Confederates,  three 
died,  six  recovered  and  were  exchanged,  and  eighteen  were  “furloughed”  from  hospitals 
within  their  own  lines,  and  it  is  only  known  of  their  ulterior  history  that  two  of  them  were 
“ retired  ” by  medical  boards. 

I have  presented  brief  memoranda  of  the  one  hundred  and  thirty-eight  alleged 
examples  of  gunshot  fracture  of  the  external  table  of  the  skull,  in  deference  to  the 
experienced  surgeons  who  have  reported  such  accidents  ; but  after  a careful  examination 
of  the  histories  of  the  individual  cases,  and  weighing  the  evidence  impartially,  I am  sure, 
I am  disinclined  to  admit  that  the  outer  table  of  the  skull  is  ever  fractured  in  the  adult 
without  injury  to  the  inner  table,  either  by  projectiles  of  war  or  any  other  external  violence, 
except  in  the  rare  instances,  enumerated  at  the  beginning  of  this  subsection,  of  blows  or  the 
impact  of  missiles  upon  the  superciliary  ridge,  or  mastoid  or  zygomatic  processes,  and  possibly. 


GUNSHOT  FRACTURES  OF  THE  INNER  TABLE  OF  THE  SKULL. 


141 


the  occipital  protuberance,  or  by  grooving  by  a sharp  shell  fragment.  Pott,  Sir  Astley 
Cooper,  Sir  Benjamin  Broclie,  Williamson,  and  others,  refer  to  indentations  of  the  skull  or 
fractures  of  the  outer  table  as  not  uncommon  ; but  I believe  the  view  entertained  by  Velpeau 
and  Samuel  Cooper,  which  I have  endeavored  to  illustrate  and  corroborate,  to  be  the  sound 
one.  The  reader  who  would  examine  further  this  interesting  subject  may  consult  the 
authorities  referred  to  in  the  foot  note.* 

Gunshot  Fractures  of  the  Inner  Table  of  the  Skull. — The  returns  furnish 
twenty  examples  of  fractures  of  the  vitreous  table  of  the  skull  without  fracture  or  depression 
of  the  outer  table.  In  ten  of  these  cases,  the  pathological  specimens  were  preserved  and 
forwarded  to  the  Army  Medical  Museum.  Of  the  ten  cases  in  which  the  specimens  are 
wanting,  one  was  observed  by  Surgeon  John  Shrady,  2d  Tennessee  Volunteers,  who  pub- 
lished an  account  of  it  at  the  time.j*  A more  minute  history  has  been  found  in  the  case- 
book of  the  hospital  in  which  the  patient  was  treated : 

Case  1. — Private;  Matthias  A.  Tapyer,  Co.  I,  97th  Ohio  Volunteers,  at  the  battle  of' Murfreesboro’,  Tenn.,  January  3cl, 
1833,  received  a slight  scalp  wound,  from  a glancing  musket  ball,  near  the  antero-superior  angle  of  the  left  pailetal.  He  made 
light  of  his  injury,  which  caused  little  pain ; but  was  sent  to  Nashville  on  the  5th,  and  was  admitted  into  Hospital  No.  19. 
Examination  with  the  probe  failed  to  detect  any  injury  of  the  skull.  Simple  dressings  were  ordered  and  the  patient  was  allowed 
the  liberty  of  the  ward.  For  the  next  few  d.ays  ho  was  restless  and  irritable,  and  kept  getting  in  and  out  of  bed;  but  these 
sjunptoms  were  not  regarded  as  significant,  as  the  patient  gave  rational  answers  when  interrogated.  On  the  10th,  the  ward-master 
reported  that  the  patient  was  exceedingly  restless  at  night,  and  he  thought,  at  times,  delirious,  at  all  events  “ very  strange  in 
his  actions.”  The  attending  surgeon  found  “nothing  abnormal,  except  a white  tongue  and  accelerated  pulse  and  a puffy 
appearance  of  the  scalp  wound.”  As  the  patient  still  replied  intelligently  to  questions,  these  phenomena  appear  to  have  excited 
little  solicitude,  and  no  active  treatment  was  instituted.  On  the  15th  there  was  great  gastric  irritability,  tlie  blandest  liquids 
being  rejected  and  the  bowels  were  obstinately  constipated.  The  jiatient  Lay  in  a state  of  stupor,  the  flexors  of  the  upper 
extremities  strongly  contracted,  with  occasional  subsultus;  the  pupils  dilated  and  irresponsive  to  light.  He  was  ordered  five 
grains  of  iodide  of  potassium  thrice  daily,  and  an  ounce  of  castor  oil  with  a drop  of  croton  oil  immediately.  It  is  not  mentioned 
whether  these  medicines  were  retained  or  not,  or  whether  enemata  were  given.  But  on  the  16th,  there  was  no  amelioi'ation  of 
the  symptoms,  and  the  eathartic  was  ineffectually  repeated.  On  January  21st  the  nurse  reported  tliat  the  patient  had  “ not  had 
a movement  from  his  bowels  since  his  admission.”  At  this  date  “all  of  the  symptoms  were  aggravated;”  the  patient  was, 
however,  still  sufficiently  conscious  to  endeavor  to  protrude  his  tongue  when  asked  to  do  so,  and  to  manifest  his  aversion  to  “a 
more  thorough  examination  of  the  wound.”  The  propriety  of  trephining  was  considered,  but  it  was  thought  that  the  pi'o.ximity 
of  the  longitudinal  sinus  to  the  seat  of  injury  forbade  this  expedient.  A crucial  incision  of  the  scalp  was  made  across  the  wound, 
and  about  two  drachms  of  pus  escaped.  The  bone  was  found  to  be  denuded  over  a space  of  the  size  of  a dime.  The  patient  died 
on  the  following  day,  January  22d,  1833.  At  the  autopsy,  when  the  calvarium  was  removed,  a fissure  of  the  inner  table  was 
discovered  an  eighth  of  an  inch  to  the  left  of  the  sagittal  suture,  with  slightly  depressed  sharp  and  jagged  edges.  For  a space 
of  two  square  inches  about  this  fissure  the  dura  mater  had  undergone  structural  alteration.  Underneath  the  dura  mater  was  an 
abundance  of  thick  greenish  pus.  The  brain  substance  beneath  the  diseased  membrane  was  softened  and  friable.  The  cerebral 
veins  were  turgid. 

The  next  case  appears  on  the  report,  for  the  third  quarter  of  1864,  of  the  general 
hospital  at  Grafton,  West  Virginia: 

Case  2. — Private  Elijah  Bennett,  Co.  A,  llGth  Ohio  Volunteers,  aged  39  years,  was  wounded  at  the  engagement  at 
Piedmont,  Virginia,  June  5th,  1834,  by  a conoidal  musket  ball  which  grazed  the  top  of  the  head,  tearing  up  the  scalp.  He  was 
treated  in  a field  hospital  until  the  19th,  and  then  transported  to  the  genei'al  hospital  at  Grafton  and  placed  under  the  care  of 
Surgeon  Socrates  N.  Shennan,  U.  S.  Vols.  He  was  then  laboring  under  symptoms  of  subacute  meningitis,  with  comi)ression  of 
the  brain.  He  died  three  days  after  admission,  June  22d,  1834.  At  the  post  mortem  examination,  a depressed  fracture  of  the 
inner  tables  of  both  parietals  was  discovered,  the  fissures  crossing  about  the  middle  of  the  sagittal  suture.  Beneath  the  dei)r('ssed 
portion  of  bone  the  dura  mater  was  extensively  diseased,  and  a large  abscess  had  formed. 

*POTT,  Observations  on  the  Nature  and  Consequences  of  Wounds  and  Contusions  of  the  Head,  Londim,  17G0,  p.  I.";.  Sir  Asti.ey  Cooi’Ei:, 
Lectures,  London,  Vol.  I,  p.  302.  SAUCEllOTnc.  Hemoire  de  V Academic  de  Chirurgie,  T.  IV,  cd.  1819,  p.  322.  IlKXNEX,  Miliiarg  Surgerg,  2d  cd., 
p.  323.  Sir  BEXJAMIN  C.  BEODIe,  Works  collected  and  arranged  hg  Mr.  Charles  Hawkins,  London,  1805,  Vol.  Ill,  p.  25.  VELPEAU,  De  V Operation 
du  Trepan  dansles  plaies  de  Tele,  Paris,  1634,  p.  27.  Medico-Chirurgical  Transactions,  Vol.  XVI,  p.  331.  WILLIAMSON,  Militarg  Surgerg,  London, 
1863,  p.  28.  M.VCLEOD,  Notes,  etc.,  (already  cited,)  p.  177.  Maitiiew,  Med.  and  Surg.  Hist,  of  Jlritish  Armg  in-  the  Crimea,  (Oji.  cit.,)  Vol.  II,  p.  28. 
Guthrie,  Commentaries.  Chisolm,  Manual,  etc.,  (Op.  cit.,)  p.  2.12.  Teevan,  Experimental  Inquiries  into  certain  Wounds  of  the  Skull,  in  Drilish 
and  Foreign  Medico-Chirurgical  Review,  Vol.  XXXIV,  p.  205.  Miller,  A Sgstem  of  .Surgerg,  Edinburgh,  1864,  p.  028.  PlRlilE,  The  Hrinciplcs  and 
Practice  of  Surgerg,  London,  1860,  p.  273.  DEXONVIlliehs  et  OOSSELIN,  Compendium  de  Chirurgie  Pratique,  I’aris,  1851,  T.  II,  p.  578.  Adams,  in 
Costello's  Cgclnpedia  of  Practical  Surgery,  Vol.  II,  p.  476.  Lanoutii,  Programme,  de  sinus  Frontalis  vulncre  sinus  Terehratione  curando,  Wittemb. 
1748.  Schneider,  Die  Kopfverletzungen,  Stuttgart,  1848,  p.  6!l. 

\ American  Medical  Times,  Vol.  VI,  p.  1 Kl,  March  7th,  1863. 


142 


WOUNDS  AND  INJUEIES  OF  THE  HEAD 


A third  case  is  noted  in  the  case-book  of  Hospital  No.  1,  Frederick,  Maryland,  in 
charge  of  Assistant  Surgeon  Eohert  P.  Weir,  U.  S.  A.: 

C.YSE  3. — Private  Hamilton  West,  Co.  G,  5th  West  Virginia  Volunteers,  aged  24  years,  at  the  battle  of  Opequan,  Virginia, 
September  19th,  1834,  was  struck  on  the  left  side  of  the  back  of  the  head  by  a musket  ball  whicli,  apparently,  inflicted  only  a 
scalp  wound.  After  a primary  dressing  in  a field  hospital,  he  was  sent  to  the  depot  for  wounded  at  Sandy  Hook,  and  thence  to 
Frederick,  Maryland,  where,  on  the  24th,  he  was  admitted  to  Hospital  No.  1,  under  the  care  of  Acting  Assistant  Surgeon  E.  W. 
Mansfield.  The  wound  was  doing  well,  he  suffered  no  pain  whatever,  his  general  condition  was  good,  and  there  was,  api)arently, 
every  likelihood  of  a speedy  recovery.  Simple  dressings  to  the  wound  were  continued,  and  little  else  was  done  in  the  way  of 
treatment.  On  October  3d  convulsions  of  an  epileptic  character  indicated  some  grave  cerebral  complication.  An  incision  was 
made  through  the  wound,  but  no  injury  to  the  cranium  could  be  found.  Wet  cups  were  applied  over  the  temporal  regions  and 
blisters  to  the  nucha,  and  a terebinthinate  enema  was  administered.  The  convulsions  subsided  under  these  measures  and  did 
not  recur.  But  there  remained  a dull  pain  in  the  liead,  hebetude,  and  a febrile  movement.  On  October  8th  there  were  rigors, 
followed  by  acute  pain  in  the  side  of  the  chest.  Coma  supervened,  and  death  followed  on  October  13th,  18G4.  At  the  autopsy 
an  ovoid  scale  of  the  external  table  was  found  necrosed.  This  was  situated  beneath  the  middle  of  the  scalp  wound  and  at  the 
lower  posterior  angle  of  the  left  parietal.  The  line  of  dem.arcation  was  well  marked,  but  there  was  not  the  slightest  depression 
of  the  outer  plate.  On  removing  the  skull-cap  an  angular  fracture  of  the  internal  table  was  discovered  at  a point  corresponding 
with  the  contusion  in  the  outer  table.  This  fracture  was  depressed  to  the  extent  of  one  line.  The  dura  mater  beneath  was 
thickened  and  ulcerated  over  a space  two  inches  in  diameter.  The  vessels  of  the  pia  mater  were  much  congested.  Both  the 
gray  and  white  matter  of  the  brain  were  softened.  The  softening  was  particularly  marked  in  the  left  hemisphere  near  the  corpus 
callosum.  In  the  chest  firm  pleuritic  adhesions  were  found,  with  effusion  on  the  right  side  and  with  old  tuberculous  deposition  at 
the  apices.  In  the  pulmonary  parenchyma  were  several  metastatic  foci,  containing  a detritus  of  blood  corpuscles  mingled  with 
pus.  The  lung  tissue  was  friable.  The  liver  was  normal;  the  spleen  weighed  twelve  ounces. 

The  next  case  is  remarkable  for  the  late  apparition  of  inflammatory  symptoms.  It  is 
noted  in  the  reports  of  five  hospitals  ; 

Case  4. — Private  Christian  Boucher,  Co.  C,  118th  Ohio  Volunteers,  aged  19  years,  was  wounded  at  the  battle  of  Ees.aca, 
Georgia,  May  14th,  1864,  by  a conoid.al  musket  ball,  in  the  occipital  region;  another  ball  injured  the  right  t(!sticle.  He  was  at 
once  .admitted  to  the  field  hospit.al  of  the  23d  Army  Corps.  On  the  register  of  this  hospital  the  head  injury  is  described  as  severe; 
but  the  symptoms  are  not  particularized,  nor  the  treatment  detailed.  In  a few  days  the  p.atient  was  sent,  by  the  way  of  Chat- 
t.anooga,  to  Nashville,  Tennessee,  and  admitted  to  Hospital  No.  1 on  May  24th.  Here  the  head  injury  was  registered  as  a slight 
scalp  wound.  Nevertheless,  the  patient  remained  for  a month  at  this  hospital,  and  was  transferred  to  Louisville,  Kentucky,  on 
June  2Gth.  The  case-books  of  the  Nashville  hospital  afford  no  information  respecting  the  progress  and  treatment  of  the  case. 
On  July  1st  the  patient  was  again  transferred  to  Cincinnati,  Ohio,  where  he  was  admitted  to  the  Marine  Hospital.  He  was 
found  to  manifest  grave  symptoms  of  cerebral  disorder,  the  nature  of  which  wms  not  particularly  specified  in  the  hospital  register. 
Insensibility,  stupor,  and  indic.ations  of  inflammation  of  the  brain  finally  supervened,  and  the  patient  died  July  14th,  1864.  At 
the  autopsy,  when  the  calvaria  was  removed,  it  was  found  that  a depressed  spicula  of  the  inner  table,  immedi.ately  beneath  the 
wound  in  the  scalp,  had  penetrated  the  dura  mater,  and  that  there  was  incipient  softening,  for  an  inch  in  diameter,  of  the  brain 
tissue,  immediately  below  this  wound  of  the  membrane.  Apart  from  this  limited  result  of  inflammation,  and  the  engorgement 
of  the  longitudinal  sinus  by  coagnla,  the  contents  of  the  cranium  were  found  in  an  apparently  normal  condition.  An  examination 
of  the  chest  showed  that  the  heart  was  healthy,  that  there  was  some  deposition  of  tubercles  in  the  lungs,  and  old  and  extensive 
adhesions  of  the  right  pleura.  The  abdominal  viscera  were  healthy,  with  the  exception  of  a slight  enlargement  of  the  spleen, 
and  traces  of  .subacute  inflammation  of  the  lower  intestines.  But  the  lesions  in  the  thoracic  and  abdominal  cavities  were 
insufficient  to  cause,  or  even  to  hasten  materially,  a fatal  issue.  The  record  of  the  case  at  the  Marine  Hospital,  Cincinnati,  is 
compiled  by  Assistant  Surgeon  F.  Grube,  U.  S.  V. 

Case  5. — Private  J.  W.  Patterson,  Co.  B,  1st  Iowa  Volunteers,  aged  21  years,  was  wounded  at  Tupelo,  Mississippi,  July 
14th,  1834,  and  is  reported  by  Surgeon  J.  N.  Niglas,  6th  Illinois  Cav.alry,  on  the  casualty  list  of  the  right  wing  of  the  16th  Army 
Corps,  as  having  a “dangerous  gunshot  wound  of  the  head,”  produced  by  a fragment  of  shell.  The  patient  being  conveyed  to 
tile  rear,  was  admitted  to  Adams  Hospital,  at  Memphis,  Tennessee,  on  July  21st,  and  died  on  July  24th,  1864.  No  particulars 
of  the  treatment  are  recorded,  but  on  the  monthly  hospital  report,  signed  by  Surgeon  J.  G.  Keenon,  U.  S.  V.,  it  is  stated  that 
“the  e.xternal  table,  not  being  in  the  least  fractured,  no  operation  was  performed;”  and  the  report  goes  on  to  state  that  the 
patient  presented  many  symptoms  of  compression  of  the  brain,  yet  they  were  judged  insufficient  to  justify  operative  interference. 
Furthermore,  that  a.  post  mortem  examination  was  made,  and  that  upon  the  skull-cap  being  remov.ed,  “the  internal  table  of  the 
cranium  was  found  to  be  severely  fractured,  and  fragments  of  bone  were  pressing  on  the  brain,  while  several  abscesses  had  formed 
just  under  the  dura  mater.”  Efforts  to  obtain  the  specimen,  or  further  particulars  of  the  case,  have  been  fruitless. 

The  next  case  furnished  a typical  specimen  of  this  rare  form  of  injury : 

Case  G. — David  H.  P , Co.  C,  35th  Wisconsin  Volunteers,  aged  20  years,  detailed  probably  as  an  orderly,  since 

his  regiment  was  not  in  the  action,  was  wounded,  at  the  engagement  at  Tupelo,  Mississippi,  July  18th,  1864,  by  a musket  ball 
which  struck  the  skull  obliquely,  and  apparently  inflicted  a scalp  wound  merely,  between  the  sagittal  suture  and  the  left 
parietal  protuberance.  There  were  no  signs  of  cerebral  disturbance.  The  wound  was  dressed  simply,  and  the  patient  was 
conveyed  to  Memphis,  Tennessee,  and  admitted  into  the  Adams  U.  S.  General  Hospital  on  July  23d.  He  was  then  perfectly 
rational  and  free  from  head  symptoms.  Two  days  subsequently  indications  of  compression  of  the  brain  were  observed,  and  on 
the  afternoon  of  the  25th  they  h.ad  r.apidly  become  aggravated.  The  pidse  was  slow,  the  respiration  labored,  the  pupils  dilated. 


GUNSHOT  FRACTURES  OF  THE  INNER  TABLE  OF  THE  SKULL. 


143 


the  sphincters  relaxed.  A very  careful  exploration  of  the  wound  was  made,  but,  of  course,  no  cranial  fracture  could  be  detected. 
The  treatment  was  limited  to  cold  applications 'to  the  head,  scarified  cups  to  the  nucha,  and  brisk  purging.  On  the  2011],  the  pa- 
tient gradually  became  comatose.  The  discharges  from  the  bowels  and  bladder  were  involuntary.  Tbe  patient  coutiiiued  to  sink 
on  th^27<h,  and  died  atone  a.  M.  on  the 28th  of  July,  183-1.  At  the  autopsy  the  pericranium  was  found  to  be  contused  ami  de- 
tached at  the  seat  of  injurv;  but  no  alteration  was  visible  in  the  outer  table  of  the  skull.  Directly  beneath  the  seal])  wound  tbe 
inner  table  was  fractured  and  depressed.  The  fractured  portion  measured  one  and  a quarter  inches  in  length  by  three-quai-ters  of 
an  inch  in  breadth,  and  was  composed  of  three  triangular  pieces  of  the  vitreous  lamina.  The  depression  at  the  apex  measured 
two  lines.  The  dura  mater  was  wounded  and  there  was  a large  abscess  in  the  left  cerebral  hemisphere.  The  specimen  was  con- 
tributed to  the  Army  Medical  Museum  by  Acting  Assistant  Surgeon  R.  W.  Coale.  It  is  well  represented  m Figures  III  and  IV 
of  the  accompanying  Plate. 

Almost  identical  with  this  were  the  symptoms,  progress,  and  result  of  the  following 
case,  though  the  extent  of  depression  in  the  fracture  of  the  inner  table  was  less : 


Case  7. — Private  Ole  O- 


-,  Co.  H,  15th  Wisconsin  Volunteers,  1st  Brigade,  3d  Division,  Fourth  Corps,  was  wounded 
on  July  22d,  1864,  at  the  battle  before  Atlanta,  Georgia.  The  right  side  of  his  head  was  struck  obliquely  by  a musket  ball  which 

tore  up  the  scalp  over  the  middle  of 
the  upper  portion  of  the  parietal  with- 
out infiicting  any  apparent  injury  on 
the  bone.  Simple  dressings  were  ap- 
plied and  the  wounded  man  was  con- 
veyed by  rail  to  tbe  general  hospital 
at  Chattanooga,  a distance  of  one 
hundred  and  twenty  miles  or  more. 

He  was  admitted  on  July  28th,  and 
was  then  la.boring  undei’  symptoms  of 
compression  of  the  brain.  He  died 
on  the  5th  of  August,  1834.*  An 
autopsy  revealed  an  abscess  in  the 

right  hemisphere  of  the  brain.  The  outer  table  of  the  skull  showed  no  trace  of  injury.  The  inner  table  presented,  a little 
below  the  anterior  third  of  the  sagittal  suture,  a lambdoidal  fissure,  the  longer  br.anch  two  inches,  and  the  shorter  three-fourths 
of  an  inch  in  lenarth,  one  ed'jre  being  slightly  depressed.  (See  FiGS.  48  and  49.)  The  sticcimen  was  conti’ibuted  by  Assistant 
Surgeon  C.  C.  Byrne,  U.  S.  A. 

In  tlie  next  case,  without  any  apparent  lesion  of  the  external  table,  a fragment  of  tlie 
vitreous  plate  of  the  frontal  bone  was  found  to  be  completely  detached  and  depressed  upon 
the  dura  mater.  It  nearly  resembles  the  case  described  and  figured  by  Stromeyer  in  his 
“ Maxims  :”f 


Fig.  48. — Lambdoidal  fisssure  of  the  vitrcoxis  table 
of  the  right  parietal.  Spec.  3406,  Sect.  I,  A.  M.  M. 


Fk;.  49. — Exterior  view  of  the  same  specimen 
showing  absence  of  injury  to  the  external  table. 


Case  8. — Private  Abram  L Co.  C,  77th  New  York  Volunteers,  3d  Brigade,  2d  Division,  Sixth  Corps,  aged  23 

years,  was  wounded  on  May  Cth,  1864,  at  the  battle  of  the  Wilderness,  by  a fragment  of  shell,  which  removed  the  seal])  .just  below 
the  coronal  suture,  and  gi’azed  the  bone  a little  to  the  left  of  the  median  line.  It  has  been  imi>racticable  to  learn  anything  of  the 
patient’s  condition  for  the  next  live  days,  during  which  he  was  in  transit  to  the  depot  for  wounded  at  Belle  Plain  ; but,  on  May 
12th,  he  was  sent  up  the  Potomac  on  a hospital  transport,  and  was  admitted  to  Armory  Sejuare  Hospital,  Washington,  comatose 
and  with  his  wound  in  an  erysipelatous  condition.  Diligent  and  repeated  examinations  of  the  records  and  rei>orts  from  Armory 
Square  Hospital  have  failed  to  discover  any  account  of  the  progress  and  treatment  of  the  case.  Tlie  patient  died  on  May  21th, 
1864.  A segment  of  the  frontal  bone  was  removed  and  forwarded  to  the  Army  Medical  Museum  by  Surgeon  D.  W.  Bliss,  U.  S. 
V.  Its  external  and  internal  surfaces  are  perfectly  represented  in  Figures  I and  II  of  the  foregoing  plate.  The  outer  table  is 
not  fractured;  but  is  porous  and  softened  where  the  pericranium  was  scraped  off  by  the  jirojectile.  A meddlesome  dissector  bas 
chipped  oft'  a bit  of  the  e.xternal  table  and  diploe  with  a scalpel  in  the  endeavor  to  ascertain  post  mortem  the  degree  of  softening 
of  the  bone.  A fragment  of  the  inner  table,  one  and  one-fourth  inches  long,  is  completely  detached. 

After  contusions  of  the  outer  with  fractures  of  the  inner  table,  where  the  pericranium 
is  removed  to  any  great  extent,  necrosis  of  the  outer  lamina  occurs  if  the  patient  lives 
long  enough,  and  a thin  exfoliation  is  separated.  Tlie  Museum  possesses  several  illustra- 
tions of  lesions  of  this  nature,  all  of  them  resulting  from  the  very  oblique  impact  of 
projectiles  : 

Case  9. — Private  Conrad  S , 54th  New  York  Volunteers,  aged  — years,  was  wounded  at  the  second  battle  of 

'Manassas,  August  30th,  1862,  by  a musket  ball  which  produced  a scalp  wound  on  the  top  of  the  head,  across  the  sagittal  suture, 


*The  Report  for  1865  of  the  Adjutant  General  of  Wisef)nsin  gives  August  lOtli  as  tho  date  of  death.  The  date  above  given  is  tliat  entered  in  tlio 
official  certificate  signed  by  the  surgeon  in  cliarge  of  tlio-hospitai. 

\ Maxime.n  (Ur  Krirgshcilkiinsl,  Sd  ed.  Hanover,  1861,  S.  .546,  I’igiircs  lil  and  13. 


144 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


parallel  to  and  an  incli  bohind  the  coronal  suture.  He  was  admitted  to  Finley  Hospital,  at  Washington,  on  September  Sd,  and 
died  of  “inflammation  of  the  brain  ” on  October  20tb,  1803.  The  records  of  Finley  Hospital  give  no  particulars  of  tlie  iirogress  and 

treatment  of  the  case,  nor  of 
the  appearances  obsei'ved  at 
the  autopsy.  A segment  of 
the  cranium  was  sent  to  the 
Army  Medical  Museum  by 
Surgeon  Israel  Moses,  U.  S. 

Vols.  It  shows  an  exfoliation 
of  the  outer  table  a quarter  of 
an  inch  by  one  inch,  the  sur- 
rounding bone  being  cribri- 

Fig.  .to. — Depressed  fracture  of  the  vitreous  table  of  form  and  sponcry.  The  thin  FIG-  51- — Exterior  view  of  the  same  specimen,  show- 
the  parietals  an  inch  "behind  the  coronal  suture.  Spec.  , i ^ -i  • ing  an  exfoliation  fi'om  contusion  of  the  skull.  Spec. 

64C,  Sect.  I,  A.  M.  M.  oval  necrosed  scale  is  not  640,  Sect.  I,  A.  M.  W. 

fractured  or  displaced.  The 
vitreous  table  is  fissured  and 

slightly  depressed.  The  wood-cuts  give  a satisfactory  representation  of  the  nature  and  extent  of  the  lesions.  (Fig.  50  and 
Fig.  51.). 


The  next  case  is  remarkable  for  the  absence  of  all  symptoms  of  cerebral  disorder  until 
within  a few  bours  of  the  patient’s  death  : 


Case  10. — Private  Daniel  C , Co.  D,  76th  New  York  Volunteers,  was  wounded  at  the  second  battle  of  Bull  Run, 

August  30th,  1333,  by  a musket  ball  wliich  inflicted  a long  transverse  scalp  wound  near  the  vertex,  the  greater  portion  of  the 
wound  being  over  the  right  parietal.  The  wounded  man  was  sent  to  Washington,  and  thence  to  Annapolis,  where  he  was 
admitted  to  the  General  Hospital  on  September  8th.  He  was  suffering  from  intermittent  fever,  and  this  diagnosis  was  placed 
upon  his  bed  card,  the  wound  being  regarded  as  trivial  in  its  nature.  Treatment  was  directed  to  the  interruption  of  the 
febrile  paroxysms,  which  recurred  obstinately  in  spite  of  the  free  administration  of  preparations  of  quinia.  On  September 
23d,  Assistant  Surgeon  J.  W.  Brewer  took  charge  of  the  patient.  The  remainder  of  this  abstract  is  compiled  from  his 
interesting  notes  of  the  case.  The  wound  looked  well  at  this  date,  and  gave  the  patient  no  uneasiness  ; it  was  covered 
by  florid  healthy  granulations,  and  discharged,  in  small  quantity,  laudable  pus.  The  man  had  had  no  chill  for  twenty-four 
liours.  Quinine  was  continued  in  small  doses,  and  a generous  diet  was  ordered.  On  the  following  day,  September  25th, 
the  patient  complained  of  acute  pain  over  the  lower  lobe  of  the  right  lung.  There  was  no  modification  of  resonance  on 
percussion;  and  auscultation  revealed  no  alteration  in  the  respiratory  murmur.  Stupes  of  turpentine  were  ordered,  and 
an  aperient  dose.  At  noon  the  pain  in  the  side  was  much  relieved ; but  the  patient  complained  of  violent  pain  in  the  right 
ankle,  and  in  the  foot  of  the  same  side.  The  cause  of  this  pain,  or  of  its  location,  could  not  be  ascertained.  At  night, 
the  pain  was  not  relieved,  and  the  patient  was  becoming  very  restless  and  irritable,  which  led  Dr.  Brewer  to  suspect 
some  occult  cerebral  disorder,  and  again  to  examine  the  wound,  and,  finally,  to  request  Assistant  Surgeon  T.  H.  Helsby, 
U.  S.  A.,  to  see  the  patient  with  him.  A careful  exploration  of  the  wound  failed  to  detect  any  injury  of  the  bone,  a 
granulating  surface  being  everywhere  presented.  In  the  absence  of  any  symptoms,  except  restlessness,  that  could  be  referred 
to  cerebral  disturbance,  it  was  concluded  that  the  wound  had  no  connection  with  the  existing  pain  and  general  irritability, 
and  the  patient  was  ordered  to  have  an  anodyne,  and  a stimulating  embrocation  to  the  ankle.  On  the  following  morn- 
ing, September  25th,  1833,  coma  suddenly  supervened,  and  death  promptly  ensued.  An  autopsy  was  made,  two  hours 
after  death,  by  Acting  Assistant  Surgeon  B.  B.  !Miles.  The  thoracic  viscera  were  found  to  be  in  a normal  condition, 
except  that  there  was  inflammatory  engorgement,  or  possibly,  hypostatic  congestion  only,  of  the  lower  lobe  of  the  right 
lung.  The  abdominal  viscera  were  carefully  examined,  but  no  cause  of  death  could  be  found  in  that  cavity.  The  calvaria 
wits  then  removed.  The  dura  mater  was  adherent  to  the  bone  beneath  the  site  of  the  wound.  A depressed  stellate  fracture 

of  the  vitreous  table  of  the  right 
parietal  was  discovered  near 
the  sagittal  suture.  A small 
quantity  of  pus  followed  the 
removal  of  the  calvarium.  On 
removing  the  dura  mater,  sev- 
eral ounces  of  jnis  were  found 
on  the  surface  of  the  left  hemis- 
phere. On  closer  examination, 
an  aperture  was  discovered  in 
the  falx,  and  it  became  evident 
that  an  abscess  had  formed 
beneath  the  depressed  fracture, 
and  had  burst  through  the 

, Repressed  fraeture  of  vitreous  table  of  falx,  inundating  the  convolu-  FIG.  53. — Exteriorviewofrhesamespeeimcn.shiw- 

sek"t  a‘!m  M.  ^ the  opposite  hemis-  ^w^exf.diaUon  resuU  Spec. 

phere.  The  veins  oD  the  lower  • 

extremity,  and  of  the  lung  wore  not  examined,  and  whether  the  pain  in  the  right  foot  and  light  chest  were  signs  indicative  of 
embolic  complications  resulting  from  the  abscess  was  not  determined.  In  conchnling  his  report.  Dr.  Brewer  ag.ain  calls  attention 


GUNSHOT  FEACTUKES  OF  THE  INNER  TABLE  OF  THE  SKULL. 


145 


to  the  fact  that  no  symptoms  of  encephalitis  appeared  in  the  case;  hut  it  i.s  to  be  remembered  that  the  chills,  which  were 
reported  as  paroxysms  of  intermittent  fever,  did  not  come  under  his  observation,  and  that  no  record  of  their  attendant  symptoms 
has  been  preserved.  The  calvaria  was  sent  to  the  Army  Medical  Museum  by  Dr.  Brewer.  (Fig.  52  and  Fig.  53.)  The  prepara- 
tion is  described  in  the  Catalogue  of  the  Surgical  Section,  (p.  8.)  It  is  fairly  represented  in  the  foregoing  w’ood-cuts  as  the  vault 
of  the  cranium,  showing  a contusion  of  the  right  parietal  bone  at  the  middle  of  its  suiierior  border.  The  outer  table  is  spongy, 
and  a thin  plate,  one  inch  in  length,  is  necrosed  and  i)artially  separated.  The  internal  table  is  fractured  and  slightly  depressed, 
and  shows  traces  of  an  attempt  at  repair. 

Case  11. — Private  Cyrenus  Sewell,  Co.  D,  2d  New  York  Heavy  Artillery,  was  wounded,  at  the  battle  of  Spottsylvania 
Court-house,  Virginia,  May  19th,  1864,  by  a conoidal  musket  ball  which  struck  the  left  parietal  bone,  near  its  articulation 
with  the  occipital,  denuding  the  cranium  for  a space  one  inch  in  length  and  half  an  inch  in  width.  No  fracture  of  the  cranium 
could  be  detected.  He  was  admitted,  on  June  1st,  to  the  Summit  House  Hospital,  Philadelphia,  complaining  of  pain  in  and 
about  the  part  struck,  but  was  otherwise  doing  well.  On  June  9th,  he  commenced  to  cough,  became  feverish,  and,  at  times, 
delirious,  and  suffered  from  pain  in  the  left  chest.  These  symptoms  continued  for  four  days.  On' the  13th,  he  was  almost 
wholly  unconscious,  could  take  no  solid  food,  and  could  only  with  difficulty  be  induced  to  swallow  fluids.  He  died  on  June  14th, 
1864.  The  autopsy  disclosed  a small  collection  of  pus  under  the  scalp,  at  the  seat  of  injury.  There  was  no  fracture  of  the 
external  table.  The  missile  had  struck  over  a Wormian  bone,  the  sutures  of  which  were  a little  loosened,  thus  admitting  a 
slight  depression  on  pressure.  On  removing  the  calvarium,  a fracture  and  depression  of  the  internal  table  was  detected;  an 
angular  piece,  an  inch  in  length  and  breadth,  was  found  depressed  a quarter  of  an  inch  or  more.  A large  abscess  was  found 
on  the  left  side  of  the  brain,  some  distance  from  the  surfoce,  and  i)us  in  large  quantities  had  collected  under  the  dura  mater. 
The  left  side  of  the  brain  was  highly  inflamed.  The  case  is  reported  by  Surgeon  J.  H.  Taylor,  U.  S.  V. 


Some  nosologists  would  perhaps  exclude  the  following  case  from  the  category  under 
consideration,  since  the  outer  table  was  grooved  by  the  projectile  which  caused  the  injury. 
But  I think  it  should  find  a place  here  as  the  outer  table  was  incised  rather  than  fractured, 
while  the  contunding  force  of  the  projectile  was  propagated  to  the  internal  table.  In  this 
as  in  the  preceding  case,  the  injury  to  the  vault  of  the  skull  led  ultimately  to  a formation 
of  pus  within  the  skull  and  to  purulent  infection  probably ; and  in  both  cases  the  pyaemic 
symptoms  appear  to  have  been  masked  and  mistaken  for  malarial  complications. 


Case  12. — Private  William  McP , Co.  A,  101st  Ohio  Volunteers,  aged  27  years,  was  wounded,  at  the  battle  of  Chick- 

amauga,  September  20th,  1863,  by  a piece  of  shell,  which  inflicted  a wound  of  the  scalp  three  inches  long  and  tw(j  inches  wide  ov(U' 
the  left  parietal  bone.  The  pericranium  was  strijiped  off  to  a somewhat  less  extent;  the  external  plate  of  the  parietal  was 
furrowed  as  if  by  a gouge.  The  patient’s  wound  was  hastily  dressed,  and  he  wms  then  sent,  by  railway,  to  Nashville,  whei-e  ho 
was  admitted  to  Hospital  No.  1,  on  September  24th.  His  general  condition  was  good;  his  pulse  slightly  accelerated,  counting  90 ; 
all  of  the  excretions  were  natural,  and  there  were  no  head  symptoms.  He  was  put  upon  low  diet,  and  cold  water  dressings 
were  applied  to  the  wound.  There  was  no  untoward  symptom  until  October  3d,  when  he  had  slight  fever  and  complained  of 
headache  and  constipation.  The  pupils  responded  readily  to  light.  He  was  ordered  four  compound  cathartic  pills.  After  being 
purged  he  appeared,  on  the  following  day,  somewhat  better.  The  cold  applications  to  the  head  and  restricted  diet  were  con- 
tinued. On  October  5th,  fifteen  days  after  the  reception  of  the  injury,  he  had  severe  rigors,  followed  by  a febrile  movement  and 
profuse  sweating.  Heiidache  had  returned  with  severity.  He  was  directed  to  take  three  grains  <jf  sulphate  of  (juinia  evei'y  four 
hours,  and  the  local  treatment  and  rigid  diet  were  continued.  On  October  6th,  he  was  comfortable.  He  had,  on  the  night  of  the 
7th,  another  paroxysm  of  rigors,  with  violent  febrile  reaction.  The  dose  of  sulphate  of  quinia  was  i-aised  to  five  grains,  and  eight 
grains  of  Dover’s  powder  was  prescribed  with  each  draught.  The  local  treatment  and  low  diet  were  persevered  in.  On  October 
8th,  there  was  no  fever,  and  the  pulse  had  fallen  to  80;  the  headache  continued.  On  October  9th,  there  was  great  complaint 

of  the  severity  of  the  head 
symptoms.  The  pn])ils  were 
slightly  dilated,  though  still 
sensitive  to  light.  There  was 
great  excitement  and  restless- 
ness. The  bowels  were  con- 
fined. He  took  two  “com- 
pound c.'ithartic  pills,”  (U.  S. 

P.)  and  cold  irrigation  to  the 
head  was  employed.  He  was 
kej)t  on  low  diet.  The  quinine 
and  opium  were  omitted,  and 
ho  was  ordered  a drachm  of 
fluid-extract  of  valerian  every 

Fig.  Fracture  with  e.aries  of  the  internal  t.ahle  of  On  the  10th,  there  pjo.  5.5._Exfoliation  from  outer  t.ahle  of  left  parie. 

the  left  parietal,  1922,  .Sect.  I,  A.  M.  M.  were  severe  rigors,  followed  *«'  resulting  from  grooving  by  a fragment  of  shell. 

, S2>cc.  1922,  Sect.  I,  A.  M.  M. 

by  fever  and  coma.  A t(‘re- 

binthinate  enema  was  administered,  without  efiect.  On  the  11th,  the  jiatient  was  still  comatose.  The  dilated  pupils  sluggishlv 

19 


146 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


coiifi’acted  wtion  cxposwl  to  tlie  liglit.  Ho  was  ordored  a powder  of  two  and  a lialf  grains  of  calomel  and  tliroe  of  bicarbonate 
of  soda  every  four  hours.  On  the  12tb,  bis  bowels  were  freely  moved,  but  the  cerebral  symptoms  wore  not  modified.  On  the 
13tb,  the  coma  was  ju-ofound.  The  pu|)ils  were  insensible  to  light.  The  respiration  15,  and  pulse  70  per  minute.  There 
was  paralysis  of  the  bladder.  Involuntary  alvino  evacitations  took  place.  The  extrenuties  were  flexed  and  rigid.  Death 
occurred  on  the  afternoon  of  the  14th  of  October,  18G3,  twenty-four  days  after  the  reception  of  the  injury.  The  autop.sy  was 
made  ten  hour.s  after  death.  The  body  was  moderately  emaciated.  The  external  plate  of  the  left  jiarietal  above  and  in  front 

of  the  protuberance  W'as  deeply  grooved  for  about  an  inch.  About  this  groove  an  ovoid 
necrosed  portion  of  the  outer  table  was  separated  by  a line  of  demarcation.  The  calvaria, 
which  was  of  unusual  thickness,  was  removed  and  transmitted  to  the  Army  Medical  kluseum 
by  C.  .1.  Kipp,  Assistant  Surgeon,  U.  S.  V.  It  is  numbered  1922  of  the  Surgical  Section.  Its 
inner  surface  presented  a fracture  of  the  vitreous  lamina  without  depression.  About  the 
fracture  the  bone  was  carious.  A thick  layer  of  pus  interposed  between  the  bone  and  the 
dura  mater.  Near  the  junction  of  the  sagittal  and  fronto-parietal  sutures,  was  an  abscess 
containing  two  ounces  of  pus.  The  dura  mater  that  covered  the  left  hemisphere  aud  the 
middle  lobe  of  the  right  hemisphere  was  much  thickened,  and  was  of  a dark  greenish  color. 
Along  the  walls  of  the  longitudinal  sinus,  adhesions  had  formed  between  the  dura  mater 
and  cerebral  layer  of  the  arachnoid.  The  longitudinal  sinus  was  filled  with  coagula, 
and  fringed  with  pseudo-membraneous  exudation.  The  superficial  cerebral  veins  were 
tinged  ^vith  black  blood.  The  grey  substance  of  the  external  convolutions  of  the  anterior 
and  middle  lobes  of  the  left  hemisphere,  and  of  limited  portions  of  the  right  hemis(diere, 
W’ere  soft,  and  of  a greenish  color.  There  were  no  abscesses  in  the  substance  of  the  brain. 
The  lateral  ventricles  contained  about  two  fluid  ounces  of  bloody  serum.  All  of  the  tho- 
racic and  abdominal  vicera  were  examined;  but  no  abnormal  appearances  were  observed 
in  them.  A segment  of  the  diseased  dura  mater  constitutes  the  preparation  numbered 
1923  of  the  Surgical  Section  of  the  Museum.  Its  external  surface  displays  a dark  dis- 
coloration over  the  surfiice  corresponding  with  the  necrosed  portion  of  the  calvaria. 
(See  ITg.  5(5.)  Its  inner  surface,  likewise,  is  discolored  over  a space  five  inches  in 

length  aud  three  inches  in  breadth,  which  is  covered  by  an  exudation  of  false  mem- 

brane. Near  the  longitudinal  sinus  are  numerous  fungous  tufts,  in  several  of  which 
bone  has  been  developed. 

In  the  next  case,  also,  the  efforts  of  nature  to  repair  the  vault  of  the  cranium  were 
fi’ustratecl  liy  the  supervention  of  inflaminatory  mischief  within  the  skull. 

Cask  13. — Sergeant  William  H.  15 , Co.  K,  47th  I’ennsylvania  Volunteers,  aged  24  years,  was  wounded  at  the  battle 

of  Cedar  Creek,  October  19th,  18C4.  He  believed  that  he  was  struck  on  the  top  of  the  head  by  a fragment  of  shell;  but  the 
wound  had  more  the  appearance  of  an  injury  inflicted  by  a musket  ball.  His  name  appears  on  the  casualty  lists,  with  the  entry 
“ flesh  wound  of  the  head — slight.”  He  was  sent  to  Newtown,  and  was  thence  transferred  to  Satterlee  Hospital  at  Philadelphia, 
where  he  arrived  on  October  2.5th.  A scalp  wound  two  inches  long  was  found  about  an  inch  behind  the  coronal  suture  and 
parallel  to  it.  It  extended  further  to  the  left  than  to  the  right  side.  The  bone  was  denuded  of  periosteum  over  a space  an  inch 
long  and  half  an  inch  wide.  The  bone  appeared  to  be  otherwise  uninjured.  The  pupils  were  dilated,  and  the  right  side  of  the 
body  was  partially  paralyzed.  The  patient  complained  of  no  pain;  his  ai)petite  was  good;  he  had  slight  diarrhoea.  It  does 

not  appear  that  his  diet  was  restricted,  and  no  record  is  made  of  the  measures  adopted  to  combat  the  s3miptoms  of  compression 

of  the  brain.  On  October  27th,  he  had  involuntarj^  fiecal  dejections,  and  more  stupor,  and  hemiplegia  was  complete.  He  had 

a slight  rigoi'  on  this  day.  On 
October  28th,  he  had  a severe 
chill  and  his  “appetite  began 
to  fail.”  Coma  supervened, 
but  tbe  patient  lingered  a week 
longer,  death  taking  place  on 
November  5th,  18o4.  No  de- 
scription of  the  post  mortem 
examination  has  been  furnish- 
ed. The  skull-cap  w'as  sent 
to  the  Army  Medical  Museum. 

It  shows  externally  (Fig.  58) 
the  efieets  of  a contusion  of 
the  outer  table  of  tbe  skull. 

A line  of  demarcation  includes 

FI(3.  .W. — Dei>rosso(t  fracture  cf  the  inner  tal)Ie  nf  tlic  an  ellijitical  partially  necrosed 
skull  fnun  a contusion  of  tlie  out(‘r  table.  Spun.  '.JOSlt,  , . -.it  . x*  • * 

Sect.  I A.  M.  M.  plate  witli  diameters  of  an  incti 

and  a quarter  and  of  three- 

fourths  of  an  inch.  The  internal  table  is  fissured,  aud  there  are  the  marks  of  diseased  action  along  the  groove  for  the 
longitudinal  sinus  .as  far  backward  as  the  occipital  hone.  (Fig.  57.)  Acting  Assistant  Surgeon  Henry  Mullen  contributed  the 
specimen,  which  is  represented  in  the  wood-cuts  above. 


Fig.  58. — Exterior  view  of  the  same  specimen,  showing 
superficial  exfoliation.  Spec.  3039,  Sect.  1,  A.  M.  HI. 


PlG.  5(i. — I’ortion  of  tlie  dura  mater 
covered  witli  pseudo-membrane.  Spec. 
1933,  Sect.  I,  A.M..M. 


GUNSHOT  FEACTURES  OF  THE  INNER  TABLE  OF  THE  SKULL. 


147 


No  casos  of  gunshot  fractures  of  the  inner  table  of  the  skull  without  external  fracture 
have  been  noticed  in  the  reports  of  the  Confederate  army  medical  department  that  have 
been  filed  in  this  office ; but  the  following  case,  and  another,  recorded  on  page  148,  pertain 
to  Confederate  prisoners  who  died  in  Union  liospitals  : 

Case  14.— Private  James  21.  B , Co.  D,  17tli  Virginia  Infantry,  17  years  of  age,  was  wonnded,  at  the  battle  of 

Spottsylvania,  Hay  I’ith,  1834,  by  two  couoidal  muslcet  balls,  one  of  which  passed  through  the  lower  portion  of  the  right  arm, 
gra/.ing  the  outer  surface  of  the  shaft  of  the  humerus,  while  the  other  denuded  the  bone  on  the  upper  left  side  of  the  forehead. 
He  was  taken  prisoner,  and  was  sent  to  Philadelphia,  where  he  was  received  at  Satterlee  Hospital  on  May  20th,  and  placed 
under  the  care  of  Acting  Assistant  Surgeon  M.  Lampen.  His  general  health  was  quite  good ; and  the  wounds  were  granula- 
ting kindlv.  He  was  allowed  to  be  up  and  to  walk  about,  and  to  have  ordinary  diet.  On  May  28th,  he  complained  of  head- 
ache ; he  liad  a slight  febrile  movement,  and  was  constipated.  The  headache  and  feverishness  persisted  on  the  three  following 
days,  and  on  the  31st,  there  was  a slight  chill  at  t\vo  in  the  afternoon,  followed  by  a severe  rigor  at  five  o'clock.  A febrile 
reaction  ensued  lasting  about  an  hour,  after  which  the  skin  was  cold  and  moist.  The  pulse  was  full  at  84 ; the  pupils  were 
contracted ; there  was  stupor  but  no  paralysis ; the  tongue  was  heavily  furred.  During  the  three  following  days,  there  \vas 
active  delirium,  alternating  with  stupor  and  occasional  lucid  intervals.  When  conscious,  the  patient  complained  of  pain  in  the 
head  and  abdomen.  During  this  period  the  pulse  averaged  110,  and  was  weak  and  compressible.  On  June  5th,  the  left  side 
of  the  fiice  was  oedematous.  The  patient  was  tolerably  quiet.  The  urine  and  fteces  passed  involuntarily.  On  June  7th,  the 
pulse  was  fluttering  and  very  frequent.  Profound  coma  supervened  about  one  in  the  afternoon,  and  continued  until  tlie  patient’s 
death,  which  took  place  early  on  the  morning  of  June  8th,  1864.  From  the  date  of  accession  of  the  headache  and  febrile 
phenomena  on  May  28th,  the  treatment  consisted  of  brisk  purging,  the  use  of  diaphoretics,  cold  applications  to  the  head  and 

revulsives  to  the  lower  extremities.  Thirty  hours  after  death,  an  autopsy 
was  made  by  Acting  Assistant  Surgeon  Charles  P.  Tutt.  At  the  junction  of 
the  lower  and  middle  thirds  the  right  humerus  was  denuded  of  its  periosteum. 
The  wound  on  the  forehead 
W'as  an  inch  and  a (juarter 
in  length  and  half  an  inch 
wide.  On  laying  back  the 
scalp  a large  amount  of  jjus 
was  found  beneath  it  on  the 
left  side.  The  external 
table  of  the  skull  was  not 
fractured,  but  above  the 
left  frontal  protuberance, 
where  the  thin  pericranium 

was  extensively  separated  fig.  GO. — Extericir  view  of  the  same  srecimen,  showing 
Fig.  59. — Fissure  of  inner  table  of  frontal  bone,  from  a , f the  spongy  te.vture  of  a contusion  near  the  left  frontal 

gunshot  contusion,  2747,  Sect.  I,  A.  M.  M.  t>y  me  ouiiotvlllj,  oi  pus,  en,inence.  .Spec.  2747,  Sect.  I,  A.  M.  M. 

the  bone  was  spongy  and 

discolored.  On  removing  the  skull-caji,  the  internal  surface  of  the  cranium  corresponding  with  the  wound  was  found  discolored, 
tind  presented  a linear  fissure  an  inch  long  without  any  depression  of  its  edges.  The  dura  mater  beneath  this  space  resembled 
a dark  eschar  in  appearance,  and  tvas  coated  with  pus.  There  was  a considerable  amount  of  pus  upon  the  suiTace  of  both  hemi- 
spheres. The  vessels  of  the  pia  mater  were  much  congested,  and  at  the  base  of  the  brain  there  was  a large  effusion  of  serum. 
In  one  or  two  places  in  which  the  results  of  meningeal  inflammation  were  conspicuous,  the  subjacent  cerebral  convolutions  were 
superficially  altered,  in  color  and  texture.  But  the  greater  portion  of  the  hemispheres,  the  ventricles,  the  cerebellum,  pons 
Varolii,  and  the  medulla  oblongata  were  normal  in  appeaiance.  Near  the  apex  of  the  left  lung,  masses  of  unsoftened  tubercles 
were  found ; there  were  extensive  pleuritic  adhesions,  and  a large  amount  of  sero-purulent  fluid  in  the  cavity  of  the  left  chest. 
There  were  three  large  metastatic  abscesses  in  the  right  lobe  of  the  liver.  The  kidneys  were  enlarged  and  presented  thi!  appear- 
ance of  the  first  stage  of  fatty  degeneration.  The  specimen  and  memorandum  of  the  autop.sy  were  contributed  by  Dr.  Tutt. 

The  next  case  is  remarkable,  as  it  appeared  to  indicate  tliat  a gunshot  fracture  of  the 
inner  table  alone  of  the  frontal  bone  may  be  caused  by  the  oblique  impact  of  a itrojectile 
upon  the  superciliary  ridge.  It  is  probable  that  the  blow  was  not  over  the  sinus,  but  upon 
a portion  of  the  bone  supplied  with  diploe. 

Case  15. — Corporal  William  McCord,  Co.  I,  14th  Michigan  Volunteers,  at  Chattahoochie,  Georgi.a,  July  5th,  18C4,  was 
struck  over  the  right  superciliary  ridge  by  a conoidal  musket  ball.  He  was  scarcely  aware  of  being  wounded,  so  slight  were 
the  immediate  effects  of  the  injury.  The  bleeding  obliged  him  to  leave  the  r.anks,  and  he  was  examined  by  Surgeon  Edward 
Batwell,*  14th  Michigan  Volunteers,  who  stated  that  he  had  been  struck  by  a glancing  ball,  which  had  cut  through  the 
integuments,  aiiparently  leaving  the  bone  intact.  He  went  to  a division  hospital  of  the  Fourteenth  Corps;  but  tliough  com- 
plaining of  slight  headache,  he  returned  next  day  voluntarily  to  duty  with  his  regiment.  On  the  eighth  day  from  the  reception 
of  the  injury,  in  consequence  of  severe  pain  in  the  seat  of  the  wound,  he  reported  at  the  hospital.  Next  day  the  pain  was 
diminished,  and  he  felt  considerably  better,  but  had  irregular  chills  through  the  day,  followed  by  slight  fever.  On  the  morning 


Surgeon  K.  llatwell  has  published  an  i^couut  of  this  case  iu  the  Michigan  Unioersity  Journal.,  Vol.  1.  No.  5.  July,  lb7().  page  ii70. 


148 


WOUNDS  AND  INJUKIES  OK  THE  HEAD 


of  tliu  t(!ntli  (lay  lie  was  very'  drowsy  and  snappish,  and  evening  bronglit  an  increase  of  these  sy'inptoins,  and  at  night  he  was 
comatose  and  insensible,  and  death  cnsnecl  soon  after.  According  to  Surgeon  Katwell’s  dates,  lie  died  on  July  Kith ; but  the 
report  of  the  adjutant  general  of  Michigan  and  the  register  of  the  Fourteenth  Army  Corps  agree  in  giving  the  date  of  death 
as  July  28th,  1864.  • A post  mortem  examination  revealed  a fracture  of  the  inner  table  of  tbe  skull,  with  slight  depression,  though 
none  was  visible  on  the  external  surface,  with  an  abscess,  containing  about  two  ounces  of  pus,  under  the  seat  of  injury  and  in 
the  substance  of  the  brain.  Dr.  Batwell  remarks;  “The curious  points  of  this  case  are  the  absence  of  urgent  symptoms  during 
the  first  nine  days,  and  the  rapidity  of  their  development  within  the  last  twenty-four  hours.” 

Ill  the  four  following  cases  of  gunshot  fracture  limited  to  the  inner  table  of  the  skull, 
tre]4iining  was  unavailingly  performed.  In  all  of  them  the  exact  nature  of  the  cause 
of  the  cerebral  compression  for  which  the  operations  were  performed  was  necessarily  only 
conjectured,  and  perhaps  in  Case  17,  only,  was  the  existence  of  a fracture  of  the  vitreous 
table  surmised.  The  operations  were  performed  on  general  surgical  principles  to  relieve 
compression  of  the  brain.  That  they  were  unsuccessful,  only  corroborati^s  the  opinion  that 
has  been  so  strongly  impressed  on  the  minds  of  surgeons  of  the  present  day,  that  authentic 
examples  of  successful  trephining  for  matter  between  the  bone  and  dura  mater  are  now 
very  rarely  cited.  It  will  be  noticed  that  those  who  died  from  encejdialitis  survived  from 
ten  days  to  a fortnight,  while  those  who  died  from  abscess  of  the  brain  lived  about  three 
weeks ; 

Case  16. — Private  William  Casey,  Co.  11,  60th  Ne(v  York  Volunteei’s,  was  Avounded  in  the  head  at  the  battle  of  Fair 
Oaks,  Virginia,  June  1st,  1862.  He  was  admitted  to  the  regimental  field  hospital,  and  thence  sent,  on  an  hospital  transport 
steamer,  to  Philadelphia,  where  he  entered  the  South  Street  Hospital,  on  June  8th,  being  insensible  on  admission.  There  was 
a lacerated  wound  of  the  scalp,  near  the  right  parietal  eminence,  but  no  fracture  of  bone  could  be  detected.  Cold  water  dressings 
.and  adhesive  strips  were  applied,  and  on  the  next  day  the  patient  aroused  and  became  quite  rational.  On  the  afternoon  of  tbe 
12th,  he  manifested  much  nervous  anxiety,  Avith  nausea  and  retching.  He  soon  afterAvards  had  a violent  chill.  His  head 
Avas  V'cry  hot,  and  the  pupils  Avere  contracted.  The  adhesions  of  the  Avound  Avere  broken  up,  and  cold  applic.ations  Avere  made 
to  the  head.  There  Avas  little  change  in  his  condition  until  June  1.5th,  Avhen  the  stupor  and  other  signs  of  cerebral  com- 
pression became  more  marked,  and  it  Avas  decided  to  apply  the  trephine.  A button  of  bone  Avas  removed.  Upon  perforating 
the  skull  an  immense  amount  of  sanious  pns  floAved  through  the  orifice,  but  the  condition  of  the  jiatient  Avas  not  ameliorated. 
He  remained  comatose  until  death,  Avhich  occurred  on  June  16th,  1862.  A careful  post  mortem,  examination  reve.aled  a fractui  e 
of  the  internal  table  of  the  cr.anium,  and  an  immense  cerebral  abscess  involving  all  the  convolutions  and  the  pia  mater  of  the 
right  hemisphere.  The  case  appe.ars  to  h.ave  been  attended,  and  the  operation  performed,  by  Acting  Assistant  Sni'geon  J. 
Hopkinson ; but,  unfortunately,  no  special  report  Avas  made,  and  the  disposition  made  of  the  specimen  is  unknoAvn.  The  Army 
Medical  kluseum  Avas  not  then  est.ablished,  and  this,  and  many  other  pathologic.al  preparations  obtained  at  the  time,  probably 
])assed  into  private  h.ands.  The  facts  above  recorded  are  gleaned  from  the  monthly  rejiort,  prescription  book,  and  case  book  of 
the  South  Street  Hospit.al. 

Case  17. — Priv.ate  Dennis  S , Co.  E,  2d  West  Virginia  Cav.alry,  aged  21  years,  was  Avounded,  in  an  engagement  at 

Harper’s  Farm,  ne.ar  Appomatto.x  Court  House,  on  April  6th,  1865,  by  the  obliipie  impact  of  a musket  ball  Avbich  denuded  and 
contused  the  front.al  bone  a little  beloAV  the  coronal  suture  and  to  the  left  of  the  median  line.  Being  taken  prisoner,  he  Avas  [daced 
in  a field  hospital  Avhero  a Avater  dressing  Avas  aiiplied,  the  hair  being  sh.aved  off  to  a suitable  extent.  A fcAV  days  subsequently, 
be  was  sent  to  the  re.ar,  and  he  re.ached  Washington  a fortnight  after  the  reception  of  his  Avound,  and  AV.as  ])laced  in  Harewood 
Hospital  on  Ajiril  IDth.  He  had  a chill  soon  .after  his  admission,  and  reported  that  for  some  days  he  h.ad  suffered  from  tAVo 
p.aroxysms  of  ague  daily.  He  had  no  pain  in  the  head,  nor  any  symptom  to  e.xcite  apprehension  .as  to  the  condition  of  the 

br.ain,  except  the  chills,  Avhich  Avere  ascribed  to  m.alarial  intluence.  They  proved, 
hoAvever,  not  to  be  amenable  to  quinia,  Avhich  Avas  freely  administered,  for  several 
days,  Avithont  adv.antago.  On  April  24th,  a slight  congestion  of  the  loAver  lobe  of 
the  light  lung  Avas  noticed.  The  next  d.ay  pneumonia  Avas  fully  deA'eloped  here, 
and  on  the  26th,  the  greater  portion  of  the  light  lung  Avas  involved,  and  there  was 
acute  pain  in  the  cardiac  region,  Avith  a souffle  accompanying  the  first  sound  of 
the  heart  and  a murmur  of  regurgitation  the  second  sound.  The  pulse  rose 
rapidly  to  1.56;  but  fluctuated  greatly  in  frequency  and  force.  At  ten  jn  the 
evening  of  this  day  the  patient  became  comatose.  Shortly  aftei-Avards,  Surgeon 
li.  B.  Bontecon,  U.  S.  Vols.,  apjilied  the  croAvn  of  a small  trephine  on  the  right 
of  the  space  in  Avhich  the  pw'icranium  Avas  removed.  When  the  outer  table  Avas 
passed,  pus  began  to  exude  from  the  cells  of  the  diploc.  When  this  Avas  pene- 
trated a depressed  fracture  of  the  inner  table  Avas  discovered.  Another  perfora- 
tion Avas  now  made  to  obtain  sp.ace  to  remove  the  d(>pressed  fragments  of  the 
vitreous  jilate.  A small  fragment  and  another  nn'.asnring  nine  by  six  lines  Avere 
found  completely  detached,  and  Avere  removed  by  common  dissecting  forceps.  The  operation  had  no  inlluence  iqion  the 
profound  coma,  that  persisted  until  the  patient’s  death,  Avhich  took  place  on  the  folloAviug  morning,  Ajiril  27th,  1865.  At  the 


Fig.  61. — Seg’ment  of  a cranium  trephined  for  a 
dejiressed  fracture  of  the  inner  table.  4344, 

Sect.  I,  A.  III.  M. 


GUNSHOT  FRACTURES  OF  THE  INNER  TABLE  OF  THE  SKULL. 


149 


a.nt()psy,  .i  large  abscess  was  found  in  the  substance  of  tlie  right  cerebral  homisnhere.  A segment  of  the'  frontal  l)onc,  with 
the  two  disks  and  the  larger  fragment  of  the  inner  table,  removed  at  the  operation,  were  forwarded  to  the  Army  Medical 
Museum,  by  Surgeon  R.  B.  Boiitecou.  U.  S.  V.,  and  are  represented  in  the  accompanying  wood-cut,  (Fid.  Gl.)  A view  of  the 
interior  of  the  specimen  is  given  in  Fig.  I,  of  the  Catalogue  of  the  Surgical  Section  of  the  Army  Medical  Museum,  (p.  (5,)  and 
in  the  Surgical  Report  in  Circular  No.  6,  S.  G.  O.,  1835,  j).  11,  Fig.  C,  and  a photograph  of  the  patient,  taken  a few  hours 
prior  to  the  operation,  is  preserved  at  the  Museum,  as  No.  58,  Vol.  I,  of  the  Series  of  Contributed  Photographs  of  Surgical 
Cases.  The  lower  figure  in  Plate  III,  opposite  page  105,  is  copied  from  the  photograph,  and  represents  the  a])pear.ance  of  the 
|)atient  after  the  graver  sym))toms  of  compression  of  the  brain  had  set  in. 


Ca.SE  18. — Privuato  Charles  H.  Leonard,  Co.  II,  57th  M.assachu setts  Volunteers,  aged  22  years,  was  wounded,  ,at  the 
battle  of  the  Wilderness,  Virginia,  May  G,  180-1,  by  a conoidal  musket  ball.  He  was  conveyed  to  AVashiugton,  I).  C.,  and, 
on  May  11th,  admitted  to  the  Columbian  Hospital.  There  was  a wouml  of  the  scalp  over  the  left  occipital  ))rotuberance,  but 
the  external  table  was  not  fractured.  On*  May  15th,  Acting  Assistant  Surgeon  H.  1).  Vosbnrg  ap])lied  the  trephine,  removed 
a portion  of  bone,  and  took  out  a fragment  of  the  inner  table,  which  was  lying  loose  on  the  dura  mater.  Coma  supervened, 
and  death  occurred  on  May  17th,  1834,  from  encephalitis. 

Ca.SE  19. — Private  John  R.  Montgomery,  Co.  A,  9th  Illinois  Volunteers,  aged  30  years,  was  wounded,  at  the  siege  of  Fort 
Donelson,  Tennessee,  Fe^  ■nary  14th,  18G2,  by  a buckshot  which  inflicted  a scal]i  wound  over  the  right  ])arietal  bone,  .and 
lodged.  Three  days  after  the  reception  of  the  injury,  the  iiatient  was  admitted  to  the  hospital  of  the  2d  division  of  the  Fifteenth 
Corps.  An  examination  of  the  wound  revealed  an  opening  in  the  scalp  of  the  size  of  a pea.  The  missile  could  not  be  defected 
by  the  probe.  There  w.as  no  depression  of  the  skull,  and  oidy  a slight  denudation  of  the  pericranium  coidd  be  discovered. 
The  patient  felt  well,  ate  heartily,  was  able  to  walk  about  the  ward,  read  neivspapers,  and  considered  his  wound  of  slight 
importance.  On  Febru.ary  19th,  he  was  .attacked  with  clonic  spasms  of  the  left  side  of  the  face  and  left  extremities.  They 
recurred  about  every  ten  minutes  at  first,  and  rapidly  augmented  in  freejuency,  becoming,  in  an  hour,  almost  continuous. 
Trephining  was  determined  upon,  and  the  patient  being  placed  under  the  influence  of  chloroform,  the  scal|)  W'as  rellected.  A 
portion  of  the  skull  of  the  size  of  a shilling  was  found  to  be  denuded  of  periosteum  and  somewhat  roughened,  but  no  fracture 
or  depression  was  evident.  Upon  ])erforating  the  e.xternal  table,  the  inner  table  was  found  to  be  broken  and  sj)lintered  to  a 
considerable  extent.  A clot  of  blood  was  found  upon  the  membranes  of  the  brain,  and  on  its  removal  the  yaitient  aroused  and 
bec.ame  conscious,  without  recurrence  of  the  convulsions.  The  splintered  portions  of  the  internal  jdate  were  removed,  the  scalp 
was  replaced,  and  simple  dressings  were  applied.  On  the  two  days  following,  the  [).atient  was  doing  well,  and  the  spasms  did 
not  recur.  Early  on  the  morning  of  February  22d,  convulsions  suddenly  came  on  again ; but  ceased  when  Dr.  Fisher  explored 
the  wound  with  a probi;,  and  removed  some  coagula.  On  the  23d,  the  convulsions  recurred,  and  soon  became  almost  incessant. 
There  were  short  lucid  interv.als  during  the  day,  when  the  j)!itieut  conversed  rationally;  but  he  was  evidently  becoming  comatose, 
and  answered  questions  with  much  difficulty  of  articulation.  On  the  24th,  a consultation  was  held  by  Urs.  Fisher,  Boone,  and 
Heydock,  and  it  was  decided  to  remove  another  portion  of  the  skull.  The  patient  was  chlorofoiined,  and  Dr.  Fi.sher  apidied 
the  trephine  and  removed  a button  of  bone  from  the  anterior  edge  of  the  perforation  previously  made.  The  wound  was 
cleaned  with  a syringe,  the  patient  rallied,  the  convulsions  ceased  for  si.x  or  eight  hours,  and  (ho  symptoms  improved.  The 
wound  began  to  discharge  freely;  but  drowsiness  and  insensibility  c.ame  on,  and  the  p.atient  went  into  a ]irofounil  coma,  ami 
died  on  the  afternoon  of  February  25th,  1832,  eleven  days  after  the  recej)tion  of  the  injury. 


The  next  case  is  a very  remarkable  example  of  contusion  of  tlic  occipital  bone  by  a 
musket  ball,  without  apparent  injury  to  the  outer  table,  and  with  de[)ressed  fracture  of  the 
inner  table,  followed  by  an  exfoliation  of  the  entire  thickness  of  the  bone  that  had  been 
divested  of  its  periosteal  covering.  This  patient  was  the  solitary  survivor  of  this  form  of 
injury  in  whom  the  diagnosis  could  bo  verified  : 


Case  20. — Priv.atc  .John  Donov.an,  Co.  I,  97th  Pennsylvania  Volunte<u's,  aged  18 
years,  was  wounded,  on  .luly  14th,  1834,  in  an  cng.ageimmt  of  the  Eighteenth  Corps  befon; 

Ih'tei’sburg,  by  .a  conoidal  musket  bid  1 which  tore  up  the  scalp  over  the  occipit.  He  was 
taken  to  the  corps  hospital,  .and  was  thence  transferred  to  the  general  hospital  at  Fort 
Monroe,  on  .July  IGth.  On  .July  25th  he  was  sent  to  New  York,  .and  was  admitted,  on 
the  27th,  to  the  McDougall  Hosiiit.al  at  Fort  Schuyler.  Here  he  remained  until  the  31st 
of  August.  The  records  of  these  three  hospitals  sinqdy  announce  the  date  of  his  admission 
and  transfer  with  “gunshot  wound  of  the  head,”  and  afforded  no  further  information  rela- 
tive to  the  nature  of  the  injury  or  the  progress  and  tiaaitment  of  the  symptoms  which  it 
induced.  On  August  31st,  Priv’.ate  Donovan  was  moved  to  Philadelphia,  and  entered 
Bro.ad  and  Cherry  Streets  Hospital  on  the  same  day,  and  came  under  the  charge  of  Acting 
Assistant  Surgeon  H.  M.  Bellows,  who  has  reported  to  the  Surgeon  General  the  little 
that  is  known  of  this  most  interesting  case.  The  patient,  on  entering  Broad  and  Cherry 
Streets  Hospital,  brought  no  written  account  of  his  case,  but  he  stated  that  he  had  suffered 
from  fever  at  Fort  Schuyler,  and  was  now  supposed  to  be  convale.scing.  He  was  anmmic, 
feeble,  and  very  much  emaciated.  He  complained  of  constant  chilliness  and  of  head- 
.ache.  Over  the  right  branch  of  the  lambdoidal  suture  there  was  a wound  presenting  a 
healthy  granulating  surface  at  the  edges,  while  in  the  middle,  denuded  bone  was  revealed. 

A tonic  regimen  was  jirescribed,  and  emollient  dressings  were  ajiplied  to  the  wound.  For  the  next  two  months  these  measureg 


Flo.  G2. — Necrosed  fragment  from  tlio 
right  parietal,  sliowing  adepressed  fmctiiro 
of  the  inner  talde  witliout  lesion  of  tlio 
external.  Spec.  ‘ll'JI,  .Sect,  I,  A.  M.  M. 


150 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


wore  unchanged  and  the  general  health  of  the  patient  steadily  improved.  The  wound  gave  little  inconvenience,  but  it  was 
obvious  tliat  it  would  not  close  until  an  exfoliation  should  take  place,  or  the  dead  bone  should  be  otherwise  detached.  On 
November  3d,  the  patient  was  granted  a fortnight’s  furlough  to  visit  his  fainil^n  On  his  I'eturn  it  was  found  that  the  denuded 
bone  was  movable,  and  on  November  23d  a necrosed  fragment  of  the  entire  thickness  of  the  cranium,  an  inch  and  a half  long, 
was  extracted  by  Dr.  Bellows.  The  dura  mater  beneath,  through  which  the  pulsations  of  the  brain  could  be  distinctly 
perceived,  was  perfectly  normal  in  appearance.  The  wound  finally  closed  on  January  28th,  1865.  On  March  2d,  the  man 
was  invalided  and  transferred  to  the  Veteran  Reserve  Corps.  On  May  29th,  1865,  he  was  discharged,  on  surgeon’s  certificate 
of  disability,  by  reason  of '‘fracture  of  the  skull,  producing  irritation  of  the  brain.”  The  specimen  illustrated  by  FiG.  62  is 
a portion  of  bone  from  the  postei’ior  portion  of  the  right  parietal,  near  the  occipito-parietal  suture,  measuring  an  inch  and  a half 
in  length  and  a little  less  than  an  inch  in  breadth.  Tlie  outer  table  is  unbroken.  The  vitreous  table  presents  a fracture 
depressed  about  one  line.  This  invaluable  specimen  was  contributed  to  the  Museum  by  Dr.  Bellows.  This  pensioner  is 
reported  on  March  9th,  1870,  as  examined  by  a board,  of  which  Drs.  Harper,  Smith,  Reed,  and  Goodman  were  members,  as 
totally  disabled,  attacks  of  vertigo  rendering  him  incapable  of  any  physical  exertion.  The  loss  of  substance  of  the  skull  had 
been  partly  replaced  by  bone,  partly  by  fibrous  tissue. 

Of  these  twenty  patients,  but  one  recovered.  The  interval  between  the  reception  of 
the  injury  and  the  fatal  termination,  in  the  other  nineteen  cases,  varied* * from  ten  to  sixty- 
one  days.  The  average  duration  of  life  was  twenty-two  days.  In  thirteen  cases,  there  was 
suppuration  beneath  the  dura  mater ; in  two,  pysemia  and  metastatic  foci  supervened,  and 
in  four  there  was  encephalitis  and  softening  of  the  brain  substance.  In  four  cases,  the  blow 
was  inflicted  upon  the  frontal  region  ; in  thirteen,  upon  the  parietal,  in  two,  on  the  occipital, 
and  in  one,  the  site  of  the  injury  is  not  specified.  In  fourteen  instances,  the  injury  was 
caused  by  the  oblique  impact  of  musket  balls ; in  four  cases,  by  shell  fragments ; in  one 
case,  by  a buckshot ; and  in  one  case  the  nature  of  the  projectile  is  not  stated. 

It  has  been  supposed  that  this  form  of  fracture  was  known  to  Hippocrates,  Oelsus, 
Paul  of  Hjgina,  Vidus  Vidius,  and  other  ancient  writers, ‘ who  regarded  the  accident  as 
dependent  upon  a species  of  contre-coup,  said  to  have  been  called  or  A-r/-/rjp.a,  or 

resonitus.  But  an  examination  of  the  references  made  to  the  works  of  these  authors,  shows 
that  they  did  not  clearly  describe  the  injury  under  consideration.  Mr.  Teevan  correctly 
observes,^  that  one  of  the  earliest  writers  who  was  aware  of  this  lesion  was  Jacobus 
Berengarius  f but  the  first  recorded  case  appears  to  be  that  of  Ambroise  Pard,^  who  relates, 
that  a nobleman  of  M.  d’Estampe’s  company  was  wounded,  at  the  breach  of  the  chateau  of 
Hedin,  by  a ball  from  an  arquebuse,  which  he  received  on  the  parietal  bone,  and  died 
apoplectic  on  the  sixth  day.  Neither  the  scalp  nor  the  external  table  of  the  skull  were 
broken ; and  Pard,  wishing  to  know  the  cause  of  death,  opened  the  skull,  and  found  the 
second  table  depressed,  the  outer  table  being  entire.  Garengeot,®  next  reports  a case  by 
M.  Mery,  successfully  trephined.  Saucerotte,®  in  his  memoir  on  fractures  of  the  skull  by 
contre-coup,  quotes  these  cases,  and  adds  one  from  Tulpius,’’’  resulting  from  gunshot  injury, 
and  terminating  fatally  on  the  sixth  day,  after  trephining.  LeDran®  records  an  example  of 
this  injury,  produced  by  a fall  from  a scaffolding,  trepanning  having  been  performed 

' Hippocr.^tes,  De  Capitis  Vulneribus,  Lutetiae,  1578.  Celsus,  De  Mcdicini,  L.  VIII,  cap.  IV,  p.  51C.  Lugclmii, 
1785.  ARCiEUS,  De  recta  curandorum  Vulnerum  ratione.  Cap.  Ill,  p.  3.  Amstelodami,  1058.  Valleriola,  Observationum 
Medicinalium,  lib.  6. 

^T/ie  British  and  Foreign  Med.  Chir.  Rev.  Vol.  XXXVI,  p.  189. 

Berengarius,  De  Fractura  Cranii.  Bologna  1535.  I have  not  been  able  to  consult  the  princeps  edition;  but  the 
passage  is  repeated  in  the  edition  in  the  Surgeon  General’s  Library,  Lugdwni  Batavorum,  1715.  Liber  Aureus,  Uactenus 
dcsideratus.  Editio  nova,  etc.,  p.  6. 

■•Par^).  Oeuvres,  ed.  1653.  T.  X,  p.  225. 

* Garengeot,  Traite  des  Opdraiions  de  Chirurgie.  Paris,  1738.  2d  ed.  T.  3,  p.  122. 

•^Saucerotte,  Mem.  sur  les  sujets  proposes  pour  les  Prix  de  V Academie  Boijale  de  la  Chirurgie.  T.  IV,  p.  322. 

’Tulpius,  Observationes  Medkce.  Lugduni  Batavorum,  1716,  ju  3.  Guthrie  seems  to  think  that  the  cracks  in  the  inner 
table  were  made  by  the  surgeon.  See  Injuries  of  the  Head,  etc.  London,  1842,  quarto,  p.  73. 

«Le  Dran,  Obs.  de  Chir.  T.  I,  obs.  17. 


GUNSHOT  FRACTUEES  OF  THE  INNER  TARLE  OF  THE  SKULL. 


151 


imsuccessfully.  Pott'  relates  two  examples  of  fracture  of  the  inner  table  alone  ; one  of  a 
young  woman  pitched  from  a wagon,  and  striking  on  the  head  on  a flat  pavement,  trephined 
on  the  fourth  day,  but  dying  from  suppuration  between  the  skull  and  dura  mater  ; the  other 
of  a porter  knocked  down  by  an  iron  hook,  who  walked  home,  but  next  morning  lost  the 
powers  of  speech,  power,  and  locomotion ; after  his  death,  on  the  third  day,  a piece  of  the 
vitreous  plate  of  the  right  parietal,  an  inch  and  a half  long,  was  found  detached.  Pott 
adds  that  these  are  the  only  instances  he  had  met  of  fracture  of  the  inner  table  alone ; but 
that  he  made  no  doubt,  that  some  of  those  “ thouglit  to  have  been  destroyed  by  concussion, 
have  sunk  under  this  kind  of  mischief.” 

Bilguer”  relates  that  “at  the  battle  of  Torgau  in  1760,  Colonel  von  Lossau,  Chief  of 
the  Grenadier  Battalion,  was'wounded  by  a small  bullet  on  the  centre  of  the  right  frontal 
bone,  in  such  a manner  as  to  leave  visible  neither  fissure,  mark  of  impression,  nor  fracture. 
For  three  days  the  colonel  would  not  consent  to  trepanning,  but  on  the  fourth  day,  beginning 
to  fall  into  a stupor,  he  permitted  the  operation.  It  was  not  performed  in  vain.  Four  large 
pieces  were  found  to  have  been  knocked  off  the  inner  plate,  and  the  trephine  had  to  be 
applied  three  times  before  these  could  be  extracted.  The  colonel  recovered  perfectly  and 
holds  at  present  a command  in  the  army.”^ 

RavatoiP  describes  the  case  of  a grenadier  at  Philisbourg,  who  received  a contusion 
from  a ball  on  the  anterior  part  of  the  right  parietal.  At  Landau,  six  weeks  afterward, 
he  had  terrible  convulsions,  and  died.  On  removing  the  skull-cap,  Puavaton  found  “ la 
seconde  table  des  os  enfoncde  et  deux  ddp6t&‘  de  matiere  purulente  dans  la  substance  du 
cerveau.” 

Samuel  Cooper'’  trephined  at  Brussels  after  the  battle  of  Waterloo,  a patient  who  had 
been  struck  on  the  right  parietal  bone  by  a musket  ball,  with  urgent  symptoms  of  com- 
pression. “ He  had  not  sawn  long  before  the  external  table  came  away  in  the  hollow  of 
the  trephine,  leaving  the  inner  table  behind,  which  was  not  only  fractured  but  driven  at 
one  point  more  than  half  an  inch  into  the  membranes,  and  substance  of  the  brain.  No 
sooner  were  the  fragments  taken  out  with  a pair  of  forceps,  than  the  man  instantly  sat  up 
in  his  bed,  looked  around,  and  began  to  speak  with  the  utmost  rationality.  It  is  a most 
extraordinary  fact  that  this  patient  got  up  and  dressed  himself  the  same  day,  without  leave 
from  the  medical  officers,  and  never  had  a bad  symptom  afterwards.” 

Baudens,  in  one  of  his  earlier  works,®  gives  the  case  of  a soldier  in  Algeria,  who  received 
a scalp  wound  apparently  over  the  right  parietal.  Except  paralysis  of  the  arm,  there  was 
no  indication  of  affection  of  the  brain.  He  was  bled  ; but  died  of  acute  encejihalitis  in  four 
days.  At  the  autopsy,  Baudens  found  ; “ une  brisure  de  la  lame  vitrde  dont  une  esquille 
longue  d’un  demi-pouce  s’etait  ddtachde  et  comprimait  le  cerveau  ; le  crane  n’offrait  h 
I’extdrieur  ni  felure  ni  contusion  apparente.” 


1 Observations  on  the  Nature  and  Consequences  of  Wounds  and  Contusions  of  the  Head.  Loiulon,  1700,  p.  IG, 

and  Chirurgical  Works,  Am.  ed.  Philadelphia,  1819,  Vol.  I,  p.  170. 

'^Bilguer,  J.  U.  Chirurgische  Wahmehmungen.  Beilin,  1763,  p.  30. 

® Velpeau,  De  V Operation  du  Trepan.  Paris,  1834,  p.  *29,  cites  another  case  from  Bilguer,  caused  by  a blow  from  a 
brick ; but  it  does  not  properly  belong  to  this  class,  as  there  was  an  external  linear  fissure. 

■'  R.waton,  Pratique  Moderns  de  la  Chirurgic.  I’aris,  177G.  T.  I,  ]>.  210. 

'^Cooper,  Surgical  Dictionarg,  8th  ed.,  p.  899.  IIennex,  op.  cit.,  ji.  327,  and  Brodie,  in  Med.  Chir.  Trans.,  vol.  XYI, 

p.  231. 

‘'Baudens,  Clinique  dcs  Plaks  d’Armes  d Feu.  Paris,  183G,  p.  80, 


152 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Bernhard  Beck'  relates  the  case  of  a soldier  of  the  Pope’s  second  Swiss  regiment, 
who  had,  at  Vincenza,  a contusion  by  gunshot  of  the  right  parietal,  making  a scalp  wound 
two  inches  long,  denuding  the  periosteum.  There  was  paralysis  of  the  left  arm.  The 
patient  died  two  days  after  the  reception  of  the  injury.  The  internal  table  was  depressed. 
Four  splinters  penetrated  the  dura  mater.  A collection  of  pus  lay  beneath  the  seat  of 
injury.  Beck  also  gives  the  particulars  of  two  other  cases  that  of  a man  who  received 
a blow  on  the  left  parietal  from  a beer  glass,  which  produced  a fracture  of  the  inner  table. 
Meningitis  followed  by  intracranial  suppuration  and  death  ensued.  The  second  was  a 
soldier  of  the  Grand  Duchy  of  Oldenburg,  who  received  a lacerated  gunshot  wound  of  the 
scalp  over  the  right  parietal.  No  cerebral  symptoms  at  first ; but  in  three  weeks  meningitis 
and  pyiemia  ensued  and  the  patient  died.  The  autopsy  showed  a fracture  with  depression 
of  one  line  of  the  inner  table.  The  dura  mater  was  separated  from  the  bone,  and  there  was 
an  abscess  beneath  in  the  cerebral  substance.  There  were  also  metastatic  foci  in  the  liver 
and  lungs. 

OchwadD  records  the  case  of  a Danish  soldier  who  received  in  the  Schleswig-Holstein 
war,  an  oblique  gunshot  wound  over  tlm  left  parietal ; the  scalp  being  much  torn,  and  the 
periosteum  denuded.  There  was  nothing  noticeable  about  the  case  until  the  fifth  day. 
Death  resulted  on  the  seventh  day  from  encephalitis.  The  autopsy  showed  a depression 
of  the  internal  table  of  the  size  of  a grosclien.  Near  the  upper  anterior  angle  of  the 
parietal,  there  was  a small  abscess  beneath  tlie  cranium  and  dura  mater,  at  the  seat  of 
injury. 

Guttenberg'  records  the  case  of  a soldier  of  the  second  Baden  regiment,  who,  at 
Rastadt,  August  4,  1861,  received  a blow  from  the  lock  of  a musket  over  the  right  parietal 
protuberance.  The  scalp  was  torn  and  the  periosteum  abraded.  He  had  headache  and 
slight  fever,  but  no  cerebral  symptoms  of  consequence  until  August  22d,  when  convulsions 
occurred,  followed  on  the  24th  by  hemiplegia  of  the  right  side.  Death  took  place  on 
August  28th.  A fracture  of  the  inner  table  three  lines  in  diameter  and  depressed  one  line, 
without  any  visible  fissure  of. the  outer  table,  was  observed  at  the  autopsy. 

Guthrie'’  has  carefully  examined  the  literature  of  this  subject,  and  adds  an  interesting 
case  which  Mr.  Deane  of  Chatteris,  in  Cambridgeshire,  had  occasion  to.  observe  in  a young 
man — a fracture  of  the  inner  table  from  a blow  below  the  left  parietal  protuberance. 
There  was  a slight  detachment  of  the  pericranium,  but  no  external  fracture ; yet  on  the 
removal  of  the  calvaria,  when  the  man  died,  a few  days  after  the  injury,  a distinct  fracture 
of  the  inner  table  about  three-quarters  of  an  inch  long,  was  found  corresponding  to  the 
external  part  injured,  and  extending  to  the  diploe  but  no  I'urther.  There  was  an  extrava- 
sation of  blood  beneath,  between  the  bone  and  dura  mater.  Guthrie®  also  details  a case 
of  injury  of  the  internal  table  without  lesion  of  the  outer,  related  by  Mr.  Trye,”'  of  Glouces- 
ter, successfully  treated  in  the  year  1786.  Nine  weeks  after  contusion  of  the  right  parietal, 
the  external  table  being  evidently  dead,  the  trephine  was  applied,  and  he  then  found  that 

' Beck,  Z)ie  Schusswunden.  Heidelberg,  1850.  S.  99,  utid  Uher  isoUrten  Bruch  der  Glastafel  in  Langenbeck’.s  Areliiv. 
Berlin,  1862,  B.  2,  S.  547. 

^ Beck,  Kriegschirurgischc  Erfaliruiigen.  Freiburg,  1867.  S.  167. 

OciiWADT,  Kriegschirurgischc  Erfahrungen.  Berlin,  1865,  S.  321. 

■' GuTTEXBEUCf,  Uchcr  Schddelbriiche  mit  Eindruclc,  in  Langenbeck's  Arebiv.  B.  IV,  S.  596. 

^Guthrie,  Commentaries,  Sixth  cd.  London,  1855,  p.  342. 

Guthrie,  Op.  Cit. — Injuries  of  the  Head,  etc.,  quarto.  London,  18.52,  p.  73. 

•Trye,  Medical  Communications.  London,  Vol.  II,  1790. 


a UNSIIOT' FRACTURES  OF  THE  INNER  TABLE  OF  THE  SKULL. 


153 


the  inner  table  had  been  removed  liy  absorption.  There  were  granulations  springing  up, 
but  whether  from  the  dura  or  pia  mater,  or  brain,  could  not  bo  accurately  ascertained.  This 
man  recovered. 

La  Motte‘  supposed  that  vdien  the  inner  table  was  broken  without  the  outer,  the  fact 
might  be  ascertained  by  the  peculiarity  of  the  resonance  of  the  skull  on  percussion 
resembling  the  “cracked  pot”  sound,  described  in  modern  times  by  auscultators  of  the 
chest,  and  cites  a case  in  illustration  of  this  idea.  Atthalen  of  Besan^on  had  the  same 
opinion,  and  adduced  an  interesting  case,  which  happened  in  1746 ; but  it  appears  that  in 
this  instance  there  was  a fissure  of  the  external  table.  Professor  Stromeyer"  also  attaches 
value  to  this  mode  of  exploration.  His  remarks  on  the  subject  are  quoted  at  length,  and 
possess  a special  interest,  as  he  reports  two  of  the  limited  number  of  cases  in  which  the 
pathological  preparation  was  preserved  : 

“ This  kind  of  injury,  of  which  only  one  case  has  come  to  my  notice,  might  be 
observed  oftener  if  we  still  used  the  trepan  as  Pott  did,  or  if  one  could  obtain  a reliable 
diagnosis  without  opening  the  cranium.  By  means  of  percussing  with  a silver  probe,  I was 
enabled  in  one  case,  where  there  was  only  a barely  perceptible  fissure  in  the  outer  table, 
to  diagnosticate  the  extent  of  the  inner  separation  accurately,  and  after  the  decease  from 
pyaemia,  in  this  same  case,  many  of  the  young  surgeons  had  the  opportunity  of  convincing 
themselves  of  the  correctness  of  my  diagnosis.  Any  one  of  them,  who  possessed  a practiced 
ear,  could  discriminate  the  sounds  when  percussing  the  outer  table  at  the  point  of  the  internal 
fracture,  or  at  other  parts  on  the  cranium.  At  the  point  of  the  internal  fracture,  the  pitch 
is  somewhat  higher.  Lanfrancus  and  Ambroise  Pare,  I find,  already  knew  of  this  diagnostic 
expedient.  It  is  wonderful  that  the  inner  table  can  be  fractured  and  driven  inwards 
considerably,  while  it  is  impossible  to  detect  the  least  injury  on  the  outer  table  by  means  of 
a lens  even,  as  is  the  case  in  my  specimens.  At  the  same  time,  these  cases  are  not  isolated. 
Partial  fractures  of  bones  by  bending  are  analogous  to  them.  The  outer  table  evidently 
possesses  a greater  elasticity  and  is  more  pliable  than  the  inner.  One  can  form  a good  idea 
of  the  elasticity  of  the  skull,  as  Hyrtl  says,  by  throwing  a fresh  cranium  on  the  floor,  when 
it  will  rebound.  These  inner  separations  remain  generally  undiscovered,  which  is,  in  my 
opinion,  lucky  for  the  patient,  because  thereby  he  escapes  the  danger  of  being  trepanned. 
It  is  not  assuming  too  much  to  suppose  that  these  cases,  would  generally  result  favorably, 
if  the  patient  was  subjected  sufficiently  long  to  an  antiphlogistic  diet ; because  the  danger 
incurred  by  these  cases  is  evidently  less  than  in  others,  where  the  access  of  air  to  the 
splintered  part  of  the  inner  table  takes  place.  For  the  older  surgeons,  who  did  not  know 
the  difference  between  subcutaneous  wounds  and  those  exposed  to  the  atmosphere,  the  lesions 
in  cases  of  head  injuries  formed  a constant  source  of  anxiety.  They  could  not  explain  to 
themselves  what  would  become  of  the  secretion  of  the  wound.  We  now  know  that  when 
the  atmosphere  is  excluded,  and  proper  care  is  taken,  the  inflammatory  exudation  will 
become  reduced  to  a minimum,  sufficient  only  to  permit  the  healing  process ; while  it  will 
never  become  so  much  as  to  require  an  exit  channel.  One  need  not  revert  fifteen  years  in 
surgical  literature  to  be  convinced  that  an  unfounded  dread  of  the  impossibility  of  an 
exit  for  the  secretions  of  the  wound  were  then  considered  proper  indications  for  trepanning. 
The  ample  information  which  one  of  the  most  zealous  advocates  of  trepanning,  one  who 
was  an  excellent  surgeon  as  well  as  a truthful  man,  I mean  Percivall  Pott,  has  given  us  in 
regard  to  the  effects  of  trepanning,  leaves  no  doubt  as  to  the  theory  that  the  access  of  air 
increases  suppuration.  In  most  cases  ’of  simple  contusions,  in  which  he  trephined  on 
account  of  the  formation  of  pus  internally,  very  little  pus  was  found  at  the  first  operation ; 

‘ La  Motte,  Observations  de  Chirurgie.  T.  II,  p.  303. 

-Stromeyer,  Op.  cit. — Maximen,  U.  S.  V.  Zweite  Auflagu,  S.  331,  uiul  543,  und  549. 

20 


154 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Kkj.  (M. — Inrijncnt  exfoliation  of  the  outer  table  of  the  os  -lAAof/A-p  FiG.  65. — Gunshot  fracture  of  the  inner  table  of  the  frontal  bone*. 

f'rontis.  [After  STUOMKYlcii.]  UUltllUcllCI.  [After  Stuomkyek.] 


y(‘t  the  symptoms  were  generally  aggravated,  and  trepanning  was  resorted  to  a second  or 
third  time,  and  not  until  the  secondary  operations  were  great  quantities  of  pus  disclosed. 
Tims,  as  usual,  one  mistake  brought  about  another,  and  one  ill-advised  use  of  the  trephine 
rendered  its  repetition  necessary.  The  main  symptoms  which  seemed  to  demand  trephin- 
ing, for  the  majority  of  surgeons  addicted  to  the  trephine,  consisted  in  the  stupor  or 
insensibility  of  the  patient.  It  really  requires  no  small  degree  of  firmness  of  conviction 
of  the  danger  of  the  trephine  to  see  a patient,  not  only  for  days  but  weeks,  in  a state  of 
greater  or  less  stupor  or  insensibility  without  resorting  to  the  operation,  when,  sometimes, 
complete  consciousness  is  restored  immediately  by  a successful  elevation  of  the  depressed 
bone,  or  the  removal  of  extravasated  blood.  It  is  not  enough  to  remind  one  that  patients 
with  typhus  often  remain  for  weeks  in  a still  deeper  stupor,  and  yet  gradually  resume  the 
use  of  their  mental  faculties ; nor  is  it  sufficient  to  recall  the  innumerable  cases  where 
trepanning,  notwithstanding  the  apparent  success  of  its  purpose  of  elevating  depressed 
bone,  or  removing  extravasations,  did  not  influence  the  restoration  of  consciousness,  but 
where  this  was  only  gradually  regained  by  means  of  an  antiphlogistic  treatment.  One 
must  have  observed  as  often  the  successful  cure  of  head  injuries,  without  trepanning,  to 
be  enabled  to  acquire  such  accuracy  of  observation,  as  nearly  every  physician  possesses  in 
regard  to  fever  patients.  Would  not  every  one  be  called  a miserable  quack  now-a-days, 
who  would  give  a typhus  patient  musk,  camphor,  or  serpentaria  on  account  of  stupor? 
It  will  not  be  long  before  no  favorable  estimate  will  be  had  of  any  surgeon  wlio  will  use 
the  trepan  on  account  of  comatose  conditions  alone.  The  campaigns  of  1849  and  1850  have, 
happily,  given  many  young  surgeons  the  opportunity  to  convince  themselves,  with  their 
own  eyes,  that  one  may  look  on  a condition  of  semi-stupor  for  weeks  without  resorting  to 
the  trepan.” 

Dr.  Stromeyer,  in  a later  portion  of  his  work,  figures  two  examples  of  this  form  of 
fracture  and  gives  the  histories  of  the  patients.  One  was  a man  who  received  a gunshot 

wound  of  the  scalp  in  Schleswig,  April  13,  1849, 
making  a long  groove  to  the  left  of  the  sagittal  suture. 


He  was  sent  to  Flensburp;,  the 


following 


day.  He 


Fig.  63. — Gunshot  fracture  of  the  iniKjr  table  of  the  left 
parietal.  [After  STllOMEYEU,  Maximoi,  Fig.  16.] 


vomited  several  times,  and  was  drowsy  and  complained 
of  headache.  His  pulse  was  weak  and  slow.  On 
April  15th,  he  was  bled,  and  the  venesection,  with  a 
saline  mixture  internally,  was  repeated  on  the  17th, 
and  the  wound  was  enlarged  and  traversed  by  a crucial 
incision.  On  the  18th,  erysipelas  appeared,  and  the 
cold  a})plications  cm])loyed  were  replaced  by  cerate  dressings.  On  the  22d,  the 
swelling  and  headache  had  greatly  diminished.  On  the  24th,  there  was  difficult  respira- 
tion, and 
the  patient 
was  again 
bled  from 
the  arm. 

He  died  on 
the  25th. 

Blood  and 


pus  were 
found  be- 
neath the 


GUNSHOT  FRACTUEES  OF  THE  INNER  TABLE  OF  THE  SKULL. 


155 


Dr.  Stromeyer  attributes  the  death  to  pya3mia.  The  other  case,  that  of  a soldier  wounded 
at  Friedericia,  July  6,  1849,  was  fatal  in  seventeen  days.  A conoidal  ball  had  grazed  the 
forehead,  and  had  removed  the  pericranium,  but  had  not  fractured  the  outer  table,  which 
showed  only  the  “ beginning  of  a necrosed  line  of  demarcation  around  the  bloodless  contused 
part  of  the  bone;”  but  the  autopsy  revealed  a portion  of  the  inner  table  lying  upon  the 
dura  mater.  This  patient  had  no  head  symptoms  for  eight  days,  when  there  was  lieadache 
and  nausea.  He  was  twice  bled  and  took  calomel,  and  mercurial  ointment  was  rubbed  in. 
On  July  20th,  there  was  slight  ptyalism.  He  died  on  July  23d.  Dr.  Stromeyer  observes 
that  this  case  proves  the  inefficacy  of  antiphlogistics  in  pysemic  inflammations  of  the  brain. 
The  pathological  preparation  is  represented  on  the  preceding  page  (Figs.  64  and  65)  as 
figured  in  Dr.  Stromeyer’s  work.^ 

There  are  several  other  examples  of  fractures  from  external  violence  of  the  inner  table 
only  of  the  skull  in  which  the  pathological  specimens  have  been  preserv^ed.  One  is  num- 
bered 29,  A,  in  the  Dupuytren  Museum.^  It  is  the  calvaria  of  a young  man  who  was  struck 
in  June,  1848,  during  the  Revolution  in  Paris,  by  a musket  ball,  fired  from  an  upper 
window  of  the  barracks  at  Pv^euilly.  There  was  a furrowed  scalp  wound  over  the  occipital 
an  inch  and  a half  in  length.  The  skull  was  denuded,  but  there  was  no  alteration  of  color 
or  solution  of  continuity  in  the  outer  table.  For  a fortnight  there  were  no  cerebral 
symptoms  ; then  ptosis,  partial  left  hemiplegia,  and  nervous  agitation  with  fever  supervened, 
and  on  the  twenty-fifth  day,  brain  symptoms  were  so  urgent  that  M.  Denonvilliers  trephined 
over  the  spot  struck,  evacuated  about  three  ounces  of  offensive  sanguinolent  puriform  matter, 
found  beneath  an  oblong  detached  fragment  of  the  internal  table  so  large  that  it  had  to  be 
divided  by  bone-forceps  before  it  could  be  extracted  through  the  trephine  hole.  The  patient 
died  from  encephalitis  six  days  after  the  operation. 

M.  LegouesP  states  that  he  brought  from  the  French  Army  in  the  Crimea  an  excellent 
example  of  this  form  of  fracture,  in  which  adherent  fragments  of  the  inner  table  of  the 
parietal  were  depressed  in  a conical  form. 

Mr.  Cowan, ‘‘  Assistant  Surgeon  of  the  55th  British  Infantry,  presented  to  the  Museum 
at  Fort  Pitt,  a calvarium  of  a soldier,  with  a linear  fissure  of  the  inner  table  along  the 
upper  edge  of  the  right  parietal,  the  skull  having  been  denuded  externally  but  not  fractured. 

' Dr.  Stromeyer  remarks  that  at  the  autopsy : “A  firm  organic  connection  was  observed,  of  tlie  separated  portions  of  tlie 
inner  table  with  the  dura  mater,  which  was  not  even  separated  by  the  process  of  suppuration  that  had  taken  place  in  tlie  neigh- 
borhood. This  observation  seems  to  prove  that  such  detachments  of  the  inner  table  need  not  excite  such  grave  apprehensions  as 
heretofore,  since  the  pieces  may  retain  their  connection  with  the  dura  mater  and  do  not  necessarily  assume  the  character  of  foreign 
bodies.  Has  not  Walther  proven  that  the  inner  table  from  which  a portion  has  been  trepanned  can  again  be  restored  ? A case,  of 
which  Dieffenbach  justly  speaks  as  being  of  great  physiological  importance.  Guthrie  did  not  comprehend  Walther’s  idea  of 
restoration  of  a trepanned  segment,  when  he  says  that  ‘ the  patient  had  recovered  in  spite  of  his  doctor.’  Tlie  fiiilure  in  the 
treatment  of  my  case  occurred  undoubtedly  in  the  first  eight  days,  during  whicli  the  patient  was  said  to  have  been  in  a good 
condition.  Pott  would  have  undoubtedly  trepanned  in  this  case,  but  what  modern  surgeon  would  expect  success  in  a case  in 
which  tlie  autopsy  revealed  an  abscess  in  the  liver?”  Op.  cit.  S.  546. 

Compendium,  de  Cldrurrjie  Pratique.  T.  II,  p.  573.  This  specimen  is  figured  at  page  283  of  M.  Legouest’s  Traitd  do 
Chirurqie  d’Armee. 

^Legouest.  Op.  cit.  p.  283.  I think  the  specimen  is  now  deposited  in  the  collection  at  Val  de  Grace. 

■•See  Williamson’s  dfiZitary  Surqerij,  p.  29 ; Holmes’s  System,  of  Suryery,  vol.  II,  p.  47.  The  patient,  Private  James 
Burke,  aged  19.  received,  August  24th,  1855,  before  Sevastopol,  a wound  which  grazed  his  head  on  the  side  of  his  seal)),  from 
a musket  ball.  He  walked  from  the  trenches  to  the  field  hos])ital.  The  bone  was  found  bare,  but  no  fracture  or  depression 
could  be  discovered.  There  were  no  general  symptoms  of  serious  injury  of  the  head.  The  seal])  was  shaved  and  cold  water 
dressings  applied.  Five  days  subsequently  the  wound  became  unhealthy  and  there  were  slight  hemi|)legia  on  the  left  side. 
Convulsions  and  coma  followed  and  death  on  the  thirtieth  day  after  the  injury.  At  the  autopsy,  the  usual  signs  of  meningitis 
were  observed,  and  a coagulum  the  size  of  a walnut  was  found  under  the  parietal  protuberance.  Thu  fissure,  limited  to  the 
internal  table,  ran  ])ar.allel  to  the  course  of  the  ball.  The  s|)ecimen  is  No.  2893,  in  the  Surgical  Museum  at  Netley. 


156 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Mr.  Proscot t llewctP  reports,  in  an  analysis  of  sovcnty-ciglit  cases  of  injuries  of  the 
liead,  examined  after  death  at  St.  George’s  Hospital,  in  the  decennium  from  January,  1841, 
to  1851,  that  three  examples  of  fracture  of  the  skull,  with  depression  of  the  inner  table 
alone,  were  observed.  In  two,  the  depression  was  so  slight  that  it  might  easily  have  escaped 
notice ; in  the  third,  the  fracture  of  the  inner  table  was  extensive  and  the  depression 
considerable. 

Mr.  Edwards,^  in  August,  1862,  presented  to  the  Medico-Chirnrgical  Society  of  Edin- 
Imrgli,  a specimen  of  a fracture  of  the  inner  table  alone  of  the  right  temporal  bone,  from 
a young  lad.  The  injury  was  caused  by  a blow  from  a cricket  ball.  There  was  a slight 
bruise  of  the  scalp  externally,  and  a crack  extending  some  distance  on  the  internal  plate, 
crossing  a canal  in  which  the  middle  meningeal  artery  ran.  A bit  of  bone  was  detached, 
and  the  artery  was  torn  across  at  this  point  and  much  blood  was  extravasated. 

Demme^  states  that  he  saw  a case  in  which  a piece  nearly  two  inches  square  of  the 
vitreous  table  was  detached,  by  the  oblique  impact  of  a musket  ball,  while  the  outer  table 
was  uninjured,  and  that  he  had  preserved  the  preparation. 

In  a paper  on  fractures  of  the  skull  in  Virchow’s  Archives,  Dr.  Hermann  Eriedberg,"* 
of  Berlin,  reports  an  interesting  specimen  of  fracture  of  the  inner  table  alone  of  the  frontal, 
from  a sailor  boy  of  seventeen  years,  who  fell  through  a hatchway  into  the  hold  of  the 
vessel. 

Bonetus,®  in  his  Sepulchretum,  states  that  Cortesius  had  a skull  in  which  the  inner 
table  was  broken,  without  any  sign  of  a fracture  externally  having  ever  taken  place. 

These  are  all  of  the  examples  that  I have  collected  of  cases  of  this  kind  of  fracture,  in 
which  the  pathological  preparations  were  preserved. 

It  would  be  possible  to  glean  from  ancient  authors  more  examples  of  this  form  of 
fracture,  and  references  to  some  of  them  may  be  found  in  the  foot  note.*’  But  a sufficient 

^ Medico-Chirurr/ical  Transactions.  2d  series,  vol.  18.  London,  1853,  p.  338.  Tlie  specimen  in  the  third  case  is  preserved, 
I believe,  in  the  Museum  of  St.  George’s  Hospital.  See  the  8th  edition  of  Cooper’s  Dictionary,  p.  889. 

Editihurgh  Medical  Journal.  Vol.  8,  part  1,  1862,  p.  191.  Edinburgh,  1863. 

^ Demme.  Specielle  Chirurgie  der  Schussiounden  nach  erfahrungen  in  den  Norditalienischen  Hospitackm  von  1859. 
Wurzburg,  1881,  S.  38. 

■‘Viiicnow.  Archiv  fiir  patJiologische  Anatomie  und  Physiologic.  Berlin,  1861.  B.  22,  S.  84. 

® Tiieopiiilis  Boxetus.  Sepulchretam,  sive  Anatomica  Practica.  Ed.  altera  by  J.  J.  Mangetus.  Folio,  Geneva,  1700. 

8 Other  cases  are  reported  by  Scultetus,  {Armamentarium  Chirurgicum.  Editio  tertia,  Ilagm-Condtum,  1662,  8vo,  p.  212. 
Ohs.  XV  and  XVI,)  who  describes  the  injury  as  “ rima  et  depressio  cranii  lamina:  interioris  exteriore  salra;”  by  SOULIEII,  of 
Montpelier,  in  the  Memoires  dc  V Academic  de  Chirurgie,  ed.  1819,  T.  1,  p.  158;  by  Salmutiiius,  (Observationum  Medicarum 
Ccnturice  tres.  Brunsvija;,  1648,  p.  14;)  by  PLiVTXER,  (Institutioncs  Chirurgia:  rationalis.  Lipsim,  1758,  p.  286;)  by  Batting, 
{Chirurgical  Facts  relating  to  Injuries  of  the  Uead.  Obs.  VIII;)  by  Smethius,  {Miscellanea.  Liber  X,  p.  570;)  by  Doring, 
(Nassauische  Mcdicinischc  Jahrbiichcr,  p.  308;)  by  Kuiik,  {Fust’s  Magazin,  B.  XL,  S.  58.)  Examples  of  this  form  of  fractures  are 
ascribed  also  to  ArC/EUS,  {Dc  recta  curandorum  Vulncrum  ratione,  cap.  3,  p.  17.  Amstelodami,  1658;)  to  Valleriola, 
{Observationum  AferficiaaZiam,  lib.  6 ;)  and  to  Borel,  {Ilistoriarum  et  Observationum  Ccnturice  2,  Obs.  20.  Frankfort,  1676;) 
but  they  do  not  appear,  from  the  descriptions  of  those  authors,  to  have  been  fair  illustrations.  Mr.  Guthrie  remarks  that:  “The 
records  of  eighteen  centuries  have  jiroduced  but  little  information  on  this  most  interesting  subject;  and  if  the  cases  were  collected 
which  I have  overlooked,  as  well  as  those  which  have  been  altogether  omitted,  I apprehend  that  very  little  more  would  be  gained. 
I therefore  think  it  safe  and  reasonable  to  come  to  the  conclusion,  that  although  these  things  have  happened,  they  will  rarely 
occur  again.  I have  never,  in  the  great  number  of  broken  heads  I have  had  under  my  care  on  many  different,  and  grand 
occasions,  actually  known  the  inner  table  to  be  separated  from  the  outer,  without  positive  marks  of  an  injury  having  been 
inflicted  on  the  bone  or  pericranium,  however  slight  that  injury  may  have  been;  and  although  it  is  not  possible  to  doubt  the  fact 
of  fracture  of  the  inner  table  having  occurred,  it  is  very  desirable  in  a practical  point  of  view  not  to  bear  it  in  mind ; for  if  a 
surgeon  should  be  prepossessed  with  the  idea  that  the  inner  table  might  be  so  readily  fractured,  and  separated  from  the  diploo 
placed  between  it  and  the  outer  table,  and  thus  cause  irritation  or  pressure  on  the  brain,  few  persons  who  had  received  a knock 
on  the  head,  followed  by  any  serious  symptoms,  without  fracture  or  depression,  would  escape  the  trephine,  and  the  worst  practice 
would  be  again  established.  An  operation  should  never  then  be  performed  under  the  expectation  that  such  an  accident  may  have 
happened,  unless  it  is  apparently  required  by  the  urgency  of  the  symptoms  indicating  compression  or  irritation  of  the  brain, 
which  cannot  be  relieved  by  other  means.” — {On  Injuries  of  the  Head,  ifc.,  p.  79.) 


GUNSHOT  FRACTURES  OF  THE  INNER  TABLE  OF  THE  SKULL.  157 

number  of  illustrations  have  been  cited,  and  it  will  be  more  profitable  to  examine  the 
mechanism  of  this  form  of  fracture,  utterly  misunderstood  until  a very  recent  period. 

For  centuries  it  has  been  taught  that  this  form  of  fracture  took  place  because  of  the 
gi’eater  brittleness  of  the  inner  table,'  and  this  explanation  was  accepted  by  the  leading 
surgical  authorities  until  1865,  when  the  experimental  inquiries  of  Mr.  W.  F.  Teevan,^  ol 
London,  proved  that  it  was  erroneous,  and  demonstrated  that  the  cause  of  this  fracture  was 
not  the  brittleness  of  the  vitreous  plate,  and  was  not  to  be  sought  for  in  any  of  the  reasons 
heretofore  assigned;  but  that  it  occurred  in  obedience  to  a well  known  physical  law,  viz.: 
That  fracture  always  commences  in  the  line  of  extension,  not  that  of  compression. 

It  can  be  shown  experimentally  that  violence  applied  to  the  inner  surface  of  the  skull 
may  produce  fracture  of  the  external  table  only,  without  any  lesion  whatever  of  the  inner, 
and  there  is  at  least  one  pathological  specimen  in  existence  illustrating  this  form  of  injury.'' 
This  is  conclusive  proof  that  the  brittleness  and  lesser  superficies  of  the  inner  table  has 
nothing  to  do  with  the  causation  of  this  form  of  fracture.  Mr.  Teevan’s  explanation  is 
undoubtedly  the  correct  one.  He  aptly  illustrates  this  variety  of  fracture  by  the  familiar 
instance  of  the  cracking  of  a thin  sheet  of  ice  under  pressure.  Fissures  are  often  seen  on 
the  under  surface  of  the  ice  and  none  on  the  upper,  and  always  the  crack  commences  on 
the  under  or  distal  surface.  In  bending  a stick  across  the  knee  it  begins  to  break  at  a 
point  opposite  to  the  spot  where  the  knee  is  applied,  the  fracture  commencing  there  in 
obedience  to  the  physical  law  that  when  pressure  is  applied  to  a body  it  will  first  give  way 
in  the  line  of  extension.  The  annexed  diagrams, 
copied  from  Mr.  Teevan’s  paper,  show  the  rationale 
of  this  form  of  fracture. As  when  a stick  is  bent, 
the  atoms  along  the  proximal  curve  at  which 
pressure  is  made  are  brought  near  together  or 
compressed,  and  the  atoms  along  the  distal  curve 

* Broilie  expressed  the  belief  of  the  English  surgeons : “ Tlie  greater  elasticity  of  the  outer  table  of  the  skull,  and  the  greater 
brittleness  of  the  inner  table,  seem  to  afford  the  only  reasonable  solution  of  these  phenomena.”  {Med.  Cliir.  Trans.  Vol.  XIV,  p. 
331.)  Vidal  de  Cassis,  {Pathologie  Ezterne,  T.  11,  p.  545,)  gives  the  views  of  the  modern  French  surgeons:  “La  table  externe 
percutee,  peut  r6si&ter,  tandis  que  la  table  interne  se  fracture  imraddiatement  au-dessous,  parcequ’elle  est  plus  cassante,  aussi 
I’a-t-on  appelee  vitrde.”  Velpeau,  {Dc  V Operation  du  Trepan,  p.  29,)  is  of  the  same  opinion:  “Plus  mince,  inoins  6tendue  en 
surface,  plus  irrdgulidre,  plus  dense  que  la  table  externe,  la  couche  vitree  6clate  et  se  fendille  sous  un  effort  manifestemont 
nioindre  que  la  prdeedente.”  Legouest,  {op.  cit.  p.  283,)  says:  “Lorsque  Tos  frappe  est  epais,  resistant  et  ft  diploe  solide,  la 
table  interne,  plus  mince  et  plus  friable  que  I’externe,  se  rompt  quelquefois,  cette  dernidre  restant  intacte.”  The  German  surgeons 
had  the  same  view  of  the  causation  of  this  fracture,  as  indicated  in  Professor  Friedberg’s  paper  in  Virchow’s  Archiv.  for  1851. 
B.  Beck,  {loc.  cit.,)  who  performed  many  experiments  on  the  dead  subject,  striking  the  skull  with  bullets,  and  often  producing, 
by  oblique  impact,  fracture  of  the  inn<ir  table  when  the  outer  was  neither  depressed  nor  fissured,  believed  that  the  result  was 
due  partly  to  the  brittleness  of  the  inner  table,  and  partly  to  its  lesser  superficies.  He  stated  that  a projectile  striking  the  outer 
table  obliquely,  and  setting  it  in  vibration,  caused  a stretching  and  depression  of  its  tissue;  the  shorter  brittle  tabula  vitrea  follow- 
ing the  process,  but  not  quickly  enough,  was  fissured  or  broken.  According  to  his  experiments,  the  outer  table  can  be  depressed 
from  half  a line  to  one  line  without  breaking.  It  may  be  asserted  that  all  surgeons,  prior  to  Mr.  Teevan,  assigned  as  the  cause 
of  this  fracture  the  gi’eater  brittleness  of  the  inner  table,  and  that  Dr.  Beck  gave  as  an  additional  explanation  its  shortness. 

^ Teevax.  British  and  Foreign  Medico-Chb'urpieal  lleview.  Vol.  XXXVI,  p.  189.  London,  October,  1885. 

^Specimen  1082’”,  in  Guy’s  Hospital  Museum,  is  the  calvarium  of  a suicide,  who  shot  himself  in  the  right  t(mii)le.  The 
])ist6l  ball  traversed  the  brain  and  struck  tbe  inside  of  the  left  ])ortion  of  the  frontal  bone,  and  remained  within  the  skull.  At  the 
point  of  impact  there  is  a black  mark,  but  no  fissure  or  fracture;  but  at  the  corresponding  point  outside  is  a starred  fissured  frac- 
ture of  the  outer  table  only. 

■*  I quote  Mr.  Teevan’s  explanation  of  the  diagrams:  “Let  A B,  Fig.  1,  be  a section  of  the  skull.  Draw  two  vertical  lines, 
C E,  and  D F,  parallel  to  one  another.  Now,  if  pressure  bo  applied  at  G,  temporary  depression  takes  place,  and  the  Ijoin;  assumes 
the  shape  of  ll  K,  Fig.  2,  and  the  lines  C E,  n F,  are  no  longer  parallel  to  each  other,  but  converge  towards  each  other  at  the 
upper  sui  fiice  i E,  .J  M,  so  that  the  distance  fi’om  t to  J is  less  than  that  from  C to  D,  but  the  distance  from  L to  M is  greater  than 


C G O 


Fig.  1.  Fig.  2. 


Fig.  06. — Diagrams  to  show  the  mechanism  of  fracture  of  the 
inner  table  of  tho  skull  alone.  [After  Teevax.] 


158 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


are  extended,  or  separated,  and  when  the  stick  breaks,  the  rent  begins  at  the  spot  in  the 
distal  curve  where  the  extension  is  greatest,  and  opposite  to  where  the  pressure  is  made ; 
so  when  violence  is  applied  to  the  external  vault  of  the  cranium,  insufficient  to  cause 
complete  fracture,  yet  depressing  the  bone  enough  to  cause  partial  fracture,  the  solution 
of  continuity  will  always  be  in  the  inner  table  opposite  the  part  struck. 

I have  satisfied  myself,  by  a large  number  of  experiments,  of  the  accuracy  of  Mr. 
Tcevan’s  conclusions.  I have  had  no  difficulty  in  producing,  by  slight  blows  with  a 
hammer  upon  the  outer  or  inner  surfaces  of  calvaria,  fissures,  or  stellated  fractures  of  the 
outer  table  only  or  of  the  inner  table  only.^  In  some  of  my  experiments,  portions  of  the 
vitreous  table  were  detached  without  visible  injury  to  the  outer  table ; but  in  striking  the 
inside  of  the  skull,  I was  able  to  make  fissures  only  in  the  outer  table  witliout  injuring  the 
inner.  Dr.  Beck’s  opinion  that  fracture  of  the  inner  table  of  the  skull  alone  only  in  those 
parts  where  there  is  but  little  diploe  is  erroneous.  It  generally  occurs,  in  cases  resulting 
iVom  accident,  in  parts  of  the  skull  where  the  diploe  is  abundant,  and  can  there  be  more 
readily  produced  experimentally.  The  explanation  offered  in  the  Surgical  Eeport  of  1865, 
from  this  Office,^  of  the  causation  of  this  form  of  fracture  is  imperfect.  It  is  true  that  the 
fracture  often  results  “from  a small  projectile  striking  the  cranium  very  obliquely,”  or 
sometimes,  as  Legouest  suggests,  from  a “ comparatively  slight  blow  from  a body  with  a 
plane  surface.”  But  it  is  the  force  and  not  the  direction  of  the  violence  to  the  exterior  of 
the  skull  that  is  the  essential  point.  A spent  bullet,  striking  at  right  angles,  may  produce 
this  fracture.  If  moving  at  a high  rate  of  velocity,  it  will  fracture  both  tables,  or  penetrate 
or  perforate  the  skull.  It  is  because  the  ball  which  glances,  or  strikes  slantingly,  acts  with 
but  little  force  at  the  point  of  impact  that  it  is  the  frequent  cause  of  this  injury.  In  the 
many  cases  in  which  I produced  it  experimentally,  I hit  the  skull  at  right  angles  with 
moderate  force,  with  a hammer  a half  inch  in  diameter  at  the  face. 

It  cannot  be  doubted  that  many  cases  of  this  form  of  injury  terminate  favorably,  and 
are  never  recognized.  It  is  obvious  that  the  diagnosis  must  always  be  obscure.  The  accident 
may  lead  to  a fatal  result  in  various  ways  ; either  by  causing  contusion  of  the  brain,  or  a 
laceration  of  its  membranes  or  substance  by.  the  jagged  edges  or  detached  spiculse  of  the 
vitreous  table ; or  else  by  these  same  causes  leading  to  acute  or  chronic  encephalitis  ; or 

that  from  1C  to  F,  signifying  tliat  the  atoms  of  bone  in  the  upper  surface  from  I to  J have  been  brought  nearer  to  each  other,  or 
compressed,  wliilst  the  atoms  of  bone  in  tlie  lower  surface,  from  L to  M,  Iiave  been  extended  or  separated  from  each  other;  there- 
fore, if  any  fracture  take  place,  it  is  clear  it  must  do  so  in  the  line  of  extension  L M,  and  at  that  point  in  the  line  where  the  great- 
est extension  is  going  on,  which  is  at  N,  exactly  ojiposite  the  spot  O,  whore  the  pressure  was  applied. 

Proof : Take  a cane  slightly  bent,  say  A B,  Fig.  1,  and  insert  two  pins  or  wires,  C E,  D F,  vertically,  and  parallel  to  each 
other,  the  more  the  pins  project  at  each  surface  the  more  manifest  will  be  the  result.  Exert  pressure  at  G till  the  cane  is  made 
Hatter,  n K.  It  will  now  be  found  that  the  wires  are  no  longer  parallel  to  each  other,  but  converge  along  the  upper  surface,  so 
that  the  distance  between  them  from  I to  J is  less  than  that  from  C to  D,  but  the  distance  from  L to  M is  greater  than  that  from 
10  to  F,  showing  clearly  that  the  atoms  along  the  line  i J have  been  compressed  and  brought  nearer  to  each  other,  whilst  those 
along  the  line  E M have  been  extended;  consequently,  if  any  fracture  takes  place,  it  must  commence  at  N.  If  the  pressure  on  the 
cane  be  continued  till  it  breaks,  it  will  be  found  that  it  commences  to  break  at  the  point  N.” — Teevan,  {op.  cit.  p.  194.) 

’ Bnuxs,  {Handbuch  der  Practischen  Chirurffie.  Tubingen,  1854,  B.  1,  S.  297.)  who  has  devoted  much  attention  to  this 
subject,  says  that  only’  once  was  he  able  to  cause,  by  a blow  with  a round  hammer  on  the  convexity  of  the  skull,  a fracture  of 
the  inner  table  alone.  But  if  the  directions  of  Mr.  Teevan  are  followed,  any  one,  with  a little  practice,  may  produce  such  frac- 
tures at  will.  The  following  is  his  method  : “A  skull-cap,  stripped  of  all  its  soft  parts,  with  a wet  cloth  inside  of  it,  is  to  be  laid 
with  its  convexity  in  the  palm  of  the  left  hand,  which  is  to  be  ])rotected  with  several  layers  of  moist  cloth,  to  obviate  an  incon- 
venient amount  of  pain.  If  the  inside  of  the  skull  be  now  struck  by  the  hammer  with  a slight  degree  of  force,  fracture  of  the 
external  table  will  be  produced  without  any  fracturing  or  fissuring  of  the  inner.” — Teevan,  op.  cit.  p.  193. 

"Circular  No.  6,  War  Department,  Surgeon  General's  Office,  Washington,  November  1,  1885.  Beports  on  the  Nature  and 
Extent  of  the  Materials  available  for  the  preparation  of  a Medical  and  Surgical  History  of  the  Rebellion.  Printed  for  the  Surgeon 
General's  Office.  By  J.  B.  Lippincott  &,  Co.,  Philadel])hia,  1885,  p.  12. 


GUNSHOT  FRACTURES  OF  BOTH  TABLES  OF  THE  SKULL. 


159 


producing  compression  of  the  brain ; or  by  the  line  of  fracture  crossing  tlie  course  of  the 
middle  meningeal  artery,  and  producing,  if  this  should  happen  to  be  enclosed  in  a bony 
canal,  a fatal  intracranial  extravasation.  The  most  common  immediate  cause  of  death  is 
compression  from  abscess  in  the  vicinity  of  the  injury.^ 

It  is  evident  that  the  treatment  of  this  form  of  injury  must  be  determined  by  those 
principles  which  guide  us  in  treating  scalp  wounds,  contusions  of  the  cranial  bones,  concussion 
and  compression  of  the  brain.  When  symptoms  of  compression  are  urgent  and  persistent, 
and  especially  if  there  is  paralysis  of  the  side  opposite  to  the  seat  of  injury,  the  application 
of  the  trephine  is  undeniably  justifiable.  In  at  least  four  cases,  reported  by  Mery,  Bilguer, 
Samuel  Cooper,  and  Trye,  recovery  took  place  after  trephining,  the  operation  having  been 
attempted  in  eleven  only  of  the  cases  I have  cited. 

Gunshot  Fractures  of  both  Tables  of  the  Skull. — The  cases  of  this  class  reported 
during  the  war  were  so  numerous,  that  it  is  practicable  to  present  only  abstracts  of  some 
of  the  moi'e  interesting  examples  of  each  variety  or  subdivision,  with  brief  notes  of  others, 
supplemented  by  numerical  tabular  statements  of  the  whole  number  returned. 

Linear  or  Capillary  Fissure. — Nineteen  cases  of  gunshot  fracture  of  the  skull,  twelve 
of  which  had  a favorable,  and  seven  a fatal  issue,  were  reported  under  this  head.  On 
reviewing  the  histories,  I am  not  satisfied  with  the  correctness  of  diagnosis  in  any  of  them. 
In  four  of  the  fatal  cases,  autopsies  were  made  ; and  injury  to  the  membranes  or  substance 
of  the  brain  were  found  in  each,  and  in  two,  very  marked  depression  of  the  vitreous  table. 
The  following  is  an  abstract  of  one  of  the  cases  : 

Case. — Corporal  William  Barthaul,  Co.  D,  45th  New  York  Volunteers,  aged  35  years,  was  wounded,  at  the  battle  of 
Gettysburg,  Pennsylvania,  July  1st,  1863,  by  a conoidal  ball  which  produced  a wound  of  the  scalp  about  an  inch  in  length,  over 
the  left  occi{)ital  region.  He  remained  in  the  field  hospital  until  the  11th  of  the  month,  when  he  was  transferred  to  the  Turner’s 
Lane  Hospital  at  Philadelphia.  The  wound  was  suppurating  slightly.  He  improved  steadily  until  the  23d,  when  the  parts  in 
the  region  of  the  wound  became  highly  inflamed,  creating  considerable  sympathetic  fever.  Flaxseed  pt)ultices  were  applied,  and 
by  the  27th  the  wound  suppurated  freely.  Milk  punch  was  now  given  during  the  day,  the  diet  otherwise  being  restricted.  The 
jiatient  bec.ame  prostrated,  and  on  the  2d  of  August,  was  attacked  with  a slight  delirium.  Death  followed  ou  the  6th  of  August, 
1863.  At  the  autopsy  a fissure  of  the  occipital  bone  was  discovered,  one  and  a half  inches  in  length,  involving  both  tables. 
About  one  ounce  of  purulent  matter  surrounded  the  line  of  fracture  outside  of  the  dura  mater.  The  case  is  reported  by  Acting 
Assistant  Surgeon  David  Burpee. 

In  the  Army  Medical  Museum  there  are  few  examples  of  capillary  -fissure  from  gunshot, 
except  those  which  have  been  referred  to  in  the  discussion  of  fractures  of  the  inner  table 
alone  ; but  good  illustrations  of  this  form  of  injury,  as  described  by  systematic  authors,  but 
caused  by  falls  or  blows,  are  furnished  by  specimens  130,  2970,  and  2876,  Section  I,  figured 
at  pp.  38,  43,  and  49,  of  this  work.  Specimens  393  and  2492,  furnish  the  nearest 
approximation  to  this  form  of  fracture  produced  by  gunshot.  In  both  cases  there  is  linear 
fissure  with  very  slight  depression  of  the  inner  table  : 

Case. — Private  Francis  B , Co.  A,  10th  Vermont  Volunteers,  aged  40  years,  was  wounded,  in  one  of  the 

engagements  at  the  crossing  of  the  Rapidan  River,  Virginia,  in  May,  1884,  in  the  forehead  by  a gunshot  missile,  probably  a 
musket  ball,  which  caused  only  very  little  external  injury.  He  was  admitted  to  the  Baptist  Church,  3d  division.  Sixth  Corps 
Hospital,  at  Fredericksburg,  thence  conveyed  to  Washington,  and  admitted  May  26th  into  the  Lincoln  Hospital,  being  then 


* Mr.  Teevax  asserts  (op.  cit,  p.  198)  that:  “There  are  two  cases  in  which  the  diagnosis  may  he  made  with  almost 
certainty.  Firstly,  when  a person  recovers  immediately  after  tin;  blow,  hut  finds  there  is  panilysis  of  some  ])art  of  the  body 
opposite  to  the  side  struck,  and  examination  fails  to  detect  any  injury  to  the  bone.  Secondly,  when,  after  the  blow,  no  evil  con- 
sequences arise  at  first,  but  iu  the  course  of  time  the  patient  begins  to  complain  of  fixed  pain  in  the  ])art  struck,  and  all  the 
symptoms  of  chronic  cerebral  irritation  show  themselves,  although  the,  surgeon  cannot  find  any  injury  to  the  e.xternal  table.” 


160 


WOUNDS  AND  INJUKIES  OF  THE  HEAD 


extremely  |irostrate(l.  No  serious  injury  to  the  head  was  suspected,  hut  an  attack  of  typhoid  fever  was  anticij>ated,  the  tongue 
being  somewhat  coated.  The  intellect  was  unimpaired.  He  seemed  to  improve  and  was  soon  able  to  leave  the  ward,  lie  continued 

so  for  two  or  three  days  when 
he  again  took  to  his  bed,  com- 
plaining of  slight  pain  in  the 
head,  but  manifesting  no  aber- 
ration of  mind.  Coma  and 
subsultus  tendimun  snjier- 
vened;  discharge  of  blood  and 
pus  from  the  right,  and  pus 
only  from  the  left,  ear  occurred, 
and  death  ensued  on  Juno  6th, 

, , ...  Fio.  08. — Exterior  view  of  the  foregoiiip;  specimen. 

1804.  At  the  autopsy  a slight 

linear  fissure  of  the  frontal 

bone  was  observed,  and  on  removing  the  calvaria  a fracture  of  the  internal  plate  and  necrosis  to  the  extent  of  three-fourths 
by  one  and  a fourth  inches  was  found  to  exist;  including  within  its  limits  part  of  the  posterior  wall  of  both  frontal  sinuses,  in 
which  some  half  a drachm  of  pus  had  formed.  The  brain  in  the  region  of  the  fracture  was  softened.  The  adjoining  wood-cuts 
(Figs.  07  .and  08)  show  the  linear  but  slightly  depressed  fracture  which  e.xisted  over  the  right  superciliary  ridge,  and  a portion 
of  the  fragment  of  the  internal  t. able  which  was  detached.  The  frontal  sinuses  are  unusu.ally  capacious;  the  walls  are  very 
thin.  The  specimen  and  notes  of  the  case  were  contributed  by  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A. 


Fig.  67. — Section  of  the  frontal  bone  showin"  a linear 
fracture  over  the  right  superciliaiy  ridge. — Sjyec.  2492. 
Sect.  I,  A.  M.  M. 


Specimen  393  represents  a dense,  heavy  and  rather  thin  calvaria  with  a gunshot 
contusion  near  the  right  frontal  eminence,  and  near  it  a linear  fissure  of  both  tables.  But 
it  apjiears  quite  probable  that  this  fissure  was  produced  in  removing  the  skull  cap,  as  not 
infrequently  happens  in  using  a cliisel  as  a lever  after  sawing  the  bone  : 

Case. — Private  II.  S.  L , Co.  A,  Sbth  Massachusetts  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of  South 

Mountain,  Maryland,  September  14th,  1832,  by  a round  musket  ball  on  the  right  side  of  the  frontal  bone,  .at  a point  about  one 
and  a half  inches  anterior  to  tlie  coronal  suture,  producing  apparently  only  a scalp  wound.  lie  was  conveyed  to  the  Newton 
University  Ffospital,  Baltimore,  on  the  20th  of  the  month.  The  wound  looked  healthy,  and  the  p.atient  was  free  from  pain  in 
his  head.  On  the  25th,  secondary  hmmorrh.age  occurred  from  a small  branch  of  the  temporal  artery  which  was  promptly 
arrested  by  division  and  the  application  of  a compress  for  a few  hours.  The  case  progressed  favorably  until  tbe  0th  of  October, 
when  a state  of  low  muttering  delirium  supervened.  When  spoken  to  the  patient  would  become  conscious  for  a few  moments, 
but  would  immediately  relapse  into  a comatose  state,  which  continued  until  the  9th,  when  death  resulted.  At  the  autopsy 
the  meninges  gave  evidence  of  a low  degree  of  inllammation  over  a surface  two  inches  in  diameter.  A few  drops  of  pus  were 
discovered  upon  the  surface  of  the  brain.  The  pathological  specimen  is  No.  393,  Sect.  I,  A.  M.  M.  The  frontal  bone  is  con- 
tused one  inch  externally  to  the  right  of  the  frontal  eminence  with  a fissure  one  inch  in  length  running  downward.  There  is  a 
stellate  fracture  of  the  inner  t.able  with  slight  depression,  the  longest  fissure  being  two  inches  in  length.  Two  sm.all  wart-like 
exostoses  existed  ne.ar  the  centre  of  the  frontal  bone,  one  on  either  side  of  the  groove  for  the  longitndimal  sinus.  The  specimen 
and  history  were  coutidbuted  by  Acting  Assistiint  Surgeon  J.  H.  Cnrrey. 

Specimen  1951  shows  linear  fissures  of  the  inner  table  beneath  a necrosed  portion  of 
the  outer  plate,  which  appears  to  he  slightly  depressed.  But  it  is  difficult  to  decide  whether 
this  case  should  be  referred  to  this  category  or  to  the  one  immediately  preceding : 


Case. — Sergeant  Ross  D , Co.  B,  19th  Massachusetts  Volunteers,  was  wounded  in  the  engagement  at  Bristow  Station, 

Virginia,  October  14th,  1803,  hy  a conoidal  ball  which  struck  near  and  external  to  the  left  frontal  eminence,  slightly  depressing 
the  external  and  fissuring  the  internal  table.  He  was  admitted  to  the  hospital  of  the  2d  division.  Second  Army  Corps,  and  on 

October  10th  was  sent  to  Lincoln  Hospital,  Washington.  No  cerebral  symp- 
toms existed  for  some  time  after  admission.  On  November  0th,  hiemorrhage,- 
which  was  arrested  by  lig.ation,  occurred  from  the  .anterior  tempoi’al  artery. 
Hcemorrhage  recurred  on  November  20th,  and  on  the  following  day  the  wound 
beo.ame  gangrenous.  The  patient  grew  comatose  and  died  on  November  29th, 
1863.  At  tlie  autopsy  the  external  table  was  found  necrosed,  the  diploe  was  filled 
with  fungous  gi-anul.ations.  The  dura  mater  was  indurated  beneath  the  injured 
spot,  although  no  evidences  of  inflammation  were  present.  On  removing  the 
brain  a large  quantity  of  thin  pale  serum  was  found  in  the  snbar.achnoid  space. 
A large  abscess  existed  in  tlie  anterior  of  the  left  hemisphere  just  beneath  the  seat 
of  injury,  extending  into  the  Lateral  ventricle,  filled  with  thick,  sanious  and  ftt'tid 
jius.  The  right  ventricle  was  normal.  The  pathologic.al  specimen  is  figured  in  the 
cut  (Fig.  09.)  The  inner  t.able  of  the  cranium  presents  a T-shaped  fissure  without 
depression,  and  is  spongy.  A thin  plate  of  bone  one  inch  in  diameter  is  necrosed 
Fig.  (fl.  Ipicar  fissure  p the  inner  tabic  of  the  on  the  external  table,  and  the  adjacent  osseous  tis.sue  is  porous  and  cribriform. 

The  sjiecimen  was  contributed  by  Assistant  Surgeon  11.  Allen,  U.  S.  A. 


GUNSHOT  FKACTURES  OF  BOTH  TABLES  OF  THE  SKULL. 


161 


Gunshot  Fractures  of  Both  Tables  of  the  Cranium  Without  Depression. — A number 
of  instances  of  fractures  of  both  tables  of  the  skull  were  reported  in  which  the  evidences 
of  injury  to  the  bone  were  so  slight  that  they  were  not  recognized  until  after  death.  The 
following  are  good  illustrations  : 


Case. — Private  William  A- 


Co.  F,  11th  Pennsylvania  Volunteer.s,  aged  29  year.s,  was  wounded  at  the  battle  of 


the  Wilderness,  Virginia,  May  7th,  1834,  by  a conoidal  ball  which  struck  the  frontal  bone  between  the  eminences,  laceratiir 

the  muscles  for  about  two  inches  and 
denuding  the  bone  of  periosteum  for 
about  one  inch.  The  wound  was  con- 
sidered slight.  The  patient  was  treated 
for  several  days  in  a field  hospital,  and 
on  May  11th  was  sent  to  the  Lincoln 
Hospital,  at  Washington,  whence,  on 
May  18th,  he  was  transferred  to  the 
Satterlee  Hospital,  Philadelphia.  Cold 
water  dressings  were  applied  to  the 
wound  and  the  patient  was  able  to  be 


Fig.  71. — Interior  view  of  the  foregoing  speci- 
men. 


Fig.  70. — Contusion  and  slight  fracture  of  the 
frontal  bone  bj'  a glancing  musket  ball.  Spec. 

2744,  Sect.  I,  A.  M.  .M. 

about  all  the  time.  He  was  in  good  condition  and  appeared  to  do  well  until  May  23d,  when  he  became  irritable,  and  complained  of 
severe  jiain  in  the  head.  The  external  wound  still  looked  well.  On  the  following  day  he  became  drowsy  and  suffered  from  nausea. 
The  pain  in  the  head  continued  unabated  and  the  pulse  was  110,  but  the  mind  clear.  Small  doses  of  creasote  and-  lime-water  were 
given  and  he  was  freely  purged.  On  May  24th  the  nausea  subsided  and  the  pulse  had  risen  to  120;  no  pain  in  the  he.ad,  and  the  patient 
was  rational  though  dull.  On  the25th  the  pulse  was  weak  at  130,  but  the  patient  seemed  perfectly  conscious,  and  his  mind  was  clear, 
and  he  declared  that  he  felt  perfectly  easy,  yet  he  died  suddenly  at  five  in  the  afternoon.  This  is  the  report  of  Acting  Assistant 
Surgeon  L.  K.  Baldwin,  yet  his  ward  case  book  states  that  the  patient  survived  until  the  26th,  having  low  muttering  delirium  in  the 
early  part  of  that  day.  The  autopsy  was  made  forty  hours  after  death  by  Acting  Assistant  Surgeon  Charles  P.  Tutt.  He 
reported  that  though  the  periosteum  was  removed  the  external  table  of  the  skull  was  scarcely  injured,  except  by  a shaving  of 
lead  from  the  ball  firmly  imbedded  beneath  the  outer  lamina  at  the  inner  upper  margin  of  the  wound  in  the  periosteum.  On 
removing  the  calvaria  a large  amount  of  piie  was  found  upon  the  dura  mater  of  the  anterior  lobe  of  the  left  hemisphere  beneath 
the  seat  of  injury.  On  removing  the  pus  a spiculum  of  bone  from  the  inner  table  was  found  to  perforate  the  dura  mater  and  a 
large  abscess  extending  into  the  anterior  horn  of  the  left  lateral  ventricle  was  found  beneath.  A large  eifusiou  of  serum  was 
found  at  the  base  of  the  brain,  and  a yellow  deposit  was  found  on  the  pons  Varolii  and  medulla  oblongata  and  in  the  fissures 
of  the  cerebellum.  A similar  deposition  of  albuminous  or  puriform  matter  was  also  found  under  the  arachnoid  near  the  left 
ventricle.  The  viscera  of  the  chest  aiid  abdomen  were  in  a normal  condition.  The  clinical  history  was  furnished  by  Acting 
Assistant  Surgeon  L.  K.  Baldwin,  who  is  also  accredited  with  the  specimen,  of  which  an  external  and  internal  view  is  given  in 
■ the  accompanying  wood-cuts,  (FiG.  70,  and  FiG.  71.)  The  notes  of  the  autopsy  were  furnished  by  Acting  Assistant  Surgeon^ 
Tutt  who  made  it.  In  the  external  table  a portion  of  bone  measui’ing  one-fourth  by  one  inch,  a small  fragment  of  which  is 
depressed  one  line  and  surrounded  by  a slight  groove,  indicated  an  incipient  exfoli.ation.  At  the  uppei-  inner  portion  of  this 
oval  groove  a bit  of  lead  is  impacted.  The  inner  table  beneath  is  fissured  for  one  inch  beneath  the  seat  of  injury. 


Case. — Private  George  W.  B , Co.  A,  10th  Pennsylvania  Reserves,  was  wounded  at  the  battle  of  Fredericksburg, 

Virginia,  December  13th,  1862,  by  a canister  shot  which  tore  the  scalp  for  an  inch  in  extent  over  the  left  parietal  bone,  just 
behind  the  coronal  suture.  He  was  conveyed  to  Washington,  D.  C.,  and  next  day  was  admitted  into  the  Stanton  Hospital. 
The  injury  was  regarded  as  slight,  there  being  no  evidence  that  the  bone  or  structures  beneath  were  seriously  involved.  With 
the  exception  of  a slight  headache,  the  case  progressed  well  until  the  morning  of  the  22d,  when  he  was  seized  with  violent  jiain 
in  the  head  in  the  vicinity  of  the  wound.  He  became  restless  and  painfully  sensitive  to  sound.  On  the  evening  of  the  23d, 
and  again  on  the  morning  of  the  24th,  chills  supervened,  attended  with  delirium.  A few  hours  later  insensibility  of  the  l ight 
side  of  the  body  was  noticed.  A blister  was  applied  over  the  nucha,  and  free  purgations  produced  by  cathartics.  In  the  afternoon 
the  patient  was  rational,  and  full  sensibility  in  the  body  was  restored.  The  chills  being  regarded  of  a malarious  character,  liberal 
doses  of  quinine  were  administered,  and  none  occurred  after  the  25th  of  the  month.  On  the  30th  he  fell  into  a semi-comatose 
state,  and  death  ensued  on  the  4th  of  Janiuary,  1833,  no  convulsions  having  occurred  at  any  time.  The  autopsy  revealed  a 
circular  depression  of  the  external  table  of  tlie  left  jiarietal  bone,  just  behind  the  coronal  suture,  half  an  inch  in  diameter,  the 
surrounding  bone  being  cribriform.  The  inner  table  was  found  irregularly  fissured  and  depressed  half  aline.  About  an  ounce 
and  a half  of  a sanguine,  purulent  fiuid  had  collected  between  the  dura  mater  and  the  cranium.  The  brain  itself,  however, 
appeared  healthy.  The  pathological  specimen  is  No.  628,  Sect.  I,  A.  M.  M.,  and  was  contributed,  with  the  history,  by  Surgeon 
.John  A.  Lidell,  U.  S.  V.  It  is  quite  remarkable  to  observe  that  several  of  the  fragments  of  the  vitreous  jilato  are  very  firmly 
re-united,  the  patient  having  survived  the  injury  only  twenty-three  days. 

A musket  ball  impinging  obliquely  upon  the  vault  of  the  skull,  will  occasionally  detach 
a portion  of  the  calvaria,  an  inch  or  more  in  its  diameter,  without  any  depression  of  the 
margins  of  the  solution  of  continuity  thus  produced  in  the  cranial  bones.  A patient  who 

21 


162 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


presented  a remarkable  illustration  of  an  injury  of  tins  description  is  represented  in  the 
plate  opposite.  The  history  of  the  case  is  as  follows : 

Case. — Private  Edson  D.  Bemis,  Co.  K,  12th  Massachusetts  Volunteers,  was  wounded  at  Antietam  by  a musket  ball 
which  fractured  the  shaft  of  his  left  humerus.  The  fracture  united  kindly,  with  very  sliglit  angular  displacement  and  quarter 
of  an  inch  shortening.  Promoted  to  be  corporal,  Bemis  received.  May  6th,  1864,  at  the  battle  of  the  Wilderness  a wound  from 
a musket  ball  in  the  right  iliac  fossa.  He  was  treated  in  the  Chester  Hospital,  near  Philadelphia.  There  was  extensive 
sloughing  about  the  wound,  but  it  ultimately  healed  entirely,  leaving  a large  cicatrix,  parallel  with  Poupart’s  ligament.  Eight 
months  after  the  injury,  Bemis  returned  to  duty  with  his  regiment.  On  February  5th,  1865,  Corporal  Bemis  was  again  severely 
wounded  at  the  engagement  at  HatcheFs  Run,  near  Petersburg,  Virginia.  Surgeon  A.  Vanderveer,  66th  New  York  Volunteers, 
reports  that  the  ball  entered  a little  outside  of  the  left  frontal  protuberance,  and  passing  backward  and  upward,  removed  a piece 
of  the  squamous  portion  of  the  temporal  bone,  with  brain  substance  and  membranes.  When  the  patient  entered  the  hospital  of 
the  1st  division  of  the  Second  Corps,  brain  matter  was  oozing  from  the  wound.  Thei'e  was  considerable  haemorrhage,  but  not 
from  any  important  vessel.  Respiration  was  slow  ; the  pulse  40 ; the  right  side  was  paralyzed  and  there  was  total  insensibility. 
On  February  8th,  the  missile  was  removed  from  the  substance  of  the  left  hemisphere,  by  Surgeon  Vanderveer.  It  was  a conoidal 
musket  ball,  badly  battered.  The  patient’s  condition  at  once  improved.  He  told  the  surgeon  his  name,  and  seemed  conscious 
of  all  that  was  going  on  about  him.  Water  dressings  were  applied,  and  an  ingeniously  arranged  sponge  absorbed  the  discharge 
from  the  wound.  He  was  kept  on  very  light  diet  and  remained  very  quiet  for  ten  days,  answering  dii'ect  questions,  but 
indisposed  to  continue  a conversation.  He  had  no  convulsions  and  his  sleep  was  not  disturbed  by  delirium.  About  February 
18th,  a marked  improvement  was  manifest.  The  patient  conversed  freely,  and  the  wound  was  rapidly  cicatrizing,  and  the 
hemiplegia  had  entirely  disappeared.  On  February  ■28th  he  was  able  to  walk  about  the  ward.  On  March  18th  the  wound  was 
nearly  healed.  The  patient  was  sent  northward  on  a hospital  transport  to  Fort  Richmond,  New  York  Haihor.  He  recovered 
perfectly,  and  in  May  was  furloughed,  and  on  May  18th  he  wrote  to  Dr.  Vandeveer,  that  he  was  doing  well  at  his  home  in 
Huntington,  Massachusetts,  suffering  only  slight  dizziness  in  going  out  in  the  hot  sun.  In  July  he  went  to  Washington  to  apply 
for  a pension,  and  entered  Campbell  Hospital.  He  was  discharged  on  July  13th,  1835,  on  surgeon’s  certificate  of  disability. 
At  this  date  he  was  photographed  at  the  Army  Medical  Museum.  The  wound  in  the  head  was  then  neaVly  healed.  There  was 
a slight  discharge  of  healthy  pus  from  one  point.  The  pulsations  of  the  brain  could  be  felt  through  the  integument.  The 
mental  and  sensory  faculties  were  unimpaired.  The  corporal  had  been  discharged  from  service  and  recommended  for  a pension. 
The  plate  opposite  is  a very  accurate  copy  of  the  photograph,  which  is  numbered  58  of  the  surgical  series,  A.  M.  M.  Mr. 
Bemis  was  pensioned  at  eight  dollars  per  month.  On  October  GOth,  1870,  he  wrote  to  the  editor  of  the  surgical  history  from 
his  home  in  Sufficld,  Connecticut,  as  follows : “ I am  still  in  the  land  of  tlm  living.  My  health  is  very  good  considering  what 
I have  passed  through  at  Hatcher’s  Run.  My  head  aches  some  of  the  time.  * * j am  niarried  and  have  one  child,  a little 

girl  born  last  Christmas.  My  memory  is  affected,  and  I cannot  hear  as  well  as  I could  before  I was  wounded.” 

The  five  following  cases  were  of  a somewhat  similar  nature,  though  the  ulterior  results 
were  less  satisfactory : 

Case. — Private  William  B.  Brock,  Co.  B,  110th  Ohio  Volunteers,  aged  3’2  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  Virginia,  June  3d,  1864,  by  a conoidal  musket  ball,  which  struck  about  two  inches  to  the  left  of  the  median  line  and 
anterior  to  the  coronal  suture,  passed  backward  along  the  sagittal  suture,  fracturing  the  external  table  of  the  left  parietal  bone, 
and  emerged  about  two  inches  from  the  point  of  entrance.  He  was  admitted  to  the  hospital  of  the  3d  division,  Sixth  Corps ; on 
June  7th,  was  sent  to  the  Lincoln  Hospital,  at  W^ashington  ; on  June  18th,  was  transferred  to  the  Summit  House  Hospital,  and 
on  October  7th,  to  the  Satterlee  Hospital,  Philad(!lphia.  The  wound  had  healed,  but  the  patient  was  nervous  and  could  not  bear 
the  heat  of  the  sun ; the  vision  of  the  right  eye  was  impaired,  and  the  right  arm  was  nearly  useless.  He  was  discharged  on 
F'ebruary  9th,  1835,  and  pensioned.  On  September  24th,  1837,  Pension  Examiner  W.  S.  Parker  rejrorted  that  the  wound,  which, 
it  seems,  resulted  in  exposing  a portion  of  the  brain,  was  about  a year  in  healing ; the  patient  is  unable  to  bear  exposure  to 
the  sun  or  heat,  and  suffers  from  vertigo.  His  disability  is  rated  total  and  doubtful. 

Case.- — Private  George  W.  Bowen,  Co.  E,  59th  Illinois  Volunteers,  aged  21  years,  was  wounded  during  the  siege  of 
Nashville,  December  9th,  1864,  by  a conoidal  musket  ball,  which  fractured  the  right  parietal  bone,  carrying  away  a piece  one 
inch  and  a half  in  length  by  nearly  an  inch  in  breadth.  On  the  same  day  he  was  admitted  to  the  hospital  of  the  3d  division. 
Fourth  Corps,  and  transferred  as  follows:  On  December  12th,  to  Hospital  No.  13,  Nashville;  January  5th,  1865,  to  Jefferson 
Hospital,  Indiana;  and  on  March  22d,  to  the  Marine  Hospital,  St.  Louis,  Missouri,  where  he  was  discharged  from  service  on 
April  18th,  1885.  His  memory  was  much  impaired,  and  his  gait  unsteady.  He  was  pensioned,  his  disability  being  rated  total 
and  permanent. 

Case. — Private  Henry  Cook,  Co.  6,  1st  Ohio  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of  Eesaca,  Georgia, 
May  15th,  1864,  by  a conoidal  musket  ball,  which  produced  a limited  fracture  of  the  skull  without  known  depression.  He  was 
admitted  to  the  hospital  of  the  3d  division.  Fourth  Corps,  and  on  May  23d  was  conveyed  to  the  field  hospital  at  Chattanooga; 
thence  was  sent  to  the  Cumberland  Hospital,  at  Nashville,  on  May  26th.  He  was  furloughed  in  August,  with  orders  to  report  at 
the  expiration  of  his  leave  to  the  Medical  Director.  On  August  23d,  1834,  he  was  discharged  the  service  and  pensioned.  Pension 
Examiner  C.  J.  Neff  reported  on  February  22d,  1868,  that  a jjortion  of  the  skull  has  been  removed,  leaving  the  brain  exposed. 
There  is  partial  loss  of  memory,  constant  headache,  paralysis  of  superior  extremities,  subsultus,  etc.  He  rates  his  disability 
as  total  and  permanent; 


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( See  page  162.) 


GUNSHOT  FRACTUEES  OF  BOTH  TABLES  OF  THE  SKULL. 


163 


Case. — Priv’ate  Elias  Hess,  Co.  C,  199th  Pensylvania  Volunteers,  aged  18  years,  was  wounded  in  an  engagement  before 
Petersburg,  Virginia,  April  2d,  1365,  by  a conoidal  musket  ball,  which  fractured  the  right  side  of  the  frontal  bone.  He  was 
admitted  to  the  hospital  of  the  Twenty-fourth  Corps,  and  on  April  5th,  was  sent  to  the  hospital  at  Fort  Jlonroe.  Application  of 
simple  dressings  constituted  the  treatment.  On  May  17th,  he  was  transferred  to  the  IVIcClellan  Hospital,  Philadelphia,  and  on 
July  10th,  1865,  he  was  discharged  the  service.  In  July,  1868,  he  was  a pensioner,  his  disability  being  rated  one- third  and 
permanent,  by  Dr.  F.  F.  Burmeister,  the  pension  examining  surgeon. 

Case. — Corporal  August  Biihhneier,  Co.  B,  20th  New  York  Volunteers,  was  wounded  at  Antietam  September  17th,  1862. 
A portion  of  the  frontal  bone,  let!  side,  had  been  fractured  and  partly  torn  away,  leaving  the  brain  exposed  for  a space  of  two 
inches  by  one  inch.  He  was  taken  prisoner,  afterward  paroled,  and  on  November  15th,  was  admitted  to  Hospital  No.  1, 
Annapolis,  whence  he  was  discharged  the  service,  March  13th,  1863,  being  unable  to  undergo  either  mental  or  physical  exertion. 
He  was  pensioned,  his  disability  being  rated  three-fourths  and  permanent,  by  Pension  Examining  Surgeons  O’Meagher,  Treadwell, 
and  Fergusson. 

Similar  lesions  were  produced  by  fractures  from  shell  fragments  : 

Case. — Private  George  W.  Washabaiigh,  Co.  G,  100th  Pennsylvania  Volunteers,  aged  22  years,  was  wounded  at  James 
Island,  South  Carolina,  June  16th,  1862,  by  a fragment  of  shell,  which  fractured  the  superior  border  of  the  right  parietal  bone, 
carrying  away  an  inch  and  a half  in  dimension,  and  lacerating  the  dura  mater.  The  wound  healed  in  four  months,  when  violent 
convulsions,  followed  by  insensibility,  supervened.  He  was  discharged  October  9th,  1862,  and  pensioned.  On  September  3d, 
1866,  Pension  Examiner  J.  P.  Hosack  reported  that  a portion  of  the  skull,  three  inches  in  length  by  one  in  width,  has  been 
removed;  that  the  patient  sutfers  from  constant  pain  in  the  head,  and  from  partial  paralysis  of  one  arm  ; and  that,  when  excited, 
he  is  subject  to  convulsions.  His  disability  is  rated  total  and,  probably,  permanent. 

Case. — Private  William  P.  Dean,  Co.  D,  8th  Pennsylvania  Reserves,  was  admitted  to  Hospital  at  Upton’s  Hill,  Virginia, 
with  a gunsliot  fracture  of  the  skull,  caused  by  a fragment  of  shell.  He  was  discharged  the  service  March  7th,  1863,  and 
pensioned.  On  February  3d,  1868,  Pension  Examiner  F.  C.  Robinson  reported  that  the  patient  has  an  opening  through  the  skull 
at  the  vertex  nearly  one  inch  long  and  one-fourth  of  an  inch  wide,  and  that  he  complains  of  headache,  vertigo,  and  dimness  of 
vision,  which  were  aggravated  by  hard  labor  or  exposure  to  the  vicissitudes  of  the  weather.  His  disability  is  rated  one-fourth 
and  permanent. 

Examples  will  be  given  hereafter  of  the  splitting  of  bullets  upon  the  cranial  bones. 
There  are  instances,  however,  which  will  more  properly  find  a place  here,  in  which  a bit  of 
lead  is  clipped  off,  and  fissure  with  very  trifling  depression  produced,  as  in  the  following 
case : 


Case. — Corporal  William  E.  S , Co.  F,  84th  Pennsylvania  Volunteers,  aged  25  years,  was  struck  at  the  battle  of  the 

Wilderness,  May  5th,  1884,  by  a musket  ball  on  the  forehead,  a little  to  the  left  of  the  median  line.  He  was  taken  to  the  third 
division  field  hospital  of  the  Second  Corps,  and  was  thence  sent  to  City  Point,  and  transferred  on  a hospital  transport  to  Wash- 
ington, and  on  May  16th  admitted  to  Mount  Pleasant  Hospital,  Washington,  D.  C.,  and  on  May  27th  sent  to  Chester  Hospital, 
Pennsylvania.  The  wound  was  discharging  sanious  matter,  and  was  much  inflamed  and  painful.  There  was  considerable  fever, 
which  increased  on  the  29th.  On  the  following  day  the  patient  became  delirious,  and  died  on  May  31st,  1864,  from  meningitis. 
The  pathological  specimen,  which  is  represented  in  the  adjoining  wood-cuts,  (Fig.  72  and  FiG.  73,)  consists  of  the  body  of  the 

frontal  bone,  with  a fragment  of  lead 
impacted  near  the  centre  and  to  the 
left  of  the  median  line.  An  ovoid 
plate  of  the  external  table,  measur- 
ing one  by  two  inches,  is  slightly 
discolored,  and  surrounded  by  a 
groove  of  demarcation,  external  to 
which  the  bone  is  cribriform.  A 
plate  of  the  inner  table,  measuring 
one  square  inch,  is  detached  by 
three  of  its  sides,  and  driven  inward 
to  the  depth  of  two  lines  at  its  free 
edges.  Two  fissures,  each  one  and 
a fourth  inches  in  length,  run  back- 
ward and  outward,  and  there  is  a slight  deposit  of  new  osseous  materials  on  the  inner  surface, 
by  Surgeon  T.  H.  Bache,  U.  S.  V. 


Fig.  72. — Exterior  view  of  a frontal  bone  contiLsed 
by  a bullet,  and  having  a fragment  of  lead  impacted 
under  the  outer  lamina.  Spec.  2523,  Sect.  I,  A.  M.  M. 


Fio.  73. — Interior  view  of  the  preceding  specimen, 
showing  the  depression  of  the  vitreous  table. 


The  specimen  was  contributed 


The  next  two  abstracts  refer  to  very  similar  cases  : 

Case.  Private  Allen  Harrison,  Co.  L,  2d  New  York  Mounted  Rifles,  aged  34  years,  was  wounded  in  an  engagement  before 
Petersburg,  Virginia,  July  8th,  1864,  liy  a conoidal  musket  ball,  which  struck  the  frontal  bone  in  the  upjter  portion,  causing  two 
slight  fissures,  small  portions  of  lead  remaining  imbedded  in  the  outer  table.  He  was  admitttid  to  the  hospital  of  the  2d 
division  Ninth  Corps,  and  on  July  16th  was  sent  to  the  Mower  Hospital,  Philadelphia.  On  .July  24th,  a severe  attack  of 
acute  pleuritis  was  followed  by  symptoms  of  hepatitis.  His  respiration  Ix-came  shoii  and  labor<>d,  and  the  conjunctiva)  and  skin 


164 


WOUNDS  AND  INJUKIES  OF  THE  HEAD 


tinged  with  yeljow;  the  tongue  was  dry  and  coated,  and  he  complained  of  severe  pain  in  the  liver.  A blister  plaster  was  applied 
to  the  side  of  the  chest,  and  squills  and  solution  of  morphia  and  stimulants  prescribed;  but  he  sank  raj)idly  and  died  on  July 
28th,  1854.  Ui)on  removing  the  calvaria  at  the  autopsy,  an  abscess  was  found  directly  under  the  point  of  injury,  over  the 
longitudinal  sinus,  containing  half  an  ounce  of  dark  green  offensive  pus.  Tlie  dura  mater  was  much  thickened,  but  there  was 
little  evidence  of  congestion  of  the  brain.  The  liver  was  pale.  One  pint  of  serum  was  found  in  each  side  of  the  pleural  cavity. 
There  had  been  inflammation  of  the  lower  lobe  of  the  right  lung.  Symptoms  of  compression,  if  present,  were  so  masked  by 
|)leuritic  and  hepatic  indications  as  to  escape  notice.  Acting  Assistant  Surgeon  W.  F.  Moon,  reported  the  case  from  notes 
furnished  by  Dr.  Fell,  and  subsequently  published  an  abstract  of  it  in  an  article  on  gunshot  wounds  of  the  head,  in  the  American 
Journal  of  the  Medical  Sciences  for  July,  1836,  and  fuller  data  have  heen  derived  from  the  hospital  registers. 

Ca.se. — Private  A.  Stanton,  Co.  G,  1st  New  York  Dragoons,  received,  at  the  battle  of  Winchester,  Virginia,  September 
19tb,  1884,  a gunshot  wound  of  the  head.  The  skull  was  fractured  from  the  right  orbital  arch  upward  and  inward  about  three 
inches.  A bit  of  the  conoidal  musket  ball  which  indicted  the  injury  was  chipped  off  by  the  outer  table  of  the  frontal.  He  was 
admitted  to  the  Cavalry  Corps  hospital  on  the  following  day.  The  patient  was  at  times  partially  conscious,  and  suffered  from 
pain  in  the  head  and  irritative  fever.  The  functions  of  the  body  were  normal,  but  he  became  very  emaciated,  sank  gradually, 
and  died,  without  convulsions,  October  ICth,  1834. 

Ill  tlie  following  cases  the  ball  lodged  in  the  diploe  or  sinuses : 

Case. — Private  Jacob  Miller,  Co.  K,  9th  Indi.ana  Volunteers,  aged  25  years,  was  wounded  at  the  battle  of  Chickamauga, 
September  19tli,  1833,  by  a buck  shot,  which  penetrated  and  lodged  in  the  frontal  bone  near  the  nasal  eminence,  causing  fracture 
of  the  left  orbit  and  cxophthalmia  of  the  eye.  On  the  same  day  he  was  admitted  to  hospital  No.  5 at  Nashville,  and  on  October 
20th  was  transferred  to  No.  13,  Louisville,  whence  he  was  transferred  on  the  25th  to  New  Albany,  Indiana,  and  thence  on 
March  19th,  1834,  to  the  hospital  at  Madison,  Indiana.  The  missile  was  extracted  on  June  15th,  1864,  and  expectant  treatment 
only  was  used.  The  patient,  recovering,  was  transferred  to  Indianapolis  Sejitember  2d,  1834,  to  be  mustered  out  of  serviee,  and 
was  discharged  September  17th,  1834,  and  pensioned.  On  August  17th,  1868,  Pension  Examiner  A.  Coleman  reports  the  patient 
suffering  from  caries  of  the  frontal  bone,  attended  with  purulent  discharge,  loss  of  power  in  left  eye,  general  disturbance  of  the 
mental  faculties,  which  are  aggravated  when  the  wound  discharges  much,  and  at  times  complete  pi’ostration.  A subsequent 
report  from  Pension  Examiner  J.  K.  Bigelow,  dated  January  7th,  1870,  confirms  previous  statement  of  patient’s  condition,  and 
rates  his  disability  as  total  and  permanent. 

Case. — Private  Charles  E , Co.  K,  51st  New  York  Volunteers,  aged  22  years,  was  wounded,  at  the  battle  of  New 

Berne,  North  Carolina,  March  14th,  1862,  by  a conoidal  musket  ball,  whicli  struck  obliquely  above  the  right  frontal  sinus. 
The  ball  split  upon  the  outer  table,  and  the  larger  portion  of  it  passed  under  the  occipito-frontalis  tendon,  and  the  remainder  was 
inqiaeted  in  the  sinus.  The  patient  was  conveyed  in  an  ambulance  to  New  Berne,  and  entered  the  Academy  Green  Hospital. 

The  portion  of  ball  which 
lodged  under  the  aponeurosis 
was  extracted.  Cold  water 
dressings  were  applied,  and 
the  case  was  treated  on  the  ex- 
pectant plan.  Synq)toms  of 
compression  of  the  brain  soon 
supervened ; yet  the  patient 
survived  until  October  25th, 

1862.  At  the  autopsy  it  was  75.-Interior  view  of  the  preceding  specimen, 

found  that  there  was  an  ab- 
scess of  the  brain,  and  that  a fracture  with  depression  passed  through  the  right 
frontal  sinus.  The  external  opening  measuring  three-fourths  of  an  inch  in  length,  and  one-third  of  an  inch  in  width,  with  edges 
rounded  by  the  commencing  repair.  One  and  a half  square  inches  of  the  inner  table  are  depressed  half  an  inch.  The  fragment 
of  ball  which  penetr.ated  the  frontal  sinus  projects  slightly  into  the  cranial  cavity  to  the  left  of  the  longitudinal  ridge  of  the  os 
frontis.  The  specimen  was  sent  to  the  Army  Jledical  Museum  from  New  Berne,  and  is  represented  in  the  accompanying 
wood-cuts,  (Fig.  74,  and  Fig.  75,)  and  was  accredited  to  Surgeon  C.  A.  Cowgill,  U.  S.  V. ; but  Dr.  Cowgill  verbally  informs  tiie 
editor  that  he  has  no  recollection  of  the  case  or  of  the  specimen.  The  specimen  is  a very  interesting  one,  and  was  probably  sent 
to  the  Surgeon  Gener.al’s  office  by  one  of  the  assistants  at  the  Academy  Green  Hospital,  without  the  name  of  the  donor,  and  only 
the  brief  memorandum,  the  chief  points  of  which  are  recapitulated  al)ove. 

Case. — Private  John  D.  Clark,  Co.  I,  53d  Ohio  Volunteers,  aged  18  years,  was  wounded  near  Eesaca,  Georgi.a,  May 
25th,  1834,  by  a conoidal  ball,  which  fractured  the  frontal  bone  above  the  right  eye  and  lodged.  On  May  29th  he  was  admitted 
to  hospital  at  Chattanooga,  Tennessee,  .and  was  transferred  as  follows:  on  June  2d,  to  hospital  No.  1,  Nashville  ; June  5th,  to 
Joe  Holt  Hospital,  Jeffersonville,  Indiana;  June  24th,  to  Camp  Dennison,  Ohio;  .luly  15th,  to  Cleveland,  Ohio  ; August  10th, 
to  Crittenden,  Kentucky,  and  on  October  7th,  to  Seminary  Hospital,  Columbus,  Ohio.  He  was  discharged  December  13th,  1864, 
and  pensioned.  Subsequent  information  states  that  the  patient  is,  at  times,  subject  to  spasms,  and  that  there  is  partial  paralysis 
of  tne  left  side.  His  disability  is  rated  one-half  and  permanent. 

C.VSE.  Private  Samuel  H.  McCartney,  Co.  K,  33th  Illinois  Volunteers,  aged  22  years,  was  wounded  at  the  battle  of  Pea 
Eidge,  Arkansas,  March  8th,  1832,  hy  a conoid.al  musket  hall,  which  struck  the  frontal  bone  about  two  IucIk's  above  the  right 


Fig.  74. — .Section  of  the  frontal  bone  with  a fragment 
of  bali  embedded  in  the  frontal  sinus.  Spec.  ,746,  Sect.  I, 
A.  M.  M. 


GUNSHOT  FEACTUKES  OF  BOTH  TABLES  OF  THE  SKULL. 


165 


superciliary  ridge,  passing  from  the  left  to  the  right,  crushing  the  hone  at  point  of  contact  and  lodged  about  one  and  a quarter 
inches  from  point  of  entrance.  The  dura  mater  was  not  injured.  The  wound  healed  in  about  four  months,  and  on  July  25th, 
1862,  he  was  discharged  the  service.  On  February  15th,  1836,  Pension  Exandner  John  Young  reports  that  he  was  troubled 
with  pain  in  the  head  at  the  point  of  injury,  was  subject  to  vertigo,  and  could  not  bear  exposure  to  sun.  His  mind  was  also 
impaired.  He  is.  not  a pensioner. 

Case.— Sergeant  J.  A.  Thompson,  Co.  E,  45th  Georgia  Eegiment,  received  a gunshot  injury  of  the  frontal  sinus  at  the 
battle  of  the  Wilderness,  May  5th,  1864.  On  May  12th  was  admitted  to  hospital  at  Farmville,  Virginia.  There  was  a sanious 
discharge  from  the  front.al  sinus ; otherwise  the  case  progressed  favorably  and  the  patient  was  allowed  to  go  home  on  furlough. 


Case. Private  Jacob  Fisher,  Co.  D,  82d  Ohio  Volunteers,  was  wounded  by  a spent  ball  at  the  b.attle  of  Chancellorsville, 

Virginia,  May  2d,  1863,  which  impinged  upon  the  frontal  bone  above  the  left  eminence,  and  produced  a slight  fracture.  He  was 
conveyed  to  the  Harewood  Hospital  at  Washington;  on  May  9th  was  sent  to  the  McClellan  Hospital,  Philadelphia,  and  on  July 
6th,  to  the  Sixteenth  and  Filbert  Streets  Hospital.  No  untoward  symptoms  are  recorded,  and  the  patient  was  returned  to  duty 
on  July  7th,  1883 ; was  discharged  July  11th,  1833-,  and  pensioned,  being  subject  to  pain  and  vertigo.  His  disability  is  rated 
one-half,  and  perhaps  permanent. 

Case.— Private  Thomas  M , Co.  C,  4th  New  York  Volunteers,  was 

wounded  near  Antietam,  Maryland,  September  16th,  1862,  bj’  a conoidal  ball 
which  fractured  the  mastoid  portion  of  the  left  temporal  bone.  He  remained  in 
the  field  hospital  until  the  26th,  when  he  was  admitted  into  the  Mount  Pleasant 
Hospit.al,  Washington,  D.  C.  Phlegmonous  erysipelas  attacked  the  scalp,  and 
the  inflammatir>n  extended  to  the  membrane  of  the  brain  and  death  supervened 
on  the  5th  of  October.  The  pathological  specimen  is  represented  in  the  adjacent 
wood-cut,  (Fig.  76.)  The  injury  of  the  outer  table  involves  a little  over  one 
square  inch  of  surface;  that  of  the  inner  table  measures  one  by  one  and  a fourth 
inches,  and  includes  the  groove  for  the  lateral  sinus.  Two  fragments  are 
attached,  the  free  edge  of  one  being  depressed  two  lines.  The  fractured  sur- 
faces are  necrosed.  The  specimen  and  history  were  contributed  by  Assistant 
Surgeon  C.  A.  McCall,  U.  S.  A. 


Case. — Private  Thomas  P- 


-,  Co.  D,  30th  Maine  Volunteers,  was,  on 


Fig.  76. — Section  of  a cranium  showing  a gunshot 
. fracture  of  the  mastoid  process.  Spec.  161,  Sect.  I,  A. 
April  5th,  1865,  admitted  to  the  Jarvis  Flospital,  Baltimore,  Maryland,  with  m.  M. 

typhoid  fever.  He  had  partially  recovered  from  fever,  when  he  died  on  July  2d, 

1865.  The  autopsy  revealed  an  indented  fracture  of  the  frontiil  bone,  above  and  external  to  the  right  frontal  eminence.  The 
rim  of  depression  was  three-fourths  of  an  inch  in  diameter,  and  the  depth  in  the  centre  one-fourth  of  an  inch.  A portion  of  the 
outer  table  had  been  removed.  The  inner  table  was  fractured  in  three  triangular  jilates,  all  of  which  were  firmly  consolidated, 
and  all  the  fissures  were  filled  up  by  a deposit  of  new  bone;  the  depression  of  that  table  being  two  lines.  The  substance  of  the 
brain  immediately  under  the  injured  bone  was  found  softened  and  disorganized.  The  pathological  specimen  is  No.  2619,  A.  M.  M., 
and  was  contributed,  with  the  history,  by  Assistant  Surgeon  D.  C.  Peters,  U.  S.  A. 


Case. — Private  D.  L.  Underwood,  Co.  D,  18th  Georgia  Regiment,  received  a gunshot  wound  of  the  head  involving  the 
frontal  sinus.  He  was  admitted  into  the  Jackson  Hospital,  division  No.  1,  Richmond,  February  17th,  1865.  A fistula  afterward 
formed.  He  was  furloughed  for  sixty  days. 


Ca.se. — Sergeant  Augustus  Reinwald,  Co.  G,  42d  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  South  Mountain, 
Maryland,  September  14th,  1862,  by  a conoidal  ball,  which  entered  the  .left  side  of  the  face  at  base  of  nose,  passed  backward, 
and  emerged  from  behind  the  right  ear,  separating  the  mastoid  process  of  the  temporal  bone.  He  became  insensible.  For 
several  hours  after  return  of  consciousness  there  was  bleeding  from  mouth,  ear,  and  eye.  On  September  29th,  he  was  admitted 
to  the  Patent  Office  Hospital,  Washington,  and  on  October  5th  sent  to  Ladies’  Home  Hospital,  New  York  City.  The  portio  dura 
and  third  pair  of  nerves  were  paralyzed.  There  was  loss  of  vision  of  right  eye,  and  of  sensation  and  mobility  of  right  side 
of  face.  The  patient  was  unable  to  swallow  or  open  his  mouth.  Febrile  action  set  in,  which,  together  with  pain  in  head  and 
jirofuse  suppuration  of  wound,  rapidly  reduced  the  strength  of  the  patient.  He  became  pale,  weak,  and  emaciated ; skin  was 
moist,  appetite  poor ; pulse  regular,  slow,  and  compressible ; the  eye  was  lachrymose,  and  the  mouth  drawn  to  ofiposite  side. 
The  wound  inThe  face  healed,  but  the  posterior  wound  continued  to  discharge  profusely.  He  was  discharged  oh  March  21st, 
1863,  and  pensioned,  his  disability  being  rated  one-half,  by  Surgeon  A.  B.  Molt,  U.  S.  Vols. 

In  many  of  the  cases  classified  under  the  head  of  gunshot  fractures  of  both  tables  of 
the  skull  without  known  depression,  the  details  of  the  symptoms  and  treatment  are  very 
meagre,  and  it  is  impracticable  to  verify  the  diagnoses  from  the  evidence  presented  in  the 
reports.  The  following  series  fairly  illustrates  this  class  of  cases,  in  which  the  instances  of 
recovery  and  pension  largely  predominated  : 


Case. — Lieutenant  .John  Adams,  Co.  G,  35th  Ohio  Volunteers,  aged  30  yiuir.s,  was  wounded  at  Chickamauga,  Seiifember 
19th,  1863,  by  a conoidal  musket  ball,  which  fractured  the  upper  jiortiou  of  the  right  side  of  the  frontal  bone;  he  also  received  a 


166 


WOUNDS  AND  INJUKIES  OF  THE  HEAD, 


gunshot  wound  of  the  liand.  Treated  at  the  hospital  of  the  3d  division,  Ninth  Corps,  the  hospital  at  Stevenson,  Alabama,  the 
officers’,  hospital  at  Nashville,  and  the  general  hospital  at  Covington,  Kentucky,  where  he  arrived  May  26th,  1864,  and  was 
discharged  June  3d,  1864.  In  September,  1867, *he  was  a pensioner,  his  disability  being  rated  tliree-fourths  and  permanent. 

Ca.se. — Captain  K.  P.  Andis,  Co.  B,  99ih  Indiana  Volunteers,  aged  34  years,  was  wounded  near  Atlanta,  Georgia,  July 
21st,  1834,  by  a conoidal  musket  ball,  which  fractured  the  left  temporal  bone.  Treated  at  hospital  of  the  4th  division,  Fifteenth 
Corps,  until  August  13th,  when  he  was  sent  north  ; admitted  to  Grant  Officers’  Hospital,  near  Cincinnati,  December  20th ; was 
discharged  the  service  December  30th,  1864,  by  special  order  of  the  War  Department.  In  July,  1838,  he  was  a pensioner,  his 
disability  being  rated  two-thirds  and  temporary. 

Case. — Sergeant  Stephen  Aldrich,  Co.  E,  141st  New  York  Volunteers,  aged  26  years.  F'racture  of  the  occipital  bone  by 
a conoidal  musket  ball.  Dallas,  Georgia,  May  25th,  1864.  Treated  at  the  hospital  of  the  1st  division.  Twentieth  Corps,  the 
field  hospital  at  Chattanooga,  the  Sherman  Hospital  at  Nashville,  and  the  hospitals  at  Jeffersonville  and  Elmira.  Discharged 
fi  om  service  February  27th,  1865.  In  March,  1868,  he  was  a pensioner,  his  disability  being  rated  one-half  and  temporary. 

Case. — Private  George  H.  Barlow,  Battery  K,  14th  New  York  Artillery,  aged  26  years.  Fracture  of  the  frontal  bone 
above  the  right  eye,  by  a conoidal  musket  ball.  Petersburg,  June  17th,  1864.  Treated  at  the  regimental  hospital.  Mount 
Pleasant,  Chester,  and,  after  several  transfers,  at  Carver  Hospital.  Discharged  from  service  May  29th,  1865,  and  pensioned,  his 
disability  being  rated  total. 

Case. — Private  Charles  H.  Barrett,  Battery  G,  2d  Massachusetts  Heavy  Artillery,  aged  25  years.  Fracture  of  the  right 
side  of  the  cranium  by  a piece  of  shell.  Plymouth,  North  Carolina,  April  8th,  1864.  Taken  prisoner.  Exchanged  December 
5th,  1884,  and  was  treated  in  No.  1 hospital,  Annapolis,  and  Dale  Hospital,  Worcester,  Massachusetts.  Discharged  from  service 
July  7th,  1865.  In  July,  1868,  he  was  a pensioner,  his  disability  being  rated  total  and  temporary. 

Case. — Piivate  C.  F.  Benton,  Co  E,  116th  Illinois  Volunteers,  aged  23  years.  Fracture  left  side  of  frontal  bone  by  a 
piece  of  shell.  Jonesboro’,  Georgia,  August  31st,  1864.  He  was  admitted  to  the  hospital  of  the  2d  division.  Fifteenth  Corps, 
where  simple  dressings  were  applied ; on  September  5th,  was  sent  to  the  hospital  of  the  Fifteenth  Corps,  and  on  November  30th, 
to  Camp  Butler,  Illinois.  Discharged  fi-om  service  April  8th,  1865.  In  July,  1868,  he  was  a pensioner,  his  disability  being 
I'ated  total  and  permanent. 

Case. — Private  Henry  A.  Bliss,  Co.  I,  18th  Massachusetts  Volunteers.  Fracture  of  the  temporal,  malar,  and  superior 
and  inferior  maxillary  bones,  right  side,  by  a conoidal  musket  ball.  Cold  Harbor,  Virginia,  June  1st,  1864.  Treated  in  the 
Fifth  Corps,  1st  Division,  Alexandria,  De  Cam'p,  and  Dale  hospitals.  Discharged  May  9th,  1865.  Not  a pensioner. 

Case. — Private  Jacob  Burnes,  Co.  K,  100th  Pennsylvania  Volunteers,  aged  27  year’s,  was  wounded  at  Fort  Steadman, 
before  Petersburg,  March  25th,  1865,  by  a fragment  of  shell,  which  entered  anterior  to  junction  of  coronal  and  sagittal  sutures, 
fracturing  the  skull  to  the  extent  of  three-fourths  of  an  inch,  but  not  detaching  the  bone.  Fie  was  admitted  to  Carver  Hospital, 
Washington,  on  April  5th,  1865,  and  was  transferred,  on  April  9th,  to  Mower  Hospital,  Philadelphia,  where  he  was  discharged 
from  service  on  May  29th,  1865,  with  every  prospect  of  entire  recovery.  Is  not  a pensioner. 

Case. — Private  Peter  Campbell,  Co.  C,  81st  Pennsylvania  Volunteers,  aged  17  years,  was  wounded  at  Hatcher’s  Kun, 
Virginia,  March  25th,  1865,  by  a conoidal  musket  ball,  which  struck  the  skull  near  the  junction  of  the  sagittal  and  lambdoid 
sutures,  carrying  away  portions  of  hone.  Treated  in  the  hospital  of  the  1st  division.  Second  Corps,  and  at  the  Armory  Square, 
White  Hall,  McClellan,  and  Mower  hospitals.  Discharged  from  service  July  31,  1865.  Not  a pensioner. 

Case. — Private  J.  A.  Dietz,  Co.  G,  3d  New  York  Volunteers,  aged  24  years.  Fracture  of  cranium  and  wound  of  shoulder, 
by  a twelve-pound  shot.  Drurj^’s  Bluff,  Virginia,  May  16th,  1864.  Treated  in  the  hospital  of  the  1st  division.  Tenth  Corps, 
and  at  Mower,  De  Camp,  and  Ira  Harris  hospitals.  Discharged  June  15th,  1865,  “able  to  earn  partial  subsistence.” 

Case. — Privmte  Thomas  Johnson,  Co.  G,  146th  New  York  Volunteers,  aged  42  years.  Fracture  and  loss  of  a portion  of 
the  occipital  bone  by  a piece  of  shell.  Petersburg,  June  24th,  1864.  Treated  at  division,  Alexandria,  Carver,  and  Ira  Harris 
hospitals.  Discharged  from  service  May  4th,  1865,  and  pensioned,  his  disability  being  rated  one-half.  At  the  latter  date,  his 
limbs  and  faculties  were  normal,  but  his  strength  was  impaired,  and  he  was  only  able  to  earn  partial  subsistence. 

Case. — Private  Augustus  Juno,  Co.  G,  147th  New  York  Volunteers,  aged  40  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  Virginia,  June  3d,  1834,  by  a conoidal  ball,  which  fractured  the  cranium.  On  the  same  day  he  was  admitted  to  the 
hospital  of  the  4th  division,  Ffifth  Corps.  The  injury  was  considered  slight,  and,  apparently,  caused  little  or  no  inconvenience, 
as  the  man  served  with  his  regiment  again  until  February  1st,  1865,  when  he  was  admitted  to  the  Fifth  Corps  hospital  at  City 
Point.  On  February  14th,  he  was  sent  to  the  hospital  at  Point  Lookout,  Maryland,  where  he  remained  until  June  10th,  1865, 
when  he  was  discharged  the  service.  In  July,  1888,  he  was  a pensioner,  his  disability  being  rated  at  one-half  and  temporary. 
His  pension  was  increased  on  March  21st,  1870. 

Case. — Private  James  Landon,  Co.  K,  179th  New  York  Volunteers,  aged  19  years.  Fk-acture  of  the  frontal  bone  by  a 
conoidal  musket  ball.  Petersburg,  April  2d,  1885.  Treated,  by  the  application  of  simple  dressings,  at  division,  Slough,  and 
Mower  hospitals.  Discharged  from  service  June  22d,  1865,  and  pensioned.  Pension  Examiner  J.  G.  Orton,  in  a communi- 
cation dated  June  29th,  1865,  stated  that  the  wound  was  still  discharging,  but  that  the  patient  would  probably  improve.  In 
July,  1868,  his  disability  was  rated  total  and  permanent. 

Case. — Private  William  Meyers,  Co.  A,  7th  Iowa  Volunteers,  aged  39  years.  F’racture  of  tlie  frontal  bone  by  a conoidal 
musket  ball.  Kesaca,  Georgia,  May  15th,  1864.  Treated  at  the  hospital  at  Chattanooga,  the  No.  1 hospital  at  Nashville,  and 
the  hospitals  at  Mound  City  and  Davenport.  Throughout  treatment,  the  patient  suffered  from  ulcers  on  v.arious  parts  of  his 
body,  sujiposed  to  have  been  caused  by  vaccination.  Discharged  June  21st,  186.5,  and  j)ensioned,  his  disability  being  rated  one- 
tliiid.  There  was  impairment  of  cerebral  functions. 


DEPRESSED  GUNSHOT  FRACTURES  OF  BOTH  TABLES  OF  THE  SKULL. 


167 


Case. — Private  Edward  B.  Ockington,  Co.  G,  37tli  Massachusetts  Volunteers,  aged  28  years,  was  wounded  at  Winches- 
ter, Virginia,  September  19th,  1864,  by  a fragment  of  shell,  which  produced  a stellate  fracture  of  the  frontal  bone.  He  was 
treated  at  corps,  Sandy  Hook,  and  McClellan  hospitals.  The  patient  had  nearly  recovered  in  December,  and  was  sent  to  Camp 
Distribution,  Virginia,  but  he  was  returned  to  the  Carver  Hospital  at  Washington,  on  December  16th,  and  on  March  13th,  1865, 
was  transferred  to  Dale  Hospital,  Massachusetts,  where  he  was  discharged  the  service  on  May  24th,  1835.  Not  a pensioner. 

Case. — Private  Owen  F.  Prentice,  Co.  C,  35th  Illinois  Volunteers,  aged  32  years.  Fracture  of  the  frontal  bone  above  the 
left  eye,  by  a conoidal  musket  ball.  Chattanooga,  November  8th,  1863.  He  was  admitted  to  the  Cumberland  Hospital  at  Nash- 
ville, on  December  9th,  and  furloughed  on  the  23d.  On  April  26th,  1864,  he  was  admitted  to  the  Camp  Butler  Hospital,  Illinois. 
The  wound,  at  this  time,  was  doing  well,  but  the  patient  was  unable  to  undergo  any  active  exertion.  He  was  discharged  from 
service  June  9th,  1864,  on  account  of  total  disability.  Not  a pensioner. 

Case. — Private  Johir  Spurrier,  Co.  A,  142d  New  York  Volunteers,  aged  22  years,  was  wounded  in  an  engagement  on  the 
Darbytown  Road,  Virginia,  October  26th,  1864,  by  a conoidal  musket  ball,  which  fractured  a portion  of  the  parietal  bone.  On 
October  29th,  he  was  admitted  to  the  Balfour  Hospital,  Portsmouth,  Virginia,  where  he  remained  under  treatment  until  March 
10th,  1865,  when  he  was  admitted  to  the  Grant  Hospital,  New  York  Harbor.  At  this  time  the  conjunctiva  was  inflamed.  He 
improved;  was,  on  April  4th,  sent  to  Rochester,  New  York,  on  July  6th,  to  the  Ira  Harris  Hospital,  Albany,  New  York,  and  on 
August  4th,  1865,  was  discharged  the  service.  Not  a pensioner. 


Gunshot  Fractures  of  Both  Tables  of  the  Cranium  with  Depression. — I shall  now 
adduce  illustrations  of  the  principal  varieties  of  depressed  gunshot  fracture  of  the  skull. 
The  oblique  impact  of  musket  balls  upon  the  vault  of  the  cranium  sometimes  produces 
a linear  fissure  of  the  outer  table,  with  extended  depression  or  displacement  of  the  vitreous 
table.  This  form  of  accident  is  more  likely  to  occur  in  a young  subject,  and  upon  those 
portions  of  the  skull  well  supplied  with  diploe.  Specimens  of  this  injury  are  not  very 
common.  It  would  be  difficult  to  select  a better  illustration  than  is  afforded  by  the 
following  case  : 


Case. — Private  If.  L.  H — , Co.  E,  21st  Virginia  Regiment,  aged  20  years,  was  wounded  at  Petersburg,  Virginia, 

in  the  assault  on  Fort  Steadman,  March  25th,  1865,  l)y  a musket  ball  which  struck  the  forehead.  He  was  made  a prisoner  and 
admitted  to  the  hospital  of  the  Ninth  Army  Corps  at  City  Point.  On  March  27th  he  was  conveyed  in  the  hospital  transport 
steamer  “ State  of  Maine  ” to  Washington,  and  placed  in  the  Lincoln  Hospital  on  March  28th,  with  a wound  over  the  left 
supra-orbital  ridge,  apparently  inflicted  by  a glancing  musket  ball.  There  were  no  cerebral  symptoms  when  the  patient  w^as 
admitted,  and  he  seemed  to  be  doing  well  for  several  days,  being  quite  free  from  pain  or  any  febrile  movement.  The 
pulse  was  normal  and  the  howels  in  good  condition.  On  April  1st,  he  complained  of  a dull  deep-seated  pain  over  the  left  eye. 
Later  in  the  day  he  was  feverish  and  restless,  his  countenance  was  pale,  and  his  pulse  slow  and  weak.  On  April  2d,  he 
failed  rapidly.  On  the  night  of  the  3d,  he  was  delirious.  On  the  4th,  there  was  violent  raving,  which  continued  until  his 
death,  on  the  afternoon  of  April  5th,  1865.  At  the  post-mortem  examination,  a fissure  was  found  extending  into  the  right 
orbit,  and  upward  beyond  the  left  frontal  prominence.  The  vitreous  table  beneath  was  largely  depressed.  There  was  a small 

abscess  in  the  anterior  lobe  of 
the  left  cerebral  hemisphere. 

The  specimen  was  contributed 
by  Acting  Assistant  Surgeon  J. 

P.  Arthur,  and  is  represented 
in  the  accompanying  wood-cuts, 

(Fig.  77  and  Fig.  78.)  Two 
fragments  of  the  inner  table  are 
driven  inward  to  the  depth  of 
half  an  inch,  touching  each 
other  by  their  inner  edges  like 
the  leaves  of  a folding  door  just 
ajar.  (See  Catalogue  Surg.  Sect. 

A.  M.  M.,  page  10.) 


Fig.  77. — Section  of  the  frontal  bone,  exhibiting 
a fissure  over  the  left  supra  orbital  region. — Spec. 
2-4,  A.  M.  M. 


Fin.  78. — Intomnl  view  of  the  foregoing  specimen, 
showing  the  c.\tensivc  splintcringoftlic  vitreous  table. 


The  examples  of  slight  depression  of  the  external  table  with  great  depression  internally 
were,  of  course,  very  numerous.  It  is  necessary  to  cite  but  few  : 

Case. — I’rivate  George  V , Co.  CV  84th  New  York  Volunteers,  was  wounded  at  Chancellorsville,  May  3d,  1863, 

and  admitted  into  Carver  Hospital  at  Waslungton,  D.  C.,  on  May  7th,  1863.  His  injury  was  supposed  to  bo  a sinqilo  scalp 
wound  from  a musket  ball.  It  was  situated  over  the  right  parietal  protuberance,  and  on  admi.ssion  was  granulating  kindly. 
Ten  days  subsequently  the  patient,  after  a walk  out  of  doors  and  sitting  in  the  hot  sijn,  had  htiadache  and  nausea,  and  the 
wound  gaped  and  its  edges  ulceratetl.  On  May  17th  there  was  headache,  and  his  stomach  would  not  retain  food.  On  May 


168 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


18tli  tlie  probe  detected  denuded  bone;  but  no  fracture  was  discovered.  There  were  no  fel)rile  or  cerebral  symptoms.  On 
May  20tli  a depression  of  the  outer  table  of  the  skull  was  detected.  At  night  there  was  delirium,  and  the  following  day  the 
pulse  b(?came  feeble  and  irregular,  the  stomach  irritable,  the  tongue  heavily  furred.  On  this  and  the  following  nights  the  patient 
had  two  and  a half  grains  of  opium  at  bedtime.  His  diet  was  low,  though  chicken  broth  and  custard  were  allowed.  On  this 

day  there  was  a decided  icteric  hue  over  the  whole 
surface.  The  patient  died  on  May  22d,  1863,  being 
conscious  and  rational  to  the  last.  At  the  autopsy, 
extensive  inflammation  of  the  dura  mater  was 
observed,  and  softening  of  the  middle  lobe  of  the 
right  cerebral  hemisphere.  The  notes  of  the  case 
were  drawn  up  by  Assistant  Surgeon  I'l.  F.  Bates, 

U.  S.  V.,  and  were  contributed  with  the  specimen, 
which  is  represented  in  the  wood-cuts  .above,  (Fig. 

79  and  FiG.  80,)  by  Surgeon  O.  A.  Judson,  U.  S.V. 
parictal~bon?'”l,^j)cc.  I'gST^A  *M  *jT  The  fracture  of  the  external  table  is  half  an  inch  Fio.  80. — Interior  view  of  the  foregoing 

in  diameter,  and  is  depressed  two  lines.  The  inner 

table  is  fractured  to  the  diameter  of  an  inch,  and  depressed  in  the  centre  one  line.  A few  hairs  are  wedged  in  among  the  frag- 
ments. The  surrounding  bone  is  porous  and  cribriform. 


The  classical  “punctured”  fracture  of  authors  was  not  infrequently  observed,  and  the 
Army  Medical  Museum  possesses  many  specimens  of  this  form  of  injury,  one  of  the  best 
of  which  is  figured  below  : 


Fig.  81. — Fracture  of  the 
fnintui  bone  by  a pistol  ball. 
Spec.  1673,  A.  M.  M. 


Case. — Private  James  K , Co.  G,  6th  New  York  Cavalry, 

was  wounded  at  the  battle  of  Gettyshurg,  July  3d,  1863,  by  a pistol  ball, 
which  produced  a punctured  fracture  of  the  os  fronth.  He  was  conveyed 
to  a hospital  at  Baltimore,  and  from  thence  to  Carver  Hospital,  at  Wash- 
ington, on  July  24th.  He  stated  that,  at  Baltimore,  he  walked  about 
and  felt  no  inconvenience  from  his  wound.  On  July  27th,  he  had  a con- 
vulsion. The  wound,  whicJi  was  nearly  healed,  was  laid  open,  and  de- 
pressed bone  being  detected,  an  etfort  was  made  to  elevate  it.  Several 
small  necrosed  fragments  were  removed,  and  a small  quantity  of  fetid 
pus  escaped.  The  patient  had  become  comatose,  and  the  operation  had 
no  influence  in  relieving  the  symptoms.  Death  took  place  a few  hours 
subsequently.  At  the  autopsy,  the  extended  depression  of  the  inner 
table  was  discovered,  and  a large  abscess  of  the  brain. 


Fig.  82. — Interi.)!-  view  uf 
the  foregoing  specimen. 


Another  common  form  is  illustrated  in  the  following  case : 

Case. — Private  Leonard  L , Co.  F,  74th  New  York  Volunteers,  was  wounded  at  the  battle  of  Williamsburg,  May 

5th,  1862,  and  was  admitted  into  Broad  and  Cherry  streets  Hospital  at  Philadelphia,  May  13th,  1862.  A musket  ball  bad 

struck  near  the  left  parietal  eminence,  and  producing  a 
slight  depression  of  the  outer  table,  had  lodged  under 
the  scalp,  whence  it  had  been  removed  by  a surgeon  on 
the  field.  The  wound  had  a healthy  aspect  when  the 
man  was  admitted,  and  there  was  no  cerebral  disorder. 

This  favorable  condition  continued  unaltered  till  !May 
20tb,  when  a febrile  movement  set  in,  accompanied  by 
nausea  and  vomiting ; drowsiness  and  stupor  followed, 
and  the  patient  died  comatose  on  May  23d,  eighteen 
days  after  the  injury.  At  the  autopsy  a small  clot  was 
found  bimeath  the  depressed  jiortion  of  the  vitreous 
plate;  the  dura  mater  was  uuinjured;  the  arachnoid 

Fig.  82.— Pertinn  of  left  p.ariot.al,  show-  near  the  seat  of  injury  was  opaque  and  studded  with  Fin-  84.— Interior  view  of  the  fore- 
itjff  II  sliffhtlv  depressed  fracture  of  the  , • /.  i i ‘ i*  r.  i -i  • spechnon,  oxhibitlnff  extensive 

outer  table.  Spec.  224,  A.  deposits  of  lymph;  tlie  gray  matter  of  the  hrain  was  splintering  of  the  vitreous  table. 

softened.  The  external  fracture  w:is  found  to  be  circuhir 

and  a half  inch  in  diameter,  a small  fragment  being  driven  in  on  the  diploe.  The  internal  table  was  more  extensively  fractured, 
and  a plate  of  hone  three-fourths  of  an  inch  in  diameter  was  driven  inward  to  the  depth  of  two  lines.  The  specimen,  which 
is  well  represented  in  the  foregoing  wood-cuts,  (FiG.  83  and  Fig.  84,)  was  presented  to  the  Army  Medical  Mnseuin  by  Acting 
Assistant  Surgeon  John  Neill. 

It  m<ay  lie  well  to  give  a few  more  illustrations  of  tlie  dilTcreiices  in  the  appearances 
of  the  outer  and  inner  tables  alter  gunshot  fracture  : 

C.\SE. — Sergeant  Oscar  B.  Ij , Co.  A,  22d  Iowa  Volunteers,  aged  25  years,  was  wounded  at  the  battle  of  Cedar  Creek, 

Virgiiiiu,  October  I9tli,  1864,  by  a musket  hall  which  fractured  and  ilepressed  th(‘  right  parietal  hone.  He  was  at  once  admitted 


DEPRESSED  GUNSHOT  FRACTURES  OF  THE  SKULL. 


169 


to  the  Sheridan  ficdd  hospital,  and  on  October  24th  sent  to  the  Jarvis  Hospital,  Baltimore,  Maryland.  On  October  29th  hemi- 
plegia of  the  left  side  was  noted.  Inliammation  of  the  brain  followed.  On  October  31st,  1864,  death  took  place.  At  the  autopsy 

a piece  of  skull  about  the  size 
of  a silver  dollar  was  found 
driven  in  upon  the  dura  mater 
rfit  the  seat  of  injury.  The 
veins  of  both  hemispheres 
were  intensely  engorged.  A 
large  abscess  immediately  be- 
neath the  fracture  and  the  lat- 
eral ventricle  of  the  brain  was 
filled  with  purulent  fluid.  The 
pathological  specimen  figured 
in  the  preceding  wood-cuts, 

(Fig.  85,  and  Fig.  83,)  to- 

Fig.  8.').— Vault  of  a cranium  showing  a depressed  irether  with  the  notes  of  the 
gunshot  fracture.  Spec.  iMl.'i,  .Sect.  I,  A.  M.  M. 

case,  were  contributed  by  Act- 
ing Assistant  Surgeon  B.  B.  Miles.  The  ojiening  in  the  outer  fable  is  three-fourths  of  an  inch  in  diameter.  The  fragments  of  the 
inner  table  measure  one  by  one  and  a half  inches,  and  consist  of  two  pieces  touching  at  their  inner  edges.  The  apex  of  the  angle 
of  depression  is  half  an  inch  below  the  general  surface  of  the  inner  table  of  the  skull. 

Very  commonly  in  fractures  of  the  skull  by  musket  halls,  long  fissures  extend  from 
the  point  at  .which  the  outer  table  of  the  skull  is  crushed  by  the  direct  impact  of  the 
missile  : 


Fig.  8fi. — Interior  view  of  foregoing  specimen. 


Case. — Private  Edwin  L.  C- 


-,  Co.  I,  34th  Massachusetts  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of 
New  Market,  Virginia,  May  15th,  1834,  by  a musket  ball  which  fractured  and  depressed  the  left  frontal,  temporal,  and  parietal 
bones.  On  the  18th,  he  was  conveyed  to  the  hospital  at  Cumberland,  Maryland,  in  an  insensible  condition.  Great  prostration 
of  the  nervous  and  vascular  system  was  apparent.  Consciousness  never  returned,  though  death  did  not  occur  until  M.ay  21st, 
1864.  At  the  autopsy  the  meninges  were  found  much  congested  and  covered  with  slight  patches  of  pus.  Fragments  of  the  frontal 

and  temporal  bones  had 
been  driven  upon  the 
brain  substance  causing 
softening  and  discolor- 
ation. The  whole  hem- 
isphere was  highly  in- 
jected, and  in  the  left 
ventricle  was  found  an 
effusion  of  blood.  The 
pathological  specimen  is 
represented  in  the  fore- 
going wood-cuts,  (Fig.87 
and  Fig.  88,)  and  shows 

a complete  fissure  two  and  a half  inches  in  length  in  the  left  parietal  and  a depressed  fracture  of  the  frontal  and  parietal  and 
temporal  bones  at  their  junction.  A jiortion  of  the  vitreous  lamina  nearly  three-fourths  of  an  inch  in  diameter  is  depressed  one 


Fig.  87. — Section  of  cranium  showing  a complete  fissure 
in  the  left  parietal  and  temporal,  caused  hy  a musket  ball. 
Spec.  425.5,  Sect.  I,  A.  M.  M. 


FIG.  88. — Interior  view  of  the  foregoing  specimen. 


line  at  the  point  of  impact  in  front  of  the  anterior  angle  of  the  parietal. 

U.  S.  V. 


The  specimen  was  contributed  by  Surgeon  J.  B.  Lewis, 


Case.— Pi^vate  Thomas  Brennen,  Co.  I,  65th  New  York  Volunteers,  aged  30  years,  was  wounded  at  the  battle  of  Cedar 
Creek,  Virginia,  October  19th,  1804,  by  a musket  ball  which  fractured  the  frontal  bone  ne.ar  the  median  line,  a jiortion  wf  the 
missile  entering  the  brain.  He  was  conveyed  to  Baltimore,  and  on  the  24th  was  admitted  to  the  Jarvis  Hospital.  Hemiplegia 
of  the  left  side  had  already  ensued.  Death  resulted  October  25th,  1864.  At  the  autopsy  the  opening  iu  the.  bone  was  found  to 
measure  three-fourths  by  one  and  one-fourth  inches.  A fissure  four  inches  in  extent  passiul  upward,  across  the  coronal  suture, 
into  the  right  panetal  bone,  and  two  others  passed  downward  and  laterally.  A jiiece  of  the  inner  table,  measuring  one-tourth  by 
one  inch,  was  partially  fractured  and  depre.ssed  one-fourth  of  an  inch.  Two  circular  pieces  of  bone,  three-fourths  ot  an  inch  in 
diameter,  were  found  driven  into  the  dura  mater,  the  brain  substance  in  the  vicinity  being  much  softened.  The  left  hemisphere 
was  covered  with  clotted  blood.  The  missile  was  found  lodged  in  the  third  ventricle,  left  side.  T he  ))athological  specimen  is 
No.  3413,  Sect.  I,  A.  M.  M.,  and,  with  the  history,  was  contributed  by  Acting  Assistant  Surgeon  B.  B.  Miles. 

Case. — Private  .John  H.  Wingert,  Co.  E,  14th  Indiana  Volunteer.s,  received  a dejiressed  fracture  ot  the  frontal  bone  at  the 
battle  of  Fredericksburg,  December  13th,  1832.  The  missile  produced  <an  opening  two  and  a ipiarter  inches  iu  length  and  three- 
fourths  of  an  inch  in  width,  extending  from  the  inner  angle  of  the  right  eye  upward  and  outward.  IL;  was  sent  to  the  hos|)itaI 
of  the'  3(1  division,  S(!Cond  Corps,  and  on  December  18th,  was  admitted  to  TIarinvood  Ilosjiital,  Washington.  The  dui'ii  mater  was 
found  lacerated,  but  no  fragments  of  lioiie  wei’e  in  the  wound.  Inflammation  of  the  brain  and  its  membranes  existerl,  and  the 
surrounding  integuments  jin^sented  an  erysipelatous  a|)pearance.  TTie  pulse  was  one  hundred  tuid  twenty  and  iiowels  costive. 

22 


170 


WOUNDS  AND  INJURIES  OF  THE  HEAD. 


No  paralysis  existed,  and  the  patient  answered  questions  correctly.  On  December  19th  stupor  supervened,  muttering  delirium 
followed,  and  death  occurred  December  20th,  1862.  On  removing  the  calvaria,  the  anterior  h.alf  of  the  dura  mater  was  found 
thickened,  and  the  superior  portion  of  the  anterior  lobe  of  right  hemisphere  was  completely  disorganized.  The  ventricles  were 
filled  with  a sanguineous  fluid,  and  the  corpus  callosum  was  softened.  The  skull-cap  was  fissured. 


Other  examples  of  fissures  extending  from  the  point  of  impact  on  the  skull  of  gun- 
shot projectiles  are  shown  in  specimens  2904,  3150,  3413,  and  3051.  The  many  varieties 
in  the  form  of  depressed  fractures  of  the  cranium  produced  by  gunshot  projectiles,  and 
depending  on  the  size,  weight,  velocity,  and  angle  of  incidence  of  the  missiles,  are  very 
amply  illustrated  in  the  surgical  cabinets  of  the  Army  Medical  Museum.  It  is  doubtful, 
however,  if  drawings,  however  carefully  made,  would  enable  surgeons  to  make  such 
deductions  as  they  might  reach  by  examining  the  specimens  themselves ; and  it  is  better 

to  occupy  the  space  by  a large  number  of  abstracts  of  cases  in 
which  the  facts  have  been  carefully  verified,  than  by  profuse 
illustration  of  minute  variations  in  the  forms  of  such  fractures, 
especially  as  in  treating  of  penetrating  and  perforating  fractures 
of  the  skull  and  of  exfoliation  and  trephining,  additional  illus- 
trations will  be  introduced.  Therefore,  hut  a few  more  speci- 
mens will  be  noticed  here.  That  represented  in  the  adjacent 
wood-cut  was  believed  by  Surgeon  Vanderkieft,  U.  S.  V.,  who 
presented  it,  to  show  a fracture  produced  by  a musket  ball  at 
very  long  range,  in  the  case  of  a Confederate  sharpshooter, 
posted  in  a tree  at  the  summit  of  South  Mountain,  whence  he 
was  dislodged  by  the  Union  skirmishers.  All  of  the  depressed 
fragments  are  adherent  by  their  outer  edges.  The  fracture  is 
so  unlike  any  others  produced  by  musket  balls  that  it  is 
questionable  if  it  did  not  occur  in  falling  from  the  tree,  or,  perhaps,  post  mortem,  by  a 
blow  from  a musket. 


Fig.  89. — Indented  fj'acture  of  the  frontal 
bone.  Spec.  12’23,  Sect.  I,  A.  M.  M. 


The  next  case  illustrates  a fracture,  in  which  the  fragments  were  much  displaced, 
caused  by  a pistol  ball  at  short  range  ; 

Case. — Sergeant  Charles  A.  C , Co.  A,  3d  Virginia  Cavalry,  was  wounded  in  a skirmish  near  Culpeper,  Virginia, 

October  11th,  1863,  by  a pistol  ball  which  fractured  the  superior  portion  of  the  frontal  bone  a little  to  the  left  of  the  median 

ine.  He  was  taken  prisoner,  conveyed  to  Washington,  and  taken  to  the 
Emory  Hospit.al  on  the  13th. 

He  was  free  from  pain,  and 
conscious  when  admitted,  but 
had  some  tendency  to  stupor. 

Spiculse  of  bone  were  re- 
moved from  the  wound,  sim- 
ple dressings  applied,  and  a 
cathartic  administered.  On 
the  14th,  the  tendency  to 
coma  increased,  and  a venous 
haemorrhage  from  the  wound 
occurred,  and  cerebral  matter 
exuded.  The  pulsations  of 
the  brain  were  distinctly 

Fig.  90. — Calvaria  and  fraprinents  of  bone  and  pistol  visible  at  tin;  opening.  At 
ball.  &)cc.  1727,  Sect.  I,  A.  M.  M.  • i*  i ■ A ■ FIG.  91.— Internal  view  of  the  foregoing  specimen. 

eight  o clock  in  the  evening, 

these  symptoms  were  still  graver,  and  the  patient  could  be  aroused  only  with  great  difficulty.  He  gradually  sank,  and  died  on 
the  following  morning,  October  IStli,  1883.  The  autopsy  showed  that  the  b.all  had  split  upon  the  skull,  one  portion  passing 
underneath  the  seal])  for  a short  distance,  the  other  entering  the  brain.  The  left  lobe  of  the  cerebrum  was  greatly  disorganized 
and  broken  down.  The  exact  point  of  lodgment  of  the  ball  could  not  be  ascertained,  as  it  dropped  tbrough  the  disorganized 


DEPRESSED  GUNSHOT  FRACTURES  OF  THE  SKULL. 


171 


tissue  at  tlie  dissection.  Tlie  calvaria  and  fragments  of  ball  are  represented  in  the  adjacent  wood-cut.  The  frontal  bone  is 
fractured  and  depressed  one  inch  above  and  internal  to  its  left  eminence.  The  opening  measures  one-half  by  one  inch  externally, 
being  slightly  more  extensive  on  the  inner  table.  The  specimen  and  history  were  contributed  by  Surgeon  N.  R.  Moseley,  U.  S.  V. 

The  next  case  illustrates  not  only  the  fracture,  but  a synostotic  cranium  curiously 
deformed  by  the  premature  union  of  the  sutures  : 


Case. — Private  A.  P.  H , Co.  A,  50th  Georgia  Regiment,  aged  21  years, 

was  wounded  at  the  battle  of  South  Mountain,  Maryland,  September  14th,  1862. 
A musket  ball  struck  the  frontal  bone  near  the  left  frontal  emuience,  causing 
fracture  and  depression;  another  ball  entered  the  left  arm  just  below  the  head 
of  the  humerus,  fractured  the  bone  and  escaped  at  the  inferior  angle  of  the 
scapula.  On  October  27th,  he  was  admitted  to  the  hospital  at  Frederick, 
Maryland,  in  a very  low  condition  and  suffering  from  diarrhoea.  Tonics  and 
stimulants  were  freely  given.  No  symptoms  of  paralysis,  compression  of  the 
brain,  or  other  cerebral  disturbance  presented  themselves.  The  arm  was  put 
in  a splint.  Profuse  and  unhealthy  discharge  from  the  wounds  soon  weakened 
the  patient,  and  he  died  November  25th,  1862,  from  exhaustion.  At  the 

autopsy  the  brain  on  the  injured  side  was  found  softened.  The  depressed 
portion  was  ovoid,  measuring  externally  three-fourths  by  one  and  three- 
fourths  inches.  The  inner  table  was  fractured  more  extensively  than  the  outer. 
The  pathological  specimen  is.  represented  in  the  adjoining  wood-cut,  (Fig.  92,) 
and  was  contributed  by  Assistant  Surgeon  G.  L.  Porter,  U.  S.  A. 


Fig.  92. — Skull-cap  showing  a depressed  gunshot 
fracture  of  the  left  side  of  the  frontal  bone. — Sjicc.  77^1, 
Sect.  I,  A.  M.  M. 


In  the  following  cases  of  gunshot  depressed  fracture  of  the  cranial  bones,  the  patients 
were  discharged  on  account  of  disabilities  of  a serious  nature,  resulting  from  their  injuries : 

Case. — Lieutenant  Jacob  Fryburger,  Co.  K,  hist  Pennsylvania  Volunteers,  aged  28  years,  was  wounded  in  an  engage- 
ment before  Petersburg,  Virginia,  June  18th,  1864,  by  a conoidal  musket  ball,  which  slightly  injured  and  depressed  a portion  of 
the  frontal  bone.  He  was  admitted  to  the  hospital  of  the  Ninth  Army  Corps ; on  June  21st,  was  sent  to  the  1st  Division  Hospital 
at  Annapolis,  Maryland;  and  on  August  25th  to  the  Officers’  Hospital  at  the  latter  place.  He  was  discharged  the  service 
October  5th,  1884,  and  was  pensioned,  his  disability  being  rated  as  total  and  probably  temporary.  Pension  Examiner  E.  Swift, 
of  Easton,  Pennsylvania,  reported  on  February22d,  1865,  that  in  the  case  of  this  officer,  any  slight  exposure  caused  great  dizziness 
or  vertigo.  Besides  the  head  injury,  he  had  received  a bad  gunshot  flesh  wound  of  the  back,  which,  however,  had  healed  at 
the  date  of  Dr.  Swift’s  report. 

Case. — Private  Louis  Starnkopf,  Co.  A,  33d  New  Jersey  Volunteers,  aged  36  years,  was  wounded  at  the  battle  of 
Buzzard  Roost,  Georgia,  May  9th,  1864,  by  a conoidal  musket  ball  which  fractured  and  depressed  a portion  of  the  frontal  bone. 
He  was  sent  to  the  hospital  of  the  2d  division.  Twentieth  Corps,  thence  was  sent  via  Chattanooga  and  Nashville,  Tennessee,  to 
the  Jefferson  Hospital,  Indiana,  where  he  remained  under  expectant  treatment  until  the  27th  of  July.  He  was  then  furlouglied, 
and  at  the  expiration  of  his  leave  was  admitted  to  the  Ward  Hospital,  New  Jersey.  On  the  28th  of  September,  1864,  he  was 
returned  to  duty.  On  June  23d,  1865,  Assistant  Surgeon  P.  Adolphus,  U.  S.  A.,  reported  the  patient  suffering  from  chronic 
cerebritis  with  softening  of  the  brain;  whereupon  he  was  discharged  the  service  June  29th,  1865,  and  pensioned,  his  disability 
being  rated  three-fourths. 

Case.— Private  William  McQuown,  1st  Regiment  Veteran  Reserve  Corps,  was  admitted  to  the  Armory  Square  Hospital, 
Washington,  from  his  company  on  September  18th,  1864,  with  a depressed  fracture  of  the  frontal  bone.  'The  records  do  not 
show  where  or  when  the  injury  was  received.  The  patient  recovered,  and  was  discharged  the  service  October  24th,  18()4,  on 
account  of  anchylosis  of  the  right  elbow-joint  and  fracture  and  depression  of  the  frontal  bone,  causing  derangement  of  the 
functions  of  the  brain.  'The  case  is  reported  by  Surgeon  D.  W.  Bliss,  U.  S.  V.  The  patient  made  a claim  for  pension,  but  it 
was  not  allowed  for  lack  of  evidence. 

Case. — Private  Thomas  C.  Little,  Co.  E,  20th  Maine  Volunteers,  aged  42  years,  was  struck  by  a conoidal  musket  ball 
at  the  battle  of  Gettysburg,  July  2d,  1863,  which  wounded  the  scalp  and  fractured  a portion  of  the  extei-nal  table  of  the  frontal 
bone.  He  was  admitted  into  the  Satterlee  Hospital  at  Philadelphia  on  July  10th,  and  on  the  1st  of  September  a portion  of 
exfoliated  bone  about  one  inch  square  was  removed  from  the  wound.  Cerate  dressings  were  afterward  a]iplied,  and  the  patient 
continuing  to  improve,  was,  on  November  0th,  placed  on  light  duty  in  the  hospital,  where  he  remained  until  December  23d,  1863, 
when  he  was  transferred  to  the  Veteran  Reserve  Corps,  and  shortly  afterward  returned  to  duty.  'Tlie  case  is  reported  by  Acting 
Assistant  Surgeon  .1.  Roberts.  lie  was  discharged  the  service  June  28th,  1865,  and  pensioned,  his  disability  being  rated  total 
and  permanent.  Subsequent  reports  show  the  patient  to  be  gradually  failing  from  the  effects  of  the  wound,  and  suffering  from 
general  derangement  of  the  nervous  system. 

Case. — Private  Jeremiah  Donovan,  Co.  A,  9th  New  York  Volunteers,  was  wounded  in  an  engagement  at  Roanoke 
Island,  North  Carolina,  February  8th,  1862,  by  a conoidal  musket  ball  which  fractured  and  depressed  a portion  of  the  frontal 
bone  in  the  vicinity  of  the  right  eminence.  The  patient  recov'ered,  and  was  examined  in  1866  by  Penision  Examiner  .James 
Neil,  Harlem,  New  York,  who  reported  him  complaining  of  headache,  dizziness,  confusion  of  ideas,  and  of  being  easily  lired. 
There  was  impairment  of  sight  in  the  right  (^ye  and  a Large  depression  existed  over  se.at  of  original  injury.  He  was  discharged 
the  service  April  22d,  1862,  and  pensioned,  his  disability  being  rated  live-eighths,  permanent,  and  liahh-  to  inerease. 


172 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Private  David  D.  Latlirop,  Co.  K,  18tli  Connecticut  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of 
Piedmont,  West  Virginia,  June  5,  1834,  by  a conoidal  musket  ball  which  fractured  the  external  table  of  the  frontal  bone.  He 
was  conveyed  to  Frederick,  Maryland;  was  there  admitted  into  hospital  on  the  20th,  and  on  July  3d  was  sent  to  the  Knight 
Hospital,  New  Haven,  Connecticut;  thence  was  sent  on  October  18th  to  Eeadville,  Massachusetts,  and  on  February  13th,  1865, 
was  transferred  to  the  Veteran  Reserve  Corps.  He  was  discharged  the  service  June  5th,  1865,  and  pensioned,  his  disability 
being  rated  one-half  and  permanent.  A report  since  received  states  that  the  w'ound  had  healed,  with  defective  audition  in  the 
left  ear. 

Case. — Private  Daniel  McGinish,  Co.  B,  47th  Alabama  Regiment,  was  admitted  to  Confederate  hospital  at  Lynchburg, 
Virginia,  with  a gunshot  wound  of  forehead.  Both  tables  of  the  os  frontis  were  destroyed.  He  was  discharged  February  2d,  1863. 

Case. — Private  George  H.  Murphy,  Co.  E,  11th  Pennsylvania  Volunteers,  was  wounded  at  Bull  Run,  August  30th,  1862, 
by  a musket  ball  which  entered  behind  the  mastoid  process  of  the  left  temporal  bone,  fracturing  a portion,  and  emerged 
immediately  exterior  to  right  ala  nasi.  He  was  conveyed  to  Alexandria,  and  on  September  3d  w's  admitted  to  the  3d  division 
hospital.  The  muscles  of  the  lower  jaw  were  rigid,  and  spicula;  of  the  mastoid  process  were  discharged  from  time  to  time.  At 
the  time  of  his  discharge  from  service,  October  23d,  1862,  the  wound  had  not  entirely  healed.  Pension  Examiner  J.  H.  Anawalt, 
in  a communication  dated  March  6th,  1867,  reports  that  the  left  lachrynio-nasal  duct  had  closed,  the  sac  constantly  becoming 
distended  with  secretion ; that  there  was  hypersesthesia  of  left  side  of  face ; and  that  the  patient  could  not  bear  exposure  to  cold 
without  much  suffering.  In  March,  1868,  his  disability  was  rated  one-half  and  permanent. 

Case. — Private  Newton  Black,  Battery  I,  2d  Pennsylvania  Artillery,  aged  19  years,  was  wounded  at  the  battle  of  Chapin’s 
Farm,  Virginia,  September  29th,  1864,  by  a conoidal  ball,  which  fractured  the  occipital  bone.  He  was  admitted  to  the  Base 
Hospital  of  the  Eighteenth  Corps  at  Point  of  Rocks,  Virginia,  on  the  next  day ; thence  was  conveyed,  on  the  5th  of  October,  to 
the  hospital  at  Fort  Monroe,  and  on  the  following  day  sent  by  steamer  to  tlie  Lovell  Hospital,  Portsmouth  Grove,  Rhode  Island. 
In  December,  he  was  furloughed,  and  on  the  19th  of  May,  1865,  discharged  from  service,  being  still  subject  to  attacks  of  vertigo 
and  headache.  In  July,  1868,  he  was  a pensioner,  his  disability  being  rated  total  and  permanent. 

Case. — Corporal  Isaac  Clapp,  Co.  E,  84th  Indiana  Volunteers,  aged  28  years.  Fracture  of  occipital  bone  by  a piece  of 
shell.  Near  Kenesaw  Mountain,  June  23d,  1864.  Treated  at  division  hospital,  hospital  No.  19  at  Nashville,  Brown  Hospital  at 
Louisville,  and  at  the  hospital  at  Madison,  Indiana.  Discharged  March  4th,  1865,  and  pensioned.  According  to  certificate  of 
disability,  there  was  loss  of  bone  to  the  size  of  a dollar,  and  the  patient  suffered  from  frequent  attacks  of  dizziness. 

Case. — Private  Andrew  Wolfran,  Co.  C,  118th  Ohio  Volunteers,  aged  35  years,  was  wounded  at  Resaca,  Georgia, 
May  14th,  1864,  by  a conoidal  ball,  which  entered  near  the  landidoid  suture,  and  emerged  in  front  and  below  the  left  ear.  He 
was  discharged  June  26th,  1865,  and  pensioned.  The  hearing  of  the  left  ear  was  destroyed,  the  muscles  of  the  left  side  of  the 
face  were  paralyzed,  and  he  was  unable  to  close  the  left  eye,  the  sight  of  which  is  affected.  His  disability  is  rated  total  and 
temporaiy. 

Case. — Private  Alexander  Hunter,  Co.  II,  54th  Massachusetts  Volunteers,  was  wounded  in  action  at  Morris  Island, 
South  Carolina,  August  18th,  1863,  by  a fragment  of  shell,  which  caused  a partial  fracture  of  cranium.  He  was  treated  in 
regimental  hospital,  and  apparently  recovered,  as  he  was  returned  to  duty  April  24th,  1864  ; but  he  was  discharged  from  service 
June  30th,  1864,  from  which  date  he  has  been  pensioned,  his  disability  being  rated  one-half,  and,  probably,  temporary. 

Case.— Private  Edward  J.  Whitmore,  Co.  A,  57th  Illinois  Volunteers,  aged  25  years,  was  wounded  at  Allatoona  Pass, 
Georgia,  October  5th,  1834,  by  a conoidal  musket  ball,  which  fractured  both  tables  of  the  i-ight  parietal  bone.  He  was  admitted 
on  the  same  day  to  the  hospital  of  the  4th  division.  Fifteenth  Corps,  and  remained  in  field  hospital  until  January  23d,  1865,  when 
he  was  sent  to  Hospital  N®.  1,  Beaufort,  South  Carolina ; thence  he  was  conveyed  per  hospital  steamer  Ben  Deford  to  New  York, 
where  he  was  admitted  to  the  McDougall  Hospital  on  January  29th,  1865.  The  treatment  consisted  in  the  application  of  simple 
dressings.  On  March  8th,  he  was  sent  to  the  St.  Joseph  Hospital,  Cential  Park,  and  was  discharged  from  service  on  March 
14th,  1865.  The  vision  of  the  right  eye  was  destroyed.  Not  a pensioner. 

Case. — Private  Harvey  Platt,  Co.  A,  7th  Indiana  Volunteers,  aged  25  years,  was  wounded  at  the  battle  of  Spottsylvania 
Court  House,  May  12th,  1864,  by  a conoidal  musket  ball  which  fractured  the  skull.  In  the  same  engagement,  he  received  a 
wound  of  the  right  leg.  He  was  admitted  to  the  hospital  of  the  4th  division.  Fifth  Corps ; thence  was  sent  to  the  Mount  Pleasant 
Hospital  at  Washington  on  the  16th,  and  was  transferred,  on  the  18th,  to  McKim’s  Mansion  Hospital,  Baltimore.  After  several 
other  transfers,  he  was  finally  admitted  into  hospital  No.  4,  at  Madison,  Wisconsin,  on  September  1st,  1864,  and  discharged  from 
service  on  January  20th,  1835,  and  pensioned.  Pension  Examiner  M.  H.  Harding  states  that  the  patient  is  disqualified  for 
manual  labor  during  the  warm  season,  owing  to  vertigo  and  pain  in  the  head,  which  seriously  impair  his  health.  He  rates  his 
disability  three-fourths. 

Case. — Private  J.  D.  Spencer,  Co.  K,  3d  Virginia  Cavalry,  received  at  the  battle  of  Bull  Run,  July  21st,  1861,  a gunshot 
fracture  of  both  tables  of  the  right  parietal  bone.  He  was  conveyed  to  the  hospital  at  Farmville,  where  he  was  dischargeil  April 
22d,  1864.  There  was  extensive  dei’angement  of  the  nervous  system,  and  the  patient  was  unfit  for  duty. 

Case. — Private  James  D.  Potter,  Co.  F,  99th  New  York  Volunteers,  was  wounded  in  an  engagement  near  Suffolk, 
Virginia,  in  April,  1833,  by  a conoidal  ball  which  fractured  the  left  parietal  bone  three-fourths  of  an  inch  anterior  to  the  protuber- 
ance. He  was  sent  to  the  regimental  hospital,  and  on  May  23th,  was  sent  to  the  Hampton  Hospital,  Virginia,  where  partial 
I'ecovery  took  place;  and  on  August  6th,  1833,  was  transferred  to  the  Veteran  Reserve  Corps.  He  was  discharged  the  service 
Juno  13th,  1864,  and  pensioned..  On  March  13th,  1869,  Pen.sion  Examiner  J.  T.  Burdick  reports  his  condition  very  fair  for  one 
of  his  age,  which  was  sixty-two  years,  and  adds  : “ he  is  sidyVct  to  frequent  and  irregular  attacks  of  vertigo,  and  has  impaired 
memory.’’  He  rates  his  disability  one-half,  permanent. 


DISABILITIES  FOLLOWING  DEPRESSED  GUNSHOT  FRACTURES. 


173 


Case. — Private  Porter  C.  .Tolmson,  Co.  B,  3d  Pennsylvania  Reserves,  received,  during  the  Peninsular  cainjiaign,  July, 
1862,  a gunshot  wound  of  the  skull.  On  July  3d,  he  was  conveyed  to  the  steamer  Stale  of  Maine,  and  on  July  7th,  was  admitted 
to  Satterlee  Hospital,  Pennsylvania.  The  wound  healed,  and  on  September  25th,  1862,  he  was  discharged  the  service,  and 
pensioned.  There  was  constant  headache  and  vertigo,  inability  to  bear  exposure  to  heat,  and  the  patient  was  mentally  and 
physically  imbecile,  according  to  the  report  of  Pension  Examining  Surgeon  T.  B.  Reed. 

Case. — Sergeant  William  Shaftoe,  Co.  K,  57th  Massachusetts  Volunteers,  aged  41  years,  was  wounded  at  the  battle 
of  Cold  Harbor,  Virginia,  June  2d,  1864,  by  a fragment  of  shell  which  struck  over  the  right  eye,  causing  a slight  depression. 
He  was  admitted  to  hospital  1st  division.  Ninth  Corps;  on  June  6th  sent  to  Mount  Pleasant  Hospital,  Washington,  D.  C.,  and 
on  June  19th  to  Mower. Hospital,  Philadelphia,  whence  he  was  returned  to  duty  September  5th,  1864.  Discharged  June  13th, 
1865.  Pension  Examiner  P.  L.  Stickney,  of  Chicopee,  Massachusetts,  reports,  February  13th,  1869,  that  this  man  was  on  the 
Pension  List,  and  that  his  disabilities  had  so  much  increased  since  his  discharge  that  he  was  incapable  of  enduring  labor.  He 
had  lost  his  hearing  in  the  right  ear,  and  he  suffered  from  headache,  giddiness,  and  fointing  fits,  and  that  his  disability  was 
undoubtedly  permanent. 

Case. — Sergeant  Flavius  G.  Arrowsmith,  Co.  G,  115th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Gettys- 
burg, Pennsylvania,  July  2d,  1863,  by  a conoidal  musket  ball  which  fractured  and  depressed  a portion  of  the  frontal  bone  a 
little  to  the  left  of  the  median  line  and  just  in  front  of  the  coronal  suture.  He  was  admitted  to  the  regimental  hospital,  and 
on  July  11th  was  sent  to  McClellan  hospital,  Philadelphia.  The  patient  recovered  and  was  returned  to  duty  April  14th,  1804; 
was  discharged  the  service  June  24th,  1865,  and  pensioned,  his  disability  being  rated  three-fourths. 

Case. — Sergeant  John  Sowers,  Co.  H,  10th  New  Jersey  Volunteers,  aged  26  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  Virginia,  June  2d,  1804,  by  a conoidal  musket  ball  which  fractured  and  depressed  a portion  of  the  frontal  bone  above 
the  superciliary  ridge.  He  was  admitted  to  the  1st  division  hospital  of  the  Sixth  Corps,  thence  was  conveyed  to  Alexandria  on 
June  16th,  and  was  treated  at  the  Soldiers’  Rest  until  June  21st,  when  he  was  sent  to  .the  Haddington  Hospital  at  Philadelphia. 
After  other  transfers  he  was  finally  sent  to  the  Ward  Hospital  at  Newark,  New  Jersey,  October  13th,  1864,  and  was  returned 
to  duty  April  15th,  1835;  was  discharged  the  service  July  1st,  1865,  and  pensioned,  his  disability  being  rated  one-third  and 
permanent. 

Case. — Private  Albert  Le  Clear,  Batteity  C,  1st  Ohio  Artillery,  was  wounded  at  Chickamauga,  September  20th,  1863,  by  a 
fragment  of  shell,  which  fractured  and  carried  away  a portion  of  the  right  parietal  bone.  On  the  12th  of  October,  he  was 
admitted  to  the  Cumberland  Hospital  at  Nashville,  was  transferred,  on  the  16th,  to  No.  2-  hospital,  Louisville,  and  thence,  to 
Camp  Chase,  Ohio,  December  19th,  1833.  There  was  paralysis,  with  impairment  of  the  mental  faculties,  which  existed  at  date 
of  his  discharge  from  service,  February  2d,  1864.  Information  from  the  Pension  Office  states  that  Le  Clear  is  a pensioner. 
There  is  a deep  groove  in  the  parietal  bone,  with  partial  paralysis  of  the  right  side.  His  disability  is  rated  totid  and  doubtful. 

Case. — Private  John  E.  Davidson,  Co.  E,  22d  Wisconsin  Volunteers,  aged  19  years,  was  wounded  at  the  battle  of 
Kenesaw  Mountain,  Georgia,  June  27th,  1864,  by  a conoidal  musket  ball,  which  fractured  the  left  parietal  bone  two  inches  above 
the  ear.  He  was  admitted  to  the  hospital  of  the  3d  division.  Twentieth  Corps,  and  two  days  later  was  sent  to  hospital  No.  1,  at 
Chattanooga,  Tennessee.  On  the  11th  of  July,  he  was  admitted  into  the  Cumberland  Hospital  at  Nashville;  thence  was  sent, 
on  the  9th  of  September,  to  Madison,  Wisconsin.  He  was  discharged  at  expiration  of  term  of  service.  May  12th,  1865,  suffering 
from  giddiness  and  constant  headache,  and  was  pensioned  from  that  date,  his  disability  being  rated  at  one-third  and  temporary 
by  the  pension  examiner.  Dr.  Joseph  Hobbins. 

Case. — Private  Lawrence  Redding,  Co.  B,  89th  Illinois  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of  Mission 
Ridge,  Tennessee,  November  25th,  1863,  by  a conoidal  musket  ball,  which  fractured  the  left  parietal  bone  near  the  junction 
of  the  sagittal  and  lambdoid  sutures.  He  was  admitted  on  the  same  day  to  Hospital  No.  4 at  Chattanooga.  On  November  19th, 
1864,  he  was  sent  to  the  Brown  Hospital,  Louisville,  Kentucky,  and  on  the  29th,  to  the  hospital  at  Mound  City,  Illinois.  The 
wound  was  open  as  late  as  .January  4th,  1865,  suppurating  freely,  and  causing  pain,  vertigo,  and  prostration.  He  was  discharged 
from  service  on  January  22d,  1865,  b(;ing  entirely  unable  to  undergo  any  active  exertion.  The  case  is  rej)orted  by'  Acting 
Assistant  Surgeon  A.  H.  Kellogg.  His  name  is  not  on  the  Pension  List. 

Case. — Private  Peter  Baliuxifer,  Co.  A,  44th  Illinois  Volunteers,  aged  38  years,  was  wounded  at  the  battle  of  Franklin, 
Tennessee,  November  30th,  1864,  by  a conoidal  ball,  which  fractured  the  frontal  bone.  On  December  23d,  ho  was  admitted  to 
hospital  No.  1.5,  Nashville,  from  Franklin;  on  January  3d,  sent  to  the  Joe  Holt  Hospital,  .Jeffersonville,  Indiana;  and  on 
January  5th,  transferred  to  the  Jefferson  Barracks  Hospital,  St.  Louis,  Missouri,  where  he  was  mustered  out  of  service  on  .June 
15th,  1865.  He  was  pensioner  at  .§4  j)er  month  until  March  8th,  1868.  Since  that  time  he  has  received  an  increased  pension  of 
$8  per  month. 

Case. — Private  John  WoiTall,  Co.  E,  59th  New  York  Volunteers,  was  wounded  at  Antietam,  September  17th,  1862,  by  a 
fragment  of  shell,  which  struck  the  left  temporal  bone  above  the  eye,  and,  cutting  through  the  skull,  passed  obliquely  backward 
over  the  top  of  the  head.  At  the  same  time,  while  going  to  the  rear,.he  received  a bullet  wound  through  the  middle  third  of  the 
left  arm,  with  injury  to  the  nerve.  On  the  19th,  he  was  admitted  to  the  hospit.al  of  the  Second  Corps  at  the  Hoffman  House,  and 
on  the  27th,  was  transferred  to  the  Satterlee  Hospitid  at  Philadelphia,  where  ho  is  reported  as  a deserter,  on  November  3d,  1862; 
but,  as  (according  to  pension  certificate)  he  was  discharged  from  service  on  October  7th,  1864,  (from  which  date  he  is  itensiotn'd, ) 
the  probability  is,  that  he  returned  to  duty,  and  was  mustered  out  with  his  regimetit.  Pension  Examiner  K.  O.  Huntington, 
under  date  of  .July  13th,  lbo9,  states,  that  the  patient's  arm  was  numb  and  weak,  and  that,  being  a blacksmith  and  left  handed, 
it  was  very  inconvenient;  and  that  the  eflect  of  the  skull  wound  w.as  such  that  a stooping  position  produced  dizziness,  dimness 
of  vision,  and  nausea.  His  disability  is  rated  total  and  permanent. 


174 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Case. — Corporal  John  B.  Frank,  Co.  D,  33d  Missouri  Volunteers,  aged  30  years,  was  wounded  in  an  engagement  at 
Nashville,  Tennessee,  December  IGth,  18G4,  by  a piece  of  shell,  which  fractured  the  cranium.  He  was,  on  the  same  day, 
admitted  to  the  Cumberland  Hospital  at  Nashville;  on  January  10th,  sent  to  the  Jeffer.son  Hospital,  Jeffersonville,  Indiana, 
whence  he  was  furloughed  on  February  13th,  1835.  On  March  24th,  he  was  admitted  to  the  Marine  Hospital,  St.  Louis, 
Missouri,  and  on  May  5th,  1805,  mustered  out  of  service.  In  July,  18G8,  he  was  a pensioner  at  $3  per  mouth,  his  disability 
being  rated  three-fourths  by  Pension  Examiner  J.  C.  Whitehill,  of  St.  Louis. 

Case. — Private  John  Parkhorst,  Battery  E,  2d  New  York  Heavy  Artillery,  aged  50  years,  was  wounded  at  Farmville, 
Virginia,  April  7th,  1865,  by  a conoidal  ball,  which  fractured  the  upper  portion  of  the  right  frontal  bone.  He  was  admitted  to 
the  hospital  of  the  1st  division.  Second  Corps,  and  on  April  16th,  was  sent  to  the  Harewood  Hospital  at  Washington.  Simple 
dressings  only  were  required.  On  May  29th,  he  was  sent  to  the  White  Hall  Hospital,  Bristol,  Pennsylvania,  and  on  June  IGth, 
1865,  was  discharged  the  sei-vice  and  pensioned,  his  disability  being  rated  three-eighths,  and  permanent.  A communication  from 
Pension  Examiner  T.  51.  Flandreau,  dated  November  20th,  1868,  says,  that  since  his  examination  in  July,  1837,  the  patient’s 
general  health  had  greatly  failed,  which  he  attributed  to  continued  pain  in  the  head,  producing  nervousness  and  drowsiness.  The 
action  of  the  heart  was  violent  and  excessive,  and,  for  six  months,  there  were  symptoms  of  ascites,  which  diminished  under 
treatment.  He  was  a night  watchman  in  a mill,  but  lost  much  time.  His  disability  was  then  rated  seven-eighths,  and  probably 
permanent. 

Case. — Private  Nicholas  Ehoade,  Battery  K,  10th  New  York  Heavy  Artillery,  aged  21  years,  was  wounded  before 
Petersburg,  July  4th,  1834,  by  a conoidal  musket  ball,  which  fractured  and  carried  away  a portion  of  the  right  temporal  bone. 
He  was  admitted  to  the  hospital  of  the  Eighteenth  Corps,  thence  on  the  8th,  sent  to  the  Fort  Alonroe  hospital,  and  after  four 
days’  treatment  was  again  transferred,  by  hospital  steamer,  to  the  Grant  Hospital,  New  York.  He  continued  in  the  hospitals  of 
that  State  until  returned  to  duty  from  De  Camp  Hospital  on  the  22d  of  November,  1864.  He  was  finally  discharged  from  service 
on  January  27th,  1865,  and  pensioned.  Dr.  C.  C.  P.  Clark,  of  Oswego,  reports,  in  January,  1865,  that  there  was  a large  loss  of 
substance  of  the  right  temporal  bone,  and  that  the  patient  complained  of  pain  and  dizziness  and  loss  of  memory.  The  cicatrix 
was  firmly  healed. 

Case. — Private  John  Gool,  Co.  H,  71st  Ohio  Volunteers,  aged  21  years,  was  wounded  in  front  of  Nashville,  Tennessee, 
December  16th,  1834,  by  a conoidal  musket  ball,  which  fractured  and  carried  away  two  inches  of  the  frontal  bone.  He  was 
admitted  to  hosj)ital  No.  1,  Nashville,  on  the  18th,  and  remained  in  the  different  hospitals  of  that  city  until  the  8th  of  January, 
1865,  when  he  was  transferred  to  Jeffersonville,  Indiana.  On  July  24th,  1835,  he  was  sent  to  Camp  Dennison,  Ohio,  where  he 
was  discharged  the  service  on  the  28th  of  September,  1865.  A communication  from  Pension  Examiner  \V.  Y.  Kisher,  states  that 
the  patient  is  “unable  to  bear  exercise,”  and  rates  his  disability  one-half,  permanent. 

Case. — Corporal  John  G.  Whigam,  Co.  I,  116th  Pennsylvania  Volunteers,  aged  22  years,  was  wounded  near  Petersburg, 
June  16th,  1834,  liy  a piece  of  shell  which  fractured  the  frontal  and  left  parietal  bones,  carrying  away  a piece  two  inches  in 
diameter.  He  was  conveyed  to  the  hospital  of  the  Second  Corps,  thence  was  sent  by  way  of  City  Point  to  Alexandria,  where 
he  was  admitted  to  the  2d  Division  Hospital  on  June  28th.  The  brain  was  exposed,  but  the  wound  healed  kindly,  and  the 
patient  was  discharged  the  service  June  25th,  1865,  still  incapable  of  any  exertion.  Until  September  14th,  1869,  he  was 
pensioned  at  six  dollars  a month.  His  pension  was  then  increased  to  fifteen  dollars.  Pension  Examiner  W.  M.  Henson,  at 
Alleghany  City,  reporting  that  the  pensioner  suffered  constant  pain  in  the  head,  and  was  totally  and  permanently  unfitted  for 
manual  labor. 

Case. — Priv.ate  Jacob  Livingston,  Co.  I,  21st  Illinois  Volunteers,  aged  22  years,  was  wounded  at  Rocky  Face  Ridge, 
Georgia,  May  9th,  1834,  by  a missUe  which  produced  a fracture,  without  depression,  of  a portion  of  the  frontal  bone.  Previous 
to  this  a ball  passed  through  the  body  of  the  inferior  maxillary  hone,  causing  fracture,  the  destruction  of  four  front  teeth,  and 
defective  articulation.  He  was  sent  to  the  general  hospital  at  Chattanooga,  thence  to  hospital  No.  8 at  Nashville,  and 
subsequently  to  the  Brown  Hospital  at  Louisville.  Finally  he  was  transferred  to  Quincy,  Illinois,  and  was  mustered  out  of 
service  August  16th,  1834,  and  pensioned.  A communication  from  Pension  Examiner  F.  R.  Paine,  June  15th,  1869,  reports 
patient  “able  to  go  about  and  seeming  tolerably  well,”  and  rates  his  disability  total,  but  not  permanent  in  its  present  degree. 

Case. — Private  51.  Wilcox,  Troop  I,  6th  New  York  Cavalry,  aged  22  years,  was  wounded  at  the  battle  of  Boonsboro’, 
5Iaryland,  July  8th,  by  a projectile,  which  fractured  the  left  parietal  bone  without  known  depression  or  involvement  of  the 
brain.  He  remained  in  the  field  hospital  until  the  18th,  when  he  was  conveyed  to  hospital  No.  1,  Frederick,  5Iaryland.  Simple 
dressings  were  applied  to  the  wound.  On  5Iay  17th,  1864,  he  was  transferred  to  Baltimore,  and  was  transferred  to  the  Veteran 
Reserve  Corps,  August  10th,  1864.  He  was  discharged  at  Point  Lookout,  5Iaryland,  (probably  at  expiration  of  term  of  service,) 
November  2d,  1834,  and  pensioned.  On  October  23d,  1867,  Pension  Examiner  Thomas  Williams  reported  that  the  patient’s 
mental  faculties  were  deranged  and  the  functions  of  the  brain  disturbed,  and  rated  his  disability  one-half  and  probably  permanent. 

The  following  cases  of  gunshot  fracture  of  the  cranial  hones  were  accompanied  by 
hemiplegia  or  paraplegia,  and  are  selected  from  a large  number  of  sucli  cases  : 

Case. — Corporal  Charles  Breitonbach,  Co.  K,  7th  Ohio  Volunteers,  was  struck  in  the  squamous  portion  of  the  temporal 
bone  by  a musket  ball  which  entered  the  skull  and  wounded  the  brain,  producing  partial  hemijilegia,  at  the  battle  of  Antietam, 
5Iaryland,  September  17th,  1832.  On  October  5th,  1832,  he  was  admitted  to  the  hospital  at  Smoketown,  51aryland,  and  was 
discharged  the  service  December  19th,  1862.  In  5Iarch,  1868,  he  was  pensioned,  his  disability  being  rated  total  and  temporary. 

Case. — Private  Henry  S , Co.  E,  118th  Pennsylvania  Volunteers,  aged  38,  was  wounded  at  the  battle  of  the 

Wilderness,  Virginia,  5I.'iy  Cth,  1864,  by  a conoidal  musket  ball  which  fractured  and  depressed  the  skull  between  the  frontal 


DISABILITIES  FOLLOWING  DEPRESSED  GUNSHOT  FRACTURES. 


175 


eminences.  He  w.is  sent  to  the  hospital  of  the  1st  division,  Fifth  Corps,  and  on  May  15th  transferred  to  Washington,  D.  C., 
and  admitted  into  the  Mount  Pleasant  Hospital.  So  far,  simple  dressings  only  had  been  applied.  On  May  27th  he  was  trans- 
ferred to  the  Satterlee  Hospital,  Philadelphia.  The  day  follow'ing  his  admission,  he  was  attacked  with  a profuse  diarrhoo.a, 
and  complained  of  pain  in  the  head;  was  dull  and  drowsy,  and  at  times  delirious.  On  June  1st  hife  mental  faculties  were 
completely  obscured,  and  paralysis  of  motion  on  the  left  side  was  observed,  though  there  was  hypermsthesia  of  the  w'hole  surface. 
Convulsions  of  an  epileptic  character  occurred  on  the  2d,  and  it  was  observed  that  the  muscular  power  of  the  left  side  was  now 
restored,  and  that  the  right  was  paralyzed.  The  pupils,  which  had  hitherto  been  dilated,  were  now  somewhat  contracted  ; the 
tongue  was  dry ; the  lungs  full  of  course  rales.  Repeated  convulsions  recurred  on  the  4th,  exhibiting  the  same  remarkable 
features  heretofore  mentioned  in  respect  to  the  side  paralyzed.  No  control  over  the  sphincters  remained.  Death  occui'red  in  the 
afternoon  of  June  4th,  1864.  At  the  autopsy  the  fractured  portion  of  bone  was  found  to  be  ovoid  in  shape  and  corresponding  in 
dimension  to  the  external  wound.  There  was  a fracture  of  the  inner  table  with  depression  of  a portion  near  the  longitudinal  sinus 
to  the  depth  of  two  lines,  and  a fissure  extended  into  the  frontal  sinus.  Beneath  was  a black  slough  of  the  dura  mater,  measui’ing 
two  inches  in  length  by  one  in  width.  The  anterior  and  lateral  surfaces  of  the  right  hemisf)here  were  bathed  \vith  pus,  which 
also  filled  the  great  longitudinal  fissure  and  the  parts  in  the  region  of  the  ethmoid  plates.  At  the  base  of  the  brain  was  an  effusion 
of  scrum.  The  meninges  on  this  side  presented  evidence  of  a high  degree  of  inflammation,  and  could  be  easily  separated  in  large 
patches  from  the  convolutions,  which  were  slightly  softened,  one  containing  a large  abscess.  The  membranes  of  the  other  side 
were  little  more  than  congested.  Further  than  this  the  brain  was  healthy.  The  pathological  specimen,  an  extraordinarily  thin' 
calvaria,  is  No.  2758,  Sect.  I,  A.  M.  M.,  and  was  contributed,  with  the  history,  by  Acting  Assistant  Surgeon  W.  W.  Keen,  jr. 

Cask. — Private  Charles  Lucia,  Co.  A,  14th  United  States  Infantry,  was  wounded  at  the  battle  of  Gettysburg,  July  1, 
1863,  by  a missile  which  entered  the  fi’ontal  bone  a little  to  the  right  of  the  nasal  eminence,  and  emerged  from  the  outer  canthus, 
destroying  the  eye,  and  fracturing  the  malar  bone.  He  was  admitted  to  the  general  field  hospital  at  that  place  on  the  3d,  and 
on  the  24th  was  transferred  to  the  Mulberry  Street  Hospital,  Harrisburg,  where  meningitis  supervened,  causing  death  August 
8th,  1863.  The  case  is  reported  by  Assistant  Surgeon  Edward  Cowles,  U.  S.  A. 

Case. — Lieutenant  William  T.  Simms,  82d  New  York  Volunteera,  was  wounded  at  the  battle  of  the  Wilderness,  Virginia, 
May  6th,  1864,  by  a conoidal  musket  ball,  which  penetrated  the  mastoid  process  of  the  left  temporal  bone  and  seriously  injured 
the  internal  ear,  leaving  a small  external  opening.  The  missile,  which  was  removed  on  the  field,  had  become  elongated.  He 
was  admitted  to  the  hospital  of  the  2d  division.  Second  Corps,  and  on  May  16th,  was  sent  to  AVashington  for  treatment.  Until 
the  latter  date,  he  had  been  speechless;  his  intellect  was  greatly  impaired.  He  partially  recovered;  on  June  25th,  was  trans- 
ferred to  the  59th  New  York  Volunteers  as  Major;  June  27th,  1865,  was  mustered  out  of  service.  The  wound  was  still  open, 
and  there  was  partial  paralysis  of  left  side  of  face,  and  partial  hemiplegia  of  right  side. 

Case. — Private  Lorenzo  D.  Kase,  Co.  G,  188th  Pennsylvania  Volunteers,  aged  18  years,  was  wounded  before  Petersburg, 
Virginia,  September  20th,  1864,  by  a conoidal  musket  ball,  which  fractured  the  skull.  He  was  at  once  conveyed  to  the  general 
hospital  at  Fort  Monroe ; thence  was  sent  on  the  8th  of  October  by  steamer  to  the  Lovell  Hospital  in  Rhode  Island.  The  details 
in  the  progress  of  the  case  are  not  recorded.  He  was  discharged  from  service  on  M.ay  22d,  1865.  A communication  from  the 
Commissioner  of  Pensions,  dated  March,  1868,  states  that  he  is  a pensioner,  and  that  his  disability  is  rated  at  two-thirds  and 
permanent.  A communication  from  Pension  Examiner  W.  11.  Bradley,  dated  July  21st,  1869,  recommends  an  increase  of  pension 
because  of  paraplegia. 

Case. — Private  Jesse  Coty,  Co.  A,  6th  Vermont  Volunteers,  aged  30  years,  was  wounded  before  Petersburg,  Virginia, 
April  2d,  1865,  by  a piece  of  shell,  which  fractured  the  posterior  superior  angle  of  the  left  parietal  bone  and  injured  the  brain. 
On  the  same  day  he  was  taken  to  the  regimental  field  hospital,  and  thence  transferred  to  the  Stanton  Hospital  at  Washington, 
where  he  was  admitted  April  8th,  1865.  The  treatment,  so  fiir  as  recorded,  consisted  of  simple  dressings.  He  recovered,  and 
was  discharged  July  1st,  1865.  In  July,  1868,  he  was  pensioned  for  an  incapacity  resulting  from  dimness  of  sight  and  partial 
hemiplegia  of  the  right  side.  His  disability  is  rated  three-fourths  and  permanent. 

Case. — Private  Levi  Bittenbender,  Co.  E,  9oth  Pennsylvania  Volunteers,  aged  22  years,  was  wounded  by  a fragment  of 
shell,  at  Spottsylvania  Court  House,  May  13th,  1864,  which  fractured  the  right  side  of  the  cranium.  He  was  at  once  admitted  to 
the  hospital  of  the  1st  division.  Sixth  Corps;  on  the  24th,  was  sent  to  the  2d  Division  Hospital  at  Alexandria.  On  the  13th  of 
June  he  was  transferred  to  York,  Pennsylvania.  Paralysis  of  the  lower  extremities  had  ensued.  On  the  21st  of  September  ho 
was  sent  to  the  Turner’s  Lane  Hospital  at  Philadelphia,  and  on  the  7th  of  October,  1864,  he  was  discharged  I'rom  service.  Not  a 
pensioner. 

Case. — Private  Charles  C.  Drew,  Co.  C,  16th  Connecticut  Volunteers,  aged  18  years,  was  wounded  near  Plymouth, 
North  Carolina,  April  20th,  1864,  by  a fragment  of  shell,  which  fractured  a portion  of  the  left  pai  ietal  bone.  He  was  taken 
prisoner;  was  exchanged  October  20th,  admitted  to  2d  Division  Hospital  at  Annapolis,  and  thence  ho  was  transferred  as  follows: 
On  November  27th,  to  Patterson  Park  Hospital,  Baltimore;  on  January  10th,  1865,  to  hospital  at  York,  Pennsylvania;  on 
February  9th,  to  Knight  Hospital,  New  Haven,  Connecticut,  whence  he  was  discharged  the  service  June  9th,  1865,  and  pensioned. 
On  June  6,  1866,  there  was  right  hemiplegia  with  vertigo  and  general  debility. 

Case. — Private  Joseph  A.  Hall,  Co.  G,  10th  Maine  Volunteers,  aged  27  years,  was  wounded  at  the  battle  of  Hatcher’s 
Run,  Virginia,  February  7th,  1865,  hy  a conoidal  musket  ball,  which  fractured  the  frontal  bone,  without  causing  depression.  On 
the  same  day,  he  was  admitted  to  tlie  hospital  of  the  3d  division.  Fifth  Corps;  on  Februaiy  10th,  1865,  was  sent  to  McKim’s 
Mansion  Hospital  at  Baltimore,  and  on  March  11th,  1865,  was  transferred  to  the  hosjdtal  at  York,  I'ennsylv.ania,  where  lie  was 
discharged  the  service.  May  10th,  186.5,  and  pensioned.  On  July  24th,  180.5,  Pension  Examiner  A.  Blossom  reported  tlie  jiatient 
physically  aiul  mentally  incapacitated,  and  hemiidegia  of  right  side  existing.  He  rated  his  disability  three-fourths,  and  ]>i  obably 
permanent. 


176 


WOUNDS  AND  INJURIES  OE  THE  HEAD 


Cask. — Sergeant  James  R.  Slonisou,  Co.  K,  13th  Ne\v  Hampshire  Volunteers,  aged  24  years,  was  wounded  before 
Petersburg,  June  23d,  1864,  by  a fragment  of  shell,  which  fractured  a portion  of  the  left  parietal  bone.  He  was  admitted  to  the 
hosjiital  of  the  Eighteenth  Corps;  thence  he  was  transferred  as  follows:  on  the  25th,  to  the  Chesape.ake  Hospital  at  Fort 
Monroe;  on  .Inly  4th,  by  steamer,  to  Sixteenth  and  Filbert  Streets  Hospital,  Philadelphia;  .and  on  January  24th,  1865,  to  the 
Webster  Hospital  in  New  Hampshire.  Paralysis  of  the  right  arm  and  h.and  had  supervened.  He  was  discharged  the  service 
May  27th,  1865,  and  pensioned,  his  disability  being  rated  one-half  and  permanent. 

Case. — Sergeant  Slade  Wooten,  Co.  C,  27th  North  Carolina  Eegiment,  aged  24  years,  received,  in  an  engagement  near 
Petersburg,  Virginiti,  August  15th,  1864,  a giuishot  fracture  of  the  left  parietal  bone  severing  the  longitudinal  sinus.  He  was 
retired  on  January  20th,  1865,  by  an  examining  board.  The  patient  afterward  suffered  from  partial  paralysis  of  the  left  side 
accompanied  by  intense  headache,  and  was  unable  to  undergo  any  exertion  without  producing  mental  confusion. 

The  following  cases  of  gunshot  depressed  fractures  of  the  cranial  bones  were  followed 
by  epilepsy  : 

Case. — Priv.ate  John  Oxspring,  Co.  G,  109th  Pennsylvania  Volunteers,  aged  36  years,  was  wounded  at  the  battle  of 
Ch.anccllorsville,  Virginia,  M.ay  1st,  1883,  by  a conoid.al  musket  ball,  which  fr.actured  the  frontal  bone  between  the  eminences, 
‘probably  causing  a depression  of  the  inner  table.  He  was  conveyed  to  Washington,  and  on  the  0th  was  admitted  into  Lincoln 
Hospital,  where  the  wound  was  properly  dressed.  Frequent  epileptic  convulsions  ensued  after  a time.  In  July  he  was 
transferred  to  the  Cuyler  Hospital,  near  Philadelphi.a,  where  he  continued  under  treatment  until  the  24th  of  March,  1804,  when  he 
was  transferred  to  the  Turner’s  Lane  Hospit.al.  The  convulsions  continuing,  resort  was  now  had  to  the  introduction  of  an 
issue  pea  in  the  hack  of  the  neck,  which,  however,  failed  to  alibrd  relief,  and  was  soon  withdrawn  on  account  of  a severe  attack 
of  erysipelas  following.  On  May  19th,  1804,  he  was  discharged  from  service.  In  January,  1868,  his  disability  was  rated  as 
three-fourths  and  permanent.  The  case  is  reported  by  Acting  Assistant  Surgeon  W.  W.  Keen,  jr. 

Ca.se. — Sergeant  John  tlaley,  Co.  C,  57th  M.assachusetts  Volunteers,  aged  36  years,  was  wounded  in  the  head  at  the 
b.attle  of  the  Wilderness,  Virginia,  Maj'  Gth,  1864,  by  a conoidal  musket  ball.  He  was  sent  to  Washington  on  the  IGth,  and  was 
admitted  into  the  Lincoln  Hospital,  where  no  fr<acturc  was  suspected.  On  July  18th  he  was  sent  north,  and  on  August  25th 
was  admitted  to  the  hospital  at  Readville,  M.assachusetts.  On  October  24th  he  was  sent  to  the  Dale  Hospital,  Worcester,  where 
it  was  ascertained  that  the  frontal  bone  was  fractured  and  depressed.  Convulsions  of  an  epileptiform  character  supervened,  but 
the  patient  finally  recovered,  and  w.as  discharged  the  service  January  16th,  1865.  He  was  pensioned,  and  on  July  20th,  1867, 
was  reported  by  Pension  Examiner  Oramel  Martin,  to  be  completely  and  permanently  disabled. 

Case. — Corporal  Otis  G.  Sti'aub,  Co.  I,  98th  Ohio  Volunteers,  aged  26  years,  was  wounded  at  Chaplin’s  Hill,  Kentucky, 
October  8th,  1862,  by  a fragment  of  shell,  which  fractured  and  slightly  dej)ressed  the  frontal  bone  at  its  centre.  Remaining  at 
the  field  hospital  about  one  month,  he  was  sent  to  Hospital  No.  1,  Lebanon,  Kentucky,  on  November  10th,  and  two  days  afterward 
was  transferred  to  Hospital  No.  18,  Louisville.  On  January  10th,  1863,  the  jaitient  was  admitted  to  the  hospital  at  Gallipolis, 
Ohio,  and  on  October  12th,  1863,  was  transferred  to  the  Veteran  Reserve  Corps,  still  subject  to  epileptic  convulsions,  which 
followed  any  active  exertion.  HTs  name  is  not  upon  the  Pension  List. 

Case. — Corporal  Ludwig  Schweitzer,  Co.  E,  12th  New  Jersey  Volunteers,  aged  23  years,  was  wounded  before  Petersburg, 
Virginia,  October  20th,  1864,  by  a conoidal  musket  hall,  wdiich  fractured  a portion  of  the  frontal  bone  on  the  right  side.  He 
was  sent  to  the  hospital  of  the  2d  division.  Second  Corps.  On  the  22d  was  sent  to  the  depot  field  hospital  at  City  I’oint,  and  on 
December  15th  was  transferred  to  Washington,  D.  C.,  and  admitted  on  the  following  day  into  the  Finley  Hospital.  The  treat- 
ment so  far  as  recorded  was  expectant.  On  the  5th  of  March,  1865,  the  patient  was  transferred  to  the  hospital  at  Beverly,  New 
Jersey,  thence  was  sent  on  the  5th  of  April  to  the  White  Hall  Hospital,  Bristol,  Pennsylvania,  and  was  discharged  the 
service  May  17th,  1865,  and  pensioned,  his  disability  being  rated 4otal  and  permanent.  Subsequent  information  shows  that  the 
patient  suft'ered  constant  pain,  vertigo  upon  slight  exertion,  and  epileptiform  convulsions. 

Case. — Private  Jacob  Yager,  Co.  K,  55th  Ohio  Volunteers,  aged  23  years,  was  wounded  in  an  engagement  near  Atlanta, 
Georgia,  July  20th,  1864,  bj^  a conoidal  ball  which  fractured  the  os  frontis  over  the  left  eye.  He  was  admitted  to  the  hospital  of 
the  3d  division.  Twentieth  Corps,  and  on  July  25th,  he  was  sent  to  Hospital  No.  3,  Chattanooga,  where  he  remained  until  April 
11th,  1865,  when  he  was  transferred  to  Hospital  No.  1,  Nashville.  Epilepsy  had  supervened.  On  May  4th  he  was  sent  to  the 
Crittenden  Ilo.spital,  Louisville,  Kentucky;  on  June  13th,  to  the  Brown  Hospital  of  the  same  city;  and  on  June  22d,  to  Camp 
Dennison,  Ohio,  where  he  was  mustered  out  on  July  18th,  1865. 

Case. — Corporal  George  Roimas,  Co.  B,  1st  Louisiana  Volunteers,  received  a gunshot  wound  of  the  head  at  Port  Hudson, 
June,  1863.  On  July  24th,  1863,  he  was  admitted  to  St.  Louis  Hos])ital,  New  Orleans,  and  was  di.scharged  the  service  October 
22d,  1863,  and  pensioned.  His  disability  was  complicated  with  hemiplegia  and  epilepsy,  and  was  rated,  on  October  22d,  1863, 
by  I’ension  Examiner  George  Kellogg,  as  total  and  permanent. 

Case. — Private  Michael  Baudfield,  Troop  D,  Gth  New  York  Cavalry,  was  admitted  to  the  H.arewood  Hospital,  Washington, 
August  17th,  1883,  with  a fracture  of  the  cranium,  produced  by  a piece  of  shell,  and  on  October  28th,  he  was  sent  to  DeCamp 
Hospital.  Epilepsy  supervened,  aiid  on  January  8th,  1864^  he  was  discharged  the  service.  He  subsequently  re-enlisted,  but 
the  epilepsy  continuing,  he  was  again  discharged  frenn  service.  May  21st,  1864.  Not  a pensioner. 

Case. — Private  James  T.  Gammon,  Co.  K,  2d  New  Hampshire  Volunteers,  was  wounded  at  Bull  Run,  August  29th,  1862, 
by  a buckshot,  which  fractured  the  cranium  at  the  junction  of  the  coronal  and  sagittal  sutures,  and  slightly  depressed  the  external 
table.  Cold  water  dressings  were  applied.  On  September  2d,  the  patient  was  conveyed  to  Philadelphia,  and  was  received  into 
the  Broad  and  Cheiaw  Streets  Hospital  on  the  following  day.  The  missile  was  found  lodged  at  the  seat  of  fracture,  and  was 


DISABILITIES  FOLLOWING  DEPRESSED  FRACTURES  OF  THE  SKULL. 


177 


removed.  The  case  progressed  satisfactorily.  Near  the -end  of  October,  however,  a necrosed  fragment  of  tlie  external  table, 
which  had  caused  considerable  irritation,  was  extracted.  He  was  returned  to  duty  on  March  4th,  1863.  On  January  1st,  1804, 
he  re-enlisted,  and  at  the  battle  of  Cold  Harbor,  June  3d,  1864,  was  wounded  in  the  hand.  He  was  admitted  to  the  Finley 
Hospital  at  Washington,  on  June  8th,  and  was  transferred  to  Knight  Hospital,  New  Haven,  Connecticut,  on  June  19th,  1864; 
he  was  still  suftering  from  the  original  injury  of  the  head  and  was  subject  to  epilepsy.  Ho  was  transferred  to  Concord,  New 
Hampshire,  where,  on  May  20th,  1865,  he  was  discharged  the  service  and  pensioned,  his  disability  being  rated  three-fourths,  and 
probably  permanent.  Surgeon  John  Neill,  U.  S.  V.,  reports  the  case. 

Case. — Sergeant  Charles  H.  Norton,  -Co.  D,  157th  New  York  Volunteers,  aged  23  years,  was  wounded  at  Gettysburg, 
July  1st,  1863,  by  a couoidal  musket  ball,  which  struck  the  right  side  of  the  head.  He  was  admitted  to  a field  hospital  on  the 
same  day.  The  injury  seemed  very  slight,  and  he  was  probably  soon  returned  to  duty,  as  no  record  of  the  case  can  be  found 
until  October  6th,  1834,  when  he  was  admitted  to  the  Hilton  Head  Hospital,  where  a fracture  of  the  right  parietal  bone  was 
discovered.  Simple  dressings  were  applied,  and  on  November  21st,  the  patient  was  returned  to  duty ; but,  on  February  18th, 
1865,  he  was  again  received  into  the  hospital  at  Hilton  Head,  suffering  from  epilepsy.  He  was  finally  discharged  from  service 
on  March  30th,  1835,  and  pensioned,  his  disability  being  rated  total  and  doubtful.  On  June  25th,  1868,  Pension  Examiner  G. 
\V.  Bradfoi-d  reports  the  wound  still  discharging,  with  epileptic  fits  from  time  to  time,  causing  physical  and  mental  disability. 

Case. — Private  John  Rummerfield,  Co.  F,  51st  Illinois  Volunteers,  aged  35  years,  was  wounded  at  the  battle  of  Chick- 
amauga,  Georgia,  September  20th,  1863,  by  a couoidal  musket  ball,  which  fractured  a portion  of  the  left  parietal  bone  above  the 
eminence.  He  remained  in  the  field  hospital  until  October  20th,  when  he  was  sent  to  the  hospital  at  Stevenson,  Alabama,  and 
thence,  on  October  23d,  to  hospital  No.  13,  at  Nashville.  He  continued  in  the  hospitals  of  that  city  until  the  latter  part  of 
January,  1864,  when  he  was  sent  to  Camp  Parole.  He  was  discharged  the  service  on  February  3d,  1865,  and  pensioned. 
On  November  15th,  1867,  Pension  Examiner  D.  L.  Dieffenb.ach  reported  that  the  wound  was  covered  with  integuments,  which 
were  soft  and  painful ; that  the  patient  had  attacks  of  epilepsy,  and  was  unsteady  in  his  gait ; and  that  there  was  partial  hemi- 
plegia of  right  side,  and  impairment  of  memory.  His  disability  is  rated  two-thirds  and  permanent. 

Case. — Private  Janies  Eouey,  Co.  G,  15th  Alabama  Infantry,  received  a gunshot  fracture  of  the  temporal  bone.  He  was 
admitted  to  the  No.  9 hospital,  Richmond,  July  14th,  1863.  Epilepsy  resulted.  The  subsequent  liistory  and  disposition  of  the 
patient  is  unknown. 

Case. — Private  Daniel  P.  Roth,  Co.  A,  42d  Indiana  Volunteers,  aged  26  years,  received,  in  an  engagement  near  Eesaca, 
Georgia,  May  24th,  1864,  a gunshot  fracture  of  the  frontal  bone.  He  was  conveyed  by  way  of  Chattanooga  to  Nashville, 
Tennessee,  and  admitted  to  hospital  No.  1,  on  May  27th,  1864.  The  injury  healed  rapidly,  and  the  patient  was  returned  to  duty 
on  August  4th,  1864.  The  wound,  however,  reopened,  and  he  was  admitted  to  the  hospital  of  the  1st  division.  Fourteenth  Corps, 
on  September  24th,  but  was  again  returned  to  duty  on  October  12th,  1864.  On  January  30th,  1865,  he  was,  for  the  third  time, 
sent  to  a hosjiital.  He  was  this  time  admitted  to  the  post  hospital  at  Bridgeport,  Alabama,  where  he  died  from  epilepsy  on 
March  14th,  1835. 

Case. — Private  Adolph  Stahl,  Co.  B,  119th  New  York  Volunteers,  aged  20  yesirs,  was  wounded  at  Fredericksburg,  May 
3d,  1863,  by  a piece  of  shell,  which  fractured  the  right  j)arietal  bone. . He  was  treated  in  the  field  hospital  for  several  weeks, 
and  on  June  10th,  he  was  admitted  to  the  Lincoln  Hospital  at  Washington,  suffering  from  epilepsy.  On  July  9th,  he  was 
conveyed  to  Philadelphia,  and  was  admitted  to  the  Christian  Street  Hospital.  Epilepsy  continued.  In  March,  1864,  he  was 
transferred  to  the  TurneFs  Lane  Hospital,  and  on  May  11th,  1864,  was  discharged  from  service.  Not  a pensioner. 

Case. — Private  Lucius  Veasey,  Co.  G,  5th  New  Hampshire  Volunteers,  was  wounded  at  Antietam,  September  17th,  1802, 
by  a fragment  of  shell,  which  caused  a compound  fracture  of  the  occipital  bone.  On  October  4th,  he  ^vas  admitted  to  hospital 
No.  1,  at  Frederick,  Maryland,  where  he  was  discharged  the  service  April  22d,  1803.  In  March,  1868,  he  received  a pension  on 
account  of  incapacity  resulting  from  epilepsy.  His  disability  was  rated  total  and  permanent,  by  Examining  Surgeon  Thomas 
Sanborn,  of  the  Pension  Bureau.  • 

Disorders  of  the  nerves  of  special  sense  often  followed  depressed  gunshot  fractures  of 
the  skull,  lesions  or  functional  derangements  of  the  optic  and  auditory  nerves  being  the 
most  common.  The  subject  will  be  more  fully  discussed  in  connection  with  penetrating 
and  perforating  wounds  of  the  skull,  but  a few  cases  may  bo  adduced  here.  Various 
forms  of  impaired  vision  were  of  very  frequent  occurrence  after  depressed  fractures  of  all 
portions  of  the  periphery  of  the  cranium ; 

Case. — Private  Absalom  Mower,  Co.  G,  111th  Ohio  Volunteers,  aged  23  years,  was  wounded  at  the  engagement  at 
Atlanta,  Georgia,  July  24th,  1864,  by  a couoidal  musket  ball,  which  fractui-ed  the  cranium  over  the  right  eye.  He  was  taken  to 
the  hospital  of  the  Twenty-third  Corps,  and  was  transferred  as  follows : on  August  8th,  to  the  Ilolston  Hospital,  Knoxville, 
Tennessee;  on  November  28th,  to  hospital  No.  8,  Nashville;  on  December  1st,  to  Jefterson,  Indiana;  and  on  April  26th,  1865, 
to  the  hospit.al  at  Cleveland,  Oliio,  where  he  was  mustered  out  of  service  on  June  9th,  1865.  The  sight  of  the  right  eye  had 
been  partially  destroyed. 

Case. — Private  William  Slantinger,  Co.  A,  41st  New  York  Volunteers,  aged  20  years,  was  wounded  at  Giittysburg,  July 
3d,  1863,  by  a fragment  of  shell  which  fractured  the  os  frontis.  He  was  admitted  into  the  Satterlee  Hospital  at  l’hiladeli)hia,  on 
the  5th,  where  simple  dressings  were  applied.  Partial  blindness  resulted,  lie  was  discharged  fi'om  service  December  3Uth, 
1833.  Surgeon  I.  I.  Hayes,  U.  S.  V.,  reports  the  case.  Not  a pensioner. 

23 


178 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Case. — Private  Abraliam  Strauss,  Co.  C,  31st  New  York  Volunteers,  was  admitted,  on  October  31st,  18G2,  to  Camp 
Banks,  near  Alexandria,  Virginia,  with  a gunshot  fracture  of  the  parietal  bone.  He  was  discharged  the  service  November  29th, 
1862,  and  pensioned.  Subsequently  to  the  patient’s  discharge.  Pension  Examiner  E.  Bradley  rejiorts  him  suffering  from  vertigo 
and  impaireil  sight  in  the  left  eye,  also  valvular  disease  of  the  hem-t,  and  rates  his  disability  total  and  permanent. 

Case. — Private  Charles  Owen,  Co.  F,  179th  New  Y’ork  Volunteers,  aged  31  years,  was  wounded  near  Petersburg,  Virginia, 
June  17th,  1864,  by  a piece  of  shell  which  fractured  the  right  parietal  bone.  On  the  same  day,  he  was  admitted  to  the  hospital 
of  the  1st  division.  Ninth  Corps;  thence  was  conveyed  to  Washington,  and  admitted  into  the  Mount  Pleasanthospitalon  July  2d. 
On  July  22d,  he  was  transferred  to  the  Mower  Hospital  at  Philadelphia.  Simple  dressings,  tonics  and  stimulants  were  employed 
in  the  course  of  the  treatment.  He  was  discharged  from  service  June  10th,  1865.  Pension  Examiner  Bardwell  reports  on 
February  1st,  1868,  that  the  patient’s  vision  was  impaired  and  that  he  was  subject  to  nausea  and  prostration  when  excited. 
He  rated  his  disability  as  one-half  and  probably  permanent. 

Case. — Private  Lyman  B.  Pollard,  Co.  G,  16th  Maine  Volunteers,  was  wounded  at  the  battle  of  Fredericksburg,  Virginia, 
December  13th,  1862,  by  a conoidal  ball,  which  fractured  the  left  parietal  bone  at  its  anterior  superior  angle.  He  was  admitted 
to  hosi^ital  2d  division.  First  Corps,  and  on  December  19th  was  sent  to  Fairfax  Seminary  Hospital,  where  he  was  discharged  on 
March  31st,  1863,  and  pensioned.  On  February  23,  1866,  Pension  Examiner  James  Bell  reported  that  exfoliation  of  bone  has 
occurred  from  time  to  time,  and  that  the  patient  suft'ers  much  from  pain  and  vertigo.  His  disability  was  then  rated  at  three- 
fourths  and  permanent.  On  October  9th,  1866,  Pension  Examiner  John  Benson  reported  that  the  exfoliation  still  continues  and 
that  the  vision  of  the  light  eye  is  materially  affected.  His  disability  is  rated  total. 

Case. — Private  George  E.  Williams,  Co.  I,  1st  Wisconsin  Cavalry,  was  wounded  at  Jonesboro’,  Arkansas,  August  2d, 
1882,  by  a projectile  which  fractured  and  tore  away  a portion  of  the  occipital  bone  near  the  protuberance.  On  November  29th 
he  was  admitted  to  the  post  hospital  at  Detroit,  Michigan,  and  was  discharged  the  service  November  29th,  1862,  and  pensioned. 
Pension  Examiner  W.  F.  Breakey,  under  date  of  January  22d,  1870,  reported  the  patient  sufi'ering  from  partial  amaurosis  and 
loss  of  memory,  with  great  nervous  prostration,  and  rates  his  disability  total. 

Case. — Private  Hugh  Ward,  Co.  H,  2d  Massachusetts  Volunteers,  was  wounded  at  Gettysburg,  July  2d,  1863,  by  a 
conoidal  ball,  which  fractured  the  cranium  at  the  vertex.  He  was  admitted  to  the  Satterlee  Flospital,  Philadelphia,  on  the  7th; 
thence,  on  August  4th,  was  transferred  to  the  Mason  Hospital  at  Boston.  Simple  dressings  only  were  required,  and  the  wound 
healed  in  a short  time.  'The  patient,  however,  was  unable  to  undergo  any  severe  exertion,  as  it  would  immediately  produce 
dizziness.  He  was  discharged  from  service  on  October  1st,  1863,  and  pensioned  in  consequence  of  total  disability,  the  result 
of  impaired  vision  and  nervous  derangement. 

Case. — Private  Morris  Wingler,  Co.  C,  26th  Wisconsin  Volunteers,  was  wounded  at  Gettysburg,  July  1st,  1863,  by  a 
musket  ball,  which  penetrated  the  frontal  bone  near  the  right  eminence,  and  exposed  the  membranes.  He  was  sent  to  a field 
hosjjital,  and  on  July  8th,  was  sent  to  South  Street  Hospital,  Philadelphia,  where  the  ball  was  extracted.  The  patient  had 
nearly  recovered  by  September  29th,  1864,  when  he  was  transferred  to  the  Veteran  Eeserve  Corps.  He  was  discharged  the 
service,  June  30th,  1865,  and  pensioned.  A subsequent  report  from  Pension  Examiner  L.  D.  McIntosh  informs  that  bony  union 
has  not  taken  j)lace ; that  the  patient  has  dimness  of  vision  in  the  right  eye,  with  pain  and  dizziness,  and  rates  his  disability  total 
and  permanent. 

Ca.se. — Sergeant  W’illiam  McKenzie,  Co.  D,  4th  Michigan  Volunteers,  aged  30  years,  was  wounded  at  the  Wilderness,  on 
May  5th,  1364,  by  a conoidal  ball,  which  fractured  the  right  external  angular  process  of  the  frontal  bone.  He  was  conveyed  to 
Washington,  and  admitted,  on  the  11th,  into  the  Stanton  Ho.spital;  thence  was  transferred,  on  the  18th,  to  the  Satterlee  Hospital 
at  Philadelphia.  The  sight  of  the  eye  was  partially  destroyed.  The  case  progressed  favorably,  though  there  was  a slight  dis- 
charge from  the  wound.  On  examination,  the  ball  was  found  lodged  in  the  bone,  and  on  the  16th  of  June,  the  opening  was 
enlarged  and  the  missile,  firmly  imbedded  in  the  oi'bital  ridge,  extracted.  The  patient  recovered  rapidly,  and  on  August  3d, 

1834,  was  transferred  to  Adrian,  Michigan,  to  be  mustered  out,  his  term  of  service  having  exjtired.  A communication  from  the 
Commissioner  of  Pensions,  dated  December  8th,  1839,  states  the*  patient  has  nearly  lost  the  sight  of  his  right  eye  and  suffers 
from  hemicrania,  owing  to  which  he  receives  a pension,  his  disability  being  rated  five-eighths  and  permanent. 

Case. — Private  James  Baher,  Co.  G,  10th  Louisiana  Infantry,  received  a gunshot  wound  of  the  temporal  region,  causing 
depressed  fracture  of  the  skull,  on  November  26th,  1863.  He  was  admitted  to  the  Louisiana  Hospital,  Eichmond.  Blindness 
resulted.  The  subsequent  history  and  disposition  of  the  case  is  unknown. 

Case. — Private  William  Wolven,  Co.  B,  98th  New  York  Volunteers,  aged  17  years,  was  wounded  in  front  of  Petersburg, 
June  24th,  1834,  by  a conoidal  ball,  which  fractured  the  frontal  bone  over  the  left  eye.  He  was  admitted  to  the  hospital  of  the 
Eighteenth  Corps,  and  on  June  25th  was  sent  to  Hampton  Hospital,  Fort  Monroe ; on  July  19th,  to  Lovell  Hospital,  Portsmouth, 
Ehode  Island,  and  on  August  22d  to  Ira  Harris  Hospital,  Albany,  New  York,  whei'e  he  was  discharged  the  service  June  30th 

1835,  and  pensioned,  his  disability  being  rated  one-fourth  and  probably  permanent.  A report  from  Pension  Examiner  A. 
Hasbrouck,  about  one  year  subsequently,  says  that  the  patient’s  condition,  both  physical  and  mental,  appears  good,  but  that  he 
cannot  bear  exposure  to  heat.  The  wound  had  impaired  his  eye-sight. 

Case. — Private  George  W.  D.  Bair,  Co.  H,  55th  Illinois  Volunteers,  was  admitted  to  the  Marine  Hospital,  Chicago, 
Illinois,  with  a gunshot  fracture  of  the  occipital  bone  at  the  right  of  the  protuberance.  He  was  discharged  from  service  October 
17th,  1832,  and  pensioned.  He  had  partial  amaurosis  of  right  eye,  and  frequent  attacks  of  neuralgia.  His  disability  is  rated 
three-fourths  and  temi)orary. 

Case. — Private  Jeremiah  N.  Featherstone,  Co.  G,  70th  Indiana  Volunteers,  aged  22  year’s,  was  wounded  at  the  affair  of 
Golgotha,  Georgia,  June  15th,  1864,  by  a fragment  of  shell,  which  produced  a ft'acture  of  the  frontal  bone,  with  but  slight 
dein-ession.  He  was  treated  in  division  liosjrital,  was  sent,  via  Chattanooga,  to  Nashville,  and  was  admitted  to  hospital  No.  14 
on  the  25th.  On  September  3d,  he  was  sent  to  the  City  Hospital  at  Indianapolis,  and  on  March  6th,  1835,  was  discharged  from 


DISABILITIES  FOLLOWING  DEPEESSED  FEACTUEES  OF  THE  SKULL. 


179 


service.  On  March  10th,  1865,  Pension  Examiner  G.  M.  Hears  reported  the  wound  entirely  healed,  but  painful  after  mental  or 
physical  excitement.  The  patient’s  sight  and  hearing  were  much  impaired,  and  he  was  incapacitated  for  any  kind  of  work,  llis 
disability  was  then  rated  three-fourths  and  doubtful. 

Case. — Private  George  Nash,  Troop  L,  1st  Michigan  Cavalry,  aged  24  years,  was  wounded  at  Dinwiddle  Court-house, 
Virginia,  by  a pistol  ball,  which  caused  a compound  comminuted  fracture  of  the  external  table  of  the  left  parietal  bone  near  the 
lambdoid  suture.  On  April  1st,  he  was  admitted  to  the  hospital  of  the  cavalry  corps;  on  April  4th,  sent  to  the  Mount  Pleasant 
Hospital,  Washington;  and  on  May  22d,  1865,  was  transferred  North.  He  was  discharged  May  30th,  1865,  and  pensioned. 
Pension  Examiner  M.  L.  Green  reported  on  November  19th,  1868,  that  the  patient  suffers  from  impaired  vision  and  disturbance 
of  the  cerebral  functions.  His  disability  is  rated  at  three-fourths  and  permanent. 

In  many  cases  of  gunshot  fractures  of  the  temporals,  occipital,  and  parietals,  partial  or 
total  deafness  resulted.  The  following  cases  are  examples  : 

Case. — Private  F.  W.  Clayton,  Co.  I,  Palmetto  Sharp-shooters,  aged  22  years,  a healthy  and  robust  man,  was  wounded 
in  an  engagement  near  Petersburg,  Virginia,  October  7,  1864,  by  a conoidal  ball  which  fractured  the  occipital  and  right  parietal 
bones.  The  missile  strnck  directly  over  the  lambdoid  snture,  producing  a linear  fissure  of  the  outer  table,  and  comminuting  and 
depressing  the  inner.  He  was  insensible  for  twenty -four  hours,  but  was  not  paralyzed.  The  loose  spiculae  of  bone  were  removed 
and  simple  dressings  applied.  The  patient  was  sent  to  Eichmond,  where  more  fragments  were  removed  as  they  became  detached, 
and  occasionally  a disinfecting  lotion  was  applied.  On  December  15th,  the  wound  had  cicatrized,  and  the  patient  was  sent  home. 
For  two  months  he  had  constant  neuralgia  of  the  head,  face,  and  neck  on  the  right  side,  and  was  a little  deaf ; the  deafness  being 
aggravated  by  the  severity  of  the  neuralgic  symptoms.  In  March,  1866,  he  was  perfectly  healthy,  but  inca])able  of  much  exer- 
tion, either  mental  or  physical.  Vertigo  and  dizziness  would  attack  him  on  suddenly  stooping,  or  on  continued  excitement  of, 
mind.  He  could  not  indulge  in  stimulants.  His  deafness  was  gradually  disappearing.  The  case  was  recorded  by  Surgeon  F. 
S.  Parker,  P.  A.  C.  S. 

Case. — Private  William  Harlin,  Co.  A,  116th  Pennsylvania  Volunteers,  was  wounded  at  Chancellorsville,  May  3d,  1863, 
by  a piece  of  shell,  which  fractured  portions  of  the  left  temporal  and  occipital  bones.  On  May  6th,  he  was  admitted  to  hospital  of 
the  2d  division.  Second  Corps;  on  June  14th,  was  sent  to  Point  Lookout  Hospital,  Maryland;  and  on  October  1st,  to  Mower 
Hospital,  Philadelphia.  He  improved  steadily,  and  was  discharged  on  February  9th,  1864,  and  pensioned.  The  patient  was 
deaf,  had  a constant  roaring  in  his  head,  and  could  not  bear  exposure  to  the  sun.  His  disability  is  rated  one-lialf,  and  probably 
permanent,  by  Pension  Examiner  J.  H.  Gallagher,  M.  D. 

Case. — Private  Charles  Eoche,  Co.  D,  1st  Wisconsin  Cavalry,  aged  21  years,  was  wounded  near  Buzzard  Eoost,  Georgia, 
May  8th,  1864,  by  a conoidal  musket  ball,  which  fractured  a portion  of  the  right  parietal  bone.  He  was  admitted  to  the  hospital 
of  the  1st  division.  Cavalry  Corps;  on  May  12th  he  was  sent  to  hospital  No.  1,  Nashville,  Tennessee,  and  on  May  16th  was  trans- 
ferred to  Clay  Hospital,  Louisville,  Kentucky,  whence  he  was  furloughed  October  23,  1864.  He  was  readmitted  November  23d, 
1864,  and  discharged  the  service  March  23d,  1865,  on  account  of  deafness  and  otorrheea. 

Case. — Captain  William  H.  Winsor,  Co.  F,  18th  Massachusetts  Volunteers,  was  wounded  by  a shell  at  the  battle  of  Fred- 
ericksburg, December  13th,  1862,  which  fractured  a portion  of  the  left  side  of  the  cranium.  He  was  admitted  to  the  hospital  of 
Griffin's  division.  Fifth  Corps,  and  thence  was  sent  to  Washington  for  treatment.  He  resigned  March  15th,  1863.  The  power 
of  hearing  was  somewhat  impaired. 

Case. — Private  Peter  Peterson,  Co.  D,  100th  Illinois  Volunteers,  aged  24  years,  was  wounded  in  the  head,  at  the  battle 
of  Chickamanga,  Geoigia,  September  19th,  186.3,  by  two  balls;  the  first  lodging  between  the  tables  of  the  frontal  bone  near  the 
vertex;  the  second  taking  effect  in  the  left  parietal  and  occipital  bones,  causing  fracture  without  known  depression.  On  Septem- 
ber 21st,  he  was  admitted  to  the  field  hospital  at  Chattanooga,  where  he  remained  under  treatment  until  October  3d,  when  he  was 
taken  to  Stev^enson,  Alabama;  thence  he  was  transferred,  on  October  12th,  to  hospital  No.  14,  Nashville.  On  January  19th,  1864, 
he  was  sent  to  the  Marine  Hospital,  Chicago,  Illinois,  and  was  discharged  from  service  on  April  2d,  1864,  and  pensioned.  On 
April  20th,  1864,  Pension  Examiner  J.  McCann  reports  that  the  wound  has  healed,  leaving  an  indentation  in  the  skull,  and  that 
the  patient’s  hearing  is  imperfect.  His  disability  is  rated  three-fourths  and  permanent. 

Case. — Private  James  Fitzgerald,  Co.  C,  81st  New  York  Volunteer.s,  aged  29  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  Virginia,  June  3d,  1864,  by  a conoidal  musket  ball  which  entered  the  anterior  part  of  the  right  squamo-parietal  suture, 
passed  downward  and  backward,  and  cut  off  the  l ight  ear.  He  was  admitted  to  the  hospital  of  the  1st  division.  Eighteenth  Corps, 
and  was  transferred,  on  June  8th,  to  the  2d  division  hospital,  Alexandria,  and  on  June  12th,  to  the  hospital  at  Chester,  Pennsyl- 
vania. He  was  discharged  January  3d,  1865,  and  pensioned,  owing  to  deafness  in  the  right  ear,  headache,  and  dizziness,  which 
partially  incapacitated  him  for  work.  His  disability  is  rated  one-fourth  and  temporary. 

Case. — Private  Charles  Eowe,  Co.  K,  139th  New  York  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of  Cold  Har- 
bor, Virginia,  June  3d,  1864,  by  a conoidal  musket  ball,  which  fractured  a portion  of  the  left  parietal  bone.  On  the  same  day,  he 
was  admitted  to  the  field  hospital  of  the  Eighteenth  Corps,  and  transferred  as  follows:  on  June  8th,  to  the  Fairfax  Seminary 
Hospital ; on  J une  29th,  to  the  McClellan  Hospital,  Philadelphia;  on  Deceiidjer  10th,  to  the  Filbert  Street  Hosj)ital ; and  on  May 
12th,  1865,  to  the  Satterlee  Hospital,  where  he  was  discharged  on  June  16tli,  1865,  and  pensioned.  On  October  30th,  1865,  Pen- 
sion Examiner  Charles  Eowkand  reported  the  patient  suffering  from  partial  deafness,  constant  pain  in  the  head,  and  impaired 
memory.  He  rates  his  disability  one-half,  and  temporary. 

Case. — Private  Eichard  Eidgely,  Co.  H,  54th  Massachusetts  Volunteers,  (colored,)  was  wounded  in  the  engagement  at 
Olustee,  Florida,  February  20th,  1864,  by  a conoidal  musket  ball  which  entered  the  left  ear  and  j)assed  through  the  mastoid  ju-o- 
cess.  On  February  22d,  he  was  admitted  to  the  hospital  at  Jacksonville,  Florida,  and  on  February  2fith,  he  was  sent  to  the  hos- 
pital at  Beaufort,  South  Carolina,  at  which  time  there  was  some  dischargi*  from  the  ear  and  laiin  in  tli(‘  head,  witli  obstinate 


180 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


constipation.  The  patient  was  treated  on  tlie  expectant  plan,  under  which  there  was  marked  improvement  by  March  31st,  and 
on  July  10th,  1884,  he  was  returned  to  duty,  though  still  deaf. 

Case. — Private  R.  W.  Wilder,  Co.  H,  7th  New  York  Volunteers,  was  wounded  at  Fredericksburg,  December  13th,  1862, 
by  a colloidal  musket  ball,  which  passed  from  behind  torward  through  the  mastoid  process  and  the  concha.  He  also  received  a 
wound  in  the  right  side  of  the  abdomen,  near  the  terminal  costal  cartilages.  The  patient  was  conveyed  to  the  hospital  of  the  1st 
division.  Second  Corps,  where  cold  water  dressings  were  applied.  On  December  20th,  he  was  sent  to  Lincoln  Hospital,  Wash- 
ington, and  on  January  17th,  1863,  was  transferred  to  the  Harewood  Hospital.  He  recovered,  except  from  the  deafness  of  the 
right  ear,  and  was  returned  to  duty  on  April  11th,  1863. 

Case. — Private  WiUiam  Thompson,  Co.  B,  48th  Georgia  Regiment,  received  a gunshot  fi’acture  of  the  head  at  the  battle  of 
Chancellorsville,  May  3d,  1863.  He  was  admitted  to  hospital  No.  16  at  Richmond,  and  recovered,  with  the  exception  of  defective 
audition  of  the  left  ear.  He  was  allowed  to  go  home  on  June  6th,  1863. 

In  tlie  following  case  the  sense  of  taste  was  lost  as  well  as  the  sense  of  hearing  : 

Case. — Sergeant  William  B.  Hutchinson,  Co.  F,  12th  New  Jersey  Volunteers,  was  wounded  at  Chancellorsville,  Virginia, 
May  3d,  1863.  The  missile  entered  in  front  of  the  external  meatus,  and  lodged  in  the  internal  ear.  He  was  admitted  to  the 
hospital  of  the  3d  division.  Second  Corps;  on  May  9th,  was  sent  to  Carver  Hospital,  Washington,  and  on  June  27th,  to  South 
Street  Hospital,  Philadelphia,  whence  he  was  discharged  the  service,  April  6th,  1865,  and  pensioned.  The  ball  remained  in  the 
wound,  and  could  be  felt  in  its  place  of  lodgment.  The  sense  of  hearing  was  completely  lost  in  the  injured  ear,  and  the  patient 
had  lost  the  sense  of  taste  and  suffered  from  vertigo. 

Balls  Splitting  on  the  Cranial  Bones. — Military  surgeons  have  long  known  that  it 
was  not  very  uncommon  .for  musket  balls  impinging  obliquely  upon  the  skull  to  be  split. 
According  to  the  velocity  of  the  ball,  it  would  be  partially  or  completely  divided.  In  the 
former  case  the  missile  would  remain  astride,  as  it  were,  of  the  wall  of  the  skull ; in  the 
latter,  one  fragment  would  penetrate  into  the  brain  cavity  and  the  other  would  fly  off  or 
lodge  under  the  aponeuroses  or  scalp.  Larrey  and  Hennen  and  Guthrie  refer  to  such 
instances.  It  was  believed  by  Macleod  and  others  that  with  the  general  introduction  of  the 
conoidal  ball,  such  forms  of  injury  would  be  seldom  observed ; but  experience  has  shown 
that,  when  moving  at  a low  rate  of  velocity,  the  elongated  ball  is  as  liable  to  split  on  striking 
sharp  angles  of  bone  as  the  round  ball.  Mr.  Wall,  surgeon  of  the  38th,  and  Dr.  Longmore, 
of  the  19th  British  regiments,  recoixfl  examples  from  the  Crimean  campaign  of  conical  balls 
splitting  on  the  cranial  bones.  The  Army  Medical  Museum  possesses  many  such  specimens. 
In  addition  to  those  referred  to  at  page  163  and  page  170  of  this  work,  the  histories  con- 
nected with  a few  others  of  the  more  interesting  specimens  may  be  noted : 

Case. — Lieutenant  Charles  W.  Burd,  Co.  F,  4th  Maine  Volunteers,  aged  26  years,  was  admitted  to  the  Hygeia  Hospital 
at  Old  Point  Comfort,  Virginia,  on  February  20th,  1832,  from  the  prison  in  Richmond  in  which  he  had  been  incarcerated.  He 
had  been  struck  at  the  first  battle  of  Bull  Run,  July  21st,  1861,  on  the  left  side  of  the  frontal  bone  by  a round  musket  ball,  and 
was  supposed  by  his  comrades  to  have  been  mortally  wounded.  He  was  made  a prisoner  and  conveyed  to  Richmond.  A pro- 
jection was  felt  under  the  sc.alp  about  four  inches  from  the  wound  in  the  integument  and  an  incision  was  made  over  it,  from  which 
half  a bullet  tvith  a polished  cut  surface  was  extracted.  He  remained  seven  months  at  Richmond,  during  which  time  the  wound 
in  his  forehead  continued  open  and  suppurated  freely.  On  his  release  he  was  examined  at  the  hospital  at  Fort  Monroe,  by  Sur- 
geon John  M.  Cuyler,  U.  S.  A.,  who  discovered  a metallic  substance  deep  in  the  wound,  after  dilating  the  small  fistulous  opening 
by  tents  and  an  incision  upward.  The  foreign  body  was  extracted  and  proved  to  be  a portion  of  the  ball  having  imbedded  in  it  a 
small  fragment  of  bone.  On  February  27th,  after  repeated  efforts,  the  remainder  of  the  ball  was  extracted  and  a piece  of  the 
inner  table  of  the  skull  which  had  been  driven  before  the  ball  was  als6  removed.  It  w.'is  found  that  the  ball  having  split  upon 
the  external  table,  and  one-half  passing  inward,  impinged  against  the  inner  table,  and  again  was  nearly  divided  and  firmly 
embraced  a portion  of  the  inner  table  in  the  fissure  thus  formed.  On  February  2Sth,  two  pieces  of  the  inner  table  which  had  been 
driven  down  before  the  ball,  were  jextracted,  one  measuring  ten  lines  in  length  and  five  lines  in  breadth,  the  .other  piece  was 
small.  The  patient  afterwards  came  under  the  care  of  Dr.  John  Mason  Warren,  of  Boston,  who  has  printed  an  account  of  the 
case  in  his  instructive  work.^  The  case  is  also  reported  in  the  surgical  report  in  Cii'cular  6,  of  this  Office,  for  1865.^  Lieutenant 
Burd  recovered  and  rejoined  his  regiment  and  served  during  the  war,  and  was  mustered  out  on  August  2d,  1866,  and  pensioned. 
Pension  E.xaminer  John  G.  Brookes  reports  in  July,  1887,  that  this  officer  had  fullness  and  giddiness  of  the  head,  and  some  pain 
and  mental  dullness  if  he  took  cold.  He  resided  at  Belfast,  Maine,  and  his  disability  was  rated  at  three-fourths  and  permanent. 
The  history  of  the  case  is  compiled  from  various  sources,  the  notes  at  Fort  Monroe  being  recorded  by  Medical  Cadet  Charles  A. 
Devendorf,  U.  S.  A. 


' Addenda  to  Lite  Sixth  Edition  of  Guthrie's  Commentaries,  p.  (M3,  el  seq. 

^ WAliltEN,  Surgical  Observations  and  Cases,  I3cstou,  18()7,  i).  543.  ^Circular  No.  6,  tS.  G.  O.,  18G5,  p.  18. 


GUNSHOT  FllACTURES  OF  BOTH  TABLES  OF  THE  SKULL. 


181 


Case. — Corporal  John  N- 


FIG.  93. — Section  of  a frontal  bone,  with  a split 
musket  ball  impacted  at  the  left  frontal  eminence. 
Spec.  1293,  A.  M.  M. 


Fig.  94. — Interior  view  of  specimen  No. 
1293,  A.  M.  M. 


ed  18  year.s,  Co.  H,  159th  New  York  Volunteers,  was  strftck  on  the  left  side  of  the 
forehead  on  April  14th,  18G3,  in  an  engagement  at  Irish  Bend,  Louisiana,  by  a round  musket  ball.  He  was  admitted  to  the 

University  Hospital,  at  New  Orleans,  on 
April  17th.  The  ball  had  been  removed  on 
the  field.  Several  dejiressed  fragments  of 
bone  wei’e  removed,  and  cold  water  dress- 
ings were  applied.  The  case  progressed 
without  a bad  symptom  until  Ajiril  30th, 
when  there  were  clonic  spasms,  which,  after 
a few  hours,  were  followed  by  a semi-com- 
atose  condition,  which  continued  until  death, 
on  May  2d,  1863.  A necroscopic  examina- 
tion revealed  extensive  meningitis,  and  a 
large  abscess  of  the  left  cerebral  hemisphere. 

The  lateral  ventricles  were  filled  with  sero- 
purulent  matter.  The  surfaces  of  the  pons 

Varolii-  and  of  the  medulla  oblongata  were  covered  with  lymph.  The  specimen 
was  forwarded  by  Assistant  Surgeon  P.  H.  Conner,  U.  S.  A.,  and  is  represented  in  the  adjacent  wood-cuts,  (Fig.  93 
and  Fig.  94.) 

Case.— Private  C.  C.  W , Co.  I,  6th  Wisconsin  Volunteers,  aged  twenty-one  years,  was  wounded  at  Spottsylvania, 

May  12th,  1864,  and  was  taken  to  the  field  hospital  of  the  4th  division  of  the  Fifth  Corps,  and  after  the  application  of  cold 
lotions  to  the  scalp,  was  sent  to  Fredericksburg,  and  thence  to  Washington,  where  he  was  admitted  into  Douglas  Ilosjntal  four  days 
after  the  reception  of  the  injury.  Here  it  was  ascertained  that  the  cranium  was  fi’actured  ;_but  the  symptoms  were  not  urgent, 
being  limited  to  slight  paralysis  of  the  right  upper  extremity,  and  operative  interference  was  deferred.  On  May  31st,  a 

colloidal  musket  ball  and 
sevei'al  fragments  of  the 
left  ]iarietal  were  removed 
by  Assistant  Surgeon  W. 

F.  Norris,  U.  S.  A.  One 
large  fragment  of  the  vit- 
reous plate  was  pressing 
on  the  dura  mater ; and 
this  was  elevated  and  re- 
moved. The  next  day, 
symptoms  of  compression 
of  the  brain  were  mani- 
fested. An  exploration  of 
the  wound  was  made,  and 
a quantity  of  pus  was  evac- 
uated. On  June  4th,  1864,  twenty-three  days  after  the  injury,  the  case  terminated  fatally.  At  the  autopsy  the  arachnoid  was 
found  little  altered.  There  was  an  abscess  in  the  posterior  lobe  of  the  left  hemis]ihere,  near  the  longitudinal  sinus,  of  the  size  of 
a walnut,  with  walls  of  a greenish-yellow  color,  and  communicating  with  the  lateral  ventricle.  The  right  ventricle  was  filled 
with  sero-sanguinolent  fluid.  There  was  a deposition  of  lymph  at  the  base  of  the  brain,  extending  from  the  medulla  oblongata  to 
the  optic  commissure.  The  specimen  and  facts  connected  with  it  were  contributed  by  Assistant  Surgeon  William  Thomson, 
U.  S.  A.  The  inner  surface  of  the  left  parietal,  near  the  fracture,  is  carious.  Externally  both  parietals  jiresent  over  their  entire 
surface  the  traces  of  the  results  of  periostitis. 


Fig.  95. — Skull-cap,  fractured  near  the  vertex,  by  a 
musket  ball  which  has  split.  Spec.  3543,  Sect.  I,  A.  M.  M. 


Fig.  96. — Interior  view  of  the  specimen.  No.  3543,  A.M.  M. 


Case. — Sergeant  J.  N.  H , Co.  K,  19th  Maine  Volunteers,  aged  36  years,  was  struck  on  the  right  side  of  the 

head  by  a musket  ball,  in  a skirmish  at  Morton’s  Ford,  on  the  Rappahannock,  February  6th,  1864.  The  ball  was  smoothly 

cut  in  two,  one  half  lodging  under  the  scalp,  and  the  other 
passing  into  the  brain.  The  patient  was  perfectly  rational 
until  Fehruaiy  11th,  when  his  mind  wandered  at  times. 

On  the  12th,  Surgeon  Justin  Dwinelle,  106th  Pennsylvania 
Volunteers,  extracted  the  fragment  of  the  ball  which  had 
buried  itself  in  the  brain.  Its  track  communicated  with 
the  right  lateral  ventricle.  The  other  portion  of  the  ball 
had  been  removed  from  under  the  scalp  immediately  after 
the  injury.  When  the  patient  recovered  from  the  influence 
of  the  chloroform,  he  was  I’ational,  and  continued  so  for 
twenty-four  hours  or  more;  hut  coma  came  on  gradually, 
and  death  took  place  on  February  15th,  1864.  The  left 
ventricle  was  found  filled  with  pns.  Tlie  specimen  was 
contributed  by  Dr.  Dwinelle,  and  is  figured  in  the  adjacent 
wood-cuts,  (Figs.  97  and  98.) 


Fig.  97. — Section  of  right  p.arietal  on 
which  a conoidal  musket  1)all  has  split. 
SiKC.  2121,  Sect.  I,  A.  M.  M. 


Fig.  9P. — Interior  view  of  speci- 
men 2121,  Sect.  I,  A.  M.  M. 


182 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Sergoant  Simon  15.  Scholl,  Co.  E,  82il  Pennsylvania  Volunteere,  aged  21  years,  was  wounded  at  the  battle  of 
S])ottsylvania,  May,  1884,  by  a musket  ball  which  penetrated  and  fractured  the  fi-ontal  bone  a little  to  the  left  of  and  involving 
the  median  line,  making  an  opening  three-fourths  by  one-half  inch ; then  split  into  two  parts,  one  of  which  lodged  beneath 
tlie  scalp  at  a corresponding  point  on  right  side,  the  other  splintered  the  crista  galli  in  its  course  and  lodged  just  over  the 
ethmoidal  cells,  the  roof  of  which  it  jtartially  destroyed.  The  patient  was  insensible  a short  time  previous  to  being  admitted 
to  the  3d  division  of  the  Sixth  Corps  Hospital.  On  May  24th,  he  was  sent  to  Mount  Pleasant  Hospital,  Washington,  and  on 
M.ay  30th  to  Cuyler  Hospital,  Philadelphia.  On  admission  to  the  latter  hospital  he  was  much  exhausted  and  depressed, 
becoming  towards  evening  feverish,  with  pain  in  head.  A portion  of  the  ball  was  removed  from  beneath  the  scalp  by  counter 
opening.  For  two  weeks  the  only  ))rominent  symptoms  were  headache,  constipation,  and  vomiting,  followed  afterward  by 
insomnia  and  great  jactation.  On  June  18th,  the  patient  became  almost  completely  comatose.  He  could  be  aroused  oidy 
with  ditliculty  and  relapsed  almost  immediately.  The  left  pupil  became  contracted,  while  the  right  was  widely  dilated,  both 
being  insensible  to  light.  He  died  June  18th,  1864.  At  the  autopsy  the  membranes  were  found  to  contain  a fine  arterial 
injection,  the  venous  trunks  also  being  considerably  engorged.  The  brain  presented  a moderate  degree  of  interstitial  congestion. 
A large  abscess  was  found  in  the  lower  part  of  the  anterior  lobe  of  the  right  hemisphere,  containing  about  three  ounces  of 
greenish,  flocculent  pus,  mingled  with  broken-down  brain  substance.  Several  spiculm  of  bone  were  found  penetrating  the 
membranes,  and  a snuill  clot  of  coagulable  lymph  showed  at  once  the  original  seat  of  injury,  and  the  point  at  which  suppuration 
had  begun.  A point  of  interest  in  this  case  was  the  rudimentary  state  of  the  frontal  sinus,  an  anatomical  variation  from  the 
customary  condition,  to  which  may  ])robably  be  attributed  the  fatal  result,  since  tlie  portion  of  the  ball  which  in  this  case  pene- 
trated the  cranium  would  in  an  ordinary  skull  have  lodged  in  the  frontal  sinus.  The  case  is  reported  by  Assistant  Surgeon 
Henry  S.  Schell,  U.  S.  A. 

Case. — Private  Thomas  Spratt,  Co.  G,  2d  California  Cavalry,  was  wounded  in  Owen’s  Valley,  California,  April  10th, 
1863,  while  fighting  Indians,  by  a two  and  a quarter  ounce  ball,  which  entered  the  skull  one  inch  and  a quarter  above  the  outer 
angle  of  the  right  eye,  driving  fragments  of  bone  into  the  brain.  The  missile  split,  one  part  going  beneath  the  scalp  for  one  inch, 
and  the  remainder  entering  the  brain.  At  the  end  of  April,  1863,  the  patient  was  walking  about,  doing  well.  He  was  discharged 
September  27th,  1864,  and  his  name  does  not  appear  on  the  pension  list.  The  case  is  reported  by  Assistant  Surgeon  G.  H.  Horn, 
2d  California  Cavalry. 

The  following  patients,  with  depressed  gunshot  fracture  of  the  cranium,  recovered 
without  any  disability,  and  were  returned  to  duty  : 

Case. — Private  John  Woods,  Co.  H,  63d  Pennsylvania  Volunteers,  aged  29  years,  was  wounded  at  the  battle  of  Bull 
Run,  Virginia,  August  29th,  1862,  by  a buckshot  which  fractured  and  depressed  the  right  frontal  eminence,  causing  a wound 
of  the  scalp  about  an  inch  in  extent,  to  which  cold  water  dressings  were  applied.  The  patient  was  sent  to  Philadelphia,  and 
was  admitted  into  the  Broad  and  Cherry  Streets  Hospital,  his  general  condition  being  good.  The  case  progressed  satisfactorily 
until  September  9th,  when  the  patient  was  seized  with  violent  headache,  followed  by  convulsions,  insensibility,  and  stertorious 
breathing.  At  the  end  of  twenty-four  hours  consciousness  returned ; his  intellect,  however,  remained  dull.  Twice  subsequently 
'Convulsions  of  a few  minutes’  duration  occurred.  The  wound  healed  rapidly,  and  about  the  end  of  October  a hard  substance  was 
observed  beneath  the  integuments  near  the  seat  of  injury,  which  was  removed  and  proved  to  be  a flattened  buckshot.  The 
patient  was  returned  to  duty  December  14th,  1862.  The  case  is  reported  by  Surgeon  John  Neill,  U.  S.  V. 

Case. — Private  Jasper  S , 18th  Missouri  Volunteers,  received  at  the  battle  of  Shiloh,  Tennessee,  April  6th,  1862,  a * 

gunshot  fracture  of  the  os  frontis,  a little  above  and  back  of  the  frontal  eminence,  the  bone  being  depressed  half  an  inch  and  the  size 
of  the  ball.  He  was  insensible  when  brought  to  the  hospital.  With  expectant  treatment,  quiet,  and  low  diet,  he  became  rational, 
and  in  less  than  three  weeks  recovered  his  usual  health.  Assistant  Surgeon  G.  B.  Houts,  18th  Missouri  Volunteers,  rej)orts  the 

case,  and  adds  that  on  his  return  from  the  army  he  saw  S , and  learned  that  the  latter  had  not  suffered  from  any  cerebral 

trouble  after  his  discharge  from  service. 

Case. — Sergeant  Joseph  Demaro,  Co.  E,  5th  Vermont  Volunteers,  aged  23  years,  was  wounded  in  an  engagement  near 
Funkstown,  Maryland,  July  10th,  1863,  by  a conoidal  musket  ball  which  apparently  produced  a trivial  wound  of  the  scalp  on 
the  light  side  of  the  head.  He  was  sent  to  the  hospital  at  Point  Lookout,  and  on  the  10th  of  August  was  transferred  to  the 
Brattleboro’  Hospital  in  Vermont.  It  was  now  evident  that  the  skull  was  fractured  and  measurably  depressed.  The  treatment, 
as  far  as  recorded,  consisted  chiefly  in  the  application  of  simple  dressings  to  the  wound.  No  unfavorable  symptoms  occurring,  the 
patient  was  returned  to  duty  October  12th,  1863.  He  is  not  on  the  Pension  List. 

The  following  patients  with  depressed  gunshot  fracture  of  the  cranial  bones,  recovered 
with  but  slight  disability  and  were  transferred  to  the  Veteran  Reserve  Corps,  or  furloughed, 
or  discharged  on  the  expiration  of  their  terms  of  service  : 

Case. — Private  John  T.  Brown,  Co.  A,  86th  Illinois  Volunteers,  aged  18  years,  was  wounded  near  Rome,  Georgia, 
M.ay  17th,  1864,  by  a buckshot  which  fractured  the  frontal  bone  at  the  superciliary  ridge  above  the  internal  angle  of  the  left 
orbit,  casing  a slight  depression.  He  was  sent  to  the  hospital  of  the  2d  division.  Fourteenth  Corps,  and  on  June  2d  was  sent 
to  the  hospital  at  Nashville,  Tennessee.  On  June  4th  he  was  transferred  to  the  Joe  Holt  Hospital,  Jeffersonville,  Indiana; 
thence  was  sent  to  Jefferson  Barracks  Hospital,  St.  Louis.  Lead-water  dressings  had  been  appliwl  to  the  wound  during  this 
time.  On  the  9th  of  July  he  was  sent  to  Quincy,  Illinois’  suffering  pain  in  the  frontal  region.  He  was  unable  to  endure  the 


GUNSHOT  FEACTUEES  OF  BOTH  TABLES  OF  THE  SKULL. 


183 


heat  of  the  sun,  but  his  appetite  was  good.  His  healtli  continued  fair,  thougli  he  experienced  occasional  headache.  On  February 
13th,  1865,  he  was  transferred  to  the  1st  battalion  Veteran  Eeserve  Corjis.  The  case  is  reported  by  Surgeon  D.  G.  Brinton, 
U.  S.  V.  He  is  not  on  the  Pension  List. 

Case. — Sergeant  Eichard  M.  Cunningham,  Co.  D,  21st  Iowa  Volunteers,  aged  39  years,  was  wounded  at  the  battle  of 
Port  Gibson,  Mississippi,  May  1st,  1863,  by  a conoidal  ball  which  fractured  the  os  frontis,  slightly  depressing  the  bone.  He 
was  admitted  to  the  Van  Buren  hospital,  Milliken  Bend,  Louisiana,  and  on  August  11th  sent  to  the  hospital  steamer  C.  Mc- 
Dougall.  The  case  progressed  favorably  and  by  the  17th  of  August  the  wound  in  the  scalp  had  nearly  healed.  The  patient’s 
mind  was  unimpaired  and  his  general  health  good.  On  August  18th  he  was  admitted  to  the  convalescent  hospital,  Benton 
Barracks,  Missouri,  and  thence  sent  to  duty  in  the  Veteran  Eeserve  Corps,  on  November  28th,  1863.  The  case  is  reported  by 
Acting  Assistant  Surgeon  Thomas  Evans.  This  man  was  discharged  from  service  June  29th,  1865,  and  pensioned.  On 
December  16th,  1867,  Pension  Examiner  A.  B.  Hanna,  reports  him  suffering  from  cephalalgia,  vertigo,  and  discharge  of  pus 
from  the  left  ear. 

Case. — Private  James  L.  Adams,  Co.  D,  11th  Illinois  Volunteers,  received,  at  the  battle  of  Jonesboro’,  Georgia,  Sep- 
tember 1st,  1864,  a wound  of  the  head  from  a shell  fragment,  with  fracture  of  the  right  side  of  the  frontal  bone  with  slight 
depression.  He  was  admitted  into  the  field  hospital  of  the  2d  division.  Fourteenth  Army  Corps,  and  about  October  28th  he  was 
admitted  into  the  No.  15  Hospital,  Nashville.  He  was  mustered  out  of  service  June  8th,  1865.  On  October  9th,  1869,  Pen- 
sioner Examining  Surgeon  G.  S.  Owen,  reported  that  this  patient,  whose  claim  for  a pension  was  still  pending,  became  partially 
insane  if  he  attempted  to  labor,  and  rated  his  disabilities  at  three-fourths  and  permanent. 

Case. — Private  Fielding  Parsons,  Co.  D,  11th  West  Virginia  Volunteers,  .aged  26  years,  Avas  wounded  at  the  battle  of 
Winchester,  Virginia,  September  19th,  1864,  by  a conoidal  musket  ball  which  entered  the  frontal  bone  above  the  left  eye  and 
lodged,  producing  a fracture  and  depression.  He  was  sent  to  a field  hospital ; thence  was  conveyed  by  way  of  Sandy  Hook  and 
Baltimore  to  York,  Pennsylvania,  where  he  was  admitted  into  the  general  hospital  on  October  4th.  The  patient  was  returned 
to  duty  on  October  28th,  1864 ; but  on  November  1st  he  was  again  admitted  to  the  general  field  hospital  at  Parkersburg, 
West  Virginia,  Avhere  the  missile  was  extracted.  Having  deserted  on  Febru.ary  24th,  1865,  nothing  Avas  known  of  him 
until  May  27th,  Avhen  he  Avas  admitted  fiom  the  Soldiers’  Rest  Hospital  into  the  Sickels’  Barracks  Hospit.al  at  Alexandria, 
Virginia.  He  Avas  discharged  the  service  on  July  6th,  1865,  in  obedience  to  General  Order  No.  77,  A.  G.  O.,  W.ar  Department, 
and  in  1868  Avas  pensioned,  his  disability  being  rated  at  three-fourths  and  temporary.  The  case  is  reported  by  Sm-geon  E. 
Bentley,  U.  S.  V. 

Case. — Private  John  LoveAvell,  Co.  A,  188th  NeAV  York  Volunteers,  aged  42  years,  Avas  Avounded  .at  the  battle  of  .South 
Side  Railroad,  Virginia,  October  27th,  1864,  by  a conoidal  musket  ball  Avhich  fractured  and  depressed  a portion  of  the  frontal 
bone  over  the  right  superciliary  ridge.  He  Avas  admitted  into  the  1st  division.  Fifth  Corps  hospital ; thence  Avas  conveyed  to 
Washington,  and  admitted  on  the  30th  into  Emory  Hospital.  The  patient  was  furloughed  in  December,  and  returned  to  duty 
April  4th,  1865.  Being  still  unfit  for  duty,  he  Avas  admitted  tAvo  days  afterw.ard  into  the  Sickel’s  Barracks  at  Alexandria,  and 
Avas  finally  discharged  the  service  June  3d,  1865,  and  pensioned,  his  disability  being  rated  temporary. 

Case. — Private  IF.  M.  Taylor,  Co.  K,  10th  Alabama  Regiment,  Avas  wounded  on  July  2d,  1863,  by  a grape-shot  Avhich 
fractured  and  depressed  a portion  of  the  frontal  bone.  He  was  admitted  into  the  2d  division  of  the  Alabama  Hospital  at  Rich- 
mond, and  on  J uly  22d  he  was  furloughed. 

Case. — Private  Timothy  Donovan,  Co.  H,  29th  Maine  Volunteers,  aged  24  years,  Avas  wounded  at  the  battle  of  Cedar 
Creek,  Virginia,  October  19th,  1864,  by  a piece  of  shell  Avhich  fractured  the  external  table  of  the  frontal  bone  to  the  left  of  the 
median  line.  On  October  22d  he  was  admitted  to  the  Satterlee  Hospital,  Philadelphia,  Avhere  expectant  treatment  Avas  used, 
under  Avhich  the  Avound  healed  rapidly,  and  on  J.anuary  18th,  1865,  the  patient  Avas  transferred  to  the  Veteran  Reserve  Corps. 
He  Avas  discharged  the  service  September  19th,  1865,  because  of  general  debility  and  headache,  and  Avas  pensioned,  his  disability 
being  rated  one-half,  and  its  probable  duration  as  doubtful. 

The  following  patients,  with  gunshot  depressed  fractures  of  the  cranial  bones,  died  from 
compression  of  the  brain,  following  the  injury,  and  produced  by  extravasation  of  blood 
within  the  skull.  Their  cases  presented  no  marked  peculiarities ; 

Case. — Private  John  Ernst,  Co.  C,  35th  loAva  Volunteers.  Gunshot  fracture  of  frontal  bone.  Vicksburg,  Mississippi, 
June  8th,  1863.  Conoidal  musket  ball.  Treated  at  Fifteenth  Corps  hospital.  Died  June  12th,  1863. 

Ca.se. — Corporal  W.  Johnson,  Co.  H,  15th  Wisconsin  Volunteers,  aged  30  years.  Gunshot  fracture  of  frontal  bone  by 
conoidal  musket  ball.  Resaca,  Georgia,  M.ay  14th,  1864.  Tre.ated  in  hospital  No.  1,  at  Nashville.  Died  .June  16th,  1864. 

Ca.se. — Private  Joseph  WarAvick,  Co.' A,  26th  Michigan  Volunteers,  Avas  Avoundcd  at  the  battle  of  Mine  Run,  Virginia, 
November  27th,  186.3,  by  a conoidal  ball  Avhich  struck  in  the  centre  of  the  forehe.ad  .and  .apparently  penetrated  the  bone.  He 
Avas  sent  to  the  hospit.al  of  the  1st  division,  Second  Corps,  thence  Avas  conveyed  to  Alexandria,  and  on  D(«ember  4th 
was  admitted  to  the  1st  division  hospital  in  a state  of  insensibility.  Consciousness  never  returned,  and  death  ensued 
December  6th,  1863. 

Case. — Private  A.  B , a Confederate  soldier,  Avas  Avounded  at  the  siege  of  Fort  Donelson,  February  16th,  1862,  by 

a musket  ball  Avhich  entered  the  skull  at  the  right  frontal  eminence.  He  w.as  conveyed  to  Nashville,  and  on  the  evening  of 
February  18th  Avas  admitted  to  the  Academy  Hospital.  He  sidl'ered  no  pain,  and  was  even  cliecrful.  Confederate  Surgeon 


184 


WOUNDS  AND  INJUIUES  OF  THE  HEAD 


Madden  after  having  anajsllietizcd  tlie  patient  explored  tlie  wound.  Upon  making  a crucial  incision  a largo  depression  was 
disclo.sed.  He  failed  to  detect  any  foreign  substance  cither  with  the  probe  or  forefinger,  which  was  introduced  in  the  direction 
of  the  left  ptirietal  eminence.  Keaction  wtis  prompt,  and  a few  hours  after  the  ])atient  was  about  the  wards.  He  took  his 
supper  with  relish  and  slept  well  during  the  night.  On  awaking,  however,  he  complained  of  pain  in  the  head  which  steadily 
increased.  There  were  no  symptoms  of  delirium.  Death  occurred  February  22d,  1862.  The  case  is  reported  by  Surgeon  Eben 
Swift,  U.  S.  A. 

Cask. — Private  Charles  Braithwait,  Co.  F,  22d  Wisconsin  Volunteers,  aged  20  years.  Gunshot  fracture  and  depression 
of  frontal  bone.  Marietta,  Georgia,  June  25tli,  1864.  Treated  at  Twentieth  Corps  and  Chattanooga  hospitals.  Died  July  27th, 
1864. 

Case. — Corporal  H.  Louth,  Co.  F,  27th  Michigan  Volunteers.  Gunshot  fi-acture  of  frontal  bone  with  depression,  by  a 
shell  fragment.  Petersburg,  Virginia,  June  17th,  1864.  Treated  at  field  hospital.  Died  June  ISth,  1864. 

Case. — Private  T.  A.  Brockway,  Co.  G,  16th  Michigan  Volunteers.  Gunshot  depressed  fracture  of  the  frontal  bone. 
Treated  at  Fifth  Corps  hospital.  Died  May  12th,  1863. 

Case. — Charles  Mervin,  a seaman  of  the  gunboat  Pittsburgh,  was  wounded  at  the  siege  of  Fort  Donelson,  February  14th, 
1862,  by  a piece  of  shell  which  struck  the  right  frontal  eminence.  He  walked  from  the  boat  to  the  hospital  at  Mound  City, 
whore  he  arrived  February  20th.  The  injury  being  considered  slight,  he  seemed  to  do  well  until  four  o’clock  p.  m.  on  February 
24th,  when  he  w'as  seized  with  nausea  and  vomiting,  wdiich  were  followed  by  delirium  and  death.  At  the  post  mortem  exam- 
ination an  extensive  fracture  with  dejtression  of  the  internal  table  was  revealed,  and  a spiculte  of  bone  was  found  driven  into  the 
substance  of  the  brain.  A clot  was  found  between  the  calvaria  and  dura  mater.  There  was  a fissure  two  inches  long  in  the 
outer  table;  but  the  pericranium  was  unbroken.* 

The  following  are  examples  of  intra-cranial  abscesses  following  depressed  gunshot 
fractures  of  the  skull : 

Case. — Private  Thomas  Bradley,  Co.  B,  6th  New  Hampshire  Volunteers,  aged  43  years,  was  wounded  at  the  battle  of 
Cold  Harbor,  Virginia,  June  3d,  1864,  by  a conoidal  musket  ball  which  fractured  and  depressed  the  frontal  bone  at  the  median 
line  and  lodged  under  the  aponeurosis.  He  was  admitted  on  the  7th,  into  the  1st  division  hospital  at  Alextindria,  where  the 
missile  was  extracted  on  the  13th.  Death  resulted  on  June  23d,  1864.  The  autopsy  revealed  an  abscess  between  the  dura 
mater  and  the  brain,  near  the  scat  of  fracture,  and  on  section  a considerable  extravasation  of  tiuid  was  found  in  the  ventricles. 
The  case  is  reported  by  Surgeon  E.  Bentley,  U.  S.  V. 

Case. — Private  John  J.  Griffith,  Co.  H,  107th  New  York  Volunteers,  aged  24  years,  received,  near  Atlanta,  Georgia, 
July  28th,  1864,  a gunshot  fracture  of  the  skull.  The  missile  entered  over  the  left  eye  at  the  superciliary  ridge,  fracturing  the 
os  frontis  for  two  inches.  He  also  received,  in  the  same  engagement,  a wound  of  the  hand.  He  was  immediately  admitted  to 
the  hospital  of  the  1st  division.  Twentieth  Corps,  where  the  forefinger  was  amputated.  On  August  2d,  he  was  sent  to  the  field 
hospital  at  Chattanooga,  where  he  died  on  Augest  21st,  1864.  At  the  autopsy,  an  abscess  about  the  size  of  a hen’s  egg  was  found 
immediately  beneath  the  fracture.  The  left  arachnoid  cavity  was  filled  with  cream-like  pus.  At  the  base  of  the  brain  twelve 
ounces  of  straw-colored  fluid  were  discovered.  The  ventricles  were  distended  with  the  same  fluid. 

Case. — Lieutenant  Charles  L.  F , Co.  K,  Cth  New  Hampshire  Volunteers,  was  wpunded  at  the  battle  of  Bull  Run, 

Virginia,  August  29th,  1862,  by  a musket  ball  which  penetrated  the  squamous  portion  of  the  temporal  bone.  He  was  conveyed 
to  Washington,  and  admitted  to  Carver  Hospital,  where  he  died  on  September  14th,  1862.  The  autopsy  revealed  fragments  of 
bone  ])ressing  upon  the  dura  mater,  and  also  a collection  of  pus  in  the  vicinity  of  the  wound.  The  pathological  specimen  is 
No.  139,  Section  I,  A.  M.  M.  Poi'tions  of  the  ball  remain  imbedded  in  the  depressed  fragments  of  the  bone.  Three  fragments 
remain  in  situ,  two  of  which  are  depressed  about  one-fourth  of  an  inch.  The  specimen  was  contributed  by  Surgeon  O.  A. 
Judson,  U.  S.  V. 

Case. — Private  Charles  O.  Homan,  Co.  D,  92d  New  York  Volunteers,  aged  22  years,  was  wounded  near  Kinston,  Noi-th 
Carolina,  December  14th,  1882,  by  a missile,  which  fractured  the  squamous  portion  of  the  temporal  bone,  driving  a spicula  of 
bone  through  the  dura  mater,  and  lodged  in  the  posterior  border  of  the  right  temporal  muscle,  whence  it  was  extracted  soon 
after.  He  was  conveyed  to  New  Berne,  and  on  December  21st  was  admitted  to  Stanley  Hospital.  His  condition  was  bad.  He 
lingered  in  much  pain  and  in  a semi-conscious  condition  until  December  28th,  when  delirium  set  in,  which  continued  with  intervals 
of  remission  until  death  occurred,  December  29th,  1862.  At  the  autopsy,  the  vessels  of  the  cephalic  membrane  were  found  to  be 
injected  with  more  than  thrice  the  usual  amount  of  blood.  One-third  of  the  right  cerebral  hemisphere  appeared  softened,  and 
a ditfused  abscess  containing  six  drachms  of  pus  lay  directly  under  the  seat  of  injury,  extending  down  to  the  petrous  portion 
of  the  temporal  bone.  The  case  is  reported  by  Acting  Assistant  Surgeon  J.  Baxter  Upham. 

Case. — Private  William  Nash,  Co.  G,  46th  Ohio  Volunteers,  received,  at  the  battle  of  Dallas,  Georgia,  May  27th,  1864,  a 
gunshot  fracture  of  both  tables  of  the  frontal  bone,  a little  to  the  left  of  the  junction  of  the  coronal  with  the  sagittal  suture.  He 
was  admitted  to  the  field  hospital.  Fifteenth  Corps,  and  experienced  only  little  trouble  from  the  wound  until  June  4th,  when  a 
convulsion  occurred.  From  that  time  he  remained  in  a semi-comatose  condition  until  death,  which  took  place  June  19th,  1864. 
The  autopsy  revealed,  a little  posterior  to  the  fracture,  an  abscess,  which  extended  into  the  convolutions  of  the  brain.  The  gray 
substance  was  destroyed  for  a distance  of  one  and  a half  inches.  The  case  is  reported  by  Surgeon  D.  J.  Swarts,  100th  Indiana 
Volunteers. 


‘ This  case  is  also  reported  in  Fkaxklix's  Science  and  Art  of  Surgery,  St.  Louis,  1867.  Vol.  1,  p.  696. 


CAEIES  AND  NECEOSIS  AFTEE  DEPEESSED  GUNSHOT  FEACTUEES. 


185 


Case. — Private  Aaron  Jones,  Co.  F,  14th  Vermont  Volunteers,  aged  36  years,  received  at  the  battle  of  Gettysburg, 
Pennsylvania,  July  3d,  1863,  a gunshot  fracture,  with  slight  depression  of  the  frontal  bone  near  the  median  line,  and  equidistant 
from  its  junction  with  the  vertex  and  nasal  bones.  He  was  admitted  to  Camp  Letterman,  and  on  July  13th  sent  to  Fort  Wood, 
New  York  Harbor.  The  patient  stated  that  after  the  first  shock  of  the  blow  he  felt  no  special  inconvenience  other  than  would 
naturally  result  from  a simple  flesh  wound.  Until  July  16th,  the  patient  was  apparently  very  comfortable;  he  slept  well,  ate 
with  a relish,  and  conversed  intelligently.  On  the  morning  of  that  day,  he  suddenly  fell  into  a semi-comatose  condition, 
characterized  by  hard  and  labored  breathing,  dilated  pupils,  and  at  times  slight,  irregular  convulsive  movements  of  the  limbs. 
He  seemed  unconscious  to  all  external  impressions,  and  at  long  intervals  would  take  a deep  inspiration,  open  his  eyes,  look 
furtively  around,  and  then  relapse  into  his  former  condition.  Counter-irritation  was  applied  to  the  spine  and  extremities,  but 
without  effect.  Death  resulted  July  17th,  1863.  At  the  autopsy,  a wide  spicula  of  bone  was  found  standing  off  from  the  plane 
of  the  surface  of  the  inner  table.  There  was  an  extensive  sufiusion  of  pus  over  the  meningeal  surfaces,  immediately  adjacent 
and  around  the  point  of  fracture ; but  no  burrowing  had  taken  place,  and  the  brain  substance  was  perfectly  health}'.  The 
bone  at  seat  of  fracture  was  very  thick  and  firm,  and  notwithstanding  the  powerful  blow  he  must  have  received,  there  were  no 
symptoms  of  concussion.  The  case  is  reported  by  Acting  Assistant  Surgeon  O.  W.  Gibson. 

Case. — Private  M.  S , Co.  F,  86th  New  York  Volunteers,  aged  25  years,  was  wounded  at  the  battle  of  Beverly 

Ford,  Virginia,  June'  9th,  1863,  by  a musket  ball,  which  fractured  the  squamous  portion  of  the  left  temporal  bone.  He  was 
conveyed  to  Washington,  and  was  admitted  to  the  Lincoln  Hospital  on  June  10th,  where  water  dressings  were  applied.  Death 
occui  red  on  June  28th,  1863.  Autopsy  : The  fracture,  which  had  radiating  fissures,  commenced  one  and  a half  inches  antei-iorly 
to  the  left  ear  and  extended  one  inch  posteriorly,  the  opening  being  filled  with  disorganized  brain.  Upon  the  removal  of  the 
calvaria,  the  left  hemisphere  was  observed  to  be  of  a dark  slate  color,  while  the  appearance  of  the  right  was  natural.  The 
dura  mater  was  lined  with  a dark  unhealthy  fluid.  Pus  also  was  found  in  the  arachnoid  cavity  on  the  left  side.  The  pia  mater 
was  not  afl’ected.  The  inferior  portion  of  the  middle  cornu  was  disorganized,  and  had  doubtless  been  involved  in  the  injury. 
Pus  was  found  upon  the  superior  surface  of  the  cerebellum  on  both  sides.  The  pathological  specimen  is  No.  1344,  Sect.  I,  A.  M.  M., 
and  shows  the  vault  of  the  cranium,  with  the  line  of  section  through  the  fi  actured  bone,  of  which  only  the  upper  part  is  apparent. 
The  specimen  and  history  were  contributed  by  Sui-geon  G.  S.  Palmer,  U.  S.  V. 

JErysipelas. — Allusion  lias  been  made  on  pp.  77  and  101  to  tlie  comparatively  small 
proportion  of  cases  of  erysipelas  that  were  observed  in  gunshot  scalp  wounds  and  contusions 
of  the  cranial  bones,  and  the  remark  is  equally  applicable  to  gunshot  depressed  fractures  of 
the  skull.  This  complication  was  reported  in  but  three  of  three  hundred  and  sixty-three 
cases  of  depressed  gunshot  fracture  of  the  skull : 

Case. — Sergeant  Byron  W.  Worden,  Co.  D,  29th  Indiana  Volunteers,  received  at  the  battle  of  Chickamauga,  September 
19th,  1863,  a gunshot  depressed  fracture  of  the  left  side  of  the  head.  On  October  1st,  he  was  admitted  to  the  hospital  at 
Chattanooga.  Erysipelas  supervened,  but  the  case  progressed  favorably,  and  on  November  19th  the  patient  was  returned  to 
duty.  Not  on  Pension  List. 

Case. — Private  Daniel  B.  Harold,  Co.  C,  21st  Virginia  Kegiment,  was  wounded  at  Gettysburg,  July  2d,  1863,  and  died 
January  7th,  1864,  at  Point  Lookout  Hospital,  from  erysipelas  following  gunshot  depressed  fracture  of  right  parietal. 

Case. — Private  Hutchinson  Miller,  Co.  H,  29th  U.  S.  Colored  Troops,  aged  40  years,  was  wounded  in  the  engagement  at 
Chapin’s  Farm,  Virginia,  October  13th,  1864,  by  a conoidal  musket  ball,  which  produced  a depressed  fracture  of  the  parietal. 
On  the  same  day,  he  was  admitted  to  the  field  hospital  of  the  Tenth  Corps,  and  thence  was  sent  to  the  general  hospital  at  Fort 
Monroe,  where  he  was  admitted  on  the  following  day.  He  died  on  February  24th,  1865,  from  traumatic  erysipelas. 

Caries  and  Necrosis. — Tlie  following  are  cases  of  caries,  or  necrosis,  following  gunshot 
injuries  of  the  cranial  bones  : 

Case.— Private  Adreas  Baumgartner,  Co.  K,  82d  Illinois  Volunteers,  aged  42  years,  was  wounded  at  Chancellorsville, 
May  2,  1863,  by  a round  ball,  which  fractured  the  upper  portion  of  the  occipital  bone.  In  the  same  engagement  he  received  a 
gunshot  wound  of  the  left  orbit.  On  May  15th,  he  was  admitted  to  the  hospital  of  the  3d  division.  Eleventh  Corps;  on  June 
15th,  he  was  sent  to  Lincoln  Hospital,  Washington,  and  on  January  1st,  1864,  was  sent  to  the  Marine  Hospital,  Chicago,  Illinois. 
He  was  discharged  on  May  5th,  1864.  In  December,  1869,  it  was  reported  by  Pension  Examiner  J.  D.  Howell  that  there  was 
necrosis  of  both  tables  of  the  skull,  leaving  the  patient  with  persistent  pain  and  vertigo,  and  general  constitutional  disturbance, 
which  rendered  him  unable  to  earn  a livelihood.  Dr.  Howell  rated  his  disability  at  three-fourths. 

Case.— Sergeant  William  F.  De  Forrest,  Troop  M,  2d  Massachusetts  Cavalry,  was  wounded  at  Ashby’s  Gap,  Virginia, 
July  12th,  1863,  by  a conoidal  musket  ball,  which  entered  the  right  temple  just  above  the  eye,  and  remained  in  the  wound  for 
two  months.  No  further  record  of  the  case  is  on  file  until  December  30th,  1863,  when  the  patient  was  admitted  to  the  Ira  Harris 
Hospital,  Albany,  New  York.  He  was  discharged  September  4th,  1864,  and  pensioned  on  November  1st,  1864.  Pension 
Examiner  S.  D.  W'illard  reported  that  there  was  necrosis  of  the  frontal  hone,  headache,  mental  impairment,  and  inability  to 
bear  exposure  to  the  sun,  which  incapacitated  the  patient  from  earning  a livelihood.  His  disability  was  rated  three-fourths  and 
temporary. 

Case.  Corporal  Joseph  E.  French,  Co.  E,  63d  New  York  Volunteers,  aged  30  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  Virginia,  June  5th,  1864,  by  a fragment  of  shell,  which  fractured  the  frontal  bone.  On  the  9th,  he  was  admitted  to  the 
Fairfax  Seminary  Hospital,  Virginia;  on  the  11th,  was  transferred  to  the  West’s  Building  Hospital,  Baltimore,  and  on  July  11th 
2*^ 


186 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


was  sent  to  tlic  Second  Division  Hospital  at  Annapolis.  Ho  was  fnrlonglied  in  August,  1864,  and  on  January  27tli,  1865,  was 
discharged  from  service  on  surgeon's  certificate  of  disability,  and  jiensioned.  A communication  from  Pension  Examiner  C.  H. 
Dan.a,  dated  April  29th,  1867,  stated  that  the  wound  discharged  freely  and  was  very  offensive.  There  was  ptosis  of  the  right 
eyelid,  and  the  jiatient  suffered  from  frequent  attacks  of  headache  and  vertigo.  His  disability  was  rated  total  and  permanent. 

Case.— Priv.lte  John  Mallon,  Co.  F,  100th  Illinois  Volunteers,  was  wounded  at  the  battle  of  Chickamauga,  Georgia, 
September  20th,  1863,  by  a fragment  of  shell,  which  lacerated  the  scalp  and  fi-actured  the  left  parietal  bone,  causing  but  slight 
depression.  Ho  Avas  taken  ])risoner,  after  a few  days  was  paroled,  and  on  October  6th  was  admitted  to  the  hospital  at  Stevenson, 
Alabama;  thence  he  was  conveyed  to  Nashville,  and  on  the  17th  was  admitted  to  hospital  No.  19.  In  November  he  was 
furloughed,  and  afterwards  received  into  the  Mailue  Hospital,  Chicago,  on  November  25th,  1863.  Caries  of  the  skull  ensued, 
and  still  existed  at  the  time  of  his  discharge  from  service,  June  9th,  1864.  In  a communication  dated  .January  7th,  1868,  the 
Commissioner  of  Pensions  states  that  Mallon  is  a pensionei’,  and  that  his  disability  is  rated  one-half  and  temporary.  Further 
information,  dated  March  4th,  1870,  and  signed  by  three  members  of  an  examining  board,  shows  that  the  wound  was  still 
discharging,  that  the  patient  was  losing  his  memory,  and  th.at  his  disability  was  rated  one-half  and  permanent. 

Case. — Corporal  Nicholas  King,  Co.  F,  18th  Kentucky  Volunteers,  aged  19  years,  was  wounded  at  the  battle  of  Chicka- 
manga,  iSeidemhcr  19th,  1863,  by  a fragment  of  shell,  which  fractured  a portion  of  the  frontal  bone  at  the  right  superciliary 
ridge.  He  was  taken  prisoner,  conveyed  to  Richmond,  exchanged  about  the  24th  of  March,  1864,  was  admitted  to  the  Second 
Division  Hospital  at  Annapolis,  was  transferred  to  the  Chase  Hospital  at  Columbus,  Ohio,  and  was  discharged  the  service 
May  17th,  1864.  There  was  caries  of  the  bone  and  purulent  discharge  from  the  nose.  On  August  8th,  1865,  Pension  Examiners 
Corlis  and  Fcris  reported  that  there  was  still  discharge  and  exfoliation  of  bone  from  the  wound,  attended  with  great  pain  and 
disability.  On  August  14th,  1865,  he  was  pensioned,  his  disability  being  rated  total  and  permanent. 

Case. — Private  Owen  Huggins,  Co.  C,  10th  Vermont  Volunteers,  aged  50  years,  was  wounded  before  Petersburg, 
Virginia,  March  25th,  1865,  by  a conoidal  ball,  which  fractured  the  left  parietal  bone.  He  was  admitted  to  the  hospital  at  City 
Point,  on  the  same  day ; on  April  5th,  was  sent  to  the  Fairfax  Seminary  Hospital ; on  April  12th,  he  was  sent  northward,  and  on 
the  15th,  was  admitted  to  the  Sloan  Hospital  at  Montpelier.  He  was  discharged  the  service  June  28th,  1885,  and  pensioned. 
The  wound  had  not  closed,  and  some  necrosed  bone  remained  undetached.  On  March  28th,  1868,  Pension  Examiner  G.  \V. 
Vanderhull  reported  that  the  bone  was  necrosed  and  depressed.  The  patient  sufl'ered  from  pain  in  the  head  with  loss  of  memory. 
Ilis  disability  was  rated  total  and  permanent. 

Case. — Private  John  Thompson,  Co.  II,  14th  North  Carolina  Regiment,  aged  22  years,  was  wounded  by  a projectile  on 
May  3d,  1863,  which  fractured  a portion  of  the  frontal  bone.  Necrosis  ensued.  On  February  20th,  1865,  he  appeared  before  an 
examining  board  at  Raleigli,  when  he  was  retired  as  permanently  disabled  and  unfit  for  duty  in  any  branch  of  the  service. 

Case. — Private  Owen  McDermott,  Battery  K,  4th  U.  S.  Artillery,  aged  28  years,  was  wounded  at  the  battle  of  Chan- 
cellorsville,  Virginia,  May  3d,  1863,  by  a conoidal  musket  ball,  which  struck  about  two  inches  above  the  left  eyebrow,  and 
slightly  fractured  the  frontal  bone.  On  May  17th,  he  was  admitted  to  St.  Aloysius  Hospital  at  Washington.  On  October  17th, 
he  was  sent  to  Harewood  Hospital,  and  was  discharged  on  November  17th,  1863.  He  re-enlisted  in  Co.  I,  8th  New  Jersey 
Volunteers,  and,  after  the  battle  of  Deep  Bottom,  Virginia,  was  conveyed  from  City  Point  to  the  Beverly  Hospital,  New  Jersey, 
which  he  entered  August  21st,  1864.  On  April  4th,  1865,  he  was  transferred  to  the  Satterlee  Hospital  at  Philadelphia,  and  was 
discharged  from  service  on  July  19th,  1865.  From  injury  to  periosteum,  slight  caries  exists  in  the  vicinity  of  the  wound,  which 
maintains  an  almost  constant  suppurative  discharge.  In  October,  1868,  he  was  a pensioner. 

Case. — Private  A.  J.  Richards,  Letcher’s  Battery,  Pegram’s  Battalion,  aged  18  years,  received,  in  an  engagement  on  the 
Weldon  Railroad,  Virginia,  August  16th,  1864,  a gunsliot  fracture  of  the  right  parietal  bone.  He  was  admitted  to  the  3d 
division,  Chimborazo  Hospital,  Richmond,  on  the  22d,  and  on  March  3d,  1865,  was  retired  by  an  examining  board.  Caries  and 
necrosis  existed,  and  he  suffered  constant  pain  in  the  head,  by  which  he  was  permanently  disabled  and  unfitted  for  any  duty. 

Case. — Private  P.  Smith,  Co.  I,  91st  Ohio  Volunteers,  aged  22  years,  was  wounded  at  the  battle  of  Winchester,  Virginia, 
September  19th,  1864,  by  a conoidal  ball,  which  fractured  the  frontal  bone  two  inches  above  the  left  eye.  On  the  same  day  he 
was  admitted  to  the  hospital  of  the  2d  division.  Army  of  West  Virginia;  thence  was  sent,  on  September  25th,  to  the  Haddington 
Hospital  at  Philadelphia.  Simple  dressings  were  applied  to  the  wound.  On  May  12th,  1865,  he  was  transferred  to  the  Satterlee 
Hospital,  and  was  discharged  the  service  June  6th,  1865,  and  received  a ])ension,  which  was  increased  in  October,  1867.  At  that 
time.  Pension  Examiner  H.  Conkling  reported  a portion  of  the  bone  lost,  the  wound  discharging  frequently,  and  the  patient 
unable  to  obtain  a livelihood  owing  to  frequent  attacks  of  vertigo  and  nausea,  which  were  aggravated  by  exposure  to  the  sun. 
His  disability  is  rated  total  and  permanent. 

Case. — Private  James  W.  Woodward,  Co.  K,  60th  Illinois  Volunteers,  was  wounded  at  Buzzard’s  Roost,  Georgia, 
February  25th,  1864,  by  a piece  of  shell,  which  fractured  the  frontal  sinus  one  inch  above  the  nasal  eminence.  He  was  admitted 
to  the  regimental  hospital  on  the  same  day,  and  on  February  29th  was  sent  to  the  hospital  at  Chattanooga,  Tennessee.  He 
recovered,  was  furloughed  on  April  0th,  1804,  and  finally  was  mustered  out  of  service  on  March  14th,  1805,  and  pensioned. 
Examining  Surgeon  G.  Brattan,  in  a communication  dated  April  20th,  1868,  states  that  there  was  necrosis  of  the  frontal  bone, 
and  that  tlie  wound  had  not  entirely  healed.  The  disability  is  rated  as  total. 

Case. — Private  Charles  Dillman,  Co.  II,  3d  New  Jersey  Volunteers,  was  wounded  at  the  battle  of  Chancellorsville,  May 
3d,  1863.  The  missile  passed  into  the  brain,  near  the  junction  of  the  parietal  and  occipital  bones.  He  was  admitted  to  the 
hospital  of  the  1st  division.  Sixth  Corps.  He  w.as  delirious,  and  would  allow  no  clothing  upon  him.  At  times,  he  would  not 
eat ; at  others,  his  apiiotite  was  ravenous.  He  ])assctl  his  urine  involuntarily,  but  retained  his  fatces.  His  memory  was  totally 
lost.  On  examination,  no  depression  about  the  circumference  of  opening  was  discovered.  Expectant  treatment  was  used,  and 
on  June  1st,  the  patient  was  much  improved.  He  ate  regularly,  slept,  and  his  memory  gradually  returned;  but  he  misplaced 


EXFOLIATIONS  OF  THE  CRANIUM  AFTER  GUNSHOT  FRACTURES. 


187 


words  and  coined  new  ones.  On  June  he  was  sent  to  Armory  Square  Hospital,  Wasliington,  and  on  Jnno  22d,  to  Citizens’ 
Hospital,  Philadelphia.  The  outer  table  of  the  cranium  became  necrosed.  He  was  returned  to  duty  March  9th,  18G4.  On 
June  2Jd,  1884,  he  was  discharged  the  service  and  pensioned,  his  disability  being  rated  one-half;  and  since,  up  to  September 
30th,  1869,  he  has  suffered  fi’om  occasional  attacks  of  epilepsy. 

Case. — Private  Ramsford  Dunsmore,  44th  New  York  Volunteers,  was  wounded  at  Hanover  Court-house,  M.ay  27th, 
1802,  by  a musket  ball,  which  entered  above  the  right  zygoma,  carried  aw.ay  part  of  the  external  ear,  fr.actured  the  petrous 
portion  of  the  temporal  bone,  and  emerged  at  the  base  of  the  occipital  bone.  He  was  delirious  for  one  hour  after  the  reception 
of  the  injury.  Small  pieces  of  bone  were  discharged  from  the  wound,  and  the  mind  was  impaired.  On  August  22d,  1802,  he 
was  admitted  to  the  Ladies’  Home  Hospital,  New  Yoi'k,  from  which  he  was  discharged  September  23d,  1802.  Afterward  there 
was  occasional  pain,  and  the  memory  was  impaired.  'This  patient  is  not  a pensioner. 

Exfoliations  after  Eepressed  Gunshot  Fractures  of  the  Skull. — Instances  of  tlio 
eliminations  of  considerable  portions  of  the  outer  table,  or  of  both  tables  of  the  cranium, 
were  not  infi'equent  results  of  necrosis  following  gunshot  fracture.  Several  illustrations 
have  been  already  cited, ^ and  others  will  be  adduced  in  connection  with  the  subjects  of 
trephining  and  the  removal  of  fragments.  Hence  it  will  be  necessary  to  refer,  in  this 
place,  to  a few  only  : 

Case. — Private  Dominick  Barney,  Co.  H,  8th  Minnesota  Volunteers,  aged  31  years,  was  wounded  at  the  battle  of  Mur- 
freesboro’, Tennessee,  December  14th,  1804,  by  a conoidal  ball,  which  caused  a penetrating  fracture  of  the  petrous  and  squamous 
poi'tion  of  the  left  temporal  bone.  For  a few  days  he  was  treated  in  a field  hospital;  thence  he  was  sent  to  hospital  No.  4, 
Murfreesboro’.'  The  case  progressed  favorably.  On  February  IGth,  1835,  the  patient  was  transferred  to  Nashville,  and  tlience, 
in  March,  to  Jefferson  Barracks  near  St.  Louis.  He  was  discharged  from  service  on  May  21st,  1865.  On  March  29th,  1866, 
Pension  Examiner  J.  F.  Scholl  reported  that  exfoliation  was  still  going  on.  The  sinus,  immediately  above  the  meatus,  w'as 
constantly  discharging  matter,  as  well  as  the  meatus  itself.  The  hearing  was  completely  destroyed  on  one  side.  The  mind 
was  much  impaired.  He  rated  his  disability  total  and  temporary. 

Case. — Private  Charles  E.  Patch,  Co.  C,  14th  New  Jersey  Volunteers,  aged  19  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  Virginia,  June  1st,  1864,  by  a gunshot  missile,  which  entered  the  face,  between  the  inferior  and  superior  maxillary  bones, 
and  emerged  behind  the  ear,  probably  traversing  the  meatus  in  its  course.  He  was  taken  prisoner  and  conveyed  to  Richmond, 
Avhere  he  was  admitted  to  Confederate  Hospital  No.  21.  By  July  31st,  the  temporal  bone  had  become  partially  exposed,  some 
fragments  had  escaped,  and  the  sense  of  hearing  was  destroyed.  With  the  exception  of  an  occasional  pain  in  the  ear,  the  patient 
was  doing  well.  He  was  afterward  paroled,  and  on  March  29th,  1865,  was  admitted  to  the  Ward  Hospital,  Newark,  New  Jersey, 
where  he  was  discharged  the  service  June  29th,  1865,  and  pensioned.  On  August  31st,  1865,  Pension  Examiner  J.  G.  Stearns 
reported  that  there  was  a purulent  discharge  from  the  wound.  On  the  28th,  a ])ortion  of  bone  came  out,  over  an  inch  in  length, 
making,  in  all  that  have  come  out  of  the  jaw  and  ear  in  consequence  of  the  wound  and  gangrene,  twelve  pieces.  There  is  total 
loss  of  external  ear,  which,  with  the  paralysis,  causes  great  deformity. 

Case. — Private 'Samuel  Binns,  Co.  C,  88th  Pennsylvania  Volunteers,  aged  17  years,  was  wounded  at  Bull  Run,  August 
30th,  1862,  by  a projectile  which  entered  the  frontal  bone  one  inch  above  the  nasal  eminence,  a little  to  the  right  of  the  median 
line,  and  emerged  at  the  external  angular  process.  He  was  admitted  to  the  Episcopal  Hospital,  Philadelphia,  December  16th, 
1802.  There  was  a discharge  of  pus  from  the  loose  tissue  of  the  superior  eyelid,  and  the  wound  of  entrance,  from  which  pieces 
of  bone  had  been  discharged  at  different  times  before  his  admission,  was  still  open.  The  wound  of  exit  had  closed,  and  the 
opening,  formed  for  the  escape  of  pus,  was  filled  with  a mass  of  granulation.  The  sight  of  the  right  eye  was  dim.  On  Decem- 
ber 20th,  another  piece  of  bone  escaped  from  the  wound  of  entrance,  which  afterward  closed,  and  the  patient  was  discharged  the 
service  March  11th,  1863,  and  pensioned.  Pension  Examiner  W.  Carson  subsequently  reports  that  exfoliation  has  resulted,  with 
great  injury  to  the  right  eye  and  ear.  His  disability  is  rated  three-fourths  and  doubtful. 

Case. — Private  Alexander  McGill,  Co.  I,  2d  New  Jersey  Volunteers,  aged  32  years,  was  wounded  at  the  battle  of  Bull 
Run,  Virginia,  August  29th,  1862,  by  a fragment  of  shell,  which  fractured  and  depressed  the  external  table  over  the  coronal 
suture.  He  was,  on  September  1st,  conveyed  to  Washington,  a distance  of  thirty  miles,  and  admitted  into  the  Unitarian  Church 
Hospital.  He  suffered  from  paralysis  of  the  right  side  of  the  body  and  retention  of  urine.  Unsuccessful  efforts  were  made  to 
elevate  the  depressed  bone.  Cold  water  dressings  were  applied.  On  September  10th,  the  power  of  motion  in  the  arm  and  leg 
had  returned,  and  on  the  20th,  the  patient  was  so  far  recovered  that  he  was  able  to  walk  with  the  help  of  a cane.  He  recovered, 
with  the  exception  of  a slight  weakness  in  the  right  knee,  and  some  difficulty  in  voiding  his  urine,  which  latter  trouble  was 
overcome  by  small  doses  of  sweet  spirits  of  nitre.  On  October  5th,  he  was  transferred  to  New  York  City  and  admitted  into  the 
City  Hospital.  Through  the  wound,  which  was  granulating  firmly,  necrosed  bone  could  be  detected.  An  attempt  was  made  to 
remove  the  latter,  but  failed.  The  patient  was  discharged  from  the  service  on  January  8th,  1863.  The  case  is  reported  by 
Surgeon  A.  Wyukoop,  U.  S.  V.  In  January,  1863,  Dr.  11.  C.  Clark,  Assistant  Surgeon,  2d  New  .Jersey  Volunteers,  re])ort<“d 
that  from  a shell  wound  received  on  August  27th,  1862,  a portion  of  the  Sliull  was  carried  away,  leaving  a space  an  inch  in 
diameter  unprotected  by  any  bony  structure,  and  added  that  the  man  was  unable  to  maintain  himself,  and  was  entitled  to  full 
pension.  His  claim  for  pension  was  rejected  December  29th,  186.5,  for  want  of  evidence. 

* .Some  of  the  more  interesting  specimens  of  exfoliations  from  the  cranium,  contained  in  the  Army  Medical  Museum,  are  represented  by  ElOL’liES 
30, 31,  3C,  37,  38,  39, 40,  47,  51,  53,  55,  58,  60,  99,  and  I’lGUltES  14  and  00,  of  the  Catalogue  of  the  Surgical  Section  of  the  Army  Medical  Museum. 


188 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Di  ivate  Jolm  H.  Booker,  Co.  L,  1st  Maine  Heavy  Artillery,  aged  23  years,  was  wounded  in  the  engagement  at 
City  Point,  Virginia,  June  IStli,  1864.  Tlio  ini.ssile  struck  the  skull  at  the  junction  of  the  coronal  aild  sagittal  sutures,  lacerating 
the  scalp,  and  fracturing  and  depressing  the  outer  table  nearly  one-lialf  inch  each  way.  At  the  same  time  the  patient  received 
gunshot  wounds  of  the. back  and  thigh.  Ho  was  admitted  to  the  hospital  of  the  3d  division.  Second  Army  Corps,  and  on  July 
2d  was  sent  to  the  3d  division  hospital  at  Alexandria,  Virginia.  The  injuries  healed  kindly  until  July  18th,  when  the  wound  of 
the  thigh  became  gangrenous,  the  disease  extending  over  a surface  of  three  inches.  Lotions  of  chloride  of  zinc  aiuLafterward 
of  creosote  were  applied,  and  tonics  and  anodynes  given.  On  August  10th,  a piece  of  exfoliated  bone  half  an  inch  in  diameter 
was  removed  from  the  wound  of  head,  and,  on  August  25th,  two  more  jiieces  of  the  same  size  were  taken  away.  The  slough 
had  separated  on  August  1st,  and  the  wound  had  again  assumed  a healthy  appearance,  and  continued  to  improve  during  the 
months  of  September  and  October,  when,  about  the  middle  of  November,  the  hands  and  feet  became  cedematous,  the  face  grew 
))ufty,  and  finally  the  abdomen  commenced  to  swell.  By  the  middle  of  December,  tlie  girth  of  the  body  at  the  umbilicus 'was 
thirty-eight  inches.  But  little  urine  was  passed,  yet  no  symptoms  of  cerebral  disturbance  were  noticed.  The  patient  died 
January  9th,  1865.  At  the  autopsy,  the  cavities  of  the  chest  and  peritoneum  were  found  much  distended  with  serum,  and  the 
kidneys  were  completely  degenerated.  The  case  is  reported  by  Surgeon  E.  Bentley,  U.  S.  V. 

Case. — Private  Jolm  G.  Wilson,  Co.  F,  24th  Ohio  Volunteers,  was  wmunded  at  the  battle  of  Sh.iloh,  Tennessee,  April 
7th,  1832,  by  a fragment  of  shell,  which  struck  the  right  pailetal  bone  near  its  posterior  superior  angle,  and  carried  away  a 
portion  of  both  tables  about  an  inch  in  dimension.  He  was  discharged  December  1st,  1862,  and  was  examined  for  a pension 
November  10th,  1863,  by  Pension  Examiner  Charles  Hay,  who  reported  the  dura  mater  exposed,  the  pulsations  of  the  brain 
visible,  and  the  patient  obliged  to  use  chloroform  to  relieve  spasms,  which  occurred  periodically.  His  general  health  had  suffered 
greatly.  There  was  no  new  formation  of  bone.  On  October  22d,  1867,  Pension  Examiner  II.  D.  Hammond  reported  a consid- 
e)  tible  loss  of  bone.  There  was  constant  discharge  of  pus  from  the  wound  and  small  pieces  of  bone  were  occasionally  thrown 
off  His  disability  is  rated  total  and  piermanent  by  Dr.  K.  D.  Hammond,  pension  examiner  at  Macomb,  Illinois. 

.Case. — Private  William  Fisher,  Co.  G,  98th  Pennsylvania  Volunteers,  was  wounded  near  Fort  Stevens,  Washington, 
July  12th,  1864,  and  was  admitted  into  Mount  Pleasant.  Hospit.al  on  the  following  day.  A little  above  the  right  ear  was  a scalp 
wound  an  inch  and  a half  long.  Acting  Assistant  Surgeon  P.  C.  Portin’,  under  whose  care  the  patient  came,  satisfied  himself 
that  a piece  of  the  mastoid  process  was  chipped  off,  and  that  a fracture  extended  into  the  petrous  portion  of  the  temporal.  From 
the  aspect  of  the  wound,  Dr.  Porter  was  inclined  to  the  belief  that  it  was  inflicted  by  a conoidal  musket  ball.  The  patient  did 
well  tvith  simple  dres.sings,  and  rest,  and  gentle  cathartics,  till  the  20th  of  July,  when  the  wound  began  to  slough.  Applications 

of  charcoal  and  yeast  poultices,  nitric  acid,  and  creosote,  failed  to  arrest  the  sloughing,  which 
presently  gave  rise  to  repeated  hemorrhages  from  brandies  of  the  temporal  artery.  The 
gangrene  continued  to  spread  until  August  9th,  when  the  eschars  separated,  leaving  a space 
five  inches  in  diameter  on  the  right  side  of  the  he.ad,  denuded  of  integuments,  fascia,  and 
muscles.  During  this  long  jieriod,  the  patient  complained  of  no  inconvenience  at  the  seat 
of  fracture,  though  there  was  at  times  acute  frontal  pain.  Early  iu  September,  it  was  evident 
that  the  exposed  portions  of  the  temporal  and  parietal  bones  were  necrosed,  and  on  September 
6th,  a fragment  of  the  squamous  portion  of  the  temporal  was  removed.  T'wo  days  subse- 
quently, other  fragments  were  detached  and  extracted.  After  this  the  wound  began  to 
cicatrize  rajiidly,  and  on  December  3d,  1864,  the  patient  was  reported  to  be  entirely  out  of 
danger,  and  in  fact  nearly  well.  Ou  February  14th,  1865,  he  was  discharged  from  service 
on  a certificate  of  disability  signed  by  Assistant  Surgeon  H.  Allen,  U.  S.  A.  He  was  pensioned. 
In  1865,  he  was  reported  as  partially  deaf.  He  was  last  paid  at  the  Philadcljihia  agency, 
September  4th,  1870.  and  his  pension  had  been  reduced,  from  which  it  may  be  inferred  that 
the  examining  surgeon  regarded  his  disabilities  as  comparatively  slight. 

Case. — Private  E.  W.  Handin,  Co.  F,  4th  Michigan  Volunteers,  aged  22  years,  was  wounded  at  Gettysburg,  July  2d, 
1863,  by  a conoidal  ball  which  entered  anterior  to  top  of  right  ear,  passed  backward  and  downward  through  the  external  ear,* 
in  jured  the  mastoid  process,  and  emerged  at  the  back  of  neck  six  inches  from  point  of  entrance.  He  fell  senseless,  and  was 
canied  to  the  Seminary  hospital,  remaining  unconscious  for  two  d.ays.  On  July  20th,  he  was  sent  to  hosj)ital  at  York,  Penn- 
sylvania. He  suffered  much  )>ain  in  side  of  head,  and  the  principal  discharge  came  from  the  external  meatus,  where  a piece  of 
bone  made  its  exit.  On  August  22d,  the  orifice  of  entrance  was  filled  with  granulations,  .and  that  of  exit  had  become  covered 
with  jdastic  lymph.  The  movement  of  jaw  became,  to  some  extent,  limited,  and  the  patient  could  not  close  the  right  eyelid  or 
raise  the  right  eyebrow.  On  May  31st,  1864,  he  was  admitted  to  Fairfax  Seminary  Hospital;  on  June  7th,  was  sent  to  Had- 
dington Hospit.al,  Philadelphia;  on  June  11th,  to  Satterlee  Hospital;  and  on  August  5th,  to  St.  Mary’s  Hospital,  Detroit, 
Michigan,  where  he  was  discharged  from  the  service  September  13th,  1864.  He  is  not  a pensioner. 

Case. — Corporal  James  W.  Williams,  Co.  G,  39th  United  States  Colored  Troops,  aged  26  yeai’s,  was  wounded  before 
Petersburg,  Virginia,  Jidy  30th,  1864,  by  a conoidal  musket  ball,  which  fractui-ed  the  frontal  bone  over  tlie  front.al  sinus,  near  the 
parietal  bone.  No  record  of  the  case  c.an  be  found  until  August  18lh,  when  the  patient  w.as  admitted  to  the  Summit  House 
Hospital,  Philadelphia.  Pie  was  thence  transferred  as  follows:  on  March  29th,  1865,  to  the  hospital  at  Beverly,  New  Jersey; 
on  May  12th,  to  the  Whitehall  Hospital,  near  Bristol,  Pennsylvania;  on  June  26th,  to  the  Satterlee  Hospital,  Philadelphia; 
and  on  July  30th,  to  the  Mower  Hospital,  where  he  was  discharged  from  service  on  September  9th,  1835,  and  pensioned. 
Subsequent  information  states  that  discharges  of  bone  continued  a year  after  the  reception  of  the  injury.  The  patient  suffered 
from  dizziness,  faintness,  and  a sense  of  insecurity,  which  unfitted  him  for  any  occupation,  especially  such  as  required  stoo])ing 
or  exertion.  His  disability  is  rated  one-half  and  temporary  by  Examining  Surgeon  J.  li.  Eowand. 


Flo.  99.— Exfi'liation  from  the  right 
parietal  and  temporal,  resulting  from 
gunshot  injury.  Spec.  ;i45i,  A.  M.  M. 


EEMOTE  RESULTS  OF  DEPRESSED  GUNSHOT  FRACTURES. 


189 


Case. — Sergeant  John  O’Flaherty,  Co.  D,  24th  Wisconsin  Volunteers,  was  wounded  by  a missile  at  the  battle  of  Chick- 
amauga,  Georgia,  September  19th,  18G3,  which  fractured  both  tables  of  the  frontal  bone  above  the  right  eminence,  lie  was 
admitted  to  the  field  hospital,  3d  division.  Twentieth  Corps,  and  on  October  21st  was  sent  to  the  hospital  at  Stevenson,  Alabama. 
A day  later,  the  patient  was  transferred  to  Hospital  No.  13,  Nashville.  About  December  1st,  he  was  sent  to  Hospital  No.  3,  at 
Louisville,  and  on  March  19th  to  the  hospital  at  Madison,  Indiana.  He  was  discharged  from  service  on  April  19th,  18G4,  and 
pensioned^  An  opening,  one  inch  and  a half  long  by  one  inch  wide,  caused  by  exfoliation  of  bone,  had  healed  and  was  covered 
only  by  the  integument.  The  patient  was  subject  to  occasional  attacks  of  vertigo  following  either  mental  or  physical  excite- 
ment, and  loud  voices  produced  pain  in  the  head.  His  disability  is  rated  three-fourths  and  doubtful. 

Case. — Private  Charles  E.  Tremain,  Co.  II,  45th  Pennsylvania  Volunteers,  aged  29  years,  was  wounded  before  Peters- 
burg, April  2d,  18G5,  by  a conoidal  musket  ball,  wliich  struck  behind  the  right  ear,  fractured  the  occipital  bone,  and  was 
afterward  extracted  from  the  neck.  In  the  same  engagement,  and  while  in  a state  of  unconsciousness,  a ball  struck  the  right 
foot  on  its  outer  edge,  near  the  middle,  and,  passing  inward  and  upward,  emerged  at  the  instep;  the  second  toe  of  the  same 
foot  had  been  carried  away  by  a rifle  ball  at  the  Wilderness,  May  6th,  1864.  He  was  treated  at  the  depot  field  hospital  of  the 
Ninth  Corps  until  April  7th,  when  he  was  sent  to  the  Slough  Hospital  at  Alexandria.  The  metatarsal  bones  became  necrosed. 
He  was  mustered  out  July  17th,  1835,  and  pensioned  from  that  date.  On  January  17th,  1870,  Pension  Examiner  F.  R.  Wagner 
reports  that  the  wound  in  the  head  often  inflames  and  suppurates,  and  that  dead  ])ieces  of  bone  exfoliate.  The  patient  was 
subject  to  pain  in  the  head,  and  his  memory  was  greatly  impaired.  The  foot  was  anchylosed  and  cold.  His  disability  is  rated 
total  and  permanent. 

Remote  Results  of  Depressed  Fractures. — Besides  epilepsy  and  derangements  of  vision 
and  hearing,  and  the  other  disabilities  referred  to  on  page  171  and  the  following  pages,  a 
large  number  of  instances  were  reported  in  which  gunshot  depressed  fractures  of  the  skull 
were  followed  by  headache  and  vertigo,  persistent  pain  at  the  part  struck,  various  forms  of 
paralysis  of  motion,  and  modifications  of  sensation,  and  mental  derangements.  A few  such 
cases  may  be  cited  : 

Case. — Private  William  H.  Cash,  Mcltitosh’s  Battalion,  Rockbridge  Artillery,  was  wounded  at  Fredericksburg,  December 
13th,  18G2,  by  a fragment  of  shell,  which  struck  the  upper  portion  of  the  left  side  of  the  frontal  hone,  carrying  away  a segment 
of  hone  an  inch  square,  and  exposing  the  brain.  He  was  admitted  to  hos{)ital  No.  1,  at  Richmond,  on  January  26th,  and,  on 
March  13th,  1865,  he  was  retired  from  the  service.  The  cicatrix  was  at  that  time  large,  and  the  pulsations  of  the  brain  were 
plainly  visible.  Paralysis  agitans,  in  an  incipient  form,  existed  at  the  date  at  which  the  patient  was  retired.  The  ulterior  history 
of  the  case  is  unknown.  The  abstract  is  from  the  records  of  the  Confederate  Surgeon  General's  Office. 

Case. — Private  Isaac  P.  Baldwin,  Co.  I,  41st  Ohio  Volunteers,  aged  24  years,  was  wounded  at  the  battle  of  Shiloh, 
Tennessee,  April  7th,  1862,  hy  a missile  which  passed  through  the  right  malar  and  temporal  bones.  The  case  progressed  finely. 
He  was  treated  at  City  Hospital,  St.  Louis,  and  at  Camp  Dennison,  Ohio.  At  the  latter,  on  August  14th,  1862,  he  was  discharged 
the  service.  He  re-enlisted  July  18th,  1863,  and  on  January  ISth,  1865,  was  again  discharged,  and  was  pensioned.  In  IMay, 
1865,  there  was  ptirtial  paralysis  of  the  left  side  of  face,  and  deafness  of  the  right  ear,  dnd  his  disability  was  rated  one-half  and 
permanent. 

Case. — Private  Samuel  Lyon,  Co.  E,  54th  Now  York  Volunteers,  aged  25  years,  was  admitted,  on  January  14th,  1863, 
to  Mower  Ho.spital,  Philadelphia,  with  a gunshot  fracture  of  the  left  parietal  bone.  The  wound  healed  readily,  and  on  !March 
27th,  1863,  he  was  discharged  the  service,  being  still  troubled  with  neuralgic  pains  in  the  frontal  region.  He  is  not  a pensioner. 

Ca.se. — Private  Robert  McAllister,  Co.  G,  57th  New  York  Volunteers,  aged  42  years,  was  struck  by  a bullet  at  Fred- 
ericksburg, December  13th,  1862,  which  caused  a lacerated  wound  of  the  scalp,  and  fractured  a poition  of  the  left  parietal 
bone.  .He  was  admitted  to  the  field  hospital  of  the  1st  division.  Second  Corps,  on  the  same  day,  and  a few  days  later  was 
transferred  to  Washington,  and  on  the  17th  was  admitted  to  the  Campbell  Hospital.  On  February  3d,  1863,  he  was  discharged 
the  service  and  pensioned,  his  disability  being  rated  total  and  permanent.  The  case  is  reported  by  Surgeon  J . H.  Baxter,  U.  S.  V. 
A subsequent  report  states  the  patient’s  right  arm  to  be  paralyzed  and  atrophied. 

Case. — Private  Henry  Rice,  Co.  B,  29th  Pennsylvania  Volunteers,  aged  27  years,  was  wounded  at  the  battle  of  Altoona, 
Georgi.a,  June  15th,  1864,  by  a conoidal  musket  ball  which  fractured  the  cranium.  He  was  admitted  to  the  hospital  of  the  2d 
division.  Twentieth  Corps,  and  on  the  22d  was  sent  to  the  general  hospital  at  Chattanooga,  Tennessee.  On  .July  7th  ho  was 
ti’ansferred  to  Nashville  and  admitted  into  hospital  No.  19,  but,  three  days  afterward,  was  sent  to  .lefferson  Hospital  in  Indiana. 
In  September  he  was  furloughed,  and  on  the  1st  of  December  transferred  to  the  hospital  at  Madison.  Partial  paralysis  of  the 
body  had  ensued,  and  the  patient  was  discharged  the  service  December  2d,  1864.  In  Sejitember,  1867,  he  was  a pensioner,  his 
disability  being  rated  total  and  perm.anent  by  Dr.  J.  Cummiskey,  theqjension  examiner.  At  that  date  paralysis  was  limited  to 
the  right  foot. 

Case. — Private  A.  Perherson,  Co.  A,  13th  Virginia  Cavalry,  was  wounded  at  the  battle  of  Gettysburg,  .July,  1833,  by  a 
piece  of  shell  which  struck  the  skull  at  the  vertex.  His  history  is  unknown  until  March  3d,  1864,  when  he  was  ailmitted  to  an 
hospital  at  Richmond,  lie  had  been  troubled  with  incontinence  of  urine  ever  since  the  reception  of  the  injury.  The  wouiul  had 
entirely  healed,  with  slight  loss  of  bone,  showing  a small  furrow.  The  patient  complained  of  severe  pain  in  the  lumbar  region, 
and  his  speech  indicated  partial  p.aralysis  of  the  tongue.  He  stated  that  his  right  side  had  been  ])artially  paralyzed,  and  he  still 
suffered  occasionally  from  numbness  of  the  right  hand  and  foot.  Oil  of  tuiqientine  was  ordered  as  a counter-irritant  to  the  back, 
but  up  to  May  23d,  1834,  there  had  been  no  material  change  in  the  condition  of  the  patiemt. 


190 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Cask.— Private  Augustus  J.  Duller,  Co.  A,  7tli  Maine  Volunteers,  aged  1!)  years,  was  wounded  at  tlie  battle  of  Cold 
Harbor,  Virginia,  .June  Ctb,  ISG-l,  by  a conoidal  musket  ball,  wbicb  fractured  the  parietal  bone  at  the  eminence.  He  was 
conveyed  by  steamer  to  Aiexandiia,  and  admitted,  on  the  14tb,  into  the  3d  division  hospital.  Paralysis  of  the  lower  extremities 
existed.  Simple  dressings  only  were  applied.  The  patient  recovered  partial  control  of  the  muscles  of  the  leg,  and  was 
discharged  from  service  January  10th,  1865.  Not  a pensioner. 

Case. — Pilvate  John  Shoemaker,  Co.  H,  100th  Illinois  Volunteers,  aged  19  years,  was  wounded  near  Hillsboro', 
Tennessee,  August  1st,  1803,  by  a musket  ball,  which  entered  the  vertical  jiortion  of  the  frontal  and  escaped  at  the  centre  of  tlie 
right  parietal  bone,  grooving  both  tables.  For  two  weeks  he  was  treated  in  the  field  hospital.  On  the  18th  he  was  sent  to  the 
Cumberland  Hospital  at  Nashville.  On  the  26th  of  September  he  was  transferred  to  Louisville,  Kentucky;  thence,  on  the  2d 
of  December,  to  the  hospital  at  Quincy,  Illinois.  Partial  paralysis  of  the  left  upper  and  lower  extremities  had  ensued  by  this 
time,  but  the  wound  was  gradually  healing,  and  his  appetite  was  good.  By  the  use  of  strychnia,  some  improvement  in  the 
motion  of  the  leg  was  obtained.  He  was  discharged  from  service  April  2d,  1864,  still  experiencing  considerable  difficulty  in 
walking.  Acting  Assistant  Surgeon  D.  C.  Owen  reports  the  case.  Not  a pensioner. 

Case. — Private  Frederick  Abel,  Troop  B,  5th  New  York  Cavalry,  aged  52  years,  was  wounded  at  the  battle  of  White 
Oak  Swam)),  Virginia,  June  15th,  1884,  by  a conoidal  musket  ball,  which  fractured  and  passed  through  the  most  prominent 
portion  of  the  occipital  bone.  He  fell  to  the  ground  insensible,  and  remained  so  for  twenty-four  hours.  lie  was  then  conveyed 
to  the  Chesapeake  Hospital  at  Hampton.  Paralysis  agitans  supervened  immediately  on  return  to  consciousness.  By  the  4th  of 
July  he  was  able  to  bear  transportation  to  the  Sixteenth  and  Filbert  Streets  hospital  in  Philadelphia.  On  March  25th,  1885,  he 
was  transferred  to  the  Turner’s  Lane  PIos))ital;  thence,  on  May  10th,  to  the  McClellan  Ilosjsital,  where  he  was  discharged  on 
July  1st,  1865.  In  January,  1888,  he  was  in  receipt  of  a pension,  his  disability  being  rated  one-half  and  permanent. 

Case. — Private  Christopher  C.  Colson,  Co.  A,  37th  Massachusetts  Volunteers,  aged  24  years,  was  wounded  at  the  battle 
of  the  Wilderness,  Virginia,  May  Gth,  1864,  by  a conoidal  musket  ball,  which  fractured  the  left  parietal  bone.  He  was  admitted 
to  the  hospital  of  the  2d  division.  Sixth  Corps ; and  thence,  on  the  25th,  he  was  sent  to  the  Armory  Square  Hospital  at  Washington. 
The  case  progressed  well  under  ordinary  treatment.  On  June  16th  he  was  transferred  to  the  Knight  Hospital,  New  Haven, 
Connecticut ; on  October  16th,  to  Eeadvillo,  Massachusetts ; and  on  Slarch  22d,  1865,  he  was  returned  to  duty  from  the  Dale 
llosj)ital,  Worcester,  Massachusetts.  Persistent  hemicrania  of  the  left  side,  however,  rendered  him  unfit  for  duty,  and,  on  May 
23d,  1865,  he  entered  the  Lincoln  Hospital,  at  Washington,  and  was  mustered  out  of  service  June  12th,  1865. 

Case. — Private  Jason  Cowles,  Co.  E,  179th  New  York  Volunteers,  aged  43  years,  was  wounded  before  Petersburg, 
Virginia,  April  2d,  1865,  by  a conoidal  musket  ball,  which  fractured  the  superior  portion  of  the  left  parietal  bone.  He  was 
admitted  to  the  hospital  of  the  2d  division.  Ninth  Corps,  on  Ai)ril  3d;  was  transferred  to  the  hospital  at  Fort  Monroe,  and  on 
June  29th  sent  to  the  Ira  Harris  Hospital,  Albany,  New  York,  where  he  was  discharged  from  service  on  July  24th,  1865.  On 
September  9th,  1867,  Pension  Examiner  L.  H.  Allen  reported  a deep  depression  from  loss  of  bone,  which  caused  gi-eat  physical 
and  mental  impairment.  His  disability  was  rated  three-fourths  and  of  uncertain  duration. 

C.\SE. — Private  Charles  11.  Rhodes,  Co.  F,  3d  Vermont  Volunteers,  aged  24  years,  received  a gunshot  fracture  of  the 
skull  at  the  battle  of  Fredericksburg,  December  13th,  1862.  He  was  admitted  to  the  regimental  hospital.  On  December  17th 
he  was  sent  to  St.  Aloysius  Hospital,  Washington ; oil  January  7th,  1863,  was  transferred  to  Governor  Smith  Hospital,  Brattleboro’, 
Vermont,  and  was  discharged  the  service  January  31st,  1833,  and  pensioned,  his  disability  being  rated  total. 

Case.— Private  John  E.  Edmonds,  Battery  E,  2d  New  York  Heavy  Artillery,  aged  22  years,  was  wounded  at  the  battle 
of  Petersburg,  Virginia,  June  18th,  1864,  by  a conoidal  ball,  which  fractured  the  right  parietal  bone.  He  was  admitted  on  the 
same  day,  to  the  1st  division.  Second  Corps,  hospital,  and  was  transferred  to  the  Carver  Hospital,  Washington,  on  June  22d. 
The  functions  of  the  brain  were  found  to  be,  in  a measure,  impaired.  He  remained  in  the  Carver  Hospital  until  October  25th, 
when  he  was  transferred  to  the  Kicord  Hos))ital.  Being  regarded  unfit  for  the  Veteran  Reserve  Corps,  he  was  discharged  from 
service  on  March  22d,  1865,  and  pensioned.  Pension  Examiner  Alonzo  Churchill  reports  that  the  patient  suffered  pain  in  the 
head  with  dizziness,  which  was  increased  by  exercise,  and  rates  his  disability  more  or  less  permanent. 

Case. — Private  George  W.  Gibson,  Co.  K,  1st  Wisconsin  Volunteers,  aged  34  years,  was  wounded  at  the  battle  of  Dallas, 
Georgia,  I^Iay  31st,  1834,  by  a piece  of  shell,  which  fractured  the  right  ])arietal  bone,  and  lodged  at  the  seat  of  fracture.  He  was 
sent  to  the  hospital  of  the  1st  division.  Fourteenth  Corps,  and  on  June  15th  was  conveyed  to  Chattanooga;  thence  was  sent,  on 
the  28th  of  June,  to  hospital  No.  3,  at  Nashville.  The  missile  was  extracted  two  months  and  five  days  after  the  injury.  On  the 
30th  of  August  the  patient  was  transferred  to  the  Harvey  Hospital  at  Madison,  W'isconsin.  There  was  hemiplegia  of  the  left 
side  which  e.xisted  up  to  October  14th,  1864,  the  date  of  his  discharge  and  pension.  On  February  15th,  1868,  Pension  Examiner 
J.  S.  Hurd  reports  the  hemiplegia  still  continuing  ; the  ))atient  subject  to  e))ilepsy  on  slight  exertion,  and  unable  to  remain  in  the 
open  air  during  warm  weather  without  pain  in  the  head.  Llis  disability  is  rated  total  and  permanent. 

Penetrating  Gunshot  Fractures  of  the  Skull. — Thoiigli  the  larger  number  of  such 
accidents  are  immediately  fatal,  the  sufferers  being  instantly  killed,  or  lingering  for  a few 
hours  at  the  field  depots  ; yet  a not  inconsiderable  number  of  cases  came  under  treatment 
at  the  hospitals.  The  following  are  among  the  more  remarkable  examples  of  survival  after 
penetrating  gunshot  fractures  of  the  skull : 

Ca.se. — Private  Thomas  W.  Dillon,  Co.  E,  3d  New  Jersey  Volunteers,  aged  27  years,  was  wounded  at  the  battle  of 
Chancellorsville,  May  3d,  1853,  by  a musket  ball.  The  ])atient  remained  within  the  enemy’s  lines  some  days  after  receiving  the 
injury,  and  was  subsequently  brought  to  the  hos])ital  of  the  Sixth  Corps  at  Potomac  Creek.  U))on  examination  it  was  found 


PENETRATING  GUNSHOT  FRACTURES  OF  THE  SKULL. 


191 


the  missile  liad  entered  the  cranium  very  near  the  superior  angle  of  the  occipital  bone,  and  had  passed  anteriorly  into  the 
substance  of  the  brain.  There  was  no  comminution,  fissuring,  or  depression  of  bone  about  the  wound  of  entrance,  nor  hernia 
cerebri.  The  wound  had  not  been  dressed,  probably  because  of  the  natural  sujiposition  that  the  case  would  prove  speedily  fatal. 
After  shaving  the  head  and  removing  a few  small  fragments  of  bone,  the  wound  was  dressed  with  cold  water,  and  the  patient 
was  placed  upon  mattresses  on  the  floor  of  the  tent,  it  being  impossible  to  retain  him  upon  a bed  without  force.  Here  he 
remained  for  a week,  in  a contorted  position,  with  pupils  dilated,  respiration  slow,  and  pulse  50,  and  passing  his  evacuations 
involuntarily.  He  slept  most  of  the  time  and  only  aroused  when  spoken  to  loudly.  The  patient  received  little  attention,  the 
case  being  regarded  as  hopeless ; but  at  the  end  of  ten  days  he  began  to  retain  his  evacuations  and  obey  the  calls  of  nature, 
sleeping  generally  at  night  and  sitting  up  during  a part  of  the  day.  At  no  time  was  he  conscious  of  pain,  except  from  light. 
By  the  first  week  of  June,  the  patient’s  strength  was  almost  entirely  restored ; the  wound  had  closed,  and  all  his  functions, 
except  memory,  were  normal.  He  remembered  nothing  since  his  admission  to  hospital,  and  did  not  recognize  intimate  relations. 
On  June  13th,  1863,  the  patient  was  transferred  to  Philadelphia,  at  wdiich  time  he  was  able  to  walk  to  the  station,  a distance  of 
nearly  half  a mile.  In  April,  1864,  he  was  returned  to  his  regiment  in  the  field,  perfectly  well  physically,  but  with  an  intellect 
somewhat  impaired.  He  remembered  all  that  had  occurred  previous  to  the  reception  of  the  injury;  but  from  that  time  till  an 
indefinite  period  in  the  autumn,  he  was  totally  unconscious.  He  is  not  a pensioner.  The  case  is  reported  by  Surgeon  Lewis 
\V.  Oakley,  2d  New  Jersey  Volunteers. 

Case. — Private  Francis  Reynolds,  Co.  F,  6th  United  States  Infantry,  aged  27  years,  was  admitted,  on  June  18th,  1863, 
to  Satterlee  Hospital,  Philadelphia,  with  a gunshot  fracture  of  the  right  parietal  bone.  A conoidal  musket  ball  had  entered  the 
right  side  of  the  forehead,  and  had  passed  upward  and  backwnard.  On  admission  the  wound  had  healed,  giving  no  sign  of 
inflammation  or  suppuration.  The  patient  was  frequently  troubled  with  a sharp  jiain  on  the  top  of  the  head,  a little  to  the  right 
side,  which  sometimes  caused  dizziness.  He  recovered,  and  was  returned  to  duty  on  September  21st,  1833.  This  man  is  not  a 
pensioner. 

Case. — Corporal  Andrew  Rupp,  Co.  C,  82d  Illinois  Volunteers,  aged  29  years,  was  wounded  in  an  engagement  at  Dallas, 
Georgia,  May  25th,  1834,  by  a round  musket  ball  which  impacted  itself  in  the  left  temporal  bone.  He  was  admitted  to  the  hos- 
pital of  the  Twentieth  Corps;  on  June  1st,  sent  to  the  field  hosjjital  at  Chattanooga;  and  on  June  9th,  to  the  Sherman  Hospital 
at  Nashville,  whence  he  was  furloughed  on  July  16th.  At  the  expiration  of  his  leave,  August  15th,  1834,  he  was  admitted  to  the 
Desmarres  Hospital,  at  Chicago,  Illinois.  The  wound  h.ad  not  healed;  cold  water  dressings  were  applied.  On  December  23d, 
the  greater  portion  of  the  ball  was  removed.  Slight  discharge  followed  the  operation  and  continued  for  some  weeks,  after  which 
the  wound  readily  cicatrized.  He  was  discharged  from  service  on  May  23d,  1835,  and  pensioned.  At  that  time  he  experienced 
but  little,  if  any,  inconvenience  from  the  remaining  portion  of  the  impacted  ball,  which  it  was  found  inijn-acticable  to  remove. 
Pension  Examiner  J.  P.  Lynn,  August  10th,  1837,  reports  thickening,  tilling  uji,  and  complete  deafness  of  patient’s  left  ear,  and 
rates  his  disability  one-third  and  permanent. 

Case. — Private  John  Daly,  Co.  C,  106th  New  York  Volunteers,  aged  22  years,  was  wounded  near  Petersburg,  Virginia, 
April  2d,  1865,  by  a.  conoidal  ball,  which  penetrated  the  frontal  bone  a little  to  the  left  of  the  median  line.  He  was,  on  the  fol- 
lowing day,  admitted  to  the  depot  field  hospital  of  the  Sixth  Corps,  and  on  April  7th,  was  transferred  to  the  Stanton  IIosj)ital, 
Washington.  Simple  dressings  only  were  applied  to  the  wound.  The  case  progressed  favorably,  and  on  June  5th,  1865,  Daly 
was  discharged  from  service,  and  was  pensiomxl.  On  March  29th,  1835,  Pension  Examiner  George  S.  Gale  reported  that  this 
man  appears  odd,  but  quite  shrewd.  He  could  then  discover  no  signs  of  paralysis,  but  the  patient  complained  of  dizziness  when 
stooping.  His  disability  is  rated  total. 

Case. — Private  Samuel  P.  Ingram,  Co.  G,  48th  Illinois  Volunteers,  was  wounded  at  Dallas,  Georgia,  August  14th,  1834, 
by  a conoidal  ball,  which  entered  at  the  outer  edge  of  the  left  superciliary  ridge  of  frontid  bone,  passed  backward  and  downward, 
invoK'iug  in  its  course  the  lower  surface  of  anterior  left  lobe  of  cerebrum.  He  was  on  the  same  day  admitted  to  the  hosj)ital  of 
the  Fifteenth  Corps,  whence  he  was  furloughed  on  August  24th.  On  January  15th,  1835,  he  was  admitted  to  the  hos])ital  at 
Evansville,  Indiana,  and  was  discharged  from  service  on  January  27th,  1865,  and  pensioned.  On  June  21st,  1866,  I’ension 
E.xaminer  J.  J.  Lesher,  reported  that  there  is  a small  depression  :^om  loss  of  hone  at  the  wound  of  entrance.  Tlie  patient’s 
mind  is  slightly  afifected,  and  he  is  guilty  of  irregularities  both  mental  and  moral.  He  rates  his  disability  at  one-fourth  and  per- 
manent. 

Case. — Private  Solomon  Farr,  Co.  F,  17th  Maine  Volunteers,  was  wounded  at  Gettysburg,  Pennsylvania,  July  2d,  1833, 
by  a conoidal  b.all,  which  penetrated  the  cranium.  When  admitted  to  the  hospital  of  the  1st  division.  Third  Corps,  ho  was 
speechless.  On  July  16th,  he  was  sent  to  McKim’s  Mansion  Hospital  at  Baltimore.  On  September  30th  was  transferred  to 
Patterson  Pai’k  Hospital  of  the  same  city,  whence  he  was  returned  to  duty  October  4th,  1803.  On  May  6th,  1864,  he  was  killed 
in  action  at  the  battle  of  the  IVildemess. 

Case. — Captain  Thomas  Church,  Co.  E,  53d  Penns.ylvania  Volunteers,  received  at  the  battle  of  Fair  Oaks,  Virginia,  .Tune 
1st,  1862,  a gunshot  wound  of  the  head  with  injury  of  the  left  parietal  bone.  He  was  conveyed  to  Philadelphia,  and  on  the  4th 
admitted  into  the  St.  Joseph  Hospital,  whence,  a few  days  later,  he  went  home  on  leave  of  absence.  On  February  23d,  1863, 
being  unfit  for  duty,  he  was  discharged  the  service,  and  pen.sioned  mi  May  9th,  1803.  Pension  Examiner  S.  R.  Wagenseller, 
reported  that  there  were  several  sinuses  passing  into  the  skull,  communicating  with  the  membranes  of  the  brain.  From  these 
sinuses  there  was  a constant  disetuarge  of  pus,  which  produced  headache,  vertigo,  etc.,  when  redained.  Ho  was  unlit  for  either 
physical  or  mental  exertion,  and  his  disability  was  rated  total  and  doubtful.  A communication  from  the  patient,  dated  .January 
17th,  1870,  says  that  his  wound  has  never  healed,  but  remains  open  and  discharges. 

Case. — Private  Andrew  .1.  McMahon,  Co.  D,  27tli  Michigan  Volunteers,  aged  19  years,  was  wounded  near  I’etorsbiirg, 
.July  30th,  1864,  by  a fragment  of  shell,  which  fractured  the  right  supi'rior  border  of  the  Irontal  bone  near  its  articulation  with 
the  parietal.  Gn  the  same  day  he  was  tidinitted  to  the  hospital  of  the  3d  division,  Ninth  Corps,  and,  on  August  Ist,  wtus  sent  to 


192 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


City  I’oint ; Ilicr.cc  lie  was  conveyed  by  hospital  steamer  to  Lovell  Hospital,  at  Portsmouth  Grove,  Rhode  Island,  where  he  was 
admitted  August  7th,  18C4.  In  November  he  was  transferred  to  the  Harper  Hospital,  Detroit,  and  was  discharged  the  service 
December  iiCth,  16C4,  and  pensioned.  On  January  27th,  1668,  Pension  Examiner  W.  E.  Breakey  reported  both  tables  of  the 
bone  lost  from  necrosis,  and  only  a membranous  formation  covering  the  opening.  There  was  protr.acted  suppurative  discharge, 
acute  susceptibility  to  he.at,  vertigo,  loss  of  memory,  melancholia,  symptoms  of  compression  and  general  mental  impairment,  all 
of  which  were  aggi’avated  by  labor  or  excitement.  Sometimes,  after  stooping,  he  would  fall  and  become  unconscious.  His  disa- 
bility was  rated  total,  and  of  the  third  grade. 

Case. — Private  Richard  Markham,  Troop  C,  4th  U.  S.  Cavalry,  was  admitted  on  April  8th,  1863,  to  Hospital  No.  8 at 
Louisville,  Kentucky,  with  a fracture  of  the  right  temporal  bone,  produced  by  a piece  of  shell.  The  patient  was  discharged 
November  28th,  1863,  and  pensioned.  The  wound  was  l epoi  ted  healed ; but  it  occasionally  discharged  pus  and  pieces  of  bone. 
He  suil'ered  from  headache  and  dizziness,  and  his  general  health  was  impaired ; his  disability  being  rated  total  and  permanent. 

Case. — Private  Warren  Mitchell,  Troop  D,  1st  Wisconsin  Cavalry,  aged  21  years,  was  wounded  in  an  engagement  near 
Jefferson  City,  Missotui,  October  7th,  1864,  by  a conoidal  musket  ball,  which  fractured  both  tables  of  the  parietal  bone.  On  the 
12th,  he  was  sent  to  the  general  hospital  at  Jefferson  City,  where  simple  dressings  were  applied.  During  the  treatment  several 
spiculffi  of  bone  were  removed  from  the  wound.  Complete  paralysis  of  the  right  side  and  partial  paral3’sis  of  the  left  ensued. 
The  patient  was  discharged  the  sendee  JUI3'  10th,  1865,  and  jicnsioned,  his  disabilitj'  being  rated  total  and  permanent.  A com- 
munication from  Pension  Examiner  N.  Udell,  states  that  the  patient  suffers  from  general  paral^'sis;  that  he  has  been  confined  to 
his  bed  for  twentj'  months,  and  is  helpless. 

Case. — Private  Michael  Murr.av',  Troop  F,  3d  New  York  Cavalry,  aged  29  years,  was  wounded  while  a prisoner  at 
Richmond,  in  October,  1864,  ly  a buckshot,  which  fractured  the  left  side  of  the  cranium.  He  was  p.arolcd,  and  on  March  11th, 
1865,  was  admitted  to  the  1st  division  hospital  at  Annapolis ; subsequently  he  was  sent  on  March  22d  to  the  Jarvis  Hospital  at 
Baltimore;  on  the  12th  of  April,  to  the  Ladies’  Home  Hospital,  New  York  City;  and  on  May  24th  to  the  McDougall  Hospital, 
Fort  Schuyler,  New  York  Harbor,  where  he  was  discharged  the  service  June  23d,  1865,  and  aftenvard  pensioned.  On  August 
20th,  1868,  Pension  Examiner  G.  S.  G.ale  reports  the  process  of  exfoliation  still  in  progress,  and  the  left  part  of  the  whole  body 
in  a semi-pandytic  state;  the  arm  useless,  and  the  patient  rendered  quite  helpless  from  frequent  convulsio’ns.  His  disability  is 
rated  total  and  permanent. 

Case. — Sergeant  William  L.  Henderson,  Co.  A,  123d  Illinois  Volunteers,  aged  27  years,  was  wounded  in  an  engagement 
at  Selma,  Alabama,  April  2d,  1865,  by  a buckshot,  which  entered  one-half  an  inch  above  and  anterior  to  the  meatus  .auditorius 
externus,  fractured  the  left  temporal  bone,  and  emerged  one  inch  from  the  point  of  entrance.  He  was  treated  in  a field  hospital 
until  M,ay  8th,  when  he  was  conveyed  to  the  hospital  steamer  D.  A.  January.  On  Maj'  25th,  ho  entered  the  hospital  at  Mound 
City,  Illinois,  and  on  May  31st,  1865,  he  was  discharged  the  service.  The  wound  had  entirelj-  healed.  On  February  7th,  1870, 
Pension  Examiner  A.  Fei-gusson  reported  that  the  ball  reirrains  imbedded  in  the  bone.  The  patient  suffered  from  vertigo,  with 
loss  of  memory,  and  was  unable  to  labor.  He  w'as  a farmer  by  occupation ; his  general  health  was  good,  and  his  habits  were 
regular.  His  disability  is  rated  at  three-fourths  and  permanent. 

Case. — Private  Gustave  Stork,  Batterj"^  B,  15th  New  Yoi'k  Artillerjq  aged  25  j'ears.  Conoidal  ball  entered  just  anterior 
to  the  external  meatus  of  left  ear  and  lodged,  probabH'  in  petrous  portion  of  temporal  bone.  Bull  Run,  Virginia,  August  29th, 
1862.  No  treatment  until  May  11th,  1864,  when  he  was  .admitted  to  Columbian  Hospital,  Washington.  He  was  transferred  as 
follows:  Maj'  15th,  1864,  to  Patterson  Park,  Baltimore;  August  17th,  to  Camden  Street,  Baltimore,  and  on  September  12th, 
1864,  to  Mow'er  Hospital,  Philadelphia,  where  an  ineffectual  attemiit  to  remove  the  ball  was  made.  Discharged  from  service 
Juno  16th,  1865.  Not  a pensioner. 

Case. — Priv.ate  George  Potter,  B.attery  C,  3d  ^Massachusetts  Heavy  Artillery,  aged  26  years,  received,  at  the  battle  of 
Mcch.anicsville,  June  11th,  1864,  a penetr.ating  fr.acture  of  the  cranium  by  a conoidal  musket  b.all,  which  entered  the  cavity 
through  the  parietal  bone.  Ho  was  sent  to  the  hospital  of  the  1st  division,  P’iflh  Corps,  and  on  June  13th,  was  transferred  to 
the  Finky'  Hospital  at  Washington.  'Phe  case  progressed  satisfactorily’  under  simple  treatment,  and  on  June  23d;  the  patient 
was  furloughed.  On  the  22d  of  August,  he  rvas  transferred  to  the  Mason  Hospital  at  Boston.  P.aralysis  of  the  left  side  h.ad 
ensued,  and  still  existed  at  the  time  of  his  discharge,  September  10th,  1864.  He  is  not  a pensioner. 

Case. — Private  Charles  J.  Williams,  Co.  E,  15th  Ohio  Volunteers,  aged  19  years,  was  wounded  at  the  Rattle  of  Shiloh, 
April  7th,  1862,  by  a missile,  which  penetrated  the  right  parietal  bone  at  its  posterior  superior  angle.  On  April  11th,  he  was 
taken  on  board  the  steamer  D.  A.  J.anuary,  and  was  conveyed  to  the  City  Hospital,  St.  Louis,  where  he  was  admitted  on  April 
14th.  He  w'.as  afterwards  furloughed,  then  admitted  to  Camp  Chase,  Ohio,  and  on  July  18th,  1862,  was  discharged  the  service. 
In  March,  1866,  Pension  Examiner  John  C.  Hupp  reports  a circular  opening  in  the  patient’s  skull  of  about  one  inch  in  diameter 
and  h.alf  an  inch  in  depth.  The  sides  of  the  opening  were  well  covered  with  integument,  the  bottom  partially  so.  Ho  was  also 
subject  to  vertigo  upon  slight  exertion.  His  disability  is  r.ated  three-fouiths  and  permauent. 

Case. — Private  George  W.  Hulse,  Go.  G,  36th  Illinois  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of  Chick- 
amauga,  Georgia,  September  20th,  1863,  by  a buckshot  which  penetrated  the  occipital  bone  near  the  iqiper  margin,  and  lodged  in 
the  brain.  In  the  same  eng.agement,  he  was  wounded  in  the  chest  by  a conoidal  ball  which  entered  between  the  seventh  and 
eighth  ribs.  No  attem])t  seems  to  have  been  made  to  extract  either  missile.  On  the  0th  of  October  ho  was  conveyed  to 
Stevenson,  Alabam.a,  for  treatment,  and  one  month  later,  he  w.as  sent  to  the  Cumberland  Hospital,  Nashville,  Tennessee.  On 
December  2d,  he  was  tran.sferrcd  to  the  ho.spital  at  Quincy,  Illinois.  During  this  lime,  simple  dressings  only  had  been  applied 
to  the  wounds.  By’  the  1st  of  March,  1864,  the  wounds  had  healed;  but  the  patient  was  anminic,  and  suffered  more  or  less  pain 
in  the  head.  On  the  11th  of  the  month,  ho  w.as  trausfem'd  to  the  Benton  Barracks  Hospital,  St.  Louis,  Missouri,  and  on  the 


BALLS  LODGED  WITHIN  THE  CRANIUM. 


193 


31st,  to  the  Lawson  Hospital.  The  external  table  was  slightly  necrosed.  He  was  discharged  from  service  July  5th,  18C4,  and 
pensioned.  The  case  is  reported  by  Acting  Assistant  Surgeon  J.  F.  Wilson.  Information  received  from  Pension  Examiner  A. 
F.  Hand,  on  April  12th,  1867,  states  that  the  patient  suffers  from  debility,  derangement  of  the  urinary  organs,  and  mental 
imbecility. 

Case. — Corporal  George  H.  Farnum,  Co.  C,  16th  Maine  Volunteers,  aged  19  years,  was  wounded  at  Gettysburg,  July 
1st,  1863,  by  a round  ball,  which  penetrated  the  cranium.  He  was  sent  to  the  Seminary  Hospital,  remaim'ng  there  until  the  19th 
of  the  month,  when  he  was  sent  to  the  hospital  at  York,  Pennsylvania.  The  treatment,  so  far  as  recorded,  was  simple,  He 
recovered  and  W’as  transferred  on  the  11th  of  February,  1864,  to  the  First  Battalion  of  the  Veteran  Reserve  Corps.  He  is  not  a 
pensioner. 

Case. — Private  James  Lavery,  Co.  E,  136th  New  York  Volunteers;  Gettysburg,  July  3d,  1863;  gunshot  penetrating 
wound  of  the  left  side  of  head;  admitted  to  a field  hospital;  July  9th,  sent  to  Satterlee  Hospital,  Philadelphia;  May  13th,  1864, 
transferred  to  Veteran  Reserve  Corps.  His  disability  is  rated  three-fourths  and  permanent.  There  is  a traumatic  cataract,  and 
the  functions  of  the  right  eye  and  right  ear  are  impaired. 

Balls  lodged  within  the  Cranial  Cavity. — Many  instances  were  reported  of  patients 
who  had  survived  the  lodgment  of  missiles  within  the  skull ; but  few  or  none  resembling 
the  cases  reported  by  Larrey,  of  balls  encysted  in  the  brain  and  giving  no  inconvenience 
for  years.  It  is,  indeed,  reported  that  some  patients  went  to  duty  with  balls  lodged  in 
the  cerebrum ; but  the  diagnostic  details  accompanying  the  histories  of  these  cases  are  not 
sufficiently  precise  to  invite  the  fullest  confidence.  In  most  of  the  cases,  in  which  the 
evidence  that  the  ball  remained  within  the  skull  was  conclusive,  either  fistulous  sinuses 
existed,  or  there  was  much  cerebral  disorder,  or  the  position  of  the  missile  was  discovered 
after  the  patient’s  death  at  a period  remote  from  the  injury ; 

Case. — Lieutenant  Herman  W.  Lilycrantz,  Co.  D,  103d  United  States  Colored  Troops,  was  wounded  at  Fort  Pulaski, 
December  24th,  1865,  by  the  accidental  discharge  of  a pistol,  at  a distance  of  about  four  feet  from  his  head.  The  ball  perforated 
the  os  frontis  over  the  right  superciliary  ridge.  When  first  seen,  fifteen  minutes  after  the  accident,  he  was  vomiting  freely,  and 
about  a fluid  ounce  of  brain  njatter  had  exuded  from  the  -wound.  The  vomiting  being  checked,  but  little  blood,  and  no  more 
brain  matter,  was  discharged.  A probe,  five  inches  long,  glided  easily,  by  its  own  weight,  its  full  length  directly  backward 
through  the  wound,  without  coming  in  contact  with  the  ball.  The  pulse  was  120,  and  weak ; blood  was  freely  discharged 
from  the  nose,  mouth,  and  ears ; there  was  considerable  extravasation  in  the  cellular  tissue  of  the  eyelids  and  the  pupils  were 
dilated.  For  ten  days  after  the  accident  the  patient  showed  a tendency  to  sleep,  but  was  easily  aroused  and  would  converse 
freely,  constantly  wandering,  however,  from  the  topic  of  conversation.  He  could  neither  taste  nor  smell,  and  his  hearmg  and 
sight  were  much  impaired,  bright  lights  causing  much  uneasiness.  He  had  very  little  pain,  but  was  restless  and  had  a constant 
tendency  to  take  hold  of  the  head  of  the  bed  and  draw  himself  toward  it.  Cold  applications  were  made  to  the  head,  morphia 
was  administered  and  low  diet  ordered.  The  pulse  gradually  declined  until  December  31st,  when  it  was  sixty  and  eighty. 
Unto  January  20th,  there  was  no  change  in  the  symptoms  or  treatment ; after  that,  full  diet  was  allowed.  On  January  24th,  he 
began  to  take  exercise  in  the  open  air,  and  on  the  31st,  all  treatment  was  discontinued.  During  the  month  of  February,  he  had 
a large  axillary  abscess.  On  March  10th,  he  went  northward  on  furlough,  complaining  only  of  muscular  weakness  and  inability 
to  look  at  a bright  light.  Occasionallj'  pus  would  ooze  from  the  wound,  which  was  covered  by  a scab.  He  was  discharged  the 
service  May  11th,  1866.  In  November,  1867,  he  was  examined  by  Dr.  H.  J.  Bigelow,  who  found  a small  scar  and  a depression 
over  the  frontal  sinus,  the  cause,  no  doubt,  of  the  epilepsy  which  attacked  the  patient  every  two  weeks.  These  attacks  were 
preceded  by  a distinct  aura  and  by  numbness  in  the  left  hand.  They  became  less  frequent,  and  otherwise  he  was  doing  well. 
The  name  of  this  patient  is  not  u]ion  the  pension  list.  The  case  is  reported  by  Assistant  Surgeon  H.  S.  Schell,  U.  S.  A.  The 
regimental  surgeon.  Dr.  Warren  M.  Babbitt,  103d  Colored  Troops,  of  Randolph,  Massachusetts,  printed  a report'  of  this  case, 
in  November,  1867.  He  records  the  patient’s  name  as  Libjencrantz ; but  in  the  official  roster  it  is  recorded  as  above.^  In  the 
spring  of  1870,  Lieutenant  Lilycrantz  called  at  the  Surgeon  General’s  Office,  and  was  examined  by  Assistant  Surgeon  G.  A. 
Otis,  U.  S.  A.  There  was  a small  depressed  cicatrix  above  the  inner  portion  of  the  right  eyebrow.  The  officer’s  replies  to 
questions  indicated  a dull  intellect.  He  articulated  distinctly  and  there  was  no  paralysis.  He  was,  at  this  time,  seeking  an 
office  in  one  of  the  executive  departments,  and  probably  obtained  one,  as  a notice  of  his  death,  in  January,  1871,  about  five 
years  after  the  reception  of  the  injury,  was  observed  in  one  of  the  Washington  newspapers. 

Case. — Private  Benjamin  B.  Claiborne,  Troop  H,  2d  Arkansas  Cavalry,  aged  23  years,  was  wounded  in  an  engagement 
at  Osage,  Kansas,  October  25th,  1864,  by  a missile  which  penetrated  the  frontal  bone  and  lodged.  He  was  immediately  conveyed 
to  Fort  Scott.  The  ball  was  not  extracted,  but  the  wound  was  dressed  in  the  usual  manner.  The  case  progressed  favorably, 
and  Claiborne  was  returned  to  duty  on  December  22d,  1864.  Surgeon  A.  C.  Van  Duyn,  U.  S.  V.,  reports  the  case.  A subsequent 
report  by  Pension  Examiner  E.  Bennett,  October  8th,  1869,  represents  the  patient  as  totally  disabled,  being  easily  overcome  by 
fatigue  or  heat,  and  compelled  to  assume  a recumbent  posture  in  frequently  recurring  attacks  of  vertigo. 

Case. — Private  William  Sheridan,  Battery  I,  5th  Ohio  artillery,  aged  21  years,  was,  on  May  27th,  1865,  admitted  to 
hospital  at  Little  Rock,  Arkansas,  with  a gunshot  wound  through  the  left  temporal  region.  The  missile  lodged  in  the  brain. 
He  recovered,  and  was  discharged  on  June  20th,  1865.  He  is  not  a pensioner. 


* Bo$ton  Medical  and  Surgical  Journal^  Vol.  LXXVII,  p.  340.  ^Official  Army  Register  of  the  Volunteer  Force^  Part  VIII,  p.  284.  Washington,  1867. 


194 


WOUNDS  AND  INJUEIES.OF  THE  HEAD, 


Case. — Private  John  H.  Secliler,  Co.  H,  21st  Wisconsin  Volunteers,  aged  21  years,  was  wounded  in  the  engagement  at 
Bentonville,  Nortli  Carolina,  March  19th,  18C5,  by  a conoidal  ball,  wliich  struck  the  os  fi'ontis  over  the  right  eye  and  passed  into 
the  brain.  He  was  admitted  to  the  hospital  of  the  1st  division.  Fourteenth  Corps;  on  April  5th,  sent  to  the  Foster  Hospital  at 
New  Berne,  North  Carolina;  on  April  12th,  to  the  Grant  Hospital,  New  Yoik  Harbor,  and  on  Slay  29th,  to  the  Swift  Hospital  at 
Prairie  du  Chien,  Wisconsin,  whence  he  was  returned  to  his  regiment  on  August  3d,  1865,  for  muster  out.  He  is  not  a pensioner. 

Case. — Private  John  Wolstenholm,  Co.  B,  37th  Indiana  Volunteers,  aged  25  years,  was  wounded  at  the  battle  of  Lost 
Mountain,  Georgia,  June  17th,  1864,  by  a conoidal  musket  hall,  which  entered  the  mastoid  process  of  the  temporal  bone  and 
penetrated  the  brain.  On  the  same  day,  he  was  admitted  to  the  hospital  of  the  1st  division.  Fourteenth  Corps;  on  June  26th, 
was  sent  to  Hospital  No.  1,  Nashville,  thence  was  transferred,  on  June  29th,  to  the  Totten  Hospital  at  Louisville ; and  on 
July  12th,  was  admitted  to  the  Soldiers’ Home  Hospital  at  Indianapolis.  He  recovered,  and  was  discharged  the  service  July 
24th,  1865.  Pension  Examiner  J.  S.  McNeily  since  reports  the  patient  entirely  deaf  in  right  ear,  the  right  eye  irritable  and 
injected,  with  constant  pain  in  the  right  side  of  the  head,  impairment  of  the  mental  faculties,  tendency  to  vertigo  upon  slight 
exertion ; and  rates  his  disability  total,  and  permanent.  He  believed  that  the  missile  had  not  yet  been  removed. 

Case. — Private  William  McCann,  Co.  C,  1st  Maryland  Eegimeut,  received  a penetrating  gunshot  wound  of  the  head,  and 
was  admitted  to  hospital  No.  1,  Eichmond,  Virginia.  The  missile  was  not  extracted.  He  was  discharged  fi’om  the  service 
January  27th,  1864,  on  recommendation  of  Surgeon  C.  B.  Gibson,  P.  A.  C.  S. 

Case. — Private  William  A.  Andrews,  Co.  D,  25th  Massachuisetts  Volunteers,  was  wounded  at  the  battle  of  New  Berne, 
North  Carolina,  March  14th,  1862,  by  a buckshot,  which  entered  the  right  ear,  back  of  the  meatus,  penetrated  the  bone,  and 
lodged  within  the  cranium.  On  March  18th,  he  was  admitted  to  the  Academy  Hospital,  New  Berne;  was  furloughed  on  April 
20th,  and  was  discharged  the  service  October  10th,  1862,  and  pensioned.  On  December  12th,  1862,  Pension  Examiner  Oramel 
Martin  reports  the  wound  still  discharging,  and  the  patient  complaining  of  stiffness  in  the  cords  of  the  neck,  with  weakness  of 
the  right  arm,  he  being  unable  to  move  it  for  five  weeks,  except  with  the  assistance  of  the  left  hand.  He  was  still  weak,  but 
gradually  gaining  strength.  At  times  he  was  subject  to  slight  deafness.  In  a subsequent  report,  dated  October  19th,  1860,  he 
says  that  the  missile  still  remained  in  the  brain,  that  the  wound  was  discharging  pus,  and  that  a sinus  was  opening  back  of  the 
ear ; that  his  general  health  was  impaired  ; and  that  his  disability  is  rated  one-half  and  permanent. 

Case. — I'rivate  William  E.  Worley,  Trooj)  K,  9th  Indiana  Cavalry,  aged  20  years,  was  wounded  at  Franklin,  Tennessee, 
December  23d,  1864,  by  a conoidal  ball,  which  entered  the  right  external  ear,  passed  downward  and  backward,  and  lodged, 
fracturing  the  occipital  bone.  He  was  taken  to  the  post  hospital  at  Columbia,  and  on  January  19th,  was  sent  to  hospital  No.  2 
at  Nashville.  On  July  20th,  the  patient  was  transferred  to  Crittenden  Hospital,  Louisville,  thence  to  Jefferson  Hospital,  Indiana, 
and  on  July  26th  to  Indianapolis,  where  he  was  mustered  out  of  service  August  23th,  1835,  and  pensioned,  his  disability  being 
rated  one-half  and  probably  permanent.  At  the  date  of  the  patient’s  discharge,  it  was  reported  by  Pension  Examiner  M.  H. 
Harding  that  he  suffered  pain  and  vertigo  after  any  active  exercise.  Accompanying  this  information  was  the  sworn  deposition 
of  the  patient  stating  the  fact  that  freipient  ju’obings  had  failed  to  reach  the  ball,  that  small  pieces  of  bone  were  discharged  at  the 
time  of  the  probing,  and  that  the  wound  was  a running  sore,  at  times  painful. 

Case. — Corporal  Edward  Steible,  Co.  G,  43d  Illinois  Volunteers,  was  wounded  at  the  battle  of  Shiloh,  April  7th,  1832, 
by  a musket  ball,  which  entered  the  frontal  bone  one  inch  above  the  superciliary  ridge,  and  one  inch  and  a half  from  the  median 
line,  passed  through  the  skull  backward  and  downward,  and  lodged.  The  patient  was  taken  on  board  the  steamer  Empress  on 
Apiil  20th,  ^vas  sent  to  the  hospital  at  Keokuk,  Iowa,  and  on  July  17th  to  the  New  House  of  Eefuge  Hospital,  St.  Louis,  where 
he  was  discharged  June  3d,  1863.  The  seat  of  the  ball,  which  still  remained  in  the  head,  could  not  be  ascertained,  and  the  wound 
was  still  suppurating.  A probe,  introduced  into  the  fistulous  wound,  passed  through  the  cribriform  plate  of  the  ethmoid,  and 
api)eared  in  the  nasal  cavity.  The  man  was  continually  subject  to  vertigo.  He  was  pensioned,  his  disability  being  rated  total 
and  permanent. 

Case. — Private  William  Cromwell,  Co.  G,  7th  Ohio  Volunteers,  was  admitted,  on  December  17th,  1862,  to  the  Continental 
Hotel  Hospital,  Baltimore,  with  a penetrating  wound  of  the  cranium  caused  by  a buckshot,  which  entered  at  the  junction  of  the 
parietal  with  the  occipital  bone.  On  May  1st,  1863,  he  was  transferred  to  Fort  Wood,  New  York  Harbor,  and  was  discharged  the 
service  May  28th,  1863,  and  pensioned.  A report  from  Pension  Examiner  O.  Pomeroy  says  that  the  shot  still  remains  within  the 
cranium,  and  that  the  patient  suffers  from  constant  headache  and  frequent  attacks  of  epilepsy,  rendering  him  unable  to  obtain  a 
livelihood;  and  rates  his  disability  total  and  permanent. 

Case. — Private  August  McClellan,  Co.  C,  28th  Massachusetts  Volunteers,  was  wounded  at  the  battle  of  Fredericksburg, 
December  13th,  1862,  by  a missile  which  penetrated  the  frontal  bone,  over  the  left  superciliary  ridge,  and  remained  within  the 
cranium.  He  was  admitted  to  the  hospital  of  the  1st  division.  Ninth  Corps ; on  December  16th,  was  sent  to  the  hosj)ital  at  Point 
Lookout,  Maryland ; on  May  1st,  1863,  to  West’s  Building  Hospital,  Baltimore,  and  on  May  9th,  to  Portsmouth  Grove,  Ehode 
Island,  where  he  was  transferred  to  the  Veteran  Eeserve  Corps.  He  was  discharged  August  31st,  1866,  and  pensioned.  The 
patient  suffered  from  vertigo  upon  exertion.  His  disability  was  rated  total. 

Case. — Corporal  John  W.  Cool,  Co.  D,  52d  Virginia  Eegiment,  aged  22  years,  was  wounded  at  the  battle  of  Winchester, 
September  19th,  1864,  by  a conoidal  ball,  which  fractured  the  occipital  bone  and  entered  the  brain.  He  was  treated  at 
Winchester  until  the  18th  of  December,  when  he  was  sent  to  West’s  Building  Hospital  at  Baltimore.  The  treatment  throughout 
wa*s  of  a very  simple  character.  The  patient  recovered,  and  was  transferred  on  January  5th,  1865,  to  Fort  McHenry  for 
exchange.  On  March  24th,  1835,  he  was  examined  by  a Confederate  retiring  board.  'Tlie  missile  was  a source  of  constant 
irritation  to  the  brain,  and  the  board  declared  that  the  patient  was  unable  to  perform  held  duty,  but  might  be  employed  at  some 
post  where  the  duties  were  not  laborious. 


BALLS  LODGED  WITHIN  THE  CRANIUM. 


195 


Case. — Private  Jonatlian  Wiser,  Co.  E,  49tli  Pennsylvania  Volunteers,  aged  35  years,  was  wounded  at  tlie  battle  of  the 
IVilderness,  May  5tli,  1864,  by  a conoidal  musket  ball,  which  fractured  and  slightly  depressed  the  cranium.  He  was  at  first 
admitted  to  the  hospital  of  the  1st  division.  Sixth  Corps,  and,  on  May  12th,  was  sent  to  the  Mount  Pleasant  Hospital,  'Wash- 
ington. The  records  of  the  latter  hospital  state  that  the  ball  had  not  been  extracted.  On  September  24th,  he  was  admitted  to 
the  Frederick  Hospital,  Maryland,  where  he  remained  under  treatment  until  June  Cth,  1865,  when  he  was  discharged  from 
service.  The  case  is  reported  by  Assistant  Surgeon  C.  A.  McCall,  U.  S.  A.  This  patient  is  not  on  the  pension  list. 

Case. — Private  John  E.  Leland,  Troop  E,  1st  Illinois  Cavalry,  was  wounded  by  a gunshot  missile,  probably  a buckshot, 
which  entered  the  mastoid  process  of  the  left  temporal  bone  close  behind  the  middle  of  the  pinna,  passed  slightly  forward  and 
lodged  in  the  cranium,  but  its  exact  locality  could  not  be  ascertained.  The  pinna  had  become  adherent  to  the  scalp  at  the 
entrance  of  the  wound.  The  patient  suffered  pain  in  the  region  between  the  entrance  of  the  wound  and  the  eyebrow.  Active 
e.xercise,  or  stooping,  would  produce  dizziness  and  pain.  The  vision  and  hearing  of  the  left  side  were  slightly  impaired.  He 
was  discharged  the  service  March  14th,  1862,  and  pensioned,  his  disability  being  rated  one-half  and  temporary. 

Case. — Corpoi’al  William  G.  Davis,  Co.  A,  105th  Ohio  Volunteers,  aged  30  years,  was  wounded  at  the  battle  of  Chick- 
amauga,  Georgia,  September  20th,  1863,  by  a conoidal  musket  ball,  which  fractured  and  penetrated  the  right  temporal  bone,  and 
lodged  within  the  cranium.  On  September  29th,  he  was  admitted  to  the  hospital  at  Chattanooga,  Tennessee,  thence  was  trans- 
ferred on  October  6th  to  Stevenson,  Alabama,  and  on  October  12th  to  Nashville,  where  he  remained  under  treatment  until  June 
18th,  1864,  when  he  was  sent  to  the  Totten  Hospital,  Louisville,  Kentucky.  On  July  15th,  he  was  sent  to  the  hospital  at  Cleve- 
land, Ohio,  and  mustered  out  of  service  May  31st,  1865,  and  pensioned.  Since  the  patient’s  discharge  he  has  suffered  from 
headache  and  vertigo,  and  impaired  functions  of  right  eye  and  ear.  His  disability  is  rated  total  and  permanent. 

Case. — Private  William  Sheridan,  Battery  M,  1st  Missouri  Artillery,  aged  34  years,  was  wounded  at  the  siege  of  Vicks- 
burg, May  19th,  1863,  by  a canister  shot.  The  missile  entered  the  left  parietal  bone,  immediately  posterior  to  the  coronal,  and 
three  inches  from  the  sagittal  suture,  passed  horizontally  inward,  a distance  of  two  and  a half  inches  (as  stated  by  the  Surgeon 
who  probed  the  wound  at  the  time  of  receipt  of  injury),  and  lodged.  He  was  taken  on  board  an  hospital  boat,  where  an  unsuc- 
cessful attempt  was  made  to  extract  the  ball.  On  May  25th,  the  ])atient  was  admitted  to  the  Van  Bureu  Hospital,  where  he 
remained  some  weeks,  going  about  the  hospital,  dressing  his  own  wound,  and  suffering  but  little  inconvenience.  He  was  returned 
to  his  battery,  and  on  September  3d,  1863,  was  discharged  from  service.  At  that  time,  and  for  weeks  previous  to  his  discharge, 
the  wound  suppurated  freely,  and  occasionally  bled,  and  small  fragments  of  bone  escaped.  In  November,  he  was  ])laced  to 
work  on  the  levee  by  the  Commissary  Department.  The  work  was  heavy,  but  he  experienced  no  trouble,  except  on  approach 
of  a storm,  when  he  had  a dull  pain  and  sensation  of  weight.  He  was,  however,  attacked  with  fever,  and  on  December  14th 
was  admitted  to  hospital  No.  12,  Na.shville,  and  on  December  28th  sent  to  hospital  No.  1,  of  the  same  place.  On  January  3d, 
1864,  the  patient  was  convalescent.  The  cicatrix  is  hard  and  bony,  and  about  on  a level  with  the  inner  table.  The  edges  of  the 
opening  through  the  outer  table  are  quite  abrupt.  He  was  returned  to  duty  on  February  24th,  1864.  He  is  not  a pensioner. 

Case. — Private  Samuel  D.  Solomon,  Co.  G,  3d  New  Jersey  Volunteers,  was  wounded  in  an  engagement  at  Bull  Run 
Bridge,  August  27th,  1862,  by  a carbine  ball,  which  struck  at  a point  two  inches  behind  the  tip  of  the  left  ear,  and  produced, 
apparently,  only  a scalp  wound  across  the  median  line.  He  fell  to  the  ground,  but  retained  his  consciousness.  When  seen  by 
the  surgeon,  a probe  was  passed  along  the  track  of  the  missile  the  depth  of  two  inches  into  the  brain  substance.  The  patient 
was  sent  to  the  3d  division  hospital  at  Alexandria.  The  extent  of  the  injury  was  not  suspected,  and  the  case  was  treated  as  a 
superficial  scalp  wound.  On  September  3d,  he  was  admitted  to  the  Broad  and  Cherry  Streets  Hospital,  Philadelphia.  Healthy 
suppuration  continued,  and  a fragment  of  bone  was  discharged  from  the  wound.  On  November  6th,  the  wound  had  healed,  and 
the  patient  was  returned  to  duty.  Two  days  later  he  was  admitted  to  the  Eyland  Chapel  Hospital,  Washington,  suffering  from 
a large  abscess  in  the  left  ear.  On  December  5th,  he  was  transferred  to  the  Stanton  Hospital.  The  discharge  from  the  ear  had 
not  altogether  ceased,  and  he  was  suffei'ing  constant  headache,  which  was  greatly  increased  by  exposure  to  cold  air ; he  also 
suffered  from  acute  darting  pains  across  the  base  of  brain,  fi-om  the  right  temple  to  the  scar  of  the  wound.  No  paralysis  existed 
and  the  functions  of  the  body  were  generally  well  performed.  The  cicatrix,  though  tender,  was  firm.  After  a few  days,  he  was 
allowed,  at  his  own  request,  to  serve  in  the  capacity  of  nurse ; but,  in  two  weeks’  time,  he  was  relieved  from  this  task,  as  the 
pain  and  vertigo  were  unduly  increased,  and  he  was  becoming  pale  and  emaciated.  He  was  discharged  the  service  January  19th, 
1863.  Surgeon  John  A.  Lidell,  U.  S.  V.,  who  reports  the  case,  states,  that  it  was  the  opinion  of  several  surgeons,  who  examined 
the  injury,  that  the  missile  still  lodged  in  the  cranial  cavity.  On  March  2d,  1870,  his  claim  for  pension  was  still  pending,  and 
his  disability  rated  three-fourths  and  probably  permanent. 

Case. — Sergeant  Walter  Rotherham,  Co.  D,  7th  New  Jersey  Volunteers,  aged  23  years,  was  wounded  at  Gettysburg, 
July  2d,  1863,  i)y  a musket  ball,  which  penetrated  the  skull  near  the  right  frontal  eminence,  passed  directly  inw'ard  and  lodged 
somewhere  on  the  membranes  or  in  the  brain  substance.  He  was  admitted  to  the  hospital  of  the  2d  division.  Third  Corps,  and 
on  July  10th  was  sent  to  the  .Jarvis  Hospital  at  Baltimore.  The  opening  through  the  bone  was  similar  to  that  made  by  a 
trephine,  and  the  track  of  the  ball  could  be  followed  on  the  dura  mater  wdth  a probe  for  a considerable  distance,  as  that  mem- 
brane was  detached  from  its  natural  connections  with  the  skull.  The  patient  was  unable  to  say  whether  there  had  been  much 
hatmorrhage  or  not.  The  parts  were  still  open,  and  in  making  an  exploration,  the  little  linger  could  be  readily  inserted  through 
the  fracture,  but  no  jagged  bone  itressing  inward  could  be  detected.  The  membranes  were  not  lacerated  at  the  seat  of  injury. 
The  pulsations  of  the  brain  could  be  distinctly  felt,  and  it  was  apparent  that  the  ball  had  not  rebounded  or  dropped  out,  but  had 
followed  a course  toward  the  back  of  the  skull,  where  it  still  was  concealed.  The  patient  further  stated  that,  on  recovering  his 
senses,  he  was  not  in  the  l(!ast  paralyzed,  and  was  able  to  conver.se,  and  that  his  surgeon  said  : “you  cannot  jwssibly  live.”  After 
a few  hours,  he  again  became  insensible,  and  remained  so  for  two  days,  when  consciousness  again  returned.  The  ptitient,  on 
admission,  was  able  to  sit  up,  stand,  and  walk,  but  he  earned  his  head  backward,  resting  between  the  shoulders,  and  complained 
of  great  pain  and  dizziness,  if  he  attempted  to  change  it  to  an  erect  ])osition.  Tliere  was  no  jyerceptibh?  loss  of  power,  motion. 


196 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


or  sensation  on  either  side  of  his  body.  He  was  directed  to  be  put  to  bed,  and  quiet  was  enjoined.  His  hair  was  then  cut  short, 
and  cold  water  dressings  were  applied.  There  being  no  arterial  excitement,  the  treatment  was  chiefly  expectant.  His  recovery 
was  rapid,  and  on  August  12th,  he  was  furloughed  for  fifteen  days,  at  the  expiration  of  which  time  he  returned,  having  sufiered 
no  inconvenience  from  the  journey.  The  wound,  however,  had  not  entirely  closed,  and  since  that  date  several  pieces  of  bone  have 
exfoliated.  He  was  transferred  to  the  Veteran  Reserve  Corps,  and  was  assigned  to  light  duty  in  the  hospital,  but  it  soon  became 
evident  that  he  was  permanently  disabled,  and  he  was  discharged  the  service  December  19th,  1863,  at  which  time  he  complained 
of  a constant  dull,  heavy  pain  at  the  back  of  his  head.  At  night  he  suffered  from  unpleasant  dreams  and  hallucinations,  which 
sometimes  caused  him  to  wake  in  a state  of  great  terror.  His  bowels  were  obstinately  constipated,  but  were  readily  relieved  by 
mild  cathartics.  Occasionally  he  was  annoyed  by  nausea  and  vomiting  after  eating  his  meals.  His  mind  was  not  impaired  to 
any  perceptible  degree.  He  is  not  a pensioner.  The  case  is  reported  by  Assistant  Surgeon  D.  C.  Peters,  U.  S.  Arm3^ 

Case. — Private  Elijah  Lanning,  Co.  K,  79th  Pennsylvania  Volunteers,  was  struck  by  a missile  at  the  battle  of  Chicka- 
maiiga,  Georgia,  September  19th,  1863,  which  penetrated  the  right  parietal  bone.  No  particulars  of  the  case  can  be  obtained, 
until  February  17th,  1864,  when  the  patient  was  admitted  to  the  field  hospital  at  Chattanooga,  Tennessee.  He  received  a fur- 
lough in  March,  and  at  its  expiration,  April  27th,  was  transferred  to  the  York  Hospital,  Pennsylvania,  suffering  at  the  time  from 
paralysis.  On  October  5th,  1864,  he  was  mustered  out  of  service  and  pensioned.  A month  after,  Pension  Examiner  S.  Cleizer 
reports  the  ball  still  remaining  within  the  cranium,  causing  paralysis  of  the  left  arm  and  both  lower  extremities,  and  rates  his 
disability  total  and  likely  to  be  permanent. 

Missiles  Extracted  from  within  the  Cranium. — In  many  cases  attempts  were  made 
to  remove  projectiles  which  had  penetrated  the  cranial  cavity,  and  even  imbedded  them- 
selves in  the  substance  of  the  cerebral  hemispheres.  Though  most  of  these  cases  had  a 
fatal  termination,  the  evidence  seems  conclusive  that,  in  a few,  this  operation  was  success- 
fully accomplished  : 

Case. — Lieutenant  Andrew  M.  Brown,  15th  U.  S.  Infantry,  received  at  the  battle  of  Wilson’s  Creek,  Missouri,  August 
10th,  1861,  a penetrating  gunshot  wound  of  the  cranium.  On  the  same  day,  he  was  admitted  to  the  hospital  at  Springfield.  He 
recovered,  and  was  returned  to  his  regiment,  then  the  1st  Missouri  Infantry,  for  duty.  The  ball  was  successfully  removed  from 
the  wound  in  1868,  seven  years  after  the  reception  of  the  injuiy.  In  January,  1871,  this  officer  was  on  duty  as  a Captain  in  the 
13th  Infantry. 

Case. — Corporal  David  Patterson,  Co.  E,  8th  New  Jersey  Volunteers,  aged  37  years,  was  wounded  at  the  battle  of 
Chancellorsville,  May  3d,  1863,  by  a conoidal  ball,  wliich  penetrated  the  left  parietal  bone.  He  was  admitted  to  the  Log  Hos- 
pital, Chancellors ville,  and  on  June  8th,  was  sent  to  the  Mower  Hospital,  Philadelphia.  The  ball  had  been  extracted  prior  to 
admission,  and  several  pieces  of  bone  had  come  away.  The  pulsations  of  the  brain  were  visible  through  the  wound.  During 
the  months  of  June,  July,  August,  and  September,  fragments  of  bone  continued  to  come  away,  but  on  October  20tb,  the  wound 
had  healed  with  the  exception  of  a small  point.  He  had  been  transferred  to  the  Veteran  Reserve  Corps  on  August  20th,  1863. 
On  September  1st,  1864,  he  was  discharged  the  service  and  pensioned.  Subsequent  information  states  that  the  patient’s  symp- 
toms, indicating  lesion  of  the  brain,  are  on  the  increase.  His  disability  is  rated  one-half. 

Case. — Private  Joseph  Shortz,  Co.  A,  15th  United  States  Infantry,  aged  25  years,  was  wounded  in  an  engagement  at 
Jonesboro’,  Georgia,  September  1st,  1864,  by  a conoidal  musket  ball,  which  penetrated  the  frontal  bone  on  the  right  side,  and 
lodged:  He  was  immediately  admitted  to  the  hospital  of  the  1st  division.  Fourteenth  Corps,  suffering,  apparently,  little  from 
the  shock  of  the  injury,  and  nothing  of  special  note  is  mentioned  until  the  12th,  when  the  operation  of  extracting  the  missile 
was  successfully  performed.  No  ill  results  ensued.  He  was  kept  quiet  in  his  quarters  until  the  23d  of  October,  when  he  was 
transferred,  by  way  of  Chattanooga,  to  Nashville,  Tennessee,  where  he  w’as  admitted  into  Hospital  No.  1,  on  October  27th.  On 
November  2d,  he  was  furloughed,  and  on  December  20th,  was  admitted  to  the  hospital  at  Keokuk,  Iowa.  At  the  expiration  of 
his  term  of  service  on  the  22d  of  February,  1865,  he  was  transferred  to  Davenport,  Iowa,  for  muster  out.  He  is  not  a pensioner. 

Case.— Private  Edward  Ware,  Co.  F,  13th  Iowa  Volunteers,  aged  24  years,  was  wounded  near  Atlanta,  Georgia,  July 
20th,  1864,  by  a conoidal  musket  ball,  which  fractured  both  tables  of  the  frontal  bone  at  the  upper  border,  left  side,  and  pene- 
trated the  brain.  He  was  admitted  to  the  hospital  of  the  4th  division.  Seventeenth  Corps,  on  July  30th;  on  August  3d,  w’as 
transferred  to  the  hospital  of  the  Seventeenth  Corps,  and  on  August  10th,  w’as  sent  north.  No  records  of  the  case  can  be  found, 
until  December  19th,  when  Ware  was  admitted  to  the  hospital  at  Keokuk,  Iowa,  from  furlough.  The  ball  had  been  rem’oved  by 
incision  on  November  6th,  1864,  and  simple  dressings  had  been  applied.  The  wound  was  still  open,  but  looked  healthy.  On 
January  2d,  1865,  Ware  was  transferred  to  Davenport,  Iowa,  for  muster  out,  and  discharged  June  2d,  1865,  and  pensioned. 
Subsequent  information  states  that  this  man  is  a confirmed  epileptic. 

Case. — Private  Morris  Winkler,  Co.  C,  26th  Wisconsin  Volunteers,  was  wounded  at  Gettysburg,  July  1st,  1863,  by  a 
missile  which  penetrated  the  frontal  bone  near  the  right  eminence,  and  entered  the  brain.  He  was  admitted  to  the  Seminary 
Hospital,  and  on  July  8th,  was  sent  to  Twenty-fourth  and  South  Streets  Hospital,  Philadelphia,  where  the  missile  was  removed 
by  Acting  Assistant  Surgeon  F.  F.  Maury.  The  patient  recovered,  and  on  September  17th,  1864,  was  transferred  to  the  Veteran 
Reserve  Corps.  He  was  discharged  the  service  June  30th,  1865,  and  pensioned  on  June  23d,  1868.  Pension  Examiner  L.  D. 
McIntosh,  reports  that  the  patient  suffered  impairment  of  sight  in  the  right  eye,  dizziness  and  headache.  His  disability  is  rated 
total  and  permanent. 


BALLS  LODGED  WITHIN  THE  CRANIUM. 


197 


Case. — Private  William  Duffy,  Co.  E,  G9tli  New  York  Volunteers,  aged  28  years,  was  wounded  at  Autietam,  September 
17th,  1862,  by  a conoidal  ball,  which  entered  the  left  parietal  about  its  junction  with  the  squamous  portion  of  the  temporal  bone, 
p.assed  downward  and  backward,  and  lodged  in  the  substance  of  the  brain.  He  was  insensible  about  an  hour,  at  the  expiration 
of  which  time  the  missile  was  removed.  The  right  arm  and  hand  were  paralyzed.  The  patient  was  admitted  to  the  Sixteenth 
and  Filbert  Streets  Hosi)ital,  Philadelphia,  Se])tember  2Gth,  1862,  where  he  gradually  recovered,  under  expectant  treatment.  He 
was  sent  to  the  Ladies’  Home  Hospital,  New  York  City,  M.ay  26th,  1863,  and  was  transferred  to  the  Veteran  Reserve  Corps 
July  29th,  1863.  He  had  nearly  recovered  the  use  of  his  hand  and  arm.  Acting  Assistant  Surgeon  J.  W.  S.  Norris  reports  the 
case.  This  man  was  discharged  the  service  November  4th,  1864,  and  pensioned.  On  April  7th,  1869,  Pension  Examiner  J. 
Neill  reports  him  suffering  from  paralysis  of  the  right  arm,  with  defective  articulation,  and  rates  his  disability  total  and  permanent. 

Case. — Private  William  E.  Chapman,  Co.  E,  69th  New  York  Volunteers,  was  wounded  near  Petersburg,  Virginia,  March 
25th,  1865,  by  a conoidal  musket  ball,  which  caused  a penetrating  fracture  of  the  temporal  bone.  He  was,  on  the  same  day, 
admitted  to  the  hospital  of  the  1st  division.  Second  Corps,  and  thence  was  conveyed  to  Washington,  and  admitted  to  the  Cami)- 
bell  Hospital,  on  March  28th,  where  the  missile  was  removed.  He  was  discharged  on  May  30th,  1865.  On  May  15th,  1868, 
Pension  Examiner  M.  C.  Hazen  reported  that,  from  time  to  time,  pieces  of  bone  have  been  discharged  from  the  ear.  There  was 
a constant  discharge  from  the  ear,  with  a continued  dull  pain  in  the  head,  and  the  jaw  was  anchylosed.  His  disability  is  rated 
three-fourths  and  temporary. 

Case. — Sergeant  Frank  D.  Hamilton,  Co.  E,  28th  Massachusetts  Volunteers,  aged  22  years,  was  wounded  at  the  battle 
of  Cold  Harbor,  Virginia,  June  3d,  1864,  by  a conoidal  musket  hall,  which  apparently  pi’oduced  only  a scalp  wound.  He  was 
sent  to  the  hospital  of  the  1st  division.  Second  Corps,  thence  was  conveyed  to  Washington,  and  on  the  7th,  admitted  to  the 
Harewood  Hospital.  On  June  16th,  he  was  transferred  to  the  Knight  Hospital  at  New  Haven,  Connecticut,  where  it  was 
discovered  that  the  fi’ontal  bone  had  been  fractured.  The  treatment  throughout  was  of  a simple  character.  In  November,  the 
patient  was  sent  to  the  Dale  Hospital,  Worcester,  JIassachusetts;  was  discharged  from  service  on  the  3d  of  January,  1865,  and 
pensioned,  his  disability  being  rated  total  and  permanent.  On  March  5th,  1868,  Pension  Examiner  C.  L.  Fisk,  jr.,  reported  that 
the  ball  had  been  extracted  from  the  brain,  but  that  the  patient  had  been  much  prostrated  ever  since,  and  was  growing  worse. 

Case. — Commissary  Sergeant  Abraham  F.  Debaun,  Co.  I,  1st  Kentucky  Cavalry,  was  wounded  at  Fair  Garden,  Tennessee, 
January  28th,  1864,  by  a conoidal  ball,  which  entered  the  forehead  at  the  right  superciliary  ridge,  and  passing  backward  and 
outward,  apparently  emerged  immediately  behind  the  right  eye.  He  was  admitted,  on  February  1st,  to  the  hospital  at  Knoxville, 
Tennessee.  On  February 7th,  he  was  returned  to  duty;  but,  on  February  12th,  was  again  admitted  to  hospital  No.  1,  Nashville. 
The  wounds  of  entrance  and  of  exit  had  cicatrized,  and  the  patient  suffered  little  or  no  inconvenience.  On  February  13th,  he 
was  transferred  to  Frankfort,  Kentucky,  and  was  discharged  December  31st,  1864,  suffering  from  headache,  neuralgia,  and 
heaviness  about  the  head,  with  occasional  dimness  of  vision  and  almost  constant  discharge  from  the  wound  of  a dirty  sanious 
pus.  In  1870,  he  came  to  Dr.  Preston  Peter  at  Louisville,  Kentucky.  The  symptoms  were  the  same  as  at  the  date  of  his 
discharge,  and  occasionally,  when  the  wound  became  temporarily  closed  or  failed  to  discharge  fi’eely,  he  would  become  sleepy, 
approaching  an  apoplectic  coma,  and  the  sight  of  the  eye  would  be  much  impaired.  An  operation  for  the  purpose  of  removing, 
as  was  supposed,  depressed  and  necrosed  bone,  was  decided  upon  and  performed  by  Dr.  D.  Cummins,  assisted  by  Drs.  .1.  A. 
Brady  and  P.  Peter.  A crucial  incision  was  made  directly  over  the  point  of  entrance  at  the  internal  angle  of  the  right  superciliai’y 
ridge;  a fungous  and  cartilaginous  growth  was  now  removed,  and  numerous  small  vessels  ligated.  An  opening  through  the 
external  table  of  the  frontal  bone  was  then  discovered,  and  upon  trimming  off  the  ragged  edge  with  bone-pliers,  evidences 
of  lead  were  found.  An  elevator  was  introduced,  and  two  pieces  of  lead,  each  about  one-third  the  size  of  an  ounce  ball,  besides 
numerous  small  particles,  all  lying  in  the  right  frontal  sinus,  were  rernoved.  When  this  was  done,  the  internal  table  was  found 
to  be  slightly  depressed,  with  an  opening'in  the  depression  communicating  with  the  dura  mater  opposite  the  site  of  the  fragments 
of  lead.  As  the  patient  had  never  suffered  from  epilepsy,  it  w'as  not  deemed  advisable  to  remove  the  depressed  bone.  The 
wound  was  closed  with  sutures,  and  isinglass  plaster  and  water  dressings  were  applied.  He  improved  rapidly,  without  any 
untoward  symptoms,  and  in  ten  daj’s  left  for  his  home.  In  August,  1870,  the  patient  was  hearty,  had  gained  considerable  flesh, 
and  was  free  from  headache,  neuralgia,  dimness  of  vision,  or  anything  of  the  Ijincl.  He  is  a pensioner.* 

Case. — Private  Jonathan  U.  Smith,  Co.  K,  20th  Ohio  Volunteers,  aged  20,  was  wounded  at  Goldsboro’,  North 
Carolina,  by  a missile,  which  struck  near  the  centre  of  the  left  parietal  bone  and  carried  away  a portion.  The  ball  was  removed 
seven  days  after  the  reception  of  the  injury.  The  patient  was  discharged  the  service  April  3d,  1865,  and  pensioned.  Subsequent 
information,  dated  June  15th,  1865,  states  that  he  was.  unable  to  exert  himself  without  severe  pain  in  the  head,  and  that  he  was 
affected  by  the  vicissitudes  of  the  weather.  His  disability  was  rated  three-fourth^  and  temporary. 

Case. — Private  Andrew  Gallagher,  Co.  D,  11th  U.  S.  Infantry,  was  wounded  at  Gettysburg,  July,  1863,  by  a conoidal 
ball,  which  struck  on  the  outer  side  of  the  left  orbit,  penetrated  behind  the  eye,  and  lodged.  He  was  admitted  to  the  hospital  of 
the  2d  division.  Fifth  Corps,  and  on  July  13th,  was  sent  to  the  Camden  Street  Hospital  at  Baltimore.  On  September  25th,  he 
was  sent  to  Fort  Independence,  Boston  Harbor,  and  there  discharged  from  service  on  January  5th,  1864.  On  April  28th,  1864, 
Pension  Examiner  W.  S.  Searle  reports  that  the  ball  had  been  extracted,  but  the  vision  of  the  eye  was  gone ; the  eyeball  was 
one-third  less  in  size,  and  the  pupil  was  insensible  to  light.  Sudden  shocks  would  give  gi’eat  pain  in  the  eye ; the  loss  of  memory 
was  almost  complete,  and  much  pain  was  felt  in  the  hand.  He  rated  his  disability  total  and  permanent. 


‘This  case  is  reported  in  the  American  Practitioner,  Vol.  II,  p.  332,  Louisville,  1870. 


198 


WOUNDS  AND  INJURIES  OK  THE  HEAD, 


The  successful  removals  of  projectiles  from  the  cranial  cavity  were  exceptional.  In 
the  majority  of  cases  such  attempts  were  unavailing.  Yet  a temporary  amendment  was 
observed  in  a number  of  interesting  cases  of  extraction  of  balls  from  the  interior  of  the 
skull : 

Case. — Captain  Ezra  Dickermaii,  Co.  I,  20tl)  Connecticut  Volunteers,  aged  ’Jo  years,  was  wounded  at  the  battle  of  Peach 
Tree  Creek,  Georgia,  July  20th,  1864.  The  missile  entered  about  an  inch  behind  and  on  a level  with  the  outer  angle  of  the  left 
eye,  passed  inward  and  forward,  and  carried  away  a portion  of  the  anterior  surface  of  the  greater  wing  of  sphenoid,  one-eighth  of 
an  inch  in  diameter.  He  was  sent  to  the  hospital  of  the  Twentieth  Corps,  which  he  reached  in  an  insensible  condition.  Attempts 
were  made  to  find  the  ball,  but  without  success.  He  remained  unconscious  for  several  days,  and  was,  in  the  meantime, 
transferred  to  Vining’s  Station,  thence  to  Chattanooga,  which  place  he  reached  on  July  27th.  He  had  at  that  time  become 
rational,  and  complained  of  pain,  but  was  delirious  at  times.  On  July  31st,  he  was  sent  to  Officers’  Hospital,  Nashville,  bearing 
the  journey  well.  On  August  1st,  at  his  own  reejuest,  chloroform  was  administered,  and  a second  search  was  made  for  the  ball, 
which  was  found  lodged  in,  or  near  the  ethmoid  bone.  So  firmly  was  it  imbedded,  that  it  took  two  assistants  to  hold  the  head, 
while  the  surgeon,  wrapping  his  handkerchief  round  the  handle  of  the  forceps,  was  obliged  to  pull  with  all  his  strength.  The 
operation  resulted  favorably,  and  in  a week  the  patient  left  for  his  home  in  Connecticut.  Then;  was  complete  loss  of  sight  and 
smell  of  left  side,  and  the  hearing  was  much  impaired.  The  orbit  of  the  left  eye  itself  was  not  jterceptibly  injured,  and  singu- 
larly enough  the  iris  responded  freely  to  the  action  of  light.  The  patient  showeil  a general  want  of  intellectual  vigor,  but  with 
the  exception  of  a loss  of  memory,  no  faculty  seemed  to  have  especially  suffered.  He  remained  on  light  duty  until  May,  1865, 
when  he  joined  his  regiment,  and  was  mustered  out  Juue  13th,  1865.  But  he  had  not  recovered;  working  in  the  sun  or  severe 
mental  application  would  invariably  bring  on  vertigo  and  headache.  In  the  summer  of  1866,  an  epileptic  convulsion  supervened, 
lasting  about  fifteen  minutes.  Subsequent  prostration  was  relieved  by  tonic  treatment,  and  in  a week  he  was  as  well  as  before 
the  attack.  Six  months  later  he  had  a severe  attack  of  colic;  the  following  day  a second  epileptic  attack  occurred,  this  time 
very  slight,  with  only  momentary  loss  of  consciousness.  A third  attack  occurred  in  December,  1867 ; there  were  no  convulsions, 
but  rigidity  .and  unconsciousness  lasted  about  half  an  hour.  Foaming  at  the  mouth  and  a dull  heavy  pain  in  the  forehead 
supervened,  with  frequent  pulse  and  considerable  languor.  Facial  neuralgia  along  the  portio  dura  followed,  and  continued  for 
three  days,  ^vlien  all  pain  ceased ; drowsiness  came  on,  which  passed  into  coma,  and  death  occurred  December  22d,  1867.  At 
the  post-mortem  examination  the  dura  mater  was  found  much  congested  over  the  whole  upper  surface.  On  its  summit  was  found 
a deeply  congested  spot  an  inch  in  diameter.  On  separating  the  two  layers  of  the  arachnoid,  transparent  threads  of  lymph 
were  seen  passing  from  one  to  the  other.  At  the  apex  of  the  brain,  corresponding  to  the  deeply  congested  spot  on  the  dura 
mater,  and  dipping  down  between  the  hemispheres,  more  firmly  organized  lymph  was  found,  uniting  the  layers  of  the  arachnoid 
so  firmly  that  they  were  only  separated  with  difficulty.  The  substance  of  the  brain  presented  a healthy  appearance,  and  the 
ventricles  contained  no  Huid.  At  the  bottom  of  the  middle  lobe  of  the  left  hemisphere  an  abscess  was  found,  containing  two  or 
three  ounces  of  dark-colored  and  oflensive  jius.  The  membrane  which  formed  the  cyst  was  firmly  united  together,  and  to  the 
bone  beneath;  the  upper  portion  was  delicate  and  transparent  like  the  arachnoid ; the  bone  was  neither  roughened  nor  discolored. 
At  the  anterior  border  of  the  portion  of  abscess  adherent  to  the  bone  was  a small  orifice  one-eighth  of  an  inch  in  diameter 
communicating  with  the  j)terygoid  fossa,  on  a line  with  the  track  of  the  ball  and  evidently  caused  by  it.  The  case  is  reported 
by  Surgeou  J.  Wadsworth  Terry,  20th  Connecticut  Volunteers. 

Case. — Private  C.  W , Co.  E,  14th  West  Virginia  Volunteers,  aged  22  years,  was  admitted  to  the  general  hospit.al 

at  Frederick,  Maryland,  September  17th,  1864,  coining  by  rail  from  the  hospital  at  Sandy  Hook,  having  been  ^vounded  at  Berry- 
ville,  Virginia,  on  September  3d,  by  a conoidal  musket  ball  which  entered  the  left  temporal  bone  an  inch  above  the  auditory 
meatus,  passed  inward  and  forward,  and  a little  upward.  Acting  Assistant  Surgeon  J.  H.  Bartholf  reports  that  he  passed  a 
probe  with  gre.at  freedom  four  and  a half  inches  into  the  wound.  There  was  paralysis  of  the  second,  thii'd,  fourth,  fifth,  sixth 
and  seventh  oraaial  nerves  of  the  left  side,  and  total  blindness  of  the  left  eye,  with  dilatation  of  the  pupil  aud  insensibility  of  the 
iris  and  retina,  anassthesia  of  the  cornea  and  conjunctiva  of  the  left  half  of  the  face.  On  one  occasion,  a pin  was  stuck  into  the 
scalp  of  the  forehead  by  an  awkward  nurse  and^the  patient  did  not  know  of  the  accident.  The  facial  aud  masticating  muscles 
of  the  left  side  were  powerless.  He  had  perception  of  strong  odors,  as  of  the  vapor  of  ammonia.  He  was  totally  deaf  in  the 
left  ear.  The  left  corner  of  his  mouth  drooped ; the  left  eyelids  remained  open.  The  discharge  from  the  wound  was  consid- 
erable. 'I'lie  wound  did  not  communicate  with  the  external  auditory  canal ; but  in  about  a week  an  abscess  opened  and  dis- 
charged through  this  channel.  The  patient  was  tolerably  strong,  and  his  general  condition  was  very  fair.  The  patient  had  no 
headache ; his  pulse,  skin  and  bowels  were  normal;  he  was  perfectly  conscious ; his  articulation  thick,  but  iinju-oving  daily.  On 
September  18th,  Acting  Assistant  Surgeon  Bartholf  succeeded  in  finding  and  extracting  Iroin  an  inch  and  a half  within  the 
skuli  one-third  of  a conical  bullet.  From  that  time  onward  the  patient  rapidly  improved.  The  removal  of  the  foreign  body 
was  immediately  followed  by  a very  free  flow  of  pus.  On  September  20th,  there  was  some  vision  of  the  left  eye.  The  next 
day  the  patient  could  count  figures  held  near  the  eye.  The  hearing  of  the  left  car  returned  sufficiently  for  the  patient  to  hear 
loud  speakings  By  October  10th,  the  patient  was  going  about  the  ward  iu  comparatively  good  health,  except  that  there  was 
ptosis,  a little  discharge  from  the,  ear,  and  slight  suppurations  from  the  entrance  wound.  The  patient  voluntarily  assisted  in 
nursing,  but  becoming  fatigued  complained  of  slight  pain  in  his  temple.  On  November  2d,  two  months  after  the  reception  of 
his  wound,  the  patient  was  transferred  to  the  hospital  at  Grafton,  West  Virginia,  whence  Surgeon  S.  N.  Sherman,  U.  S.  V., 
wrote  to  Assistant  Surgeon  E.  F.  Weir,  U.  S.  A.,  that  the  wound  was  healed  when  the  patient  came  to  him,  but  that  there  was 
some  discharge  from  the  e.ar;  that  he  had  learned  from  the  attendants  that  the  patient  had  drank  immoderately  of  spirits  on  his 
^vay  from  Frederick  to  Grafton;  one  of  the  nurses  stating  that  he  drank  at  least  a (piart  of  whiskey  on  the  day  prior  to  his 
arrival  at  Grafton.  Yet  he  seemed  tolerably  well  on  the  day  of  his  arrival  and  on  the  following  day;  but  on  November  4th 


BALLS  LODGED  WITHIN  THE  CEANIUM. 


199 


he  had  a severe  chill  in  the  morning,  and  on  the  5th  convulsions  with  strabismus  of  the  right  eyeball.  On  the  morning  of  the 
Gth  he  died,  iifter  a convulsion  accompanied  by  opisthotonos.  Twenty-eight  hours  after  death  a post-mortem  examination  was 
made.  After  removing  the  calvaria  and  the  brain,  a poition  of  a conoidal  musket  ball,  comprising  nearly 
two-thirds  of  the  missile,  was  found  resting  against  the  sella  Turcica,  having  traver.sed  the  long  diameter  of  the 
temporal,  being  cut  off  very  clean.  Dr.  Sherman  adds  that  he  understands  that  the  other  third  of  the  ball  was 
removed  from  beneath  the  scalp ; but  Dr.  Bartholfs  notes  are  conclusive  as  to  the  position  of  the  other  frag- 
ment. Dr.  Sherman  preserved  the  patient’s  skull,  with  a view  of  forwarding  it  with  a histoiy  of  the  case  to 
the  Surgeon  General’s  Office;  but  the  specimen  was  never  received  at  the  Army  Medical  Museum.  The  notes 
furnished  by  Dr.  Bartholt^  and  a conversation  of  Dr.  Sherman  with  the  editor  of  this  work,  have  permitted  the 
completion  of  this  history.  The  fragment  of  the  bullet,  extracted  by  Assistant  Surgeon  Bartholf^  is  figured  in 
the  adjacent  wood-cut.  It  weighs  nearly  half  an  ounce. 


Fig.  100. — Frag- 
ments of  ball  ex- 
tracted from  tlie 
brain.  Sp.  5555, 
Sect. I,  A.  M.M. 


Case. — Private  O.  E.  Lawless,  Co.  E,  28th  Virginia  Regiment,  aged  45  years,  received,  near  Richmond,  Virginia,  .Tune 
17th,  18G4,  a penetrating  gunshot  fracture  of  the  frontal  bone,  the  missile  entering  near  the  left  eminence.  On  the  following  day, 
he  was  admitted  to  Chimborazo  Hospital  No.  5 at  Richmond,  where  the  ball  was  extracted,  and  expectant  treatment  was  used. 
The  patient  suffered  some  pain,  but  was  in  good  condition,  the  tongue  being  natural,  and  pulse  seventy-two,  but  intermittent. 
On  June  20th  he  was  in  possession  of  all  his  faculties  and  doing  well,  and  on  June  22d  the  pulsations  were  visible  through 
the  wound.  On  June  2Gth,  his  pulse  was  natural,  but  he  kept  his  eyes  closed,  only  opening  them  when  spoken  to.  He 
answered  questions,  but  was  little  inclined  to  talk.  There  was  a collection  of  pus  which  rose  and  fell  with  the  pulsation  of  the 
brain.  The  patient  died  June  27th,  1834,  without  exhibiting  any  violent  symptoms. 


Case. — Piivate  Francis  Donohue,  Co.  B,  83d  Penn.sylvania  Volunteers,  aged  19  years,  was  wounded  at  the  South  Side 
Railroad,  Virghiia,  March  31st,  1885,  by  a conoidal  projectile  which  penetrated  the  frontal  bone  one  inch  above  the  right  frontal 
eminence.  He  was  sent  to  theosp  hital  of  the  1st  division.  Fifth  Corps,  and  thence  was  conveyed  to  Washington,  and  admitted 
to  the  Lincoln  Hospital  on  April  4th.  On  the  13th,  the  patient  being  in  a comatose  condition.  Acting  Assistant  Surgeon  John 
Morris  extracted  a large  portion  of  the  frontal  bone  and  removed  the  ball.  There  was  extensive  laceration  of  the  integument 
and  considerable  comminution  of  bone.  Considerable  brain  substance  escaped  through  the  opening  in  the  craiuuTn.  Expectant 
treatment  was  resorted  to,  in  spite  of  which  the  patient  sank  rapidly,  and  died  April  IGth,  18C5.  A post-mortem  examination 
revealed  a large  abscess  in  the  anterior  lobe  of  the  right  hemisphere.  The  case  is  reported  by  Surgeon  J.  C.  McKee,  IT.  S.  A. 


Case. — Private  Thomas  J.  C , Co.  B,  28th  New  York  Volunteers,  was  wounded  at  the  battle  of  Antietam,  September 

17th,  18G2,  by  a spherical  projectile  which  entered  near  the  centre  of  the  forehead,  passed  downward  through  the  anterior  lobe 
of  the  right  hemisphere,  penetrating  the  roof  of  the  orbit,  and  lodging  near  the  apex.  He  was  conveyed  by  rail  to  Philadelphia, 
a distance  of  one  hundred  and  fifty  miles,  and  was  admitted  to  24th  and  South  Streets  Hospital  on  September  26th,  1862.  The 
right  eye,  which  was  in  a sloughing  condition,  was  extirpated  next  day  and  the  missile  removed.  Death  cccurred  October  4th, 
18G2.  At  the  autopsy,  a large  abscess  was  found  behind  the  orbit  pressing  on  the  base  of  the  brain,  with  e.xtensive  softening  and 
infiltration  in  its  vicinity.  The  pathological  specimen  is  No.  21(),  Sect.  I,  A.  M.  M.  A section  of  frontal  bone  perforated  just 
above  the  inner  angle  of  the  right  orbit.  The  fractured  portion,  externally,  measures  one  inch  in  diameter ; and  three  depressed 
fragments  of  the  anterior  wall  of  the  sinus  remain  attached  to  the  edge  of  the  opening.  Two  square  inches  of  the  inner  table 
have  been  c.arried  away,  including  a portion  of  the  orbital  plate.  A fissure  extends  downward  through  the  entii’e  thickness  of  the 
supra-orbital  arch,  and  a second  fissure  traverses  the  plate  of  bone  between  the  frontal  sinuses.  The  specimen  was  contributed 
by  Surgeon  J.  Hopkinson,  U.  S.  V. 

Case. — Sergeant  J.  Tf'ilds  Williamson,  Co.  B,  21st  South  Carolina  Cavalry,  aged  27  years,  was  admitted  in  May,  1864, 
to  South  Carolina  Hospital,  Petersburg,  Virginia,  with  a gunshot  fracture  of  the  skull,  received  May  Gth,  1864.  The  missile, 
which  had  entered  the  centre  of  the  occipital  bone,  was  extracted  on  the  field.  Considerable  loss  of  brain  matter  ensued,  and 
the  patient  died  May  10th,  18G4. 

Case. — Sergeant  Aurelius  A.  Robinson,  Co.  I,  17th  Maine  Volunteers,  was  wounded  at  the  battle  of  Gettysburg,  July  2d, 
1833,  by  a conoidal  ball  which  struck  the  forehead,  penetrated  the  outer  table  of  the  skull,  and  became  impacted  in  the  inner 
table.  He  was  sent  to  the  1st  division  hospital  of  the  Third  Corps.  On  examination,  the  ball  was  found  flattened  quite  thin, 
with  very  ragged  edges.  These  points  and  indentions  \vere  so  closely  matched  by  corresponding  ])oints  and  depressions  on  the 
skull,  that  a fine  probe  could  not  be  inserted  between  them.  The  ball  was  removed  with  forceps  by  Surgeon  II.  F.  Ijyster,  5th 
Michigan  Volunteers.  The  case  proved  fatal  July  Gth,  1863. 


Case. — Private  Montellion  Smith,  Co.  H,  5th  Vermont  Volunteers,  aged  39  years,  was  wounded  at  the  battle  of  Cedar 
Creek,  Virginia,  October  19th,  1864,  by  a conoidal  musket  ball,  which  struck  the  squamous  portion  of  the  left  temporal  bone. 
The  ball  was  extracted  on  the  field.  He  was  admitted  to  the  hospital  of  the  2d  division.  Sixth  Corps,  and  on  October  23d  was 
sent  to  the  Cuyler  Hospital,  Philadelphia.  The  patient  stated  that  he  was  stunned  and  unconscious  for  five  hours  after  the 
reception  of  the  injury.  On  admission,  the  wound  looked  favorable.  On  the  26th,  his  memory  began  to  fail,  articulation  became 
difficult,  and  stupor  and  muttering  delirium  followed.  On  the  28th,  the  wound  was  enlarged,  when  an  extensive  fracture  of  the 
bone  was  disclosed.  Cold  water  dressings  were  a])plied  continuously  ; the  pupils  of  the  left  eye  became  much  contracted,  urine 
passed  involuntarily,  and  death  occurred  on  November  3d,  1864.  At  the  autopsy,  several  fragments  of  bone  were  found  imbedded 
in  the  brain  substance.  The  dura  mater  near  the  wound  was  disorganized  and  coated  with  a i)urulent  and  lymphy  depo.sit.  A 
large  abscess  extended  to,  but  did  not  open  into,  tlui  lateral  ventricle  ; there  was  considerable  interstitial  congestion  through  the 
brain. 


200 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Case. — Corporal  McD , Troop  F,  Cth  South  Carolina  Cavalry,  was  wounded 

February  10th,  1804,  by  a conoidal  ball,  which  perforated  the  skull  under  the  superior  curved 
line  of  the  right  side  of  the  occipital  bone.  He  was  admitted  to  the  field  hospital  at  John’s 
Island,  South  Carolina,  on  the  same  day.  The  perforation  was  round  and  smooth,  and  allowed 
the  entrance  of  a body  no  more  than  one  and  three-eighths  of  an  inch  in  circumference,  the  ball 
having  perforated  the  occipital  with  the  apex  only,  falling  out  afterward.  After  diligent  search, 
half  of  the  missile  was  found  under  the  scalp,  one  inch  from  the  original  injury,  and  was  easily 
removed.  The  patient  died  February  11th,  18114.  The  missile,  a conoidal  ball,  which  appears  to 
have  struck  base  first,  obliquely  flattened,  and  from  which  a portion  is  wanting,  is  represented 
in  the  adjacent  wood-cut.  It  was  contributed  by  Surgeon  S.  Brillantowski,  41st  New  York 
Volunteers. 

Case. — Corporal  John  Sponsler,  Co.  H,  48th  Pennsylvania  Volunteers,  was  wounded  at  Campbell’s  Station,  near 
Knoxville,  Tennessee,  on  November  29th,  1863,  by  the  plug  of  a shell,  which  passed  through  the  skull  near  the  coronal  suture. 
He  was  admitted  to  the  field  hospital  of  the  Ninth  Corps,  where  Surgeon  A.  M.  Wilder,  U.  S.  V.,  removed  the  plug  from  the 
anterior  portion  of  the  brain.  Death  supervened  in  a few  hours  after  the  operation. 

Case. — Lieutenant  Colonel  Cornelius  W.  Tolies,  chief  quartermaster  Middle  Military  Division,  was  attacked  on  the  11th 
of  October,  1864,  by  a band  of  guerillas  as  he  was  passing  through  Newtown,  Virginia,  on  his  way  to  the  front.  Although  he 
surrendentd  without  resistance,  one  of  the  treacherous  party,  stepping  behind  the  Colonel,  shot  him  in  the  head.  The  missile,  a 
pistol  ball,  penetrated  the  cranial  cavity  through  the  occipital  bone  at  a point  midway  between  the  superior  angle  and  the  curved 
line,  three-fourths  of  an  inch  to  the  left  of  the  median  line,  making  a clean  perforation  and  lodging  in  the  posterior  lobe  of  the 
cerebrum  one-half  inch  deep.  He  was  conveyed  to  Winchester,  and  placed  under  the  care  of  Dr.  Emanuel,  Acting  Staff  Surgeon 
U.  S.  A.  This  officer  states  that  the  wound  suppurated  well,  and  caused  no  pain.;  the  patient’s  mental  faculties  remained 
unimpau'ed,  and  his  appetite  good,  so  that  a favorable  prognosis  was  granted.  On  October  22d,  the  ball  was  extracted  in  small 
fragments.  About  the  end  of  October,  evacuations  of  the  faeces  and  urine  began  to  occur  involuntarily ; on  the  31st,  there  was 
an  entire  suppression  of  the  urine,  as  ascertained  by  the  introduction  of  the  catheter,  and  the  faeces  were  again  discharged 
involuntarily.  On  the  4th  of  November,  the  vision  and  hearing  became  defective.  Delirium  ensued,  and  death  occurred  on 
November  7th,  1864.  Upon  removing  the  calvaria,  at  the  autopsy,  the  dura  mater  around  the  wound  was  found  ecchymosed, 
and  the  cavity  in  the  cerebrum,  which  was  about  one-half  inch  deep,  filled  with  purulent  and  ofiensive  pus,  and  lined  with  plastic 
filamentous  fibrin.  A fragment  of  bone,  about  three-fourths  of  an  inch  in  diameter,  was  extracted  from  a point  just  below.  The 
pia  mater  had  sufiered  morbid  changes.  A sero-purulent  fluid  w'as  found  in  the  inferior  and  posterior  depressions  of  the  lateral 
ventricles,  and  likewise  in  the  fourth  ventricle,  the  lining  membrane  of  which  cavity  had  undergone  softening,  as  had  also  the 
sheaths  of  the  roots  of  the  seventh,  eighth,  and  ninth  pairs  of  nerves,  which  were  of  a greenish  hue;  the  optic  commissure  was 
congested.  The  substance  of  the  encephalon  was  sound  throughout.  The  semi-lunar  lobe  of  the  left  lateral  hemisphere  of  the 
cerebellum  was  firmly  adherent  to  the  tentorium.  The  case  is  reported  by  Acting  A'ssistant  Surgeon  W.  L.  Hammond. 

Case. — Private  A.  A.  Watson,  Co.  B,  48th  North  Carolina  Eegiment,  was,  on  June  7th,  1864,  admitted  to  hospital  No. 
24,  Eichmond,  Virginia,  with  a gunshot  fi-acture  of  the  skull.  The  missile  entered  at  the  right  protuberance  of  the  frontal  bone, 
passed  through  and  lodged.  He  was  speechless  until  June  9th.  An  abscess  formed  on  the  back  part  of  the  head,  which  was 
opened  on  June  12th,  and  the  ball  removed.  Slight  improvement  followed,  but  in  a few  days  the  wound  became  very  offensive. 
The  patient  slept  nearly  all  the  time  until  death  ensued,  June  20th,  1864. 

The  following  cases  of  penetrating  gunshot  fractures  of  the  head  terminated  fatally : 

Case. — Private  D.  C , Co.  D,  10th  Pennsylvania  Eeserves,  aged  26  years,  was  wounded  near  Old  Church,  Virginia, 

May  30th,  1864,  by  a conoidal  ball,  which  fractured  the  anterior  inferior  angle  of  the  right  parietal  bone,  and  lodged  in  the  brain. 
He  was  admitted  to  the  hospital,  3d  division.  Fifth  Corps,  on  the  same  day,  and  was  transferred  to  the  Stanton  Hospital  at 
Washington,  on  the  4th  of  June.  Several  fragments  of  bones  were  removed.  A cerebral  abscess  formed,  and  death  ensued  on 
the  11th.  The  pathological  specimen.  No.  2682,  Sect.  I,  A.  M.  !M.,  is  a section  of  cranium,  from  which  fragments  have  been 
removed  for  a distance  of  two  inches  from  before  backward,  and  one-half  inch  in  width ; a fragment,  half  an  inch  long,  remains 
in  situ.  The  inner  table  is  fractured  to  a somewhat  greater  extent,  and  two  small  fragments  remain,  with  their  free  edges  slightly 
depressed.  There  is  caries  of  the  fractured  surface,  but  no  distinct  attempt  at  repair.  The  specimen  and  history  were  contributed 
by  Assistant  Surgeon  G.  A.  Mursick,  U.  S.  V. 

Case. — Sergeant  George  W.  Burtiss,  Co.  G,  173d  New  York  Volunteers,  was  accidentally  wounded,  on  Januaiy  23d, 
1864,  by  a pistol  ball,  which  fractured  the  cranium  and  lodged  in  the  left  side  of  the  brain.  He  became  unconscious  and  was 
taken  to  the  regimental  hospital.  Ten  minutes  after  the  accident  his  countenance  was  livid,  pulse  slow  and  full,  respiration 
labored  and  spasmodic.  Some  reaction  took  place  now,  and  he  cried  out  to  have  his  face  wiped.  He  struggled  to  get  up  to 
urinate  and  begged  his  attendants  to  let  hhn  go  out  of  the  tent  for  that  purpose,  but  he  could  not  pass  any  urine.  In  half  an 
hour  he  relapsed  into  a quiet  state.  The  pulse  continued  slow  but  irregular,  and  occasionally  spasmodic  movements  of  the 
extremities  occurred.  The  pupils  were  not  affected  by  strong  light.  Tlie  patient  died  nine  hours  after  the  reception  of  the 
injury.  At  the  autopsy  two  small  wounds  were  found,  one  incised,  about  one  inch  above  the  left  eyebrow.  The  areolar  tissue 
of  the  left  eyelid  and  surrounding  the  wounded  parts  were  infiltrated  with  blood.  Several  spiculae  of  bone  and  a small  scale  of 
lead  were  lodged  in  the  soft  parts  near  the  wound.  A circular  opening  about  a half  inch  in  diameter  through  the  external,  and 
three-fourths  of  an  inch  through  the  internal  table,  was  found  in  the  frontal  bone  about  one  inch  above  the  left  superciliary  ridge. 


Fig.  101 . — Two  lateral  views  of 
a fragment  of  a conoidal  ball 
split  upon  the  skull.  Spec.  4150, 


FATAL  PENETRATING  GUNSHOT  FRACTURES  OF  THE  SKULL. 


201 


Between  the  skull  and  dura  mater  were  several  spiculae  of  bone.  The  left  hemisphere  of  the  cerebrum  was  extensively  lacerated 
through  its  longitudinal  diameter.  The  bullet  was  found  in  the  posterior  lobe  of  left  hemisphere  near  the  dura  mater.  Large 
clots  of  blood  covered  tlie  left  hemisphere  and  lay  at  the  base  of  the  brain,  surrounding  the  upper  extremity  of  the  spinal  cord. 
The  case  is  reported  by  Surgeon  N.  W.  Leighton,  173d  New  Yoi’k  Volunteers. 


Case. — Private  Anton  Lambert,  Co.  E,  9th  Kansas  Cavalry,  was  wounded,  in  a skirmish  with  guerillas,  near  Westport, 
Missouri,  June  17th,  1863,  bj'  a conoidal  ball,  which  passed  through  the  mastoid  process  of  the  right  temporal  bone,  and 
fractured  a part  of  the  petrous  portion,  at  its  union  with  the  jugular  process  of  the  occipital.  On  the  following  day,  he  was 
admitted  to  the  hospital  at  Kansas  City,  Missouri,  and  died  June  20th,  1863.  The  autopsy  revealed  a rupture  of  the  lateral  sinus. 
The  ball  had  glanced  forward,  destroying  the  labyrinth ; had  passed  under  the  basilar  process  of  the  occipital  bone,  and  had 
lodged  in  the  masseter  muscle,  near  the  coronoid  process  of  the  lower  jaw. 


Case. — Sergeant  G.  C— ^ , Co.  A,  11th  New  Jersey  Volunteers,  aged  26  years,  was  wounded  at  the 

battle  of  Chancellorsville,  May  3d,  1863,  by  a musket  ball,  which  penetrated  the  right  temporal  bone,  and  lodged 
deeply  in  the  substance  of  the  brain.  He  was  conveyed  to  Washington,  and  on  the  7th,  was  admitted  to  the 
Douglas  Hospital.  Hemiplegia  of  the  left  side  existed  at  the  time  of  his  admission  ; the  pupil  of  the  riglit  eye  was 
much  dilated,  and  brain  substance  was  protruding  from  the  wound  of  entrance.  Simple  dressings  were  applied 
to  the  wound,  and  expectant  treatment  was  had  recourse  to;  but  he  died  on  the  11th  of  the  month.  At  the 
autopsy,  the  missile  was  found  lodged  behind  the  sella  Turcica.  It  was  a bullet,  with  a deep  groove  containing 
a fragment  of  the  temporal  bone,  contributed,  with  its  history,  by  Acting  Assistant  Surgeon  John  O.  Smith. 


Fig.  I02.-Round 
ball  lodged  in 
the  cerebrum. 
Sp.  1288,  Sect. 
I,  A.  M.  M. 


Case. — Private  E.  G , 18th  Indiana  Battery,  aged  25  years,  was  accidentally  wounded  on  January  7th,  1865,  by  a 

pistol  Sail  which  penetrated  the  cranium  one  inch  above  the  superciliary  ridge  and  three- fourths  of  an  inch  to  the  left  of  the 
median  line.  He  was  sent  to  Hospital  No.  8,  at  Nashville,  in  a semi-conscious  condition.  Digital  examination  revealed  a 
circular,  well  defined  opening  through  the  os  frontis,  corresponding  with  the  tegumentary  opening.  A gum-elastic  bougie  could 
be  passed  two  and  a half  inches  in  the  track  of  the  ball  antero-posteriorly  through  the  left  hemisphere.  Brain  substance  escaped. 
On  January  9th,  the  wound  of  entrance  through  the  scalp  was  enlarged  to  promote  free  discharge  of  pus ; clots  of  brain  substance 
continued  to  escape.  On  January  10th,  the  patient  talked  incoherently,  his  respiration  was  slow  and  sighing,  face  flushed,  and 
pupils  natural.  On  January  12th,  he  was  unable  to  speak;  coma  supervened,  and  death  occui-red  .lanuary  14th,  1865.  The 
ball  had  traversed  the  whole  length  of  the  left  hemisphere,  its  course  being  easily  distinguished  by  the  black,  sloughing,  ragged 
appearance  of  the  track,  which  terminated  at  the  occipital  without  rupturing  the  membranes  or  fracturing  the  occipital  bone. 
The  entire  encephalon,  with  the  exception  of  parts  immediately  around  the  track  of  the  missile,  presented  a normal  appearance. 
The  cranial  cavity  was  thoroughly  explored,  and  the  brain  was  cut  into  small  pieces  in  order  to  find  the  ball,  but  the  search  was 
fruitless.  The  ball  must  have  dropped  out  of  the  wound  of  entrance  at  some  time  when  the  face  and  head  hung  lower  than  the 
body.  On  no  other  theory  can  the  absence  of  the  ball  be  explained.  The  pathological  specimen  is  No.  3747,  Sect.  1,  A.  M.  M., 
and  was  contributed  by  Assistant  Surgeon  C.  C.  Byrne,  U.  S.  A.,  while  the  history  of  the  case  is  reported  by  Acting  Assistant 
Surgeon  H.  C.  ilay. 


Case. — Private  Alpheus  Salisbury,  Co.  K,  7th  Rhode  Island  Volunteers,  was  wounded  at  the  battle  of  Fredericksburg, 
December  13th,  1862,  by  a piece  of  shell,  which  fractured  the  skull  behind  the  right  ear.  On  December  18th,  he  was  admitted 
to  Harewood  Hospital,  Washington,  and  on  January  10th,  1863,  was  sent  to  Lovell  Hospital,  Portsmouth  Grove,  Rhode  Island. 
He  was  discharged  March  19th,  1363,  and  died  July  2d,  1883,  his  widow  receiving  a pension  fi-om  that  date.  Doctor  William 
H.  Bowen,  in  a report  relative  to  this  case  says,  that  the  most  prominent  symptoms  were  great  pain  in  the  head,  frequent  vomitings, 
constipation,  and  a kind  of  stupor.  The  wound  in  the  head  had  not  healed,  and  on  probing  it  pus  and  blood  were  discharged. 
He  learned  that  several  pieces  of  bone  had  been  taken  away  since  the  injury  was  inflicted.  On  July  1st,  he  saw  the  patient,  in 
consultation  with  another  physician.  Pain  in  the  head  and  vomiting  still  continued,  and  there  was  more  perfect  unconsciousness. 
The  next  morning  there  was  paralysis  of  the  side  opposite  the  wound  in  the  head,  with  one  pui)il  contracted  while  the  other  was 
dilated,  and  he  was  perfectly  comatose.  He  thinks  that  the  wound  was  the  primary  and  the  original  cause  of  death. 

Case.— Sergeant  William  B.  Etter,  Co.  D,  16th  Maine  Volunteers,  aged  26  years,  was  wounded  at  Fredericksburg, 
December  13th,  1862,  by  a piece  of  shell,  which  fi-actured  both  tables  of  the  cranium  at  the  vertex  to  the  right  of  the  median 
line.  He  was  admitted  to  the  2d  division.  First  Corps  hospital.  Partial  paralysis  of  the  left  upper  and  lower  extremities, 
involving  the  bladder,  followed.  On  December  19th,  the  patient  was  transferred  to  Alexandi  ia,  and  was  admitted  to  the  3d 
division  hospital.  Stimulating  lotions  were  applied  to  the  extremities  and  a catheter  was  used  for  several  days.  He  died  on 
January  23d,  1863.  The  autopsy  revealed  the  external  table  fissured  to  the  left  ear.  A fragment  of  bone,  one  inch  in  diameter, 
was  found  pressing  upon  the  brain  ; smaller  fragments  had  penetrated  its  substance.  The  left  pleura  was  covered  with  extensive 
and  recent  adhesions  and  studded  with  deposits  of  lymph  and  pus.  The  right  lung  contained  a large  number  of  abscesses.  The 
case  is  reported  by  Surgeon  E.  Bentley,  U.  S.  V. 

C..V.SE.— Private  George  Knapji,  Co.  D,  8th  New  Hampshire  Volunteers,  was  accidentally  wounded  on  October  29th,  1864, 
while  on  picket  near  Natchez,  Mississippi,  by  a conoidal  ball  which  sdruck  the  left  side  of  the  frontal  bone  over  the  superciliary 
ridge,  about  one  and  one-fourth  inches  to  the  left  of  the  median  line.  The  missile  split ; one-half  lodged,  the  other  penetrated 
the  skull  and  passed  deeply  into  the  brain.  It  is  recorded  that  the  missile  before  wounding  this  man  had  passed  through  the 
body  of  a comrade.  The  patient  was  sent  to  hospital  at  Natchez,  where  a portion  of  the  ball  was  removed.  Coma,  stertorous 
breathing,  vomiting,  and  involuntary  evacuations  followed ; and  death  occurred  October  30th,  1864,  twelve  hours  after  rece[)tion 
of  injury.  The  autopsy  revealed  an  extensive  depressed  fracture  at  scat  of  wound  and  a line  of  fracture  extending  across  the 
parietal  bone  to  the  lambdoid  suture.  One-half  of  the  ball  was  found  imbedded  in  the  substance  of  the  brain  just  above  the  sella 
Turcica.  The  left  lateral  ventricle  contained  a large  coagulum  extending  into  the  track  of  the  ball. 

26 


202 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Case. — Corporal  Gardner  Gaylord,  Co.  B,  IGth  Massachusetts  Volunteers,  was  wounded  at  the  battle  of  Bull  Run, 
Virginia,  August  30th,  1862,  by  a conoidal  ball  which  penetrated  the  cranium  just  above  the  right  frontal  eminence,  causing  a 
stellate  fracture  witli  cleanly  cut  edges.  On  September  1st  he  w:is  admitted  to  the  Judiciary  Square  Hospital,  being  perfectly 
conscious.  All  his  functions  remained  normal ; he  was  able  to  help  himself  and  com|)lained  of  no  pain.  On  September  3d  he 
became  comatose,  and  died  September  5th,  1862.  At  the  autopsy  the  ball  was  found  to  have  entered  the  anterior  lobe  of  the  right 
hemisphere,  carrying  with  it  fragments  of  botie  and  traversing  the  brain  substance  nearly  the  full  extent  of  the  hemisphere.  At 
the  point  of  entrance  there  was  an  abscess  the  size  of  a walnut,  and  the  track  of  the  ball  was  filled  with  pus.  A small  quantity 
was  also  found  in  the  left  ventricle.  The  case  is  reported  by'Surgeon  Charles  Page,  U.  S.  A. 

Case. — Private  J.  D , Co.  G,  5th  Tennessee  Regiment,  aged  30  years,  was  wounded  at  the  battle  of  Tunnel  Hill, 

Georgia,  April  30th,  1864,  by  a musket  ball  which  fractured  the  frontal  bone,  traversed  the  brain  and  lodged.  He  was  conveyed 
to  Nashville,  and  on  the  5th  of  May  was  admitted  into  hospital  No.  1.  Brain  matter,  yielding  a thin,  greenish,  and  fetid  dis- 
charge, protruded  from  the  wound,  which  evidently  was  of  considerable  extent.  An  examination  of  the  wound  w'as  made  and  it 
was  ascertained  that  a plate  of  the  central  portion  of  the  frontal  bone  had  been  displaced  so  as  to  project  half  an  inch  or  so,  thus 
allowing  free  protrusion  of  the  cerebral  substance.  The  surrounding  soft  parts  were  of  course  much  inflamed  and  swollen.  The 
patient  was  perfectly  rational  and  would  answer  questions  promptly,  though  he  had  no  inclination  to  converse,  and  if  left 
undisturbed,  ^vould  sleep  the  greater  part  of  the  time.  The  pulse  was  alternately  strong  and  intermittent.  The  digestive 
functions  remained  undisturbed.  The  patient  did  not  complain  of  much  pain,  and  could  stand  and  walk.  The  treatment  was 
expectant ; but  the  patient  gradually  sunk  into  a comatose  state,  though  when  fully  aroused  he  would  recognize  the  attendants, 
and  make  his  desires  known,  as  late  as  May  14th.  Death  took  place  on  May  15th,  1864.  At  the  autopsy  the  displaced  fragment 
of  the  frontal  bone  was  found  to  measure  four  and  a half  inches  in  diameter.  A fissure  passed  downward  separating  a part  of  the 
great  ala  of-the  sphenoid  and  the  squamous  portion  of  the  temporal  bone.  The  missile  was  found  in  the  vicinity  of  the  left  great 
wing  of  the  sphenoid  against  which  it  had  struck,  the  point  of  contact  being  evident  by  discoloration  as  well  as  by  a slight  fissure 
of  the  vitreous  table.  The  pathological  specimen  with  history  was  contributed  by  Surgeon  R.  L.  Stanford,  U.  S.  V.  It  is 
numbered  3358  in  the  surgical  section  of  the  museum. 

Case. — Captain  W.  E.  Tucker,  Co.  B,  67th  Pennsylvania  Volunteers,  was  wounded  at  Annapolis,  Maryland,  October 
29th,  1862,  by  a conoidal  ball  which  fractured  and  depressed  both  tables  of  the  os  frontis  one  and  a half  inches  above  the  left 
superciliary  ridge  and  penetrated  the  brain.  On  the  same  day  he  was  admitted  to  the  1st  division  hospital  in  a state  of  stupor 
with  respiration  labored,  pupils  contracted,  and  pulse  full  and  slow.  Upon  probing  the  wound  brain  matter  exuded.  The  treat- 
ment was  expectant.  Full  consciousness  wms  restored  on  the  morning  of  the  30th,  so  that  when  aroused  he  readily  recognized 
his  friends  and  answered  questions  correctly.  He  soon  relapsed  into  tlie  former  comatose  condition.  On  the  following  day  two 
small  fragments  of  bone  were  discharged  from  the  wound.  On  the  morning  of  November  1st,  a decided  febrile  action  w'as 
established.  The  pulse  rose  from  55  to  90  and  the  skin  became  hot  and  dry.  Tincture  of  aconite  was  administered  in  five-drop 
doses  every  two  hours,  and  twelve  hours  afterward  the  dose  was  increased  to  ten  drops,  but  failed  to  effect  a reduction  of  the 
pulse,  which  had  reached  160  on  the  2d  of  November,  when  death  occurred.  No  deliilum  existed  at  any  time  during  the  progress 
of  the  case.  At  the  autopsy  a small,  smooth  perforation  was  found  to  the  left  of  the  median  line  about  three-eighths  of  an  inch  in 
diameter.  The  injury  to  the  inner  table  wms  more  extensive,  covering  three-fourths  of  an  incli  in  diameter.  Fragments  of  the 
inner  table  were  driven  into  the  anterior  lobe  of  the  left  hemis])here  and  softening  existed  in  their  immediate  vicinity.  The  missile, 
which  w’eighed  32  grains,  w'as  traced  diagonally  downward  through  the  corpus  callosum  to  its  place  of  lodgment  beneath  the 
])osterior  lobe  of  the  light  hemisjdiere.  A large  clot  of  blood  surrounded  the  orifice  in  the  cranium  and  purulent  spots  were 
present  in  the  surface  of  the  cerebrum.  The  lateral  ventricle  was  filled  with  blood.  The  case  is  reported  by  Assistant  Surgeon 
James  W.  Pettinos,  67th  Pennsylvania  Volunteers. 

Case. — Private  Thomas  Urch,  Co.  F,  211th  Pennsylvania  Volunteers,  was  wounded  before  Petersburg,  Virginia,  April 
2d,  1835,  by  a conoidal  ball  which  entered  the  brain  through  the  frontal  bone  one  and  a half  inches  above  the  right  eye.  On 
the  same  day  he  was  admitted  to  the  hospital  of  the  3d  division.  Ninth  Corps,  and  thence  was  conveyed  to  Armory  Square 
Hospital,  at  Washington,  which  he  entered  on  Ajiril  10th.  An  attempt  was  made  on  the  following  day  to  remove  the  ball,  but 
was  unsuccessful.  Death  from  apoplexy  occurred  April  14th,  1865. 

Case. — Private  George  Deal,  Co.  D,  148th  New  York  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of  Coal 
Harbor,  Virginia,  June  3d,  1864,  by  a conoidal  musket  ball,  which  penetrated  the  cranium  and  passed  through  the  anterior  portion 
of  the  cerebrum.  He  was  admitted  to  the  Eighteenth  Corps  Field  Hospital,  and  on  the*7th  of  June  transferred  to  the  Carver 
Hospital,  Washington,  D.  C.  The  particulars  in  the  progress  of  the  case  are  not  known.  Death  took  place  on  the  8th  of  June, 
1864. 

Case. — Sergeant  Alexander  E , Co.  B,  56th  North  Carolina  Regiment,  aged  30  years,  was  wounded  at  Petersburg, 

March  2Sth,  1865,  by  a conoidal  ball,  which  entered  the  body  of  the  left  malar  bone,  producing  a comminuted  fracture,  passed 
from  left  to  right  through  the  orbit,  fracturing  the  ethmoid  bone,  and  lodged  in  the  anterior  portion  of  the  base  of  brain  on  the  right 
side.  He  "was  conveyed  to  a field  hospital,  and  on  Mai’ch  30th  was  admitted  to  Lincoln  Hospital,  Washington,  being  nearly 
comatose.  The  probe  could  be  passed  into  the  braiu.  Death  occurred  on  April  2d,  1865,  from  exhaustion  and  congestion.  The 
autopsy  revealed  the  course  of  the  ball  as  above  stated.  The  j)athological  specimen  is  No.  85,  Sect.  I,  A.  M.  M.,  and  consists  of 
nine  fragments,  chiefly  from  the  malar  bones,  and  the  ball,  separated  into  two  parts.  The  specimen,  with  the  history,  was 
contributed  by  Acting  Assistant  Surgeon  T.  P.  Arthur. 

Case. — Sergeant  Charles  B.  Hummell,  Co.  D,  127th  I’enusylvania  Volunteers,  aged  22  years,  was  wounded  at  the  battle 
of  Fredericksburg,  Virginia,  May  1,  1863,  by  a spherical  case-shot  which  penetrated  the  right  parietal  bone  near  the  junction  of  the 
sagittal  and  coronal  sutui’cs.  On  the  morning  of  the  6th,  he  was  conveyed  by  steamer  to  Wtishington,  and  was  admitted  to  the 


FATAL  PENETRATIJv'G  GUNSHOT  FEACTUEES  OF  THE  SKITLI,. 


203 

Stanton  Hospital,  in  a stato  ol’  uiieonscioiisiioss,  snii'wiug  from  the  shock  of  injury ; his  pulse  was  one  humlreil  and  sixty  and  very 
feeble.  By  the  afternoon  of  th.at  day  he  had  rallied  considerably,  thongh  he  still  remained  insensible.  No  paralysus  of  any  part 
of  the  body  could  be  detected.  He  lay  upon  his  back,  apparently  sleeping,  his  respiration  being  ])erfectly  natural.  During  the 
examination  of  the  pupils,  which  were  found  somewhat  contracted,  though  still  sj'mmetrical,  he  exhibited  manifestations  of  con- 
sciousness by  offering  some  resistance.  A probe  was  readily  passed  a considerable  distance  along  the  track  of  the  missile  into  the 
brain  substance.  Very  little  haemorrhage  from  the  wound  occurred.  The  patient  swallowed  without  difficulty  and  passed  his 
urine  involuntarily.  After  shaving  the  head  a bag  of  ice  was  applied;  a stimulating  injection  was  then  employed,  which  acted 
well,  and  nutriment  was  given  in  the  form  of  beef  tea.  The  next  morning  the  pulse  was  one  hundred  and  fourteen  and  some- 
what stronger;  the  pupils  were  natural  in  size,  and  contracted  readily  under  the  action  of  light.  He  readily  Hexed  and  extended 
his  legs,  raised  his  hands  to  his  head,  rubbed  his  eyes,  which  he  kept  closed,  stretched  and  yawned  like  one  awaking  from  a 
sound  sleep,  and  endeavored  to  remove  the  ice  bag.  He  manifested  dislike  to  beef  tea  and  seemed  to  recognize  the  souml  of  his 
name  when  addressed,  but  took  no  notice  of  surrounding  objects.  ■ The  enema  was  repeated.  On  the  morning  of  the  9th.  the 
pidse  had  risen  to  one  hundred  and  thirty,  with  further  dilation  of  the  right  pupil.  Half  grain  doses  of  calomel,  with  one-eighth 
grain  of  ipecac,  were  now  given  every  eighth  hour.  On  the  10th,  stupor  became  profound,  with  paralysis  of  the  right  buccinator 
muscle.  No  other  face  muscles  were  involved  and  there  were  no  convulsions  or  paralysis.  On  the  11th  there  was  full  dihitation 
of  the  right  pupil,  the  left  remaining  natural.  The  respiration,  still  without  stertoi-,  was  greatly  increased  in  frequency,  the 
diaphragm  assisting  but  little  in  the  breathing.  The  power  of  deglutition  was  lost  and  the  right  arm  was  partially  paralyzed. 
The  enema  was  repeated  but  the  patient  continued  to  sink,  and  died  at  eight  P.  Ji.  on  the  11th  of  May.  At  the  autopsy,  some 
fragments  of  bone  were  found  at-4he-waund  of  entrance.  On  removing  the  calvaria,  a large  quantity  of  serum,  slightly  tinged 
with  blood,  escaped  froln  the  cavity.  The  missile  had  passed  downward,  backward,  and  to  the  left  side,  into  the  left  cerebral 
hemis{)here.  Several  small  pieces  of  bone,  a piece  of  scalp,  and  some  liair,  were  distributed  along  the  track,  around  which,  for 
the  distance  of  half  an  inch;  the  bi’ain  was  softened  by  inflammation.  A large  clot  of  blood  lay  along  the  right  side  of  the  falx 
cerebri.  The  pathological  specimen.  No.  1137,  Sect.  1,  A.  M.  M.,  showing  five  fragments  of  bone,  with  a round  bullet,  removed 
at  the  autopsy,  was  contributed,  with  the  history,  by  Surgeon  John  A.  Lidell,  U.  S.  V. 

Case. — Lieutenant  John  Harris,  of  McIntyre’s  Command,  C.  S.  A.,  aged  27  years,  was  wounded  in  action  near  Helena, 
Arkansas,  about  the  middle  of  June,  18ti4,  by  a conoidal  musket  ball  which  detached  the  riglit  ear  and  entered  the  cranial  cavity 
at  the  junction  of  the  parietal  and  occipital  bones.  He  was  admitted  on  June  24th  into  the  general  hospital  at  Helena.  The 
wound  soon  became  gangrenous,  and  death  resulted  on  July  1st,  18fi4.  No  further  particulars  are  recorded. 

Case. — Private  Alexander  Johnson,  Co.  A,  102d  U.  S.  Colored  Troops,  received  at  the  battle  of  Pocotaligo,  South  Caro- 
lina, December  9lh,  18(14,  a penetrating  fracture  of  the  cranium  from  a missile  which  entered  at  the  right  orbit  and  involved  the 
brain.  He  was  conveyed  by  hospital  steamer  to  Beaufort  and  admitted  into  the  general  hospital  on  the  12th.  The  wound  was 
dressed  in  the  usual  manner.  On  the  14th  he  Avas  transferred  to  division  hospital  No.  2,  at  the  same  place.  Death  resulted  on 
December  22d,  1864. 

Case. — Private  John  .Johnson,  Co.  H,  72d  Indiana  Volunteers,  was  Avounded  in  the  head  in  a skirmish  at  \Ve.st  Point, 
Mississippi,  February  22d,  1864,  by  a musket  ball  Avhich  entered  the  cranial  cavity  on  the  left  side  and  lodged  in  the  substance 
of  the  brain.  He  Avas  conveyed  to  Memphis,  Tennessee,  and  admitted  on  the  27th  into  the  Washington  Hospital.  Meningitis 
and  coma  supervened,  and  death  resulted  on  the  11th  of  March,  1864.  At  the  autopsy  the  ball  Avas  found,  but  the  exact  jilace  of 
lodgment  is  not  stated. 

Case. — Captain  John  K.  Lamrie,  Co.  D,  6th  Wisconsin  Volunteers,  aged  28  years,  Avas  Avounded  at  Hatcher’s  Eun,  Vir- 
ginia, February  6th,  183.’3,  by  a conoidal  ball,  Avhich  penetrated  the  cranium.  He  Avas  .admitted  to  hospital  3d  division.  Fifth 
Corps,  and  on  February7th,  sent  to  hospital  of  Fifth  Corps  at  City  Point.  There  was  evidently  compression  of  brain  from  extra- 
vasation of  blood.  He  died  February  18th,  188.').  At  the  .autojisy  the  greater  longitudinal  sinus  Avas  found  jteiforated,  and  fr.ag- 
ments  of  bone  Avere  lying  loose  upon  the  brain.  Abscesses  had  formed  in  the  superior  and  internal  portion  of  each  hemisphere 
and  Avere  in  a sujjpurating  condition. 

Case. — Corporal  IF.  F.  Lancaster,  Co.  F,  3d  Virginia  Regiment,  aged  24  years,  Avas  AVounded  at  the  battle  of  Gettysburg, 
July  1st,  1863,  by  a musket  ball  Avhich  penetrated  the  squamous  portion  of  the  right  temporal  bone,  just  above  and  anterior  to 
the  meatus  auditorius  and  lodged.  'The  missile  was  extracted  on  the  field  and  the  p.atient  Avas  conveyed  to  the  Seminary  Hos- 
pital, Avhere  he  remained  until  the  20th  of  the  month.  He  Avas  then  sent  to  West’s  Building  Hospital,  Baltimore,  being  at  the 
time  irritable,  as  his  Avound  Avas  painfid,  and  his  sleep  at  night  disturbed.  Cold-Avater  dressings  and  expectant  treatment  Avere 
used.  On  the  1st  of  August  short  periods  of  delirium  occurred,  Avith  quick,  sm.all  pulse,  which  Avas  folloAved  by  obstinate 
diarrhoea.  By  the  4th,  delirium  had  hecome  constant,  terminating  five  days  later  in  a state  of  p.artial  stupor.  Insensibility  fol- 
loAved,  on  the  morning  of  the  10th;  his  respiration  becoming  stertorous,  pulse  frequent  and  Aveak;  and  death  occurred  at  five 
o’clock  in  the  afternoon.  At  the  autopsy,  the  portions  of  the  squ.amous  bone  immediately  surrounding  the  upper  part  of  the  per- 
foration Avere  found  dejtressed  nearly  a fourth  of  an  inch.  The  parietal,  sphenoid,  and  frontal  bones  Avere  also  involved  in  the 
fracture,  Avhich  measured  three  and  a half  by  tAVo  inches.  In  the  immediate  vicinity  of  the  fragments  disorg.aniz<ation  of  the  brain 
existed,  but  in  the  other  [lails  its  structure  Avas  healthy.  The  pathological  specimen  is  No.  1720,  Sect.  I,  A.  M.  M.,  and  Avas 
contributed,  Avitli  the  history,  by  Assistant  Surgeon  E.  Brooks,  U.  S.  A. 

Case. — Private  J.  O’Brien,  Co.  F,  47th  Pennsylvania  Volunteers,  Avas  Avounded  at  the  battle  of  Pocot.aligo,  South  Caro- 
lina, October  22,  1862,  by  a musket  ball,  Avhich  entered  half  an  inch  beloAV  the  centre  of  the  loAver  edge  of  the  right  orbit,  passed 
toAvard  the  centre  of  the  head,  and  lodged  deep  in  the  brain.  On  the  foIloAving  day  the  man  Avas  conveyed  by  steamer  to  the 
general  hospital  at  Hilton  Head.  He  became  comatose  on  October  25th,  and  died  on  the  folloAving  day.  The  case  is  reported 
by  Assistant  Surgeon  .John  Bell,  IT.  S.  A. 


204 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Case. — Lieutenant  Colonel  Melanchtlion  Smith,  45th  Illinois  Volunteers,  was  wounded  at  the  siege  of  Vicksburg,  Missis- 
sippi, June  2Cth,  18G3,  by  a buckshot,  which  fractured  the  cranium.  The  action  of  organic  life  seemed  to  be  principally  affected 
and  circulation  and  respiration  gradually  failed  together.  He  died  on  June  ‘28th,  18C3.  The  autopsy  revealed  a small  penetrat- 
ing wound  of  occipital  bone.  The  missile  comminuted  the  external  table  and  diploe  and  turned  aside  an  oval  portion  of  the  inter- 
nal table,  passed  through  the  right  lobe  of  cerebellum  and  lodged  in  the  fold  of  the  dura  mater  which  separates  that  body  from 
the  right  lobe  of  cerebrum.  There  was  but  little  disorganization  in  the  track  of  the  ball  and  not  much  congestion  of  the  meninges 
and  cerebrum.  The  case  is  repoited  by  Surgeon  A.  B.  Ormsby,  45th  Illinois  Volunteers. 

Case. — Colonel  Thomas  JRvffin,  1st  Nortli  Carolina  Cavalry,  aged  37  years,  was  wounded  at  Bristow  Station,  Virginia, 
October  14th,  18C3,  by  a conoidal  ball,  which  struck  the  skull,  near  the  junction  of  the  coronal  and  sagittal  sutures,  and  passed 
along  the  latter  a distance  of  four  inches,  fi’actuilng  both  tables.  He  was  admitted  to  the  2d  division  hospital  at  Alexandria  on 
the  following  day,  being  peifectly  conscious.  No  paralysis  existed  and  the  pupils  were  normal.  On  the  17th  there  was  slight 
delirium  occurring  at  intervals.  The  bowels  being  constipated,  half  an  ounce  of  castor  oil  was  administered.  He  retained  full 
possession  of  Ids  faculties  until  a minute  before  his  death,  which  occurred  suddenly  on  the  18th.  On  the  removal  of  the  skull- 
cap, it  was  found  that  the  inner  table  was  shattered  for  a space  of  one  and  a quarter  inches  in  diameter;  spiculae  being  lodged  in 
the  membranes  and  driven  into  the  substance  of  the  brain.  As  this  organ  was  taken  fi’om  the  cavity  for  special  examination,  two 
ounces  of  blood  collected  in  the  back  of  the  skull;  and  two  clots  containing  somewhat  more  than  an  ounce  of  fluid,  with  about 
three  ounces  of  a sero-purulent  character,  were  found  lying  upon  the  left  anterior  lobe,  beneath  the  dura  mater.  A flattened 
piece  of  the  missile  was  found  in  the  right  anterior  lobe,  (.u  a level  with'the  corpus  callosum,  directly  beneath  the  wound  of 
entrance.  The  pathological  specimen  is  No.  1734,  Sect.  1,  A.  M.  M.  The  fractured  and  depressed  portion  measures  three- 
fourths  by  one  inch.  A fissure  one  inch  in  length  runs  downward  in  the  centre  of  the  frontal  bone.  The  fragments  removed 
consist  entirely  of  diploe  and  inner  table.  The  fragments  of  the  outer  table  remain  in  situ.  The  specimen  and  history  were  con- 
tributed by  Acting  Assistant  Surgeon  T.  H.  Stillwell. 

Case. — Corporal  Lucian  Sanderson,  Independent  Company,  9th  Massachusetts  Light  Artillery,  was  wounded  at  the  battle 
of  North  Anna,  Virginia,  May  23d,  1864,  by  a conoidal  ball,  wliich  struck  the  left  temporal  bone  immediately  above  the  meatus 
auditorius  externus  arid  penetrated  the  brain.  He  was,  on  the  same  day,  admitted  to  the  hospital  of  the  4th  division.  Fifth  Corps, 
in  a comatose  condition,  with  the  brain  substance  oozing  from  the  wound.  Simple  dressing  was  applied,  but  death  supervened 
on  May  24th,  1864. 

Case. — Pi  ivate  Butler  G.  S , Co.  F,  9th  Kentucky  Cavalry,  was  wounded  July  12th,  1863,  Morgan’s  Raid,  by  tliree 

buckshot;  the  first  entered  at  the  external  angle  of  the  left  eye,  passed  through  the  upper  lid  close  to  the  superciliary  ridge,  pene- 
trated the  orbital  plate  of  the  frontal  bone  and  lodged  in  the  cerebrum ; the  second  entered  over  the  zygomatic  process  of  the  left 
side,  and  the  third  over  the  superior  maxillary  bone  near  the  origin  of  the  zygomaticus  major  muscle.  He  was  admitted  to  the 
hospital  at  Madison,  Indiana,  July  12th,  1863.  He  remained  unconscious  for  three  days.  On  July  17th,  his  condition  had 
improved,  but  on  July  23d,  inflammation  of  brain  and  coma  followed.  He  died  July  24th,  1863.  The  pathological  specimen  is 
No.  4568,  Sect.  I,  A.  M.  M.  It  was  contributed  by  Surgeon  A.  M.  Wilder,  U.  S.  V. 

Case. — Private  H.  Thompson,  Co.  D,  16th  Georgia  Regiment,  was  wounded  at  the  battle  of  Chancellorsville,  May  3d, 
1863,  by  a buckshot,  which  penetrated  the  left  temple  just  above  the  zygomatic  process,  one  inch  posterior  to  outer  portion  of 
orbit.  When  admitted  to  the  Chimborazo  Hospital  at  Richmond,  he  complained  of  much  pain  in  the  vicinity  of  the  wound,  which 
was  slightly  tumefied  and  discharged  a small  quantity  of  healthy  pus.  The  pulse  was  natural ; there  was  no  fever,  and  the 
bowels  were  moved  once  daily.  Cold  applications  were  regularly  kept  up  until  May  15th,  when  symptoms  of  oppression 
appeared.  There  was  stertorous  respiration,  with  pulse  70,  the  mind  much  confused;  mouth  and  tongue  quite  dry,  but  no  dila- 
tation of  pupils  was  noticed.  The  orifice  of  wound  was  enlarged  to  permit  free  exit  of  discharge ; the  head  was  shaved  and  ice 
freely  applied  to  the  scalp.  From  May  18th,  the  patient  improved,  and  apparently  recovered,  but  on  May  30th,  he  became  sud- 
denly comatose,  and  died  May  31st,  1863.  At  the  autopsy,  a buckshot,  much  flattened,  was  found  imbedded  a quarter  of  an  inch 
in  base  of  an  anterior  portion  of  the  middle  lobe  of  left  hemisphere.  The  ball  had  passed  through  the  wings  of  the  sphenoid 
bone,  and  a considerable  quantity  of  healthy  looking  pus  flowed  freely  mto  the  cavity  of  the  cranium  from  the  temporal  fossa 
through  the  orifice.  A complete  sac  had  invested  the  ball,  and  also  a small  fragment  of  bone,  which  had  been  carried  with  it. 
There  was  vei-y  slight  congestion  of  the  pia  mater  and  arachnoid. 

Case. , was  brought  into  the  Prince  Street  Hospital,  Alexandria,  Virginia,  May  14th,  1864,  with  a pene- 

trating fracture  of  both  tables  of  the  left  parietal  bone  at  the  anterior  superior  angle.  He  was  comatose,  passed  urine  involun- 
tarily. He  moved  his  arms  freely;  but  the  legs  were  motioidess,  the  pupils  dilated  and  fixed,  and  the  right  eyelid  ecchymosed. 
A puffy  swelling  existed  in  the  right  temporal  region.  Convulsions  supervened,  and  death  ensued  the  same  evening. 

Case. — Private  E.  N.  York,  Co.  E,  9th  New  Y^ork  Heavy  Artillery,  aged  30  years,  was  wounded  at  the  battle  of  Monocacy 
Junction,  Maryland,  July  9th,  1864,  by  a conoidal  musket  ball,  which  entered  the  occipital  bone  and  lodged  in  the  hrain.  He 
was  sent  to  the  Frederick  Hospital  on  the  evening  of  the  same  day.  The  brain  exuded,  but  the  patient  could  readily  move  about 
in  his  bed,  and  with  assistance  could  sit  up,  being  well  able  to  converse.  He  continued  in  this  state,  with  occasional  severe  head- 
ache, for  five  days;  then  stupor  supervened,  with  strabismus,  and  the  case  terminated  fatally  on  the  15th  of  July,  1864.  The 
orifice  made  by  the  missile  was  a smooth  round  opening  without  depression  of  the  surrounding  bone.  The  case  is  reported  by 
Acting  Assistant  Surgeon  John  H.  Bartholf. 

In  the  five  following  curious  cases,  the  presence  of  balls  within  the  cranial  cavity  was 
unsuspected  during  life; 

Case. — Private  Antoine  Pascha,  Co.  F,  6th  Vermont  Volunteers,,  aged  21  years,  received  a gunshot  wound  in  the  head 
during  the  Peninsular  campaign.  No  record  of  the  case  can  be  found  until  September  26th,  1862,  when  the  patient  was  admitted 


FATAL  PENETEATING  GUNSHOT  FRACTURES  OF  THE  SKULL. 


205 


to  Carver  Hospital  at  Washington.  On  January  8th,  1863,  he  was  sent  to  Baxter  Hospital,  Burlington,  Vermont,  and  on  April 
7th  to  Fort  Wood,  New  York  Harbor.  He  had  been  treated  for  a wound  received  in  another  engagement,  and  had  nearly 
recovered  on  May  6th,  1833,  when  an  attack  of  encephalitis  supervened,  causing  death  on  May  8th,  1863.  The  autopsy  revealed 
a bullet  in  the  brain,  behind  the  frontal  bone,  near  which  a small  abscess  had  formed.  Surgeon  John  Campbell,  U.  S.  A., 
reported  the  case. 


Exterior  view  of  tbe  foregoing 


Fig.  103. — Conoidal  ball  embedded  between  the  sphe- 
noid and  frontal  bones.  Spec.  1108,  A.  M.  M. 


Case. — Corporal  G.  W.  S , 12th  Massachusetts  Volunteers,  aged  twenty-nine  years,  was  wounded  at  the  battle  of 

Fredericksburg,  December  13th,  1862,  and  was  admitted  to  Camden  Street  Hospital,  Baltimore,  six  days  subsequently.  The 
humors  of  the  right  eye  had  been  evacuated  by  a ball,  which  had  likewise  inflicted  a slight  wound- of  the  lower  lid.  The  left 
eye  was  observed  to  be  unnaturally  prominent,  but  its  functions  were  undisturbed.  The  patient  did  not  complain  of  pain  or  any 

inconvenience,  except  a slight  headache. 

There  were  no  cerebral  symptoms,  and 
no  one  suspected  that  the  projectile  had 
entered  the  brain.  The  functions  of  the 
left  eye  were  in  no  way  disordered, 
although  it  was  observed  that  the  globe 
was  unnaturally  prominent.  Opiate 
lotions  were  applied  to  the  right  eye. 

There  were  no  symptoms  of  importance 
excejit  the  comparatively  slight  local 
pain,  and  frontal  headache.  The  wound 

healed  kindly,  and  after  three  weeks  the  man  walked  about  the  city  habitually, 
with  a hospital  pass.  He  appeared  to  be  well,  except  that  he  had  an  occasional 
pain  over  the  left  eye,  until  February  6th,  1863,  when  he  had  a chill,  followed  by  a febrile  reaction.  The  fever  assumed  a 
continued  form  with  occasional  chilliness.  No  marked  cerebral  disorder  supervened,  however,  until  February  10th,  when 
delirium  was  noticed  at  night.  On  the  following  day  the  patient  was  comatose,  though  intelligence  was  not  entirely  abolished. 
He  would  occasionally  answer  a question,  or  put  out  his  tongue  when  ordered.  The  pupil  of  his  remaining  eye  was  greatly 
dilated.  The  sphincters  were  relaxed.  Cupping  and  blistering  were  employed  without  benefit.  The  patient  sank  rapidly,  and 
at  midnight  of  February  15th,  he  died.  The  autopsy  revealed  a conoidal  musket  ball  wedged  between  the  sphenoid  and  the  left 
orbital  plate  of  the  frontal  bone,  and  lying  in  contact  with  the  dura  mater.  On  lemoving  the  calvaria,  the  pia  mater  was  found 
much  congested,  and  from  the  confluence  of  the  longitudinal  and  lateral  sinuses,  or  torcular  herophili,  a considerable  quantity  of 
dark  fluid  blood  escaped.  The  ball  depressed  the  thin  inner  wall  of  the  left  orbit,  thus  diminishing  its  capacity  and  forcing 
forward  the  eye.  This  fact  explained  its  unnatural  prominence  observed  during  life.  The  missile  had,  after  passing  through 
the  eye,  entered  the  cranium  through  the  third  inner  wall  of  the  right  orbit,  at  the  junction  of  the  sphenoid  and  ethmoid  bones. 
The  ball  did  not  penetrate  the  dura  mater,  but  remained  in  contact  with  and  pressing  against  it.  In  consequence  of  this  pressure, 
ulceration  of  that  membrane  resulted,  and  an  abscess  formed,  extending  from  the  point  of  contact  to  the  left  lateral  ventricle, 
containing  about  two  drachms  of  pus.  A few  drops  of  pus,  apparently  encysted  by  lymph,  were  discovered  pressing  directly 
against  the  commissure  of  the  optic  nerve,  which  was  the  probable  cause  of  the  extreme  dilation  of  the  pupil.  The  pons  Varolii 
and  the  medulla  oblongata.  Were  found  bathed  in  pus.  The  autopsy  was  made,  and  the  specimen,  which  is  represented  in  the 
accompanying  wood-cuts,  (Fig.  103,  and  Fig.  104,)  was  presented  to  the  museum  by  Acting  Assistant  Surgeon  George  H.  Dare, 
who  also  furnished  the  very  interesting  notes  of  the  case. 


Case. — Sergeant  J.  E.  B , Co.  A,  55th  Virginia  Regiment,  aged  26  years,  was  wounded  at  Poplar  Grove  Church, 

Virginia,  October  1st,  1864,  by  a conoidal  ball,  which  entered  just  above  the  inner  canthus  of  the  left  eye,  fractured  the  frontal 
bone,  passed  backward  and  to  the  right,  and  lodged  at  the  posterior  angle  of  the  right  orbit.  He  was  conveyed  to  the  hospital 
of  the  first  division.  Fifth  Corps,  and  on  October  8th  was  sent  to  Lincoln  Hospital,  Washington.  The  right  eye  was  inflamed, 
and  had  a bulging  appearance.  No  bad  symptoms  occurred  until  October  26th,  when  the  patient  vomited.  He  became  comatose 
and  feverish  on  the  evening  of  the  28th,  and  died  on  the  following  morning,  October  29th,  1864.  At  the  autopsy  disorganization 
of  the  anterior  lobe  of  the  left  hemisphere  was  found  extending  to  the  left  lateral  ventricle ; both  ventricles  were  filled  with  a 
purulent  sanguineous  fluid,  and  the  base  of  brain  was  covered  with  pus.  The  pathological  specimen  is  No.  3373,  Sect.  1,  A.  M.  M. 
A section  of  skull,  showing  fracture  and  comminution  of  the  intraorbital  septa,  and  of  the  right  orbital  plate  of  the  frontal  bone. 
The  specimen  and  history  were  contributed  by  Acting  Assistant  Surgeon  H.  M.  Dean. 

Case. — Private  A.  Van  Walker,  Co.  A,  7th  Wisconsin  Volunteers,  aged  20  years,  was  woulided  at  the  battle  of  Gettys- 
burg, July  1st,  1863,  by  a conoidal  musket  shot  which  perforated  the  frontal  bone  about  half  an  inch  above  the  right  orbit  and 
entered  the  brain.  He  was  admitted  to  the  Camp  Letterman  Hospital  on  the  same  day,  where  he  remained  until  the  8th,  when 
he  was  transferred  to  McKim’s  Mansion  Hospital  at  Baltimore.  Considerable  inflammation  existed  in  the  region  of  the  wound, 
which  readily  yielded  to  expectant  treatment,  which  was  continued  until  the  3d  of  September,  when  the  patient  complained  of 
pain  in  his  head,  though  apparently  doing  well.  On  the  12th,  he  _walked  two  miles  to  witness  a 
parade,  without  suffering  any  inconvenience  fi-om  the  exposure  and  exertion.  On  the  18th  he  was 
seized  with  violent  pain  in  the  head,  which  was  attended  with  nausea  and  vomiting.  Temporary 
relief  was  in  a measure  afforded  by  the  use  of  opiates  and  counter-irritants ; but  coma  ensued  next  day, 
and  death  resulted  at  midnight  of  the  20th.  At  the  autopsy,  the  missile  and  a fragment  of  bone  were 
found  lodged  in  the  anterior  lobe  of  the  cerebrum,  on  the  right  side  of  the  sella  Turcica.  The  anterior 
lobe  of  the  right  hemisphere  was  a disorganized  mass.  The  case  is  reported  by  Acting  Assistant 
Surgeon  William  G.  Smull.  The  ball,  represented  in  the  adjacent  wood-cut,  was  forwarded  to  the 
Museum  by  Surgeon  L.  Quick,  U.  S.  V. 


Fig.  105. — A bullet  which 
remained  eighty  two  dayfl 
in  the  brain.  Spec.  lOli?, 
Sect.  I,  A.  M.  M. 


206 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — J.  B.  I was  received  on  board  the  hospital  steamer  State  of  Maine  from  City  Point,  on  April  5tli,  1805, 

with  a gunshot  fracture  of  the  frontal  hone  over  the  left  eminence  caused  hy  a small  iron  canister  shot.  He  died  while  on  tlie 
way  to  Alexandria.  At  the  autopsy  a portion  of  the  depressed  hone  and  the  missile  wei’e  found  imbedded  in  the  anterior  lobe, 
and  pus  e.xisted  under  the  pia  mater  on  the  frontal  and  parietal  convolutions.  The  substance  of  brain  was  mostly  of  a dark  slate 
color  and  was  greatly  softened.  There  were  no  special  bloody  etfusions.  The  pathological  specimen  is  No.  1497,  Sect.  I,  A.  M. 
jM.  The  wound  of  the  external  table  is  one  inch  by  one  and  three-fourths  from  which  two-thirds  of  the  substance  have  been 
removed,  the  I’cmaining  fragments  being  slightly  depressed.  The,  fracture  and  loss  of  substance  of  the  inner  table  are  somewhat 
greater  and  the  borders  are  necrosed.  The  specimen,  with  the  history,  was  contributed  by  Surgeon  E.  Bentley,  U.  S.  V. 

Perforating  Gunshot  Fractures  of  the  Skull.— A few  instances  were  reported 
in  wliicli  men  survived  after  perforations  of  the  craniums  by  musket  balls.  The  abstract  of 
the  following  case  furnislies  an  instructive  example,  the  more  interesting,  because  the  patient 
lias  been  kept  under  observation  for  nearly  nine  years  from  the  date  of  the  reception  of 
the  injury  : 

Case. — -Private  Patrick  Hughes,  Co.  K,  4th  New  York  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of  Antietam, 
Sopteniber  17th,  18o2,  in  Sumner’s  attack  on  the  right,  near  Dunker's  Chapel.  Several  special  reports,  at  variance  in  regard  to 
some  particulars  of  the  case,  have  been  received.  In  the  note  book  of  Surgeon  J.  H.  Brinton,  U.  S.  V.,  it  is  stated  that  “ two 
missiles  had  struck  the  back  portion  of  his  head,  the  one  near  vertex  causing  injury  of  greatest  extent,”  and  that  “he  did  not 
entirely  lose  his  consciousness  at  time  of  injury.”  But  the  field  report,  and  the  majority  of  the  subsequent  hospital  repoi'ts,  state 
very  positively  that  the  injury  was  a perforation  of  the  skull  by  a single  conoidal  musket  ball  entering  near  the  inner  posterior 
angle  of  the  right  parietal,  and  emei’ging  at  a higher  point  of  the  left  parietal,  making,  after  traversing  a portion  of  the  brain,  a 
large  exit  wound.  Little  is  known  of  the  early  history  of  the  case,  except  that  the  patient  dragged  himself  from  the  field,  and, 
after  a preliminary  dressing  from  Surgeon  G.  W.  Lovejoy  of  his  regiment,  was  conveyed  to  a field  hospital  in  a barn  near  Keedys- 
ville,  where  he  remained  until  the  20th,  when  he  was  sent  to  Hagerstown.  The  regimental  surgeon  reports  that  the  shock  and 
depression  from  the  injury  was  great,  but  that  the  patient  was  conscious  and  answered  questions  rationally.  There  is  no  report 
from  the  Hagerstown  hospital,  except  that  the  patient  was  sent  to  Washington  on  the  24th.  On  the  25th,  he  was  received  .at  the 
Mount  Pleasant  Hospital.  The  following  is  an  extract  from  the  report  of  Acting  Assistant  Surgeon  Thomas  Carroll,  who  had 
immediate  charge  of  the  case,  after  the  patient’s  admission  to  Mount  I’leasant  Hospital : “The  ball  entered  half  an  inch  posterior 
to  the  junction  of  the  coronal  and  sagittal  sutures  on  the  median  line,  passed  backward  under  the  scalp  and  escaped  one  inch  above 
the  occipital  protuberance,  inflicting  a wound  four  inches  in  length,  producing  a compound  comminuted  fracture  of  the  skull  of  the 
.s.ame  extent.  At  the  time  of  his  admission  to  the  hospital,  eight  days  after  the  reception  of  the  wound,  so  much  tumefaction  of  the 
))arts  e.xisted  that  it  could  not  be  ascertained  whether  or  not  the  brain  or  its  membranes  were  injured.  The  general  condition  of 
the  jiatient  was  good  ; suppuration  had  commenced ; no  febrile  action  existed,  the  ])ulse  was  regular,  sleep  not  materially  disturbed, 
mind  clear  and  manifesting  no  signs  of  compression  of  the  brain,  or  inflammation  of  its  membranes.  Little,  if  any,  change  was 
perceptible  for  several  days,  when  the  swelling  of  the  scalp  and  tissues  subsided,  leaving  a prominence  nearly,  if  not  altogether, 
one  inch  in  height,  and  two  and  a half  or  three  inches  in  length  of  brain  substance,  in  which  the  pulsation  of  the  arteries  could  be 
distinctly  observed.  From  the  closest  examination  that  could  now  be  made,  it  was  supposed  that  the  membranes  of  the  brain  were 
not  lacerated,  though  this  supposition  was  by  no  means  certain-,  as  there  was  reason  to  believe  the  brain  itself  had  been  penetrated. 
The  chief,  and  in  fact,  the  onlj^  unpleasant  symj)tom  complained  of  by  the  patient,  was  an  occasional  paroxysm  of  giddiness  that 
occurred  at  intervals  of  from  ten  to  fifteen  days ; the  ])aroxysms  continued  to  return,  though  less  frequently,  while  he  remained 
in  the  hospital.  Early  in  December,  he  was  able  to  sit  up  and  walk  about  the  ward,  and  was  never  afterwards  much  confined  to 
bell.  The  protuberance  now  began  to  subside,  and  was  soon  reduced  nearly  to  a level  with  the  skull;  numerous  pieces  of  bone 
were  removed  as  they  became  detached  from  the  tissues,  leaving  a com]dete  channel  in  the  cranium  from  the  point  where  the  ball 
entered  to  where  it  emerged.  At  the  time  this  man  was  discharged  from  the  service,  January  2Cth,  1863,  the  wound  was  nearly 
healed.  There  was  but  little  discharge  of  pus,  and  with  the  exception  of  an  occasional  recurrence  of  the  paroxysms  of  giddiness, 
he  suffered  but  slight  inconvenience.  The  treatment  consisted  simply  in  cutting  the  hair  short,  and  applying  cold  water  dressing 
locally,  paying  strict  attention  to  the  diet,  and  administering  a cathartic  as  often  as  symptoms  seemed  to  indicate  its  use.” 
Assistant  Surgeon  C.  A.  McCall,  U.  S.  A.,  in  charge  of  Mount  Pleasant  Hospital,  furnished  a report  of  the  case,  from  which  the 
following  extracts  are  made.  “ The  ball  passed  from  about  one  inch  above  and  to  the  right  of  occipital  protuberance  into  the 
cavity  of  cranium  and  emerged  at  a point  on  the  left  of  the  median  line,  about  one  and  three-fourths  inches  from  the  point  of 
entry;  probably  a conoidal  ball.  From  the  posterior  margin  of  the  inferior  wound  to  anterior  margin  of  superior  was  about  four 
inches.  At  the  time  of  his  admission  to  hospital,  eight  days  after  the  injury,  so  much  tumefaction  and  hardened  clot  existed, 
that  it  was  deemed  inadvisable  to  make  a very  strict  examination  with  a view  to  determine  the  extent  of  lesion.  The  hair  was 
closely  shaved,  and  cold  water  dressings  apjslied  and  patient  placed  in  a sitting  posture.  The  general  condition  of  patient  was 
promising,  although  all  the  brain  functions  appeared  clouded,  the  memory  impaired,  speech  desultory  or  given  in  fragments,  j'et 
being  readily  aroused  and,  generally  at  such  times,  answering  promptly  and  clearly.  In  a short  time  healthy  supj)uration  was 
established,  febrile  action  decreased,  the  pulse  became  regular,  sleep  became  natural,  the  mind  began  to  show  clearness,  and  he 
seemed  to  lose  all  symptoms  of  compression  or  of  infiammation  of  the  brain  or  its  membr.anes.  The  swelling  and  induration  of 
the  parts  gradually  disappeared,  leaving  in  their  place  a fungus  cerebri  of  considerable  size,  ])erhaps  an  inch  in  height  by  two 
and  a half  or  three  inches  in  length,  in  which  the  imlsation  could  be  distinctly  seen  and  felt.  The  only  unpleasant  symptom 
now  existing  was  the  occurrence  of  a paroxysm  of  giddiness  at  intervals  of  ten  or  twelve  days,  which  symptom  continued, 
although  at  much  greater  intervals,  during  the  remainder  of  his  stay  at  the  hospital.  The  size  and  extent  of  the  fungus  deterred 
me  from  using  the  knife,  and  I had  resort  to  compression  as  recommended  by  the  sui’geons  of  France,  but  with  such  serious 
results  tliat  1 was  startled  for  the  safety  of  my  patient,  and  therefore  threw  aside  all  dressing  save  the  simple  cerate  on  soft  lint. 


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PERFORATING  GUNSHOT  FRACTURES  OF  THE  SKULL. 


207 


and  proper  guard  for  the  delicate  tissues.  Early  in  December,  he  was  able  to  sit  up  and  walk  about  the  wards,  and  was  never 
afterwards  confined  to  the  bed.  From  this  time  the  fungus  commenced  to  decrease  in  size,  and  continued  to  do  so  until  shortly 
before  his  discharge  from  the  service,  January  2Gth,  1863,  when  it  liad  shrunk  below  the  level  of  the  skull,  and  both  openings 
had  been  well  covered  by  cicatricial  tissue.  During  the  progress  of  the  case  numermts  spiculse  of  bone  were  removed  as  they 
became  detached.  The  constitutional  treatment  consisted  in  paying  strict  attention  to  the  diet,  and  exhibiting  saline  cathartics 
and  turpentine  injections  as  the  symptoms  seemed  to  call  for.  When  the  soldier  left  my  hands  he  complained  of  no  inconvenience 
whatever  with  the  exception  of  the  occasional  attack  of  giddiness,  and  the  fact  that  he  could  not  see  a small  object  when  placed 
in  a j)osition  directly  on  a level  and  on  a middle  line  between  the  eyes.  Both  which  defects,  I consider,  will  diminish  with  time 
until  lost.  Shortly  before  the  patient’s  discharge  from  Mount  Pleasant,  an  excellent  picture  of  the  aspect  of  the  injury  at  that 
time  was  made  in  water  color,  under  the  direction  of  Surgeon  J.  11.  Briuton,  U.  S.  V.,  who  was  then  in  charge  of  the  Division 
of  Surgical  Records  of  the  Surgeon  General’s  Office,  and  had  secured  the  services  of  an  artist,  Mr.  Stanch,  whose  admirable  draw- 
ing and  coloring  have  furnished  some  of  the  best  illustrations  of  this  book.  The  figure  on  the  right  of  the  chromo-lithograph 
opposite  is  a good  copy  of  Mr.  Stauch’s  water-color  diawing.  I take  the  following  memorandum  of  the  case  from  one  of  the  mem- 
orandum books  turned  over  to  me  by  Dr.  Briuton  : 'Gunshot  wound  of  head:  The  picture  of  this  case  was  taken  at  the  Surgeon 
General’s  Office,  whither  the  man  came  us  an  orderly,  or  on  an  errand.  He  was  perfectly  well.  A small  carnified  cerebral  hernia 
existed  at  the  exit  wound,  which  was  healing  rapidly.  The  ball  went  into  cavity  of  the  skull  and  emerged.  No  symptoms 
existed  at  all,  when  the  patient’s  portrait  was  taken.  The  wound  was  then  some  three  or  four  months  old.  The  history  of  this 
case,  which  I took  at  the  time,  has  been  unfortunately  mislaid.’”  After  this  we  have  the  history  of  the  case  taken  up  by  the  pen- 
sion examining  surgeons.  The  patient  went  to  Newcastle,  Delaware,  and  was  pensioned  at  four  dollars  a month,  until  June. 

1869,  when  his  pension  was  increased  to  eight  dollars  a month.  Dr.  D.  W.  Maull  reports  at  this  date,  that  there  was  a loss  of 
substance  of  the  skull  two  inches  wide  and  three  inches  long,  leaving  a large  depression,  covered  only  by  the  integuments  of  the 
cranium.  "Through  this  can  be  seen  at  all  times  the  pulsations  of  the  brain.  About  the  cavity  the  bone  is  ridged  by  the  union 
of  the  fractured  margins.  There  is  almost  constant  dull  pain,  some  loss  of  hearing,  and  the  sight  of  the  right  eye  is  impaired.” 
Dr.  Maidl  regarded  the  disability  as  total.  Yet  the  man  worked  afterw.ards  in  an  iron  foundry  as  puddler.  On  December  20th, 

1870,  this  patient  was  examined  by  Doctors  William  Thomson  and  W.  W.  Keen  of 
Philadelphia,  who  have  published  an  interesting  account'  of  his  condition  at  that 
time,  with  a photograph,  of  which  a reduced  copy  is  given  in  the  annexed  wood- 
cut,  (Fig.  103.)  I make  the  following  quotations  from  this  paper:  “His  memory 
is  quite  good,  but  by  no  means  so  good  as  before  the  injui-y.  He  is  rather  easier 
bothered  and  confused,  and  more  irritable  than  formerly.  The  sight  of  his  right 
eye,  he  thinks,  is  poor.  Whisky  affects  him  as  usual.  Sexual  power  undiminished. 

He  has  no  paralysis.  The  wound  of  entrance *  * * is  marked  by  a slight 

depression  in  the  bone,  the  wound  of  exit  bj'  a hollow  two  and  a half  by  two  inches, 
and  one  inch  deep.  No  bone  lias  closed  this  opening,  but  the  scalp  and  hair  dip 
down  into  the  hollow.  The  arterial  pulsations  are  barely  perceptible.  When  recum- 
bent the  hollow  is  gradually  obliterated  and  replaced,  in  about  one  minute,  by  a 
rounded  protuberance.  To  prevent  pain  during  this  change,  he  supports  the  parts 
with  his  hand.  When  he  coughs,  even  with  moderate  force,  the  depressed  scalp 
instantly  bulges  up  in  a cone,  which  nearly  reaches  the  general  level  of  the  skull 
and  obliterates  the  depression,  and  then  as  suddenly  subsides.”  Drs.  Keen  and 
Thomson  observe  that  “the  complete  recovery  from  paralysis,  (as  evinced  by  his 
subsequent  severe  labor,)  and  the  almost  enti-e  restoration  of  his  mental  faculties, 
are  remarkable,  especially  in  view  of  the  probable  deep  lesion  of  the  brain,  both  by 
the  primary  injury  and  the  subsequent  fungus  cerebri.”  They  comment  also  upon 
"the  rapid  changes  in  the  state  of  the  cranial  contents,  due  to  any  change  of  posi- 
tion, to  coughing,  etc.,  as  evinced  by  the  efifacement  of  the  depression  at  the  wound 
of  exit.”  The  authors  also  regard  the  case  as  of  value  in  throwing  light  upon  the  probable  anatomy  of  the  optic  commissure. 
Their  discussion  on  this  point  is  given  in  a foot-note.^ 


Fig.  106. — Cicatrix  of  .a  gunshot  perforation  of 
the  skull,  eiglit  years  after  tlie  reception  of  the 
wound.  [From  a pliotograph.] 


^Photographic  Rcritm  of  Medicine  and  Surgery.  Vol.  1,  No.  3,  p.  26.  Philadelphia,  February,  1871.  .1.  15.  Lippincott  Co. 

* "Wollaston,  (Phil.  Trans.  1821,  p.  3JJ,)  reasoning  from  two  attacks  of  transient  hemiopsia,  occurring  in  himself,  and  other  cases  in  friends,  appears 
to  have  been  the  first  to  point  out  the  semi-deoussation  of  the  optic  nerves  at  the  chiasm.  Longet  (Traitfi  de  Phys.,  2d  cd.  ii,  476)  seems  to  assent  to  the 
explanation,  though  he  refers  to  cases  of  perfect  sight  in  which  it  is  asserted  no  chiasm  existed ; and  in  his  Traite 
d'Anat.  et  de  I’hys.  du  Syst.  Nerv.,  p.  666,  he  gives  cases  of  perfect  sight  in  both  eyes,  in  spite  of  nnil.ateral  ccrehral 
atrophy  or  traumatic  lesion.  Von  Graefc  (.Vrehiv,  ii,  286)  assents  cordially  to  Wollaston's  view,  admitting  that 
he  proposes  nothing  new,  but  that  which  is  far  too  little  knoivn.  Hubert  Airy,  (On  a Distinct  Form  of  Transient 
Hemiopsia,  Proc.  Hoy.  .Soc.,  Feb.  17th,  1870,  in  “ Nature,”  i.  111,)  after  a careful  examination  of  preceding  writers, 
also  supports  it ; and  the  experiments  of  I.aborde  and  i.even,  (Med.  Gaz.,  Nov.  5th,  1870 ; from  Gaz.  Jled.  de  I’aris.) 
who  found  atrophy  of  the  right  optic  nerve  following  tlie  removal  of  the  superficial  right  cerebral  convolutions,  and 
without  any  apparent  irritative  processes,  would  also  point  in  the  same  direction.  In  our  own  case,  the  point  to 
which  we  desire  to  call  special  attention  is  tlie  rigid  optical  e,xamination  of  the  region  between  the  porus  opticus  and 
the  macula  lutea.  The  semidecussation  of  the  nen-es  .at  ttie  chiasm  being  admitted,  it  would  naturally  be  supposed 
that  the  fibres  a from  the  left  tract  would  supply  the  left  retina  from  the  porus  opticus  towards  a' ; but  our  extimina- 
tion  show-s  tlmt  it  suppiies  /css  than  this.  viz. ; only  that  ptirt  of  the  retina  from  c to  a' ; while  in  the  right  eye  the 
fibres  b,  instead  of  supplying  the  retina  from  the  porus  opticus  to  6',  sii]'ply  more  than  this,  viz. ; that  piirt  of  the  retina 
from  c'  to  6'.  In  other  words  the  fibres  a and  b of  the  left  optic  tract  su]>ply,  matlicmatically,  the  left  halves  of  the 
two  retinae  from  c to  a'  and  c'  to  ?/,  and  the  rigid  tract  tlie  rigid  halves.  As  to  the  cerebral  scat  of  the  sense  of  vision,  relations  of  tlio  optic  commissure  and 
the  amount  and  depth  of  tlie  injury  to  the  brain  arc  too  uncertain,  perhaps,  to  warrant  us  in  venturing  on  any  specu- 
lations as  to  its  locality.” 


Fig.  107. — Diagram  indicating  tlie 


208 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case.— Private  Abraham  D.  Myers,  Co.  K,  4th  New  York  Cavalry,  aged  21  years,  was  wounded  in  an  engagement  near 
Charlestown,  Virginia,  August  28th,  1864,  by  a conoidal  musket  ball,  winch  penetrated  the  frontal  bone  just  above  the  right  eye, 
and  passing  downward  through  the  orbit  emerged  near  the  right  ear.  On  the  following  day  he  was  admitted  to  the  general  hos- 
pital at  Sandy  Hook,  Maryland.  On  September  4th,  he  was  sent  to  the  Jarvis  Hospital  at  Baltimore,  and  on  the  12th,  was  trans- 
ferred to  the  !Mower  Hospital,  Philadelphia.  The  treatment  seems  to  have  been  of  a general  character.  He  I’ecovei'ed,  and  on 
February  13th,  1865,  was  transferred  to  the  Veteran  Reserve  Corps.  This  patient  is  not  a pensioner. 

In  the  following  cases  of  perforation  of  the  skull  by  musket  halls,  the  patients  sur- 
vived, though  totally  and  permanently  disabled  : 

Case. — Private  Hugh  Collins,  Co.  I,  26th  New  York  Volunteers,  was  wounded  at  Antietam,  September  17th,  1862,  by  a 
conoidal  ball,  which  entered  the  cranium  just  above  the  right  eye  and  lodged  in  the  left  side  of  the  neck,  four  inches  below  the 
ear.  The  ball  was  removed,  and  the  patient  was  admitted  to  the  field  hospital  at  Smoketown,  Maryland,  October  8th,  1862.  On 
December  20th,  he  was  discharged  the  service.  On  February  18th,  1833,  he  was  examined  for  a pension  by  Pension  Examiner 
H.  B.  Day.  Partial  amaurosis  of  both  eyes  existed,  otherwise  the  man  enjoyed  good  health.  Subsequent  information  states  that 
this  man  was  unable  to  work,  and  that  his  sight  was  impaired.  His  disability  is  rated  total  and  permanent. 

Case. — Piivate  John  H.  Stallman,  Co.  A,  4th  Pennsylvania  Cavalry,  aged  21  years,  was  admitted  to  the  National  Hos- 
pital at  Baltimore,  from  Sandy  Hook,  IMaryland,  September  8th,  1864,  having  been  wounded  at  Wincbester,  Virginia,  July  24th, 
1864,  by  a musket  ball,  which  entered  at  the  right  temple  and  emerged  at  the  opposite  side  of  the  head.  When  admitted  he  was 
stupid  and  almost  comatose,  in  which  condition  he  remained  for  several  weeks.  He  finally  recovered  so  fiir  as  to  be  fit  for  light 
duty,  but  being  subsequently  seized  with  a spasm  was  again  placed  under  treatment.  On  December  10th,  1864,  he  was  trans- 
ferred to  Cuyler Hospital,  Philadelphia.  On  admission,  the  wounds  were  entirely  healed;  his  bowels  were  constipated,  and  he 
suffered  from  almost  constant  nausea.  His  pulse  was  slow  and  feeble;  tongue  slightly  coated  with  a whitish  fur,  the  tip  and 
edges  remaining  red;  his  pupils  were  equal  and  constantly  dilated.  He  had  no  strabismus.  He  stated  that  he  had  purulent  dis- 
charges from  his  right  ear,  attended  with  pain.  His  mental  faculties  w'ere  slow  and  uncertain  and  his  memory  impaired,  but  he 
had  no  hallucinations  or  mental  aberrations.  While  in  this  hospital  he  had  one  slight  spasm.  On  May  10th,  1865,  he  was  ti'ans- 
ferred  to  the  Mower  Hospital,  Philadelphia,  whence  he  was  discharged  the  service  May  23d,  1865,  and  subsequently  pensioned. 
On  June  24th,  1865,  Pension  Examiner  W.  J.  McKnight  reports:  “It  is  beyond  my  power  to  tell  the  extent  of  the  injury.  I 
only  wonder  that  the  boy  lives.”  He  rates  his  disability  as  total. 

Case. — Private  William  H.  Haggart,  Co.  G,  92d  Illinois  Volunteers,  aged  17  years,  was  wounded  at  Powder  Springs, 
Georgia,  October  3d,  1864,  by  a conoidal  musket  ball,  which  struck  the  left  side  of  the  head,  and  passing  through  carried  away.a 
large  fragment  of  the  left  half  of  the  occipital  bone.  He  became  insensible  and  lost  more  than  an  ounce  of  cerebrum,  leavmg  bare 
the  meningeal  artery.  For  several  weeks  he  was  treated  in  the  hospital  at  Marietta,  and  on  November  10th,  was  sent,  via  Chat- 
tanooga, to  Nashville,  Tennessee,  where  he  was  admitted  to  Hospital  No.  2,  on  November  12th.  He  was  furloughed  on  Novem- 
ber 10th,  and  afterward  was  admitted  to  the  hospital  at  Mound  City,  Illinois.  He  was  discharged  on  April  20th,  1865.  The 
pupils  of  both  eyes  were  dilated,  causing  dimness  of  vision,  so  that  he  could  only  read  very  coarse  print.  The  case  is  reported 
by  Acting  Assistant  Surgeon  J.  K.  Fay.  A communication  from  the  Commissioner  of  Pensions  dated  January  21st,  1870,  states 
that  the  man  was  a pensioner  until  November  19th,  1868,  when  he  died. 

Case. — Private  Joshua  F.  Lock,  Co.  E,  15th  Iowa  Volunteers,  aged  21  yejirs,  was  wounded  near  Atlanta,  Georgia,  August 
llth,  1864,  by  a conoidal  musket  ball,  which  caused  a perforating  fracture  of  the  base  of  the  cranium.  On  the  same  day  he  was 
admitted  to  the  hospital  of  the  4th  division.  Seventeenth  Corps ; on  the  14th,  was  sent  to  the  Seventeenth  Corps  hospital,  and  on 
September  20th,  1864,  was  furloughed.  On  November  22d,  he  was  admitted  to  the  hospital  at  Keokuk,  Iowa.  Simple  dressings 
only  were  applied  to  the  wound.  He  was  discharged  the  service  August  2oth,  186.5,  and  pensioned.  On  August  28th,  1865,  Pen- 
sion Examiner  H.  F.  Cleaver  states  that  there  was  partial  hemiplegia  of  the  right  side,  and  rates  the  disability  total. 

Case. — Sergeant  James  M.  Woodman,  Troop  E,  1st  District  of  Columbia  Cavalry,  was  wounded  in  the  engagement  at 
Weldon  Railroad,  Virginia,  August  23d,  1864,  by  a gunshot  missile,  which  entered  just  above  the  left  frontal  eminence  and 
emerged  at  a point  one  inch  behind  the  upper  margin  of  the  right  ear.  He  was  unconscious  for  several  hours,  and  for  three 
months  was  delirious  during  the  night.  He  was  examined  on  P^ebruary  2d,  1865,  by  Pension  Examiner  R.  K.  Jones.  At  the 
wound  of  entrance  was  a cutaneous  scar,  but  the  bone  was  not  depressed.  At  the  wound  of  exit,  eight  small  fragments  of  bone 
had  been  discharged,  leaving  a depression  one-third  to  one-half  inch  deep.  Both  scars,  esjjecially  the  latter,  were  sensitive  to 
pressure.  The  organs  of  special  sense  and  the  intellect  were  unimpaired.  At  night,  and  when  he  stooped  or  was  exposed  to 
heat,  he  had  pain  in  his  head.  He  was  discharged  the  service  August  10th,  1865,  and  pensioned.  On  August  7th,  1867,  Pen- 
sion Examiner  John  Benson  reported  that  small  portions  of  bone  had  exfoliated.  The  patient  suffered  considerably  from  dizzi- 
ness and  sharp  pains  in  the  head,  and  was  unable  to  perform  much  labor.  He  had  been  subject  to  great  suffering  and  pain  ever 
since  he  was  wounded.  His  disability  is  rated  total  and  permanent. 

Case. — Private  Charles  C.  Trotman,  Co.  H,  9th  Mississippi  Infantry,  aged  17  years,  was  wounded  at  the  siege  of  Atlanta, 
Georgia,  August  30th,  1864,  by  a ball,  which  entered  the  forehead  just  above  the  left  eye,  and  emerged  beliind  the  right  ear. 
He  was  retired  by  an  examining  board  on  January  3d,  1865.  The  vision  of  both  eyes  was  affected,  and  he  was  permanently 
disabled. 

Case. — Lieutenant  W.  H.  Coward,  Co.  F,  7th  Arkansas  Regiment,  aged  22  years,  was  w'ounded  in  an  engagement  at 
Jonesboro’,  Georgia,  September  1st,  1864,  by  a conoidal  musket  ball,  wliich  entered  the  cranium  one  inch  above  the  mastoid 
process  and  presented  itself  on  the  opposite  side,  where  the  cerebral  matter  left  no  doubt  as  to  tbe  fact  that  the  brain  was  injured. 


PERFORATING  GUNSHOT  FRACTURES  OF  THE  SKULL. 


209 


On  the  following  day,  he  was  admitted  to  the  hospital  of  the  2d  division,  Fourteenth  Corps,  being  perfectly  unconscious,  with 
stertorous  breathifig.  Toward  evening,  he  became  conscious  and  restless,  complaining  of  loss  of  vision  and  inability  to  raise  his 
head.  Toward  midnight  he  commenced  to  scream,  ami  for  three  weeks  did  so  incessantly,  even  during  his  moments  of  sleep. 
On  September  20th,  he  suddenly  became  composed  and  quiet,  and  answered  questions  coherently.  The  left  side  for  some  daj’s 
seemed  paralyzed,  as  he  could  not  use  his  hand  or  leg.  The  face  was  drawn  to  the  light,  and  he  seemed  to  have  some  difficulty 
in  swallowing;  his  secretions  were  natural,  and  he  had  constant  priapism,  with  seminal  emissions.  All  these  symptoms,  how- 
ever, became  gradually  better;  but  as  soon  as  he  became  able  to  move  about,  he  seemed  unable  to  guide  his  movements,  and  the 
power  of  will  over  motion  seemed  lost.  Hut  he  rapidly  improved.  During  the  progress  of  healing,  several  spiculm  of  bone  came 
away.  About  the  seventh  week  all  discharge  from  the  wound  had  ceased.  The  patient  was  transferred  to  Nashville  on  October 
30th,  183-1.  The  pupil  of  the  left  eye  seemed  permanently  dilated  and  intolerant  of  light.  On  December  8th,  18G4,  he  was  sent 
to  the  Provost  Marshal  for  exchange.  The  case  is  reported  by  Surgeon  Edward  Batweli,  14th  Michigan  Volunteers. 

Cask. — Private  Eugene  Plumly,  Co.  L,  8th  New  York  Heavy  Artillery,  aged  23  years,  was  wounded  at  I’etersburg,  Vir- 
ginia, June  16th,  1834,  by  a conoidal  musket  ball,  wliicli  entered  at  the  inner  angle  of  the  left  eye,  passed  through  the  brain 
substance  and  emerged  behind  the  left  ear.  He  was  admitted,  on  the  same  day,  to  the  Second  Corps  hospital,  and  thence  was 
conveyed  to  the  Lovell  Hospital  in  Rhode  Island,  where  he  arrived  on  June  26th.  He  remained  under  treatment  at  Portsmouth 
Grove  until  the  22d  of  August,  when  he  was  transferred  to  the  Ira  Harris  Hospital,  Albany,  New  York,  the  wound  being  still 
open.  The  treatment  consisted  chiefly  in  the  dressings  of  the  wound,  which  had  cicatrized  by  the  22d  of  December.  His  gen- 
eral health  being  good  at  that  date,  he  was  discharged  the  service  and  pensioned,  the  vision  of  the  left  eye  being  obscured.  On 
March  7th,  1867,  Pension  Examiner  John  I’ost  reported  that  there  was  a discharge  of  pus  from  the  orifice  of  entrance  of  the  ball 
and  through  the  right  nostril  and  upper  part  of  the  |iosterior  nasal  cavity  into  the  mouth.  There  was  constant  headache;  he  could 
not  stoop  without  becoming  dizzy,  and  his  eye-sight  was  imperfect.  At  night,  pus  ran  into  his  mouth  so  that  lie  was  often  obliged 
to  rise  and  cleanse  his  throat  in  order  to  sleep.  His  disability  is  rated  total  and  permanent. 

Case. — Private  James  R.  Gailey,  Co.  F,  67th  Pennsylvania  Volunteers,  aged  37  years,  was  wounded  in  an  engagement 
at  Sailors’  Creek,  Virginia,  April  6th,  1835,  by  a conoidal  ball,  which  entered  the  left  external  ear  and  mastoid  process  of  the 
temporal  bone,  passed  obliquely  thi'ough  the  left  lobe  of  the  cerebrum  and  emerged  at  the  centre  of  the  occiput.  He  was  admitted 
to  the  hospital  of  the  1st  division,  Sixth  Corps,  on  the  same  day ; thence  was  sent,  via  City  Point,  to  the  Carver  Hospital,  Wash- 
ington, which  he  entered  May  14th,  1865.  Simple  dressings  only  were  applied  to  the  wound.  He  was  discharged  from  service 
on  July  15th,  1865,  with  total  deafness  of  the  left  ear,  and  was  pensioned,  his  disability  being  rated  total  and  temporary. 

Case. — Private  Samuel  P.  Starrett,  Co.  I,  1st  Michigan  Volunteers,  was  shot  through  the  head  at  Gaines’s  Mill,  Virginia, 
June  27  th,  1862.  The  missile  passed  from  temple  to  temple,  causing  the  loss  of  both  eyes.  He  was  taken  on  board  the  St  earner 
Vanderbilt,  and  on  July  24th,  was  admitted  to  DeCamp  Hospital,  New  York  Harbor,  where  he  was  discharged  the  service  on 
September  29th,  1862,  and  pensioned,  his  disability  being  rated  total. 

Case. — Private  Robert  Elliott,  Co.  E,  H9th  Pennsylvania  Volunteers,  aged  39  year.s,  was  wounded  at  the  battle  of  Wil- 
derness, Virginia,  May  6th,  1864,  by  a conoidal  ball,  which  entered  at  the  occij)ital  bone  and  escaped  under  the  right  eye.  He 
was  immediately  admitted  to  the  1st  division.  Sixth  Corps,  hospital,  and  on  May  27th,  was  conveyed  to  the  2d  Division  Hospital, 
Alexandria,  Virginia.  On  J une  20th,  he  was  transferred  to  the  hospit.al  at  Chester,  Pennsylvania.  Partial  j)ara]ysis  of  the  lowei' 
extremities  had  occurred.  On  March  20th,  1865,  he  was  sent  to  the  Turner’s  Lane  Hospital,  Philadely)hia,  and  was  discharged 
from  service  on  August  29th,  and  pensioned.  On  September  llthj  1836,  Pension  Examiner  M.  G.  Emanuel  rej>orted  that  his 
disabiUty  then  consisted  in  partial  paralysis  of  both  lower  extremities,  imperfect  vision,  disturbance  of  the  mental  faculties,  and 
severe  pain  in  the  head.  In  1867,  his  disability  was  rated  total  and  permanent. 

Case. — Private  Samuel  Caldwell,  Co.  H,  16th  United  States  Infantry,  was  wounded  at  the  battle  of  Stones  River,  Tennes- 
see, .January  3d,  1863,  by  a round  musket  ball,  which  entered  the  skull  about  the  middle  of  the  left  temporal  fossa  and  emerged 
at  precisely  the  same  point  on  the  opposite  side.  After  remaining  on  the  field  forty-eight  hours,  he  was  removed  to  a field  hos- 
])ital.  Inflammation  extended  over  the  entire  upper  part  of  his  face,  his  eyes  being  closed  and  exceedingly  painfid;  the  head  and 
face  were  much  swollen.  Under  simple  antiphlogistic  treatment  the  case  rapidly  improved.  By  the  13th,  all  violent  pain  and 
inflammation  had  subsided.  Several  spiculae  of  bone  were  removed,  and  all  accessible  sharp  points  of  the  fractured  skull  wei’e 
broken  off.  About  this  time,  the  patient  averred  that  he  could  discern  light  with  one  of  his  eyes.  The  wounds  closed  with 
healthy  granulation,  and  the  case  was  progressing  finely  on  the  17th,  when  he  was  sent  to  Hospital  No.  12,  Nashville,  Tennessee. 
He  was  discharged  the  service  March  14th,  1863,  by  reason  of  total  blindness,  and  was  pensioned,  his  disability  being  rated  total 
and  permanent.  The  case  is  reported  by  Surgeon  John  M.  Todd,  65th  Ohio  Volunteers. 

In  the  foregoing  fourteen  cases,  in  which  the  patients  survived  gunshot  perforations  of 
the  cranium,  the  disabilities  resulting  were  regarded  by  the  pension  examining  surgeons  as 
total  and  permanent;  “total,”  in  the  classihcation  of  the  Pension  Bureau,  implying  inca- 
pacity to  earn  a livelihood  by  either  physical  or  mental  exertion.  Vision  was  destroyed  in 
two  instances,  and  more  or  less  impaired  in  seven  others.  Complete  deafness  resulted  in 
one  case;  hemiplegia  in  one  case,  paraplegia  in  another,  and  local  paralysis  in  three  others; 
and  nearly  all  of  the  patients  suffered  from  vertigo,  headache,  defective  memory,  and  various 
forms  of  impairment  of  the  mental  faculties.  The  reports  are  not  sufficiently  detailed  to 
27 


210 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


permit  a more  minute  analysis  of  the  results  of  the  extended  lesions  of  the  brain,  which 
co-existed  with  the  fractures,  in  tliis  series  of  cases. 

The  re})orts  of  a few  of  the  fatal  cases  of  perforating  fractures  emljrace  some  particu- 
lars of  interest.  The  following  nine  patients  were  under  treatment  for  periods  varying  from 
two  hours  to  four  months: 

Case. — Sergeant  Ij.  O.  Blanding,  U.  S.  Signal  Corps,  aged  35  years,  was  wounded  in  action  near  Nasliville,  Tennessee, 
April  lltli,  18t5;J,  by  a musket  ball,  which  entered  near  the  centre  of  the  left  superciliary  ridge  and  emerged  just  outside  of  the 
external  angular  process  of  the  frontal  bone.  Only  little  hteinorrhage  occurred,  but  he  immediately  became  insensible,  and  was 
conveyed  to  Hospital  No.  t)  at  Nashville.  An  exidoration  of  the  wound  revealed  a comminution  of  the  superciliary  ridge  and  of 
the  orbital  jdate.  About  a teaspoonful  of  cerebral  matter  had  been  scooped  out  by  the  mi.ssile.  The  patient  never  reacted ; he 
remained  in  a comatose  condition  until  his  death,  April  Kith,  18()‘J,  forty-eight  hours  aftei’  the  reception  of  the  injury.  The  his- 
tory of  the  case  was  contributed  by  Surgeon  Eben  Swift,  U.  S.  A. 

Case. — 1‘rivate  John  Nulty,  Co.  C,  28th  Massachusetts  Volunteer.s,  aged  23  years,  W'as  wounded  at  the  battle  of  Antietam, 
Maryland,  September  17th,  1862,  by  a conoidal  musket  ball,  which  entered  the  light  zygomatic  region  anterior  to  the  meatus 
anditorius,  passed  through  the  internal  ear  and  mastoid  jirocess  of  the  temjxu-al  bone,  and  emerged  two  and  a half  inches 
directly  behind  the  meatus.  He  was  admitted  to  the  Locust  Spring  Hospital,  where,  in  the  course  of  treatment,  two  small 
pieces  of  bone  were  discharged  from  the  meatus  and  one  from  the  anterior  wound.  The  wound  of  exit  had  nearly  healed  at  the 
time  of  his  transfer  to  Camp  1!  Hospital  at  Frederick,  Maryland,  December  bth,  1862,  but  the  anterior  wound  was  discharging 
somewhat.  The  power  of  hearing  in  the  right  ear  was  destroyed,  and  the  patient's  vision  was  impaired.  After  his  removal  to 
Frederick  he  failed  gradually,  and  died  on  January  20th,  1863.  The  case  is  reported  by  Surgeon  T.  11.  Sipiire,  H'Jth  New  York 
Volunteers. 

Case. — I’rivate  .1.  J.  Frazier,  Co.  D,  3d  Arkansas  Ivegiment,  was  wounded  in  an  engagement  on  the  Williamsburg  Road, 
Virginia,  October  27th,  1864,  by  a conoidal  musket  ball,  which  entered  one  inch  to  the  right  of  the  occipital  protuberance,  jiassed 
laterally  and  a little  downward,  and  emerged  one  inch  to  the  letl  of  the  occipital  i)rotuberance.  On  October2yth,  he  was  admitte<l, 
in  an  insensible  condition,  to  the  Receiving  and  Way.side  llosi)ital  at  Richmond,  where  cold-water  drc'ssings  were  a])i)lied.  On 
October  30th,  the  patient  bad  somewhat  rallied;  he  could  hear  and  open  his  eyes,  but  could  not  see;  could  speak,  but  not  remem- 
ber, and  comiilained  of  pain.  October  31st,  could  hear,  smell,  taste,  and  feel;  urinated  freely,  but  his  bowels  were  constii)ated. 
On  November  7th,  he  regained  his  e^'esight.  On  the  following  day,  chills  followed  by  fever  supervened,  leaving  the  patient 
again  blind.  On  the  10th,  another  chill  occurred;  on  the  lllh,  ju'ofuse  discharge  of  bloody  mucus  from  the  wound  took  place, 
and  death  occurred  on  the  same  day. 

Case. — Sergeant  M.  V.  Temples,  Co.  A,  2d  Arkansas  Regiment,  aged  21  years,  was  wounded  at  Rocky  Face  Ridge, 
Georgia,  May  8th,  1861,  by  a conoidal  ball,  which  entered  just  in  front  of  the  left  ear,  passed  ujiward  and  forward  and  emerged 
just  above  the  right  eye.  On  the  next  day,  he  was  adnutted  to  the  Institute  Hospital  at  Atlanta.  He  was  perfectly  rational, 
with  no  constitutional  disturbance,  could  see  but  little  with  the  right  eye,  and  said  that  the  vision  of  the  left  was  lost  from  the 
time  of  the  l eception  of  the  injury.  On  May  11th,  his  mind  was  wandering,  but  on  tbe  Kith,  he  was  again  rational,  with  some 
appetite.  From  the  18th  to  the  26th,  he  was  unconscious,  but  seemed,  at  times,  to  understand  when  si)oken  to  very  loudly.  He 
was  feeble  and  emaciated  and  discharged  faces  involuntarily;  the  wound  sujipurated  freely,  lie  died  on  June  8th,  of  asthenia. 
The  case  is  reported  by  Surgeon  D.  C.  O’Keefe,  P.  A.  C.  S. 

Case. — Private  Henry  E.  H.  1’ , Troo|)  K,  .5tb  Iowa  Cavalry,  was  woumled  at  Wartrace,  Tennessee,  October  6tb, 

1863,  by  a conoidal  ball,  which  entered  the  centre  of  the  os  frontis  and  passed  out  at  the  squamous  j)ortion  ot  the  left  tempoi'al 
bone.  Upon  admission  into  the  general  hospital  at  Tullahoma,  October  6th,  lacerated  brain  protruded  trom  botb  wounds  ; tbe 
patient  was  insensible  and  there  was  complete  hemiplegia  of  the  right  side.  He  remained  unconscious  and  died  at  four  o clock 
p.  M.,  on  Oct(d)er  ttth,  1863.  The  |)athological  specimen  is  No.  2075,  Sect.  I,  A.  M.  M.  The  fractured  surface  measures  four 
iTiches  ill  diameter,  involving  the  anterior  inferior  angle  of  the  jiarietal  and  adjoining  portions  ot  the  troiital  bone.  The  aperture 
of  entrance  is  hardly  larger  than  the  point  of  the  missile,  which  had  acted  like  a wedge,  splitting  the  bone  iii  every  direction; 
one  of  the  fissures  extending  acro.ss  the  vertexV^that  of  exit  was,  at  least,  an  inch  in  diameter,  and  from  this  a fissure  extimded 
two  inches  into  the  right  parietal,  through  both  ^bles.  On  removung  the  skull-cap,  large  coagiilm  were  observed  lining  the  dura 
mater,  and  the  membranes  of  the  brain  and  medulla  were  deeply  congested.  The  specimen  and  history  were  contributed  by  Sur- 
geon B.  Woodward,  22d  Illinois  Volunteers. 

Case.— Private  T.  E.  lli(/<ji'ns,  Co.  A,  43d  Alabama,  aged  36  years,  was  woumled  at  Spottsylvania  Court-house,  May  10th, 

1864,  by  a conoidal  musket  ball,  which  entered  at  the  middle  of  the  frontal  bone,  |i(‘netrated  and  emerged  at  tbe  middle  of  the 
left  temporal  bone.  He  was  conveyed  to  Ricbmond  and  was  admitted  to  Chimborazo  Hospital  No.  4.  For  two  days  he  was 
comatose.  On  May  PJth,  his  intellect  became  clearer,  but  be  did  not  S|)eak,  and  expressed  himself  by  signs.  He  had  the  use  ot 
his  limbs  to  a considerable  extent.  On  May  2()tb,  be  lay  in  a state  of  semi-tori)or,  and  from  the  wound  in  tbe  forehead  a sero- 
purulent  discharge  was  expelled  at  each  pulsation  of  the  brain.  Pulse  7.5  and  natural.  There  was  jmrtial  })aralysis  ot  the  nerves 
supplying  the  organs  of  speech,  causing  a slight  defect  of  utterance.  The  right  eye  was  considerably  ecebymosed.  On  the  23d, 
the  pulse  was  90  and  weak;  the  patient  continued  to  sink,  and  died  on  May  31st,  1804.  The  case  is  taken  trom  the  Confederate 
Hospital  Records. 


PERFOEATING  GUNSHOT  FRACTURES  OF  THE  SKULL. 


211 


Ca.se. — Coi  poral  Alexaiulci'  Fivncli,  Co.  K,  3il  Michigan  Volunteers,  was  wounded  at  the  battle  of  Mine  Run,  Virginia, 
November  iiTth,  1SG3,  by  a conoidal  ball,  wbich  passed  laterally  from  right  to  lelt  through  the  occipital  bone,  traversing  the 
substance  of  the  brain  four  inches,  and  making  its  exit  at  a point  directly  opposite  the  wound  of  entrance.  He  was  sent  to  the 
regimental  hospital,  and  on  December  4th,  wiis  transferred  to  the  'A1  Division  Hospital,  Alexandria,  Virginia.  Simple  dressings 
were  ajiplied.  The  case  terminated  fatally  on  December  5th,  lSti3.  The  case  was  rejiorted  by  Assistant  Surgeon  W.  15. 
Morrison,  3d  Michigan  Volunteers. 

Case. — Lieutenant  7/.  JR.  F , Co.  E,  ‘i3d  North  Carolina  Regiment,  aged  28  years,  was  wounded  at  the  battle  of 

Winchester,  Virginia,  July  20th,  1804,  by  a conoidal  musket  ball,  which  entered  at  the  middle  of  the  inferior  border  of  the  right 
parietal  bone  and  passed  out  just  behind  its  [)osterior  inferior  angle,  leaving  a bridge  of  bone  one  inch  and  three-fourths  wide, 
and  lodged  beneath  the  integuments  over  the  occij)ital  ])rotuberance.  On  July  23d,  he  was  admitted  to  the  hospital  at  Cumber- 
land, Maryland,  where  the  ball  was  removed,  and  simple  dressings  were  apjdied.  A tumor  appearing  near  the  jdace  whence  the 
missile  had  been  extracted  was  opened,  and  discharged  about  two  ounces  of  pus.  Death  resulted  on  July  30th,  1804.  At  the 
autopsy,  upon  dissecting  back  the  integuments,  a large  j)ortion  of  the  skull,  already  detached,  fell  out.  Suppuration  had  broken 
dowti  the  substance  of  the  middle  and  posterior  lobes  of  the  brain,  and  the  remainder,  with  the  meninges,  were  turgid  and  con- 
gested. The  pathological  specimen  is  No.  4257,  Sect.  I,  A.  M.  M.  The  fractured  surface  measures  posteriorly  two  by  three 
inches,  the  greater  jmrtion  of  the  fragments  being  in  situ.  There  are  two  short  fissures  of  the  parietal  and  one  of  the  occipital 
bone.  The  sjiecimen  and  history  were  contributed  by  Surgeon  J.  R.  Lewis,  U.  S.  V. 

C.\SE. — Private  E.  BadcUffe,  Trooj)  E,  1st  Maiyland  Cavalry,  was  wounded  by  a pistol  ball,  which  entered  the  centre  of 
the  parietal  bone,  and  passing  through  the  substance  of  the  brain,  emerged  near  the  centre  of  the  left  lambdoid  suture.  Upon 
admission  to  the  Receiving  and  Wayside  Hospital  at  Richmond,  on  March  Dth,  cerebral  matter  protruded  from  both  wounds, 
the  pulsations  of  the  brain  wore  very  distinct,  there  was  hemijdegia  of  the  right  side  of  the  body,  and  the  power  of  speech  was 
lost;  notwithstanding  these  symptoms  his  intellect  was  ])erfectl3'  clear,  ajipetite  good,  and  bowels  regular.  The  treatment 
consisted  in  the  constant  a])plication  of  tepid  water  to  the  wound,  a light  stimulating  diet,  and  as  perfect  quiet  as  ])ossible. 
Erysipelas  of  the  face  having  occurred,  was  speedily  relieved  by  the  local  a])j)lication  of  iodine.  Rj'  May  1st,  the  general  con- 
dition of  the  patient  had  improved,  and  th(Miemij)legia  had  graduall}' diminished.  He  was  able  to  move  the  limbs  and  speak 
quite  di.stinctly.  The  wound  of  entrance  had  entirely  healed,  and  the  wound  of  exit  nearly  so,  only  a small  granulating  surface 
remaining.  On  May  10th,  he  complained  of  sickness,  vomited  a greenish  matter,  and  .sym])toms  of  tetanus  presented  themselves. 
RraiKhq  quinine,  and  morjdiia  were  freely  given,  and  the  synq)toms  somewhat  abated.  On  the  following  day  spasms  occurred 
and  an  abscess  opened  on  the  edge  of  the  wound.  The  tetanic  s3'mj)toms  continued,  and  death  occurred  on  May  12th,  18154.  The 
case  is  reported  by  Assistant  Surgeon  C.  W.  Rrock,  P.  A.  C.  S. 

In  forty-five  other  cases  of  perforating  gunshot  fractures  of  the  cranium,  in  which  the 
patients  survived  long  enough  to  be  placed  in  hospitals  for  treatment;  in  which  also,  tlie 
positions  of  the  entrance  and  exit  wounds  were  noted,  and  indisputable  proof  that  the  missiles 
had  traversed  some  portion  of  the  brain  tissue  was  adduced  ; in  which,  likewise,  the  dates  of 
injury  and  of  death  were  recorded,  four  patients  survived  after  admission  to  hos})ital  from 
one  to  twelve  hours  only  ; nine  lived  about  twenty-four  hours  ; six,  about  two  days  ; eight 
lived  three  days ; four,  lour  days ; two,  five  days ; two,  six  days ; three  died  on  the 
seventh,  eighth,  and  ninth  days,  respectively,  and  two  on  the  eleventh  day;  one  died  on  the 
thirteenth,  one  on  the  fourteenth,  and  two  on  the  fifteenth  days ; while  one  survived  a 
perforation  of  both  parietals  and  lioth  cerebral  hemispheres  for  forty  days.  In  one  instance 
the  ball  opened  the  longitudinal  sinus,  and  in  another,  and  perhaps  three  others,  passed 
through  the  cerebellum.  It  is  to  be  regretted  that  in  the  latter  cases  the  symptoms  were 
not  recorded  more  fully.  The  facts  compiled  from  the  hospital  registers,  case-books,  and 
fjuarterly  re2)orts  in  the  last  three  cases  are  as  follows : 

Case. — Private  Zimri  R.  Hiatt,  Co.  K,  3il  Iowa  Cavaby,  receiviMl,  in  an  engagement  at  Little  Rock,  Arkansas,  April  25th, 
18(54,  a wound  of  the  skull  by  a conoidal  musket  ball.  One  account  states  that  the  wound  was  accidental.  The  missile  entered 
to  the  left  and  a little  in  advance  of  the  occii)ital  protuberance  and  pas.sed  inward  and  downward,  penetrating  the  cerebellum  and 
making  its  exit  through  the  right  portion  of  the  occipital,  without  injurijig  the  lateral  sinus.  After  treatment  at  a field  hospital, 
the  patient  was  admitted,  on  !May  1st,  18(54,  to  the  general  hosj)ital  at  Little  Rock.  He  was  comatose  ami  died  a few  hours  after 
his  admission.  The  case  is  recorded  by  .Snigeon  E.  A.  Clark,  8tli  Missoni  i Cavalry. 

Case. — Corporal  Daniel  Tippin,  Co.  11,  .57th  Ohio  Volunteers,  received,  near  Kenesaw  Mountain,  Georgia,  June  27th, 
18(54,  a gunshot  fracture  of  the  cranium.  The  missile,  a musket  ball,  penetrated  from  one  lateral  angle  of  the  occiiutal  bone  to 
the  other,  passing  through  the  brain.  The  i)atient  was  conveyed  to  the  hospital  of  the  Fifteenth  Corps,  in  a comatose  condition, 
and  died  July  2d,  18(54.  These  facts  are  recorded  by  Surgeon  A.  Goslin,  48th  Illinois  Volunteers.  The  regimental  surgeon, 
Dr.  Asa  C.  Messenger,  only  reports  the  case  on  the  coi’ps  casualty  list. 


212 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Corporal  William  Sliuddook,  Co.  C,  Jd  Massachusetts  Artillery,  aged  21  years,  was  wounded  near  Petersburg, 
Virginia,  June  20th,  180-1,  by  a conoidal  hall,  which  entered  the  mastoid  process  of  the  temjioral  bone,  and  passed  u})ward  and 
backward  through  the  occipital  protuberance,  just  above  the  toicidar  Heropbili.  In  its  course  it  opened  the  superior 
longitudinal  sinus.  The  patient  was,  on  the  same  day,  admitted  to  the  field  hospital  of  the  Fifth  Corps  in  a comatose  condition. 
He  had  lost  much  blood,  and  died  eight  hours  after  admission. 

In  a case,* *  reported  by  Surgeon  A.  M.  Wilder,  U.  S.  V.,  a conoidal  musket  ball  entered 
at  tlie  glabella  and  passed  through  the  brain  substance  and  emerged  at  the  occipital 
protuberance,  a linear  fissure  of  the  vault,  over  seven  inches  in  length,  connecting  the 
apertures  of  entrance  and  exit. 

In  another  case,^  reported  by  Surgeon  G.  A.  Otis,  27th  Massachusetts  Volunteers, 
the  patient,  whose  skull  had  been  traversed  by  a conoidal  musket  ball  which  entered  at 
the  middle  of  the  forehead  and  emerged  at  the  junction  of  the  inferior  curved  lines  and  crest 
of  the  occipital,  survived  three  days,  cerebral  matter  and  grunious  blood  issuing  freely  from 
the  exit  wound.  The  patient  was  apparently  conscious,  and  indicated  his  recognition  of  his 
friends  by  jdaintive  gestures.  He  was  unable  to  articulate,  but  took  food  and  drink  without 
difficulty.  On  the  second  day,  at  intervals  of  one  or  two  hours,  he  would  throw  his  arms 
and  legs  about  wildly,  and  it  became  necessary  to  secure  his  lower  limbs  to  prevent  injury 
to  the  amputated  men  who  lay  beside  him  on  the  floor  of  the  field  hospital.  On  the  third 
day,  he  occasionally  uttered  piercing  shrieks,  and  tossed  about  in  great  distress,  and  then 
would  follow  a comparatively  lucid  interval,  when  he  was  apparently  conscious,  and  would 
recognize  those  about  him  and  take  nourishment,  and  attend  decorously  to  the  wants  of 
nature.  Later  in  the  day,  he  gradually  became  comatose,  and  died  sixty-two  hours  after 
the  reception  of  the  injury.  It  was  inferred,  from  the  direction  of  the  track  of  the  ball  and 
from  the  disorderly  movements  of  the  limbs,  that  the  cerebellum  was  injured.  Tlie 
exigencies  of  the  occasion  forbade  an  autopsy. 

Crash  or  Smash. — The  depressed  fractures  of  the  skull  produced  by  cannon  balls  or 
by  the  explosion  of  large  shells,  were  commonly  attended  by  frightful  comminution  and 
disjunction  of  the  sutures,  and  were  almost  always  immediately  fatal,  and  hence  had  little 
surgical  interest.  Yet,  in  a few  instances,  patients  survived  these  dreadful  injuries  for  several 
days,  even  when  the  brain  substance  had  been  lacerated  or  tom  away.  It  was  observed 
also  that  musket  balls,  and  even  carbine  and  pistol  balls,  fired  at  very  short  range,  would 
cause  as  great  destruction  of  the  walls  of  the  cranium  as  was  produced  generally  by  the 
larger  projectiles  : 

Case. — Private  Owen  Owens,  Co.  C,  3d  New  York  Artillery,  was  wounded  aceidentally  on  January  9tli,  ISti.'i,  l)y  a 
fragment  of  shell,  which  fractured  anil  depressed  the  left  temporal  and  parietal  hones.  He  was,  on  the  same  d.ay,  admitted  to  the 
Foster  Hospital,  New  Berne,  North  Caiolina.  Simple  dressings  wei  e applied,  and  stimulants  were  employed.  The  patient  lay 
in  a comatose  state,  quite  unconscious' of  the  terrible  nature  of  his  injury,  or  of  surrounding  objects,  for  three  days.  The  usual 
symptoms  of  compression  of  the  brain  were  present.  The  patient  died  on  January  12th,  1865.  Surgeon  C.  A.  Cowgill,  U.  S.  V., 
reports  the  case. 

Some  patients  not  only  survived,  for  a short  time,  these  severe  injuries  of  the  head, 
but  were  conscious  and  rationtvl  for  a while ; 

Case. — Private  William  Kay,  Co.  F,  7th  Connecticut  Vohmteer.s,  was  wounded  at  the  battle  of  Pocotaligo,  South  Carolina. 
October  22d,  1862,  by  a grapeshot,  which  fractured  the  parietal  bone  near  its  union  with  the  frontal  and  temporal  bones,  passed 
downward,  fractured  the  temporal,  malar,  and  superior  maxillary  bones,  and  lodged.  On  the  following  da}’  he  was  admitted 
to  the  hospital  at  Hilton  Head.  Although  in  a stupor,  he  could  be  ai’oused  without  difficulty,  and  would  then  indicate,  by  the 


' Case  of  Private  R.  A.  Fisk,  Co.  E,  ijlst  Massachusetts,  Knoxville,  November  Cltli,  18G3.  Died  November  27tli,  18G3. 

*Case  of  Private  Samuel  A.  Dunning,  Co.  A,  27th  Massachusetts,  New  Berne,  March  l-ltli,  18G2.  Died  March  17th,  1862. 


CRASH,  SMASH,  OR  ECRASEMENT. 


213 


cloai'iiess  of  his  right  eye,  ;i  perception  of  external  impressions.  Tlie  left  eye  was  closed  by  extensive  tumefaction.  Below  tlie 
inferior  maxilla  a large  protuberance  was  found  which  contained  tlie  missile.  Acting  Assistant  Surgeon  Thomas  T.  Smiley  made 

an  incision  and  extracted  the  .same.  It  proved  to  be  an  iron  ball  fully  an  inch  in  diameter  and  weighing  nearly  four  ounces. 

The  patient  died  October  24th,  18112,  fifteen  hours  after  the  operation.  There  was  diastasis  of  the  squamous  and  coronal 
sutures, -w'ith  much  comminution  of  the  left  parietal  and  temporal.  Acting  Assistant  Surgeon  Thomas  'J'.  Smiley  reports  the  case. 

Case. — Private  Clark  D , Co.  G,  24th  Michigan  Volunteer^,  was  wounded  at  the  battle  of  Fredeilcksbnrg,  Virginia, 

December  13th,  1862,  by  a fragment  of  shell  w'hich  carried  away  a largo  portion  of  the  right  teniporid  and  frontal  bones.  He 
was  taken  to  the  hospital  of  the  First  Corps  at  Belle  Plain,  where  he  remained  in  a gently  comatose  condition,  taking  fluid 
nourishment  when  administered.  Occasionally  he  had  spasms  or  convulsions,  though  not  of  a violent  nature.  The  wound 
of  the  scalp  was  huge,  extending  nearly  to  the  vertex.  A piece  of  bone  about  the  size  of  a hen’s  egg  was  gone  from  the 
anterior  portion  of  the  wound.  On  the  morning  of  December  19th, 
healthy  granulations  were  observed  rising  from  the  wounded  cerebrum; 
but  during  the  day  haemorrhage  took  place  from  the  middle  meningeal 
artery,  or  some  of  its  branches,  and  death  occurred  shortly  afterward. 

At  the  autopsy  it  was  found  that  an  opening  extended  from  the  right 
frontal  eminence  to  the  mastoid  portion  of  the  right  temporal  bone,  being- 
live  inches  long  and  one  and  a half  inches  wide.  From  the  anterior 
extremity  of  this,  a fracture  traversed  the  frontal  bone  to  the  middle 

of  the  left  branch  of  the  coronal  suture,  while  from  the  ]>osterior  portion 

a second  fissure  traversed  the  right  parietal  to  the  centre  of  the  occipital 
bone.  Lines  of  fractures  traversed  the  right  supra-orbital  arch,  the  nasal 
process  of  the  right  superior  maxillary,  and  the  base  of  the  mastoid 
process  of  the  right  temporal.  The  pathological  specitnen  is  quite  accu- 
rately figured  in  the  accompanying  w-ood-ent,  (Fig.  108.)  It  was  con- 
tributed, with  the  history  of  the  case,  by  Surgeon  ,T.  II.  Beach,  24th 
Michigan  Volunteers. 

The  next  case  furnishes  the  best  example  contained  in  the  Army  Medical  Museum 
of  diastasis  of  the  cranial  bones  from  external  violence.  Almost  every  suture  is  widely 
separated  : 

Case. — X , an  unknown  Confederate,  was  brought  into  Lincoln  Hospital  on  July  17th,  1864,  in  an  ambulance  train- 

convening  the  wounded,  abandoned  by  General  Early,  in  front  of  Fort  Stevens.  According  to  the  official  rej-xjrts,  the  Confederates 
retired  from  befoi-e  Washington  on  the  night  of  July  12th.  The  stretchcr-bearer.s  reported 
that  this  man  was  found  nearly  three  miles  north  of  Fort  Stevens,  unconscious  and 
unable  to  articulate,  with  a terrible  wound  over  the  vei-tex,  and  that  near  by  him  was 
the  huge  fragment  of  shell  supposed  to  have  inflicted  the  injury,  and  to  have  been  fired 
from  one  of  the  eleven-inch  guns  at  Fort  Stevens.  It  appears  .almost  incredible  that 
the  patient  could  have  survived  so  long.  He  died  two  hours  after  his  admission  to 
hospital.  On  the  following  day  an  autopsy  was  made.  Over  the  anterior  snperior 
angle  of  the  left  parietal  bone  there  was  an  extended  scalp  wound.  On  retlectiug  the 
scalp,  multiple  depressed  fractures  of  the  vault  of  the  cranium  came  into  view.  4'lie 
point  of  greatest  depression  is  an  inch  to  the  left  of  the  median  line,  near  the  coi-onal 
suture.  The  depressed  fragments  measure  from  before  backw-ard  two  inches,  and  from 
right  to  left  three  inches,  .and  involve  both  parietals  and  the  osfrontiti.  A fissure  runs 
through  the  squamous  portion  of  the  left  temporal,  and  all  the  sutures  of  tliis  bone  are 
separated.  The  autopsy  was  made  and  the  specimen  was  forwarded  by  Acting 
Assistant  Surgeon  Henry  M.  Dean.  It  is  figured  in  the  adjacent  wood-cut,  and  much 
better  in  the  Surgical  Photograph  Series’  of  the  Army  Medical  Museum. 

A yet  more  remarkable  case  is  reported  from  Lincoln  Hospital.  The  patient  survived 
a fortnight : 

Case. — Private  William  W.  Howell,  Co.  G,  llth  Pennsylvania  Res('rves,  was  wmtmded  at  the  battle  of  Fredericksburg, 
Virginia,  December  13th,  1832,  by  a shell,  which  fractured  .and  tore  aw.ay  nearly  all  of  the  left  parietal  bone.  Though  in  .a  state 
of  stupor,  he  was  able  to  sw-allow  food  and  stimulants.  Ho  was  treahal  at  a field  hospital  for  nine  days,  and  then  was  conveyed, 
on  a hospit.al  transport  steamer,  to  Washington,  .and  admitted  to  Lincoln  Hospital  on  December  23d,  .at  which  time  about  omo 
third  of  the  left  cerebr.al  homis[)here  had  sloughed.  Nearly  all  the  brain  sloughed  away  liefore  his  death,  which  occurred  on 
December  26th,  1862.  Surgeon  Henry  Bryant,  U.  S.  V'.,  recorded  tin?  case. 


Fio.  too, — Ci-animn  fractured  by  a large 
fragment  of  slieU.  .Vpcc.  2871,  Sect  I,  A.  M.  M. 


Fig.  108. — Cranium  fractm-ed  by  a fragment  of  sbcll. 
fipec.  831,  Sect.  I,  A.  M.  M. 


' Photnyraphs  nf  Surgical  Cases  aa-l  Specimens.  I’repared,  riy  direction  of  the  .Surgeon  fleneral,  by  lirevet  Lieutenant  Colonel  George 
A.  Otis,  Assistant  .Surgeon,  U.  S.  A.  Wa-sliington.  1800.  .O  Vols.,  Quarto,  Vol.  I,  Case  3. 


214 


WOUNDS  AND  INJURIES  OP  THE  HEAD 


The  specimen  represented  in  the  sul)joine(l  wood-cut,  (Fia.  110,)  is  from  a soldier 
who  survived  liis  injury  tor  a tew  liours  only,  and  who  was  left  on  the  battle  field; 

Cask. — A soldier  of  General  Longstreet’s  Corps  was  killed  in  a charge  upon 
one  of  the  Union  hatteries,  in  the  second  battle  of  Manassas,  August  29th,  1802,  by  a 
grapeshot,  at  short  range.  The  cranium  was  ])icked  up,  a year  subsequently,  by 
Surgeon  F.  W(»lfe,  39th  New  York  Volunteers,  under  an  abatis  near  the  stone  bridge 
over  Bull  Run.  The  missile  entered  the  lett  jiarietal  near  the  lainhdoidal  suture,  and 
made  its  exit  through  the  squamous  portion  of  the  temporal.  It  is  erroneously  stated 
in  the  CdUdof/ue  of  the  SiirijicaJ  iSeelion  of  the  Army  Alediral  Museum  (p.  30),  that  the 
fracture  was  intlicted,  “ pr(d)ahly  by  a musket  hall.”  The  j)robabilities  ai’e  that  the 
missile  was  a grajieshot,  as  suggested  by  the  collector,  who  had  good  reasons,  apai't 
from  the  ajipearance  of  the  injured  skull,  for  his  o])inion.  It  has  been  supposed  that  this 
skull  presented  an  examjjle  of  fracture  by  coufre-rotip,  a subject  to  be  discussed 
hereafter.  Tliere  are,  undoubtedly,  fissures  of  the  great  wing  of  the  sphenoid,  and  of 
the  frontal,  before  and  behind  the  right  external  angular  process  of  the  frontal — fissures 
unconnected  with  the  lesions  on  the  left  side  of  the  skull;  and  the  right  orbital  jdate 
i.s  slightly  depres.sed  and  a fissure  extends  through  the  right  upper  maxillary  bone 
Unless  these  fi’actures  wei’e  pi'oduced  mortem,  they  must  be  regarded  as  fractures  by  rontrc-covp. 

Tilt'  iK'xt  case  illustviites  tlie  great  extent  of  fractures  of  tlie  cranium  tltat  may  he 
produced  liy  small  [trojectiles.  Tlie  Army  ]\Iedical  Museum  possesses  many  examples  of 
sudi  multiple  comminuted  gunshot  fractures;  hut  they  have  been  collected  since  the  close 
of  the  War: 


I'ld.  110. — Shull,  exliibitiiig'  an  extensive 
rmeture  l>v  ifrapcsliut.  Spec.  1318,  iSect.  I, 
A.  B'l.  bI. 


Case. — Pj-ivalo  Thomas  Dikes,  Co.  F,  12th  ]\Iissouri  Cavalry,  was  wounded  accidtaitally  on  October  20th,  1863,  by  a 
largo  pistid  ball,  which  shattorod  and  carried  away  a part  of  the  fioutal  and  lu'arly  the  entire  right  parietal  hones,  and  also 
lacerated  and  dashed  out  nearly  one-third  of  the  entire  cerelnal  mass,  lie  was  immediately  conveyed  to  the  liospitaTat  St. 
Josejdi,  Missouri,  lie  was  speechless  and  comatose.  Death  resulted  in  nine  hours  and  some  minutes  after  the  recejition  of  the 
injury.  Assistant  Surgeon  Wesley  Jones,  12th  Mi.ssouri  Gavalry,  I'ejiorts  the  case. 


It  would  he  easy,  hut  of  doubtful  utility,  to  adduce  other  instances  of  oliviously 
fatal  comminution  of  the  cranium  liy  gunshot  jtrojectiles.  One  or  two  more  examples 
will  suffice,  and  the  reader  may  lie  referred  to  the  collections  in  the  Army  Medical 
Blusemn,  where  the  subject  is  fully  illustrated.^ 


-,  Co.  D,  17th  Massachusetts  Volunteers,  was  wounded  near  New  Benie,  Noilh  C.arolina, 


Case.— Piivate  Joseph  B- 

geptember  1st,,  18fi2,  by  a fragment  of  shell  which  entered  about  the  centre  of  the  frontal  bone,  passed  around  the  left  side  of 

the  lu'ad,  and  emerged  near  the  temporo-frontal  suture,  lie  was  admitted 
to  the  Douglas  llosjiital,  Washington,  on  September  5th,  1862,  being 
partially  conscious,  with  the  right  eye  closed  and  greatly  swojlen.  The 
skull  between  the  two  aperture's  felt  soft.  On  September  10th, en  abscess 
over  the  right  eye  (qiened  about  the  middle  of  the  upper  lid,  and  pus  and 
a few  fragments  of  home  were  freely  elischarged..  On  S(*j)tember  13th,  the' 
patient  became  comatose,  and  died  on  Septendeer  16th,  1862.  At  the 
autopsy,  a large  abscess  was  limnd  in  the  anterior  lobe  of  the  left  hemi- 
sphere. The  ])athological  s])ecimens  are  Nos.  236  and  514.  Thefornnr 
shows  a section  of  the  craiuum  with  an  extensive  comnunuted  fracture 
of  the  frontal  hone  a little  to  the  left  of  the  median  line;  the  latter  a wet 
preparation  of  the  enc(>phalon,  with  perforation  of  the  dura  mater,  and 
abscess  in  the  u)iper  i)ai  t of  the  anterior  lobe  of  the  left  half  of  the  cerebrum.  The  specimens  were  contributed  by  Assistant 
Surgeons  W.  Webster  and  J.  W.  Williams,  U.  S.  A.,  res|)ectively.  The  calvaria  is  represent(‘d  in  the  wood-cut,  (Fig.  111.) 
It  is  very  thin. 


Fl(».  111. — Fracture  of  the  frontal  bone 'by  a shell  fragment. 
Spec.  236,  Sect.  I,  A.  M.  M. 


In  the  Confederate  hospital  records,  an  instance  is  found  of  a patient  who  survived 
a terrible  depressed  fracture  oi’  the  skull  for  a fortnight,  tdthough  there  was  the  comjdica- 
tion  of  erysipelas  of  tlie  scalp; 

Case. — Private  J.  A.  Hewlett,  Co.  A,  1st  North  Carolina  V(duntcer.s,  on  May  11th,  1863,  was  admitted  to  Howard  Grove 
Hospital,  Kichmond,  Virginia.  He  had  received,  at  the  battle  of  Chancellorsville,  May  3d,  a shell  wound  of  the  left  side  of  the 
head,  shattering  and  depres.sing  the  parietal  very  extensively,  and  badly  lacei-ating  the  seal]).  The  j)atient  was  in  a state  of 
stupor,  with  muttering  delirium,  and  erysipelas  had  invaded  the  seal]).  The  erysipelatous  inflammation  extended,  yet  the 
unfortunate  patient  lingered  until  May  17th,  1863.  Surgeon  C.  D.  Rice,  P.  A.  C.  S.,  recoi'ded  the  case. 


See,  among  others,  specimens  1167,  860,  1166,  1319,  Sect.  I,  A.  M.  M. 


REMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


215 


Removal  of  Fragimehts  after  Gunshot  Fractures  of  the  Skull.— Many 
instances  of  exfoliation  and  of  removal  of  necrosed  or  detached  fragments  of  the  cranial 
bones  after  gunshot,  injuries  have  been  relatc'd  in  previous  pages  of  this  Section,  in  the 
abstracts  of  cases  in  which  some  other  feature  was  more  prondnent.  The  remainder  of 
the  cases  that  were  reported,  in  whicli  o})erative  interference,  short  of  perforating  the 
skull  by  the  tre})hine,  was  resorted  to,  will  be  recorded  in  tins  Subsection.  The  first  series 
of  twenty-eight  such  cases  recovered,  with  slight  disabilities,  and  were  returned  to  duty: 

Case. — Private  Benjamin  Bird,  Co.  F,  Kitli  Virginia  Regiment,  aged  ItO  years,  received,  on  August  3()tli,  1862,  a gunshot 
wound  in  the  riglit  temporal  region,  fr.acturing  the  hone  and  dejiressing  the  fragments.  Hewa.s  admitted  into  the  Confederate 
hospital  at  Charlottesville,  Virginia,  and  on  Sejitember  6th,  was  operated  upon,  when  all  detached  pieces  of  hone  were  removed. 
The  wound  healed  in  six  weeks  without  a single  unfavorable  symjitom.  Surgeon  J.  L.  Cabell,  P.  A.  (h  S.,  reported  the  case.' 

Case. — Sergeant  James  Stapleton,  Co.  A,  82d  Pennsylvania  Volunteers,  aged  20  years,  was  wounded  while  on  special 
duty  at  Cold  Harbor,  Virginia,  on  June  5th,  1864,  by  a conoidal  ball,  which  fractured  and  depressed  the  right  side  of  the  frontal 
bone.  He  was  taken  to  the  field  hosjiital  of  the  1st  division,  Sixth  Corps,  thence  convej'ed  to  Washington,  I).  C.,  and  on  the 
10th,  admitted  into  Emory  Hospital,  where  the  ball  was  extracted.  On  June  14th,  he  was  transferred  to  the  general  hosjiital, 
York,  Pennsylvania.  He  became  feveiLsh  and  suffereil  great  jiain.  On  .Tune  22d,  Surgeon  Henry  Palmer,  U.  S.  V.,  removed  a 
jioT-tion  of  the  bone,  leaving  the  dura  mat(‘r  exjiosed.  The  parts  surrounding  the  w'ound  were  very  much  inflamed,  swollen,  and 
painful.  The  wound  healed  rapidly,  and  on  the  13th  of  December,  1864,  the  jiatient  was  returned  to  duty.  He  is  not  a 
jiensioner.  The  case  is  rejiorted  by  Surgeon  Henry  I’ahner,  U.  S.  V. 

Case. — Hosjiital  Stewaid  Bernard  Blair,  169th  New  York  Volunteers,  aged  23  yeai'S,  was  wounded  at  Dutch  Gap, 
Virginia.  August  13th,  1864,  by  a gunshot  missile,  which  fractured  the  cranium  a little  to  the  right  of  the  vertex.  He  was 
admitted  to  the  hosjiital  of  the  Tenth  Corps,  .and  on  the  15th,  conveyed  to  Fort  Monroe,  Virginia.  He  was  furloughed  on  the 
4th  of  September,  1864.  White  on  leave,  a jiortion  of  the  outer  table  of  the  skull  was  removed  by  Acting  Assistant  Surgeon  C. 
L.  Hubbell.  On  the  2()th  of  October,  he  entered  the  general  hosjiital  at  Troy,  New  York.  'The  wound  healed  rajiidly,  and  on 
the  20th  of  December,  1864,  the  patient  was  returned  to  duty. 

Case. — Corporal  William  G.  Cunningham,  Co.  A,  44th  New  York  Volunteers,  aged  21  years,  was  wounded  at  the  battle 
of  Gettysburg,  Penu.sylvania,  .Inly  2d,  1863,  by  a conoidal  ball,  whicli  struck  the  head  just  behind  the  left  mastoid  jirocess, 
passed  upward  and  inward,  and  lodged  in  a depression  of  the  skull.  At  the  same  time  he  received  a flesh  wound  in  the  scalp 
and  another  in  the  left  shoulder.  He  was  admitted  into  Seminary  Hosjiital  on  .July  4th,  and  transferred  to  the  hosjiital  at  York, 
Pennsylvania,  on  the  19th.  The  patient  stated  that  he  became  senseless,  and  remained  so  five  days,  and  that  he  could  not  sjieak 
for  nine  days.  Spiculae  of  bone  and  the  ball  were  removed,  aod  cold  water  dressings  ajijilied,  after  which  the  jiatient  imjiroved 
rajiidly.  On  August  24th,  the  wound  had  filled  with  healthy  granulations.  A marked  dejiression  in  the  bone  bebind  the  mastoid 
Jirocess  could  be  felt.  Appetite,  assimilation,  and  secretion  were  good,  but  beadache  recurred  about  three  hours  each  afternoon. 
During  Sejitember,  he  suffered  from  erysijielas  of  the  face,  but  be  recovered  and  was  returned  to  duty  on  January  Ifith,  1864.  He 
is  not  a pensioner.  The  case  is  reported  by  Surgeon  E.  Swift,  U.  S.  A. 

Case. — Private  .James  Duffy,  Co.  A,  116th  Pennsylvaida  Volunteers,  aged  33  years,  was  wounded  at  the  battle  of 
Chaucellorsville,  Virginia,  May  3d,  1863,  by  a jiiece  of  shell,  which  fractured  the  parietal  bones  at  the  apex.  Tie  was,  on  the 
same  day,  admftted  to  the  regimental  hosjiital  near  F.ahnouth,  Virginia;  on  May  8th,  sent  to  the  Mount  Pleasant  Hosjiital, 
Washington,  and,  on  the  12th,  transferred  to  the  Satterlee  Hosjiital,  Philadeljihia.  He  recovered  under  simjile  treatment 
and  was  returned  to  duty  on  the  24th  of  October,  1863.  He  was  discharged  .July  21st,  186.5,  and  pensiomal.  Pension  Examiner 
Thomas  B.  Reed,  in  October,  1867,  reports  that  there  is  a large  dejiression  in  the  skull,  .and  that  fifteen  jileces  of  bone  have  been 
removed.  The  man  is  subject  to  fainting  spells  and  dizziness,  and  cannot  bear  exposure  to  the  sun. 

Case. — Sergeant  .John  Ij.  Evans,  Co.  G,  91st  Pennsj’lvania  Volunteer.s,  aged  33  years,  was  w’onnded  at  the  battle  of 
Spottsylvania  Court-house,  Virginia,  Maj'  12th,  1864,  by  a conoidal  ball,  which  fractured  the  left  p.arietal  bone.  He  was  admitted 
to  the  1st  division.  Fifth  Corji.s,  hospital,  and  transferred  to  the  Carver  Hosjiital,  Washington,  on  the  14th.  Sequestra  were 
removed  and  simjile  dressings  apjilied  to  the  wound.  On  the  2()th  of  .June,  he  was  transferred  to  the  McClellan  Hosjiital, 
I’hiladeljihi.a,  and  returned  to  duty  on  the  12th  of  .July,  1864.  He  served  with  his  regiment  until  the  14th  of  November,  when 
he  was  admitted  to  the  Fifth  Corjis  field  hosjiital  at  City  Point,  sufl'ering  from  ejiilejisy,  r(‘sulting  from  the  wound  of  the  head. 
He  was  again  returned  to  his  regiment,  served  till  the  1st  of  T'ebruary,  IHtFi;  was  re-admitted  to  hosjiital,  and  on  the  27th, 
conveyed  to  Washington  oil  the  hosjiital  steamer  State  of  Maine.  He  entered  Camjibell  Hosjiital  the  following  day.  On  the  6th 
of  Ajiril,  be  was  transferred  to  the  Mower  Hosjiital,  Phllailelphia,  sent  to  'riiruers’  Iv.ane  on  the  Pith,  thence  to  McClellan  on  the 
Kith  of  May,  and  returned  to  duty  on  the  7tb  of  .June,  1865.  He  was  discharged  .July  lOth,  186.5,  and  jiensioned.  On  .January 
llth,  18(i7,  Pension  Examiner  Cuniminskey  rejiort(*d  that  the  jiatient  siiH’ered  from  slight  exfoliation  from  the  wound  and  dizziness. 
He  was  unable  to  ascend  elevated  jilaces  or  to  be  exjiosed  to  tbe  lu'at  <if  tbe  sun  without  falling  down  in  somewhat  like  an  epilejitic 
tit.  Dr.  Cumminskey  rates  his  disability  one-half  and  jiermammt. 


' Confe.df.rate.  Slalex  Medical  and  Snri/iral  Journal,  Vol.  I,  Nii.  page  42.  “Eigliteeii  eases  ef  tiiinsliot  Womuls  of  tlie  Head,  oliscrvcd  at  the 
Oeneral  Hospital,  Charlottesville,  Virginia.  ’ .Surgeon  Allen  is  said  to  have  drawn  up  these  alisiraets,  from  notes  furnished  liy  different  operators. 


216 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Case. — Lieafenant  Colonel  H.  A.  Frink,  11th  Pennsylvania  Volunteers,  wa.s,  on  January  15th,  1863,  admitted  to  the 
Officers’  Hospital,  Philadelphia,  with  a gunshot  fracture  of  the  occipital  bone  at  its  prominence.  A portion  of  the  outer  table 
was  necrosed  and  came  away;  there  were  symptoms  of  compression,  hut  the  wound  was  nearly  healed,  and  the  discharge  was 
very  slight.  On  Api-il  1st,  a piece  of  bone  the  size  of  a finger  nail  and  one-sixteenth  of  an  inch  in  thickness,  was  removed  from 
the  outer  table.  No  further  complications  occurred,  and  Colonel  Frink  returned  to  duty  in  April,  1863.  He  is  not  a pensioner. 

Case. — Private  Philip  Grace,  Co.  K,  127th  Illinois  Volunteers,  aged  20  j’ears,  was  wounded  at  the  siege  of  Vicksburg, 
May  19th,  1863,  by  a musket  ball,  which  passed  through  the  l ight  ear  and  fractured  the  mastoid  procc'ss.  He  was  conveyed  to 
Blair’s  division  hospital,  where  he  remained  until  the  4th  of  June,  was  then  removed  to  the  Fifteenth  Corps  hospital,  and  thence 
sent  to  the  general  hospital  at  Mound  City,  Illinois,  on  July  28th.  He  suffered  from  vertigo  and  headache,  and  the  wound  was 
still  discharging.  On  August  21st,  a piece  of  necrosed  bone,  one-fourth  of  an  inch  in  diameter  and  one-eighth  of  an  inch  in 
thickness,  was  removed.  He  improved  gradually,  and  by  the  30th,  the  wound  had  entirely  healed.  Patient  had  intermittent 
fever,  which  soon  subsided.  He  was  placed  on  duty  as  nurse,  acting  in  that  capacity  until  April  25tli,  1865,  when  he  was 
returned  to  duty.  He  is  not  a pensioner. 

Case. — Private  Alexander  Hamilton,  Co.  C,  17th  United  States  Infantry,  aged  33  years,  was  wounded  at  the  battle  of 
Spottsylvania  Court-house,  Virginia,  May  9th,  1864,  by  a conoidal  ball,  which  fractured  the  cranium  at  the  vertex.  On  the 
same  day,  he  was  admitted  to  the  hospital  of  the  4th  division.  Fifth  Corps,  where  the  detached  portions  of  bone  were  removed 
from  the  wound.  On  May  12th,  he  was  sent  to  the  Columbian  Hospital,  Washington;  on  May  15th,  to  the  Patterson  Park 
Hospital,  Baltimore,  and  on  June  20th,  to  Camp  Parole,  Annapolis,  whence  he  was  sent,  on  September  12th,  1864,  to  Fort 
Preble,  Maine,  probably  for  duty.  This  soldier  was  discharged  the  service,  March  31st,  1865,  and  pensioned.  On  January  27th, 
1867,  Pension  Examiner  G.  McCook  reported  that  the  integument  does  not  cover  the  wound;  the  patient  complains  of  headache, 
which  he  alleges  prevents  him  from  laboring.  His  disability  is  rated  one-half  and  temporary. 

Case. — Private  Lewis  W.  James,  Co.  B,  3d  Wisconsin  Volunteer.s,  aged  18  years,  was  wounded  at  Atlanta,  Georgia, 
July  20th,  1864,  by  a conoidal  ball,  which  penetrated  the  right  side  of  the  os  frontis  at  the  external  angular  process,  and  lodged 
within  the  cranium.  He  was  admitted,  on  the  following  day,  to  the  hospital  of  the  1st  division.  Twentieth  Corps,  where  the 
ball  was  extracted  with  the  bullet  forceps  by  Surgeon  Darius  Mason,  31st  Wisconsin  Volunteers.  On  July  29th,  he  was 
conveyed  to  the  Cumberland  Hospital  at  Nashville^  Tennessee,  where  three  ]iieces  of  bone  were  removed  on  August  6th.  On 
August  23d,  he  was  transferred  to  the  Jefferson  Hospital,  Jeffersonville,  Indiana,  and,  on  September  4th,  admitted  to  the  Simons 
Hospital,  Mound  City,  Illinois.  The  wound  was  healing  kindly;  the  discliarge  health3^  He  suffered  from  coutmual  headache, 
and  complained  of  numbness  over  the  right  eye.  On  September  24th,  he  was  sent  to  Keokuk,  Iowa,  but  again  transferred  to 
the  Harvey  Hospital  at  Madison,  Wisconsin,  on  February  23d,  1865,  whence  he  was  returned  to  duty  on  February  25th,  1865. 
He  was  discharged  in  July,  1865,  and  his  claim  for  pension  is  still  penduig. 

Case. — Private  Robert  Linton,  Co.  D,  14th  United  States  Infantiy,  aged  19  years,  was  wounded  at  the  battle  of  Spott- 
sylvania Court-house,  Virginia,  May  13th,  1864,  by  a fragment  of  shell,  wliich  fractured  both  tables  of  the  frontal  bone.  He 
was  at  once  admitted  to  the  1st  division.  Fifth  Corps,  hospital,  and  on  May  24th,  transferred  to  the  Finley  Hospital,  Washing- 
ton. He  experienced  periodical  attacks  of  dizziness  and  some  headache  until  June  1st,  when  Acting  Assistant  Surgeon  F.  G.  H. 
Bradford  removed  several  fragments  of  bone  from  the  wound.  Simple  di-essings  were  applied;  the  patient  recovered  rapidly, 
and  was  returned  to  his  regiment  for  duty  on  August  26th,  1864.  He  is  not  a pensioner. 

Case. — Private  John  Mock,  Co.  II,  53d  Pennsylvania  Volunteers,  aged  19  years,  was  wounded  at  the  battle  of  Spott- 
sylvania Court-house,  Virginia,  May  12th,  1864,  by  a conoidal  ball,  which  fi'actured  and  depressed  the  left  parietal  bone.  He 
was  immediately  admitted  into  the  hospital  of  the  1st  division.  Second  Corps,  and  thence  transferred  to  the  Columbian  College 
Hospital,  Washington,  on  the  21st,  and  on  the  following  day,  the  ball  and  portion  of  bone  were  removed.  On  May  31st,  he  was 
transferred  to  the  Cuyler  Ilosjjital,  Philadelphia,  and  finally  returned  to  duty  on  October  24th,'1864.  He  is  not  a pensioner. 

Case. — Private  John  Montague,  Co.  K,  7th  Indiana  Cavalry,  aged  19  years,  was  wounded  while  on  picket  near  IMempliis, 
Tennessee,  July  16th,  1864,  by  the  accidental  bursting  of  his  gun,  which  caused  lacerated  wounds  of  hand,  face,  and  right  eye, 
and  fractured  the  frontal  bone.  He  was  admitted  to  the  Adams  Hospital,  Memphis,  on  the  i7th.  He  was,  on  the  same  day, 
placed  under  the  iuttuence  of  chloroform,  and  Surgeon  J.  G.  Keenon,  U.  S.  V.,  removed  fragments  from  the  frontal  bone, 
exposing  the  dura  mater  above  the  oi’bit  of  the  eye  to  the  extent  of  two  inches  in  length  by  one-half  inch  in  width,  and 
extirpated  the  right  eye.  Full  diet,  iron,  quinine,  wine,  and  whiskey,  were  ordered,  and  simple  dressings  applied.  By  the  31st 
of  August  the  parts  had  nearly  healed,  and  on  January  17th,  1865,  the  patient  was  returned  to  duty.  He  is  not  a pensioner. 
The  case  is  reported  by  the  operator.  Surgeon  J.  G.  Keenon,  U.  S’.  V. 

CAi5E. — Private  Reuben  L.  Patterson,  Co.  K,  14th  West  Virginia  Volunteers,  aged  34  years,  was  wounded  at  Halltown, 
Virginia,  on  the  26th  of  August,  1864,  by  a conoidal  ball,  which  fractured  and  depressed  the  left  parietal  bone.  On  the  following 
day,  he  was  admitted  into  hospital  at  Sandy  Hook,  Maryland,  and  thence  transferred,  on  the  28th,  to  the  hospital  at  Frederick. 
He  complained  of  headache,  his  tongue  was  coated  white,  bowels  costive,  and  there  was  considerable  fever,  with  fi'equent  and 
small  pulse.  A fragment  of  ball,  which  was  found  wedged  in  between  the  tables  of  the  skull,  was  removed.  On  the  3d  of 
September,  the  headache  and  fever  continuing.  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  removed  the  depressed  bone  with  bone 
gouge  forceps  and  elevator.  By  the  10th,  the  jiatient  was  free  from  headache,  his  j)ulse  became  natural,  appetite  good,  tongue 
clean,  and  his  bowels  regular,  his  diet  being  principally  farinaceous.  On  September  20th,  he  was  able  to  sit  up  and  sometimes 
walked  about  the  ward;  his  general  health  improving  rapidly,  and  healthy  granulations  covei-ing  the  wound.  On  the  4th  of 
November,  he  received  a furlough  for  thirty  day.s,  and  left  the  hospital  in  excellent  spirits,  the  wound  being  nearly  healed.  On 
the  same  day,  he  entered  the  general  hospital  at  Grafton,  West  Virginia,  where  he  remained  until  the  23th  of  May,  1865,  when 
he  was  returned  to  his  regiment  for  duty,  lie  was  discharged  June  27th,  1865,  and  pensioned,  his  disability  being  rated  one- 
half  and  permanent.  The  case  is  reported  by  Acting  Assistant  Surgeon  R.  M.  Mansfield. 


REMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


217 


Case. — Corporal  Richard  H.  Pear],  Co.  B,  31st  Maine  Volunteers,  aged  20  years,  was  wounded  at  the  battle  of  Peters- 
burg, Virginiii,  June  28th,  1864,  by  a conoidal  musket  ball,  which  fractured  the  right  temporal  bone.  He  was  admitted  to  the 
hospital  of  the  2d  division,  Ninth  Corps,  on  the  same  day,  where  several  pieces  of  bone  were  removed.  Thence  he  was  conveyed 
by  hospital  steamer  to  Washington,  and  admitted  into  the  Carver  Hospital  on  July  5th.  On  the  18th,  he  was  transferred  to 
Blackwell’s  Island,  New  York  Harbor,  and  in  September,  sent  to  Augusta,  !Maine.  He  recovered  and  was  returned  to  dut}'  on 
February  4th,  1865.  He  was  discharged  June  6th,  1865,  and  pensioned,  his  disability  being  rated  total  and  permanent.  Pension 
Examining  Surgeon  S.  Willey,  St.  Paul,  Minnesota,  under  date  June  24th,  1868,  reports  that  the  outer  edge  of  the  right  orbit, 
where  loss  of  substance  occurred,  is  unhealthy,  red,  and  painfid.  The  conjunctiva  of  the  left  eye  is  injected,  the  pupil  dilated, 
and  the  power  of  sight  diminished.  Exertion  or  stooping  causes  vertigo.  There  had  been  temporary  loss  of  memory  and 
frequent  pains  back  of  the  orbits. 

Case. — Private  Edward  Powers,  Co.  F,  11th  New  Jersey  Volunteers,  was  wounded  at  the  battle  of  Gettysburg,  July  2d, 
1863,  by  a conoidal  ball,  which  fractured  and  depressed  both  tables  of  the  frontal  bone  in  the  median  line,  and  lodged.  He  was 
admitted  into  Seminary  Hospital,  at  Gettysburg,  on  the  same  day,  and  on  July  5th,  the  ball  and  depressed  fragments  of  bone 
were  removed  from  the  wound.  The  patient  was  transferred,  on  the  13th,  to  the  Camden  Street  Hospital,  Baltimore.  The 
pulsations  of  the  brain  were  distinctly  visible  over  a space  an  inch  in  diameter.  The  jiortions  of  the  outer  table  surrounding  the 
orifice  being  denuded  and  in  a state  of  necrosis,  and  becoming  nearly  detached,  were  easily  removed  with  dressing  forceps  on 
the  2d  of  August.  Simple  dressings  were  applied.  The  case  progressed  favorably,  and  on  the  2d  of  October,  1863,  Powers 
was  returned  to  duty,  and  discharged  March  18th,  1864.  The  case  is  reported  by  Surgeon  Z.  E.  Bliss,  U.  S.  V.  In  October, 
1865,  Pension  Examiner  Thomas  B.  Reed  states  that  the  man  suffers  from  headache,  dizziness,  inability  to  stoop,  impaired 
memory  and  intellect. 

Case. — Private  Thomas  Prescott,  Co.  K,  110th  Pennsylvania  Volunteers,  aged  21  j'ear.s,  was  wounded  before  Petersburg, 
Virginia,  August  18th,  1864,  b}’  a fragment  of  shell,  which  fractured  the  skull  at  its  posterior  portion.  He  was  immediately 
admitted  to  the  3d  division.  Second  Corps,  hospital  at  City  Point,  Virginia;  thence  sent  to  Washington,  where  he  entered  the 
Finley  Hospital  on  August  27tli.  On  the  1st  of  September,  symptoms  of  compression  supervened.  A careful  examination 
revealed  a spicula  of  bone  driven  into  the  brain  substance,  also  slight  depression  of  the  bone  upon  the  side  of  the  opening.  The 
patient  having  been  placed  under  the  influence  of  chloroform,  the  wound,  was  freely  opened  and  several  pieces  of  bone  were 
removed  by  Acting  Assistant  Surgeon  F.  G.  11.  Bradfiu’d,  relieving  the  compression.  The  case  progi’essed  favorably,  and  on  the 
12th  of  September  the  patient  was  furloughed.  On  December  12th  he  was  admitted  to  the  3d  division.  Second  Corps,  hospital 
at  City  Point,  Virginia,  and  returned  to  duty  on  December  21st,  1864.  He  is  not  a pensioner.  The  case  is  reported  by  Surgeon 
G.  L.  Pancoast,  U.  S.  V.  ' 

Case.— Sergeant  Martin  V.  B.  Quick,  Co.  B,  6th  New  York  Cavalry,  aged  24  years,  was  wounded  at  Sailors’  Creek, 
Virginia,  April  6tli,  1865,  by  a ball  from  a canister  shot,  which  struck  the  left  side  of  the  forehead,  transversely,  producing  a 
compound  comminuted  fractuie  of  both  tables  of  the  frontal  bone  just  below  the  protuberance;  the  scalp  was  severely  lacerated, 
and  the  brain  pulsations  distinctly  visible.  Surgeon  A.  P.  Clarke,  6th  New  York  Cavalry,  removed  several  fragments  of  bone 
immediately  after  the  reception  of  the  injury,  dressed  the  wound,  and  administered  stimulants.  Quick  was  conveyed  to  the  field 
hospital  of  the  1st  division.  Cavalry  Corps,  and  after  several  da3's,  transferred  to  Citj’  Point,  Virginia,  entering  the  Cavahy 
Corps  depot  field  hospital  on  the  14fh.  On  the  following  day  he  was  transferred,  per  hospital  steamer  Connecticut,  to  Wash" 
ington,  entering  Lincoln  Hospital  on  the  16th,  and  thence,  on  the  22d  of  May,  to  Satterlee  Hospital,  Philadelphia.  The  woimd 
was  still  open,  with  some  necrosis.  Water  dressings  were  applied  and  full  diet  ordered.  The  case  progressed  favorably’,  and  on 
the  12th  of  July,  the  patient  was  returned  to  duty,  the  wound  having  healed.  He  is  not  a pensioner. 

Case. — Private  Crowell  J.  Ramsey,  Co.  C,  4th  Maine  Volunteers,  aged  21  j'ears,  was  wounded  at  the  battle  of  Fred- 
ericksburg, Virginia,  December  13th,  1862,  ly  a musket  ball,  which  fractured  and  depressed  the  ujiper  posterior  portion  of  the 
cranium,  a little  to  the  right  of  the  median  line ; he  also  received  a slight  flesh  wound  of  the  left  hand.  He  was  conveyed  to  the 
regimental  field  hospital,  and  on  the  15th,  was  transferred  to  the  3d  Division  Hospital,  Alexandria,  in  a convalescent  condition. 
On  January  7th,  1863,  he  was  sent  to  Lovell  Hospital,  I’ortsmouth  Grove,  Rhode  Island,  and  on  March  2d,  1863,  returned  to 
duty.  On  the  15th  of  June,  he  entered  2d  Division  Ho.spital,  Alexandria,  with  cerebral  symptoms,  caused  by  depression  of  a 
portion  of  the  fractured  craiuum,  a fragment  of  which  was  removed.  Ity  the  1st  of  .September,  the  wound  was  entirely’  closed, 
all  cerebral  sj'mptoms  had  disappeared,  and  on  the  l.^th  of  Januaiy,  1864,  he  was  returned  to  duty.  He  is  not  a pensioner. 

Case. — Private  Erastus  R.  Rugg,  Co.  I,  7th  Wisconsin  Volunteers,  aged  43  j’oars,  was  wounded  at  the  battle  of  the 
Wilderness,  Virginiii,  May  5th,  1864,  by  a conoidal  ball,  which  penetrated  the  left  temjioral  bone  and  passed  through  the  dura 
mater.  He  was,  on  the  following  day,  admitted  to  the  4th  division.  Fifth  Corps,  hos])ital,  and  on  the  12th,  transferred  to  the 
Douglas  Hospital,  Washington.  Simple  dressings  w'.ere  employed.  On  Maj'  28th,  he  was  sent  to  the  Broad  and  Cherry  Streets 
Hospital,  Philadelphia,  where  a small  piece  of  necrosed  bone  was  extracted  from  the  wound.  The  missile  had  been  previousl  y 
removed.  The  patient  remained  at  the  above  hospital  until  the  27th  of  June,  when  he  was  transferred  to  the  Haddington 
Hospital.  He  recovered,  and  was  returned  to  duty  on  February  11th,  1865.  He  was  discharged  July  6th,T865,  and  pensioned.  ■ 
A communication  from  the  Commissioner  of  Pensions,  Januaiy  20th,  1870,  states  that  there  is  a deep  depression  at  the  seat  of 
injury.  The  functions  of  the  right  ear  are  lost,  those  of  the  left  are  tremulous  and  weak,  and  the  man  is  subject  to  dizziness 
upon  slight  exertion. 

Case. — Private  Joseph  F.  Singer,  Co.  E,  24th  Wisconsin  Volunteers,  aged  24  years,  was  wounded  in  a skirmish  at 
Dallas,  Georgia,  May  27th,  1804,  by  an  explosive  bullet,  which  fractured  the  external  table  of  the  occipital  bone  at  its  superior 
portion,  near  the  right  parietal  bone.  He  was  admitted  to  the  hospital  of  the  2d  division.  Fourth  Corjis,  on  the  same  da^',  and 
on  the  3d  of  June,  was  sent  to  Hospital  No.  3,  Nashville,  Tennessee,  suffering  considerablj-  from  headache  occasioned  ly  the 

28 


218 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


existence  of  partially  detached  scales  of  bone  at  the  seat  of  fracture.  The  pain,  however,  ceased  as  soon  as  the  fragments  were 
removed.  On  July  IGth,  he  was  transferred  to  the  Jefferson  Hospital  in  Indiana,  and  on  September  4th,  was  conveyed  by 
steamer  to  the  Jloimd  Cit^'  Hos])ital  in  Illinois;  the  wound  was  still  discharging,  hut  his  general  health  was  good.  On  Septembei' 
“J4th,  he  was  sent  to  the  Keokuk  Hosj)ital,  Iowa,  and  from  there  returned  to  duty  on  the  12th  of  December,  18G4.  He  was 
discharged  on  June  22d,  18(15.  The  case  is  reported  by  Surgeon  M.  K.  Taylor,  U.  S.  V.  A communication  from  Pension 
Examiner  E.  Kramer,  dat(‘d  Maj'  19th,  18G9,  stnt<‘d  that  the  cicatrix  was  very  tender  and  tlie  scalp  was  bald.  The  patient 
suffered  from  lieadache  and  dizziness,  especially  in  liot  weather.  He  rated  his  disaliility  two-thirds  and  permanent. 

Cask. — Private  Rivers  II.  Trask,  Co.  A,  114th  New  York  Volunteers,  aged  2J  years,  was  wounded  at  Winchester, 
Wrginia,  September  19th,  1864,  by  a conoidal  hall,  which  passed  antero-posteriorly  over  the  left  frontal  protuberance,  producing, 
seemingly,  a ilesh  wound  of  the  scalp,  lialf  an  inch  wide  and  an  inch  long.  He  was,  on  the  same  day,  admitted  to  the  hosjntal 
of  the  3d  division,  Si.xth  Corps,  thence  sent  to  the  field  hospital  at  Sandy  Hook,  Maryland,  on  the  23d,  and  on  the  following  day 
transfern'd  to  Philadelphia,  entering  Satterlee  Hospital  on  the  25th.  The  wound  looked  healthy,  but  the  patiimt  complained  of 
dull  pain  over  tlie  left  eyebrow,  and  bis  pupils  appeared  to  be  rather  dilated.  His  mind  was  confused  and  his  articulation 
difficult.  Quiet,  low  diet,  and  simple  dressings  were  ordered.  On  the  following  day,  the  pain  w'as  more  severe  and  the  ))npils 
more  dilated.  A severe  epileptic  fit  supervened  on  the  27th,  which  lasted  forty-five  minutes,  and  a state  of  semi-unconsciousness 
followed,  while  the  pulse  was  full,  regular,  and  very  slow.  Ilis  pupils  dilated  still  more,  and  for  two  hours  after  the  convulsion 
his  respiration  was  stertorous.  On  the  following  day,  he  was  placed  under  the  influence  of  one  part  of  chloroform  and  three  parts 
of  ether.  A free  crucial  incision  was  made  in  the  nearly  cicatrized  scalp,  which  revealed  a w’ell-marked  depressed  fracture  of  the 
bone.  Fragments  covering  one  and  a half  square  inches  of  both  tables  were  removed,  exposing  the  dura  mater  much  congested. 
On  recovering  from  the  ansethe.sia,  the  li.atient  seemed  to  breathe  more  fully  and  said  that  the  pain  in  the  head  was  relieved. 
Two  teaspoonfuls  of  solution  of  morphia  every  two  hours  w’ere  ordered  and  no  food  allowed  for  the  fiivst  day,  and  for  twelve 
days  no  other  nourishment  than  beef  essence  w'.as  permitted.  The  head  and  face  were  attacked  with  (‘ly.sipelas  on  the  fourth  day 
after  the  oi)eration.  Tinct.  ferri  chlor.  was  freely  administered  for  several  days.  On  the  11th  of  October  some  light  food  was 
allowed,  and  on  the  20th  full  diet  ordered.  By  the  middle  of  November,  tbe  wound  had  closed  and  the  jiatient  was  perfectly 
well.  He  was  furloughed  on  the  18th  of  January,  18G5,  returned  to  hospital  on  the  8th  of  Februai’y,  and  was  returned  to  duty 
on  February  ]4tb,  18G5.  He  is  not  a jiensioner. 

Case. — Private  Noah  Truitt,  Co.  E,  lltb  United  Slates  Infantry,  aged  34  years,  was  wounded  in  an  engagement  at 
Petersburg,  Virginia,  June  18tb,  18G4,  by  a fragment  of  shell,  which  caused  a fractim*  of  the  frontal  bone.  H(!  was  admitted  to 
the  hosjiital  of  the  2d  division.  Fifth  Corps,  on  tbe  same  day,  and  thence  conveyed  to  Alexandria,  and,  on  the  2d  of  July, 
admitted  into  the  2d  Division  Hospital ; but  shortly  afterward  was  sent  to  the  Droad  and  Cherry  Str(!ets  lIos])ital,  and  thence  to 
the  Haddington  Hosi)ital  at  Philadeljihia.  Itnring  the  progress  of  tla^  case,  spicula;  of  bone  w.ere  removed  from  the  external 
table.  Tbe  patient  recovered,  and  was  la  tnrned  to  duty  l )<“cember  1 Itb,  18G4.  He  was  discharged  February  22d,  18G5,  and 
p<>nsioned.  His  disability  is  rated  two-tliLrds. 

Case. — An  unknown  ('onfctlrmtc  suhlh r belonging  to  Nichols's  Eouisiana  lirigade,  was  wounded  at  the  battle  of  Chan- 
cellorsville,  Virginia,  Maj'  2d,  1863.  'I'he  missile  entered  the  frontal  bone  from  oblicjue  direction,  passed  inward  and  lodged 
alioiit  two  inches  )iosterior  to  the  wound  of  entrance.  In  entering  the  cavity  of  the  cranium,  the  hall  came  in  cdntact  with  the 
opposite  margin  of  th(>  orifice  in  the  bone,  and  was  deflected  in  its  Course.  An  ounce  or  two  of  cerebrum  was  lost.  The  hall, 
considerably  llattened,  could  be  felt  with  tbe  jioint  of  the  little  finger.  The  patient  being  semi-consciou.s,  the  opening  in  the 
c.iamium  was  enlarga'd  by  1 ley’s  saw,  and  the  ball  extracted.  The  case  progressed  favorably,  the  patient  recovered,  and  was 
afterward  i-etnnu*d  to  duty. 

Case. — Private  Richard  I'jdiam,  Co.  P>,  3Gth  Visconsiu  Volunteer.s,  aged  42  years,  was  wounded  at  Cold  Harbor, 
Virginia,  .June  1st,  1864,  by  a conoidal  musket  ball,  in  the  right  side  of  the  head.  He  was,  on  June  8th,  admitted  to  the 
Lincoln  Hospital,  Washington,  Avhere  the  injury  was  diagnosial  as  a wound  of  the  .scalji.  On  June  18th,  he  was  conveyed  to 
Philadeljdiia,  and  admitted  into  the  Summit  House  Hospital.  The  wound  was  then  indolent.  On  the  24th  of  August,  he  was 
transferre^d  to  Satterlee  Hospital,  where,  it  was  ascertained  that  the  parietal  bone  was  fractured  at  the  articulation  with  the  fi-ontal 
bone,  one  and  a balf  inebes  fiom  tbe  median  line.  Sim])le  dressings  were  ajtplied  to  tbe  wounil.  Quite  a number  of  small 
spiculas  of  bone  wiu-e  removed.  Thi;  case  ju-ogressed  favorably  and  tbe  wound  healed,  leaving  a depression  of  one-half  inch. 
He  was  returned  to  duty  on  I)ecend)er  10th,  1864,  but  still  sufl'ered  fi-om  vertigo  after  much  exertion.  He  was  discharged  Julj' 
12th,  1865,  and  his  claim  for  pension  is  ])ending. 

Case. — Private  James  A.  .1.  Williams,  Co.  A,  2d  Kentucky  Cavalry,  aged  18  year-s,  was  wounded  at  Dairysville,  Georgia, 
October  9th,  1864,  by  a conoidal  ball,  which  fractured  the  superior  border  of  the  parietal  hone.  He  entered  Hospital  No.  1, 
Nashville,  Tennessee,  on  the  1st  of  November,  comjdaining  of  constant  j)ain  in  his  head.  On  the  7th,  the  pulse  was  intermittent, 
very  irregular,  from  50  to  75  jier  niinutt';  his  bowels  were  constijiated,  and  there  was  a profuse  discharge  of  carious  jnis  from 
the  opening  in  the  wound,  also  a small  abscess  beneath  tbe  dura  mater.  He  was  placed  under  the  influence  of  chlorofonn,  and 
Acting  Assistant  Surgeon  M.  L.  Herr  made  a crucial  incision  two  and  a half  inches  in  extent  and  removed  the  fractured  portions 
of  bone,  exposing  the  brain  substance.  Cold  water  dressings  w’ere  applied  and  low  diet  ordered.  The  wound  healed  rapidly. 
He  was  transferred  to  the  Jefferson  Hospital,  Jeffersonville,  Indiana,  on  the  11th  of  December,  and  retiuTied  to  duty  on  the  7th 
of  February,  1865.  He  was  dischargi'd  IMay  25th,  186.5,  and  died  February  28th,  1867,  of  inflammatory  softening  of  the  brain. 

Case. — Private  Andrew  J.  Gordon,  Co.  3lst  Ohio  Volunteers,  aged  21  years,  w'as  wounded  at  the  battle  of  Chick- 
amauga,  Georgia,  September  20th,  1863,  by  a coi  oidal  musket  ball,  which  fractured  the  parietal  bone,  ])rodncing  a large  depres- 
sion. Being  conveyed  to  Nashville,  Tennessee,  he  was  admitted,  on  the  25th,  into  Hospital  No.  3.  Simple  dressings  only  were 
required;  the  patient  recovered  rapidly ; w'as  transferred  to  No.  15,  October  7th;  thence  to  No.  19,  February  13th,  1864,  and 


REMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


219 


returned  to  duty  on  March  Otli,  lS(j4.  He  was  discharged  Sepfeinher  19fli,  1804,  and  pensioned.  On  Noveinher  ilOth,  1809, 
Pension  Examiner  .1.  R.  Reck  reports  tliat  a large  de])ression  exists  over  the  seat  of  the  wound,  througli  whicli  the  ])ulsations 
of  the  meningeal  arteiy  could  he  clearly  distinguished,  d’he  patient  was  suhject  to  cerehi  itis  upon  the  slighte.st  exjcosiire.  The 
effects  of  his  en.otions,  such  as  rage,  joy,  or  fear,  ])roduced  attacks  of  insensihility.  He  could  not  endure  the  heat  of  a warm 
room  and  was  unahle  to  perform  any  labor  ivquiring  mental  or  muscular  effort.  He  rates  his  disability  total  iind  permanent. 

Case. — Private  George  W.  Ramsey,  Co.  A,  10th  Connecticut  Vohintc'ers,  was  woundcal  in  the  engagement  at  Roanoke 
Island,  North  Carolina,  February  8th,  1802,  by  a conoidal  hall,  which  entered  about  one  inch  j)osterioi'l3'  to  the  fronto-parietal 
suture,  and  about  two  and  a half  inches  above  the  ear  on  the  left  sidcc,  and  passed  in  an  ohlicjue  direction  fi'om  before  backward. 
When  brought  to  the  field  hospital  he  was  insemsihle,  surface  cold,  breathing  stertoi’ous,  pulse  slow,  about  40.  iStimulants  were 
freely  given  and  the  loose  portions  of  hone  removed  by  Surgcxm  J.  H.  'Thompson,  U.  8.  V.  In  the  evening,  eight  hours  after 
the  reception  of  the  injury,  he  was  still  unconscious,  and  there  was  that  peculiar  whitting  by  the  month  during  ex])iration  w hich 
frecjuently  accompanies  grave  cases  of  compression;  the  eyes  were  fi.xed  and  the  pupils  much  dilated.  During  the  night,  there 
was  convulsive  action  of  the  left  arm  and  leg;  the  right  siile  a])p<*ared  ))aralyzed ; the  left  eye  was  suffused  and  proti  udeil 
considerably.  A clot  of  blood  which  partially  filled  the  wound  was  I'einoved,  and  the  patient  laid  upon  his  left  side  to  give  an 
opportunity  for  the  blood  to  drain  from  the  wound ; the  hlad<ler  was  em])tied  h}' catheter  and  a strong  cathartic  administered. 
In  the  afternoon  of  the  second  day  there  was  considerable  improvement.  He  appearecl  to  understand  what  was  said  to  him, 
giving  signs  with  his  left  hand.  'The  juijhls  were  not  so  much  dilated.  From  the  time  he  w'as  turned  ov(‘r  ujxm  his  side,  the 
paralysis  gradually  diminished,  and  the  jiatient  seemed  to  improve  each  hour.  Speech  slowly  returned  hut  was  not  )ierfect. 
Notwithstanding  this  marked  improvement,  his  case  was  considered  ho])eless,  for  it  was  known  that  the  ball  was  within  the 
cranium  and  the  ])atient  thus  subjected  not  only  to  the  danger  arising  from  the  comj)ression  but  to  the  almost  certain  one, 
inflammation  and  probable  subse(juent  softtming  which  the  presence  of  such  a foreign  body  would  )iroduce.  On  the  morning  of 
the  fourth  day  after  the  battle,  the  operator  was  astonished  to  see  the  man  sitting  on  a log  before  the  lire  smoking  his  jhpe.  His 
answers  to  (jnestions  were  given  with  some  hesitation,  hut  tvere  correct  and  rational.  From  this  time  onward  all  his  functions 
were  perfomied  normally,  and  at  the  end  of^three  weeks  he  went  home  on  furlough.  The  operator  saw  him  on  the  day  he  left, 
there  was  still  a weakness  hardiv  amounting  to  paralysis  of  the  right  siile,  considerable  deafnes.s,  and  the  left  eye  much 
protruded  and  congested;  otherwise  he  presented  no  indication  of  having  so  recently  been  the  victim  of  such  a severe  injury. 
He  recovered  and  re-eidisted  as  a veteran  in  the  same  regiment  on  February  8th,  18(14.  He  is  not  a pensioner.  'The  case  is 
reported  by  the  operator,  Surgeon  ,1.  II.  Thompson,  U.  S.  V. 

Cask. — Private  Abram  1).  Heiser,  Co.  11,  1st  Pennsylvania  Reserves,  was,  on  Se]iteniber  .Tl,  1862,  admitted  to  8outh 
Street  I lospital,  Philadelphia,  with  a gunshot  fracture  of  the  frontal  bone,  involving  the  frontal  sinus.  Adhesive  strips  and 
warm  water  dressings  were  applied  to  the  wound,  and  on  the  following  ilay  a small  piece  of  bone  was  removed.  On  Septembi'r 
5th  he  was  seized  with  convulsions,  when  constant  ice  applications  to  the  head  were  ordered,  and  calomel  and  syr.  rhei  aromat. 
were  administered.  'The  patient  impi-oved  and  was,  on  September  7th,  entirely  rational.  Ice  applications  were  continued,  and 
on  September  9tb,  two  jiieces  of  bone  were  removed  from  the  wound.  On  September  17th,  the  wound  suppurated  freely  and  the 
patient  was  doing  well  ; an  unsuccessfid  search  was  made  for  the  ball.  On  Se]>tend)er  22d,  several  pieces  of  necrosed  bone  came 
away,  and  the  discharge  had  become  offensive.  Ice  dressings  were  discontinued,  .and  the  patient  was  ordered  to  lay  on  his  side. 
On  September  26th,  the  wound  was  again  carefully  examined,  the  probe  could  be  passed  far  down  the  frontal  sinus  without  the 
least  obstruction  ; at  the  ujiper  and  outer  side  it  came  in  contact  with  some  hard  and  firm  material,  hut  whether  hone  or  bullet 
could  not  be  ascertained.  Sloughing  of  necrosed  bone  continued  until  March  20th,  1866,  when  a large  piece  of  both  tables  was 
removed  through  incision.  All  necrosed  portions  of  bone  being  removed,  the  wound  healed  rapidl}'.  No  ill  effect  remained,  save 
a slight  numbness  at  a jilace  about  two  inches  from  the  seat  of  injury.  He  was  returned  to  duty  Mai-cli  60th,  1866.  'The  man 
is  not  on  the  pension  rolls.  The  case  is  reported  by  Acting  Assistant  Surgeon  Henry  C.  Hart. 

Beventeen  patients  with  depressed  gunsliot  fractures  of  the  skull,  who  liad  been  treated 
by  the  removal  ot  detached  fragments  of  bone,  recovered  sufficiently  to  go  to  modified  duty 
in  the  Veteran  Reserve  Corps.  Eleven  of  tliem  appear  to  have  ultimately  completely 
recovered. 

Ca.se. — Private  Bradley  Allen,  Co.  1,  20th  Connecticut  Volunteers,  was  wounded  at  the  battle  of  Gettysburg,  Penn- 
sylvania, July  2d,  1866,  by  a piece  of  a shell,  which  fractured  the  frontal  bone  one  inch  above  the  right  eyebrow  and  frontal 
sinus.  He  was  admitted  into  Seminary  Hospital  at  Gettysburg,  on  the  same  day,  and  was  insensible  for  five  days.  On  July 
20th,  he  was  transferred  to  the  hospital  at  York,  Pennsylvania.  'There  was  a star-shaped  ffosh  wound,  with  one  of  its  tails 
extending  across  the  outer  extremity  of  the  brow,  and  reaching  three-fourths  of  an  inch  to  the  outside  of  the  external  angle  of 
the  left  e3'e.  'There  was  extensive  swelling  and  redness,  but  not  much  pain,  and  ecchymosis  of  the  njiper  ej'clid.  A fr.agment  of 
bone  was  removed,  after  which  the  patient  improved  gradually  under  a supporting  treatment.  On  August  24th,  the  wound  was 
irregularly  shaped,  almost  an  inch  across,  and  was  filled  with  granulations  which  were  soft  and  (lahbv.  'Thei  e was  marked 
deju’ession  of  the  forehead  at  that  point,  while  the  supra-orbital  arch  apjieared  to  bo  broken.  'The  brow  was  much  deformed. 
'The  upper  lid  was  of  a dark  red  color,  fdled  with  serum,  and  was,  with  much  diflicultj’,  lifted  off  the  eye,  which  was  uninjured. 
By  the  Ist  of  Novend)er,  the  discoloration  of  the  eyelid  had  almost  distijipeared,  hut  the  upper  lid  was  still  afl'ected  with  ptosis. 
The  wound  in  the  integuments  over  the  forehead  had  closed  to  a mere  jioint.  He  was  transferred  to  the  Veteran  Reserve  Corps 
on  Februar}'  15th,  1864. 

Case. — Private  .Tosejdi  N.  Day,  Co.  II,  34th  Massachu.setts  Volunteers,  aged  26  years,  was  wounded  at  the  battle  of 
Winchester,  Virginia,  September  19th,  1864,  by  a conoidal  hall,  which  fractured  the  occipital  bone,  with  slight  depression.  He 


220 


WOUNDS  AND  IN  JUDIES  OF  THE  HEAD, 


was,  on  the  same  day,  admitted  to  the  hospital  of  the  1st  division  of  the  Army  of  West  Virginia,  and  thence,  on  the  27th,  sent 
to  the  Slower  Hospital  at  I'hiladelphia.  Here,  three  small  pieces  of  bone  were  removed.  The  treatment  related  refers  more 
particularly  to  the  topical  dressings.  On  the  1st  of  January,  18G5,  the  patient  was  transferred  to  the  Dale  Hospital  in  Massa- 
chusetts. U)ion  his  recovery  he  was  transferred  to  the  Veteran  Reserve  Corps,  May  2d,  18G5.  lie  is  not  a pensioner. 

Casj;. — Sergeant  Joseph  C.  Fox,  Co.  F,  15Gth  New  York  Volunteers,  aged  30  years,  was  wouTided  at  the  battle  of 
Winchester,  Virginia,  September  19th,  18G4,  by  a conoidal  ball,  which  fractured  and  depressed  the  left  side  of  the  frontal  bone. 
He  was  admitted  to  the  hospital  of  the  2d  division.  Nineteenth  Corps,  and,  on  the  22d,  was  sent  to  the  depot  field  hospital.  On 
September  2.'jth,  the  missile  and  some  fragments  of  bone  were  extracted,  while  the  patient  was  under  the  influence  of  chloroform. 
Simple  dressings  were  applied.  On  October  17th,  he  was  transferred  to  the  Cuyler  Hospital,  Germantown,  Pennsylvania,  and 
on  October  21st  and  27th,  Acting  Assistant  Surgeon  John  Ashhurst  removed  fragments  of  bone.  Slight  head  symptoms  existed 
at  the  time ; but  the  wound  healed  rapidly.  On  May  10th,  18G5,  the  man  was  sent  to  the  Mower  Hospital,  and  on  May  IGth, 
1865,  he  was  transferred  to  the  Veteran  Reserve  Corps.  He  is  not  a pensioner. 

Case. — Private  Jacob  S.  Jessup,  Co.  D,  18th  Pennsylvania  Cavalry,  aged  22  years,  was  wounded  at  a skirmish  at  St. 
Mary’s  Church,  Virginia,  June  15th,  1864,by  a fragment  of  shell,  which  fractured  the  right  parietal  bone.  He  was  admitted  to 
the  field  hospital  of  the  3d  division.  Cavalry  Corps,  and  thence  sent  to  New  York  and  admitted,  on  the  25th,  into  the  McDoiigall 
Hospital.  On  the  23d  of  September,  he  was  sent  to  the  Haddington  Hospital  in  Philadelphia.  During  the  treatment  of  the  case 
several  siuculae  ot  the  external  table  were  removed.  Jessup  was  transferred  to  the  Veteran  Reserve  Corps  on  Mai'ch  2d,  18G5. 
He  is  not  a pensioner.  Surgeon  .1.  Hopkinson,  U.  S.  V.,  r ecorded  the  case. 

Case. — Corpoi'al  John  B.  Merritt,  Co.  B,  170th  New  York  Volunteers,  aged  22  years,  was  wounded  at  Petersburg, 
Virginia,  June  16th,  1864,  by  a conoidal  ball,  which  produced  a compound  fracture  of  the  frontal  b(me,  over  the  supra-orbital 
region.  On  the  same  day,  several  pieces  of  bone  wore  extracted  by  Assistant  Surgeon  IT.  A.  DuBois,  U.  S.  A.  Uie  patient  was 
admitted  to  tlie  hospital  of  the  2d  division.  Second  Corps,  and  thence  conveyed  to  the  hospital  at  I’ortsmouth  Grove,  Rhode 
Island,  on  the  26th.  On  August  11th,  he  w.as  admitted  into  Gi’ant  Hospital,  Willett’s  Point,  New  York  Harbor.  By  the  5th  of 
December,  1864,  the  wound  had  closed,  leaving  a large  scar  over  the  eye.  On  the  25th  of  January,  1865,  IMerritt  was  transferred 
to  the  Veteran  Reserve  Corps,  and  mustered  out  Jul^'  13,  1865.  He  is  a pensioner. 

The  next  case  refers  to  a man  who,  apparently,  belonged  to  one  of  the  classes  of 
recruits  who  were  hnown  during  ilie  latter  part  of  the  war  as  “ Bounty  Jumpers the 
class  of  disabled  men,  who,  through  the  culpalile  negligence  of  the  local  examining  officers, 
were  allowed  to  arfain  and  anain  ro-enlist,  and  to  receive  the  large  bounties  then  offered, 
only  to  be  discharged  in  a few  W’eeks  or  to  encumber  the  hospitals  : 

Case. — Private  George  Moritz,  Co.  I,  7th  United  States  Infantry,  aged  34  years,  was  wounded  at  the  battle  of  Chancel- 
lorsville,  Virginia,  May  1st,  1863,  by  a conoidal  ball,  which  entered  the  right  parietal  bone,  near  the  coronal  suture,  producing  a 
stellate  fracture  of  both  tables,  and  lodged.  The  ball  and  portions  of  comminuted  bone  were  I’emoved  on  the  field,  through  a 
crucial  incision.  The  patient  was  conveyed  to  W’ashington,  and  entered  Lincoln  Hospital  on  the  15th  of  June,  remaining  until 
the  11th  of  September,  when  he  was  returned  to  his  regiment  to  be  mustered  out  of  service.  On  the  4th  of  .January,  1864,  he 
entered  the  3d  Division  Hospital,  Alexandria,  Virginia,  as  a recruit  of  the  2d  New  York  Cavalry.  On  March  31st,  he  was 
transferred  to  Fairfax  Seminary  Hospital,  lu-ar  Alexandria,  Virginia,  and  discharged  from  the  service  on  the  5th  of  May,  by 
reason  of  impaired  intellect  and  derangement  of  the  nervous  .system,  being  unfit  for  the  Veteran  Reserve  Corps.  On  the  5th  of 
July,  1864,  he  entered  Carver  Hospital,  Washington,  as  a private  of  Co.  1),  7th  New  Jersey  Volunteers,  suffering  from 
cephalalgia  to  such  an  extent  as  to  entirely  disable  him  for  duty.  The  wound  was  entirely  healed.  There  was  a depression  over 
the  right  parietal  protuberance  about  an  inch  in  diameter,  and  half  an  inch  in  depth.  On  the  30tli  of  September,  he  was  placed 
on  light  duty  in  the  hospital,  and  on  the  25th  of  April,  1865,  transferred  to  the  Veteran  Reserve  Corps.  He  is  not  a pensioner. 

Ca.se. — Private  Charles  Rogers,  Co.  G,  44th  Illinois  Volunteers,  aged  20  j-ears,  was  wounded  at  tlu!  battle  of  Chick- 
amauga,  Georgia,  September  20th,  1863,  by  a round  ball,  which  fractured  the  right  parietal  bone,  a second  ball  lodged  beneath 
the  lachrymal  sac,  and  a third  struck  near  the  centre  of  the  left  orbit  at  the  lower  margin.  He  was  admitted  into  hospital  at 
Stevenson,  Alabama,  on  the  25th ; transferred  to  Hospital  No.  8,  Nashville,  Tennessee,  October  28th  ; sent  to  Hospital  No.  3, 
Imuisville,  Kentucky,  November  29th,  and,  on  the  following  day,  again  transferred  to  the  hospital  at  Quincy,  Illinois.  A portion 
of  both  tables  of  the  skull  had  been  removed  previous  to  his  admission  to  the  latter-  hospital.  Simple  dressings  and  full  diet 
were  ordered.  He  recovered  and  was  trausferr(‘d  to  the  Veteran  Reserve  Coi'ps  on  the  23d  of  March,  1864.  He  is  not  a 
pensioner.  Acting  Assistant  Surgeon  F.  K.  Baily  repoi-ts  the  case. 

Ca.se. — Sergeant  John  Reagan,  Co.  I.  37th  Wisconsin  Volunteers,  aged  .30  years,  was  wounded  near  Petersburg,  Virginia, 
•Tune  18th,  1864,  by  a coiroid.al  ball,  which  lacei-ated  the  scalp,  and  slightly  fractured  the  left  parietal  bone  irear  the  jirnction  of 
the  coronal  and  sagittal  sutures.  He  also  received  a gunshot  wound  of  the  leg.  He  was  admitted  to  the  hospital  of  the  3d 
division.  Ninth  Corps,  sent  to  City  Point,  Virginia,  and  thence  conveyed  per  Hospital  Steamer  Connecticut  to  Annapolis,  Mary- 
land, entering  1st  Division  Hospital  on  June  20th.  On  the  17th  of  August,  he  was  transferred  to  the  hospital  at  York,  Penn- 
sylvania, where,  on  the  following  day,  a small  piece  of  bone  was  removed.  'Ihe  wound  was  dressed  with  cold  water,  dud  in 
about  two  w'eeks  was  entirely  healed.  Spasms  occurring,  the  wound  was  reopened  with  a view  to  discover  the  cause,  but 
nothing  unusual  could  be  observed.  The  patient  was  furloughed  on  the  23d  of  September,  1864,  re  admitted  on  October  17th, 
and  remained  until  the  13th  of  March,  1865,  when  he  was  transferred  to  the  Veteran  Reserve  Corps.  [He  was  sent  to  the  Sol- 
diers’ Home,  at  Dayton,  Ohio,  and  committed  suicide,  May  21,  1873,  by  taking  arsenic.] 


EEMOVAL  OF  FEAGMEKTS  AFTEE  GUNSHOT  FEACTUEES  OF  THE  SKULL. 


221 


Case. — Corporal  J.  Y.  Sclianjlhie,  Co.  1,  51st  IVmisylvania  Volunteers,  was  wounded  at  the  battle  of  I’rederieksburg, 
Virginia,  December  IStli,  1862,  by  a piece  of  shell,  which  fractured  and  depressed  the  frontal  bone  to  the  left  of  the  median  line, 
near  the  coronal  suture.  He  fell  senseless,  but  consciousness  soon  returned,  when  he  was  conveyed  from  the  lield.  Ho  was 
taken  to  Washington,  and  entered  the  Judiciary  Square  Ilosjiital  on  the  l^tli,  where  coma  supervened.  During  the  evening  of 
the  same  day,  several  fragments  of  bone  were  removed  and  the  depressed  jiortions  elevated.  No  anesthetic  was  used.  The 
patienf  rallied  and  became  partially  sensible;  strabismus  disa]ipcared  before  morning.  On  the  second  day  after  the  operation, 
his  pulse  was  76,  appetite  fair,  but  the  mind  rather  slow.  On  the  1st  of  January,  186J,  he  was  a little  giddy  and  complained  of 
slight  headache,  but  was  otherwise  impioving  rapidly,  lie  was  transferred  to  the  Invalid  Corps  on  May  ITth,  186J.  He  is  not 
a pensioner. 

Case. — Erivate  Eeuben  Lysle,  Co.  1,  14Sth  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Chancellorsville, 
Virginia,  May  3d,  1863,  by  a piece  of  shell,  which  fractured  and  d('j>ressed  both  tables  of  the  cranium.  Surgeon  C.  S.  Wood, 
(>6th  New  York,  laid  open  the  scalp,  cxti  acted  the  loose  portions  of  the  bone,  and  elevated  the  de])ressed  parts.  The  brain, 
apparently,  was  not  injured.  ' For  scveial  weeks  he  was  treated  in  the  1st  division.  Second  Corps,  held  hospital,  and  on  June 
14th,  admitted  into  Carver  Hospital,  Washington.  On  the  ICth,  he  was  transferred  to  West’s  Building  Hospital,  Baltimore, 
and  thence,  on  July  4th,  to  the  general  hospital,  Point  Lookout,  Maryland.  He  recovered  and  was  transferred  to  the  Veteran 
Reserve  Corps,  June  28th,  1804.  The  case  is  reported  by  the  operator.  Surgeon  C.  S.  Wood,  C6th  New  YTrk.  The  i)atient’s 
naine  does  not  appear  upon  the  Pension  List. 

Case. — Private  Albert  Sobers,  Co.  B,  1st  Mhiuesota  Volunteers,  aged  20  years,  was  wounded  at  the  battle  of  Gettysburg, 
Pennsylvania,  July  2d,  1803,  by  a fragment  of  shell,  which  ti-actured  the  light  parietal  bone  near  the  vertex.  He  was  also 
struck  in  the  left  leg  by  a conoidal  ball,  which  entered  at  the  middle  third  upon  the  front  surface,  between  the  tibia  and  hbula, 
and  passed  directly  upward,  injuring  the  head  of  the  fibula,  whence  it  was  cut  out  by  a free  incision  at  the  outer  side  of  the  knee. 
He  was  admitted  to  the  Seminary  Hospital,  Gettysburg.  The  leg  began  to  swell  and  considerable  pus  formed  in  front  of  the 
semi-membranosus  along  the  outside  of  the  thigh.  On  July  6th,  the  ims  was  evacuated,  and  a gradual  improvement  took  jilace. 
On  July  18th,  he  was  sent  to  the  hospital  at  York,  Pennsylvania.  ’A  small  piece  of  boue  was  removed  from  the  cranium,  and 
from  the  aperture  left,  at  different  times,  small  portions  of  brain  exuded.  For  a few  days,  the  patient  suffered  from  dizziness ; 
but  the  wound  healed  kindly,  and,  in  December,  1863,  it  was  covered  with  scalp  and  hair.  The  wound  of  the  leg  had  also 
healed;  but  the  leg  was  somewhat  "weak  and  could  not  be  straightened.  He  was  transfei'red  to  the  Veteran  Reserve  Corps  on 
December  24th,  1863.  He  is  not  a pensioner.  The  case  is  reported  by  Acting  Assistant  Surgeon  H.  F.  Bowen. 

In  five  of  the  cases  of  the  foregoing  series  the  fractures  were  produced. by  shell 
fragments,  and  in  six,  by  musket  balls. 

The  names  of  six  of  the  patients  who  had  undergone  operations  for  the  removal  of 
detached  fragments  of  bone  after  depressed  gunshot  fractures  of  the  skull,  are  found  on 
the  Pension  Poll.  Three  of  these  pensioners  suffered  from  epileptiform  convulsions,  two 
from  dizziness  and  impaired  vision,  and  one  from  headache  and  nervousness  : 

Case. — Private  Sebastian  Langendorf,  Co.  H,  14th  Ohio  Volunteers,  aged  37  years,  was  wounded  at  Atlanta,  Georgia, 
August  Cth,  1864,  by  a conoidal  ball,  which  fractured  the  left  side  of  the  frontal  bone,  just  anterior  to  the  coronal  suture.  He 
was  at  once  admitted  to  the  hospital  of  the  3d  division.  Fourteenth  Corps,  thence  was  conveyed  to  Nashville,  Tennessee,  where 
he  entered  Hospital  No.  1,  on  the  17th.  The  brain  substance  was  exposed  to  view.  On  the  6th  of  October,  a circular  piece  of 
bone,  over  an  inch  in  diameter,  was  removed.  Simple  dressings  were  applied.  On  the  25th  of  November,  the  patient  was 
transferred  to  Evansville,  Indiana,  where  he  i-emained  until  the  Kith  of  January,  1865,  when  he  was  sent  to  Camj)  Dennison, 
Ohio.  He  was  linally  ti’ansferred  to  the  1st  Battalion,  Veteran  Reserve  Corps,  on  March  31st,  1865.  A.  M.  M.  Phot.  Series, 
Vh)l.  1,  page  6.  This  soldier  was  discharged  the  service  August  5th,  1865,  and  pensioned,  because  of  epilepsy.  On  November 
12tli,  1867,  I’ension  Examiner  Samuel  S.  Thorn  rates  his  disability  total  and  temporary. 

Case. — Sergeant  L.  E.  Claik,  Co.  E,  26th  Michigan  Volunteers,  aged  21  years,  was  wounded  near  Petersbuig,  Virginia, 
June  17th,  1864,  by  a conoidal  ball,  which  fractured  the  right  temporal  bone  two  inches  above  the  ear,  and  lodged.  He  was 
conveyed  to  the  hospital  of  the  1st  division.  Second  Corps,  and  remained  insensible  until  the  next  day,  when  the  ball  was 
exti'acted  and  sev’eral  fragments  of  boue  were  removed.  The  operation  gave  great  relief;  but  the  left  arm  and  leg  remained 
paralyzed  until  the  middle  of  July,  when  the  patient  recovered  the  use  of  the  leg,  and  jiartial  use  of  the  arm.  For  two  or  three 
days  after  the  removal  of  the  ball  he  was  almost  totally  blind;  but,  in  December,  his  vision  was  only  slightly  im])aired.  He 
was,  on  December  9th,  sent  to  Augur  Hospital,  Alexandria;  on  December  16th,  to  Armory  Square,  Washington,  and  on  I'ebruary 
20th,  1865,  to  Cliffburne  Barracks,  whence  he  was  transferred  to  the  Veteran  Reserve  Corps  on  M.arcli  25th,  1865.  Heyvas 
discharged  the  service  June  28th,  1865,  and  pensioned.  In  June,  1866,  Pension  Examiner  R.  C.  Hutton  reported  th.at  the  man 
needs  constant  watching  on  account  of  lo.ss  of  intellect,  and  of  frequejitly  recurring  spasms,  caused  by  compression  of  the  brain. 

C.V.SE. — Private  Alfred  Green,  Co.  H,  70th  I’ennsylvania  Volunteers,  aged  22  years,  was  wounded  at  Fort  Wagm'r,  S(juth 
Carolina,  July  llth,  1863,  by  a conoidal  musket  ball,  which  fractured  the  ti-ont.al  bone,  right  side.  Ho  Vvas  taken  i)i  isoner  and 
remained  in  the  hands  of  the  enemy  until  September  30lh,  when  he  was  admitted  to  the  2d  Division  Hospital  at  Annapolis, 
Maryland.  In  October,  he  was  transferred  to  I’hiladelphia,  where  he  arrived  at  the  Satterlce  Ilosjiital  on  the  25th.  Several 
small  spicuhe  of  bone  had  been  removed  from  time  to  time,  but  the  wound  was  nearly  healed,  leaving  a deep  scar.  On  January 
25th,  1864,  he  was  transferred  to  the  Veteran  Reserve  Corps,  and  was  discharged  Octolxu'  28th,  1864.  In  February,  1870, 
Pension  E.xaininer  A.  Davis  reported  that  the  man  is  subject  to  tie(pient  and  severe  convulsions  of  an  epileptic  character,  which 
occur  on  an  average  once  a week,  and  last  from  one-half  to  six  hours. 


222 


WOXTNDS  and  injuries  of  the  head, 


Cask. — Private  \V.  Kidder,  Co.  A,  iJd  Massacliiisetts  Volunteers,  aged  ‘23  years,  was  wounded  at  the  battle  of 

Gettsybnrg,  Pennsylvaniti,  July  2d,  1803,  by  a eonoidal  ball,  wliicli  fractured  both  tables  of  tbe  skull  without  causing  depression. 
He  ir  inained  in  tbe  Held  liospilal  until  the  18tb,  when  lie  was  transferred  to  tlie  hospital  at  York,  Pennsylvania,  He  so  far 
recovered  ii’oni  tbe  injury  that  be  was  transferred  to  the  1st  battalion.  Veteran  Reserve  Corps  on  the  24tb  of  December,  1803. 
He  was  discharged  July  25tli,  1804.  In  January,  1808,  Pension  Examiner  Nathan  Allen  reported  that  this  man  siifi'ers  from 
dizziness  and  loss  of  sight  upon  stooping  or  excitement. 

Cask. — Private  Elkanah  B.  Vondei’smith,  Co.  H,  88th  Illinois  Volunteers,  aged  39  j’ears,  was  wounded  at  Dallas,  Georgia, 
JMay  29th,  1804,  by  a eonoidal  ball,  which  fractuieil  the  outer  table  of  the  cranium  at  the  apex  and  lacerated  the  scalp  exten- 
sively. He  was,  on  the  following  day,  admitted  into  the  field  hospital  of  the  2d  division.  Fourth  Corps,  whence  he  was  trans- 
ferred to  Ack  worth,  Georgia,  on  the  8th  of  June.  Dn  the  17th,  he  entered  the  genei  al  field  hospital  "at  Chattanooga,  Tenne.ssee  ; 
was  transferred  on  the  ‘29th,  to  Eouisville,  Kentucky,  entering  Totten  Hosjiital  on  the  30th;  on  July  5th,  sent  to  Jefferson 
Barracks  Hosjiital,  Jlissouri,  and  on  the  ‘27th,  transferred  to  Quincy,  Illinois.  A small  jiiece  of  the  outer  table  of  the  skull  was 
removed  on  the  4th  of  August,  fsinijile  dressings  were  ajijdied,  and  full  diet  was  ordered.  The  wound  healed  rajiidlv;  and  by 
the  1st  of  January,  18C5,  it  had  entirely  closed.  The  jiatient’s  general  health  was  excellent;  but  he  could  not  endure  much 
fatigue,  lie  was  transferred  to  the  2d  battalion  of  the  Veteran  Reserve  Corjis  oii  the  13th  of  Eebriiary,  1805,  and  discharged 
from  the  service  July  15th,  1805,  and  jiensioned.  Pension  Examiner  A.  E.  Hand,  under  date  of  August  28th,  1805,  rejiorts  that 
the  man  is  unable  to  do  anything  by  reason  of  dizziness  and  blindness  on  stooping. 

Cask. — Private  A.  J.  AVilliainson,  Co.  C,  19th  Indiana  Volunteers,  aged  25  year.s,  received,  at  the  battle  of  Gettysburg, 
Pennsylvania,  July  1st,  1803,  a gunshot  injury  of  the  cranium.  The  missile  entered  at  the  vertex  and  made  an  ojiening  about 
three  inches  in  length.  The  bone,  ajipareutly,  was  not  injured.  He  was  admitted  to  the  hosjiital  of  the  1st  division.  First  Corps, 
and  on  July  7th,  sent  to  Mower  Hosjiital,  Philadeljihia.  On  July  8th,  the  wound  had  almost  healed ; the  granulations,  being 
somewhat  jirofuse,  were  touched  with  nitrate  of  silver.  Dn  August  "27th,  the  jiatieiit  comjilaiued  of  jiaiii  in  the  chest,  and  a blister 
was  ajijilied,  giving  relief.  ( )u  August  ‘lOtli  the  wound  ha'd  become  jiainful  and  discharged  more  freely  than  usual,  and  on  August 
31st,  a Jiiece  of  the  outer  table  of  the  skull,  almost  the  size  of  a thumb  nail,  was  removed.  The  wound  then  healed,  but  the  man 
comjilained  of  vei  tigo.  He  was  transferred  to  the  2d  battalion  Veteran  Re.serve  Corjis,  and  on  December  19tli,  18(i3,  sent  to 
liidianajiolis,  Indiana.  He  was  discharged  Ajiril  (ith,  18(J4,  and  jiensioned.  He  sullers  from  constant  headache  and  nervousness, 
and  his  disability  is  rated  total. 

Til  the  yixteeii  following  cases,  in  which  fragments  of  hone  were  removed  after  gun- 
shot fractures  of  the  skull,  the  patients  recovered  and  were  returned  to  duty  at  intervals 
at  Irom  one  to  twenty  months,  the  average  jieriod  of  treatment  in  hospital  being  seven 
and  oiie-half  months.  All  but  two  of  the  [)atients  were  under  thirty  years  of  age,  and  a 
majority  between  seventeen  and  twenty-five  years  of  age.  In  all  of  the  cases,  the  frac- 
tures were  on  the  upper  and  anterior,  or  else  on  the  superior  lateral  portions  of  the 
cranium  : 

Ai-GKI!,  Joskpii  E.,  Plivilte,  Co.  B,  35th  Iiiwa,  aged  17  years.  I’leasaiit  Hill,  Ajiril  9th,  18G4.  Fracture  at  vertex  by 
colloidal  musket  ball.  Gaj'oso  Hosjiital,  Memjibis.  Two  fragments  of  bone  removed.  Duty,  June  2d,  1804. 

An1)K1!S(I2s',  Samukl,  Private,  Co.  E,  11th  Pennsylvania,  aged  18  years.  Wilderness,  IMay  (ith,  1804.  Frontal  fractured 
by  colloidal  hall.  Mount  Pleasant  Hosjiital,  Washington.  In  May,  fragments  of  both  tables  removed.  Duty,  August  20th,  1804. 

Eki.miws,  Saimukk,  Private,  (hi.  A,  27th  Indiana,  aged  2‘2  years.  Gettysburg,  .July  3d,  1803.  Fracture  of  right  jiarietal 
by  colloidal  ball.  Mower  Hosjiital.  August  0th  and  9lh,  necrosed  bone  removed.  Duty,  May  3d,  1804. 

Eostki:,  Cai.kI!  R.,  Private,  Co.  B,  102d  Pennsylvania,  aged  17  years.  Wilderness,  May  5th,  1804.  Fracture  at  vertex 
by  eonoidal  ball.  I’inley  and  Satterlee  Hosjiitals.  Fragments  of  external  table  removed  June  17tli.  Duty,  lUarch  17th,  1805. 

HalloCK,  Hknkv  8.,  Pi'ivate,  Co.  F,  24th  Iowa.  Port  Gibson,  May  1st,  1803.  Gunshot  fraetiire  of  left  jiarietal.  Union 
Hosjiital,  IMenijiliis.  Removal  of  fragments,  July  1st.  Duty,  August  30th,  1803. 

FArottTJO,  Zkkiiamaii,  Private,  Co.  F,  ‘23d  Ohio,  aged  ‘27  years.  Autietam,  iSejitember  17th,  1802.  Fracture  of  frontal 
by  eonoidal  ball.  Frederick  and  Baltimore  hosjiitals.  Removal  of  fragments.  Retained  in  hosjiital  as  nurse.  Duty,  May 
10th,  1804. 

McC.vnn,  R.,  Quartermaster  Sergeant,  1st  Louisiana  Union  Volunteers.  Port  Hudson,  June  14th,  1803.  Gunshot 
fracture  of  left  jiarietal.  Regimental  hosjiital.  January  12tli,  1805,  removal  of  large  jiiece  of  jiarietal  bone  tbrough  crucial 
incision.  Duty,  I'ebruary  3d,  1805. 

Pkklks,  Jaimks  W.,  Private,  Co.  G,  150th  New  Yoik,  aged  ‘25  3'ears.  Winchester,  Sejitember  19th,  1804.  Gunshot 
fracture  of  jiarietal  bone  by  eonoidal  ball.  Samp’  Hook  and  York  hosjiitals.  Fragments  of  inner  table  removed,  October  5th, 
18(i4.  Duty,  December  14th,  1804. 

RoiKii,  Lkvi,  Private,  Co.  A,  143d  Pentusylvania,  aged  19  j-ears.  Petersburg,  June  17th,  1804.  Fracture  of  cranium  at 
vertex  by  eonoidal  musket  ball.  New  York  and  Philadeljihia  hosjiitals.  Several  fragments  of  bone  leinoved.  Duty,  February 
15th,  1805. 


EEMOVAL  OF  FRAGINIENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


223 


Rooney,  Mahtin,  Corpoml,  Co.  A,  119th  New  York,  aged  23  years.  Lost  Mountain,  June  15th,  18(14.  Fracture  of 
teiiiporal  bone  by  conoidal  innsket  ball.  Chattanooga,  Nashville,  and  New  Y’ork  hospitals.  August  12th  and  21th,  Ibnr  large 
fragments  of  bone  removed  by  incision.  Ihity,  November  21st,  1804. 

SK.vitS,  1>A\1I)  T.,  Private,  Co.  C,  llOth  ( )hio,  aged  35  years.  'Winchester,  September  19(h,  1804.  Gunshot  fracture  of 
cranium.  Field  and  Frederick  hospitals.  Fragments  of  loose  bone  removed,  lluty,  November  23d,  1804. 

Shinn,  FliANKLlN,  Private,  Co.  11,  23d  New  Jersey,  aged  21  yeaivs.  Fredericksburg,  December  13th,  1802.  Fracture 
of  parietal  bone  by  shell,  llarewood  and  Satterlee  Hospitals.  A thin  shell  of  bone  removed,  February  13th,  1803.  Duty, 
•hme  2d,  1803. 

Styles.  Geoi!GE  M.,  Sergeant,  Co.  K,  98th  Peim.sylvania.  aged  29  years.  Gettysburg,  July  2d,  1803.  Slight  fracture 
of  left  i)arietal  bong  by  conoidal  musket  ball,  llaltimore,  Annapolis,  and  Philadel[)hia  hospitals.  Removal  of  necrosed  bone 
thi-ougb  ci'ueial  incision  and  by  an  elevatoi’,  January  18th,  1804.  Duty,  March  lUth,  1804. 

AV1LLIA.M.S,  TTiosias,  Corpoial,  Co.  E,  102d  New  York  Volunteers,  aged  32  years.  Cane  River,  Louisiana,  Ajuil  23d, 
1804.  Gunshot  fracture  of  right  ])arietal.  Ilaton  Rouge  Hospital.  Fragment  of  external  table  removed  May  30th,  1804. 
Duty,  August  27th,  1804. 

WOGI),  TTioma.S  L.,  I’rivate,  Co.  G,  2d  New  York  Heavy  Artillery,  aged  18  years.  Petersburg,  June  10th,  1804.  Frac- 
ture of  left  parietal  by  conoidal  musket  ball.  City  I’oint  and  New  York  Hospitals.  Fragments  of  bone  and  ball  removed.  Duty, 
March  2d,  1805. 

YocUJI,  Heniiy,  I’rivate,  Co.  C,  150th  I’ennsylvania,  aged  24  years.  Gettysburg,  July  2d,  1803.  Gunshot  fracture  of 
frontal  bone  by  conoidal  musket  ball.  llarewood  and  Satterlee  Hospitals.  Fragments  of  bone  from  both  tables  removed. 
Duty,  January  25th,  1804. 

In  tlie  following  eleven  cases,  lielonging  to  the  class  under  consideration,  the  patients 
were  sent  to  inodihed  duty  in  hos})ital  or  garrison  ; hut  their  physical  disabilities 
ultiinatol}"  compelled  their  dischtirge  and  admission  to  the  I’ension  List.  Nearly  all  were 
young  soldiers,  the  ages  ranging  from  seventeen  to  twenty-seven  years.  The  fractures  were 
of  the  upper  fronttd,  tenpioral,  or  parietal  regions,  except  in  the  instance  of  one  fracture 
of  the  occi})ital.  The  fractures  were  produced  by  conoidal  halls  in  nine,  and  by  shell 
i'ragments  in  two,  of  this  scries  of  cases.  The  average  duration  of  hospital  treatment 
was  aljoiit  six  months : 

Dowty,  Aisneii  S.,  I’rivute,  Co.  R,  33d  Massachusetts,  aged  20  years.  Rusaca,  May  15th,  1864.  Fracture  of  left 
parietal  by  conoidal  hall.  Nashville  and  Louisville  hos))itals.  Duty,  September  9th,  1864.  Discharged  June  11th,  1865. 
E.xaminer  Foster  Hooper,  M.  D.,  reports.  May  21st,  1869,  that  a number  of  pieces  of  bone  have  been  removed,  leaving  a large 
cicatrl.x,  much  depressed,  and  that  the  man  is  subject  to  fits  anil  headache. 

Doyle,  James,  Private,  Co.  M,  24th  New  York  Cavalry,  aged  23  years.  Cold  Harbor,  Virginia,  June  Ist,  1864. 
Fracture  of  left  parietal  bone  by  conoidal  musket  ball.  Washington  and  Philadelphia  hospitals.  Duty,  February  7th,  1865. 
Mustered  out  July  23d,  1865.  E.xaminer  11.  W.  Loomis,  M.  D.,  January  20th,  1866,  states  that  several  pieces  of  bone  have 
been  removed.  The  right  ami  is  ]iartially,  and  the  right  leg  slightly,  paralyzed.  The  vision  of  both  eyes  is  imfiaired  and  he 
suffers  from  dizziness  and  pain. 

Gillem,  Eow.vud,  Captain,  Co.  G,  1.58th  New  York,  aged  26  years.  Hatcher's  Run,  Virginia,  March  29th,  1865. 
Fracture  at  verte-x  by  conoidal  b.all.  Point  of  Rocks  and  Fort  Monroe  hospitals.  Duty,  June  30th,  1865 ; discharged.  Examiner 
.lames  XT-ill,  M.  D.,  rejiorts,  August  2(1,  186.5,  that  a fragment  of  bone  has  been  removed  and  that  the  pensioner  is  subject  to 
hemiplegia  and  nervous  irritability. 

Golden,  P.vtjmck,  Private,  Co.  D,  2d  New  Y'^ork  Heavy  Artillery,  aged  27  years.  North  Anna  River,  May  18th,  1864. 
Fracture  of  frontid  bone,  with  e.xtensive  laceration  by  conoidal  ball.  AVashington  and  Philadelphia  hospitals.  June  19lh  and 
25th,  removal  of  fragments  of  bone  and  ball.  Duty,  Sei)tember  22d,  1864 ; dischaiged.  Examiner  11.15.  Day,  JM.  D.,  states 
that  the  sight  of  the  left  eye  is  impfu  feet.  In  September,  1869,  the  pensioner  filed  an  application  for  an  increase  of  pension. 

II.VNCOCK,  John  F.,  I’rivate,  Co.  F,  25th  Ohio,  Chancellorsville,  May  3d,  1863.  Fracture  of  parii-tal  bone  by  c(moidal  ball. 
Washington,  Philadelphia,  and  Covington  liospitals.  Duty,  December  1st,  1863;  discharged  July  26th,  1864.  Examiner  Julius 
Nichols,  M.  D.,  rejrorts  that  pieces  of  bone  have  been  removed,  that  the  hearing  is  imperfect,  and  that  the  pensioner  is  subject  to 
dizziness. 

Hays,  .James,  Cor|)oral,  Co.  D,  87th  New  Y'ork,  aged  23  years.  Fair  Oaks,  Ma_v31st,  1862.  Fracture  of  temi)oral  bone 
by  conoidal  ball.  R’ew  York  hospitals.  Ten  pieci-s  of  bone  removed  at  different  ixn-iods.  1 )uty,  February  26tb,  1863 ; discharged 
March  27th,  1863.  Examiner  D.  R.  Good,  M.  1).,  reports,  Alarch  21st,  1864,  that  e.xfoliation  is  still  going  on,  and  that  the  man 
is  suffering  from  incipient  jdithisis. 

.Johnson,  William  .1.,  Private,  Co.  A,  2d  New  York  Mounted  Rilles,  aged  17  years.  I’etersburg,  June  25th,  1864. 
Fracture  of  cranium,  right  side,  by  conoidal  musket  ball.  Washington  and  Philadel[)hia  hosi)itals.  Removal  of  large  fragment 
of  bone.  Duty,  .January  18th,  1865  ; discharged  August  10th,  1865.  Examiner  J.  II.  Uelmer,  M.  D.,  January  10th,  1867,  states 
that  the  pen.sioner  is  suffering  from  phthisis  pulmoualis,  and  that  his  disability  is  total. 


224 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Sticknky,  Wuxiam  11.,  Private,  Co.  B,  Clli  New  Hampshire,  aged  24  years.  Petersburg,  July  6th,  1864.  Fracture  of 
parietal  bone  at  vertex  by  couoidal  ball.  City  Point  and  Philadelphia  ho.spitals.  Removal  of  fragments  of  bone.  Duty,  October 
17th,  1864 ; mustered  out  November  27th,  1864.  Examiner  I’hiiicas  Spalding,  M.  D.,  May  15th,  1866,  states  that  the  ])ensioner 
is  afflicted  with  numbness  and  loss  of  action  in  aim,  that  he  suffers  almost  constant  [lain  in  the  head,  and  that  his  stomach  is  very 
irritable. 

SxuiiDEVANT,  Clakk,  Private,  Co.  E,  27th  New  York.  Chancellorsville,  May  3d,  1863.  Fracture  of  cranium  by  shell. 
Treated  in  Washington  hospitals.  Removal  of  loose  fragments  of  bone.  Duty,  August  11th,  1863;  discharged  May  31st,  1864. 
Examiner  J.  L.  Stewart,  M.  D.,  states  that  exercise  gives  evidences  of  pressure  on  the  brain. 

McCain,  William,  Private,  Co.  I),  63(f  Pennsylvania.  Gettysburg,  July  2d,  1863.  Fracture  of  cranium;  portion  of 
bone  carried  away  by  conoidal  ball.  Gettysburg,  Harrisburg,  and  Y'ork  hospitals.  Duty,  July  13th,  1864  ; discharged.  Exam- 
iner A.  B.  Otto,  M.  D.,  reports,  August  21st,  1865,  that  numerous  pieces  of  bone  have  been  removed;  that  the  sight  of  the  right 
eye  is  almost  entirely  destroyed,  and  the  left  sympathetically  affected. 

Smith,  Williaim  P.,  I’rivate,  Co.  B,  IHli  Vermont,  aged  23  years.  Newport  Bairacks,  February  2d,  1864.  Fracture  of 
occipital  bone.  Morehead  City  and  Burlington  hospital.«.  March  26th,  removal  of  piece  of  bone.  Duty,  Augu.st  1st,  1864; 
discharged.  Examiner  C'yrus  Porter,  M.  D.,  September  16lh,  1869,  states  that  there  is  partial  de-afness,  attended  with  dizziness 
and  headache. 

Nearly  all  of  these  patients  suffered  from  vertigo,  headache,  or  some  disorder  of  the 
cerebral  fimctions  ; one  had  epileptiform  convulsions  ; three  suflfered  from  paralysis  of  some 
of  the  motor  nerves;  two  were  deaf;  three  had  defective  vision,  and  two  were  laboring 
under  pulmonary  phthisis  at  the  date  of  the  last  report  of  the  pension  examiner. 

Discharged  and  Pensioned.- — Of  the  numerous  cases  reported  of  patients  who 
recovered  after  fragments  of  bone,  fractured  by  gunshot  projectiles,  had  been  removed, 
those  cases  in  which  the  names  of  the  patients  remain  on  the  Pension  Roll  will  first  be 
considered  ; 

Case. — Private  William  Angus,  Co.  E,  173d  New  York  Volunteers,  aged  42  years,  was  wounded  at  Port  Hudson, 
Louisiana,  June  14th,  1863,  by  a conoidal  ball,  which  comminuted  and  depressed  the  right  parietal  bone.  He  was  conveyed  to 

New  Orleans,  and  entered  University  Hospital  on  June  17th. 
Assistant  Surgeon  P.  S.  Conner,  U.  S.  A.,  removed  nine  frag- 
ments of  bone  from  the  wound.  The  fracture  was  situated 
immediately  superior  and  anterior  to  the  right  parietal  emi- 
nence, and  was  an  inch  and  a half  by  three-fourths  of  an  inch 
in  extent,  tlie  dura  mater  being  uninjured.  The  left  side  of  the 
body  became  paralyzed.  However,  this  disappeared  a few 
days  after  the  operation,  and  the  patient  so  far  recovered  that 
he  was  placed  on  duty  in  the  hospital  as  a nurse.  On  June 
1st,  1864,  he  was  transferred  to  the  Clentral  Park  Hospital, 
New  York,  and  on  June  16th,  1864,  he  was  discharged  fi’om 
the  service.  The  wound  of  the  scalp  was  then  pei-fectly 
healed,  with  an  hiatus  in  the  bony  covering  of  the  brain  one 
and  one-fourth  by  three-fourths  of  an  inch  in  extent,  closed, 
apparently,  by  a tough  membranous  septum.  The  fragments 
removed  are  outlined  in  the  adjacent  wood-cut,  (Flli.  112.)  This  patient  was  reported,  in  1871,  as  pensioned  because  of  mental 
imbecility  and  general  debility. 

Case. — Captain  Winfield  S.  Barr,  Co.  B,  105th  Pennsylvania  Volunteers,  aged  23  years,  was  wounded  in  an  engage- 
ment before  Petersburg,  Virginia,  August  16th,  1864,  by  a conoidal  ball,  which  fractured  the  mastoid  process  of  the  temporal 
bone,  and  injured  the  base  of  the  occiiiital.  He  was  admitted  to  the  hospital  of  the  3d  division.  Second  Corps,  and  thence 
was  sent  to  the  Satterlee  Hospital.  On  admission,  August  20th,  the  patient  was  delirious,  and  the  wound  had  an  unhealthy 
aspect.  On  August  23d,  haemorrhage  to  the  amount  of  eight  ounces  occurred  from  the  posterior  auricular  and  some  of  the 
small  deep  cervical  branches.  This  bleeding  was  arrested  by  styptics,  compress,  and  roller.  On  the  following  day  luemoi'rhage 
recurred,  and  about  five  ounces  of  blood  was  lost.  From  that  time  the  case  progressed  favorably.  On  December  7th,  several 
spiculae  of  neci-osed  bone  came  away,  and,  on  December  30th,  a large  portion  of  the  mastoid  process  was  removed.  On  January 
19th,  1865,  Captain  Barr  was  transfeiTcd  to  the  Officers’  Hospital,  Philadelphia,  and  thence  mustered  out  of  the  service.  On 
Jlay  15th,  1865,  he  was  a pensioner,  and  his  disability  was  rated  as  total  and  permanent. 

Case. — Private  Freeman  Behymer,  Co.  A,  104th  Ohio  Volunteers,  aged  37  years,  was  wounded  at  the  battle  of  Franklin, 
Tennessee,  November  29th,  1864,  by  a conoidal  ball,  w'hich  fractured  the  parietal  and  frontal  bones  at  the  junction  of  the  sagittal 
and  coronal  sutures'.  He  was  admitted  on  the  following  day  to  hospital  No.  8,  Nashville,  where  he  remained  until  December 
9th,  when  he  was  transferred  to  the  Joe  Holt  Hospital,  Jeffei’sonville,  Indiana.  On  December  20th,  he  was  sent  to  the  Camp 


REMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


225 


Dennison  Hosi)ital,  Ohio.  On  May  (ith,  18o5,  the  parts  had  heconie  infianied,  painful,  and  suppurating.  Tlie  patient  was 
chloroformed,  when  Surgeon  Clark  McDermont,  U.  S.  V.,  made  a slight  incision  through  the  integument,  and  removed  a loose, 
irregular-shaped  piece  of  dead  bone  two  and  a quarter  inches  long  and  two  inches  wide.  Glycerine  dressings  were  applied.  The 
case  progressed  favorably,  granulations  being  abundant  and  healthy,  and  on  October  31st,  1835,  the  man  was  discharged  from 
the  service.  A communication  from  the  Commissioner  of  Pensions,  dated  July,  1808,  states  that  Behymer  is  a pensioner,  and 
that  his  disability  is  rated  total  and  permanent. 

Case. — Private  Emanuel  Brown,  Co.  I,  4th  Rhode  Island  Volunteers,  was  wounded  in  an  engagement  near  Petersburg, 
Virginia,  July  30th,  1831,  by  a conoidal  ball,  which  fractured  the  cranium.  He  was  admitted  into  the  field  hospital  of  the  2d 
division.  Ninth  Army  Corps,  where  fragments  of  bone  were  removed,  and  on  August  5th  he  was  transferred  to  Knight  Hospital, 
New  Haven,  Connecticut,  whence  he  was  discharged  from  the  service  on  October  2Gth,  1864,  by  reason  of  expiration  of  term  of  > 
service.  There  is  a water  color  drawing  of  the  recent  wound  in  the  Army  Medical  Museum.  In  March,  1868,  Brown  was  a 
pensioner,  his  disability  being  rated  total  and  permanent.  Pension  Examiner  Henry  Wheaton  Rivers,  formerly  Surgeon  4th 
Rhode  Island  Volunteers,  reported  that  there  was  an  opening,  closed  by  fibrous  tissue,  between  the  bones  of  the  frontal  and  pari- 
etal regions,  of  an  inch  in  w'idth  and  about  two  inches  in  length.  “He  has  pain,  dizziness,  defective  vision,  and  deafness  in  left 
ear.  The  present  disability  is  total  and  permanent.  The  disability  is  not  caused  by  any  fault  of  his  own.” 

Case. — Second  Lieutenant  Isaac  Branson,  Co.  E,  19th  Indiana  Volunteers,  aged  28  years,  was  wounded  at  the  battle  of 
South  Mountain,  September  14th,  1802,  by  a round  musket  ball,  which  entered  the  mastoid  portion  of  the  left  temporal  bone 
about  one  and  a half  inches  above  and  behind  the  meatus  auditorius  externus,  and  lodged.  After  remaining  insensible  for  a few 
minutes,  he  attempted  to  rise,  but  being  unable  to  control  his  limbs,  he  would  constantly  stumble  and  fall.  He  states  that  he 
introduced  his  little  finger  into  the  wound  for  more  than  an  inch,  and  could  feel  the  brain  substance.  Spiculm  of  bone  were 
removed.  On  September  loth,  he  was  sent  to  the  hospital  at  Frederick,  and  thence  was  transferred,  on  September  19th,  to  the 
Patent  Otfice  Hospital  at  Washington.  The  wound  being  very  painful,  he  did  not  wish  to  have  it  probed,  and  therefore  did  not 
tell  the  attending  surgeon  that  the  ball  remained  in  the  wound.  Simple  dressings  were  applied.  For  several  weeks  he  stag- 
gered and  had  fever,  but  never  was  delirious.  Spiculm  of  bone  continued  to  come  away  for  some  tveeks,  but  the  wound  healed 
gradually,  and  on  October  3d  the  patient  was  sent  to  New  York.  He  was  afterward  returned  to  his  regiment,  and  mustered  out 
on  October  23th,  1834.  He  was  e.xamined  on  March  29th,  1833,  by  Dr.  G.  W.  II.  Kemper.  A prominent  scar  marks  the  entrance 
of  the  ball,  which,  according  to  the  patient's  belief,  remains  in  the  cranium.  He  is  subject  to  headache  in  the  back  part  of  the 
head.  His  intellect  does  not  seem  to  be  impaired.  On  October  7th,  1837,  Pension  Examiner  J.  C.  Helm  reports  the  patient  as 
nearly  unfit  for  any  business,  owing  to  vertigo,  headache,  and  dizziness.  Pie  rates  his  disability  as  total  and  permanent. 

Case. — Private  Reuben  Clark,  Co.  II,  31st  Maine  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of  Petersburg, 
Virginia,  April  2d,  1835,  by  a fiagment  of  shell,  which  struck  near  the  anterior  superior  angle  of  the  right  parietal  bone,  pro- 
ducing a fissure  one  and  one-half  inches  in  length,  denuding  the  bone  of  the  periosteum,  and  slightly  depressing  the  external 
table.  He  was  admitted  into  the  general  field  hospital  of  the  Ninth  Army  Corps  on  the  same  day,  and  a few  days  later  sent  to 
Washington,  and  admitted  on  the  5th  into  the  Carver  Hospital.  On  the  8th,  the  patient  was  transferred  to  the  Mower  Hospital 
at  Philadelphia.  -Simple  dressings  were  used.  On  the  13th,  prominent  cerebral  symptoms,  with  pain  in  the  head  and  high  fever, 
were  ushered  in  by  a chill.  Cathartics  were  administered,  and  cold  water  a))plied  to  the  head.  Small  doses  of  calomel  and 
opium  were  given  for  a few  days  afterward.  Some  small  pieces  of  necrosed  bone  were  subsequently  removed.  On  June  15th, 
1835,  he  was  discharged  the  service.  The  case  is  reported  by  Acting  Assistant  Surgeon  W.  P.  Moon.  In  August,  1836,  Pension 
Examiner  James  C.  Weston  reports  that  this  pensioner  is  sometimes  subject  to  dizziness,  especially  on  stooping,  and  that  his 
eyes  fill  with  tears  when  reading.  His  disability  is  rated  one-half. 

Case. — Private  Edward  W.  Hawkins,  Co.  E,  28th  U.  S.  Colored  Troops,  was  wounded  near  the  Chickahominy,  Vir- 
ginia, June  25th,  1834,  by  a conoidal  ball,  which  apparently  injured  the  scalp  only.  He  was  admitted  on  June  28th  to  L’Ouver- 
ture  Hospital,  Ale.xandria,  and  returned  to  duty  July  18,  1884.  On  August  17th,  he  was  admitted  to  Satterlee  Hospital,  where 
the  case  was  diagnosticated  a fracture  of  the  cranium.  The  records  also  state  that  the  patient’s  skull  had  been  operated  upon,  at 
the  time  of  injury,  by  the  removal  of  detached  fragments.  He  was  suffering  from  chronic  diarrhoea,  which  gradually  amended 
under  treatment.  On  September  29th,  he  was  sent  to  Summit  House  Hospital;  on  March  29th  to  Beverly;  and  on  May  12th  to 
Whitehall,  where  he  was  discharged  the  service  May  2Gth,  1865.  On  September  26th,  1868,  Pension  Examiner  W.  D.  Thomas 
states  that  the  patient  complained  of  inability  to  labor  because  of  vertigo  and  intense  pain  in  the  head.  He  rated  his  disability 
at  one-half  and  temporary. 

Case. — Lieutenant  A.  G.  Williams,  Co.  E,  63d  Pennsylvania  Volunteers,  received,  at  the  battle  of  the  Wilderness,  Vir- 
ginia, May  5th,  1834,  a gunshot  fracture,  with  depression  of  the  frontal  bone,  left  side;  also  a wound  of  the  temple;  the  occipito- 
frontalis muscle  was  severed.  He  was  admitted  to  the  hospital  of  the  2d  division.  Sixth  Corps,  where  the  depressed  portions  of 
bone  were  removed;  thence  he  was  conveyed  to  Washington,  D.  C.,  and  there  attended  in  his  quarters  until  May  18th,  when  he 
was  furloughed.  He  reported  at  the  Otlicers’  Hospital  at  Annapolis,  Maryland,  on  July  27th,  and  on  August  9th  was  discharged 
from  the  service  by  re.ason  of  Special  Order  No.  261,  A.  G.  O.,  August  6th,  1884.  He  subsequently  made  application  for  a pen- 
sion, and  was  examined  by  G.  McCook,  examining  surgeon  for  pensions,  Pittsburgh,  Pennsylvania,  who  reported  that  the  third 
pair  of  nerves  were  affected.  His  disability  is  rated  at  one-fourth  and  permanent. 

Case. — Private  Walter  Wheeler,  Co.  B,  91st  New  York  Volunteers,  aged  37  years,  was  wounded  before  Petersburg,  Vir- 
ginia, April  Isf.,  1835,  by  a conoidal  ball,  which  entered  above  the  anterior  zygomatic  articulation,  fractured  and  depressed  the 
temporal  bone,  and  emerged  just  above  the  external  meatus,  right  side.  He  was  conveyed  to  the  depot  field  hospital  of  the  Fifth 
Army  Corps,  where  he  remained  until  the  18th,  when  he  was  sent  to  Washington,  and  admitted  into  the  Harewood  Hospital  on 
the  19th.  Three  days  later  he  had  a slight  hemorrhage  from  the  common  temporal  artery,  which  was  ligated.  The  wounds  of 

29 


226 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


entrance  and  of  exit  'were  eonnnunicated,  wlien  it  was  found  tliat  a small  |>ortiou  of  bone  at  tlie  point  of  exit  was  denuded  of  pericra- 
nium. Snbsecjuently  the  ibmuded  ])ortio7i  was  removed.  By  June  I7tb  Wheeler  bad  fully  recovered,  and  on  June ‘JOtb,  1S65, 
was  discharged  from  tlie  service.  In  July,  1838,  be  was  a pensioner,  bis  disability  being  rated  as  total  and  permanent.  Pboto- 
graplis  of  the  case  will  be  found  in  Vduine  VII,  I’bot.  Series  A.  M.  1\I. 

C.\SE. — Corporal  Ezra  Scarborough,  Co.  G,  loth  New'  .lersey  Volunteers,  aged  84  years,  was  wounded  at  the  battle  of 
Cbancellorsville,  Vii'ginia,  Jlay  3d,  18C3,  by  a musket  ball,  'wliicb  fractured  and  depressed  a portion  of  both  tables  of  the  right 
parietal  bone  near  the  vertex.  He  was  sent  to  a field  hospital ; thence  to  Washington,  and  was  admitted  into  Stanton  Hospital, 
May  8th.  The  left  ui)per  and  lower  exti’cnnties  wei'e  paralyzed,  except  the  fingers  of  the  left  hand,  which  could  be  slightly 
flexed.  The  paralysis  was  limited  to  the  motor  nerves,  those  of  sensation  being  unaffected.  He  complained  of  headache,  and 
there  w'as  some  confusion  of  intellect,  though  no  delirium.  The  j)upils  were  contracted  and  .symmetrical, 
but  sluggish  to  stimulus  of  light.  The  skin  was  soft,  moist,  and  natui'al  in  temperature.  Water  dressings 
and  ice  were  aiiplied  to  the  wound,  a saline  purgative  w'as  administei’ed,  and  low  diet  was  ordered.  The 
case  progressed  favor.ably,  and  on  the  10th,  the  patient  could  flex  the  left  elbow.  The  pupils  were  still 
contracted  and  sluggish,  the  pulse  ranging  from  G.5  to  70.  By  the  25th,  the  patient  had  recovered  control 
of  the  left  arm,  though  it  was  not  yet  as  strong  as  the  right;  the  pu])ils  were  still  sluggish,  but  not  con- 
tracted; the  detached  bone  appeared  elevated.  On  .Tune  7th,  a detached  fragment  of  the  inner  table,  one 
inch  in  length  and  h.alf  an  inch  in  width,  was  removed  by  Surgeon  John  A.  Lidell,  U.  S.  V.  It  consisted 
of  diploe  and  the  vitreous  table,  and  when  I’emoved,  the  dura  mater  and  the  i)ulsations  of  the  brain  were 
distinctly  visible.  Tbo  ])upils  had  become  natural  in  size,  contracting  readily  under  the  stimulus  of  light; 
the  wound  suppurated  freely  and  looked  healthy,  having  slightly  contracted.  The  applications  of  ice  were 
now  discontinued.  On  the  12th,  the  pulse  had  risen  from  65  to  80 ; paralysis  of  left  leg  had  diminished  in 
a marked  degree.  June  24th,  pai’alysis  was  still  diminishing,  but  the  patient  still  complained  of  headache  induced  by  constipa- 
tion. .Tuly  8th,  the  brain  pulsations  were  no  longer  visible,  the  patient  was  able  to  leave  his  bed,  and  on  August  1st,  could  walk 
with  the  aid  of  a cane.  He  continued  to  improve  rapidly,  and  on  the  17th,  had  recovered  sufficiently  to'  go  home  on  fuilough. 
He  was  transferred  to  Ward  Hospital,  Newark,  New  Jersey,  on  November  13th,  1863,  and  was  discharged  the  service  on  Decem- 
ber 11th,  1863,  and  pensioned.  On  June  6th,  1853,  Pension  Examiner  E.  Swift  reports  that  a deep  depression  existed  over  the 
ci’iginal  seat  of  in  jury.  There  wars  pai’alysis  of  the  left  side,  mon?  marked  in  the  leg  than  in  the  arm.  The  limbs  were  atrophied 
and  weak,  although  they  preserved  their  natural  movements.  The  patient  suffered  a great  deal  from  headache  and  from  severe 
pain  in  the  affected  limbs.  His  speech  was  much  impaired,  and  he  was  unable  to  do  manual  labor.  His  disability  was  then 
rated  total  and  perm.anent.  A communication  from  the  Commissioner  of  Pensions,  dated  January  3d,  1868,  states  that  Scarbor- 
ough was  a pensioner,  his  disability  being  rated  total  and  temporaiy. 

Case.— Sergeant  William  Dougherty,  Co.  G,  101st  Pennsj'lvania  Volunteers,  aged  34  years,  was  wounded  at  Plymouth, 
North  Carolina,  A])ril  20th,  1834,  by  a conoidal  ball,  which  fractured  the  left  parietal.  A portion  of  the  bone,  two  inches  in  length 
and  one  inch  in  breadth,  was  subsequently  extracted,  leaving  the  dura  mater  exposed.  He  ■was  taken  prisoner,  and  upon  being 
exchanged  was  sent  to  Annapolis,  entering  the  1st  division  hospital  on  October  20th,  1864,  suffering  from  partiid  hemiplegia. 
He  was  ftuloughed  on  the  4th  of  November,  and,  at  the  expiration  of  his  le.ave,  November  22d,  entered  the  hospital  at  Pittsburgh, 
Pennsylvania,  where  he  was  discharged  the  service  on  Februaiy  10th,  1865.  He  subsequently  applied  for  a pension,  and  was 
examined  by  Dr.  G.  McCook,  E.xamining  Surgeon  for  Pensions,  Pittsburgh,  Pennsylvania,  who  rei)orts  that  there  were  substan- 
tial granulations  from  the  dura  mater.  In  1838,  Dougherty  w'as  a pensioner,  his  disability  being  rated  total  and  tempoi’ary.  On 
July  28th,  1839,  I’ension  Examiner  P.  B.  Rice  reports  pai  tial  paralysis  of  the  left  side,  and  rates  his  disability  permanent. 

Case. — Private  Horace  G.  Conant,  Co.  D,  1st  Ohio  V<dunteers,  aged  21  years,  was  wounded  at  Mission  Ridge,  Tennessee, 
November  25th,  ISnii,  by  a shell,  which  fractured  the  occipital  bone.  He  ■was  conveyed  to  Chattanooga,  Tennessee,  and  admitted 
to  Hospital  No,  5,  on  the  6th  of  December.  Eurloughed  on  the  23th  of  January,  he  was,  on  his  return,  March  25th,  admitted  to 
the  hospital  at  Cleveland,  Ohio,  and  disch.arged  the  service  on  the  24th  of  June,  1834.  A portion  of  the  external  table  of  the 
occipital  bone  had  been  removed,  but  the  [dace  and  date  of  the  operation  are  not  ascertained.  On  May  5th,  186.5,  Pension  Exam- 
iner D.  E.  Alsdorf  reported  both  tables  of  the  bone  absent,  and  the  wound  but  recently  closed.  Active  exercise  causes  severe 
pain  over  the  right  eye  and  dull  pain  at  the  seat  of  injury.  The  left  arm  is  jiaralyzed.  He  rates  his  disability  three-fourths  and 
temporary. 

C.t.SE. — Private  .Josiah  Reed,  Co.  E,  148th  New  York  Volunteers,  aged  39  years,  was  wounded  at  the  battle  of  Cold  Har- 
bor, Virginia,  .June  3d,  1834,  by  a conoidal  ball,  which  fractured  and  depressed  the  posterior  supeilor  angle  of  the  right  parietal 
bone.  He  was  admitted  to  the  held  hospital.  Eighteenth  Corps,  on  the  same  day;  sent  to  St.  Paul’s  Church  Hospital,  Alexan- 
dria, Virginia,  on  the  8th,  and  thence  transferred  to  the  Cuyler  Hospital,  Germantown,  Pennsylvania,  on  the  13th.  He  suffered 
from  headache  without  stupor  or  delirium;  partial  paralysis  of  the  left  foot  and  leg  existed,  and  the  tongue  was  drawn  toward 
the  left  side.  These  .synqjtoms  continued  without  any  change,  except  a gradual  dinunution  of  the  par.'dysis  until  the  beginning 
of  .July,  when  increased  dullness  and  hebetude  and  a decided  icteroid  tinge  over  the  whole  body,  rendered  the  ])i'ognosis  more 
serious.  On  July  2d,  the  soft  parts  were  divided,  the  seat  of  fracture  ex])osed  and  all  sequestra  removed.  One  spicula  measured 
an  inch  in  length  by  half  an  inch  in  width,  involving  both  tables.  Considerable  fetid  pus  flowed  from  the  wound.  The  dura 
mater  was  covered  with  healthy  granulations.  The  patient  was  kept  in  bed  with  his  head  elevated;  cold  applications  wore  made 
to  the  wound,  and  an  occasional  mercurial  and  saline  cathartic  was  administered.  By  September  30th,  the  wound  had  entirtdy 
healed.  No  cerebral  symptoms  appeared  during  the  treatment.  On  May  10th,  1835,  he  was  sent  to  the  Mower  Ilosjiital,  Phila- 
delphia, and  on  the  16th,  was  tramsferred  to  the  Veteran  Re.sBrve  Corps.  The  case  is  reported  by  Assistant  Surgeon  II.  S.  Schell, 
U.  S.  A.  This  soldier  was  discharged  the  service  July  10th,  1835,  and  pensioned.  On  February  13th,  1836,  Pension  Examiner 
R.  C.  Bardwell  reports  that  the  man  suffered  from  partial  hemiplegia  of  the  left  side,  with  confusion  of  ideas,  loss  of  memory, 
etc.  He  rated  his  disability  one-half  and  temporaiy. 


Fig.  11;3. — Fragment 
removed  from  right 
parietal  after  guusliot 
fracture.  Spec.  16ti(!, 
Sect.  I,  A.  M.  M. 


REMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


227 


Q^vsE. — ITivate  Janies  H.  Quiniby,  Battery  L,  1st  Maine  Heavy  Artillery,  aged  21  years,  was  wounded  at  .S|)oltsylvania 
Court-house,  May  l&th,  183-1,  by  a conoidal  musket  ball,  which  penetrated  the  outer  table  of  the  left  temporal  bone,  passed 
downward  and  chipped  off  a portion  of  the  mastoid  process.  Another  ball  entered  beneath  the  left  clavicle,  injuring  the  apex 
of  the  left  lung,  and  passed  out  at  the  axilla.  He  remained  on  the  battle-fiehl  three  days  without  attendance  ; was  then  removed 
to  Fredericksburg,  Virginia  ; thence  sent  to  the  Columbian  Hospital  at  Washington  on  May  28th,  and  was  furloughed  .Tune  12th, 
1884.  He  was  treated  at  his  home  by  Pension  E.xaminer  E.  Russell.  Simjde  dressings  and  expectant  treatment  were  used. 
On  .July  23d,  a piece  of  the  outer  table  of  the  temporal  bone,  about  three-fourths  by  one-half  inch  in  size,  was  removed.  After 
the  operation,  the  patient  slowly  recovered.  On  August  4th,  1884,  he  was  admitted  to  the  Cony  Hospital  at  Augusta,  Maine ; 
on  February  18th,  1865,  was  transferred  to  the  Veteran  Reserve  Corps  ; and  on  June  10th,  1865,  was  discharged  the  service  and 
pensioned.  At  this  date  the  wound  had  healed,  but  active  exercise  caused  dyspnoea.  Subsefpient  information  from  Pension 
Examiner  J.  B.  Bell  states  that  the  patient  suffered  from  deafness,  heatlache,  vertigo,  and  paralysis  of  arm.  He  was  unable  to 
bear  exposim?  to  heat.  His  disability  is  rated  total  and  permanent. 

Case. — Sergeant  Allen  C.  Taylor,  Co.  B,  7th  New  Hampshire  Volunteers,  aged  23  years,  was  wounded  before  Petereburg, 
Virginia,  May  9th,  1864,  by  a conoidal  musket  ball,  which  struck  the  left  parietal  bone,  passed  backward  parallel  with  the 
sagittal  suture,  produced  a furrow  in  the  scalp  of  four  or  five  inches  in  length,  and  involved  the  bone  for  the  same  distance.  Ho 
was  admitted  to  the  Hampton  Hospital  on  May  11th,  and,  in  a few  days,  sent  by  .steamer  to  the  Central  Park  Hospital,  New 
York,  where  he  arrived  on  the  23d  of  the  month.  The  wound  was  ragged  in  appearance  and  tumefied  ; the  bone  was  bared  and 
burrowed.  There  was  no  evidence  of  compression,  and  the  pulse  was  full.  On  the  27th,  the  tumefaction  had  involved  the  right 
eye,  .and  a sluggish  movement  of  the  pupils  was  observed,  the  patient  feeling  dull.  The  wound  all  this  time  was  painful  and 
emitting  an  unhealthy  discharge.  Upon  a thorough  examination  of  the  parts,  pieces  of  the  missile  were  found  impacted  in  the 
outer  table.  Poultices  were  now  applied  to  the  head,  and  on  June  17th  Acting  Assistant  Surgeon  George  E.  Shrady  removed  an 
irregular  depressed  portion  of  the  external  table,  which  lunl  Ijecome  detached,  measuring  three-fourths  of  an  inch  by  one  and 
a half  inches.  Three  days  later,  a portion  of  the  vitreous  table,  one-half  by  three-fourths  of  an  inch,  came  away.  On  the  25th, 
again  several  fragments  of  the  outer  table  were  removed,  and  on  the  5th  of  July  another  portion  of  the  inner  table,  in  which 
was  imbedded  a good-sized  piece  of  the  missile.  Spiculfc  of  bone  and  jiieces  of  lead  were  afterward  extracted  at  different 
periods.  The  patient  experienced  a good  deal  of  pain  in  the  head,  and  the  occurrence  of  a fungus  cerebri  was  a])prehended, 
the  pulsations  of  the  brain  being  visible.  The  dura  mater  was  uninjured,  and  the  discharge  from  the  wound  was  free  and 
healthy.  The  patient  recovered  rapidly,  and  w.as  discharged  from  service  on  November  21st,  1864,  being,  at  the  time,  in  the 
full  possession  of  his  mental  powers  and  a good  degree  of  strength.  The  case  is  reported  by  Surgeon  B.  A.  Clements,  U.  S.  A. 
In  1869  Taylor  was  a pensioner,  his  disability  being  rated  at  three-fourths.  Pension  Examiner  W.  D.  Buck  reports  that  this 
pensioner  has  partial  paralysis  of  the  left  arm,  and  vertigo,  and  that  there  is  a depression  half  an  inch  deep  at  the  upper 
anterior  angle  of  the  left  parietal. 

C.VSE. — Private  M.  R.  Armour,  Co.  E,  83d  Pennsjdvania  Volunteers,  was  wounded  at  the  battle  of  Gaines's  Mill,  Vii’ginia, 
June  27th,  1832,  by  a conoidal  ball,  which  fractured  the  right  parietal  bone.  He  remained  in  the  field  hospital  until  .July  29th, 
when  he  was  sent  to  Chester,  Pennsylvania,  and  thence,  on  September  18th,  to  the  Sixteenth  and  Filbert  Streets  Hospital, 
Philadelphia.  Acting  Assistant  Surgeon  1j.  Fassitt  removed  a portion  of  the  fractured  bone  about  one  inch  long  and  one-third 
of  an  inch  wide.  Simple  dressings  were  applied  to  the  wound.  The  patient  i-ecovered,  and  was  discharged  from  service  on 
November  23th,  1832.  He  could  not  bear  exposure  to  the  sun,  and  his  left  hand  was  partially  paralyzed.  The  Commissioner 
of  Pensions  states  that  in  March,  1863,  Armour's  disability  was  rated  “one-half  and  temporary.”  The  case  is  rejioi’ted  by  Acting 
Assistant  Surgeon  Richard  J.  Dunglison. 

Case. — Privsite  David  K.  I’illsbury,  Co.  E,  12th  New  Hampshire  Volunteers,  receivi'd,  at  the  battle  of  Chancellorsville, 
Virginia,  Jlay  3d,  1833,  a gunshot  fracture  of  the  left  parietal  bone  at  its  j oslerior  superior  aspect.  He  was  admitted  to  field 
hos|)ital  Third  Corps;  on  June  14th,  sent  "to  1st  division  hospital,  Alexandria ; and  on  June  19th,  to  Satterh'e  Hos])ital, 
I’hiladelphia.  There  was  constant  cephalalgia  and  di.zziness.  A piece  of  bone  from  the  outer  table,  three-fourths  by  three-eighths 
of  an  inch,  was  detached.  On  .July  23th,  the  patient  was  sent  to  Concord,  New  Hamp.shire.  Bone  had  exfoliated  ; hc.adache, 
nausea,  and  p.artial  paralysis  of  arms  and  legs  existed,  and  the  patient  was  greatly  enfeebled.  He  was  discharged  September 
4th,  1863,  and  pensioned,  his  disability  being  rated  three-fourths  and  doubtful. 

Ca.se. — Private  Adam  W.  Zimmerman,  Co.  B,  184th  Pennsylvania  Volunteers,  aged  30  years,  was  wounded  at  the  battle 
of  Petersburg,  Virginia,  June  22d,  1834,  upon  the  left  side  of  the  head,  near  the  sagittal  .suture,  by  a conoidal  musket  ball, 
which  jiassed  directly  backward,  tearing  uj)  the  seal])  and  fracturing  the  ])arietal  bone.  He  was  immediately  admitted  to  the 
hospital  of  the  Second  Corps,  and  thence  conveyed  to  Alexandri.u,  and  admitted  on  July  4th  into  the  2d  division  hosi)ital.  On 
July  13th,  he  was  transferred  to  the  Broad  and  Cherry  Streets  Hospital  at  Philadelphia.  Soon  after,  a fi’agment  of  bone, 
measuring  one  and  one-fourth  inches  in  length  by  three-fourths  in  width,  was  removed.  On  July  18th,  he  was  sent  to  the  Summit 
House  Hospital,  and  thence,  on  August  24th,  transferred  to  the  Satterlee  Hospital,  where,  on  October  20th,  another  piece  of 
bone  of  nearly  the  same  size,  including  a i)ortion  of  the  inner  table  three-fourths  of  an  inch  in  diameter,  was  removed.  An 
extensive  incision  of  the  scalp  was  now  made  to  secure  a ready  discharge  of  juis.  Other  small  scales  of  bone  were  removed  as 
they  became  detached;  otherwise  the  case  progres.sed  satisfactorily.  The  wound  had  fully  cicatrized  by  the  middle  of  March, 
1865,  and  the  i)atient  was  discharged  from  service  on  May  6th,  1835.  The  case  is  reported  by  Surgeon  Isaac  1.  Hayes,  U.  S.  V. 
In  1839,  he  was  a pensioner,  his  di.sability  being  rated  permanent.  'J'he  right  arm  and  leg  were  ])artially  paralyzed. 

C.VSE. — Sergeant  .James  W.  Coaltrap,  Co.  G,  174th  Ohio  Volunteers,  aged  29  years,  was  wounded  near  Murfreesboro’, 
Tennessee,  December  7th,  1834,  by  a shell,  which  lacerated  the  seal])  over  the  frontal  bone.  He  was  admitted  to  hos])ital  at 
Murfreesboro’,  and  in  February,  18.55,  sent  to  Harewood  Hos])ital,  Wasliingtoii,  wIkmc*  he  was  dischargi'd  the  service  .June  22d, 


228 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


1805,  and  was  afterward  pensioned.  On  ilay  3d,  18o9,  Pension  Examiner  J.  II.  Todd  reported  this  man  to  be  suffering  from 
constant  severe  headache,  with  a marked  nervous  irritation,  insomnia,  violent  vertigo,  partial  paralysis,  and  mental  obtusencss — 
all  of  which  symptoms  were  on  the  increase. 

Case. — Corporal  Henry  Sweigcr,  Co.  I,  20Sth  Penns^dvania  Volunteers,  aged  18  years,  received,  near  Petersburg, 
Virginia,  Jlarch  25th,  18G5,  a gunshot  fracture  of  the  right  parietal  bone.  He  was  sent  to  the  hospital  of  the  3d  division.  Ninth 
Corps  ; thence  to  Washington,  where  he  was  admitted  to  the  Lincoln  Hospital  on  March  30th.  On  May  13th,  he  was  transferred 
to  the  Mower  Hospital,  Philadelphia.  Simple  dressings  were  applied  to  the  wound.  On  June  1st,  an  exfoliation  of  the  outer 
table,  three-fourths  of  an  inch  in  length  by  one-half  inch  in  width,  was  removed,  and  two  days  later  another  piece,  one  inch  in 
length,  was  taken  out.  No  untoward  symptoms  followed,  and  the  patient  was  discharged  the  service  on  June  21st,  1865,  and 
pensioned.  On  March  2Gth,  1868,  Pension  Examiner  M.  H.  Strickler,  reported  this  man  to  be  suffering  from  partial  paralysis 
of  the  left  side,  and  to  be  unable  to  perform  manual  labor  or  bear  exposure  to  the  sun.  He  recommends  an  increase  of  pension. 

Ca.se. — Priv.ate  William  Coneley,  Co.  II,  14th  Illinois  Volunteers,  was  wounded  at  the  battle  of  Shiloh,  Tennessee, 
April  6th,  1862,  by  a musket  ball,  which  fractured  the  centre  of  the  left  parietal  bone.  The  ball  and  several  long  spiculae 
of  bone  were  removed  from  the  wound.  He  was  probably  treated  in  a field  hospital  until  July  10th,  1862,  when  he  was  admitted 
to  the  hospital  at  Keokuk,  Iowa.  lie  was  discharged  on  October  17th,  1832,  and  was  subsequently  pensioned.  On  May  19th, 
1863,  Pension  Examiner  T.  S.  Hening  reports  that  the  paralysis  of  the  right  arm,  occurring  immediately  after  the  removal  of  the 
ball  and  fragments,  still  continues.  He  rates  the  patient’s  disability  total  and  temporary. 

Case. — Private  Hugh  Finnegan,  Co.  A,  4th  Rhode  Island  Volunteers,  aged  35  years,  was  wounded  near  Petersburg, 
Virginia,  July  30th,  1864,  by  aconoidal  ball,  which  fractured  the  upper  part  of  the  left  parietal  bone.  He  was  admitted  to  the 
hospital  of  the  2d  division.  Ninth  Corps;  on  August  3d,  sent  to  hospital  of  the  Ninth  Corps  at  City  Point ; and,  on  August  Gth, 
to  Lovell  Hospital,  Portsmouth,  Rhode  Island.  He  was  discharged  on  Juno  1st,  1835,  and  pensioned,  his  disability  being  rated 
at  two-thirds.  There  was  headache,  dizziness,  and  partial  p.aralysis  of  right  arm.  A portion  of  the  temporal  bone  had  been 
removed,  but  at  what  time  cannot  be  definitely  ascertained.  On  March  11th,  1837,  Pension  Examiner  R.  W.  Rims  reported  this 
man  to  be  totally  deaf  in  the  left  ear,  and  suffering  almost  constant  pain,  with  vertigo.  There  is  also  paralysis  of  the  right  hand 
and  ann. 

In  the  following  curious  case,  paraplegia,  relieved  by  the  removal  of  the  missile  and 
depressed  fragments  from  a depressed  fracture  of  the  parietal,  was  followed  by  hemiplegia, 
first  of  the  right  and  then  of  the  left  side  ; 

Case. — Private  David  C.  Minium,  Co.  F,  49th  Pennsylvania  Volunteers,  aged  26  years,  w’as  wounded  at  the  battle  of 
Winchester,  Virginia,  Sejitember  19th,  1834,  by  a spent  ball,  which  fractured  and  depressed  the  left  parietal  bone  at  the  top  of 
the  head  to  the  extent  of  one  inch  in  diameter,  and  then  lodged  in  the  wound.  He  was  conveyed  to  the  hospital  of  the  1st 
division.  Sixth  Corps,  and  on  September  25th,  sent  to  the  hospital  at  Sandy  Hook,  and,  on  September  27th,  admitted  to  the 
hospital  at  Frederick,  Jlaryland.  On  October  3d,  half  of  the  ball  and  several  fi-agmentsof  bone  were  removed  by  Acting  Assistant 
Surgeon  J.  H.  Bartholf,  relieving  immediately  the  paralysis  of  the  lower  extremities,  which  had  existed  before  the  operation. 
He  recovered  and  was  discharged  on  July  24th,  1835.  At  this  date.  Assistant  Surgeon  Thomas  H.  Helsby  reported  that  there 
was  partial  paralysis  of  the  right  side  of  the  body,  with  frequent  attacks  of  headache  and  vertigo.  On  May  31st,  1866,  Pension 
Examiner  T.  C.  Morris  I’eported  that  there  was  a deep  depression  of  the  skull,  “ causing  a partial  paralysis  of  the  entire  left  side.” 

Epilepsy. — Many  patients  who  recovered  after  gunshot  fractures  of  the  skull,  treated 
by  the  removal  of  detached  or  depressed  fragments  of  bone,  suffered,  ultimately,  from 
epilepsy.  Abstracts  will  be  given  of  a few  of  these  cases  : 

Case. — Private  Benjamin  K.  Gardner,  Co.  B,  76th  Pennsylvania  Volunteers,  aged  18  years,  was  wounded  in  front  of 
Petersburg,  Virginia,  July  27th,  1864,  by  a conoidal  musket  ball,  which  slightly  fractured  the  cranium.  He  was  at  once 
admitted  to  the  hospital  of  the  2d  division.  Tenth  Corps,  sent  to  the  general  hospital  at  Fort  Monroe  on  August  1st,  and  thence, 
on  August  7th,  by  steamer  to  the  De  Camp  Hospital  in  New  York  Harbor.  He  was  furloughed  on  August  11th.  On  reaching 
home  he  became  unconscious,  and  remained  so  fur  a period  of  five  weeks.  On  November  19th,  he  was  admitted  into  the  Satterlee 
Hospital,  at  Philadelphia,  where,  on  the  22d,  several  spiculm  of  bone  were  removed,  one  of  them  measuring  one  by  one-fourth 
of  an  inch.  During  the  progress  of  the  case  several  other  spicultE  were  removed,  the  last  being  extracted  in  Januarjq  1865. 
The  wound  afterward  healed  rapidly,  but  the  patient  continued  to  suffer  from  headache  until  the  day  of  his  discharge  from 
service.  May  16th,  1835.  The  Commissioner  of  Pensions  states  in  a letter  dated  March,  1868,  that  Gardner  receives  a pension 
of  eight  dollars  per  month,  his  disability  being  rated  total  and  doubtful.  On  January  11th,  1869,  Pension  Examiner  D.  D.  Mahon 
rates  this  man’s  disability  total,  of  the  third  grade,  and  recommends  an  increase  of  pension,  owing  to  the  presence  of  epilepsy, 
partial  paralysis  of  the  limbs,  and  threatening  amaurosis. 

Case. — Sergeant  Daniel  W.  Hayden,  Co.  H,  7th  New  Hampshire  Volunteers,  aged  23  years,  was  wounded  at  the  battle 
of  Olustee,  Florida,  February  20th,  1834,  by  a shell,  which  fractured  and  depressed  the  left  parietal  bone.  He  was  sent  to 
Jacksonville,  Florida,  and  transferred  to  Hilton  Head,  South  Carolina,  on  February  25th.  The  depressed  bone  had  been 
elevated,  and  blood  extravasated  within  the  cranium  had  been  removed  before  his  admission.  Simple  dressings  were  applied. 
The  patient  recovered  rapidly  and  was  discharged  from  the  service  on  the  28th  of  April,  1864.  In  March,  1868,  his  disability 
was  rated  at  three-fourths  and  permanent.  On  .January  29th,  1870,  Pension  Examiner  .1.  F.  Titts  reported  the  disability  as 


EEMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


229 


total.  A square  incli  of  tlie  parietal  was  gone,  part  having  been  removed  by  operation,  and  the  rest  having  exfoliated.  The 
cicatrix  was  j)ainful,  the  pain  being  much  increased  by  pressure.  Frequent  epileptic  fits  recurred,  brought  on  by  even  slight 
fatigue  or  excitement.  The  convulsions  have  increased  rather  than  diminished  in  intensity  as  time  has  worn  on.  The  pensioner 
feared  to  leave  home  unaccompanied.  Ultimate  ruin  of  the  ment.al  powers  was  apprehended  by  the  examiner. 

Case. — Private  John  P.  Patterson,  Co.  A,  49th  Pennsylvania  Volunteers,  aged  19  years,  was  wounded  at  Rappahannock 
Station,  Virgini.a,  November  7th,  1833,  by  a conoid.al  ball,  which  fractured  and  depressed  both  tables  of  the  left  parietal  bone  near 
the  vertex.  He  was  conveyed  to  Washington,  and  admitted  into  the  Stanton  Hospit.al  on  the  9th.  Several  fragments  of  bone 
were  removed  exposing  the  dura  mater.  For  two  days  convulsions  occurred  ; after  that  the  patient  became  tranquil,  with  the 
loss  of  voluntary  motion  in  the  right  arm  and  leg.  On  the  20th,  the  paralysis  disappeared.  • The  wound  suppurated  moderately 
and  filled  with  healthy  granulations.  On  the  23th,  and  again  on  the  27th  of  December,  several  small  spiculse  of  bone  were  re- 
moved. By  J.anuary  1st,  1834,  the  patient  had  entirely  recovered  ; was  furloughed  on  the  7th,  and  admitted  to  Turner’s  Lane 
Hospital,  Philadelphia,  on  May  11th.  Epilepsy  supervened,  and  he  was  disch.arged  from  the  service  on  July  18th,  1804.  A 
communication  from  the  Commissioner  of  Pensions,  dated  January  2d,  1838,  states  that  Patterson  is  a pensioner,  and  that  his 
disability  is  rated  total  and  permanent.  The  case  is  reported  by  Acting  Assistant  Surgeon  C.  Campbell.  Dr.  W.  W.  Keen,  Jr.,  in  a 
letter  dated  April  12,  1873,  st.ates  that  “ Patterson  still  limps  from  partial  paralysis;  has  to  use  a cane  ; his  epilepsy  is  entirely 
gone ; studied  medicine  ; and  was,  in  April,  1873,  practicing  medicine  at  2116  Ridge  street,  Philadelphia.” 

Case. — Private  James  McEvoy,  Co.  F,  28th  Massachusetts  Volunteers,  aged  32  years,  was  wounded  at  the  battle  of 
Chantilly,  Virginia,  September  1st,  1832,  by  a fragment  of  shell,  which  struck  the  right  parietal  bone  about  an  inch  above  the 
squamous  portion  of  the  temporal  bone,  fracturing  both  tables,  and  denuded  the  parietal  for  a space  of  three  and  a half  inches  in 
length  by  one  and  a half  inches  in  width.  Leaving  the  battle-field  without  assistance,  he  was  admitted  into  the  Emory  Hospital 
at  Washington,  on  the  following  day,  where  Surgeon  William  Clendenin,  U.  S.  V.,  removed  all  loose  spiculae  of  bone.  Profuse 
hsemorrhage  from  the  meningeal  artery  was  arrested  by  the  application  of  ice.  Cold  water  dressings  were  applied  and  morphia 
administered.  On  the  8th,  the  pupils  were  dilated,  and  the  left  arm  was  partially  paralyzed,  but  the  patient  was  perfectly 
rational.  On  the  14th,  a piece  of  bone,  one  and  one-fourth  by  three-fourths  of  an  inch,  was  removed.  Water  dressings  were 
discontinued,  and  cerate  dressings  were  substituted.  Mineral  tonics,  cathartics,  and  nouri.shing  diet  were  ordered.  On  the  28th, 
the  wound  was  discharging  but  a small  amount  of  pus,  and  the  patient  was  able,  with  some  effort,  to  close  his  hand,  but  had  no 
further  use  of  it.  By  the  8th  of  October,  the  wound  was  nearly  healed  ; a small  surface,  covered  by  healthy  granulations,  cov- 
ered the  brain.  The  pupils  were  still  dilated,  but,  with  thd  exception  of  his  palsied  arm,  the  patient  was  doing  well.  On  Novem- 
ber 11th,  1832,  he  was  discharged  the  service  and  was  pensioned.  The  case  is  reported  by  Surgeon  W.  Clendenin,  U.  S.  V.  On 
February  4th,  1837,  Pension  Examiner  H.  B.  Hubbard  reports  the  patient  subject  to  frequent  epileptic  fits,  and  rates  his  dis- 
ability total  and  permanent. 

Case. — Corporal  George  W.  Monk,  Co.  A,  78th  New  York  Volunteers,  was  wounded  at  the  battle  of  Chancellorsville, 
Virginia,  May  3d,  1833,  by  a conoidal  ball,  which  fractured  the  right  parietal  bone  near  its  posterior  superior  angle.  He  fell  to 
the  ground  in  a state  of  insensibility ; when  consciousness  returned  he  passed  his  finger  into  the  wound  one  or  two  inches.  His 
left  arm  and  both  of  his  legs  were  paralyzed.  He  remained  on  the  field  for  three  days,  exposed  to  a cold  and  drenching  rain 
without  shelter,  and  was  then  seized  with  convulsions.  He  was  admitted  to  the  Log  Hospital  on  May  6th,  and  on  June  1.5th, 
sent  to  the  Armory  Square  Hospital,  Washington.  From  time  to  time,  fragments  of  bone  from  both  tables  escaped.  About  the 
end  of  .Tune,  haemorrhage  occurred,  probably  from  the  middle  meningeal  artery,  but  was  arrested  by  jilugging.  It  recurred 
about  four  weeks  later,  but  was  again  arrested.  On  August  27th  he  was  furloughed  ; on  October  14th,  admitted  to  the  Ladies’ 
Homo  Hospital,  New  York,  and  on  February  6th,  1864,  discharged  from  service.  The  paralysis  had  disappeared  entirely,  except 
from  his  left  arm,  where  it  remained  in  a slight  degree.  On  March  26th,  1868,  Pension  Examiner  N.  W.  Leighton  reports  that 
the  patient  was  a helpless  epileptic.  There  was  abscess  of  the  brain  and  paralysis  of  the  left  arm,  with  morbid  excitability  of  the 
whole  cutaneous  surface.  He  rates  his  disability  total  and  permanent. 

Case. — Corporal  James  C.  MeCTusky,  Co.  D,  11.5tli  Pennsylvania  Volunteers,  aged  56  years,  was  wounded  at  the  battle 
of  Chancellorsville,  Virginia,  !May  3d,  1833,  by  a conoidal  musket  ball,  which  i)roduccd  a comminuted  fracture  of  both  tables  of 
the  frontal  bone,  right  side,  and  lodged.  The  missile  and  a portion  of  the  os  frontis,  an  inch  in  diameter,  which  was  pressing 
upon  the  brain,  were  removed  three  days  subsequently  in  the  field  hospital.  He  was  sent  to  the  Harewood  Hospital,  Washing- 
ton, bn  the  15th,  where  he  remained  until  the  23d,  when  he  was  transferred  to  the  Satterlee  Hospital  in  Philadelphia.  For  a 
while  he  improved  steadily,  but  about  the  1st  of  August,  began  to  sink  into  a state  of  insensibility,  in  which  he  remained  several 
days.  He  rallied,  however,  made  a rapid  recovery  and  was  discharged  from  service  on  the  23d  of  October,  1863.  In  January, 
1833,  his  disability  was  rated  total  and  permanent.  The  case  is  reported  by  Surgeon  I.  I.  Il.ayes,  U.  S.  V.  On  January  27th, 
1861, 1’ension  Examiner  John  Lowman  reports  this  man  to  be  subject  to  epilepsy,  .and  rates  his  disability  total  and  permanent. 

Case. — Private  John  Hurt,  Co.  E,  83d  Indiana  Volunteers,  was  wounded  near  Vicksburg,  Mississi{)pi,  December  28th, 
1862,  bj'  a fragment  of  shell,  which  fractured  the  frontal  bone  over  the  right  eye.  Fragments  of  bone  were  removed  by  Surgeon 
E.  Andrews,  1st  Illinois  Light  Artillery.  He  was  conveyed  to  the  Hospital  Steamer  City  of  Memphis,  and  thence,  on  Januaiy 
13th,  1833,  transferred  to  Paducah,  Kentucky.  He  was  disch.arged  the  service  on  March  23d,  1833,  and  \yas  suhsequently 
pensioned.  On  August  7th,  1838,  Pension  Examiner  J.  C.  Burt  reports  that  this  man,  in  addition  to  a depression  of  the  skull 
and  the  loss  of  an  eye,  suffers  from  pain  in  the  head,  and  alleges  that  he  has  .attacks  simulating  epilepsy.  He  rates  lUs  disability 
permanent. 

Case. — Private  Columbus  Custer,  Co.  C,  16th  Iowa  Volunteers,  aged  33  years,  was  wounded  at  Atlanta,  Georgia,  July 
22d,  1864,  hy  .a  piece  of  shell,  which  fractured  the  parietal  bone.  He  was  admitted  to  a hospital  at  Chattanooga,  on  November 
28lh;  sent,  via  Nashville,  Tennessee,  to  the  .Jeffer.son  Hospit.al  at  Jeffersonville,  Indi.ana,  where  he  was  admitted  on  December 
1st,  1864.  The  wound  had  entirely  healed.  The  patient  was  discharg(!d  on  April  4th,  186.5.  On  .lanuary  4th,  1866,  Pension 


230 


WOUNDS  AND  INJUEIES  OF  THPJ  HEAD, 


Examiner  Iv.  S.  Lewis  reports  this  man  to  lie  suffering  from  jiartial  paralysis  of  the  right  side,  and  from  epileptic  fits,  winch 
occur  once  or  twice  monthlj'.  He  rates  his  disability  total  and  temporary.  A commuiucation  from  the  Commissioner  of  Pen- 
sions, dated  July,  1868,  states  that  Custer  is  a pensioner  at  $8  per  month,  his  disability  being  rated  total  and  temporary. 

Cask. — Private  Josej)!!  Link,  19th  New  York  Independent  Battery,  aged  24  years,  was  wounded  at  Spottsylvania  Court- 
house, Virginia,  May  12th,  1864,  by  a shell,  which  fractured  the  frontal  bone,  right  side,  half  an  inch  above  the  superciliary 
ridge;  fragments  of  inner  table  were  imbedded  in  the  membranes  above  the  frontal  sinus.  Inflammation  and  compression  fol- 
lowed and  fragments  eif  both  tables  were  removed  by  forceps  and  elevator.  He  was  dischai'ged  May  2d,  1865,  anel  was  subse- 
(piemtly  pensioned.  On  October  17tb,  1866,  Pension  Examiner  J.  H.  Helmers  reports  a small  ))iece  of  bone  to  be  still  denuded. 
There  was  a slight  discharge  from  the  wound,  and  the  patient  was  subject  to  frequent  attacks  of  ejtilepsy.  Ho  rates  his  disability 
total. 

C.VSE.— I’rivate  James  W.  Hotchkiss,  19th  New  York  Battery,  was  wounded  in  the  engagement  before  Petersburg,  Vir- 
ginia, November  9th,  1864,  by  a musket  ball,  which  fractured  the  cranium.  He  was  admitted  to  the  hospital  of  the  1st  division. 
Ninth  Corps ; on  November  13th,  sent  to  the  depot  field  hospital  at  City  Point,  and  on  November  29th,  transferred  to  3d  division 
hospital  at  Alexandria.  He  was  discharged  from  the  service  on  April  3d,  1865,  on  account  of  fracture  of  skull  and  ])artial  par- 
alysis, and  was  afterward  ])ensioned.  On  January  2,5th,  1868,  Pension  Examiner  J.  H.  Helmers  reported  this  man  to  be  suffer- 
ing from  partial  paralysis  of  the  left  side,  with  loss  of  memory.  He  also  credits  the  ])atient’s  statement  of  being  subject  to  fre- 
quent and  severe  epileptic  fits.  He  rated  his  disability  equivalent  to  the  loss  of  a foot  or  hand  and  permanent. 

Defective  Vision. — In  tliose  patients  who  recovered  after  gunshot  fractures  of  the  skull, 
treated  Ijy  removal  of  fragments,  partial  or  complete  loss  of  vision  was  one  of  the  most 
frequent  of  the  remote  results. 

Ca.se. — Priv.ate  Adam  Cornw.all,  Co.  B,  91st  Pennsylvania  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  Virginia,  June  21st,  1864,  by  a i)iece  of  shell,  wdiich  struck  the  outer  angle  of  the  orbital  ridge,  fractured  the  orbital 
phate,  and  partially' destroyed  the  sight  of  the  right  eye.  He  was  at  once  admitted  to  the' hospital  of  the  Fifth  Corps ; on  the 
lUth,  sent  to  Sickel  branch  of  the  2d  division  hosiiital  at  Alexandria,  Virginia ; and  on  the  20th  transferred  to  Philadelphia, 
entering  Satterlee  Hospital  on  the  25th.  On  June  28th,  Acting  Assistant  Surgeon  Ezra  Dyer  removed  two  pieces  of  th.e  orbital 
ridge.  The  patient’s  constitutional  condition  at  this  time  was  excellent,  but  there  was  some  cerebral  irritation.  On  Jidy  Ist,  an 
incision  in  the  scalp  was  made,  and  two  j)ieces  of  bone  were  removed ; one  the  siz(;  of  a filbert,  the  other  as  large  as  a ]iea.  Sim- 
j)le  antiphlogistic  treatment  was  employed,  and  the  patient  progressed  finely'.  On  April  13th,  188.5,  he  was  discharged  from 
the  service  by  reason  of  loss  of  sight  of  the  right  eye.  A communication  from  the  Commissi(Hier  of  Pensions,  dated  IMarcli  26th, 
1838,  states  that  xVdam  Cornwall  is  a pensioner,  and  that  his  disability  is  rated  at  one-half  and  permanent.  Examining  Surgeon 
J.  Cumminskey  reports  that  the  vision  of  the  right  ey'e  is  totally'  destroy'ed,  but  that  the  left  eye  is  unaft’ected. 

Case. — Private  Louis  Dubar,  Co.  K,  12th  Maine  Volunteers,  aged  21  y'ears,  w.'is  wounded  at  the  battle  of  Cedar  Creek, 
Virginia,  October  19th,  1864,  by  a conoidal  ball,  which  fractured  and  depressed  the  middle  of  the  frontal  bone.  The  fracture 
extended  backward  a distance  of  four  inches.  He  was  taken  to  a field  hospital,  and  thence  sent  to  I’hiladelphia,  where  he  was 
admitted  into  Satterlee  Hospital  on  the  23d,  suft’ering  much  pain.  Sim])le  dressings  were  applied,  and  low  diet  ordered.  On 
November  10th,  coma  supervened,  and  the  right  upper  extremity  became  paraly'zed.  An  examination  revealed  the  edges  of  the 
bone  depressed,  and  several  small  pieces  lying  loose  between  them.  The  fragments  were  removed,  and  the  depressed  portions 
elevated,  revealing  the  dura  mater  intact.  He  improved  at  once,  and  in  five  day's  was  aide  to  walk  about  the  ward  free  from  any 
symptoms  of  nervous  disoi’der.  On  May  20th,  1865,  he  was  discharged  from  the  service  by  reason  of  impaired  vision.  The  case 
is  re])orted  by  Surgeon  I.  I.  Hay’es,  U.  S.  V.  I’ension  Examining  Surgeon  H.  Lenox  Hodge  reports  that  this  pensioner  is  suf- 
fering from  giddiness  and  faintness,  and  that  the  vision  of  the  left  eye  is  much  impaired. 

Case. — Priv'ate  Jerome  Dickerson,  Co.  B,  179th  New  York  V<dunteers,  was  wounded  in  the  engagement  near  the  Weldon 
Railroad,  Virginia.  June  17th,  1834,  by'  a conoidal  ball.  He  was  at  once  admitted  to  the  hospital  of  the  1st  division,  Ninth 
Corps,  and  on  July  1st  was  sent  to  the  Mount  Pleasant  Ho.spital,  Washington.  The  injury  was  ti'eated  as  a slight  scalp  wound, 
and  on  July'  20th  the  patient  was  sent  to  Mower  Hospital,  Philadel|)hia,  where  it  was  discovered  that  the  frontal  bone  was  frac- 
tured near  its  eminence.  Small  pieces  of  bone  were  removed  at  various  times.  He  recovered,  was  returned  to  duty  on  Decem- 
ber 5th,  1884,  and  discharged  the  service  June  8th,  1835,  and  pjensioned.  On  April  2d,  1866,  Pension  Examiner  H.  W.  Ny'e 
stated  that  the  patient  suffers  from  ])ain,  giddiness,  and  partial  loss  of  sight  of  right  ey'c.  The  patient  also  deposed  that  he  was 
unable  to  labor  in  the  summer,  on  account  of  dizziness  and  frequent  pain  in  the  head. 

Case. — Private  James  W.  Duncan,  Co.  B,  10th  West  Virginia  Infantry,  aged  19  ycar.s,  was  wounded  at  Ashby’s  Gap, 
Virginia,  July  18th,  1834,  hy  the  explosion  of  a caisson,  causing  de])ressed  fracture  of  both  tables  of  the  superior  portion  of  the 
frontal  bone,  a little  to  the  right  of  the  median  line.  He  was  admitted  to  the  general  hospital  at  Sandy  Hook,  Maryland,  on  the 
22d,  and  was  transferred  to  the  hospital  at  Frederick  on  the  27th,  suffering  from  headache  and  pain  in  the  chest.  Assistant  Sur- 
geon R.  F.  Weil’,  Lh  S.  A.,  removed  the  depressed  fragments  to  the  extent  of  two  and  a half  inches  with  bone-cutting  forceps. 
No  cerebral  symptoms  existed  at  the  time.  The  injury  to  the  head  healed  well,  but  the  patient  suffered  for  some  time  from  em- 
pyema’ and  pneumothora.x.  He  recovered,  was  transferred  to  the  hospital  at  Grafton,  West  Virginia,  on  January  31st,  1865,  and 
discharged  the  service  on  June  5th,  1865.  A communication  from  the  Commissioner  of  Pensions,  of  March  26th,  1868,  states 
that  Private  Duncan  is  a pensioner,  his  disability  being  rated  as  total  and  permanent.  The  other  facts  in  the  case  were  reported 
hy  .Surgeon  .S.  N-.  Sherman,  U.  S.  V.  On  March  12th,  1839,  Pension  E.xaminer  Thomas  Kenney  states  that  this  man  is  totally 
blind  in  the  left  eye.  E.xeroiso  or  stooping  produced  total  blindness.  He  rates  his  disability  total  and  permanent. 


REISIOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


231 


Case. — Piiv:ite  George  W.  Eastlick,  Co.  C.,  SOth  Ohio  Volunteers,  aged  30  years,  was  wounded  at  tlio  battle  of  Port 
Rejmblic,  Virginia,  June  9tb,  1862,  by  a conoidal  ball,  wliieli  fractured  and  depressed  the  cranium  at  the  left  parietal  eminence. 
He  was  rendered  insensible  by  the  blow,  and  remained  in  that  state  for  about  four  hours,  when  he  recovered  sufficiently  to 
leave  the  field.  The  ball,  which  had  fractured  both  tables  of  the  skull  and  split  upon  the  sharp  edge  of  the  outer  table  for 
two-thirds  of  its  length,  was  readily  removed  on  the  field.  On  Juni*  15th,  he  was  admitted  into  Clifflmrne  Hospital,  Washington. 
His  general  condition  was  good,  but  there  was  considerable  mental  confusion,  loss  of  memory,  marked  deficiency  in  the  strength 
and  sensibility  of  the  right  arm,  slight  but  persistent  and  daily  increasing  contraction  of  the  fingers.  The  wound  lo<>ked  healthy 
and  was  granulating.  Absolute  (juiet  was  enjoined,  and  taxation  and  light  diet  ordered;  but  the  unfavorable  symptoms 
evidently  increased.  On  June  23d,  ether  was  administered,  and  Assistant  Surgeon  John  S.  Hillings,  U.  S.  A.,  made  a crucial 
incision  over  the  seat  of  injury,  cut  away  a small  portion  of  the  sound  bone  with  the  bone-gouge  forceps;  then  introduced  the 
elevator  into  the  opening,  and  removed  the  depressed  portions  of  bone,  comprising  a circle  of  about  three-fourths  of  an  inch  in 
diameter.  Half  an  hour  after  the  opeiuition  it  was  found  that  sensibility  had  returned  to  the  right  arm,  and  that  the  right  hand, 
which  had  previously  been  powerless,  had  recovered  its  strength.  No  untoward  symptoms  supervened,  and  the  wound,  which 
was  kept  open  for  two  weeks  to  permit  the  free  escape  of  pus,  healed  rapidly.  On  July  9th,  while  holding  a candle  and  assisting 
in  dressing  a patient,  he  was  suddenly  seized  with  vertigo,  and  was  immediately  compelled  to  lie  down.  A full  saline  cathartic 
was  given,  and  low  diet  ordered.  No  further  cerebral  symptoms  occurred,  and  by  the  20th  he  was  j)erfectly  convalescent.  He 
was  discharged  August  5th,  1862.  The  case  is  reported  hy  Assistant  .Surgeon  .1.  S.  Billings,  U.  .S..  A.  In  September,  1867, 
Pension  Examiner  John  F.  Rat'  reports  that  the  vision  in  the  left  eye  is  impaired  and  intolerant  of  light.  His  disability  is 
rated  two-thirds  and  })ennanent. 

Case. — Lieutenant  William  Finn,  Co.  C,  14th  Michigan  Volunteers,  aged  22 years,  was  wounded  at  the  battle  of  Jonesboro’, 
Georgia,  September  Ist,  1864,  by  a conoidal  ball,  which  fractured  the-  right  ])arietal  bone.  He  was  on  the  same  day  admitted 
to  the  hospital  of  the  2d  division.  Fourteenth  Corps,  and  on  October  2.5th  sent  to  the  Officers’  Hospital  at  Lookout  Mountain, 
Tennessee.  During  the  treatment  several  spiculse  of  bone  were  removed.  On  November  5th,  1864,  the  wound  had  healed,  and 
I'''inn  received  a leave  of  absence.  He  was  mustered  out  on  December  15th,  1864,  on  account  of  expiration  of  term  of  service, 
and  was  afterward  pensioned  on  account  of  partial  loss  of  sight  in  both  eyes,  with  cephalalgia  and  dizziness.  On  March  26th, 
186.5,  Pension  Examiner  J.  N.  Brown  rated  his  disability  one-half  and  permanent. 

Case. — Sergeant  Robert  Hay.s,  Co.  E,  13th  Tennessee  Cavalry,  aged  32  years,  received,  in  an  engagement  at  Bull's  Gap, 
November  12th,  1864,  a fracture  of  the  cranium.  He  was  probably  treated  in  afield  hospital  until  M.ay  17  th,  1865,  when  he 
was  admitted  to  the  Asylum  Hospital,  Knoxville,  Tennessee.  He  was  discharged  on  May  24th,  1865,  and  was  pensioned.  On 
October  12th,  1867,  Pension  Examiner  C.  Wheeler  reports  that  the  wound  was  succeeded  b}-  necrosis  and  exfoliation,  a 
large  piece  of  the  right  parietal  bone,  measuring  three  inches  in  length  by  one  inch  in  width,  having  been  removed.  'The  patient 
suffers  from  violent  pain  in  the  head,  with  vertigo,  dimness  of  vision,  and  other  distressing  symptoms.  His  disability  is  rated 
total.  In  July,  1868,  Hays  was  a pensioner  at  eight  dollars  per  month,  his  disability  being  rated  total. 

Case. — Private  August  Heiinan,  Co.  K,  1st  New  York  Cavalry,  was  wounded  on  picket,  near  Harrison's  Landing, 
Virginia,  August,  1862,  by  a piece  of  shell,  which  fractured  the  occipital  and  the  ujiper  edge  of  the  right  parietal  bone.  He  was 
conveyed  to  Philadelphi.a,  entering  Broad  and  Cherry  .Streets  Hospital  on  the  7th.  On  the  28th,  he  was  transferred  to  the 
S.atterlee  Hospital.  The  wound  was  kept  open  to  facilitate  the  discharge  of  pus,  and  the  bowels  were  kt'jit  in  a relaxed  condition 
by  the  administration  of  sulphate  of  magnesia.  As  he  had  severe  pain  in  the  head,  on  November  25th,  the  wound  was  enlarged 
and  a tent  was  introduced.  An  abscess  in  the  scalp,  just  below  the  wound,  was  opened  on  the  27th,  and  a compress  applied. 
A sequestrum  of  bone,  one-half  by  one-fourth  of  an  inch,  was  removed  on  the  8th  of  December,  and  on  the  13tli,  several  pieces 
were  taken  out.  Again  complaining  of  pain  in  the  head,  on  the  26th,  the  wound  was  still  further  enlarged  and  another  tent 
introduced.  On  January  23d,  1863,  additional  fragments  of  bone  from  both  tables  were  removed.  By  the  31st,  the  sc.al])  wound 
had  almost  entirely  healed,  but  the  patient  complained  of  pain  at  the  seat  of  injury  and  gi’eat  dizziness  upon  making  any 
exertion.  On  February  1st,  he  was  slightly  feverish,  and  still  complained  of  pain  in  the  head.  On  March  17th,  he  was  trams- 
ferred  to  the  hospital  guard  for  duty;  but  was  re-admitted  on  the  19th,  being  unable  to  perform  any  duty.  He  was  discharged 
from  the  service  on  March  30th,  on  account  of  general  debility,  irritability  of  tlie  heart,  and  a constant  headache.  On  .Iidy  25th, 
1864,  he  applied  for  a pension  and  was  examined  by  Dr.  Charles  Rowland,  examining  surgeon  for  pensions,  Brooklyn,  New 
York.  The  wound  had  healed,  leaving  a large  indentation  one  inch  in  diameter,  the  scalp  and  mendu'anes  alone  protecting 
the  brain.  The  applicant’s  memory  and  vision  in  the  right  eye  were  impaired.  'The  ca.se  is  rej)f)rted  by  .Surgeon  Isaac  1. 
Hayes,  U.  .S.  V. 

Ca.se. — Private  Alexamler  Kreiger,  Co.  D,  7th  Iowa  Volunteers,  aged  19  years,  was  wounde<l  December  11th,  1K64, 
while  on  picket  near  Anderson’s  Farm,  Georgia,  by  a conoidal  ball,  which  fractured  tlie  outer  t.able  of  the  left  parietal  l.oiie  near 
its  superior  po.sterior  angle.  He  was  immediately  admitted  to  the  regimental  hospital,  and  thence  sent  to  the  corps  hospital, 
where  fragments  of  bone  were  removed.  f)n  the  19th,  he  was  transfeiTed  to  Beaufort,  .South  Carolina,  and  .January  23d,  186.5, 
taken  on  the  hospital  steamer  Ben  Deford  to  the  McDougall  Hospital,  New  York,  where  he  remained  until  Jliiirh  14th,  when 
he  was  transferred  to  the  hospital  at  Keokuk,  Iowa.  On  May  24th,  186.5,  he  was  transferred  to  Daven))ort,  to  !)(■  mustered  out 
of  service.  He  was  discharged  May  27th,  1865,  and  pensioned.  Pension  Examiner  R.  H.  Wyman  reported,  on  A])ril  2d,  18{)7, 
that  there  was  almost  constant  discharge  from  the  wound,  with  defective  eyesight  and  memory.  He  rated  his  disability  two- 
thirds  and  permanent,  unless  removed  by  an  operation. 

Ca.se. — I’rivate  John  Lanyon,  Co.  E,  140th  New  I'ork  Volunteers,  aged  35  years,  was  wounded  at  th('  battle  of  Si)ott- 
sylvania,  Virginia,  May  13th,  1864,  hy  a conoidal  musket  hall,  which  entereil  the  frontal  hoiuf  to  the  right  of  the  median  line, 
near  the  coronal  suture,  and  lodged  hencatli  the  scalp  near  the  place  of  entrance,  apparently  without  producing  any  fracturt?  of 


232 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


tlie  skull.  He  was  rendered  unconscious  from  the  shock,  and  lay  in  a state  of  insensibility  until  the  missile  was  extracted  by 
the  regimental  surgeon,  Henry  C.  Dean,  five  hours  after  the  reception  of  the  injury.  The  ball  was  much  flattened  and  weighed 
an  ounce.  The  patient  was  at  once  conveyed  to  the  division  hospital,  suffering  at  the  time  great  pain  in  the  head  and  constant 
dizziness.  Forty-eight  hours  later,  to  avoid  capture  by  the  advancing  enemy,  he  started  on  foot  for  Fredericksburg,  some 
eighteen  miles  distant,  which  he  reached  in  twenty  hour’s,  greatly  exhausted.  He  was  obliged  to  lay  for  ten  hours  after  his 
arrival  exposed  to  the  rain  before  he  could  be  admitted  into  a temporary  hospital.  He  remained  there  four  days  and  was  then 
sent  to  Washington,  and  admitted  into  the  Campbell  Hospital  on  May  24th,  1864.  About  June  1st,  he  received  a furlough  and 
visited  Buffalo,  New  York,  were  he  came  on  June  Gtli,  under  the  care  of  Acting  Assistant  Surgeon  S.  W.  Wetmore,  who 
discovered  that  the  frontal  bone  was  fractured.  The  wound  at  this  time  was  discharging  freely;  but  there  being  no  cessation  of 
the  headache  and  dizziness.  Dr.  Wetmore,  on  the  4th  of  July,  removed  the  fractured  portion  of  the  external  as  well  as  some 
pieces  from  the  internal  table.  On  July  20th,  Lanyon  returned  to  Washington;  was  sent  to  the  Lovell  Hospital,  Portsmouth 
Grove,  Rhode  Island,  on  July  30th,  and  thence  sent,  on  August  24th,  to  the  hospital  at  Rochester,  New  York,  -where  he  was 
discharged  fi’om  service  on  the  2Gth  of  December,  1834.  He  was  able  to  follow  his  trade  as  a carpenter,  but  as  late  as  June, 
1866.  he  had  not  become  entirely  free  from  attacks  of  dizziness  and  neuralgic  pain.  A communication  from  the  Commissioner  of 
Pensions,  dated  Jul^",  1888,  states  that  Lanyon  is  a pensioner  at  $6  per  month,  his  disability  being  rated  at  three-fourths  and 
permanent.  On  May  21st,  1869,  Pension  Examining  Surgeon  Horatio  N.  Loomis  reported  that  this  pensioner  complained  of 
headache  and  dizziness  and  dimness  of  vision  and  occasional  faintness;  but  that  he  was  able  to  work  moderately  a great  part 
of  the  time. 

Case. — Private  John  Lahey,  Co.  E,  38th  New  York  Volunteers,  was  wounded  at  Fredericksburg,  Virginia,  December 
13th,  1862,  by  a conoidal  ball,  which  fractured  the  right  temporal  bone  above  the  zygomatic  arch  and  lodged  in  the  diploe. 
He  was  sent  to  Harewood  Hospital,  Washington,  where  the  ball  was  removed  at  the  first  dressing.  On  December  25th,  a 
triangular  piece  of  the  external  table  was  removed  through  incision,  and  the  inner  table  was  found  to  be  fissured.  The  wound 
healed  rapidly  by  granulation,  and  on  Ajjril  20th,  1833,  the  man  was  discharged  the  service.  In  June,  1804,  Pension  Examiner 
James  Neil  reports  that  there  is  incipient  amaurosis,  and  that  the  mental  powers  seemed  to  be  somewhat  obtuse. 

Case. — Lieutenant  Isaac  N.  Morgan,  Co.  B,  1st  Maine  Artillery,  aged  23  years,  was  wounded  at  the  battle  of  Spottsylvania, 
May  19th,  1864,  by  a conoidal  ball,  which  entered  above  the  inner  angle  of  the  right  eye,  fractured  the  supra-orbital  ridge,  and 
lodged  in  front  of  the  right  ear.  The  ball  and  a portion  of  the  supra-orbital  ridge  were  removed.  The  patient  was  admitted  to 
the  Seminary  Hospital,  Georgetown,  on  May  25th,  1864.  He  was  transferred  to  the  Officers’  Hospital  at  Annapolis,  August  8th, 

1864,  and  discharged  August  15th,  1864.  Lieutenant  Morgan  w’as  aftenvard  pensioned.  On  September  15th,  1865,  Pension 
Examiner  R.  K.  Jones  reports  that  he  has  much  pain  in  the  forehead,  and  that  any  e.xposure  to  the  heat  of  the  sun,  or  exercise, 
causes  giddiness,  with  severe  pain  in  the  other  eye,  and  dimness  of  vision.  He  rates  his  disability  total. 

Case. — Private  Daniel  D.  O’Donovan,  Co.  K,  59th  Massachusettts  Volunteers,  aged  23  years,  was  wounded  at  the  battle 
of  the  Wilderness,  Virginia,  May  6th,  1864,  by  a conoidal  musket  ball,  which  injured  the  orbital  ridge  of  the  frontal  bone.  He 
was,  on  May  11th,  admitted  to  the  Lincoln  Hospital,  Washington,  D.  C.;  on  May  16th,  sent  to  the  Patterson  Park  Hospital, 
Baltimore,  Maryland;  on  June  17th,  to  the  Knight  Hospital,  New  Haven,  Connecticut;  on  October  Kith,  to  Readville;  and 
thence,  on  October  24th,  to  the  Dale  Hospital,  Worcester,  Massachusetts,  -whei’e  he  was  discharged  from  service  on  March  2d, 

1865,  and  pensioned.  The  vision  of  the  left  eye  was  totally  destroyed,  and  the  man  suffered  from  morffid  sensibility.  On  April 
9th,  1867,  Pension  Examiner  G.  S.  Jones  reported  this  man  to  be  suffering  from  a sympathetic  affection  of  the  right  eye,  with 
pain  in  the  head  and  vertigo.  He  rates  his  disability  total  and  probably  permanent. 

Case. — Private  Joseph  G.  Robinson,  Co.  I,  14th  Connecticut  Volunteers,  aged  54  years,  was  wounded  at  the  Weldon 
Railroad,  Virginia,  August  19th,  1864,  by  a fragment  of  shell,  which  struck  the  right  parietal  bone  at  a point  midway  between 
the  coronal  and  lambdoidal  sutures,  producing  a compound  comminuted  fracture  of  both  tables  of  the  right  parietal  bone.  He 
was  admitted  to  the  hospital  of  the  Second  Corps,  and  thence  conveyed  to  Washington,  D.  C.,  and  admitted  into  Carver  Hospital 
on  August  30th.  The  patient  was  somewhat  emaciated,  and  there  was  slight  constitutional  disturbance.  On  September  11th, 
Acting  Assistant  Surgeon  J.  O.  French  made  a crucial  incision  through  the  scalp,  elevated  the  depressed  edges  of  the  fractured 
bone,  ami  removed  the  detached  sequestra  of  both  tables.  Anodyne  poultices  were  applied,  and  afterward  simple  dressings.  On 
the  15th,  the  patient  was  doing  w'ell,  his  constitutional  condition  having  improved.  On  February  20th,  1865,  he  was  discharged 
from  the  service  by  reason  of  impaired  vision.  He  is  a pensioner,  and  his  disability  is  rated  total  and  permanent. 

Case. — Sergeant  Thomas  W.  Scott,  Co.  A,  5th  Ohio  Volunteers,  received,  at  Cedar  Mountain,  Virginia,  August  9th,  1862, 
a gunshot  fracture  of  the  skull.  He  was,  on  August  ICth,  admitted  to  2d  division  hospital  at  Alexandria,  and  discharged  Octoher 
22d,  1862.  Pension  Examiner  William  Devens  reports,  October  26tb,  1868,  that  a portion  of  the  left  parietal  hone,  one  inch  by 
three-fourths  of  an  inch,  comprising  both  tables,  with  the  intervening  diploe,  have  been  removed,  and  that  the  patient,  six  years 
after  the  reception  of  the  injury,  was  seriously  affected  by  loss  of  eyesight,  frequent  headache,  dizziness,  and  loss  of  memory. 

Case. — Private  Christian  Strucoe,  Co.  K,  5th  Michigan  Volunteers,  aged  32  years,  -was  wounded  at  the  battle  of  the 
Wilderness,  Virginia,  May  5th,  1864,  by  a conoidal  ball,  which  fractured  the  frontal  bone,  imbedding  itself  in  the  outer  angle  of 
the  left  orbital  ridge.  He  was,  on  May  12lh,  admitted  to  Douglas  Hospital,  Washington,  and  on  .May  26th,  to  Satterlee  Hospital, 
Philadelphia.  On  xVugust  9th,  two  small  pieces  of  bone  were  removed  from  the  wound.  The  case  progressed  favorably,  and  on 
August  25th,  the  patient  was  transferred  to  St.  Mary’s  Hospital,  Detroit,  Michigan,  and  discharged  from  the  service  on  June 
17th,  1865,  on  account  of  gunshot  wound  causing  loss  of  sight  of  the  left  eye.  He  had  also  received  an  injury  to  his  back  l\v  a 
fall  from  a wagon.  In  March,  1868,  he  was  a pensioner  at  $4  per  month,  his  disability  being  rated  total  and  permanent.  Thu 
certificate  is  signed  by  Acting  Assistant  Surgeon  H.  C.  Kibbie. 


REMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


233 


In  two  instances  of  gunshot  fractures  of  the  occipital  bone,  blindness  ensued  after 
the  removal  of  fragments  of  bone,  in  consequence,  no  doubt,  of  some  lesion  of  the  optic 
centres,  the  nature  of  which  could  only  be  conjectured. 

C.\SE. — Private  John  W.  Snyder,  Co.  B,  49th  Peinisj’lvania  Volunteers,  aged  22  years,  was  wounded  in  the  trenches  of 
Petersburg,  Virginia,  April  1st,  1865,  by  a conoidal  ball,  which  fractured  the  skull  at  the  apex  of  the  lambdoid  suture,  involving, 
probably,  both  parietals  .and  the  occipital.  He  was  sent  to  the  hospital  of  the  1st  division.  Sixth  Coi’ps  ; thence  to  the  Judiciary 
Square  Hospital  at  Washington,  whore  he  arrived  on  the  12th.  He  lay  in  a stupor,  from  which  he  could,  with  difficulty,  be 
aroused.  His  pupils  were  extensively  dilated;  the  tongue  was  moist,  and  the  pulse  at  56;  but  no  pai’.alysis  existed.  The 
fractured  portion  of  bone  was  depressed,  and  the  brain  matter  was  oozing  out.  On  April  13th,  Acting  Assistant  Surgeon  F.  H. 
Coulton  removed  a piece  of  depressed  bone  three-fourths  of  an  inch  squcarc.  The  symptoms  of  compression  of  the  brain  now 
gradually  subsided.  During  his  convalescence,  it  was  noticed  that  his  vision  was  impaired,  especially  on  the  left  side.  By  the 
loth  of  June,  the  wound  had  cicatrized,  except  at  one  point,  where,  probably,  some  slight  necrosis  existed.  About  the  middle 
of  June,  Assistant  Surgeon  Brinton  Stone,  U.  S.  V.,  by  whom  the  foregoing  facts  were  communicated,  brought  this  patient  to 
the  Army  Medical  Museum,  when  a photograph  of  the  cicatri.x  was  m.ade.  {Photographs  of  Surgical  Cases  and  Specimens,  Vol. 
I,  No.  44.)  On  June  19th,  the  p.atient  was  transferred,  convalescent,  to  the  Doughas  Hospital.  He  wtis  discharged  on  September 
29th,  1865,  and  pensioned.  Pension  Ex.aminer  G.  G.  Hartswick  reports,  October  11,  1869,  this  pensioner’s  disability  as  total, 
because  of  complete  loss  of  vision. 

Case. — Captain  Frank  Gordon,  Co.  G,  121st  New  York  Volunteers,  aged  30  years,  was  wounded  at  the  battle  of  Spott- 
sylvania  Court-house,  Virginia,  May  8th,  1864,  by  a conoidal  musket  ball,  which  fractured  the  occipital  bone  at  the  protuberance. 
He  was  admitted,  on  the  same  day,  to  the  1st  division,  Sixth  Corps,  hospital,  and  on  the  10th,  sent  to  the  1st  division  hospital  at 
Alexandria.  On  examination,  the  fracture  was  found  to  extend  one  and  seven-eighths  inches,  being  one  inch  wide  at  the  largest 
space.  Fragments  of  bone  were  removed  and  ice  applied.  E.xtensive  suppuration  followed.  On  June  15th,  several  pieces  of 
dead  bone  were  removed,  followed  by  haEmorrh.age ; the  orifice  was  kept  open  by  sponge  tents.  He  had  so  far  recovered  in  July 
that  a leave  of  absence  was  granted  to  him.  On  his  return  from  furlough,  he  was  admitted  to  the  Officers’  Hospit.al,  Annapolis, 
Maryland.  On  October  7th,  1864,  he  was  discharged  from  service  and  pensioned.  Examiner  J.  A.  Brown,  M.  D.,  reported, 
February  18th,  1865,  that  there  was  jiartial  paralysis  of  the  optic  nerve  of  both  eyes,  the  right  being  most  affected.  Exertion 
caused  pain  in  head  and  vertigo. 

Deafness. — In  the  cases  of  this  category,  deafness  was  a less  frequent  complication 
than  defective  vision.  It  was  generally  associated  with  impairment  of  other  special  senses 
or  of  the  mental  faculties  : 


Case. — Private  Charles  Burger,  Co.  G,  70th  New  York  Volunteers,  was  wounded  at  the 
battle  of  Williamsburg,  Virginia,  May  5th,  1862,  by  a musket  ball  which  entered  the  left  side  of 
the  head,  passed  through  zygoma  and  emerged  at  the  mastoid  process  of  the  temporal  bone. 
He  was  conveyed  to  Baltimore,  JMaryland,  and  admitted  into  McKim’s  Mansion  Hospital  on  May 
10th.  Four  fragments  of  bone  were  removed  from  the  squamous  portion  of  the  left  temporal  hone ; 
the  large.st  measuring  one-fourth  by  one  inch.  He  improved  rapidly,  and  on  August  Cth,  1802, 
was  discharged  from  servdee,  having  recovered,  with  paralysis  of  the  seventh  pair  of  nerves. 
The  pathological  specimen,  contributed  by  Surgeon  L.  Quick,  U.  S.  V.,  is  figured  in  the  adjacent 
wood-cut,  (Fig.  114).  In  August,  1869,  Burger  was  a pensioner  at  .§4  per  month,  his  disability 
being  rated  one-half.  The  certificate  of  Pension  Examiner  D.  A.  Otis,  dated  April  25th,  1804, 
states  that  the  sight  of  the  left  eye  and  the  hearing  of  the  left  car  are  destroyed,  and  that  twenty- 
eight  necrosed  pieces  of  bone  had  been  discharged  from  the  wound. 


Fig.  114. — Fragments  of  tem- 
poral removed  after  gunshot 
fracture.  Spec.  411,  Sect.  I,  A. 
M.  M. 


Case. — Private  George  Schroeder,  Co.  A,  82d  Illinois  Volunteers,  was  wounded  at  the  battle  of  Chancellorsville,  Virginia, 
May  3d,  1863,  by  a conoidal  b.all,  which  fractui-ed  the  mastoid  portion  of  the  right  temporal  bone.  On  May  5th,  he  was  admitted 
to  the  hospital  of  the  3d  division.  Eleventh  Corps,  where  fragments  of  bone  were  removed  by  Surgeon  C.  S.  Wood,  66th  New 
York  Volunteers.  On  May  23th,  the  patient  was  sent  to  2d  division  hospital  at  Alexandria,  and  on  Seiitember  16th,  1863, 
returned  to  duty.  He  was  discharged,  August  26th,  1864,  and  pensioned.  His  pension  was  increased  in  Septimiber,  1867, 
reduced  in  September,  1869,  and  in  March,  1870,  he  applied  for  an  increase  of  pension,  claiming  that  his  disabilities  had  increased. 
Pension  Examiner  J.  W.  Thompson  certifies  that  there  was  a depression  in  the  mastoid  portion  of  the  temporal,  and  that  the 
patient  complained  of  neuralgic  pains  on  the  right  side  of  the  head,  and  of  deafness  of  the  right  ear ; but  after  sev'eral  weeks  of 
observation  of  this  pensioner,  he  did  not  recommend  any  increase  over. his  present  rate  for  three-fourths  disability. 


Case.  Private  II.  Elkin,  Co.  I,  35th  Ohio  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of  Chickamauga, 
September  19th,  1863,  by  a conoidal  ball,  which  entered  at  a point  one-fourth  of  an  inch  posterior  to  the  left  ear,  and  immediately 
anterior  to  the  lower  portion  of  the  mastoid  process,  opening  the  meatus,  and  emerged  from  the  forehead  at  a point  two  inches 
above  the  outer  canthus,  and  one  inch  above  the  superciliary  ridge  of  the  left  eye.  He  was  admitted  to  the  ho.spital  of  the  1st 
division.  Fourteenth  Corps,  and  on  September  29th,  was  sent  to  Hospital  No.  1,  at  Chattanooga.  There  were  no  cerebral  symp- 
toms. Some  small  spicula)  of  bone  were  removed  from  the^upper  o[)ening.  No  unfavorable  symptoms  presented  themselves. 
The  patient  was,  on  November  13th,  sent  to  the  field  hospital  at  Bridgeport,  Alabama ; on  November  14th,  to  Cumberland ; 
December  6th,  to  Taylor  Hospital,  Louisville,  Kentucky;  and  February  23d,  1864,  to  Jeffersonville,  Indiana,  whence  he 

30 


was 


234 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


rfturiicd  to  duty  Fidnuarv  29tl),  ISOI.  He  was  discliarged  August  31st,  lS(i5,  and  pensioned.  Pension  Examiner  J.  S. 
McNeeley  reported,  in  October,  1807,  tliat  there  was  total  loss  of  hearing  in  the  left  ear,  and  of  sight  in  the  left  eye,  and  mental 
imbecility,  unfitting  this  jiensioner  for  business  pursuits  or  for  manual  labor. 

Ca.se. — Private  Richard  8.  McLaury,  Co.  G,  101st  New  York  Volunteers,  received,  in  the  engagement  near  Chantilly, 
Virginia,  Sejitember  1st,  1802,  a fractury  of  the  light  parietal,  and  a slight  wound  of  the  scrotum.  He  was  conveyed  to  Wash- 
ington and  admitted  to  Douglas  Hospital.  On  October  2r)th,  a piece  of  bone  was  removed  from  the  skull ; otherwise  the  wound 
did  well,  and  the  patient  was  sent  to  Jarvis  Hospital,  Baltimore,  where  he  was  discharged  from  the  service  on  Decemher  27th, 
1802,  and  |iensioned.  In  8eptember,  1803,  Examiners  O.  S.  Bundy  and  J.  G.  Orton  reported  that  this  pensioner  had  defective 
hearing  and  vision,  and  that  his  intellect  was  im|iaired  and  general  health  seriously  undermined.  They  rated  his  disability  as 
total.  No  improvement  is  noted  in  the  reports  since  that  date. 

Case. — Private  Oliver  M.  Phillips,  Co.  B,  Jj8th  Massachusetts  Volunteers,  aged  29  years,  was  wounded  at  the  battle  of 
Cold  Harbor,  Virginia,  June  3d,  1804,  by  a conoidal  musket  ball,  which  entered  near  the  superior  angle  of  the  occipital  bone  and 
emerged  about  one  inch  above.  He  was  admitted  to  the  hospital  of  the  2d  division.  Ninth  Corps,  and  on  June  7th,  sent  to  the 
1st  division  hospital  at  Alexandria,  where  several  ])ieces  of  bone  were  removed.  Here  he  remained  until  February  25th,  1865, 
^vhen  he  was  sent  to  the  Fairfax  Seminary  Hospital.  He  recovered,  and  was  discharged  from  the  service  on  May  29th,  1805. 
The  Pension  Examiner  reported,  September  21st,  1865,  that  there  was  a depressed  cicatrix  near  the  vertex,  half  an  inch  wide 
and  three  inches  in  length,  and  that  the  patient  was  totally  deaf  in  the  right  ear.  and  that  he  had  constant  pain  in  the  head. 

The  following  two  cases  were  believed  to  be  examples  of  recovery  with  balls  lodged 
in  the  brain.  (See  p.  193,  ante.) 

Case. — Corporal  Ellroy  Churchill,  Co.  A,  1st  New  York  Mounted  Rifles,  aged  23  years,  on  April  8th,  1863,  was  admitted 
to  Ladies’  Home  Hosjiital,  New  York,  with  a gunshot  tvound  of  the  head.  The  missile  had  entered  just  anteriorly  to  the  right 
ear,  and  lodged  in  the  external  auditory  canal.  On  admission,  there  was  free  purulent  discharge  from  the  right  meatus.  In 
front  of  the  corresponding  tragus  was  the  scar  of  a gunshot  wound.  Deep  in  the  external  auditory  canal  was  a mass  of  florid 
granulations  giving  issue  to  pus,  and  supposed  to  cover  the  seat  of  the  rifle  ball.  Deafness  was  marked,  but  not  complete, 
proving  that  the  internal  eai-  I'emained  uninjured.  Tlie  auditory  canal  tvas  kept  clear,  and  a solution  of  nitrate  of  silver  was 
appli(*d  to  the  granulations  with  a view  of  reducing  their  size  and  making  exploration  for  the  ball  possible.  On  May  9th,  the 
l)atient  was  placed  under  the  influence  of  chloroform,  and  two  small  pieces  of  carious  bone  were  removed  from  a mass  blocking 
up  the  canal.  The  meatus  was  freely  incised,  and  a plug  of  sponge  introduced  with  the  expectation  of  making  another  attempt 
to  remove  the  remaining  mass  and  to  reach  the  ball,  but  before  the  latter  operation  coidd  be  attempted,  the  ])atient  was  discharged 
from  the  service  on  May  20th,  1863,  and  left  the  hospital.  Pension  Examining  Surgeon  W.  !M.  Chamberlain  reported,  August 
4th,  1863,  that  there  was  a ball  lodged  in  the  right  temporal  bone,  causing  necrosis  and  loss  of  hearing.  The  patient  appears 
not  to  have  been  pensioned  at  the  time.  The  records  of  the  Interior  Department  show'  that  the  case  was  reopened  for  investigation 
March  17th,  1870,  the  patient  having  insisted  on  his  right  to  pension. 

Case. — Private  Richard  N.  Thorndyke,  2d  Battery,  1st  Maine  Artillery,  aged  23  years,  was  wounded  at  the  battle  of 
Gettysburg,  July  2d,  1863,  by  a conoidal  ball,  which  struck  the  left  side  of  the  head  one  inch  and  a half  above  and  behind  the 
ear,  penetrated  the  skull,  and  lodged.  He  w'as  admitted  to  the  Camp  Letterman  Hospital  on  the  following  day,  and,  on  the  19th, 
transferred  to  the  hospital  at  York,  Pennsj'lvania,  The  patient  stated  that  he  was  insensible  for  an  hour  or  more  after  the 
reception  of  the  wound,  that  a portion  of  the  bone  had  been  removed,  and  that  he  had  suffered  constant  pain  in  the  opposite  side 
of  the  head.  He  was  deaf  in  the  left  ear,  and  had  confused  hearing  in  the  right.  Cold-water  dressings  were  applied,  and  by 
August  7th,  the  wound  had  healed ; but  dizziness  still  occurred  whenever  exposed  to  the  sol.ar  heat.  He  was  discharged  fi'om 
the  service  on  November  30th,  1863,  with  loss  of  hearing,  impaired  mental  power,  ami  imperfect  vision,  the  missile  still 
undiscovered.  In  1866,  he  w’as  examined  by  Dr.  Charles  N.  Germaine,  pension  examining  surgeon.  Tlie  missile  still  remained 
in  his  brain,  causing  total  deafness  of  left  ear,  impaired  eyesight,  defective  memory,  vertigo,  weakness,  and  inability  to  walk, 
and  wholly  unfitting  him  to  jierform  any  manual  labor.  He  is  a pensioner,  and  his  disability  is  rated  total  and  pennanent. 

The  patient  whose  history  is  related  in  the  next  abstract  must  afford  an  interesting 
subject  for  physiological  study — the  senses  of  smell,  vision,  hearing,  and  taste  being  more 
or  less  completely  destroyed  on  one  side,  in  connection  with  facial  paralysis  : 

Case. — Private  Albert  W.  Bullock,  Co.  B,  22d  Wisconsin  Volunteers,  aged  22  years,  was  wounded  at  Atlanta,  Georgia, 
August  17th,  1864,  by  a conoidal  musket  ball,  which  entered  the  left  side  of  the  head  two  inches  in  front  of  the  ear,  and  emerged 
one  and  a half  inches  behind  the  ear,  fracturing  the  mastoid  process  of  the  temporal  bone.  He  was  admitted  to  the  hospital 
of  the  3d  division.  Twentieth  Corps,  and,  on  September  1st,  sent  to  Hospital  No.  1,  Chattanooga.  On  October  15th,  he  was 
admitted  to  the  Joe  Holt  Hospital,  Jeffersonville,  Indiana;  thence  sent  to  the  Jefferson  Barracks,  St.  Louis,  Missouri;  on 
December  16th,  transferred  to  the  Swift  Hospital,  Prairie  du  Chien,  W’isconsin ; and  on  February  9th  to  the  Harvey  Hospital, 
Madison,  Wisconsin.  At  the  latter  hospital  it  is  stated  that,  on  August  17th,  1864,  several  pieces  of  the  mastoid  process  were 
removed.  On  May  23d,  1865,  Bullock  was  mustered  out  of  service.  In  1868,  he  was  a pensioner  at  four  dollars  per  month,  his 
disability  being  rated  at  one-half  and  temporary.  His  pension  was  aftenvard  increased  to  fifteen  dollars  per  month.  Pension 
Examiner  H.  B.  Johnson,  jM.  D.,  having  certified  as  follows:  “The  wound  leaves  him  with  complete  loss  of  hearing,  taste,  and 
smell  of  left  side,  with  partiid  blindness  of  that  eye,  from  retinitis;  also  has  paralysis  of  .all  the  muscles  of  the  injured  side. 


REMOVAL  OF  FRAGMENTS  AFTER  GUNSFIOT  FRACTURES  OF  THE  SKULL. 


235 


iiialiilitv  to  closo  flip  eyelids,  and  tenderness  of  eyeball.  The  condition  of  the  brain  induces  vertigo  and  unsteadiness  of  gait. 
He  cannot  stoop  for  many  moments  without  complete  syncope.  The  deformity  is  very  considerable,  causing  an  a])pearance  of 
imbecility  when  seen  from  the  injured  side.  So  far  as  known,  his  habits  are  good.  The  disability  seems  to  be  pennanent  in 
cliaracter,  and,  in  my  opinion,  is  total.” 

Erysipelas. — The  comparative  rarity  of  erysipelatous  complications  of  injuries  of  the 
head,  especially  among  the  Union  troops,  has  been  adverted  to  several  times  in  the  preced- 
ing pages  of  this  chapter.*  The  observation  holds  good  in  regard  to  the  cases  of  gunshot 
fractures  of  the  skull  in  which  it  was  necessary  to  remove  fragments.  In  the  histories  of 
one  hundred  and  twenty-six  patients  of  this  series  who  recovered  and  were  discharged  and 
pensioned,  this  complication  is  noticed  in  three  instances  only. 

Ca.se. — Private  Jacob  Arnold,  Co.  E,  G4th  New  York  Volunteers,  aged  22  years,  received  at  the  battle  of  Antietam, 
M aryland,  September  17th,  1832,  a gunshot  fracture  of  the  left  parietal  bone,  with  depression  of  both  tables.  Treated  first  at 
his  regimental  hospital,  he  was  sent,  on  September  24th,  to  the  general  hospital  at  Frederick.  On  admission,  he  had  complete 
paralysis  of  the  right  leg  and  arm,  and  several  convulsions  soon  after  occurred.  A crucial  incision  was  made,  and  depressed 
bone  was  elevated  and  removed  by  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.  The  flaps  were  then  replaced,  and  adhesive  strips 
and  cold-water  dressings  were  applied.  Erysipelas  of  the  forehead  supervened,  but  this  was  successfully  treated  by  the  usual 
remedies.  By  November  17th  the  wound  had  cicatrized,  and  by  April,  1863,  the  paralysis  had  disa])peared.  Arnold  was 
discharged  from  the  service  May'  21,  1833.  He  is  a pensioner,  and  his  disability'  is  rated  total. 

Case. — Private  William  Bennett,  Co.  B,  7th  Michigan  Volunteers,  was  wounded  at  the  battle  of  Gettysburg,  July  2d,  1863, 
by  a ])iece  of  shell,  which  fractured  the  frontal  bone  just  above  the  ey'e.  He  was  admitted  to  the  hospital  of  the  2d  division. 
Second  Corp.s,  and  on  July'  7th  was  sent  to  Mower  Hospital.  On  July'  17th,  erysipelas  set  in,  but  was  readily'  checked.  On 
July  20th,  a piece  of  loose  bone  was  removed.  From  that  time  the  wound  healed  rapidly',  and  in  December,  1863,  the  patient 
was  doing  light  duty'  in  the  ward.  On  August  22d,  he  was  sent  to  Detroit,  and  discharged  fi'om  the  service  on  September  2d, 
1864.  He  is  a pensioner,  suffering  frequently  from  headache  and  dizziness,  and  his  disability  is  rated  one-half  and  temporary. 

Ca.se. — Private  Erick  Ward,  Co.  C,  31st  Iowa  Volunteers,  aged  29  years,  was  wounded  in  an  engagement  before 
Vicksburg,  Mississijipi,  May'  20th,  1863,  by'  a s]^herical  musket  ball,  which  fractured  the  left  parietal  bone.  He  was,  on  May 
23d,  admitted  to  hospital  steamer  Nashville;  on  June  6th,  transferNd  to  steamer  R.  C.  Wood  ; and  on  June  8th,  sent  to  Union 
Hospital  at  Memphis.  On  July  9th,  he  was  sent  to  City  Hosi)ital,  St.  Louis,  where  jxirtions  of  the  fractured  bones  were  removed, 
leaving  the  brain  exposed.  On  July  26th,  he  was  sent  to  .left'erson  Barracks,  where  he  was  treated  for  erysipelas  and  acute 
conjunctivitis.  He  was  finally  discharged  on  iMay'  10th,  1864,  and  pensioned.  At  that  date,  I’ension  Examiner  F.  G.  Porter 
suras  up  the  case  as  follows  : “ The  result  is  a loss  of  a portion  of  the,  left  parietal  bone  and  partial  paralysis  of  the  right  side  ; 
epilepsy'  and  deafness  of  the  right  ear,  and  imp.aired  vision.”  On  March  25th,  1870,  this  pensioner  applied  for  an  increase  of 
pension,  on  the  ground  that  his  disabilities  had  augmented. 

Gangrene. — Several  of  the  cases  of  this  suhsection  were  complicateJ  with  sloughing. 
The  fatal  cases  will  be  noted  farther  on.  The  following  four  recovered,  and  were  pen- 
sioned : 

Ca.se. — Corporal  James  P.  Barton,  Co.  C,  36th  Illinois  Volunteers,  aged  21  year.s,  was  w'onnded  in  a skirmish  at 
Adairsville,  Georgia,  May  17th,  1884,  by  a conoidal  ball,  which  struck  the  skull  about  three  inches  above  the  left  ear,  split  upon 
the  bone,  and  lodged.  One-half  of  the  missile  was  removed  at  the  first  dressing.  He  was  admitted  to  the  field  hospit.'il  at 
Resaca,  and,  during  the  first  three  weeks,  he  was  insensible.  He  remained  in  that  hospital  until  the  22d  of  June,  when  he  was 
transferred  to  the  Cumberland  Hospital,  Nashville.  At  this  time  there  was  a moderate  disch.arge  from  the  wound.  About  the 
latter  part  of  August,  gangrene  set  in,  and  laid  the  skull  bare  for  a large  space  around  the  wound,  exposing  the  attachments  of 
the  external  ear.  At  this  stage  the  remaining  portion  of  the  ball,  battered  and  misshapen,  was  discov'cred  and  removed.  At 
the  same  time  several  jiieces  of  bone  were  taken  out,  one  nearly  one  inch  square,  from  the  scpiamous  portion  of  the  temporal 
bone,  and  another  nearly  as  large  from  the  parietal.  The  patient  stated  that  some  of  the  brain  substance  was  removed  at  several 
of  the  dressings,  but  he  did  not  know  whether  there  was  hernia  cerebri  or  not.  He  went  home  on  furlough  on  September  1.5th, 
and  returned  on  December  1st.  On  January'  26th,  1865,  he  was  returned  to  duty,  and  served  with  his  regiment  until  mustered 
out  of  serv'ice  on  October  8th,  1865.  During  this  time  he  w'as  troubled  v'ery  much  with  headache  and  pains  in  the  region  of  the 
wound.  On  May  8th,  he  was  examined  for  a pension  hy'  Dr.  John  Young,  examining  surgeon  for  pensions  at  Monmouth,  Illinois. 
The  headache  and  pains  in  the  region  of  the  wound  still  continued,  but  were  not  so  severe  or  fre(pient.  There  was  a de))rcssion 
at  the  place  of  injury'  about  two  inches  in  length  and  three-fourths  of  an  inch  in  width,  of  a crescentic  form,  apparently  closed 
by  firm  fibrous  tissue.  There  was  also  a groove  running  from  the  low'er  jiosterior  corniu-  of  the  depression  downwai'd  and 
backward  a distance  of  one  and  a half  or  two  inches,  and  another,  ahout  an  inch  long,  running  directly  downward  toward  the 
ear.  With  the  exception  of  the  occasional  headache  before  mentioned,  he  felt  no  inconvenience  from  the  injury. 

Case. — Private  Edwin  8.  Edgerly,  Co.  E,  12th  New  Hampshire  Volunteers,  aged  20  years,  was  wounded  at  the  battle 
of  Chancellorsville,  Virginia,  May  3d,  1863,  by  a conoidal  ball,  which  fractured  and  depressed  the  cranium.  He  was  admitted 


.See  pp.  77,  tot,  and  185,  ante. 


236 


WOUNDS  AND  INJUEIES  OF  THE  HEAD 


to  the  Third  Corps  field  hospital  on  the  next  day;  sent  to  Mount  Pleasant,  Washington,  on  May  8th;  transferred  to 
the  McClellan  Hospital,  Philadelphia,  June  19th ; to  the  Knight  Hospital,  New  Haven,  Connecticut,  August  9th ; and  thence 
to  Brattleboro’,  Vermont,  August  10th,  18C3.  Fragments  of  btme  had  been  removed  at  different  times.  Gangrene  of  the  wound 
appearing,  bromine  was  applied  to  it,  and  subsequently  simple  dressings.  On  February  Gtb,  18G4,  the  patient  had  sufficiently 
recovered  to  be  discharged  from  the  service.  On  August  7th,  18GG,  Pension  Examiner  Ira  S.  Chase  reported  that  the  patient  is 
wholly  unable  to  do  any  manual  or  mental  labor.  His  disability  is  rated  total  and  permanent. 

Case. — Private  Israel  M.  Euff,  Co.  B,  142d  Pennsylvania  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of 
Gettysburg,  Pennsylvania,  July  1st,  1863,  by  a fragment  of  a shell,  which  comminuted  both  tables  of  the  skull  at  the  right 
pai'ietal  eminence,  and  rendered  him  insensible  for  a short  time.  He  was  conveyed  to  a field  hospital,  where  the  wound  was 
enlarged,  and  spiculse  of  both  tables  were  removed,  while  the  patient  was  under  the  influence  of  chloroform.  On  July  23d,  he 
was  admitted  into  the  Broad  and  Cherry  Streets  Hospital,  Philadelphia,  Pennsylvania.  No  constitutional  derangement  existed  at 
that  time.  A granulating  surface  one  inch  in  diameter,  over  which  the  brain  pulsations  were  distinctly  visible,  occupied  a position 
corresponding  to  that  of  the  parietal  eminence.  Plain  nutritious  diet  was  ordered,  and  the  wound  dressed  with  a weak  solution 
of  sulphate  of  co)>per.  Under  this  treatment  he  continued  to  improve  until  August  5th,  when  he  was  taken  with  fever,  and  his 
wound  began  to  slough.  The  sloughing  continued  for  several  days,  until  it  occupied  a space  two  inches  in  diameter,  but  of 
slight  depth.  A weak  solution  of  chlorinated  soda  was  applied,  and  healthy  granulations  again  sprung  up.  By  October  1st  the 
wound  had  almost  cicatrized,  though  the  brain  pulsations  were  still  visible.  Pie  was  discharged  from  the  service  on  December 
ICth,  1863.  Pension  Examiner  J.  W.  Blackburn  reported,  January  6th,  1864,  that  there  was  persistent  pain  in  the  forehead,  and 
weakness  of  sight  and  of  intellect.  A communication  from  the  Commissioner  of  Pensions,  January  2d,  1868,  states  that  Euff  is 
a pensioner,  and  that  his  disability  is  rated  at  three-fourths  and  permanent.  Surgeon  John  Neill,  U.  S.  V.,  reports  the  earlier 
facts  of  the  case. 

Case. — Private  Asbell  A.  Webster,  Co.  1, 19th  Michigan  Volunteers,  received,  at  the  battle  of  Peach  Tree  Creek,  Georgia, 
July  20th,  1864,  a gunshot  fracture  of  the  parietal  bone.  He  was  insensible  or  delirious  for  a considerable  time.  Pie  was  taken 
to  the  hospital  of  the  3d  division.  Twentieth  Corps,  and  on  July  27th,  admitted  to  Cumberland  Hospital,  Nashville.  Six  or  eight 
pieces  of  bone,  the  largest  three-fourths  of  an  inch  in  length,  were  removed  by  Assistant  Surgeon  S.  C.  Ayers,  U.  S.  V.,  from 
the  cranium,  exposing  the  dura  mater.  The  wound  became  gangrenous,  and  a portion  of  the  scalp,  the  size  of  a half  dollar, 
sloughed  away.  On  September  27th,  the  wound  had  healed,  but  sores  would  break  out  occasionally,  especially  in  hot  weather. 
On  October  2;"th,  he  was  sent  to  St.  Mary's  Hospital,  and  on  December  10th,  transferred  to  Harper  Hospital,  Detroit,  Michigan, 
where  he  was  discharged  on  January  Gth,  1865.  His  mental  faculties,  especially  his  memory,  were  somewhat  impaired,  and  the 
('yesight  was,  to  some  extent,  weakened,  according  to  the  report  of  Pension  Examiner  E.  F.  Stratton.  In  1868,  he  was  a 
pensioner  at  $8  per  month,  his  disability  being  rated  total  and  temporary.  The  pathological  specimen  is  No.  4731,  Sect.  I,  A.  M.  M., 
and  was  contributed  by  the  operator.  It  consists  of  seven  small  fragments  of  bone,  most  of  them  from  the  outer  table,  but  the 
larger  comprising  both  tables  and  the  intervening  diploe. 

Foreign  Bodies. — There  were  a few  instances  of  recovery  after  removal  of  fragments 
of  the. skull  for  gunshot  fracture.  Such  extraneous  substances  as  cloth  or  felt  or  leather 
were  extracted  with  the  bone  splinters,  having  been  driven  in  from  the  soldier’s  hat  or  cap 
by  the  projectile.  The  missile  itself,  or  portions  of  it,  was  of  course  often  extracted  with 
the  bone  fragments.  The  following  series  of  six  cases  of  this  description  can  be  collated 
with  those  referred  to  on  pages  181  and  196.  Other  instances  will  be  noted  among  the 
cases  of  removal  of  fragments  of  the  skull  that  had  a fatal  issue : 


Case. — Private  C.  C.  Blake,  Co.  G,  2d  United  States  Sharpshooters,  aged  23  years,  was  struck,  at  the  battle  of  Antietam, 
Maryland,  September  17th,  1862,  upon  the  top  of  his  head,  by  ball  and  buckshot,  the  missiles  passing  laterally  over  the  sk>ill. 
Temporary  symptoms  of  concussion  followed,  and  after  lying  down  fifteen  or  twenty  minutes,  the  patient  walked  to  a field 
hospital  a short  distance  to  the  rear.  His  lower  extremities,  especially  the  left,  were  numb.  The  same  sensation  existed  in  a 
slight  degree  in  the  arms.  The  wound  of  scalp  was  two  inches  long  by  one  inch  wide,  and  fracture  of  the  skull  not  suspected. 
The  head  was  shaved  and  cold  water  dressings  were  applied.  At  the  expiration  of  forty-eight  hours,  the  man  started  and 
walked  to  Frederick,  a distance  of  twenty  miles.  At  the  hospital  there,  a portion  of  felt  from  his  hat  and  some  hair  were 
removed  from  the  wound.  The  patient  was  then  sent  to  Washington,  and  thence,  on  the  24th,  he  was  again  transferred  and 
arrived  at  DeCamp  Hospital,  David’s  Island,  New  York,  on  the  28th.  A fissure  of  the  right  parietal  bone,  near  the  sagittal 
suture,  was  discovered.  At  the  expiration  of  a week,  an  incision  was  made  by  Acting  Assistant  Surgeon  E.  B.  Boot,  and  some 
small  portions  of  the  external  table  were  removed ; the  fissure  was  found  to  extend  upward  of  two  inches  beyond  the  line  of  the 
incision.  Five  days  subsequently  portions  of  both  tables  were  removed,  exposing  the  dura  mater  to  the  extent  of  the  size  of  a 
ten  cent  piece.  The  internal  tablej  which  was  found  depressed  about  four  lines,  was  elevated.  The  patient  had  suffered  from 
neuralgic  pain  over  his  eyebrows,  extending  through  the  right  temple  to  the  wound.  These  pains  and  the  numbness  of  the 
extremities  disappeared  after  the  elevation  of  the  depressed  bone.  The  patient  was  discharged  from  the  service  on  November  3d, 
1862.  The  wound  had  nearly  healed,  there  being  a few  granulations  at  its  centre.  These  moved  with  the  pulsations  of  the  brain. 
No  head  symptoms  e.xisted.  A cotnmunication  from  the  Commissioner  of  Pensions,  dated  January  2d,  1868,  states  that  Blake 
is  a pensioner,  and  that  his  disability  is  rated  total.  The  case  is  reported  by  Surgeon  S.  W.  Gross,  U.  S.  V. 


REMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


237 


Case. — Sergeant  Conrad  Bryan,  Co.  H,  75th  Oliio  Volunteers,  aged  25  years,  was  wounded  at  the  hattlo  of  Chancollors- 
ville,  Virginia,  May  2d,  1863,  by  a conoidal  ball,  which  fractured  the  left  parietal  bone.  He  was  admitted  to  the  hospital  of  the 
1st  division.  Eleventh  Corps,  and  on  June  15th,  transferred  to  the  Carver  Hospital  at  Washington;  but  on  the  20th,  sent  to  the 
Mower  Hospital,  Philadelphia.  The  wound  at  this  time  was  very  much  inllamed  and  discharging  freely.  Flax-seed  poultices 
and  subsequently  cold  water  dressings  were  applied.  On  June  30th,  a small  portion  of  bone,  together  with  a piece  of  his  cap, 
which  had  been  driven  into  the  wound,  were  removed.  On  July  24th,  lie  was  transferred  to  the  Seminary  Hospital  at  Columbus, 
Ohio,  the  wound  being  nearly  healed.  Caries  of  the  skull,  how’ever,  ensued,  followed  by  attacks  of  epilepsy.  The  patient  was 
discharged  from  service  on  April  ICth,  1864.  He  is  a pensioner,  his  disability  being  rated  total  and  doubtful.  The  early  history 
of  the  case  is  I’eported  by  Surgeon  George  Suckley,  U.  S.  V. 

Case. — Private  William  H.  Whitelaw,  Co.  D,  2d  Connecticut  Heavy  Artillery,  aged  25  years,  was  wounded  at  the  battle 
of  Winchester,  Virginia,  September  19th,  1864,  by  a bullet  from  a sphei  ical  case  shot,  which  perforated  and  depressed  the  frontal 
bone  in  the  median  line.  He  also  received  a flesh  wmund  of  the  left  thigh.  He  was  at  once  admitted  to  the  hospital  of  the  1st 
division.  Sixth  Corps,  and  thence  conveyed,  via  Winchester  and  Slartinsburg,  to  the  hospital  at  Frederick,  where  he  arrived  on 
October  12th.  The  missile  and  fragments  of  bone  had  been  removed  before  admission.  No  head  symptoms  existed.  On 
November  20th,  a circular  disc  of  bone,  the  size  of  a bullet,  came  out  of  the  orifice  and  was  removed  by  the  patient.  The  piece 
had  apparently  been  cut  out  by  the  ball,  and  had  been  driven  upon  the  brain.  On-  the  28th,  Acting  Assistant  Surgeon  J.  IT. 
Bartholf  removed  two  pieces  of  jagged  bone,  each  an  inch  in  length,  and  one-third  of  an  inch  in  width,  and  of  an  irregular 
shape.  Simple  dressings  were  applied.  The  patient  did  well  and  was,  on  February  25th,  1865,  transferred  to  the  Knight  Hos- 
pital, New  Haven,  and  on  Jlay  15th,  1865,  discharged  from  the  service,  by  reason  of  surgeon’s  cei'tificate  of  disability.  On 
April  1st,  1868,  Whitelaw  was  a pensioner;  his  disability  being  rated  at  three-fourths  and  temporary.  Pension  Examiner  11. 
Pierpont  reported  the  man  incapable  of  active  exertion ; severe  headache  and  roaring  in  the  ears  resulting  from  slight  exercise. 

Case. — Private  Joseph  Aldridge,  Co.  A,  14th  New  York  Volunteers,  was  wounded  by  a musket  ball,  which  fractured  the 
frontal  bone,  two  inches  above  the  left  eyv.  The  missile  split  upon  the  edge  of  the  bone,  and  remained  fastened  to  it,  recpiiring 
much  force  to  remove  it.  He  was  admitted  to  the  Satterlee  Hospital,  Philadelphia,  on  July  2Gth,  1862.  No  treatment  is 
recorded,  but  ho  recovered,  and  was  discharged  from  the  service  August  25th,  1862.  When  examined  for  a pension  by  Pension 
Examining  Surgeon  H.  B.  Day,  on  December  4th,  1862,  the  wound  had  not  yet  healed.  On  May  16th,  1868,  Examining  Surgeon 
A.  Churchill  reported  this  pensioner’s  disability  as  total,  in  consequence  of  vertigo  and  loss  of  memory.  Dr.  Churchill  states  that 
he  removed  the  ball  at  the  time  of  injury.  Dr.  Dfiy  states  that  several  fragments  of  bone  had  been  removed,  and  that  necrosed 
spiculae  came  away  for  several  months  subsequently. 

Case. — Private  Louis  Fuhr,  Co.  B,  McClellan’s  Dragoons,  received,  in  an  engagement  near  Cheese  Cake  Church, 
Virginia,  May  4th,  1862,  a fracture  of  the  right  parietal,  from  a musket  ball,  which  struck  near  the  upper  posterior  angle.  On 
August  16th,  1862,  he  was  admitted  to  De  Camp  Hospital,  New  York,  whence  ho  was  discharged  and  pensioned  January  5th, 
1863.  Examining  Surgeon  F.  Rubach,  reports  that  “the  ball  lodged,  and  was  extracted,  with  several  spiculm  of  bone;  that 
there  was  a deep  depression  of  the  skull  at  the  seat  of  injury;  that  the  patient  was  affected  by  vertigo  and  intense  .headache,  and 
to  a great  extent  hindered  from  performing  his  usual  labor.” 

C..VSE. — Private  Timothy  Pender,  Co.  F,  3d  Michigan  Volunteers,  was  wounded  at  the  battle  of  Chancellorsville,  Virginia, 
May  2d,  1863,  by  a round  musket  ball,  which  struck  the  right  side  of  the  frontal  bone,  about  one  inch  and  a half  anterior  to 
coronal  suture,  fracturing  both  tables  of  the  bone.  The  missile  was  removed  on  the  field.  He  was  admitted  to  regimental  hos- 
pital; on  May  25th,  sent  to  Judiciary  Square  Hospital,  Washington,  and  on  August  3d  admitted  to  St.  Mary’s  Hosj)ital,  Detroit, 
Michigan.  The  wound  was  in  a bad  condition,  and  on  examination  the  probe  revealed  necrosed  bone.  A crucial  incision  was 
made,  and  a ring  of  necrosed  bone  one-fourth  of  an  inch  in  width  and  comprising  both  tables  was  removed,  which  had  completely 
encircled  the  original  wound.  The  operation  exposed  the  dura  mater  for  a space  as  large  as  half  a dollar.  The  injury  gave  the 
patient  but  little  trouble;  he  recovered  rapidly;  was  discharged  November  3d,  1863,  and  pensioned.  On  August  12th,  1867, 
Pension  Examiner  J.  B.  Scovel  reports  this  man  to  be  subject  to  vertigo  and  severe  neuralgic  pain  in  the  head.  He  rates  his 
disability  three-fourths  and  permanent. 

The  forty  following  patients  survived,  with  disabilities  of  various  degrees.  In  nearly 
all,  the  brain  was  more  or  less  seriously  affected.  Nine  were  insane.  Many  suffered  from 
vertigo,  headache,  partial  paralysis,  inability  to  co-ordinate  the  action  of  the  muscles,  and 
other  indications  of  injury  of  the  nervous  centres.  This  series  completes  the  list  of  cases 
found  on  the  records  of  recoveries  after  the  removal  of  fragments  in  gunshot  fractures  of  the 
skull,  except  cases  of  formal  trephining  and  cases  of  cerebral  hernia: 

Brannixger,  William,  Private,  Co.  I,  183d  Ohio,  aged  43  years.  Franklin,  November  30th,  1864.  Shell  fracture  of 
right  side  of  occipital.  Nashville,  Jeffersonville,  Washington,  and  Philadelphia  hospitals.  Fragments  of  bone  removed  Aj)ril  22d, 
1865.  Wound  healed  May  19th.  Discharged  July  24th,  1865.  August  15th,  1865,  Examiner  W.  Owens,  ]M.  D.,  reports  that 
the  patient’s  mind  was  seriously  impaired,  and  that  large  fragments  of  bone  were  removed  sifter  he  left  the  hospital. 

Germain,  Henry  J.,  Private,  Co.  K,  155th  New  York,  aged  20  years.  North  Anmi,  May  18th,  1864.  Shell  fracture  of 
left  parietal.  Alexandria,  New  Tork,  and  Buffalo  hospitals.  Discharged  June  8th,  186.5.  Pension  Ollice  reports,  November  8th, 
1869,  this  pensioner  partially  insane,  with  defective  sight  and  hearing,  requiring  a watcher. 


238 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Noukse,  Gf.ohg]C  U.,  I’l'ivate,  Co.  E,  ‘23(1  Jlasisaclmsctts.  Kinston,  Docfinbcn'  lltli,  186*2.  Slioll  IVactiiro  of  loft  parietal 
near  tlie  ]iusterior  superior  angle.  Foster  Hospital,  New  Ilerne.  Removal  of  fragments  on  the  twenty-third  day  after  reception 
of  the  injury,  ^\ilh  immediate  relief  to  the  stupor,  cephalalgia,  and  convergent  strahisiniis,  which  had  existed  from  the  date  of  the 
wound.  Transferred  to  Wason  Hospital,  Boston,  Fehruary  14th,  1863.  Discharged  and  ])cnsioned  A))ril  27th,  1863.  January 
16th,  1867,  Examiner  J.  W.  Spalding,  M.  D.,  rejiorts  his  disability  as  total  on  account  of  mental  imbecility. 

Wagxei:,  CuAliLES,  I’rivate,  Co.  L,  1st  New  York  Cavalry,  aged  25  years.  Pistol  hall  fracture  of  temjioral.  Washing- 
ton, June  26th,  1865,  Aimoi}*  S(juare  Hosjiital,  Removal  of  fragments  by  Surgeon  D.  W,  Bli,ss,  U,  S.  V,,  and  ligation  of 
posterior  auricidar.  Transferred  to  Ilarewood  Hospital  August  15th;  discharged  October  l‘2tli,  1865,  Pension  Office  reports, 
July  10th,  1868,  disability  total.  Examiner  P.  S.  Treadwell,  December  13th,  1869,  states  that  insanity  is  said  to  have  ensued. 

Libby,  Sami  el  B.,  I’rivate,  Co.  B,  17th  Maine,  aged  23  years.  Spottsylvania,  May  21st,  1864.  Fracture  over  vertex 
by  colloidal  musket  hall.  Emory,  Blackwells  Island,  and  C’ony  hospitals.  Fragments  removed;  dura  mater  exposed;  left  leg 
partially  )iaralyzcd.  Discharged  Deccndier  15th,  1864.  April  26th,  1865,  Examiner  D.  O.  I’erry,  M.  D.,  reports  complete  left 
hemiplegia,  mental  ohtuseness,  and  severe  pain  in  the  head,  and  rates  the  disability  three-fourths  and  somewhat  amenable  to 
treatment.  September  30th,  1867,  Examiner  T.  A.  Foster  reports  that  this  man,  after  recxiveriug  almost  entirely  from  paralysis, 
had  headache,  temporary  insanity,  and  epileptic  fits. 

SiMMiNG,  IlENiiY,  Private,  Co.  F,  74th  Pennsylvania.  Cross  Keys,  June  8th,  1862.  Gunshot  fracture  of  upper  angle 
of  right  parietal.  Two  inches  of  hone  removed.  Grafton  Hospital,  West  Virginia.  Discharged  October  17th,  1864.  January 
3d,  1865,  Examiner  Cook,  AI.  D.,  reported  this  applicant’s  mind  deranged.  In  March,  1868,  this  man's  disability  was  rated  at 
three-fourths  and  temjiorary. 

Lew'is,  Lucian,  Private,  Co.  D,  69th  New  York,  aged  18  years.  Petersburg,  September  30th,  1864.  Fracture  of 
occipital  by  conoidal  musket  hall.  Corps,  Judiciary  Sipiare,  and  Satterlee  hospitals.  Bone  splinters  removed  and  dura  mater  laid 
hare.  Discharged  May  10th,  1865.  Pension  Office  reports  him  a pensioner,  and  that  he  suffers  from  cephalalgia  and  impaired 
mind. 

Lovii,  John,  Private,  Co.  C,  57th  Mas.«achusetts,  aged  35  years.  Petersburg,  October  8th,  1864.  Depressed  fracture  of 
left  parietal  near  vertex  by  conoidal  hall.  Corps,  Beverly,  and  Satterlee  hospitals.  Removal  of  large  fragments.  Discharged 
May  24th,  1865.  July  lUth,  1868,  disability  rated  total  by  Examiner  Oramel  Martin,  M.  D. 

Byeks,  Thomas  P.,  Corporal,  Co.  F,  18th  Ohio.  Murfreesboro’,  December  31st,  1802.  Shell  fracture  near  upper 
portion  angle  of  left  parietal.  Fragments  removed,  leaving  an  opening  an  inch  long  and  half  an  inch  wide.  Was  hemiplegic 
for  two  months.  Nashville  hospital  No.  14.  Discharged  April  29th,  1803.  Examiner  G.  D.  Hildreth  rates  the  disability  at 
three-fourths.  Examiner  J.  11.  Brow'n  pronounces  it  permanent,  and  says  that  there  is  depression  over  the  youtliful  corporal’s 
posterior  fontanelle. 

Campion,  Edwabd  J.,  Corporal,  Co.  C,  20th  Massachusetts,  aged  31  years.  Antietam,  September  17th,  1862.  Shell 
fracture  of  right  temporal  hone.  Baltimore  hospitals.  Removal  of  sidculte  of  hone.  Discharged  March  10th,  1863.  Examiner 
David  Choate,  M.  D.,  reports,  November  ‘27th,  1863,  that  the  patient  is  subject  to  vertigo,  paljiitation,  and  morbid  tvakefulness. 

Cleveland,  William  P.,  Private  Co.  K.,  51st  New  York,  aged  23  years,  Petersburg,  July  7th,  1864.  Shell  fracture  of 
frontal.  Bone  splinters  removed.  Ninth  Coips  hospital.  Fairfax  Seminary  Hospital.  Discharged  from  service  January  21st, 
1865,  and  pensioned.  Examiner  Samuel  Hutchings  reports,  March,  1866,  that  the  bone  is  gone  over  the  right  eye,  which  is  weak, 
and  rates  the  disability  at  three-fourths. 

O'Connor,  John,  Pi  ivate,  Co.  F,  86th  New  York,  aged  27  years.  Gettysburg,  Jul^*  3d,  1863.  Fracture  of  rigid  parietal 
by  conoidal  ball.  Mis.sile  lodged,  but  was  removed  on  the  field.  Gettysburg  and  Philadelphia  hospitals.  Removal  of  small 
fi’agmeid  of  bone  July  9th.  Symptoms  of  a typhoid  character  supervened,  but  were  readily  subdued.  Discharged  Sej)t('mber 
19th,  1864.  Examiner  S.  N.  Pierce,  M.  D.,  June  l*2th,  1867,  reports  that  the  pensioner  has  convulsions,  followed  by  severe  jiros- 
tration.  Disability  total  and  permanent. 

Dugan,  I’atrick,  Private,  Co.  A,  31st  Massachusetts.  Port  Hudson,  Louisiana,  May,  1863.  Gunshot  fracture  of  cranium 
by  a conoidal  ball.  Treated  at  barracks  bospital.  New*  Orleans.  Discharged  November  I'Jth,  1863.  August  17 th,  1864,  Examiner 
George  C.  Lawrence  imports  that  a portion  of  the  skull  has  been  removed,  and  that  the  patient  sufl'ers  from  pain  in  haad  and 
dizziness.  Disability  three-fourths  and  permanent. 

Dygert,  Edwin  F.,  Private,  Co.  D,  114th  Illinois.  Jackson,  Tennessee,  January  14th,  1863.  Fracture  of  frontal  by  a 
pistol  ball,  near  the  median  line.  Accide.  dal.  Jefferson  and  St.  Louis  hospitals.  Fragments  of  skull  removed.  Discharged 
June  5th,  1863.  Discharge  paper  states  that  he  has  “lost  control  over  his  locomotion,  so  far  as  direction  is  concerned.  He  cannot 
walk  in  a straight  line,  but  moves  in  a zig-zag.”  Examiner  G.  W.  Cook  subsequently  reported  that  there  was  persistent  pain  at 
the  point  struck,  with  vertigo,  and  described  the  cicatrix  as  over  the  upper  anterior  angle  of  the  right  parietal. 

Cutler,  Hiram,  Private,  Co.  B,  2d  New  Hampshire.  Bull  Run,  August  29th,  1862.  Fracture  of  right  temporal  and 
parietal  by  conoidal  ball.  Douglas  Hospital.  Removal  of  a fragment  of  sejuamous  portion  of  temporal  one  by  one  and  a half 
inches.  Discharged,  December  14th,  1862.  I’ensioned.  Complains  of  giddiness. 

Niciiol.s,  Hiram  B.,  Private,  Co.  C,  11th  Maine,  aged  18  j’ears.  Deep  Run,  August  16th,  1864.  Fracture  of  right  parietal 
at  eminence.  New  York  and  Manchester  hospitals.  Discharged  June  17th,  1865.  September  14th,  1867,  Examiner  Charles  W . 
Snow  reports  that  several  pieces  of  bone  have  been  removed,  leaving  the  brain  exposed.  The  patient’s  memory  is  impaired,  and 
he  suffers  from  vertigo  and  headache.  Disability  three-fourths. 


EEMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


239 


Aixkn,  \Vili.ia:\i  H.,  Corporal,  Co.  K,  llltli  Illinois,  aged  23  year.s.  Fort  McAllister,  Savannah,  Ueceinher  loth,  18(54. 
Fracture  of  left  i)arictal  hy  conoidal  ball.  Corps,  Reanfort,  and  New  York  hosjiitals.  Eeniovid  of  several  fragments.  Dis- 
charged May  Gth,  18G5.  July,  18G8,  Pension  Office  reports  his  disability  total  and  permanent. 

Gipple,  Emanuel,  Co.  I,  93d  Pennsylvania,  aged  24  years.  Sjiottsylvania,  iMay  12th,  18u4.  Shell  fracture  of  temporal 
bone.  Corps,  "Washington,  Philadelphia,  and  Harrisburg  hospitals.  Discharged  June  13th,  18G5.  June  1st,  18G7,  Examiner 
John  Levergood,  M.  I).,  states  that  a piece  of  the  outer  table  of  bone  has  been  removed.  Disability  one-half  and  jtermiinent. 

Rice,  Hikam  E.,  Sergeant,  Co.  E,  112th  New  York,  aged  22  years.  Fort  Fisher,  January  15th,  1865.  Shell  fracture 
of  frontal  bone.  Mansfield,  New  Berne,  and  Buffalo  hospitals.  Removal  of  fragments  of  botie.  Discharged  July  13th,  1865. 
Exanuner  G.  \Y.  Hazelton,  March  29th,  18C6,  rejtorts  disability  one-half  and  permanent. 

Math.\ny,  CYilliam  F.,  Private,  Co.  C,  19th  Ohio,  aged  30  years.  Chickamauga,  September  19th,  1863.  Gunshot 
fracture  of  frontal  bone.  Field  and  Cleveland  hospitals.  Removal  of  several  fragments  of  bone.  Discharged  July  27th,  1864. 
Examiner  C.  D.  Griswold,  M.  D.,  reports,  July  27th,  1864,  that  the  pensioner  is  mentally  and  physically  disabled. 

Meeeneu,  Geoi:ge,  Private,  Co.  K,  15th  West  "Yirginia,  aged  18  years.  Petersburg,  April  2,  1865.  Shell  fracture  of 
left  parietal  bone.  Portsmouth  and  Baltimore  Hospitals.  Removal  of  fragment  of  bone  one  and  a half  by  one  inch.  Discharged 
June  14th,  1865.  Examiner  "W.  S.  Bates,  M.  D.,  reports,  September  14th,  1866,  that  the  pensioner  suffers  from  attacks  of 
blindness  and  giddiness,  and  that  he  is  unable  to  work  for  many  days  together. 

Hollis,  John  E.,  Private,  Battery  I,  1st  Massachusetts  Heavy  Artilleiy,  aged  20  years.  Spottsylvania,  May  19th, 
1864.  Stellate  fracture  of  occipital  bone,  right  side,  by  conoidal  musket  ball.  Corps,  Washington,  Readville,  and  lYorcester 
hospitals.  Removal  of  a fragment  of  bone  through  incision.  Discharged  November  20th,  1865.  January,  1868,  Pension  Office 
reports  his  disability  two-thirds  and  d(nibtful.  Caries  still  existed. 

Jociiu.M,  John  J.,  Private,  Co.  B,  14th  New  York  State  Militia,  aged  28  years.  Gettysbui^,  July  1st,  1863.  Gunshot 
fracture  of  occipital  and  right  parietal  bones.  Corps  and  New  York  hospitals.  Removal  of  fragments  from  parietal  and  occipital 
bones.  Discharged  July  25th,  1864.  Examiner  Charles  Rowland,  M.  D.,  states  that  the  ])ensioner  is  unable  to  work,  but  that 
he  will  eventually  recover.  Disability  three-fourths. 

Chapman,  Joseph,  Private,  Co.  K,  29th  Wisconsin,  aged  17  years.  Compound  fracture  of  right  iiarietal  bone  by  shell. 
Mobile,  St.  Louis,  and  Madison  hospitals.  About  four  square  inches  of  bone  -were  removed.  Discharged  October  5th,  1865. 
May  8th,  1869,  Examiner  William  T.  Galloway  reports  that  the  pensioner  has  the  appearance  of  an  ejtileptic.  Disability  total. 

Rhoades,  Benjamin  F.,  Private,  Co.  I,  93d  Pennsylvania,  aged  24  years.  Wilderness,  May  5th,  1864.  Gunshot 
fracture  of  both  parietal  bones,  near  latnbdoidal  suture.  Washington  and  Philadelphia  hospitals.  Removal  of  bone  by  Acting 
Assistant  Surgeon  L.  E.  Nordman.  Discharged  February  18th,  1885.  March  4th,  1868,  Examiner  John  Levergood  reports 
that  the  pensioner  is  disqualified  for  manual  labor. 

Fl.lvin,  Edwakd  H.,  First  Lieutenant,  Co.  A,  14th  New  York  State  Militia.  Spottsylvania,  May  8th,  1864.  Gunshot 
fi’acture  of  anterior  edge  of  occipital  at  crown  of  head.  Corps,  AVashington,  and  New  York  hospitals.  Removal  of  fragments 
of  bone.  Discharged  June  Gth,  1864.  Examiner  Charles  Rowland,  M.  D.,  states.  May  10th,  1865,  that  there  is  constant  vertigo 
and  partial  loss  of  memory. 

AA'ook,  John  M.,  Private,  Co.  C,  107th  Pennsylvania,  aged  23  years.  Fredericksburg,  December  13th,  1862.  Shell 
fracture  of  frontal,  a little  to  the  right  of  the  median  line.  AA'^ashington  and  Philadelphia  hospitals.  January  25th,  1863, 
removal  of  fragments  of  bone,  leaving  brain  pulsations  visible.  Discharged  March  24th,  1863.  January  2d,  1868,  Pension 
Office  reports  his  disability  one-half  and  temporary. 

Nichols,  AA^alteii,  I’rivate,  Co.  K,  7th  Alichigan,  aged  24  years.  Petersburg,  .luue  22d,  1864.  Gunshot  fracture  of 
fi'ontal  bone.  Corps  and  Philadelphia  hospitals.  Fragments  of  bone  removed  at  various  limes.  Discharged  January  5th,  1865. 
July  7th,  1868,  Examiner  S.  S.  Cutter,  Al.  D.,  reports  that  the  pensioner  suffers  from  dizziness,  dimness  of  vision,  and  general 
prostration,  and  that  his  nervous  system  is  very  much  affected.  Disability  total  and  permanent. 

AIcitPiiY,  Owen,  Private,  Co.  A,  6th  New  A’ork  Cavalry.  Chancellorsville,  Alay  3d,  1863.  Gunshot  fracture  of  parietal 
•bone,  .near  coronal  suture.  AA^ashington  and  Baltimore  hospitals.  Removal  of  ])ieces  of  bone  Alarch  7th,  1864.  Discharged 
July  9th,  1864.  Examiner  .1.  T.  Burdick,  AI.  D.,  reports,  Alay  18th,  1867,  that  there  is  constant  vertigo.  Disability  one-fourth 
and  temporary. 

AIcBitiDE,  Samuel  B.,  Private,  Co.  G,  140th  Pennsylvania.  Chancellorsville,  Alay  3d,  1863.  Gunshot  fracture  of 
frontal  by  conoidal  ball.  Point  Lookout  and  Philadelphia  hosj)itals.  Sharp  points  of  bone,  and  several  fragments  removed. 
Discharged  December  18th,  1863.  February  24th,  1864,  Examiner  J.  R.  AVilson  reports  that  the  pensioner  has  pain  and  heavi- 
ness in  head  atid  along  the  cervical  and  dor.sal  regions  of  the  spine. 

Pollock,  Aleked,  Private,  Co.  G,  78th  Illinois,  aged  21  years.  .Jonesboro’,  September  1st,  1864.  Shell  fracture  of 
occipital  near  protuberance.  Nashville  and  Quincy  hospitals.  Fragments  of  bone  removed.  Furloughed,  and  while  at  home 
had  his  left  leg  fractured  by  a threshing  machine.  Leg  amputated.  Discharged  Alay  18th,  1885.  Examiners  Robbins  and 
Bassett  rate  his  disability  from  wound  of  head  total  and  permanent,  on  account  of  vtu'tigo  and  dizziness. 

Hannah,  .JoSEni,  Private,  Co.  B,  11th  Alissouri.  Corinth,  October  3d,  1882.  Gunshot  fracture  of  frontal  bone.  St. 
John's  Hospital,  Paduc.ah,  Kentucky.  Removal  of  several  spiculm  of  bone.  Discharged  February  3,  1883.  E.xaminer 
Thomas  S.  Hening,  M.  D.,  reports  that  the  pensioner  has  pains  in  the  head,  and  that  his  nervous  system  is  in  a morbid  atid 
excitable  condition. 


240 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


liussELL,  Ci.EJiENT  II.,  Private,  Co.  F,  37tli  Massacliusetts,  aged  19  years.  Wilderness,  May  5tli,  18G4.  Gunshot  frac- 
ture of  cranium  hy  conoidal  ball.  Washington  and  Philadelphia  hospitals.  Removal  of  fragments  of  hone,  leaving  a large 
cavity  in  the  skull.  Discharged  June  12th,  1855.  December  Gth,  18G7,  Examiner  C.  L.  Fisk  reported  that  the  j)ensioner  sutlers 
from  headache  and  dizzines.s,  and  is  unable  to  bear  exposure  to  heat  or  light.  There  is  loss  of  memory,  with  cerebral  excitement 
on  taxing  the  brain  to  any  great  degree. 

Pfaff,  Johx  W.,  Lieutenant,  Co.  A,  101st  Indiana.  Chickamauga,  September  20th,  18G3.  Gunshot  fracture  of  left 
parietal  at  the  posterior  superior  angle.  Corps,  Chattanooga,  and  Nashville  hospitals.  Fragments  of  bone  removed  October  22d 
and  2Gth.  Resigned  February  21,  18G4.  Examiner  T.  S.  Butler,  M.  U.,  November  23d,  18G5,  reports  that  the  physical  system 
of  the  pensioner  is  prostrated.  Disability  one-half  and  permanent. 

Morgan,  Patrick,  Private,  Co.  B,  57th  New  York.  Fredericksburg,  December  11th,  1832.  Gunshot  fracture  of  left 
parietal  bone  by  conoidal  ball.  Corps  and  Washington  hospitals.  Removal  of  a fragment  of  bone  one  and  a half  by  two  and  a 
half  inches.  Space  partially  filled  with  callus.  Discharged  April  25,  18G3.  Examiner  Alonzo  Churchill,  M.  D.,  August  11th, 
1868,  reports  that  the  pensioner  suffers  from  dizziness  and  numbness  of  right  foot  and  hand. 

Terry,  Arthur,  Private,  Co.  B,  8th  Connecticut,  aged  18  years.  Antietam,  September  17,  1832.  Fracture  of  the  left 
side  of  the  frontal  by  a conoidal  musket  ball,  and  flesh  wounds  of  the  side  and  shoulder.  Made  prisoner,  and  paroled  September 
30th,  and  sent  to  Camden  Street  Hospital,  Baltimore.  Necrosed  fragments  of  the  skull  removed  from  time  to  time  by  Acting 
Assistant  Surgeon  A.  W.  Colburn.  Discharged  December  19th,  1832.  In  May,  1864,  Examiner  R.  Strickland  reports  the  wound 
firmly  healed,  and  rates  the  disability  at  one-third  and  temporary. 

McKatheran,  Martin,  Private,  Co.  I,  32d  Massachusetts.  Fredericksburg,  December  13,  1832.  Gunshot  fracture  of 
skull  at  vertex.  Corps  and  W''ashington  hospitals.  Removal  of  fragments  of  bone.  Discharged  February  21st,  1863.  Exam- 
iner George  Stevens,  M.  D.,  reports,  October  15th,  1863,  that  the  pensioner  has  constant  vertigo,  and  periodical  pain. 

Bullock,  Alfred  W.,  Sergeant,  Co.  C,  3d  Massachusetts  Cavalry.  Sabine  Cross  Roads,  April  8th,  1864.  Gunshot 
fracture  of  frontal  bone,  left  side,  by  conoidal  ball.  New  Orleans  and  Readville  hospitals.  Removal  of  exfoliated  bone. 
Discharged  December  19th,  1864.  May  9th,  1866,  Examiner  W.  II.  Page,  M.  D.,  states  that  the  man  suffers  from  dizziness  and 
pain,  especially  on  stooping. 

Van  Valkenburg,  C.vlvin,  Private,  Co.  I,  91st  New  York,  aged  22  years.  South  Side  Railroad,  April  1st,  1865. 
Fracture  of  frontal  by  musket  ball  near  junction  of  coronal  and  sagittal  sutures.  Fifth  Corps,  Lincoln,  and  Ira  Harris  hospitals. 
April  11,  fragments  removed  by  Surgeon  J.  C.  McKee,  with  immediate  relief  of  the  symptoms  of  compression. ^ The  patient 
was  discharged  September  11th,  1865.  In  1835,  Examiner  W.  H.  Craig  reported  that  this  pensioner  suffered  from  giddiness  and 
pain  in  the  head;  and  in  July,  1868,  the  Pension  Office  reports  that  he  is  still  a pensioner,  his  disability  rated  at  three-fourths 
and  permanent. 

Leap,  John  C.,  Private,  Co.  G,  28th  New  Jersey,  aged  43  years.  Fredericksburg,  December  13th,  1832.  Gunshot 
fracture  of  frontal  bone  by  round  ball.  Washington  and  Philadelphia  hospitals.  Spiculie  of  bone  removed  by  crucial  incision. 
Difficulty  of  mictm-ition,  and  pain  in  temples  and  nape  of  neck.  Discharged  March  Gth,  18G3.  September  30th,  1869,  Examiner 
James  E.  Armstrong,  M.  D.,  reports  that  the  missile  still  remains  within  the  cavity,  and  is  supposed  to  be  near  the  base  of  the 
brain.-  His  memory  and  sight  are  impaired,  and  he  is  subject  to  attacks  of  vertigo  and  syncope. 

The  following  series  of  abstracts  refers  to  patients  who  recovered  after  gunshot 
fractures  of  the  skull  treated  by  the  removal  of  fragments ; but  whose  names,  at  last 
accounts,  had  not  been  placed  upon  the  Pension  Roll ; 

Case. — Corporal  Maurice  Fitzgerald,  Co.  E,  28th  Massachusetts  Volunteers,  aged  25  years,  was  wounded  at  Fort  Stead- 
man, Virginia,  March  25th,  1865,  by  a conoidal  ball,  which  comminuted  and  depressed  the  left  parietal  bone  one  and  a half 

inches  to  the  left  of  the  median  line.  On  the  following  day,  he  was  taken  to 
the  hospital  of  the  1st  division.  Second  Corps,  thence  was  conveyed  to  Wash- 
ington, and  admitted  to  the  Emory  Hospital  on  the  30th,  being  in  a state  of 
insensibility  and  unable  to  articulate  or  raise  the  right  hand ; his  tongue 
inclined  to  the  right  side,  when  protruded.  His  pulse  was  slow  but  strong. 
Being  placed  under  the  influence  of  chloroform  on  March  31st,  Surgeon  N.  R. 
Moseley,  U.  S.  V.,  enlarged  the  wound,  removing  numerous  portions  of  the 
cranium,  with  pieces  of  the  ball.  On  April  2d,  jiills  of  calomel  and  extract  of 
henbane  were  administered  to  produce  slight  ptyalism.  On  April  15th,  the 
patient  was  able  to  walk  and  speak,  and  had  proper  use  of  all  parts  of  the 
body.  On  June  3d,  he  was  transfeiTcd  to  the  Mower  Hospital  at  Philadelphia; 
thence,  on  July  24th,  was  transferred  to  Massachusetts.  The  pathological 
specimen  was  contributed,  with  the  history,  by  Surgeon  N.  R.  Moseley,  U.  S.  V.,  and  is  figured  in  the  adjacent  wood-cut.  This 
soldier  was  discharged  the  service,  July  22d,  1865.  His  olaim  for  a pension  is  pending. 

Case. — Sergciant  Brayton  C.  Bailey,  Co.  H,  84th  New  York  Volunteers,  aged  24  years,  was  wounded  at  the  second  battle 
of  Bull  Ruu,  August  30th,  1832,  by  a conoidal  ball,  which  fractured  both  tables  of  the  cranium  at  the  right  frontal  eminence. 


’ .See  photograph  9,  Vol.  HI,  of  Contributed  Surgical  Photographs,  A.  M.  M. 

^ See  the  series  of  nineteen  cases  on  p.  193,  ct  seq.,  with  which  this  would  have  been  grouped  had  the  evidence  been  more  satisfactory. 


REMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


241 


Appareiitly  the  ball  had  split  on  tlie  edge  of  tlie  hone,  and  one  part  of  the  missile  had  passed  into  the  cranial  cavity.  The  ])atient 
was  insemsible  for  several  days.  On  September  dd,  he  was  admitted  to  the  Sixth  and  Master  Streets  Hospital,  Philadelidiia, 
where  he  remained  nnder  treatment  for  four  and  a half  months.  Thence  he  was  transferred  to  the  Mower  llospital.  Two 
months  subsequently,  his  wound  was  probed  and  pieces  of  dead  hone  from  both  tables  were  removed.  The  wound  discharged 
freely,  hut  gradually  closed;  and  the  patient  was  discharged  from  the  service  on  April  ‘27th,  18G3.  Dr.  G.  S.  M'alker,  of  llion, 
Herkimer  County,  New  York,  writing  under  date  of  JMarch  Gth,  18GG,  says  that  the  scar  is  about  an  inch  and  a half  in  dianieter, 
and  gradually  depressed  from  its  outer  margin  toward  the  centre.  There  seems  to  he  a deficiency  of  bony  tissue  for  about  half 
an  inch  about  the  centre.  The  depression  at  the  centre  of  the  scar  is  about  five-eighths  of  an  inch.  The  skin  over  the  scar  has 
not  yet  assumed  its  natural  color  but  is  of  a bluish  tint.  The  jiatient’s  health  had  been  good  ; hut  any  severe  exercise,  mental 
or  physical,  would  induce  dizziness  and  a severe  headache.  At  times,  when  perfectly  quiet,  he  is  attacked  with  a sharp  pain,  as 
if,  according  to  his  description,  his  “ brain  was  being  pierced  with  a pointed  instrument  at  a point  oj)posite  the  wound;”  and  at 
such  times,  any  little  jar  of  the  head  makes  the  pain  so  severe  that  it  almost  blinds  him.  Aside  from  these  attacks,  his  health  is 
good.  He  is  not  on  the  Pension  Roll. 

Case. — Private  William  L.  Copeland,  Co.  A,  1st  Mississippi  Marine  Brigade,  aged  21  yeai’s,  was  wounded,  July  4th, 
18G4,  at  Coleman’s  Cross  Roads,  near  Rodney,  Mississijqii,  by  a musket  ball,  which  entered  the  cranium  two  inches  directly 
above  the  outer  canthus  of  the  right  eye,  fractured  tin*  frontal  bone  and  lodged  in  the  wound.  The  missile  and  fragment  of  bone 
were  removed  on  the  following  day.  He  was  conveyed  to  Vicksburg,  and  entered  McPherson  Hospital  on  the  Gth.  Anodynes 
were  administered  internally,  and  cold  and  emollient  applications  made  to  the  wound.  On  the  1st  of  September,  another  piece  of 
hone  was  removed,  and  on  the  Gth,  a third  fragment  was  removed  by  Surgeon  E.  Powell,  72d  Illinois  Volunteers.  The  wound 
continued  very  painful  until  after  the  removal  of  the  last  piece  of  detached  bone,  when  it  healed  rapidly.  He  recovered 
sufficiently  to  act  as  nurse,  but  had  lost  his  voice.  When  returned  to  duty  on  December  4th,  18G4,  he  had  recovered  his  voice 
He  is  not  a pensioner.  ) •'' 

Case. — Private  Louis  Miller,  Co.  D,  4Gth  New  York  Volunteers,  aged  34  years,  was  wounded  at  Petersburg,  Virginia, 
June  30th,  1884,  by  a shell,  which  fractured  the  cranium  near  the  superior  parietal  angle.  He  was  at  once  admitted  to  the 
hospital  of  the  3d  division.  Ninth  Corps,  where  fragments  of  the  parietal,  temporal,  and  frontal  bones  were  removed,  and  the 
flaps  united  by  a slight  suture.  On  July  3d,  he  was  sent  to  Washington,  and  entered  Ilarewood  Hospital  on  the  4th,  being 
somewhat  uneasy,  but  not  complaining  of  pain.  The  ))ulse  was  slightly  accelerated,  tongue  clean,  and  appetite  good.  U)ion 
removing  the  suture  the  wound  was  found  to  be  full  of  maggots.  The  dura  mater  was  exposed  for  a space  about  three  inches  in 
circumference,  and  of  a greenish  color ; the  pulsations  of  the  brain  were  distinctly  visible.  On  the  Gth,  the  flaps  became 
gangrenous,  and  were  entirely  destroyed.  The  wound  was  healthy,  but  the  external  layer  of  the  dura  mater  was  sloughing. 
Flax-seed  poultices  were  applied.  The  upper  margin  of  the  wound  gi-anulated  finely.  An  incision  was  made,  and  a dressing  of 
chlorinated  soda  was  employed.  The  granulation  of  upper  margin  continued  healthy.  On  July  28th,  secondary  hatmorrhage 
occurred  from  the  left  temporal  artery,  which  was  ligated  ; about  ten  ounces  of  blood  having  been  lost.  From  that  time  the 
wound  assumed  a healthy  appearance.  Small  pieces  of  bone  wore  removed  as  they  became  detached.  Partial  necrosis  of  the 
parietal  bone  supervened.  The  necrosed  portion,  consisting  of  both  lamellaj,  was  removed.  The  discharge  now  became  less 
copious,  and  the  wound  healed  rapidly.  Miller  was  furloughed  on  November  3d,  18G4,  returned  on  the  IGth,  and  was  discharged 
from  the  service  on  July  25th,  18G5,  being,  at  the  time,  in  very  good  health.  He  is  not  a pensioner.  The  case  is  reported  by 
Surgeon  R.  B.  Bontecou,  U.  S.  V. 

Case. — Private  William  Furlong,  Co.  G,  153d  Pennsylvania  Volunteers,  aged  33  j'ears,  was  wounded  at  the  battle  of 
Gettysburg,  Pennsylvania,  July  1st,  18G3,  by  a fragment  of  shell,  which  struck  the  external  angular  jirocess  of  the  frontal  bone 
and  carried  away  the  left  superciliary  ridge.  The  wound  was  about  one  and  a half  inches  in  width,  and  four  inches  ui  length. 
He  was  insensible  only  for  a short  time,  and,  considering  the  serious  nature  of  the  injury,  it  is  remarkable  that  he  walked  with 
his  companions  to  a sand-bank,  and  actually  dug  therefrom,  with  his  own  hand,  the  fragments  of  the  shell  which  inflicted  the 
injury.  He  received  little  or  no  treatment  until  July  IGth,  when  lie  was  admitted  to  Cotton  Factory  Hospital,  Harrisburg, 
Pennsylvania.  Tepid  water  was  injected  into  the  wound,  and  several  spicnlaj  of  bone  were  removed  from  the  substance  of  the 
brain.  One  piece,  however,  was  not  removed  and  still  remains,  as  it  was  feared  that  haimorihage  would  follow  ; besides,  the 
conscious  condition  of  the  jiatient  did  not  warrant  further  interference.  The  jiulse  throughout  I’emained  normal,  and  sleep 
natural.  On  August  10th,  the  patient  was  cheerful,  and  healthy  granulations  had  commenced.  There  was  considerable  tume- 
faction of  the  left  eye,  and  inability  to  move  the  lids.  On  forcibly  opening  them  the  pupil  was  found  dilated ; the  intellect  was 
unimpaired.  On  August  18th,  the  pulsations  of  the  brain  were  still  manifest,  although  granulations  were  nicely  closing  the 
wound.  During  August  and  September,  scales  and  spiculm  of  bone  which  were  forced  to  the  surface  by  the  granulations,  were 
removed.  He  was  discharged  on  September  14th,  18G3.  He  is  not  a pensioner.  The  case  is  reported  by  Acting  Assistant 
Surgeon  Lewis  Post. 

Case. — Private  Thomas  B.  White,  Co.  K,  94th  Ohio  Volunteers,  was  wounded  at  Murfreesboro’,  Tennessee,  Decemlxu- 
31st,  1862,  by  a conoidal  ball,  which  struck  the  posterior  angle  of  the  left  parietal  bone  at  a point  equidistant  one  inch  from  the 
sagittal  and  lambdoid  sutures,  passed  through  the  posterior  portion  of  the  left  hemisphere  of  the  cerebrum,  and  lodged  upon 
the  tentorium  cerebelli,  a distance  of  thi-ee  inches  from  point  of  entrance.  He  became  completely  insensible,  but  recovered 
within  an  hour,  and,  with  the  aid  of  an  assistant  upon  either  side,  walked  to  the  tield  hospital.  Careful  examination  showed 
that  the  hall  was  not  impacted  in  any  of  the  structures ; it  was  therefore  removed,  together  with  a few  loose  spiculm  of  hone. 
During  the  opertition  some  brain  substance  escaped.  Shortly  afterward  he  became  insensible,  and  remained  so  for  three  weeks. 
When  consciousness  returned,  he  was  unable  to  move  his  right  arm  or  leg,  was  very  deaf,  especially  in  the  right  ear,  complained 
of  loss  of  vision  of  right  eye,  and  could  with  difficulty  sj)eak.  lie  improved  very  slowly,  and  at  the  erjd  of  Aju  il,  18G3,  could 
standalone.  He  was  discharged  April  28th,  18G3.  In  August,  1863,  he  looked  well,  and  could  walk  without  difficulty;  the 

31 


242 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


motion  of  his  ann  was  yet  imperfect,  hut  the  wound  was  almost  healed.  Small  spiculae  of  hone,  too  finnly  attacln^  to  be 
removed  at  the  date  of  the  first  operation,  had  from  time  to  time  been  loosened  and  detached  by  the  efi'orts  of  nature.  No  pension 
granted.  Case  still  pending. 

Case. — Private  Patrick  Finnegan,  Co.  I,  Gist  Now  York  Volunteers,  was  wounded  at  the  battle  of  Chancellorsville, 
Virginia,  May  3d,  1863,  by  a round  ball,  which  struck  the  skull  obliquely,  fractuiing  both  tables  of  the  right  paiietal  bone,  just 
above  the  superior  edge  of  the  temporal  bone.  The  ball  split ; one-half  escaped,  the  other  half,  flattened,  lodged  between  the 
tables.  He  was  taken  prisoner,  and  remained  in  the  hands  of  the  enemy  until  May  ICth,  whin  he  was  admitted  to  the  hospital 
of  the  1st  division,  Second  Corps.  The  left  arm  and  leg  were  paralyzed,  and  a number  of  pieces  of  bone  were  fixed  in  the 
substance  of  the  brain.  Two  or  three  ounces  of  pus,  mixed  with  portions  of  brain,  escaped.  The  bone  around  the  orifice  was 
denuded  on  outer  and  inner  surfiices.  On  about  May  21st,  spiculas  of  bone  and  portion  of  ball  were  removed  by  Surgeon  C.  S. 
Wood,  G6th  New  York  Volunteers,  when  the  paralysis  abated.  On  June  14th,  he  was  admitted  to  the  hospital  at  PointLookout, 
Maryland.  A number  of  small  spiculae  of  bone  escaped  from  time  to  time,  but  the  healing  process  continued  without  interruption. 
The  patient's  mind  appeared  somewhat  debilitated,  and  his  hearing  was  imperfect,  but  ho  was  in  excellent  spirits,  sleeping  and 
eating  well.  He  was  discharged  on  June  10th,  1865. 

Case. — Private  Henry  R.  Cox,  Co.  D,  47th  New  York  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of  Olustee, 
Florida,  February  20th,  1834,  by  a conoidal  musket  ball,  which  fractured  the  right  side  of  the  frontal  bone,  without  apparently 
causing  a depression.  He  was  admitted  to  the  ho.spital  at  Jacksonville,  Florida,  February  22d,  1864,  and  sent  on  the  25th 
to  Hilton  Head,  South  Carolina,  where  several  fragments  of  depressed  bone  were  removed,  and  simple  dressings  applied  to  the 
wound.  In  May,  1864,  he  was  transferred  to  New  Y’’ork,  and  on  the  12th  admitted  to  the  St.  Joseph  Hospital,  Central  Park. 
He  recovered,  and  was  mustered  out  on  June  10th,  1865.  He  is  not  a pensioner. 

•<- 

Case. — Private  Peter  Englehart,  Co.  E,  lOth  Wisconsin  Volunteers,  aged  25  years,  was  w'ounded  near  Kenesaw  Mountain, 
Georgia,  June  18th,  1864,  by  a piece  of  shell,  which  struck  the  os  frontis  at  the  junction  of  the  frontal  and  left  parietal  bones, 
causmg  a slight  depression.  He  received  in  the  same  engagement  a perforating  flesh  wound  of  the  left  leg  four  inches  below  the 
knee.  He  w’as  at  once  admitted  to  the  1st  division.  Fourteenth  Corps,  field  hospital ; on  June  29th,  sent  to  No.  1,  Chattanooga; 
and  thence,  on  July  12th,  transferred  to  Hospital  No.  8,  Nashville.  On  July  19th,  he  was  again  transferred  to  the  Jelferson 
Hospital,  Jeffersonville,  Indiana,  and  thence,  per  steamer  R.  C.  Wood,  sent  to  the  Simons  Hospital,  Mound  City,  Illinois.  The 
records  of  the  latter  hospital  state  that  the  patient  remained  insensible  for  ten  days  subsequent  to  the  injury,  and  that  two  small 
pieces  of  bone  were  removed.  The  wound  healed.  On  September  24th,  Englehart  was  admitted  to  the  hospital  at  Keokuk, 
Iowa,  and  discharged  from  the  service  on  October  13th,  1864.  He  is  not  a pensioner. 

Case. — Private  Charles  W.  Webb,  Co.  B,  144th  New  Y’’ork  Volunteers,  aged  18  years,  was  wounded  at  Pocotaligo,  South 
Carolina,  December  6th,  1834,  by  a musket  ball,  which  fractured  and  depressed  the  left  parietal  bone.  He  was  on  the  same 
day  admitted  to  the  regimental  hospital,  and  transferred,  on  December  9th,  to  the  hospital  at  Beaufort,  South  Carolina.  He  had 
lost  the  power  of  speech,  and  was  hemiplegic  on  the  right  side.  A small  portion  of  the  brain  substance,  which  protruded,  had 
sloughed  away,  exhibiting  clearly  the  depressed  portion  of  bone.  On  December  15th,  Surgeon  John  Trenor,  jr.,  U.  S.  V.,  re- 
moved several  fragments  of  the  outer  table  and  elevated  the  inner  table.  W’ater  dressings  were  applied.  The  wound  was  kept 
thoroughly  cleansed  by  syringing  with  water  and  solution  of  chlorinated  soda,  and  the  bowels  were  kept  laxative  by  cathartics. 
Ho  improved  gradually,  regained  his  speech,  and  recovered  by  degrees  the  use  of  the  right  arm  and  leg.  Ho  was  transferred 
on  January  23d,  1865,  and  entered  McDougall  Hospital,  Fort  Schuyler,  New  York  Harbor,  on  January  29th.  On  April  28th, 
he  was  transferred  to  Troy,  New  York,  where  he  remained  until  June  12th,  1865,  when  he  was  discharged  from  the  service.  He  is 
not  a pensioner.  The  case  is  reported  by  the  operator. 

Case. — Private  August  Wiosner,  Co.  A,  50th  Pennsylvania  Volunteers,  aged  25  years,  was  wounded  at  Petersburg, 
Virginia,  June  28th,  1834,  by  a conoidal  ball,  which  fractured  and  depressed  the  left  parietal  bone  between  the  parietal  eminence 
and  the  lambdoidal  suture.  He  Avas  conveyed  to  the  field  hospital  of  the  3d  division.  Ninth  Corps,  where  the  depressed  portion 
was  elevated  by  Surgeon  Wells  B.  Fox,  8th  Michigan  Volunteers.  The  patient  was  sent  to  City  Point,  and  thence,  by  hospital 
steamer,  to  the  McDougall  Hospital,  Fort  Schuyler,  Ncav  Y'ork  Harbor,  which  he  entered  on  July  10th.  He  remained  until 
August  18th,  when  he  was  furloughed,  and  ordered  to  report  at  the  expiration  of  his  leave  to  tli'e  medical  director  at  Philadelphia. 
He  entered  Mower  Hospital  on  September  20th,  and  Avas  discharged  from  the  service  on  July  14th,  1865.  He  is  not  a pensioner. 

Case. — Sergeant  John  Walton  Hartley,  Co.  I,  61st  Ncav  Y’’ork  Volunteers,  Avas,  on  June  12th,  1662,  admitted  to  TAventy- 
second  and  Wood  Streets  Hospital,  Philadelphia,  Avith  a gunshot  Avound  of  the  head.  The  missile  had  removed  the  external 
table  of  the  right  parietal  bone  and  depressed  the  inner  table.  He  Avas  furloughed,  and  Avhile  at  his  home,  the  depressed  portion 
of  the  inner  table  Avas  removed.  He  Avas  discharged  on  Januaiy  28th,  1863.  His  left  side  Avas  partially  paralyzed.  Not  a 
pensioner. 

Case. — Private  John  Duffy,  Co.  A,  28th  Massachusetts  Volunteers,  received,  at  the  battle  of  Bull  Run,  Virginia,  August 
31st,  1862,  a gunshot  fracture  of  the  external  table  of  the  left  parietal  bone.  He  Avas  admitted  into  the  Carver  Hospital,  Wash- 
ington, September  7th;  on  December  10th,  he  Avas  furloughed ; and  Avas  discharged  the  service  February  6tli,  1863.  On  May 
21st,  1863,  Pension  Examiner  6.  S.  Jones  reports  this  man  to  have  a depression  in  the  skull  from  Avhich  loose  bone  has  been 
removed,  and  to  be  suffering  from  cephalalgia  and  A’ertigo.  He  rates  his  disability  one-half  and  doubtful.  On  April  13th,  1865, 
Pension  Examiner  J.  T.  Galloupe  reports  this  man  to  have  re-enlisted  February  28th,  1864,  as  a private  in  the  29th  Massachu- 
setts Volunteers;  and  to  have  done  full  duty  from  that  time  until  the  date  of  his  report,  Avhen  the  man  Avas  a paroled  prisoner  of 
Avar,  his  disability  being  removed. 


REMOVAL  OF  FEAG^^IENTS  AFTER  GUNSHOT  FRACTURES  OF  TtlE  SKULL. 


243 


Case. — Corporal  Patrick  Farrell,  Co.  C,  140tli  New  York  Volunteers,  aged  2o  years,  was  wounded  at  the  battle  of  Spott- 
sylvauia,  Virginia,  May  9tli,  1834,  by  a conoidal  musket  ball,  which  fractured  the  skull.  He  was  at  once  admitted  to  the  1st 
division.  Fifth  Corps,  hospital,  and  thence,  on  the  12th,  sent  to  the  3d  division  hospital  at  Alexandria.  A few  small  scales  of 
hone  were  taken  from  the  wound  by  forceps,  but  no  untoward  symptoms  manifested  themselves  in  the  progress  of  the  case.  On 
June  6tli,  the  patient  was  furloughed.  He  w'as  discharged  the  service  September  2d,  1834.  On  February  25th,  1837,  Pension 
Examiner  H.  T.  Montgomery  reports  this  man  to  bo  perfectl}'  healthy  looking,  and  complaining  only  of  nervousness.  He  does 
not  think  him  disabled  by  the  wound. 

McQueeny,  John,  Private,  Co.  I,  2d  Connecticut  Heavy  Artillery,  aged  18  years.  Cedar  Creek,  October  19th,  1804. 
Gunshot  fracture  of  zygomatic  process  of  left  temporal  bone.  Corps,  Philadelphia,  and  New  Haven  hospitals.  Portions  of 
zygoma  were  removed.  Discharged  June  20th,  1834.  Not  a pensioner. 

Mosbery,  Alexander,  Private,  Co.  E,  40th  New  York,  aged  22  years.  Petersburg,  March  25th,  1865.  Gunshot 
fracture  of  cranium  one  inch  below  squamous  suture,  right  side.  Corps,  Washington,  and  Whitehall  hospitals.  Removal  of 
depressed  bone  by  incision.  Discharged  July  3d,  1865.  Not  a pensioner. 

B.,vrr,  Tiiojias  T.,  Co.  H,  33d  Ohio  Volunteers,  aged  24  years.  Chickamauga,  September  20th,  18631  Fracture  of 
skull  below'  and  to  the  left  of  the  occipital  protuberance  by  shell.  Treated  in  Confederate  hospitals  at  Ringgold  and  Richmond. 
Paroled  March  6th,  1834,  and  admitted  to  hospital  at  Annapolis  Junction.  Ten  fragments  of  bone  removed.  Discharged 
September  20th,  1864.  Not  a pensioner. 

McCormick,  William  C.,  Private,  Co.  A,  80th  Illinois,  aged  30  years.  Atlanta,  August  20th,  1864.  Gunshot  fracture 
of  fi’outal  bone.  Atlanta,  Chattanooga,  and  Nashville  hospitals.  Removal  of  fragments  of  bone.  Musteredout  June  10th,  1865. 
Not  a pensioner. 

Nutze,  Charles  F.,  Sergeant,  Co.  B,  6th  Pennsylvania  Cavalry,  aged  32  years.  Culpeper  Court-house,  August  1st, 
1863.  Gunshot  fracture  of  external  angular  process  of  temporal.  Corps  and  Washington  hospitals.  Fractured  bone  removed. 
Discharged  March  3d,  1834.  Sight  of  left  eye  lost.  Not  a pensioner. 

Murgatroyd,  George  M.,  Captain,  Co.  A,  68th  Pennsylvania,  aged  32  years.  Jacob’s  Ford,  November  27th,  1863. 
Gunshot  fracture  of  zygoma.  Alexandria  hospital.  Removal  of  spiculm.  Recovered;  transferred  to  Co.  1, 186th  Pennsylvania 
Volunteers,  and  mustered  out  August  15th,  1865.  Not  a pensioner. 

Wassdre,  Louis,  Corporal,  Co.  B,  27th  Michigan,  aged  22  years.  Petersburg,  July  30th,  1864.  Depressed  shell 
fracture  of  left  parietal.  Removal  of  fragments  of  skull  at  Ninth  Corps  hospital,  by  Surgeon  W.  C.  Shurlock,  Slst  Pennsylvania 
Volunteers.  Sent  to  DeCamp  Hospital,  and  discharged  for  disability,  February  1st,  1865. 

McCall,  James,  Corporal,  Co.  I,  144th  New  York,  aged  23  years.  Pocotaligo,  December  9th,  1834.  Fracture  of  left 
side  of  frontal  by  conoidal  musket  ball.  Beaufort,  Fort  Schuyler,  Troy,  and  Albany  hospitals.  Removal  of  fragments  by 
Surgeon  Hendrickson.  Sent  to  be  mustered  out,  June  17,  1865. 

Bartholojiew',  Francis  T.,  Corporal,  Co.  C,  1st  West  Virginia  Cavalry.  Culpeper,  November,  1833.  Gunshot 
fracture  of  frontal  bone.  Removal  of  fragments  of  bone.  Discharged  at  Wheeling.  February,  1867,  Assistant  Surgeon  C.  R. 
Greenleaf,  U.  S.  A.,  examined  the  man  and  states  that  the  wound  has  entirely  healed.  Not  a pensioner. 

Grieein,  Albert  C.,  Private,  Co.  F,  107th  Pennsylvania,  aged  21  years.'-  Gettysburg,  July  1st,  1863.  Gunshot 
fracture  of  right  parietal  bone  by  conoidal  musket  ball.  Corps,  Philadelphia,  and  Alexandria  hospitals.  Removal  of  small  frag- 
ments of  bone  by  forceps.  Discharged  December  29th,  1864.  Not  a pensioner. 

Roe,  John,  Private,  Co.  D,  31st  Illinois,  Jackson,  September,  1862.  Gunshot  fracture  of  frontal  and  parietal  bones  by 
conoidal  musket  ball.  Memphis  and  St.  Louis  hospitals.  Fragments  of  both  tables  removed.  Discharged  February  3d,  1863. 
Not  a pensioner. 

Laeitte,  Charles,  Sergeant,  Co.  A,  40th  New  Jersey,  aged  36  years.  Middletow'n,  November  15th,  18(54.  Shell 
fracture  of  left  parietal  bone ; also  fracture  of  lower  four  ribs.  AVinchester,  Frederick, ’and  Washington  hospitals.  Removal  of 
fragments  of  bone.  Discharged  May  30th,  1865.  Not  a pensioner. 

O'-Rorke,  John,  Private,  Co.  C,  10th  New  York,  aged  21  years.  Spottsylvania,  May  10th,  1864.  Gunshot  fracture  of 
cranium.  Washington  hospitals.  Bone  splinters  removed.  Discharged.  Not  a pensioner. 

Dorr,  Joseph,  Corporal,  Co.  C,  12th  Connecticut,  aged  22  years.  Cedar  Creek,  October  19th,  1804.  Stellate  fracture 
of  parietal  bone  by  conoidal  ball.  Frederick  and  Baltimore  hospitals.  Removal  of  depressed  bone.  Discharged  September 
21st,  1865.  Not  a pensioner. 

Twenty-four  patients,  enumerated  in  the  following  series,  recovered  after  removal  of 
fragments  of  the  skull,  produced  by  gunshot  fractures,  and  were  either  furloughed,  retired, 
released,  or  exchanged.  The  first  three  cases  were  complicated  by  erysipelas  : 

Case. — Private  Galoin  Forest,  Co.  G,  8th  North  Carolina  Infantry,  aged  18  years,  was  woundc’d  at  the  battle  of  Cold 
Harbor,  Virginia,  Jlaj-  31st,  1864,  by  a conoidal  hall,  which  entered  one  inch  above  the  left  zygomatic  process,  passed  through 
the  left  orbit,  destroying  the  eye,  and  emerged  from  the  inner  wall  of  the  right  orbit,  carrying  with  it  the  right  eye.  He  was 


244 


WOUNDS  AND  INJUEIES  OF  THE  HEAD 


udinitted  into  the  geueral  field  hospital  on  June  ‘2d,  and  on  the  10th  he  was  transferred  to  the  Lincoln  Hospital,  Washington,  in 
a delirious  condition.  Erysipelas  had  attacked  the  wounds,  and  he  suftered  considerably.  Five  spiculat  of  bone  were  removed 
daily.  Simple  dressings  were  used.  Tonics  were  administered.  The  wounds  gradually  liealed.  There  was  a loss  of  the  senses 
of  taste  and  smell ; but  that  of  taste  became  almost  entirely  restored.  He  was  transferred  to  the  Old  Capitol  Prison,  for 
exchange,  on  October  1st,  1864.  Assistant  Surgeon  J.  Cooper  McKee,  U.  S.  A.,  reports  the  case. 

Case. — Private  J.  W.  Taylor,  Co.  A,  34th  Virginia  Regiment,  aged  33  years,  received,  on  May  20th,  1864,  a gunshot 
fracture  of  both  tables  of  the  occipital  bone,  near  the  posterior  fontanelle.  He  was,  on  June  20th,  admitted  to  Chimborazo 
Hospital  No.  2,  Richmond,  Virginia.  On  admission,  the  wounds  were  erysipelatous ; but  some  loose  spiculm  of  bone  were 
removed,  and  the  injury  soon  assumed  a healthy  appearance,  and  on  July  24th  the  patient  was  allowed  to  go  home  for  GO  days. 

Case. — Piivate  71'.  C.  Allen,  Co.  E,  1st  Georgia  Infantry,  aged  22  years,  was  admitted  into  the  Confederate  hospital  at 
Charlottesville,  Virginia,  on  August  27th,  1862,  with  a gunshot  wound  in  the  scalp,  about  an  inch  and  a half  above  the  zygomatic 
process,  and  half  an  inch  anterior  to  the  left  ear.  The  wound  was  suppurating  slightly,  but  there  were  no  symptoms  of  serious 
injury  to  the  skull  or  brain.  The  patient  was  walking  about  as  if  nothing  w’as  the  matter,  and  eating  heartily.  The  probe  could 
not  be  introduced  to  the  skull,  the  track  of  tlie  wound  being  closed,  probably  by  a firm  clot,  which  had  not  been  discharged  by 
suppurative  action.  At  the  next  examination,  four  or  five  days  after  his  admission,  the  probe  readily  passed  downward  under 
the  temporal  muscle  to  the  bone,  which  was  found  fractured  and  depressed,  but  to  what  extent  could  not  be  ascertained,  excep. 
by  cutting,  wdnch  recpiired  a division  of  the  swollen  and  putty  integument,  and  the  temporal  muscles  in  the  vicinity  of  the  fracturet 
A consultation  wuis  held,  and  an  operation  determined  upon.  The  missile,  a common  musket  ball,  had  been  removed  through  the 
wound  by  a surgeon,  shortly  after  the  reception  of  the  injury.  On  the  2d  of  September,  the  patient  was  chloroformed,  and  J.  L. 
Cabell,  surgeon  in  charge  of  hospital,  made  a crucial  incision,  two  inches  in  length,  in  the  scalp,  and  in  doing  so  it  was  found 
necessary  to  ap23ly  ligatures  to  the  temporal  artery  and  one  of  its  branches.  When  the  flaps  were  dissected  up,  the  fracture  was 
found  to  be  quite  irregular,  and  as  large  as  a twenty-five  cent  piece,  while  the  fragments  were  driven  in  and  pressing  upon  the 
dura  mater.  With  considerable  difficulty,  thirteen  pieces  of  bone  were  removed  with  the  forceps,  several  of  these  being  quite 
large,  and  grooved  on  the  inner  surface,  showing  the  seat  of  injury  to  be  directly  over  the  middle  meningeal  artery.  After 
removing  all  the  pieces  that  could  be  felt  with  the  fingers,  the  parts  were  drawn  together  by  strips  of  adhesive  plaster,  and  the 
wound  was  dressed  with  lint.  The  next  day  slight  erysipelas  made  its  appearance  around  the  wound,  involving  the  car  and  side 
of  the  face,  and  nearly  closing  the  left  eye.  Muriated  tincture  of  iron,  ten  drops  every  two  hours,  were  ordered,  and  the  patient 
kept  25erfectly  quiet.  lu  twenty-four  hours  the  erysipelas  had  disappeared,  and  from  the  third  day  after  the  oireration,  no 
unpleasant  symptoms  occurred,  the  wound  suppurating  finely,  and  closing  rapidly,  and  this,  too,  with  the  patietit  going  about  the 
liosjjital  more  or  less  every  day,  as  it  was  found  impossible  to  keep  him  in  bed.  The  treatment  after  the  disapi)eai'ance  of  the 
erysipelas,  consisted  solely  in  the  application  to  the  wound  of  wet  lint  twice  a day,  and  keeping  it  clean.  By  the  18th  of  Sep- 
tember the  wound  had  healed,  except  at  the  intersection  of  the  two  incisions.  A small  opening  the  size  of  a imobe  existed  at  that 
point,  through  which  a slight  discharge  was  kept  up.  The  patient  was  discharged  from  the  service  on  February  3d,  1863.  The 
case  is  reported  by  Assistant  Surgeon  B.  W.  Allen,  F.  A.  C.  S. 

Case. — Captain  T.  J.  Hadley,  Co.  A,  3d  Arkansas  Regiment,  received,  near  Petersburg,  Virginia,  July  16th,  1864,  a 
gunshot  fracture  of  the  cranium,  just  in  front  of  the  junction  of  the  occipital  with  the  parietal  bone.  He  was,  on  the  following 
day,  admitted  to  a hospital  at  Petersburg,  and  thence  sunt  to  Howard  Grove  Hospital,  Richmond,  where  a section  of  both  tables, 
one  and  a half  inches  in  diameter,  was  removed.  There  was  i)aralysis  of  the  left  side,  from  which  the  patient  never  fully 
recovered.  He  was  retired  from  the  service  on  December  13th,  1864,  being  permanently  disabled  for  field  service. 

Case. — Sergeant  S.  J.  Bavgston,  Co.  I,  45th  Georgia  Regiment,  was  wounded  at  the  battle  of  Gettysburg,  Pennsylvania, 
July  2d,  1863,  by  a fragment  of  shell,  which  fractured  and  depressed  the  outer  table  of  the  occipital  bone  on  the  right  side. 
At  different  periods,  several  fragments  of  bone  were  removed  with  elevator  and  forceps.  Loss  of  power  in  the  extremities, 
headache,  and  vertigo  followed,  and,  subsequently,  spasmodical  mental  derangement  supervened.  He  was  admitted  to  the 
De  Camp  Ho.spital,  David’s  Island,  New  York  Harbor,  July  19th,  1833 ; thence  transferred  to  Bedloe’s  Island,  October  24th ; and 
on  January  10th,  1884,  sent  to  the  Hammond  Hospital,  Point  Lookout,  Maryland.  The  wound  had  healed,  and  presented  a 
depression  about  one  and  a half  inches  long  by  half  an  inch  wide.  His  condition  imjn’oved  slowly,  and  in  March,  18G4,  he  had 
only  occasional  manifestations  of  mental  aberration,  with  a decided  disinclination  to  converse.  On  the  10th,  he  was  sent  to  the 
provost  marshal,  and  on  the  14th  was  transferred  for  exchange.  The  case  is  reported  by  Acting  Assistant  Surgeon  W.  F, 
Buchanan. 

Case. — Private  McCleary  was  shot  on  October  19th,  1863,  while  trying  to  escape  from  prison  at  Point  LookoiV,  Maryland. 
The  missile,  a pistol  ball,  struck  the  cranium  just  above  the  coronal  suture,  left,  side,  causing  a triangular-shaped  depression  of 
both  tables,  and  glanced.  He  also  received  wounds  of  the  liver  and  lung.  On  October  24th,  he  was  admitted  to  the  hosjrital  at 
Point  Lookout.  There  were  no  unfavorable  symptoms;  the  wounds  were  filthy,  but  perfectly  healthy  ; the  secretions  normal. 
It  was  stated  that  the  patient  had  remained  comatose  for  two  days  after  the  reception  of  the  injury,  but  on  admission  he  was 
perfectly  rational  and  cheerful,  and  suffered  no  pain.  The  pulsations  of  the  brain  were  visible.  The  wounds  were  cleansed,  and 
simple  dressings  .applied.  In  February,  1864,  a piece  of  the  skull,  which  had  become  detached,  was  removed.  The  wound 
healed  rapidly,  and  April  27th,  1864,  the  man  was  sent  to  the  provost  marshal  for  exchange.  For  two  or  three  weeks  before  his 
exchange,  he  had  ijerformed  the  duties  of  a nurse  in  the  ho.spital. 

Case. — Private  William  B.  liobertson,  Co.  E,  48th  Alabama  Regiment,  aged  26  years,  received,  at  the  battle  of  Antietam, 
Maryland,  September  17th,  1862,  a gunshot  depressed  fracture  of  the  cranium  at  or  near  the  right  temporal  ridge.  No 
paralysis  existed.  He  was  admitted  into  the  hosjiital  at  Charlottesville,  Virginia,  where  he  was  ojter.ated  upon  on  October 


EEMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


245 


lOlli,  at  which  time  lie  had  heeouie  much  enfeebled.  The  scalp  was  imderiiiined,  the  bone  denuded  around  the  fractured  portion, 
and  large  quantities  of  pus  were  discharged  daily.  During  the  operation  it  was  found  necessary  to  use  lley’s  saw  to  release  a 
large  fragment  of  depressed  bone.  No  unpleasant  symptoms  followed,  and  the  j)atieut  finally  i'ecov(Ted.  with  a large  depressed 
cicatrix,  lie  was  discharged  on  March  23d,  18G3.  The  case  is  reported  by  Assistant  Surgeon  11.  W.  Allen,  1*.  A.  C.  S. 

Case. — Private  (!.  H.  Sanford,  Go.  A,  8th  Geoigia  Regiment,  aged  27  yeai's,  received,  on  August  28th,  1862,  a gunshot 
depressed  fracture  of  both  tables  of  the  superior  jiortion  of  the  left  parietal  bone.  There!  was  paralysis  of  the  right  side  of  the 
body,  but  the  mind  was  clear.  Ho  was  admitted  into  the  Confederate  hosj)ital  at  Charlottesville,  Virginia,  and  on  September 
23d  was  operated  upon.  All  the  pieces  of  bone  were  removed.  Ten  daj’s  after  the  ojiera’tion,  the  paralysis  had  entirely 
disaiipeared.  The  patient  inqn’oved  rapidly,  was  furloughed  soon  after,  and  is  believed  to  have  recovered  entirely.  The  case 
is  reported  by  Assistant  Surgeon  B.  W.  Allen,  P.  A.  C.  S. 

Case. — Pi-ivate  James  I).  Ferris,  Co.  II,  18th  Virginia  Regiment,  aged  18  years,  was  wounded  at  Hatcher’s  Run, 
Virginia,  Apill  1st,  1835,  by  a conoidal  ball,  which  fractured  the  j^arietal  bones,  the  fracture  extending  from  the  coronal 
suture  backward  one  and  a half  inches  over  the  sagittal  suture.  He  was  taken  piisoner,  admitted  into  the  hospital  of  the  3d 
division,  Fifth  Corps,  and  thence  sent  to  the  Lincoln  Hospital,  Washington,  on  the  8th.  On  Aiwil  20th,  Surgeon  J.  C. 
McKee,  U.  S.  A.,  removed  several  fragments  of  depressed  bone.  The  wound  healed  rapidly,  and  the  patient's  general  health 
remained  excellent.  On  the  14th  of  June,  he  was  released  upon  taking  the  oath  of  allegiance,  having  entirely  recov’ered.  The 
case  is  reported  by  the  operator.  Surgeon  J.  C.  iMcKee,  U.  S.  A.  Vide  Photographs  of  Surgical  Cases,  A.  M.  M.  Vol.  Ill, 
No.  17. 

Case. — Major  N.  M.  Xorris,  14th  Tennessee  Regiment,  aged  30  years,  was  wounded  at  the  second  battle  of  Bull  Run, 
Virginia,  August  30th,  1862,  by  a musket  ball,  ^vhich  struck  the  left  side  of  the  cranium  a little  in  front  of  and  on  a level  with 
the  parietal  protuberance,  fractured  the  skull  for  about  two  and  a half  inches  longitudinally  and  about  one  inch  across,  and 
lodged.  The  wound  of  scalp  was  still  more  cxten.sive ; the  membranes  were  laeei’atcd,  and  brain  substance  exuded.  He  was 
not  examined  by  a surgeon  on  the  field,  as  no  one  who  saw  him  thought  he  would  live  beyond  a few  hours.  The  day  following, 
a large  piece  of  bone  was  removed,  by  his  brother,  ^vitll  his  fingers.  The  patient  was  perfectly  unconscious  for  five  days,  and 
when,  at  the  expiration  of  that  time,  consciousness  returned,  he  was  found  to  be  paralyzed  on  the  right  side  of  the  body.  Three 
months  after  the  reception  of  the  injury,  the  ball  and  a large  piece  of  bone  were  removed.  Several  smaller  pieces  were  taken 
away  or  discharged  at  intervals,  the  last  of  them  about  four  months  after  he  was  wounded.  His  general  health  had  not  been 
good  for  several  months  prior  to  the  reception  of  the  injury,  having  suffered  from  chronic  diarrhoea.  By  July  1st,  1803,  his 
])aralysis  was  slowly  getting  better,  and  he  was  able  to  walk  about  with  the  assistance  of  a crutch.  He  could  speak  oidy  with 
gi’eat  difficulty,  frequently  forgetting  wdiat  he  was  talking  about,  and  stated  that  he  could  not  read  anything  fi’om  inability  to 
connect  the  woi-ds  into  a sentence.  His  appetite  was  good,  and  general  health  much  improved.  The  wound  was  not  entirely 
healed.  There  was  a large  cicatrized  surface,  covering  a depression  two  and  a half  inches  long  and  three-fourths  of  an  inch 
wide,  beneath  which,  when  the  head  was  inclined  forward,  the  pulsations  of  the  brain  could  be  distinctly  seen  and  felt.  The 
case  is  reported  by  Assistant  Surgeon  B.  W.  Allen,  P.  A.  C.  S. 

Case. — Sergeant  John  Moore,  Co.  E,  38th  Alabama  Regiment,  aged  24  years,  was  wounded  in  an  engagement  near 
Atlanta,  Georgia,  May  9th,  1834,  by  a musket  ball,  which  entered  just  over  tlie  external  canthus  of  the  left  eye,  passed  upward 
and  backward,  and  lodged  under  the  scalp,  near  the  occipital  protubei-ance,  fracturing  the  skull  in  its  whole  course.  He  was 
admitted  to  the  Institute  Hospital,  Atlanta,  Georgia,  on  May  11th,  being  completely  unconscious  and  imable  to  move  his  limbs; 
pulse  feeble  aud  £0,  deglutition  almost  impossible,  and  the  j)ower  of  articulation  almost  entirely  lost.  There  was  grea 
tumefaction  and  discoloration  of  the  whole  face  and  head.  A sci’uple  of  calomel  was  with  difficulty  administered,  which,  on  thet 
following  day,  produced  free  purgation.  On  May  12th,  he  seemed  to  understand  when  spoken  to,  and  on  the  following  day 
could  see  a little  out  of  the  right  eye.  On  the  16th,  brain  substance  was  sloughing  out  from  the  anterior  wound.  On  the  19th, 
wounds  discharged  cerebral  matter  freely,  and  a soft  tumor  appeared  near  the  posterior  wound.  Involuntary  actions  of  the 
bowels  occun-ed,  the  pulse  became  slow  and  feeble,  aud  the  patient  was  thought  to  he  sinking.  On  the'  16th,  the  abscess  near 
the  jiosterior  wound  opened  and  discharged  freely.  From  that  date  his  condition  improved.  On  .lime  1st,  ho  was  partially 
conscious,  and  could  articulate  a feiv  words.  There  was  now  w’ell-nuu'ked  hemiplegia  of  the  right  side.  Several  loose  splculae 
of  bone  were  removed.  A gradual  and  steady  improvement  took  place.  On  June  30th,  his  appetite-was  good;  he  could  sit  up 
in  bed,  and  was  rapidly  gahuug  strength,  but  articulated  imjierfectlyv  The  tumefaction  had  subsided,  and  revealed  depressed 
bone  to  the  extent  of  si.x  iiiclics  in  length  by  four  in  width.  The  wounds  were  open  aud  siqqmratiug.  The  case  is  reported  by 
Surgeon  1).  C.  O'Keefe,  1’.  A.  C.  S. 

CASI't. — Rl'ivate  L.  IS.  Locegreen,  Co.  A,  25th  South  Carolina  Regiuient,  was  wounded  in  an  engagement  at  Walthal 
Junction,  Virginia,  May  7th,  1834,  by  a conoidal  ball,  which  struck  the  iqiper  and  receding  portion  of  the  frontal  bone,  left 
side,  one  inch  from  the  median  line;  the  outer  table  was  fractured,  the  edges  being  roughened  aud  irregular ; the  inner  talde 
was  broken  into  several  fragments  varying  in  size.  The  wound  was  an  inch  wide  and  nearly  an  inch  and  a half  in  length, 
extending  almost  to  the  coronal  suture.  He  was  senseless  for  over  an  hour,  but  then  recovered  eonsciousness.  The  loose 
spiculffi  were  removed,  simple  dressings  applied,  and  on  the  following  day  he  was  .sent  to  Richmond.  Pieces  of  bone  were 
I’emoved  as  they  became  sejiarated.  He  was  delirious  more  or  less  for  three  weeks  ; the  wound  looking  unhealthy,  with  a 
tendency  to  sloughing.  Poultices  and  disinfecting  lotions  were  substituti'd  for  sinqdc  dressings.  At  the  end  of  the  fourth  week, 
the  case  looked  more  favorable,  and  shortly  afterward  the  patient  was  returned  to  iSoutli  Candina,  the  wound  being  still  oiieu 
and  spiculffi  of  bone  discharging  from  time  to  time;  thirty-seven  spieuhe  eauie  away  in  all.  In  July,  180.5,  a linn  cicatrix  had 
formed  over  the  cavity.  In  March,  1806,  the  man  was  not  equal  to  niueh  jihysical  exertion;  he  sjioke  slowly  and  with  less 
fluency  than  before  and  suffered  eontiuually  from  hemicrariia,  most  severe  at  the  site  of  the  wound  and  invariably  brought  on  by 
bodily  and  mental  exertion  or  exposure  to  the  sun.  Cannot  indulge  in  stimulants.  The  case  is  leported  by  iSurgeon  F.  S. 
Parker,  P.  A.  C.  S. 


246 


WOUNDS  AND  INJUEIES  OF  THE  HEAD 


Case. — Private  John  McG , Co.  C,  1st  Maryland  Eegiment,  aged  27  years,  was  wounded  at  the  battle  of  Gettys- 

burg, Pennsylvania,  July  Jd,  18C3,  by  a conoidal  musket  ball,  wliicli  fiaetnrcd  both  tables  of  the  left  parietal  bone.  He 
was  admitted  into  Seminary  Hospital,  Gettysburg,  and  thence  transfeired  to  Baltimore,  and  admitted  into  West’s  Buildings 
Hospital  on  the  28th.  Partial  hemiplegia  of  the  right  side  existed,  aflecting  both  limbs  to  some  extent.  Simple  dressings  were 
applied  and  stimulants  administered.  On  August  3d,  Assistant  Surgeon  E.  Brook.s,  U.  S.  A.,  removed  fragments  of  bone  to  the 
extent  of  one  and  a half  by  three-fourths  of  an  inch  in  surface,  -which  had  become  detached.  This  greatly  relieved  the 
hemiplegia.  By  the  10th,  the  patient  was  able  to  walk  about  the  ward  and  appeared  to  sutler  no  inconvenience  excejit  a little 
uncertainty  and  weakness  in  his  gait.  On  August  31st,  the  wound  was  fast  closing  and  discharging  but  very  little.  The  patient 
ate  and  slept  well  and  acted  as  nurse  for  some  time.  On  November  12th,  he  was  transferred  for  exchange;  and,  on  the  16th, 
admitted  into  the  Chimborazo  Hospital,  Eichmond,  Virginia.  He  had  entirely  recovered.  The  pathological  specimen  is  No. 
1719,  Sect.  I,  A.  kl.  M.,  and  shows  live  necrosed  fragments  from  the  left  parietal  bone,  removed  by  operation.  The  specimen 
and  history  wcfl-e  contributed  by  the  operator.  Assistant  Surgeon  E.  Brooks,  U.  S.  A. 

Fhilips,  T.  M.,  Private,  Co.  I,  11th  Alabama  Eegiment.  Gettysburg,  July  2d,  1863.  Gunshot  fracture  of  left  parietal 
bone  near  vertex.  Chester  and  Point  Lookout  hospitals.  Eemoval  of  several  fragments  of  bone.  Exchanged  March  3d,  1864. 

Stiegel,  Charles  B.,  Co.  II,  5th  Virginia  Eegiment.  Fort  Steadman,  March  25tli,  1865.  Fracture  of  right  parietal  by 
conoidal  ball.  Corps  and  Washington  hospitals.  Eemoval  of  fragments  of  depressed  bones.  Eecovered,  and  released  on  taking 
the  oath  of  allegiance. 

Pcllum,  E.,  Private,  of  Holcomb’s  Legion.  Near  Charlottesville,  September,  1862.  Gunshot  fracture  of  frontal  bone. 
Treated  at  Charlottesville.  Eemoval  of  loose  fragments  of  bone,  including  portions  of  the  orbital  plate.  Furloughed  October 
8th,  1862. 

Toleman,  William,  Private,  Co.  L,  55th  Virginia  Eegiment.  kVilderness,  May  6th,  1864.  Gunshot  fracture  of  external 
angular  process  of  frontal  bone.  Field  and  Chimborazo  Hospital.  Eemoval  of  several  pieces  of  bone.  Furloughed  June  23d, 
1864. 

Dixon,  H.,  Private,  Co.  D,  30th  North  Carolina  Eegiment.  Gunshot  fracture,  with  depression  of  both  tables  of  left 
parietal  bone.  Chimborazo  Hospital.  Eemoval  of  loose  pieces  of  bone.  F urloughed  August  25th,  1832. 

(JEourlce,  Captain,  5th  Louisiana,  klaryland  Heights,  Jnly  6th,  1864.  Gunshot  ii-acture  of  frontal  bone  by  conoidal  ball. 
Considerable  brain  matter  escaped.  Loss  of  consciousness,  and  convulsive  movement  of  right  side.  Depressed  bone  elevated, 
and  fragments  removed.  Eesult  unknown. 

Cooh,  M.  S.,  Private,  Co.  C,  48th  North  Carolina,  aged  23  j-ears.  Petersburg,  September  16th,  1864.  Fracture  of  righ 
temporal  by  a conoidal  b.alh  Eemoval  of  fragments.  Farmville  Hospital.  Eesult  unknown. 

Sharp,  Gordon,  Private,  Co.  G,  6th  Alabama.  Gunshot  fracture  of  cranium.  Petersburg,  April  2,1835.  Corps  and  City 
Point  hospitals.  Eemoval  of  spiculm.  Eecovered. 

Willingham,  S.  M.,  Private,  Co.  D,  5th  Alabama,  aged  25  years.  Gunshot  fracture  of  frontal  bone,  right  side.  Boonsboro’, 
Maryland,  September  14tli,  1862.  Philadelphia  and  Charlottesville  hosjdtals.  Eemoval  of  fractured  bone.  Eccovery. 

Cogan,  Tobias,  Private,  Co.  B,  19th  Virginia  Cavalry.  kVinchester,  Virginia,  August  20th,  1834.  Gunshot  fracture  of 
frontal  bone  by  conoidal  ball.  kVinchester  and  Baltimore  hospitals.  Eemoval  of  fragments  of  bone.  Exchanged. 

Damron,  I.  T.,  Private,  Co.  H,  18th  South  Carolina  Eegiment.  Gunshot  fracture  of  frontal  bone.  Charlottesville  hospital. 
September  6th,  1862.  Eemoval  of  several  pieces  of  bone.  Fuiloughed  October  8th,  1862. 

In  three  cases  of  removal  of  fragments  from  the  cranium,  it  has  been  impracticable 
to  trace  the  histories  to  a conclusion.  They  probably  kvere  all  three  examples  of  recovery  : 

kViLSON,  T.,  Private,  Co.  D,  5th  United  States  Cavalry,  aged  28  years,  was  wounded  at  Brandy  Station,  Virginia,  June 
9th,  1863,  l)y  a musket  ball,  which  fractured  the  left  parietal  protuberance,  about  four  inches  above  the  car.  He  was  insensible 
for  several  days,  and  partially  paralyzed  on  the  right  side.  He  was  taken  prisoner,  and  conveyed  to  Confederate  hospit.al  at 
Charlottesville,  Virginia,  where,  on  June  13th,  the  ball  and  pieces  of  bone  were  removed.  On  July  Cth  he  was  apparently  doing 
well,  and  the  wound  healing.  He  never  complained  of  pain  in  the  head,  but  had  a constant  numbness  and  pain  in  his  i-ight  arm, 
with  partial  loss  of  its  motions.  But  this  -^vas  rapidly  improving,  and  ho  bade  fair  to  recover  entirely.  The  case,  is  reported  by 
Assistant  Surgeon  B.  kV.  Allen,  P.  A.  C.  S. 

Case. — Corj>oral  Theodore  Boese,  Co.  K,  1st  New  Jersey  Volunteers,  was,  on  August  13th,  1863,  admitted  to  Ladies’ 
Home  Hospital,  New  York,  with  a wound  of  the  head.  On  examination,  the  bone  was  found  to  be  depressed.  Several  spiculae 
were  removed,  when  all  bad  symptoms  disappeared  ; but  his  memory  remained  impaired,  and  at  times  he  would  experience  severe 
pains  in  the  region  of  the  wound.  He  deserted  November  1st,  1833. 

Case. — Frederick  E , 43d  Illinois  Volunteers,  received,  at  the  battle  of  Shiloh,  April  6th,  1832,  a gunshot  fracture 

of  the  parietal  bone,  near  its  posterior  superior  angle.  The  loose  pieces  of  bone  were  carefully  removed,  the  ilaps  adjusted,  wr.rm 
water  dressings  aj)plied,  and  opiates  freely  administered.  In  about  three  weeks  a cartilaginous  substance  cijinmcnced  to  be 
deposited  in  the  space  from  which  the  fragments  had  been  removed.  This  substance  became  to  some  extent  ossified,  and  in 
about  six  weeks  the  wound  had  entirely  healed.  The  case  is  reported  by  Assistant  Surgeon  S.  B.  Houts,  18th  klissouri 
Volunteers. 


TvEMOVAL  OF  FEAGMENTS  AFTEE  GUNSHOT  FEACTUEES  OF  THE  SKULL.  247 

Fatal  Cases  of  Gunshot  Fractures  of  the  Shull  treated  by  the  Fcrtwval  or  Elevation 
of  Fragments. — Tlie  following  series  of  fatal  cases  of  gnnsLot  injuries  of  the  skull  treated 
by  operation,  but  not  by  formal  trephining,  comprise,  perhaps,  more  instructive  instances 
than  the  series  of  cases  of  recovery,  inasmuch  as  the  extent  of  the  injury  could  be 
ascertained  with  precision,  and  the  organic  alterations  ensuing  accurately  observed. 
Extravasation  of  blood  within  the  cranium  was  the  cause  of  the  rapidly  fatal  termination 
of  several  of  these  cases  : 


Case. — Sergeant  D.  A.  K , Co.  D,  25th  South  Carolina  Eegiment,  was 

■wounclecl  at  Six  Mile  House,  Virginia,  August  21st,  1864,  by  a conoidal  ball,  which 
causer!  a depressed  fracture  of  the  frontal  bone.  He  also  received  flesh  wounds  of  the 
right  aiTn,  left  fore-ann  and  hip.  Soon  after  the  reception  of  the  wound,  he  was  sent 
to  the  hospital  of  the  3d  division.  Fifth  Corps,  where  eight  fragments  of  bone  were 
removed  from  the  vault  of  the  cranium,  on  the  day  of  his  admission,  by  Surgeon  E. 
G.  Chase,  104th  New  York  Volunteers.  But  the  symptoms  of  compression  were  not 
I’clieved,  and  the  patient  gradually  sank  into  a comatose  state  and  died  August  23d, 
18G4,  from  cfi'usion  of  blood  over  the  brain.  Six  of  the  I’emoved  fragments  are 
represented  in  the  adjacent  wood-cut,  and  were  contributed,  with  the  history  of  the 
case,  by  the  operator. 


Fig,  llfi. — Fragments  of  skull  removed  for 
depression  from  p’unshot  fracture  cf  the  right 
parietal.  Spec.  4744,  Sect.  J,  A.  ]\I.  M. 


Case. — A soldier,  supposed  to  be  John  R , Co.  D,  0th  Massachusetts  Volunteers,  aged  22  years,  was  admitted  into  the 

Stanton  Llospital,  Washington,  on  M.ay  18th,  1834,  having  been  wounded  five  or  six  days  previously  by  a conoidal  ball,  wliich 
entered  the  left  side  cf  the  frontal  bone,  three-quarters  of  an  inch  above  the  frontal  protuberance,  and  lodged  in  the  brain.  He 
was  in  a comatose  condition ; his  respirations  were  sighing,  pulse  110  and  feeble,  pupils  dilated,  and  his  right  side  was  jiaral  vzed. 

' Assistant  Surgeon  George  A.  Mursick,  U.  S.  V.,  enlarged  the  wound  of  soft  parts  by  crucial  incision,  and  removed  four  s])linters 
of  bone  with  an  elevatoi’,  one  of  them  being  depressed  about  half  an  inch.  An  ice  bag-  was  applied  to  tiic  b.ead  and  a stimulating 
enema  ordered,  but  the  patient  sank  rapidly  and  died  May  19th,  18G4,  ton  hours  after  the  operation,  from  extravasation  of  blood. 
The  autopsy  showed  the  anterior  lobe  of  the  left  cerebrum  to  be  injured.  There  was  a copious  exudation  of  plastic  matter 
between  the  dura  mater  and  the  arachnoid.  The  specimen  is  No.  2381,  Sect.  I,  A.  M.  M.,  and  was  contributed,  with  the  history, 
by  Assistant  Surgeon  George  A.  Mursick,  U.  S.  V. 

Case. — Private  William  B , Co.  G,  8th  Pennsylvania  Cavalry,  aged  18 

years,  was  wounded  in  an  engagement  at  Deep  Bottom,  Virginia,  August  14th,  1834, 
by  a conoidal  ball,  which  fractured  and  depressed  the  posterior  portion  of  both  tables 
of  the  right  parietal  bone.  The  ball,  which  was  split  from  apex  to  centre,  was  found 
impacted  on  the  edge  of  the  fracture  and  was  removed  on  the  field.  He  was  admitted, 
on  the  following  day,  to  the  hospital  of  the  2d  division.  Cavalry  Corps,  and  thence 
conveyed  to  'Washington,  where  he  entered  the  Emory  Hospital,  August  17th.  Cold 
water  dressings  were  applied,  the  head  kept  cool  by  constant  application  of  iced 
water,  and  low  diet  ordered.  On  the  morning  of  the  20th,  there  wero  symptoms  of 
compression ; jmlse  88,  slow  and  soft.  Chloroform  was  administered  and  Surgeon 
N.  R.  Moseley,  U.  S.  V.,  removed  five  small  fragments  of  bone  which  had  become 
detached,  and  elevated  the  depressed  bone.  The  soft  parts  were  quite  extensively 
lacerated.  A strictly  antiphlogistic  course  of  treatment  was  established,  and  the 
patient  remained  comfortable  until  the  evening  of  the  23d,  when  febrile  symptoms  of 
a severe  character  occurred;  death  supervened  on  August  25th,  1834.  An  autopsy 
showed  extensive  disorganization  of  the  brain;  the  middle  lobe  cf  right  hemisphere 
was  in  a suppurating  condition,  and  the  diseased  action  had  extended  as  far  back  as 
the  base  of  the  brain.  The  pathological  specimen  is  shown  in  the  wood-cut,  and  was 
contributed  by  the  operator.  Surgeon  N.  R.  Moseley,  U.  S.  V. 

Case. — Corporal  Henry  F.  M , Co.  G,  39th  Massachusetts  Volunteers,  aged  19  years,  was  wounded  at  the  battle  of 

Spottsylvania  Court-house,  Virginia,  May  12th,  1834,  by  a conoidal  musket  ball,  which  penetrated  the  right  frontal  and  parietal 
bones  and  lodged  in  the  brain.  He  was  admitted  to  the  3d  division.  Second  Corps,  hospital,  and  on  the  18tli,  transferred  to  the 
Stanton  Hospital,  Washington.  His  intellect  was  confused,  but  he  would  answer  questions  intelligently  when  spoken  to  in  a 
loud  voice.  His  left  side  was  paralyzed;  respiration  sighing;  pulse  120  and  full.  He  complained  of  intense  jiain  in  his  head, 
and  had  purulent  conjunctivitis  of  both  eyes,  with  rupture  of  the  cornea  of  the  left  eye.  Deglutition  was  unimpaired.  On  Slay 
19th,  Assistant  Surgeon  George  A.  Mursick,  U.  S.  V.,  enlarged  the  wound  by  crucial  incision,  and  removed  tb.o  depressed  bone 
with  an  elevator.  Ice  was  applied  to  the  head,  a stimulating  enema,  fluid  extract  of  acoiute,  and  an  astringent  lotion  for  the 
eyes,  ordered  On  the  20th,  coma  supervened  and  deglutition  became  difiicult.  On  the22d,  his  breathing  was  stei  foroue-,  with 
puffing  of  the  corners  of  the  mouth.  The  comatose  condition  continued  without  interruption  until  the  day  of  his  death.  May  2^>th, 
1834.  At  the  autopsy,  the  ball  was  found  lodged  in  an  ab-scess  in  the  posterior  lobe  of  the  right  hemisphere.  I’urulent  de|)osit 
between  the  dura  mater  and  the  arachnoid  extended  over  the  whole  hemisphere.  The  pathological  specimen  is  No.  2380,  Sect.  I, 


Eig.  117. — .Split  ball  and  fragments  f f rigl.t 
liarictal.  Spec.  3131,  .Sect.  I,  A.  M.  Ivl.  \. 


248 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


A.  JI.  M.  A segment  of  cranium  fractured  at  tlic  coronal  suture.  Five  fragments  of  bone,  chiefly  from  the  inner  table,  are 
attached.  Ths  opening  externally  measures  one-half  by  one  inch,  the  edge  being  beveled  internally.  The  specimen  and  history 
tvere  contributed  by  Assistant  Surgeon  G.  A.  IMursick,  U.  S.  V. 

Case. — Private  T.  AI.  J , Co.  II,  45th  North  Carolina  Regiment,  aged  38  years,  was  wounded  at  Silver  Spring, 

near  Washington,  Jidy  l'2th,  1834,  by  a colloidal  ball,  which  entered  at  the  middle  of  the  superior  border  of  the  right  temporal 
bone,  and  passing  transversely,  fractured  both  tables  of  the  skull.  He  was  taken  jirisoner  and  conveyed  to  the  Lincoln  Hospital, 
Washington,  on  the  17th,  being  conscious  at  the  time.  On  the  27th,  the  wound  was  enlarged  and  fragments  of  bone  were 
removed.  The  wound  was  in  a healthy  condition,  and  the  patient's  pulse  full  and  regular.  Convulsions,  followed  by  paralysis 
of  the  right  side,  succeeded  the  operation.  These  symptoms  continued  until  the  29tli,  when  be  became  comatose.  Mercurial 
jnirgatives,  cold  applications,  friction  and  sinapisms  to  the  extremities,  were  used  without  avail.  The  patient  sank  rapidl}",  and 
died  on  the  29th.  'Yhn  post-mortem  examination  revealed  a fragment  of  bone,  about  one  inch  in  diameter,  lying  upon  the  brain 
substance.  An  abscess  existed  about  the  size  of  an  English  walnut.  The  brain  substance  of  the  riglit  lobe  was  much  softened 
and  congested,  and  the  ventricles  were  filled  with  serous  fluid.  The  vault  of  the  cranium  was  preserved,  and  is  figured  in  the 
wood-cut.  Fragments  have  been  removed  from  ati  elliptical  space,  measuring  one  by  one  and  one-fourth  inches.  The  posterior 
half  of  the  sagittal  suture  is  separated,  and  five  fissures  radiate  from  the  fractured  point.  The  edges  of  the  opening  are  necrosed, 
cribriform,  and  crumblii^.  The  specimen  and  history  were  contributed  by  Acting  Assistant  Surgeon  T.  L.  Leavitt. 

Case. — Sergeant  Joseph  C , Co.  B,  3d  Pennsylvania  Cavalry,  was  wounded  at  the  battle  of  Mine  Run,  Virginia, 

November  27th,  1833,  by  a conoidal  musket  ball,  which  entered  above  the  right  zj’goma  and  penetrated  the  skull.  lie  was 
treated  in  the  field  hospital  until  December  4th,  when  he  was  conveyed  to  Alexandria  and  admitted  to  the  3d  division  hospital. 
Delirium  had  supervened,  which  continued  until  within  twelve  hours  of  his  death.  Several  fragments  of  bone  were  removed, 
but  the  patient  was  unable  to  take  food,  and  drank  but  two  or  three  times  of  whiskey  and  water.  He  became  comatose,  and 
died  on  December  5th,  1863.  At  the  autopsy,  the  right  lobe  of  the  cerebrum  was  found  to  be  comjtletely  destroyed.  The 
pathological  specimen  is  No.  2641,  Sect.  I,  A.  M.  M.  The  perforation  is  at  the  centre  of  the  squamous  suture,  and  measures 
three-fourths  of  an  inch  by  one  inch  externally,  having  the  edges  beveled  at  the  expense  of  the  inner  table.  There  is  no  Assuring. 
The  specimen  and  history  were  contributed  by  Surgeon  E.  Bentley,  U.  S.  V. 

Case. — Private  Foster  H.  B , Co.  E,  7tli  Michigan  Volunteers,  aged  20  years,  was  woiuided  at  Re.am’s  Station, 

A'^irginia,  August  25th,  1864,  by  a conoidal  ball,  which  fractured  and  depressed  the  frontal  bone  over  the  left  orbit,  tearing  off 
a portion  of  the  external  table  tw'o  and  a quarter  indies  in  length,  and  nearly  an  inch  in  width.  In  the  same  engagement  he 
received  a flesh  wound  of  thigh.  He  w'as  taken  to  the  2d  division.  Second  Corps,  hospital,  where  a portion  of  both  tables  was 
removed  by  Surgeon  G.  Chaddock,  7th  Michigan  Volunteers.  On  the  28th,  he  was  conveyed  to  AVashington,  and  admitted  to 
the  Lincoln  Hospital.  Two  days  later  he  became  delirious.  Coma  supervened  on  September  1st,  and  the  pupils  contracted. 
On  the  3d,  while  the  coma  still  existed.  Acting  Assistant  Sui-geon  T.  F.  Betton  made  an  elliptical  incision  through  the  integuments, 
and  remov'ed  a portion  of  a musket  ball  and  several  depressed  fragments  of  bone  from  the  anterior  lobe  of  the  brain.  The  wound 
was  cleansed,  and  the  edges  brought  together  and  united  by  straps  of  adhesive  plaster.  The  operation  failed  to  relieve  the  coma, 
and  patient  died  the  same  day.  The  post-mortem  examination  revealed  a portion  of  the  inner  table,  about  the  size  of  a dime, 
depressed;  the  meninges  of  the  brain  were  batbed  in  pus,  and  a large  abscess  existed  in  the  anterior  portion  of  the  left  hemisphere, 
the  substance  of  the  brain  surrounding  it  being  very  much  softened.  The  pathological  specimen  is  No.  2078,  Sect.  I,  A.  M.  Al., 
and  was  contributed,  with  tlie  history,  by  Acting  Assistant  Surgeon  H.  M.  Dean. 

Case. — Sergeant  Presley  AV.  N , Co.  C,  1st  Ohio  Volunteer  Cavalry, 

aged  24  years,  was  wounded  near  Culpeper,  A'’irginia,  September  13th,  1833,  by  a 
musket  ball,  which  cojnminuted  both  tables  of  the  left  temporal  bone  two  inches 
above  the  mastoid  process.  He  was  conveyed  to  AVashington,  and  admitted  into 
Armory  Square  IIos[)ital  on  the  15th,  where  simple  dressings  tvere  applied  to  the 
wound.  The  head  symptoms  were  very  slight  until  October  7th;  from  that  time  he 
gradually  grew  worse.  On  the  17tli,  nau.sea  and  vomiting  supervened.  An  incision 
was  made  over  the  cicatrix  by  Surgeon  D.  AV.  Bliss,  U.  S.  V.,  and  several  small 
.spiculm  of  bone  were  removed,  wliich,  however,  afi'orded  no  relief,  and  the  vomiting, 
with  increased  pain  in  head,  continued.  The  patient  sank  rapidly,  and  died  on  the 
20th.  The  post-mortem  examin.ation  revealed  the  vessels  of  tlie  membranes  and  of 
the  brain  in  a high  state  of  congestion.  An  abscess  was  found  in  the  left  ventricle, 
which  communicated  with  the  external  wound,  and  contained  an  ounce  of  dark. 
Fig.  Its.— Sef’-mpnt  of  left  temporal  bone,  greenish  pus.  The  substance  of  the  brain  in  the  vicinity  of  the  abscess  was  softened, 
from  which  fragments  have  been  removed.  Communication  existed  between  the  external  wound  and  the  abscess,  which  was 
size.]  hlled  with  spiculffi.  Ibe  pathological  specimen  is  represented  m the  adjacent  wood- 

cut. The  edges  of  the  fracture  in  the  cranium  are  somewhat  I'oundcd,  exhibiting  evidence  of  attempts  at  repair.  The  specimen 
and  history  were  contributed  by  Surgeon  D.  W.  Bliss,  U.  S.  V. 

Case. — Private  Otis  G , Co.  C,  16th  Maine  A'’olunteers,  aged  21  years,  who  was  a very  stout  and  vigorous  person, 

weighing  180  pounds,  was  struck,  at  the  affair  on  the  AV'eldon  Railroad,  August  18th,  1834,  upon  the  top  of  the  head  by  a 
conoidal  musket  ball,  which  produced  a fracture  of  the  skull  one  inch  posterior  to  the  coronal  suture.  On  the  following  day 
ho  was  admitted  into  the  field  hospital  of  the  3d  division.  Fifth  Corps,  where  he  remained  until  the  21st,  when  ho  was  conveyed 
to  AA'ashiugton,  and  admitted  into  the  Lincoln  Hospital.  Ice-water  dressings  were  aiiplied  to  tho  head,  and  sedatives  were 
administered.  In  the  progress  of  the  case,  fragments  of  both  the  outer  and  inner  tables  were  removed,  leavhig  the  brain  exposed. 


EEMOVAL  OP  FEAGMENTS  AFTEE  GUNSHOT  FEACTUEES  OF  THE  SKULL. 


249 


The  patient  failed  rapidly,  and  died  apparently  from  exhant-tion  on  August  30th,  1.8G3.  At  tlie  autopsy,  the  scalp  in  the. vicinity 
of  the  wound  was  found  to  he  infiltrated  with  pus,  the  periosteum  being  easily  detached.  The  fracture  involved  both  jiarietal 
bones,  measuring  one-half  by  one  inch,  the  longest  diameter  rumnng  at  right  angles  with  the  sagittal  suture.  Upon  the  removal 
of  the  calvarium,  the  depressed  portion  of  hone  was  held  in  position  by  the  dura  mater.  Through  both  tables  of  the  left  parietal 
bone,  from  the  jilace  of  injury  to  the  posterior  inferior  angle,  ran  ii  fissure,  along  which  tnices  of  an  attemi)t  tit  repair  were 
observed.  The  meninges  in  the  vicinity  were  congested  and  thickened.  In  the  left  hemisphere  a cerebral  abscess  existed, 
extending  from  the  surface  of  the  brain  to  a level  with  the  cor[)iis  callosum,  three-fourths  of  an  inch  in  diameter.  The  contiguous 
portion  of  brain  was  much  softened,  as  was  the  right  hemisphere  within  the  limits  of  the  fracture.  The  pathological  specimen 
is  No.  3150,  Sect.  I,  A.  M.  JL,  and  was  contributed  by  Acting  Assistant  Surgeon  H.  M.  Dean. 

Case. — Corporal  AYilliam  M , Co.  E,  23d  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Malvern  Hill, 

Virginia,  July  1st,  1862,  by  a fragment  of  shell,  which  fractured  and  depressed  the  right  parietal  bone,  about  one  inch  from  the 
sagittal  suture.  He  was  conveyed  to  New  York,  and  on  the  24th  admitted  into  the  DeCamp  Hospital,  David’s  Island,  New 
York  harbor.  Hemiplegia  of  the  right  side  of  the  body  existed  from  the  date  of  the  injury ; but  with  this  exception  no  unfavorable 
symptoms  appeared  until  August  15th.  On  the  following  day  two  pieces  of  necrosed  bone,  about  an  inch  and  a half  in  diameter, 
and  also  portions  of  depressed  bone,  were  removed  with  the  forceps.  A very  fetid  pus  surrounded  the  fractured  parts.  The 
patient  was  delirious,  grew  rapidly  worse,  and  died  August  17th,  1862.  The  autopsy  revealed  au  abscess  about  two  inches  in 
extent,  seated  in  the  left  henusphere  of  the  brain,  immediately  below  the  seat  of  the  injury.  The  pathological  specimen  is 
No.  1059,  Sect  I,  A.  M.  M.,  and  consists  of  a portion  of  the  cerebrum,  with  a small  abscess  in  the  upjter  part  of  the  anterior  lobe 
of  the  right  hemisphere.  On  the  external  surface  of  the  brain,  one-half  inch  to  the  right  of  the  longitudinal  fissure,  is  a dark 
spot,  with  disorganization  of  the  brain  substance,  and  the  surrounding  parts  are  discolored.  The  case  is  reported  by  Sin-geon  S. 
W.  Gross,  U.  S.  V. 

Case. — Private  James  F.  W , Co.  H,  3d  Maine  Volunteers,  aged  24  years,  was  wounded  at  Eaccoon  Ford,  Virginia, 

November  27th,  1863,  by  a musket  ball,  which  fractured  both  tables  of  the  occijjital  bone,  just  above  and  to  the  left  of  the 
protuberance.  He  was  admitted  to  the  1st  division.  Third  Corps,  field  hospital  on  the  same  day,  and  transferred  to  the  3d 
Division  Hospital,  Alexandria,  Virginia,  on  December  4th.  On  the  following  day  he  was  still  conscious,  but  very  restless;  his 
head  was  very  painful,  pulse  120,  strong  and  full,  tongue  coated  and  dry,  skin  hot  and  bowels  constipated.  During  the  night  he 
was  delirious  and  vomited  often,  and  on  the  next  morning  he  became  comatose.  A piece  of  bone,  one  inch  long,  and  three-fourths 
of  an  inch  wide,  was  removed  from  the  wound,  but  failed  to  relieve  the  patient,  and  he  died  at  twenty  minutes  after  three  o’clock 
P.  M.  of  the  same  day.  The  autopsy  revealed  a congested  and  discolored  state  of  the  meninges,  and  an  abscess  extending  from 
the  wound  into  the  left  lateral  ventricle.  Several  small  spiculm  were  lying  loose  in  the  wound.  An  opening  was  found  near  the 
middle  and  a little  to  th(»»Ieft  of  the  centre  of  the  occipital  bone,  through  which  a portion  of  the  brain  was  protruding.  The 
pathological  specimen  is  Eo.  1904,  Sect.  I,  A.  M.  M.,  the  posterior  portion  of  the  cranium  showing  a nearly  circular  fracture  of 
both  tables.  The  internal  surface  of  the  opening,  which  measures  one  inch  in  diameter,  is  slightly  the  larger.  The  specimen 
and  history  were  contributed  by  Acting  Assistant  Surgeon  J.  Cass. 

Ca.se. — Private  Peter  W , jr.,  Co.  F,  126th  New  Yorlc  Volunteers,  aged  19  years,  was  wounded  at  Bristow  Station, 

Virginia,  October  14th,  1883,  by  a conoidal  musket  ball,  which  fractured  and  depressed  the  inferior  angle  of  the  left  parietal,  at 
its  junction  with  the  frontal  bone,  and  penetrated  the  brain.  He  was  admitted  into  the  2d  division  hospital,  Alexandria,  on  the 
15th,  in  a state  of  insensibility.  His  right  side  was  paralyzed,  pulse  56  and  full,  and  the  pupils  were  somewhat  contracted.  On 
the  16th  seven  pieces  of  bone  were  removed ; the  largest  being  nearly  an  inch  square.  A large  quantity  of  sanguinolent  fiuid  was 
discharged,  in  which  appeared  portions  of  brain  matter.  The  next  morning  a discharge  of  a bloody,  foul-smelling  fluid  followed, 
and  the  patient  passed  his  urine  involuntarily.  On  the  IStli  the  discharge  continued;  the  pulse  became  more  frequent  and  feeble, 
and  death  occuiTed  at  two  o'clock  A.  m.,  October  19th,  1883.  The  post-mortem  revealed  inflammation  of  the  membranes  over 
both  hemispheres;  also  an  abscess  occupying  the  upper  half  of  left  hemisphere  of  the  cerehrum,  at  the  posterior  pai't  of  which 
was  found  a rifle  ball.  The  pathological  specimen  is  No.  1739,  Sect.  1,  A.  M.  M.  The  de])rossed  iiortion  measures  one  by  one 
and  a half  inches,  from  which  four  fragments  have  been  removed.  A fissure  extends  diagonally  across  the  parietal  bone,  from 
the  anterior  inferior  to  the  opposite  angle,  and  another  fissure  passes  downward.  The  specimen  and  history  are  contributed  by 
Acting  Assistant  Surgeon  C.  1‘.  Bigelow. 

Case. — Private  Warren  W , Co.  A,  159th  New  Yoi-k  Volunteers,  aged  26  years,  was  wounded  in  the  action  at  Irish 

Bend,  Louisiana,  April  14th,  1833,  by  a conoidal  musket  ball,  which  cut  the  .scalp  upon  the  right  side  of  the  head,  one  inch  and 
a half  in  extent,  so  that  the  belief  was  entertained  that  the  wound  had  heen  produced  by  a li-airmeut  of  shell.  Violent  delirium 
succeeded  rapidly,  as  reported  by  the  field  surgeon  who  had  charge  of  the  case  i)revious  to  his  admission  into  the  University 
Hospital  at  New  Orleans,  April  17th,  1883.  An  examination  of  the  wound  was  now  made  with  a probe,  which  j)enetrated  the 
brain  by  its  own  weight  to  the  distance  of  four  inches.  On  tht;  following  day  he  was  restless,  moaned,  and  complained  of  pain 
in  the  head,  and  toward  evening  active  delirium  supervened,  which  subsequently  alternated  with  periods  of  quiet  consciousness. 
Spasms,  however,  occurred  at  all  times.  On  the  eleventh  day  after  the  injury  a fraginentof  bone  was  discharged  from  the  wound, 
after  which  he  seemed  quite  rational.  But  delirium  soon  returned,  followed  by  coma,  and  death  resulted  on  the  morning  of  April 
27th,  1883.  At  the  autopsy,  the  space  from  which  fragments  of  bone  had  been  removed,  at  the  ])osterior  inferior  angle  of  the 
parietal  bone,  measured  one  and  one-fourth  inches  in  length  by  three-fourths  of  an  inch  in  width,  the  edges  of  the  opening  being 
beveled  at  the  expense  of  the  inner  table;  a fissure  through  both  tables  passed  forward  to  the  squamous  suture.  One  fragment 
of  the  inner  table  was  depressed  two  lines,  but  remained  attached.  The  inner  table  in  the  vicinity  of  the  fracture,  exhibiti^d 
evidences  of  extensive  disease.  The  cerebral  substance  immediately  surrounding  the  missile,  which  was  flattened  and  battered, 
was  disorganized  ; otherwise  the  brain  ap|)eared  healthy.  The  j)ia  mater  ai)p<!ared  intich  congested,  and  the  ventricles  contained 
a small  quantity  of  fluid.  The  pathological  specimen  is  No.  1292,  Sect.  I,  A.  M.  M.,  and  was  contributed,  with  the  history,  by 
Assistant  Surgeon  1’.  S.  Conner,  U.  S.  A. 


250 


WOUNDS  AND  INJUEIES  OP  THE  HEAD 


I 


Case. — Private  Henry  G , Co.  B.  53(1  North  Carolina  Eegiment,  aged  SO  years,  was  wounded  at  the  battle  of 

Gettysburg,  July  1st,  18G3,  by  a conoidal  musket  ball,  Avhich  penetrated  the  skull  at  the  left  parietal  eminence,  causing  a depression 
of  the  fragments.  The  fractured  pai'ts  were  removed  on  the  field.  He  was  admitted  to  the  Frederick  Hospital,  Mai^'sdand,  on 
the  6th,  being  nearly  insensible,  and  only  muttering  in  reply  to  (questions  addressed  to  him.  The  pupils,  however,  were  sensible 
to  light;  softened  brain,  mixed  with  blood,  was  oozing  from  the  wound.  Death  supervened  on  the  afternoon  of  the  following 
day.  At  the  autopsy,  two  r ather  large  pieces  of  skull  were  found  protruding  inward  from  the  wound  in  such  a way  that  the  ball 
could  have  lodged  just  within  the  aperture.  The  missile  liad  evidently  been  removed.  The  pathological  specimen  is  No.  3861, 
Sect.  I,  A.  M.  M.  The  fractured  portion  measures  cxter-nally  one  inch  in  diameter,  internally,  one  and  one-fourth  inches.  More 
than  half  the  fractured  surface  is  removed  ; the  remainder  is  composed  of  the  outer  table  only,  and  is  depressed  one-fourth  of  an 
inch.  The  specimen  and  history  were  contributed  by  Acting  Assistant  Surgeon  J.  H.  Bartholf. 

Case. — Corporal  Joseph  D.  T , Co.  F,  27th  Indiana  Volunteers,  was  wounded  at  the  battle  of  Chancellorsville, 

May  3d,  1863,  by  a round  ball,  which  struck  the  frontal  bone,  penetrated  both  tables,  and  lodged  in  the  right  ventiicle.  He  was 
admitted  into  the  Twelfth  Corps  hospital,  Aquia  Creek,  Virginia,  on  Slay  16th.  He  had  received  no  surgical  treatment  up  to 
that  date,  but  w'as  sutficiently  strong  to  walk  from  the  ambulance  to  the  tent.  On  the  next  morning  he  became  partially  comatose, 
but  exhibited  no  other  symptoms'  of  cerebral  lesion,  except  slight  headache.  The  pulse  was  natural,  and  the  skin  cool  and 
moist.  Assistant  Surgeon  Andrew  J.  Gilson;  5th  Connecticut  Volunteers,  removed  five  fragments  of  bone  from  the  wound,  giving 
exit  to  considerable  pus,  mixed  with  clots  of  blood  and  pieces  of  membrane.  After  the  operation  the  patient  expressed  himself 
relieved,  but  he  was  still  inclined  to  sleep.  Cold  water  dressings  w'ere  constantly  applied  and  frequently  renew'od.  No  material 
change  took  place  until  the  21st,  when  the  ball  appeared  at  the  orifice  of  wound,  and  w'as  removed.  Partial  hemiplegia  and 
complete  coma  supervened ; the  patient  gradually  became  exhausted,  and  died  at  nine  o’clock  P.  M.,  May  2lst,  1863.  The 
autopsy  revealed  a compound  fracture  of  right  parietal  and  frontal  bones.  The  brain  substance  was  extensively  lacerated, 
crushed,  and  in  a state  of  putridity ; over  the  right  orbit  the  track  of  ball  w'as  found  leading  to  the  right  ventricle,  which  was 
filled  with  pus.  The  missile  was  expelled  by  the  action  of  the  escaping  pus.  The  cerebellum  was  intlamed  and  congested.  The 
pathological  specimen  is  No.  1267,  Sect.  I,  A.  IM.  M.,  and  was  contributed  by  Assistant  Surgeon  A.  J.  Gilson,  5th  Connecticut 
Volunteers. 

Case. — Captain  X. , a Confederate  officer,  was  admitted  into  Stanton  Hospital,  Washington,  on  May  18th,  1864, 

in  a comatose  condition.  He  had  bee)i  wounded  at  Spottsylvania  on  the  12th  by  a conoidal  ball,  which  perforated  the  frontal 
bone  to  the  right  of  the  median  line.  The  dura  mater  was  penetrated,  and  several  splinters  were  driven  into  the  brain.  On 
May  19th,  he  was  still  in  a comatose  condition ; the  pupils  widely  dilated ; breathing  stertorous,  with  puffing  of  the  corners  of 
the  mouth;  right  side  and  bladder  paralyzed;  pulse  108,  and  full;  deglutition  difficult.  Assistant  Surgeon  George  A.  Mursick, 
"U.  S.  V.,  enlarged  the  wound  by  a crucial  incision,  and  removed  several  large  splinters  with  an  elevator.  Ice  was  applied  to 
the  head,  and  a stimulating  enema  was  ordered,  and  the  urine  was  drawn  ofl’  by  a catheter.  On  the  following  morning  the 
coma  was  yet  more  profound,  and  the  patient  died  during  the  day.  May  20th,  1864.  At  the  autopsy,  the  right  frontal  and 
temporal  bones  were  found  to  be  fissured,  the  fracture  of  the  temporal  bone  extending  nearly  to  the  ear.  A conoidal  ball  was 
found  in  the  middle  lobe  of  the  right  hemisphere ; also  a plastic  exudation  on  the  vertex,  betw’een  the  dura  mater  and  the 
arachnoid.  The  pathological  specimen  is  No.  2683,  Sect.  I,  A.  M.  M.  The  opening  in  the  frontal  bone  is  elliptical,  measuring 
three-fourths  by  one  and  one-half  inches.  The  fractured  surface  of  the  inner  table  is  the  larger.  The  specimen  and  histoiy  were 
contributed  by  Assistant  Surgeon  George  A.  Mursick,  U.  S.  V. 

Case. — Private  Charles  B , Co.  H,  2d  Michigan  Volunteers,  aged  36  years,  was  wounded  near  Petersburg,  Virginia, 

June  17th,  1864,  by  a shell,  which  fractured  the  left  parietal  bone  at  the  middle  of  the  lower  edge.  He  was  admitted  into  the 
field  hospital  of  the  3d  division.  Ninth  Corps,  and  thence  sent,  on  June  21st,  to  the  Harewood  Hospital,  Washington,  D.  C.  On 
June  28th,  fragments  of  the  outer  table  to  the  extent- of  an  inch  in  diameter  were  taken  out,  and,  on  June  29th,  a fractured 
portion  of  the  inner  table,  which  had  become  loose,  was  removed.  There  being  some  cerebral  symptoms,  ice  was  applied  to  the 
head;  cathartics  were  then  administered,  and  poultices  applied.  Coma  supervened  on  June  30th,  1864,  and  the  patient  died  on 
the  same  day.  A.  post-mortem  examination  revealed  meningitis  and  a considerable  amount  of  pus  beneath  the  membranes.  The 
pathological  specimen  is  No.  3051,  Sect.  I,  A.  M.  M.,  a segment  of  cranium  showing  an  elliptical  opening  one  inch  from  above 
downward  and  one-half  inch  in  width ; there  is  a short  fissure  of  the  inner  table,  with  depression  of  one  edge  to  the  extent  of  one 
line.  No  attempt  at  repair  is  visible.  The  specimen  and  history  were  contributed  by  Surgeon  E.  B.  Bontecou,  U.  S.  V. 

Case. — Corporal  James  D.  M , Co.  D,  108th  New  York  Volunteers,  wms  wounded  at  the  battle  of  Fredericksburg, 

Virginia,  December  13th,  1862,  by  a conoidal  ball,  which  lacerated  the  scalp  over  the  upper  anterior  portion  of  the  left  parietal 
bone.  He  was  admitted  into  Grace  Church  Hospital,  Alexandria,  on  the  13th,  where  the  wound  was  diagnosticated  as.a  gunshot 
wound  of  the  scalp.  He  was  able  to  walk  about,  and  stated  that  he  had  been  unconscious  only  a short  time.  After  a few  d.ays 
he  was  attacked  with  convulsions,  which  aflected  only  the  right  side,  producing  clonic  spasms,  only  lasting  about  one  hour.  He 
recovered  from  these  sufficiently  to  bo  again  able  to  walk  about.  About  the  18th  or  19th  of  January,  1883,  the  convulsions 
I'eturned  and  grew  more  frequent,  until  he  sank  into  a comatose  state,  with  constant  rigidity  of  the  right  side.  He  could  be 
aroused  sufficiently  to  answer  questions  by  yes  and  no.  The  right  pupil  was  dilated,  and  the  pulse  slow  and  intermitting. 
Acting  Assistant  Surgeon  A.  W.  Tryon  cut  down  on  the  skull  and  removed  several  pieces  of  bone,  one  of  which,  triangular  in 
shape,  and  about  half  ati  inch  in  length,  had  been  driven  into  the  brain  matter.  The  operation  afforded  no  relief,  and  the 
symptoms  ahove  described  gradually  increased,  till  death  supervem'd  on  January  30th.  At  the  post-mortem  examination  an 
immense  abscess  was  found,  which  occupied  nearly  the  whole  anterior  lobe  of  the  left  hemisphere,  and  penetrated  into  the 
ventricle  of  that  side.  The  septum  lucidum  was  broken  down,  and  the  right  ventricle  filled  with  pus.  The  under  portions  of 
the  meninges  of  the  brain  were  inflamed,  being  much  injected  -(vith  blood.  At  a number  of  places  pus  had  formed  under  the 
arachnoid.  There  were  congested  spots  in  the  brain  matter,  about  the  sac  of  the  abscess,  and  nearlj'  tbe  whole  mass  of  brain 


REMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


251 


matter  was  mucli  softer  than  natural.  The  pathological  specimen  is  No.  1723,  Sect.  I,  A.  M.  M.  The  vault  of  the  cranium  is 
fractured  just  below  the  anterior  superior  angle  of  the  left  parietal  bone.  Fragments  have  been  removed  from  an  opening  three- 
fourths  of  an  inch  in  diameter.  Two  fragments  of  the  outer  and  inner  tables  remain  attached,  being  depressed  two  lines  on  the 
free  edge.  The  surrounding  bone  is  soft  and  porous.  The  specimen  and  history  were  contributed  by  Acting  Assistant  Surgeon 
A.  W.  Tryon. 


Case.— Private  Norman  O , Co.  E,  44th  New  Yorlc  Volunteers,  aged  37  years,  was  wounded  at  the  battle  of 

Chancellorsville,  May  1st,  1833,  by  a musket  ball,  which  penetrated  the  frontal  bone  an  inch  anterior  to  the  coronal  suture,  and 
a little  to  the  right  of  the  median  line,  fracturing  both  tables  of  the  skull.  While  he  was  lying  upon  the  field.  Assistant  Surgeon 
John  S.  Billings,  U.  S.  A.,  removed  several  fragments  of  bone,  together  with  a metallic  figure  4,  about  half  an  inch  in  length, 
which  had  been  driven  from  the  front  of  his  forage  cap  into  the  substance  of  the  brain.  There  was  considerable  discharge  of 
arachnoid  fluid.  On  the  next  day  he  was  removed  to  the  Fifth  Corps  hospital  at 
Brooks’s  Station.  The  brain  pulsations  were  distinctly  visible.  The  patient  was 
perfectly  rational,  conversing  freely,  and  complaining  of  hunger.  No  pain  in  the 
head  was  experienced,  nor  any  functional  cerebral  derangement.  Water  dressing 
was  applied,  .and  perfect  quiet  enjoined.  On  the  10th,  suppuration  was  free  and 
healthy.  The  patient  then  complained  of  great  inconvenience  from  a rattling  sound 
in  the  head,  which  could  be  heard  at  a distance  of  several  paces  from  the  bed,  and 
which  was  synchronous  with  the  brain  pulse,  being  apparently  caused  by  the 
vibrations  of  pus  at  each  pulsation.  On  May  12th,  the  pulse  was  136  and  strong, 
and  the  patient  complained  of  considerable  pain  in  the  head.  Ice  was  applied  to 
the  wound,  and  tinct.  veratri  virid.  given  every  hour,  which,  in  about  twenty 
hours,  reduced  the  pulse  to  80.  He  was  somewhat  stupid  and  sleepless,  had 
involuntary  discharges,  and  slight  paralysis  of  left  arm  and  leg,  though  no  diminu- 
tion of  sensibility  existed.  The  wound  still  suppurated  freely.  Patient  was 
occasionally  turned  on  his  face,  to  allow  the  pus  to  drain  from  the  wound.  The 
paralysis  and  stupor  increased  gradually  until  May  20th,  when  difficulty  in  mictu- 
rition was  observed;  delirium  set  in,  and  continued  with  only  occasional  inter- 
missions. On  the  25th,  paralysis  of  left  side  had  become  complete.  The  right 

side  of  face  was  partially  paralyzed,  the  pulse  extremely  irregular,  and  the  vision  entirely  gone.  These  symptoms  increased  in 
gravity  until  the  27th,  when  the  patient  died  in  a somnolent  but  not  comatose  condition.  The  post-mortem  revealed  an  adhesion 
of  the  dura  matter  to  the  braf*x  matter,  and  also  to  the  skull  around  the  orifice.  An  abscess  was  found,  extending  from  the 
opening  through  the  rigjit  anterior  lobe  of  cerebrum;  also,  pus  on  the  cribriform  plate  and  around  the  optic  foramina.  No 
traces  of  the  ball  were  discovered.  The  pathological  specimen  is  figured  by  the  wood-cut.  The  opening  in  the  frontal  bone  is 
elliptical,  and  measures  one-half  by  one  inch,  and  is  surrounded  by  a ring  of  bone  in  process  of  separation;  the  lino  of 
demarcation  having  formed.  The  specimen  and  history  were  contributed  by  Surgeon  A.  M.  Clark,  U.  S.  V. 


Fig.  119. — .Segment  of  frontal  bone,  showing 
e.\folintii;n  about  a gunshot  perlor.ation.  Sjicc. 
1190.  Sect.  1,  A.  JI.  M.f. 


Case. — Private  Gottlieb  S , Co.  E,  122d  New  York  Volunteers,  was  wounded  at  the  battle  of  Cold  Harbor, 

Virginia,  June  4th,  1834,  by  a conoidal  musket  ball,  which  fractured  the  frontal  bone  at  the  coronal  suture,  just  behind  the  loft 
frontal  eminence.  He  was  admitted  to  the  hospital  of  the  1st  division.  Sixth  Corps,  and  on  June  7th,  sent  to  Lincoln  Hospital, 
"Washington.  On  the  following  day,  the  ball  and  fr.agments  of  bone  were  removed,  leaving  the  dura  mater  exposed.  On  June 
9th,  erysipelas  supervened,  and  death  occurred  on  June  10th,  1834.  On  opening  the  scalp  at  the  autopsy,  one  and  a half  ounces 
of  blood  exuded;  the  dura  mater  beneath  the  injury  was  firmly  covered  with  blood  clots ; the  left  hemisphere  of  the  brain  -was 
much  congested,  and  the  injured  part  down  the  corpus  callosum  so  much  contused  as  to  resemble  boiled  chocolate.  The  patho- 
logical specimen  is  No.  2539,  A.  M.  M.  The  opening  in  the  bone  is  an  inch  in  diameter,  the  amount  of  the  vitreous  table 
removed  being  the  greater.  The  ball  is  traversed  by  a broad,  deep  groove  from  point  to  base.  The  specimen  was  contributed 
by  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A. 

Case. — Private  Edward  F , Co.  K,  47th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Pocotaligo, 

South  Carolina,  October  22d,  1832,  by  a musket  ball,  which  divided  the  central  and  posterior  portion  of  the  scalp,  penetratial 
and  lodged  in  the  frontal  bone.  He  was  admitted  into  the  general  hospital  at  Hilton  Head  on  the  following  day,  when  the  missile 
was  removed.  The  wound  did  well  for  three  weeks,  when  erysipelas  set  in.  It  disappeared  under  approjiriate  treatment. 
Suppuration  commenced  and  spiculm  of  bone  came  away,  or  were  removed  at  various  times.  Constant  headache,  of  a dull, 
heavy  nature,  was  present.  The  wound  closed,  and  no  uneasiness  was  expei’ienced  except  upon  exposure  to  the  rays  of  the  sun. 
He  was  retumed  to  duty  on  November  19th,  1832.  About  February  4th,  he  was  admitted  into  the  Fort  Jefferson  Hospital, 
Tortugas,  Florida,  with  marked  symptoms  of  compression.  The  pupils  were' slightly  dilated;  pulse  75,  and  of  moderate 
volume;  severe  headache,  and  alternate  flashes  of  heat;  anorexia.  The  tongue  was  covered  with  a heavy  white  fur.  The 
bowels  were  torpid.  Blisters  were  applied  to  the  nape  of  the  neck,  aird  a cathartic  given.  He  gradually  grew  weaker,  notwith- 
standing the  administration  of -tonics.  Opiates  were  given  to  promote  sleep.  Partial  paralysis  of  the  lower  extremities  took 
place.  His  mind  remained  clear  until  about  thirty-six  hours  before  death.  A comatose  condition  gradually  set  in,  his  piqiils 
became  much  dilated,  and  he  expired  on  February  10th,  1833.  Tho  post-mortem  revealed  a slight  congestion  of  the  membranes 
and  a slight  depression  of  osseous  matter  beneath  the  seat  of  injury.  An  abscess  was  found  in  the  left  jiosterior  lobe  of  the 
cerehrum,  which  contained  about  eight  ounces  of  dark  colored  and  very  offensive  pus.  The  sides  of  the  cavity  were  lined  by  a 
yellowish  white  membrane,  which  was  readily  broken  tip  by  the  fingei's.  The  left  anterior  lobe  was  in  a nonnal  condition. 
The  case  is  reported  by  Assistant  Surgeon  I.  H.  Schcetz,  47th  Pennsylvania  Volunteers. 


252 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Private  Simon  Kessler,  Co.  E,  9th  New  York  Heavy  Artillery,  aged  22  years,  was  wounded  at  Petersburg, 
Virginia,  Aiu’il  2d,  1835,  by  a conoida!  ball,  which  fractured  the  occij)ital  bone  near  its  centre  and  penetrated  the  brain ; he  also 
received  a slight  flesh  wound  over  the  light  scapula.  He  was,  on  the  next  day,  admitted  to  the  hospital  of  the  Sixth  Corps, 
and  thence  tran.sferred  to  the  Lincoln  Hospital,  Washington,  on  the  8th.  On  the  10th,  the  patient  had  become  slightly  comatose. 
He  was  placed  under  the  influence  of  other,  and  Acting  Assistant  Sui’geoii  W.  D.  Chambers  made  a vertical  incision  through  the 
integument  and  removed  the  ball  taid  fragments  of  bone,  including  the  occij)ital  protuberance.  Cold  water  dressings  and  lead 
and  opium  wash  were  applied  and  quinine  and  iron  administered.  Traumatic  erysipelas  supervened,  .and  death  resulted,  on 
April  18th,  from  exhaustion.  A post-mortem  ex.amination  showed  extensive  comminution  of  bone.  The  posterior  portion  of 
brain  was  much  congested.  The  case  is  reported  by  Surgeon  J.  C.  McKee,  U.  S.  A. 

Case. — Private  P.  C.  Schools,  Co.  E,  40th  Virginia  Eegiinent,  P.  A.  C.  S.,  aged  41  years,  was  admitted  into  Confederate 
Ilospit.al  No.  12,  Richmond,  yirgini.a,  on  the  12th  of  May,  1833.  He  had  been  wounded  at  the  battle  of  Chancellorsville, 
Virginia,  !May  3d,  1803,  by  a shell,  which  fractured  and  depressed  the  right  parietal  bone,  and  ;dso  fractured  one  of  the  meta- 
carpal bones  of  the  right  hand.  On  admission,  paralysis  of  the  left  side  existed  and  his  bowels  had  not  been  moved  for  two 
weeks.  Calomel  and  purgative  enemata  were  given.  On  M.ay  20th,  Drs.  Campbell  and  Petacolas  removed  several  loose  pieces 
of  bone  througli  incisions  in  the  scalp.  After  the  operation  coma  supervened,  followed  by  erysipelas  of  scalp  and  face.  Pounded 
ice  was  applied  to  the  head,  purgative  enemata  ordered,  and  tincture  of  iodine  apjilied  locally.  Death  occurred  on  May  25th,  1863. 

Ca.se. — Private  Harrison  H , Co.  E,  53d  North  Carolina  Regiment,  aged  29  years,  was  wounded  in  the  engagement 

near  Washington,  D.  C.,  July  12th,  1834,  by  a couoidal  b.all,  which  entered  in  front  of  the  right  br.anch  of  the  coronal  suture, 
travei’sed  the  brain,  fractureil  the  posterior  angle  of  the  right  parietal  bone  two  inches  from  the  occipital  protuberance,  and 
lodged  beneath  the  scalp.  He  was,  on  July  14th,  admitted  to  the  Lincoln  Hospital.  Brain  substance,  in  a disorganized 
condition,  oozed  from  the  wound.  Cold  water  dressings  -were  applied,  and  calomel,  opium,  cathartics,  and  low  diet  ordered. 
On  .July  19th,  the  patient  rejected  all  food,  became  unconscious,  and  groaned  as  if  in  much  pain.  Ho  was  attacked  by  frequent 
and  severe  convulsions,  and  evacuated  urine  involuntarily.  At  times  there  were  lucid  intervals  of  short  duration.  Strabismus 
to  a marked  degree  existed.  On  July  22d,  he  had  improved  a little,  and  on  .July  24th  free  incisions  were  made  to  evacuate  a 
large  amount  of  pus.  The  missile  and  several  fragments  of  the  parietal  bone  were  also  removed.  He  continued  to  improve 
until  .July  27th,  when  haemorrhage  occurred  from  branches  of  the  meningeal  artery,  rvhich  was  arrested  by  compress.  He  was 
now  perfectly  conscious,  but  complained  of  weakness.  On  the  following  d.ay  convulsions  recurred,  and  continued  with  increased 
severity,  until  death  occurred  on  July  28th,  1834.  The  autopsy  revealed  extensive  cotnminution  of  the  right  parietal  hone  in  the 
track  of  the  ball,  which  was  six  inches  in  length ; the  posterior  part  of  the  right  lobe  of  brain  was  protruding,  and  in  a state  of 
disorganization;  the  anterior  ])nrtion  was  apparently  healthy;  the  pericranium  was  much  thickened  and  congested.  The  case  is 
reported  by  Acting  Assistant  Burgeon  T.  L.  Leavitt.  The  pathological  specimen  is  No.  2905,  Sect  I,  A.  M.  M.,  and  was 
contributed  by  Acting  Assistant  Surgeon  11.  M.  Dean.  Between  the  wounds  of  entrance  and  exit  is  a bridge  of  bone  two  and  a 
half  inches  wide.  The  edges  of  the  fracture  are  uecrosed.  The  surrounding  bone  is  porous,  and  shows  traces  of  the  formation 
of  a line  of  dem.arcation. 

Case. — Private  Charles  A.  S , Co.  D,  4Gth  New  York  Volunteers,  aged  25  years,  w.as  wounded  in  an  engagement 

near  Petersburg,  Virginia,  June  23th,  1834,  by  a conoidal  musket  ball,  which  entered  above  the  left  superciliary  ridge,  fractured 
the  roof  of  orbit  and  the  iuner  table  of  skull,  opened  the  front.al  sinus,  and  lodged.  The  eye  was  bulged  out,  and  the  sclerotic 
coat  had  the  appearance  of  being  blistered  ; fracture  extended  ten  lines  above  the  supra-orbital  arch.  He  was  conveyed  to  the 
field  hospital  of  the  3d  division.  Ninth  Corps,  where  the  ball  and  spiculae  of  bone  were  removed  by  Surgeon  W.  C.  Shurlock, 
51st  Pennsylv.ania  Volunteers.  He  was  thence  sent  to  City  Point,  Virgini.a,  and  on  July  1st  transferred  to  W.ashington,  D.  C., 
entering  Lincoln  Hospital  on  tire  same  day.  The  wound  was  looking  well  for  several  days,  when  it  became  inflamed  and 
swollen,  and  in  order  to  permit  free  evacuation  of  pus  it  was  enlarged.  The  case  progressed  favorably  until  the  14th,  when  he 
became  very  wild  and  restless,  with  some  fever.  Saline  cathartics  and  small  doses  of  calomel  were  administered,  also  ipecac 
and  opium.  Collodion  was  applied  to  brain  substance,  which  protruded  like  a cauliflower  excrescence.  Coma  supervened, 
and  death  ensued  on  July  27th,  1834.  The  post-mortem  examination  revealed  a large  amount  of  subarachnoid  effusion ; the 
brain  substance  in  the  region  of  the  wound  was  very  soft  and  pulpy ; the  left  lobe  of  the  cerebellum  was  softened,  and  on  its 
external  surface  was  a deposit  rcsembUng  pus.  A similar  deposit  'was  also  observed  in  tlie  medulla  and  upper  portion  of  the 
spinal  cord.  The  pathological  specimen  is  No.  2891,  Sect.  I,  A.  M.  M.  One  inch  of  the  su])ra-orl)ital  .arch  is  carried  away,  and 
the  opening  involves  one  square  inch  of  the  external  table.  The  opening  internally  is  a little  larger,  part  of  the  orbital  plate  is 
absent,  the  frontal  sinus  is  opened,  and  a fissure  extends  inward  to  the  cribriform  plate  of  the  ethmoid.  The  bone  immediately 
around  the  opening  is  cribriform,  and  is  covered  with  a thin  chalky  layer  of  new  formation.  The  specimen  was  contributed  by 
Acting  Assistant  Surgeon  II.  M.  Dean. 

Case. — Priv.ate  David  L.  T , Co.  G,  12th  Georgia  Regiment,  .aged  20  years,  was  wounded  at  the  battle  of  Cold 

Harbor,  Virginia,  June  3d,  1834,  by  a conoidal  ball,  which  entered  three-fourths  of  au  inch  outside  of  the  outer  canthus  of  the 
left  eye,  passed  through  the  zygomatic  arch,  grooved  the  squamous  portion  of  the  temporal  bone  for  a distance  of  two  inches, 
nvolving  both  tables,  and  partly  imbedded  itself  in  the  brain.  He  remained  in  a field  hospital  until  June  8th,  when  he  was 
transferred  to  the  Lincoln  Hospital,  Washington.  He  was  able  to  answer  questions  by  “yes”  and  “no,”  but  not  understand- 
iiigly.  The  pupils  were  moderately  dilated ; the  pulse  78  and  weak.  On  the  following  day  he  was  etherized,  and  the  ball 
and  some  fragments  of  tbe  bone  were  I'emoved  through  an  incision  in  the  scalp.  The  wound  was  full  of  pieces  of  fr.actured 
bone,  and  exhibited  a disposition  to  slough.  The  incision  was  united  by  two  stitches,  .and  cold  water  dressings  and  a bandage 
were  api)lied.  For  an  hour  subsequent  to  the  operation  the  patient  was  very  wild,  requiring  to  be  held  in  bed.  He  gradu.ally 
became  quiet,  and  slept  during  the  night.  On  the  T2th,  he  answered  some  interrogatories  correctly;  Lis  appetite  was  good, 


EEMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


253 


and  his  bowels  open.  He  continued  in  this  condition,  eating  and  sleeping  well  and  answering  questions,  until  the  20th, 
when  the  coma  deepened,  and  death  finally  took  place  on  June  23d,  1834.  A post-mortem  examination  revealed  the  left 
hemisphere  entirely  broken  down,  and  the  cerebellum  very  much  softened.  The  pathological  specimen  is  No.  2GG5,  Sect.  I, 
A.  M.  M.,  and  was  contributed,  with  the  history,  by  Acting  Assistant  Surgeon  H.  M.  Dean. 

Case. — Private  Edward  S , Co.  L,  11th  Vermont  Volunteers,  aged  18  years,  was  wounded  at  the  battle  of  Cold 

Harbor,  Virginia,  June  od,  1864,  by  a conoidal  ball,  which  fractured  the  occipital  bone,  just  above  the  left  extremity  of  the 
superior  cuiwed  line.  He  was  conveyed  to  Washington,  and  on  the  10th,  admitted  into  Emory  Hospital.  On  the  11th,  Surgeon 
N.  E.  Moseley,  U.  S.  V.,  extracted  the  ball  from  the  left  lateral  sinus,  removed  spiculte  of  bone,  and  elevated  the  depressed 
portions.  Well  mai-ked  symptoms  of  compression  of  the  brain  existed,  with  great  mental  derangement,  and  the  patient  was 

comatose  most  of  the  time.  Sponges 
were  introduced  into  the  wound  to 
control  litBinorrhage,  and  cold  water 
dressings  were  applied.  A temporary 
improvement  took  place,  but  death 
ensued  on  June  18th,  1864.  The 
pathological  specimens  are  shown  in 
the  wood-cuts.  The  opening  in  the 
occipital  bone,  from  which  fragments 
have  been  removed,  measures  one  and 
a half  inches  horizontally  and  one 

^ „ . , , , , , X hich  in  width ; the  posterior  part  of 

Fig.  120. — Section  of  cranium  fractured  liy  musket  y . 

tall.  Spec.  25U5,  Sect.  I,  A.  M.  M.  edge  shows  marks  of  havnig  been 

cut  away  by  the  bone  gouge  forceps. 

There  is  no  ilssuring.  The  surrounding  portions  of  the  inner  table  show  marks  of  diseased  action.  The  specimen  was 
contributed  by  Surgeon  N.  E.  Moseley,  U.  S.  V. 

Case. — Private  John  S , Co.  D,  170th  New  York  Volunteers,  aged  52  years,  was  wounded  at  the  battle  of  North 

Anna  Eiver,  Virginia,  May  24th,  1834,  by  a conoidal  musket  ball,  which  caused  a depressed  fracture  of  the  parietal  bone.  He 
was  admitted  into  field  hospital,  3d  division,  Second  Corps,  and  thence  sent  to  the  Emory  Hospital,  Washington,  May  29th. 
His  mind  being  weak  and  wandering.  Surgeon  N.  E.  kloseley,  U.  S.  V.,  elevated  and  removed  a portion  of  depressed  bone. 
Cold  water  dressings  and  light  compression  were  applied  to  the  wound.  The  patient  died  on  June  8th,  1864.  The 
pathological  specimen  is  No.  4723,  Sect.  I,  A.  M.  M.,  consisting  of  eight  small  fragments  of  bone,  principally  from  the  inner 
table,  the  largest  being  about  one-half  inch  m width  and  three-fourths  of  an  inch  in  length,  contributed  by  Surgeon  N.  E. 
Moseley,  U.  S.  V. 

Case. — Private  Benjamin  N , Co.  6,  19th  Massachusetts  Volunteers,  aged  35  years,  was  wounded  at  Deep  Bottom, 

Virginia,  August  14th,  1834,  by  a conoidal  musket  ball,  which  passed  through  the  zygoma  and  squamous  portion  of  the  left 
temporal  bone  and  penetrated  the  brain.  Ho  was  admitted  into  the  hospital  of  the  Second  Corps  at  City  Point  on  the  16th, 
being  delirious  at  the  time.  On  the  following  day,  he  vvas  forwarded  by  hospital 
steamer  to  Washington,  and  admitted  to  the  Emory  Hospital  in  a comatose  condition. 

His  right  side  was  paralyzed,  pulse  feeble  and  105  per  minute,  and  extensive  ecchy- 
mosis  existed  around  each  eye.  There  was  considerable  laceration  of  the  soft  parts 
and  extensive  comminution  of  bone.  The  brain  protruded  and  discharged  from  the 
opening.  Chloroform  was  administered,  and  Surgeon  N.  E.  Moseley,  U.  S.  V., 
removed  the  ball  and  several  spiculae  of  bone,  which  had  been  forced  into  the  brain. 

Cold  water  dressings  were  apjilied,  and  the  patient  was  placed  on  the  injured  side 
to  promote  discharge.  Calomel  and  strict  antiphlogistic  treatment  were  ordered, 
but  death  supervened  on  August  19th,  1834.  An  autopsy  showed  extensive  lacei’- 
ation  of  anterior  and  middle  lobes  of  brain.  The  ball  had  passed  through  a portion 
of  pons  varolii  and  the  crura  cerebelli  of  left  side.  The  brain  was  considerably 
congested.  The  pathological  specimen,  represemted  by  the  wood-cut,  shows  a 
fragment  of  the  squamous  portion  of  the  left  temporal,  with  a conoiiial  ball  half 
severed  by  the  edge  of  the  fractured  bone.  The  fragments  include  one  square  inch  of 
surface.  The  sjiecimen  was  contributed  by  the  operator.  Surgeon  N.  E.  Moseley,  U.  S.  V. 

Case. — Private  William  A.  H , Co.  E,  19th  Indiana  Volunteers,  aged 21  years,  was  wounded  at  the  battle  of  Antietam, 

Maryland,  September  17th,  1832,  by  a conoidal  ball,  which  fractured  and  depressed  both  tables  of  the  anterior  inferior  jiorfion  of 
the  right  parietal  bone.  The  missile  had  split  upon  the  fractured  edge  of  the  bone.  He  was  conveyed  to  Washington,  and 
admitted  to  the  Capitol  Hospital  on  the  23d,  and  was  thence  transferred  to  the  Satterlee  Ilosjiital,  Philadelphia,  October  12th. 
Three  days  later.  Assistant  Surgeon  E.  de  W.  Breneman,  IT.  S.  A.,  made  a semi-lunar  incision  in  the  scalp,  and  dissected  up  the 
flap,  when  a copious  haemorrhage  occurred.  He  then  removed  several  small  detached  pieces  of  bone,  and  also  a triangular  piece 
of  the  internal  table,  which  was  pressing  heavily  upon  the  dura  mater,  and  by  means  of  an  elevator,  I’iiised  an  adjacent  jjortion 
of  the  bone.  The  membranes  of  the  brain  were  found  to  be  penetrated,  and  from  the  character  of  the  dischargi;,  it  was  IxReved 
that  the  brain  itself  was  seriously  injured.  The  pulsations  of  the  middle  meningeal  artery  were  distinctly  felt.  After  the 
operation  the  symptoms  of  compression  passed  away.  The  patient  was  much  prostrated,  but  in  the  full  ])osse.“sion  of  his  senses. 
He  was  kept  in  bed,  on  low  diet,  and  under  antiphlogistic  treatment.  On  October  23d  he  was  attacked  with  colliquative 


Fig.  122. — Ball  and  fragments  of  bone  re- 
moved  from  tlic  skull.  Spec.  3130,  Sect.  I,  A. 
M.  U.  i. 


Fig.  121. — Split  ball  and  fragments  of  cra- 
nium. Spec.  4964,  Sect.  I,  A.  M.  M. 


254 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


diarrlicEa.  Pyajmia  superveiifecl,  causing  death  on  the  21st  of  November,  18G2.  The  pathological  specimen,  No.  883,  Sect.  I, 
A.  M.  M.,  shows  five  small  fragments,  from  both  tables  of  the  parietal  bone,  representing  nearly  one  square  inch  of  surlaco. 
The  specimen  and  history  were  contributed  by  Assistant  Surgeon  E.  do  W.  Breneman,  U.  S.  A. 

Case. — Corporal  John  B , Co.  D,  103d  Pennsylvania  Volunteers,  aged  49  y^ears,  was  ^vounded  at  the  battle  of  Cold 

Harbor,  Virginia,  June  3d,  1804,  by  a conoidal  musket  ball,  which  fractured  and  depressed  the  left  parietal  bone,  at  a point  one 
inch  po.sterior  to  the  articulation  with  the  temporal  bone,  and  on  a line  with  the  temporal  ridge.  The  missile  lodged.  He  was 
admitted  into  the  Emory  Hospital,  Washington,  on  the  7th;  being  unconscious  at  the  time.  On  removing  spiculm  of  the  bone, 
and  coagula,  considerable  haemorrhage  occurred,  and  cerebral  matter  exuded.  Consciousness  returned,  but  the  patient  was 
extremely  weak  and  exhausted  from  loss  of  blood.  Stimulants  rvere  freely  given,  and  cold  water  dressings  applied  to  the  head. 
On  .June  8th  the  wound  was  again  examined,  and  four  spiculac  of  bone  were  removed  by  Surgeon  N.  E.  Moseley,  U.  S.  V. ; the 
ball  could  not  be  discovered.  No  marked  improvement  took  place  at  any  time.  A low,  muttering  delirium  supervened,  and 
death  occurred  on  June  12th,  1834.  At  the  autopsy,  a fractui’e  was  found  extending  from  the  point  of  entrance  to  the  anterior 
border  of  the  left  parietal  bone.  A part  of  the  petrous  portion  of  the  temporal  bone  was  carried  away.  Extensive  inflamma- 
tion existed  throughout  the  left  hemisphere.  The  pathological  specimen.  No.  2500,  Sect.  I,  A.  M.  M.,  was  contributed  by  Surgeon 
N.  R.  Moseley,  U.  S.  V.,  and  consists  of  three  fragments  of  bone  of  the  cranium,  involving  a little  over  one  square  inch  of  the 
imrer  table. 

Case. — Private  Benjamin  H.  C , Co.  6,  48th  Illinois  Volunteers,  was  wounded  in  an  engagement  near  Atlanta, 

Georgia,  July  21st,  1834,  by  a conoidal  ball,  which  fractured  both  tables  of  the  cr.anium,  at  the  middle  of  the  superior  border  of 
the  left  parietal  bone.  He  was  immediately  conveyed  to  the  hospital  of  the  4th  division.  Fifteenth  Corps,  where  he  remained 
until  August  11th,  when  he  was  transferred  to  Marietta,  Georgia,  and  admitted  into  general  field  hospital.  Fifteenth  Corps. 
Several  fragments  of  bone  were  removed,  cold  water  dressings  applied  to  the  head,  and  nourishing  diet  ordered.  The  case 
progressed  favorably  until  the  20th,  when  the  patient  began  to  fail.  Convulsions  occurred,  coma  supervened,  and  death  ensued  on 
August  23d,  1864.  The  pathological  sjtecimen  is  No.  3483,  Sect.  I,  A.  !M.  M.,  a segment  of  cranium  necrosed  at  the  seat  of 
injuryn  The  diseased  surface  of  the  outer  table  measures  two  by  two  and  a half  inches,  and  there  is  an  opening  three-fourths  of 
an  inch  in  diameter.  Other  fragments,  almost  separated,  are  in  situ,  and  the  rest  of  the  bone  is  discolored,  cribriform,  and 
carious.  Internally  the  diseased  surface  measures  one-fourth  by  two  and  a half  inches.  The  specimen  was  contributed  by 
Surgeon  A.  Goslin,  48th  Illinois  Volunteers. 

Case. — Sergeant  James  F , Co.  K,  14th  Maine  Volunteers,  aged  34  years,  was  wounded  at  Port  Hudson,  Louisiana, 

May  27th,  1833,  by  a conoidal  musket  ball,  which  caused  a compound  comminuted  fracture  of  the  right  parietal  bone,  one  inch 
anterior  to  the  parietal  eminence.  He  was  convoymd  to  New  Orleans,  and  entered  the  University  Hospital  on  the  29th.  A 
number  of  small  pieces  of  bone  rvere  removed  from  the  anterior  portion  of  the  parietal  bone.  The  case  progressed  well  until  June 
5th,  when  the  jratient  became  comatose  and  died.  A continued  discharge  of  brain  substance  had  taken  place  for  fourteen  hours 
before  his  death.  The  pathological  specimens  are  No.  1301  and  1302,  showing,  the  former,  a section  of  the  cranium  ; and  the 
latter,  a wet  irreparation  of  a segment  of  the  scalp.  The  fracture  in  the  cranium  measures  one  and  three-fourths  inches  antero- 
posteriorly,  and  nearly  one  inch  in  width.  A fragment  of  the  inner  table  remains  attached,  being  depressed  two  lines  on  the 
free  edge.  A fissure  of  both  tables  passes  into  the  temporal  bone,  entering  the  auditory  canal.  The  specimens  and  history  were 
contributed  by  Assistant  Surgeon  P.  S.  Conner,  U.  S.  A. 

Case. — Sergeant  Lewis  N.  E , Co.  1, 1st  Michigan  Volunteers,  aged  28  years,  was  wounded  March  29th,  1865,  at  the 

South  Side  Railroad,  Virginia,  by  a conoidal  ball,  which  entered  at  the  posterior  superior  angle  of  the  parietal  bone.  He  was 
at  once  admitted  to  the  hospital  of  the  1st  division.  Fifth  Corps,  and  thence  sent  to  the  Emory  Hospital,  Washington, 
where  he  arrived  on  April  4th  in  a comatose  condition,  with  partial  paralysis  of  the  lower  extremities.  He  was  on  the  same 
day  placed  under  the  influence  of  chloroform  and  ether,  and  Surgeon  N.  R.  Moseley,  U.  S.  V.,  removed  nine  spiculse  of  bone, 
together  with  a portion  of  the  ball.  Water  dressings  were  applied,  tonics,  stimulants,  and  nutritious  diet  ordered,  but  death 
ensued  on  April  23il,  1835,  from  exhaustion.  The  pathological  specimen  is  No.  4075,  Sect.  I,  A.  M.  M.,  part  of  a conoidal  ball 
and  six  fragments  of  outer  and  inner  table  and  diploe,  making  up  together  nearly'  one  square  inch  of  bone.  The  specimen  and 
history  were  contributed  by  Surgeon  N.  R.  Moseley,  U.  S.  V. 

Case. — Private  Augustus  E , Co.  D,  20th  Maine  Volunteers,  aged  20  years,  was  wounded  at  the  battle  of  Spottsylvania, 

Virginia,  May  12th,  1864,  by  a fragment  of  shell,  which  fractured  the  anterior  superior  angle  of  the  right  parietal  bone.  He 
was  admitted  into  Stanton  Hospital,  Washington,  on  the  20th,  where  spiculm  of  bone  were  removed.  Ice  dressings  were 
applied,  and  tonics  and  stimulants  administered.  The  patient  sank  rapidly,  and  died  on  May  24th,  1834,  from  exhaustion. 
The  pathological  specimen  is  No.  2679,  Sect.  I,  A.  M.  M.  A section  of  cranium,  with  six  fragments  of  bone.  The  oq^ening  in 
the  parietal  measures  one  and  three-fourth  inches  from  right  to  left,  and  half  an  inch  antero-posteriorly.  The  shape  of  the 
opening  is  very  unusual,  being  nearly  that  of  a rectangle.  The  specimen  and  history  were  contributed  by  Assistant  Surgeon 
George  A.  Mursick,  U.  S.  V. 

Case. — Private  John  W.  A , Co.  F,  70th  Indiana  Volunteers,  was  wounded  at  the  battle  of  Eesaca,  Georgia, 

May  14th,  1884,  by  a conoidal  ball,  which  entered  at  the  outer  and  upper  angle  of  the  right  orbit.  He  was  for  several  weeks 
treated  in  the  hospital  of  the  3d  division.  Twentieth  Corps,  near  Eesaca,  where  fragments  of  bone  were  removed.  On  June  25th, 
he  was  conveyed  to  the  field  hospital  at  Chattanoog.a,  Tennessee.  The  patient  was  insensible  at  the  time  of  admission,  and  died 
within  half  an  hour.  At  the  autopsy,  the  opening  made  by  the  missile  was  found  to  be  nearly  an  inch  in  diameter,  the  fracture 
involving  the  superciliary  ridge,  the  orbital  plate,  the  external  angular  process,  and  frontal  sinus.  Tho  pathological  specimen 
is  No.  1235,  Sect.  I,  A.  M.  M.  One  fragment  of  the  orbital  plate  remains  in  situ,  slightly  depressed.  The  inner  table  opposite 
each  frontal  eminence  is  cribriform.  The  specimen  was  contributed  by  Acting  Assistant  Surgeon  H.  S.  Kilbourne. 


EEMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


255 


Case. — Private  Asher  P , Co.  G,  14th  New  Jersey  Volunteers,  aged  32  yi'ars,  was  wounded  at  the  battle  of  Cold 

Harbor,  Virginia,  Juno  1,  1834,  by  a conoidal  ball,  which  entered  at  the  centre  of  the  supra-orhital  ridge,  left  side  of  the  os 
frontis,  producing  a comminuted  fracture,  which  extended  transversely  to  the  coronal  suture,  and  beloAv  to  the  junction  of  the 
zygoma  with  the  malar  bone.  The  missile  lodged  in  the  brain.  He  was  immediately  admitted  to  the  3d  division,  Sixth  Corps, 
hospital,  and  on  June  10th  transferred  to  the  Lincoln  Hospital,  Washington.  No  untoward  symptoms  appeared  until  the  18th, 
when  he  complained  of  f)ain  in  his  head.  Several  spiculae  of  bone,  and  a bucltshot  much  put  out  of  shape,  were  extracted. 
On  the  20th,  he  was  placed  under  the  inlluence  of  ether.  A crucial  incision  was  then  made  in  the  scalp,  and  several  portions 
of  the  supra-orhital  plate,  and  of  the  inner  table  of  the  frontal  bone,  were  removed ; also  a conoidal  ball,  which  was  deeply 
imbedded  in  the  brain  substance.  After  the  operation,  the  patient  improved  until  the  24th,  when  delirium  set  in.  Total 
unconsciousness,  restlessness,  and  low  muttering  supervened,  succeeded  by  partial  and  then  entire  paralysis  of  the  body. 
These  symptoms  prevailed  until  June  24th,  1331,  when  death  ensued.  Thz  post-mortsm  examination  revealed  the  brain  at  the 
seat  of  injury  very  much  disorganized,  of  a dark  brown  color,  and  of  the  consistency  of  starch.  The  rest  .of  the  brain  was 
much  softened,  the  ventricles  containing  a large  quantity  of  fluid.  The  pathological  specimen  is  No.  23GG,  Sect.  I,  A.  M.  M.,  and 
was  contributed  by  Acting  Assistant  Surgeon  A.  Ansell. 

Case. — Private  Charles  S.  Mattox,  Co.  H,  12th  Pennsylvania  Reserves,  aged  20  years,  was  wounded  at  the  battle  of 
Spottsylvauia  Court-house,  Virginia,  May  10th,  1834,  by  a conovlal  ball,  which  fractured  and  depressed  the  left  iiarietal  hone. 
He  was  brought  to  the  Emory  Hospital,  Washington,  on  the  13th,  in  an  almost  senseless  condition.  On  the  18th,  Surgeon  N. 
E.  Moseley,  U.  S.  V.,  removed  the  depressed  bone  and  applied  cold  water  dressings.  The  patient  revived  and  continued  to 
impi'ov'e  until  the  21st,  when  he  suddenly  relapsed  into  a comatose  condition,  and  died  on  the  following  day.  The  history  was 
contributed  by  Surgeon  N.  E.  Moseley,  U.  S.  V. 

Case. — Sergeant  George  Saunders,  Co.  D,  7th  Now  York  Heavy  Artillery,  aged  39  years,  was  wounded  at  the  battle  of 
Cold  Harbor,  Virginia,  June  3d,  1864,  by  a conoidal  ball,  which  entered  the  back  of  the  head  a little  above  the  occipital  protu- 
berance, and  to  the  right  of  the  median  line,  comminuted  the  bone  at  the  orifice  of  entrance  and  lodged  in  the  cranium.  He  was 
conveyed  to  Washington,  entering  Emory  Hospital  on  June  7th,  whence  he  was  transferred  to  Baltimore  on  the  11th,  and 
admitted  to  Camden  Street  Hospital.  On  June  16th,  he  was  jilaced  under  the  influence  of  chloroform,  and  Surgeon  Z.  E.  Bliss, 
U.  S.  V.,  removed  a number  of  loose  fragments  of  bone,  and  with  a probe  traced  the  track  of  the  ball  through  the  substance  of 
the  brain,  in  a forward  and  upward  direction  about  four  inches,  but  failed  to  discover  the  hall.  Some  pus  escaped  as  the  probe 
was  introduced.  The  parts  were  very  little  swollen  and  not  very  painful.  The  patient  reacted  promptly.  Interrupted  sutures 
were  inserted,  adhesive  strips  and  cold  water  dressings  applied,  opiates  administered,  and  stimulants  and  nutritious  diet  ordered. 
There  was  no  apparent  change  in  the  patient’s  condition  after  the  ojieration.  Coma  supervened,  and  death  occurred  June  18th, 
1834. 

Case. — Adjutant  Henry  McConville,  25th  Massachusetts  Volunteers,  aged  25  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  Virginia,  June  3d,  1834,  by  a conoidal  musket  ball,  which  entered  the  right  parietal  eminence,  causing  extensive 
comminution,  and  lodged  in  the  substance  of  the  brain.  He  received,  in  the  same  engagement,  two  other  wounds ; one  in  the 
neck  and  the  other  in  the  chest.  On  June  3d,  he  was  admitted  to  the  Eighteenth  Corps  hospital,  and  thence  transferred,  on 
June  6th,  to  the  Armory  Square  Hospital,  Washington.  Simple  dressings  were  applied  to  the  head.  On  June  11th,  several 
spiculae  were  removed  from  the  fractured  cranium.  Coma  supervened  and  the  case  terminated  fatally  on  June  12th,  1864. 

Besides  tlie  cases  of  removal  of  fragments  of  the  skull  after  gunshot  fracture  some 
details  of  which  have  been  given  in  the  foregoing  abstracts,  one  hundred  and  five  cases  of 
a similar  nature  are  entered  upon  the  registers.  Many  of  them  present  features  of  interest ; 
but  the  space  allotted  to  this  Section  will  not  admit  a full  record  of  their  histories.  It  is 
only  practicable  to  enumerate  them,  and  to  note  the  more  prominent  complications. 

Hoemorrhage. — Bleeding,  either  intracranial  or  from  vessels  without  the  skull,  is 
mentioned  by  the  reporters  as  an  important  element  in  seven  of  these  cases. 

Aherncathy,  J.  TV.,  Sergeant,  Co.  B,  15th  South  Carolina  Regiment,  aged  26  years.  Fredericksburg,  December  13th 
1862.  Fracture  of  right  parietal  by  conoidal  ball.  Charlottesville  Hospital.  Removal  of  ball  and  fragments.  Arteiial 
haimorrhages  occurred  December  16th  and  19th,  1832.  Died  December  19th,  1832. 

Dane,  William,  Private,  21st  Massachusetts,  aged  16  years.  South  Mills,  April  18th,  1862.  Fracture  of  frontal  by 
conoidal  ball.  Hygeia  Hospital.  May  4th,  removal  of  ball  and  fragments  of  bone.  Haemorrhage  giving  rise  to  clot  within  the 
cranium.  May  5th,  clotted  mass  was  removed.  Died  May  7th,  1832. 

Delano,  Eveeett  M.,  Private,  Co.  E,  1st  Maine  Heavy  Artillery,  aged  21  years.  Spottsylvauia,  May  12th,  1864 
Fracture  of  left  temporal  by  conoidal  ball.  Emory  Hospital,  Washington.  Removal  of  ball  and  fragments  of  bone.  May  22d. 
Hsemorrhage  from  jugular  vein  took  place,  causing  death  within  two  minutes.  May  22d,  1834. 

Dougiieiixy,  Joseph,  Sergeant,  Co.  B,  69th  New  York,  aged  23  years.  Spottsylvauia,  May  13th,  1834.  Fracture  of 
right  parietal  by  shell.  Alexandria  hospital.  Removal  of  fragment  of  hone.  Haemorrhage  from  middle  meningeal  artery. 
Ligation  of  common  c.arotid  above  the  omo-hyoid.  ilay  26th,  haimorrhage  recurred.  Died  May  28th,  1864. 

Konkle,  77'.  //.,  Private,  Co.  B,  44th  Georgia  Regiment.  Cold  Harbor,  .7uno  2d,  1834.  Fracture  of  frontal  )>y  shell. 
Chimborazo  Hospital,  Richmond.  Removal  of  fragments  of  bone.  I laemorrbage.  Death,  .June  8th,  1834. 


256 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Neal,  Joseph,  Private,  Co.  B,  1st  Jlaryland.  Chaiicellorsville,  May  3cl,  1863.  Fracture  of  right  parietal  bj'  canister- 
shot.  St.  Aloysius  Hospital,  Washington.  May  lOtli,  removal  of  spicnla;.  June  8tli,  hemorrliagc  from  a branch  of  the 
temporal  artery.  Died  June  ICth,  1863. 

Taylor,  Rodxey  I.,  Private,  Co.  F,  Ist  Maine  Heavy  Artillery,  aged  years.  Spottsylvania,  May  19th,  1864. 
Fracture  of  left  temporal  by  conoidal  ball.  Armory  Square  Hospital,  Washington.  Removal  of  spicula;,  and  ligation  of 
temi^oral  arteiy,  June  3d.  Death,  June  5th,  1864. 

In  four  instances,  the  bleeding  was  from  vessels  within  the  skull ; in  two,  from  the 
temporal  artery  or  its  branches ; in  one,  from  the  jugular  vein.  In  two  of  the  cases  of 
intracranial  bleeding,  solutions  of  persulphate  of  iron  on  dossils  of  lint  were  employed. 
In  the  case  of  rupture  of  the  middle  meningeal  artery.  Surgeon  E.  Bentley,  U.  S.  V., 
resorted  to  the  extreme  measure  pf  ligating  the  common  carotid  artery.  The  hsemorrhage 
did  not  recur;  but  the  patient  succumbed  on  the  thirteenth  day,  after  a series  of  chills  and 
other  phenomena  of  pysemic  infection.  In  the  case  of  Aberneathy,^  paraplegic,  treated 
by  Dr.  J.  S.  Davis,  of  the  University  of  Virginia,  the  temperature  was  observed,  and 
found  lowered  on  the  side  opposite  the  injury.  In  three  of  the  seven  cases,  balls,  as  well 
as  bone  splinters,  were  removed.  Surgeon  N.  R.  Moseley,  U.  S.  V.,  ascribed  the  almost 
instantaneous  death,  in  the  patient  with  hsemorrhage  from  the  jugular  vein,  to  the  entrance 
of  air  into  the  vessel,  which  was  found  largely  opened  by  ulceration. 

Gangrene. — Among  the  cases  of  this  category  were  three  of  sloughing  of  the  wound 
of  the  scalp  : 

Caley,  John,  Sergeant,  Co.  A,  11th  Tennessee  Cavaliy,  aged  51  years.  Nashville,  October  27th,  1864.  Penetrating 
fracture  of  parietal  by  pistol  ball,  during  an  affray.  Cumberland  Hospital.  Removal  of  fragments.  November  5th,  gangrene 
aj^peared.  Death,  November  7th,  1864. 

Shannon,  James  F.,  Captain,  Co.  C,  9th  Pennsylvania  Reserves,  aged  33  years.  Bull  Run,  August  29th,  1862. 
Gunshot  fracture  of  left  parietal.  Hospital  at  Georgetown,  D.  C.  September  7th,  removal  of  fragments  of  bone;  September 
10th,  gangrene ; September  12th,  death. 

Starr,  James  A.,  Corporal,  Co.  B,  18th  Indiana.  Gunshot  fracture  of  the  left  parietal.  Admitted  to  Hospital  No.  6, 
New  Albany,  Indiana,  October  7th,  1863.  Removal  of  fragment  of  bone.  December  20th,  gangrene  attacked  the  woimd. 
Death,  December  26th,  1863. 

Pyaemia. — This  complication  is  not  often  referred  to  in  the  notes  of  the  cases  of  this 
class,  though  doubtless  often  existing  unremarked.  The  all-pervading  malarial  element 
to  which  our  sick  and  wounded  were  continuously  exposed,  while  modifying  the  symptoms 
of  many  diseases,  served  yet  more  remarkably  to  mask  the  phenomena  resulting  from 
traumatic  affections.  And  this  was  especially  true  in  regard  to  pyaemia.  The  most  skilled 
observers  were  frequently  at  a loss,  whether  to  regard  a chill  occurring  in  a wounded  man, 
as  the  result  of  the  malaria  of  the  locality,  or  the  premonition  of  pus  formation.  In  a 
great  number  of  cases  time  or  opportunity  for  autopsy  were  lacking. 

Bristol,  L.  T.,  Corporal,  Co.  G,  37th  Wisconsin,  aged  25  years.  Petersburg,  July  30th,  1864.  Fracture  and  depression 
of  occipital  by  conoidal  ball.  Field  and  New  York  hospitals.  Removal  of  fragments  of  bone.  August  11th,  pyaemia  developed. 
Died  August  14th,  1864. 

ChrisJiolm,  Neal  Jf.,  Private,  Co.  H,  17th  Alabama  Regiment,  aged  38  years.  Atlanta,  July  20th,  1864.  Fracture  of 
frontal  by  conoidal  ball.  Nashville  hospitals.  Removal  of  fragments  of  bone,  September  5th.  October  6th,  pyaemia  supervened, 
resulting  in  death,  October  12th,  1864. 

Abscess. — Formations  of  pus  between  the  skull  and  membranes,  and  within  the  brain 
tissue,  were  not  uncommon. 

Archel,  Moses,  Private,  22d  U.  S.  Colored  Troops,  aged  28  years.  Petersburg,  June  15th,  1864.  Fracture  of  frontal 
l>y  conoidal  ball.  Field  and  Balfour  hospitals.  Removal  of  fragments  at  various  times.  Died  August  11th,  1864,  from  pressure 
on  brain  produced  by  pus  accumulated  beneath  the  skull. 

* For  a full  account  of  this  case,  see  Confederate  States  Medical  and  Surgical  Journal.  Vol.  I,  page  42.  Mareh,  1864. 


EEMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


257 


Haydon,  Michael,  Private,  Co.  D,  Cth  Wisconsin.  Gettysburg,  July  1st,  18G3.  Fracture  of  loft  side  of  frontal  bone 
by  colloidal  ball.  Camp  Letterman  and  York  hospitals.  Removal  of  fragments.  Epileptic  convulsions  July25lli.  Death, 
August  5th,  1863.  Autopsy  revealed  a large  abscess  under  pia  mater. 

Parker,  Louis,  Private,  Co.  K,  43d  New  York,  aged  32  years.  Fredericksburg,  December  13th,  1862.  Fracture  of 
occipital  by  conoidal  ball.  Third  division  hospital,  Alexandria.  Removal  of  several  fragments.  Died  January  13th,  1863. 
Autopsy  revealed  two  ounces  of  grayish  pus  between  dura  mater  and  cerebellum. 

P , Dominick,  Private,  Co.  K,  10th  New  York.  Fredericksburg,  December  13th,  1862.  Depressed  fracture 

of  occipital  by  conoidal  ball.  Field  and  Georgetown  hospitals.  Several  fragments  of  bone  removed.  Death,  December  31st, 

1862.  Autopsy  revealed  subarachnoid  effusion  of  blood  and  softening  of  posterior  lobe  of  brain.  Viscera  inflamed.  The 

pathological  specimen  is  No.  865,  Sect.  I,  A.  M.  M.,  a segment  of  cranium,  with  depression  of  fragments.  Contributed  by 
Brigade  Surgeon  John  L.  Le  Conte,  U.  S.  V.  _ 

Turney,  Richard  L.,  Private,  Co.  E,  2d  Pennsylvania,  aged  23  years.  Petersburg,  August  3d,  1864.  Fracture  and 
depression  of  right  parietal  by  shell.  Field  and  Fort  Monroe  hospitals.  Removal  of  pieces  of  depressed  bone  August  9th. 
Died  August  10th,  1864,  from  compression  of  the  brain  by  pus  beneath  the  dura  mater. 

Dunham,  George  W.,  Private,  Co.  E,  9th  New  York  Heavy  Artillery.  Cold  Harbor,  June  1st,  1864.  Penetrating 
fracture  of  left  parietal  by  conoidal  ball.  Corps  and  Fairfax  Seminary  hospitals.  Removal  of  fragments.  Died  June  11th, 
1864,  from  abscess  formed  in  the  brain. 

Unknown.  Gunshot  fracture  of  left  temporal.  Lincoln  Hospital,  Washington,  April  8th,  1865.  Removal  of  fragments 
April  10th.  Died  April  12th,  1865.  Autopsy  showed  a large  abscess  involving  nearly  the  entire  left  side  of  cerebrum. 

Worley,  William,  Private,  Danville  Artillery,  aged  22  years.  Petersburg,  April  1st,  1865.  Penetrating  fracture  of 
parietal  by  conoidal  baU.  Lincoln  Hospital,  Washington.  Removal  of  fragments  April  18th.  Death,  April  23d,  1865.  Autopsy 
revealed  an  abscess  in  upper  portion  of  brain. 

Encephalitis. — Of  course  nearly  all  the  fatal  cases  might  come  under  this  heading, 
but  a few,  undistinguished  by  special  complications,  are  placed  here  : 

Quine,  John,  Private,  Co.  G,  12th  Illinois.  Allatoona,  Georgia,  October  5th,  1864.  Fracture  of  fi-ontal,  left  side,  by 
conoidal  ball.  Left  eye  destroyed.  Corps  hospital.  Removal  of  fragments  and  some  brain  substance.  Meningitis.  Died 
October  13th,  1864. 

Smith,  John  E.,  Private,  Co.  D,  16th  Indiana.  Arkansas  Post,  January  11th,  1863.  Fracture  of  left  parietal  by 
grape-shot.  Dura  mater  not  injured.  Adams  Hospital,  Memphis.  Removal  of  depressed  bone.  Inflammation  of  meninges. 
Died  February  8th,  1863. 

Howeth,  John,  Lieutenant,  Co.  C,  6th  New  Jersey.  Chancellorsville,  M.ay  3d,  1863.  Fracture  of  fi-ontal  by  conoidal 
ball.  Removal  of  ball  and  fragments.  Aloysius  Hospital,  Washington,  May  13tli.  Traumatic  encephalitis.  Died  May  14th, 

1863. 

Louderbeck,  George,  Private,  Co.  B,  4th  Ohio,  aged  27  years.  Ream’s  Station,  August  25th,  1864.  Depressed  fracture 
of  frontal  bone  by  conoidal  ball.  Corps  and  Emory  hospitals.  Elevation  and  removal  of  spicula)  August  31st.  Died  September 
3d,  1864,  of  phreuitis. 

Taylor,  J.,  Private,  Co.  C,  5th  North  Carolina  Regiment,  aged  23  years.  Winchester,  September  19th,  1864.  Fracture 
of  cranium  by  conoidal  ball.  Depot  hospital  at  Winchester.  Removal  of  fragments.  Died  September  21st,  1864,  from  cerebritis. 

Thompson,  William,  Private,  Co.  E,  10th  Massachusetts,  aged  41  years.  Spottsylvania,  May  12th,  1864.  Fracture 
of  frontal  by  conoidal  ball.  Corps  and  Emory  hospitals.  Removal  of  baU  and  fragment  of  bone  May  18th.  Inflammation  of 
brain.  Died  May  30th,  1864. 

The  two  following  cases  illustrate  the  danger  of  cerebral  inflammation  at  periods 
remote  from  the  reception  of  the  injury  : 

Young,  George  J.,  Corporal,  Co.  D,  29th  Ohio,  aged  20  years.  Pine  Knob,  Georgia,  June  15th,  1864.  Fracture  of 
frontal  by  conoidal  ball.  Field,  Nashville,  and  Columbus  hospitals.  Removal  of  fragment  of  bone.  Inflammation  of  brain. 
Died  June  13th,  1865. 

B , Hugh,  Corporal,  Co.  I,  2d  U.  S.  Infantry,  aged  33  years.  Gettysburg,  July  2,  1863.  Fracture  of  frontal  and 

zygomatic  process  of  malar  bone  by  conoidal  ball.  Left  eye  destroyed.  Gettysburg  and  York  hospitals.  Removal  of  several 
fragments.  Died  February  6th,  1864,  from  inflammation  of  brain,  the-result  of  a debauch. 

Missiles  lodged. — The  nine  following  cases  present  examples  of  the  lodgment  of 
projectiles  in  the  brain  tissue  : 

Atchinson,  Nathan,  Private,  Co.  F,  7th  Illinois.  Allatoona,  October  5th,  1864.  Penetrating  fracture  of  frontal, 
left  side,  by  conoidal  ball;  missile  lodged.  Field  hospital.  Removal  of  fragments;  loss  of  brain  substance.  Died  October 
10th,  1864. 

33 


258 


WOUNDS-  AND  INJUEIES  OF  THE  HEAD, 


Caulhh,  E.  T.,  Private,  Co.  I,  3d  New  Hampshire.  Fort  Darling,  May  15th,  1864.  Fracture  of  sphenoid  and  petrous 
portion  of  left  temporal  bone  by  conoidal  ball.  Field  and  I’oint  Lookout  hospitals,  lieinoval  of  fragments.  Died  May  22d, 
1864.  At  the  autopsy  a portion  of  the  missile  was  found  driven  deeply  into  the  brain  matter. 

Claek,  Henry,  Private,  Co.  B,  1st  New  Jersey,  aged  23  years.  Petersburg,  March  31st,  1865.  Fracture  of  right 
parietal  by  conoidal  musket  hall.  Field  and  Washington  hospitals.  Removal  of  fragments.  Died  April  13th,  1865.  The 
autopsy  revealed  the  ball  in  the  middle  lobe  of  the  brain. 

George,  John,  Corporal,  Co.  I,  51st  Pennsylvania,  aged  26  years.  Petersburg,  July  30th,  1864.  Penetrating  fracture 
of  frontal  by  conoidal  hall.  Treated  in  field  hospital.  Fragments  of  hone  removed ; missile  remained  in  the  wound.  Died 
August  8th,  1864. 

JOURDON,  W.,  Co.  F,  1st  United  States  Sharpshooters.  Chickahominy,  June  28th,  1862.  Fracture  of  right  parietal  by 
conoidal  musket  ball.  The  greater  part  of  the  missile  passed  into  the  brain  substance.  Field  and  Annapolis  hospitals.  Removal 
of  fragments.  Died  August  12th,  1862. 

Krieger,  FRjVNCIS,  Private,  Co.  II,  110th  Ohio  Volunteers,  aged  20  years.  Monocacy,  July  9th,  1884.  Penetrating 
fracture  of  left  parietal ; missile  lodged  in  the  substance  of  the  brain.  Frederick  hospital.  Removal  of  several  depressed 
fragments  of  bone.  Died  July  12th,  1834. 

UNKNOtVN,  admitted  to  Lincoln  Hospital,  Washington,  April  8th,  1865.  Gunshot  penetrating  wound  of  left  parietal ; 
missile  lodged  in  the  brain  substance.  Removal  of  depressed  fragments  of  bone  April  9th.  Died  April  10th,  1865. 

Williams,  CiIjARLES  P.,  Lieutenant,  Co.  F,  24th  New  York  Cavalry.  Sailor’s  Creek,  Virginia,  April  Gth,  1865. 
Penetrating  fracture  of  cranium ; missile  lodged  in  the  brain  substance.  Field  hospital.  Removal  of  portion  of  bone.  Death, 
April  10th,  1835. 

Henry,  Charles,  Private,  Co.  F,  26th  Pennsylvania,  aged  38  years.  Mine  Run,  November  27th,  1863.  Gunshot 
fracture  of  frontal  by  conoidal  hall.  Field  and  Alexandria  hospitals.  Removal  of  ball  and  fragments  December  4th.  Died 
December  6th,  1883. 

Next  is  a misplaced  case  of  intracranial  extravasation  : 

Hawkins,  William  C.,  Private,  Co.  C,  11th  Vermont,  aged  18  years.  Petersburg,  June  24th,  1864.  Gunshot  wound 
of  the  occipital  bone.  Field  and  New  York  hospitals.  Removal  of  portion  of  bone.  Died  July  14th,  1864,  from  cerebral 
apoplex}'.^ 

Deaths  from  inter  current  Diseases. — Three  have  been  so  classified; 

Burke,  Andrew,  Pi-ivate,  Co.  E,  47th  Pennsylvania,  aged  23  years.  Cedar  Creek,  October  19th,  1864.  Fracture  of 
orbital  bones,  and  lower  third  of  right  humerus,  by  conoidal  halls.  Field,  Winchester,  and  Frederick  hospitals.  Removal  of 
hone  from  cranium,  December  13th,  1834.  Died  December  23tl,  1834,  from  phthisis  pulmonalis., 

Dewel,  Asa,  Private,  Co.  11,  109lh  New  Yoi-k,  aged  27  years.  Petersburg,  July  9th,  1864.  Depressed  fracture  of 
parietal  by  conoidal  ball.  Corps  and  New  York  hospitals.  Removal  of  fragments  of  bone.  Died  August  10th,  1834,  from 
chronic  diarrhoea. 

W , William,  M.,  Private,  Co.  1, 19th  Georgia  Regiment.  Fredericksburg,  December  13th,  1862.  Fracture  of  frontal 

and  right  parietal  bones  by  a buckshot.  Washington  hospitals.  Removal  of  fragments.  Died  March  1st,  1863,  of  pneumonia. 
The  pathological  specimen  is  No.  991,  Sect.  I,  A.  M.  M.  Probably  a case  of  metastic  foci. 

In  many  cases,  the  proximate  cause  of  death  was  not  distinctly  stated  : 

Arnold,  Edwin,  Private,  Co.  F,  2d  Michigan.  Petersburg,  June  28th  ,1864.  Fracture  of  cranium  by  conoidal  hall. 
Corps  hospital.  Removal  of  spiculse.  Died  June  29th,  1864. 

Bremer,  Ludwig,  Private,  Co.  C,  45th  Pennsylvania,  aged  45  years.  Petersburg,  April  2d,  1865.  Fracture  of  right 
parietal  by  conoidal  ball.  Corps  and  Washington  hospitals.  Removal  of  fragments  of  depressed  hone,  April  8th.  Death, 
April  12th,  1865. 

Burns,  John,  Private,  Co.  A,  45th  New  York.  Gettysburg,  July  2d,  1863.  Fracture  of  cranium  by  conoidal  ball. 
Regimental  hospital.  Removal  of  bone.  Death,  July  13th,  1863. 

Bolster,  George,  Private,  Co.  G,  2d  New  York  Cavalry.  Five  Forks,  April  1st,  1865.  Fracture  of  cranium  by  piece 
of  shell.  Regimental  and  corps  hospitals.  Removal  of  fragments,  April  3d.  Death,  April  17th,  1865. 

Bradford,  P.  C.,  Private,  Co.  I,  10th  Texas.  Atlanta,  July  20th,  1864.  Penetrating  fracture  of  cranium  by  conoidal 
ball.  Confederate  and  corps  hospitals.  Removal  of  bone.  Death,  December  28th,  1864. 

Boen,  Nicholas,  Private,  Co.  G,  110th  New  York.  Vermillion ville,  November  12th,  1863.  Fracture  of  right  parietal 
by  fr.agment  of  shell.  Corps  hospital.  Elevation  and  removal  of  bone.  Death,  December  12th,  1863. 

Brown,  Herman,  1‘rivate,  Co.  C,  5th  Wisconsin,  aged  32  years.  Fort  Steadman,  April  2d,  1865.  Fracture  of  left 
parietal,  posterior  portion  of  temporal,  and  inferior  portion  of  occipital,  by  a conoidal  ball.  Corps  and  Alexandria  hospitals. 
Removal  of  portions  of  loft  parietal.  Death,  April  8th,  1865. 

* This  case  should  have  foUo-vved  that  of  Reed,  on  page  247. 


KEMOVAL  OF  FRAGMENTS  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL.  259 

Blanford,  Josiah,  Private,  Co.  D,  24th  New  York  Cavalry.  Petersburg,  July  1st,  1864.  Fracture  of  parietal  by 
musket  ball.  Field  hospital.  Removal  of  fragments.  Death,  July  3d,  1864.  • 

Call,  John  H.,  Private,  Co.  F,  14th  New  York.  Petersburg,  July  30th,  1864.  Fracture  of  occipital  by  solid  shot. 
Corps,  City  Point,  and  New  York  hospitals.  Removal  of  spiculae,  August  29th.  Death,  November  19th,  1864. 

Clark,  Solomon,  Private,  Co.  H,  25th  Iowa.  Dallas,  May  28th,  1864.  Perforating  fracture  of  cranium  by  conoidal 
ball.  Corps  hospital.  Removal  of  spiculae.  Death,  June  1st,  1864. 

Colored  Cook  of  the  109th  New  York.  Petersburg,  July  10th,  1864.  Fracture  of  the  parietal  and  penetration  of  the 
cerebnim  by  a gunshot  missile.  Corps  hospital.  Removal  of  fragments  of  bone.  Death,  July  10th,  1864. 

Dunbar,  Sajiuf,l,  Private,  Co.  H,  102d  Pennsylvania,  aged  36  years.  Cedar  Creek,  October  19th,  1864.  Fracture  of 
the  left  parietal  by  conoidal  ball.  Philadelphia  and  Baltimore  hospitals.  Removal  of  spiculm  of  bone  one-half  and  three-fourths 
of  inch.  Paralysis.  Died  after  discharge,  February  22d,  1866. 

Duke,  J.,  Private,  Co.  K,  9th  Georgia.  Darbytown,  August  16th,  1864.  Fracture  of  the  right  temporal  and  the  frontal 
by  a conoidal  ball.  Richmond  hospitals.  Removal  of  spicula3  of  bone.  Death,  August  22d,  1864. 

Donway,  S.,  Private,  Co.  A,  Palmetto  Sharpshooters.  Fort  Harrison,  September  29th,  1864.  Extensive  fracture  of  the 
frontal  by  conoidal  ball.  Richmond  hospital.  Removal  of  spiculm  of  bone  October  2d.  Death,  October  6th,  1864. 

Ewell,  William  D.,  Sergeant,  Co.  C,  38th  Massachusetts,  aged  38  years.  Cedar  Creek,  October  19th,  1864.  Com- 
pound comminuted  fracture  of  cranium  by  conoidal  ball.  Corps  hospital.  Removal  of  depressed  bone.  Death,  November 
2d,  1884. 

Eggert,  Solomon  F.,  Private,  Co  I,  2d  New  York  Rifles.  Petersburg,  June  20th,  1864.  Gunshot  fracture  of  cranium. 
Corps  hospital.  Removal  of  spiculae  of  bone.  Death,  July  1st,  1864. 

Eddy,  Henry  M.,  Captain,  Co.  D,  114th  Pennsylvania.  Five  Forks,  April  2d,  1865.  Fracture  of  occipital.  Regi- 
mental and  City  Point  hospitals.  Removal  of  loose  pieces  of  bone  on  day  of  injury.  Death,  April  11th,  1865. 

Foster,  James  F.,  Private,  Co.  D,  100th  Pennsylvania.  Petersburg,  October  2d,  1864.  Fracture  of  right  parietal  by  a 
musket  ball.  Corps  hospital.  Removal  of  spiculae  and  elevation  of  the  depressed  parts  October  2d.  Death,  October  4th,  1864. 

Farrell,  John  W.,  Private,  Co.  E,  87th  Indiana,  aged  23  years.  Chickamauga,  September  20th,  1863.  Fracture  of 
left  parietal  by  conoidal  ball.  Chattanooga  hospital.  Removal  of  loose  pieces  of  bone  October  1st.  Death,  October  12th,  1863. 

Galbraith,  Hugh,  Corporal,  Co.  G,  56th  New  York,  aged  23  years.  Honey  Hill,  November  30th,  1864.  Fracture  of  left 
parietal  by  conoidal  ball.  Hilton  Head  hospital.  Removal  of  fragments  of  bone  December  1st.  Death,  December  1st,  1864. 

Horan,  Michael,  Private,  Co.  H,  10th  Michigan,  aged  39  years.  Petersburg,  June  10th,  1864.  Fracture  of  left 
inirietal  by  conoidal  ball.  Field  and  Washington  hospitals.  Removal  of  loose  bone  fragments  and  elevation  of  bone  July  2d. 
Death,  July  7th,  1804. 

Hall,  Myron,  Private,  Co.  K,  8th  Illinois  Cavalry.  Muddy  Run,  Virginia,  November  8th,  1863.  Fracture  of  the 
cr.anium  by  conoidal  ball.  Coi’ps  hospital.  Removal  of  fragments  of  bone.  Death,  November  10th,  1863. 

H^vnnowdell,  W.  H.,  Private,  Co.  E,  2d  Pennsylvania  Heavy  Artillery.  Petersburg,  August  19th,  1864.  Fracture 
of  file  frontal,  left  side,  by  a conoidal  ball.  Corps  and  Alexandria  hospitals.  Removal  of  spiculm.  Death,  August  ftOth,  1864. 

Howard,  O.,  Private,  Co.  F,  36th  Massachusetts.  Jackson,  July  22d,  1863.  Fracture  of  the  cranium  at  the  junction  of 
parietal  and  occipital  by  conoidal  ball.  Corps,  regimental,  and  Cincinnati  hospitals.  Removal  of  one  square  inch  of  skull  July 
22d.  Death,  September  22d,  1863. 

Hunt,  Paul  S.,  Private,  Co.  D,  57th  Indiana.  Dallas,  May  27th,  1864.  Gunshot  fracture  of  the  left  parietal.  Corps 
hospital.  Removal  of  a piece  of  bone  May  27th.  Death,  June  4th,  1864.  ^ 

Keller,  Conrad,  Private,  Co.  M,  6th  New  York  Cavalry.  Trevillian  Station,  Juno  11th,  1864.  Gunshot  fracture  of  the 
skull.  Corps  hospital.  Removal  of  fragments  of  bone.  Died  June  14th,  1864. 

Knightlinger,  George  W.,  Private,  Co.  F,  8th  Michigan.  Petersburg,  July  26th,  1864.  Fracture  and  depression 
of  the  cranium  by  a piece  of  shell.  Corps  and  field  hospitals.  Removal  of  spiculm  and  elevation  of  bone  J uly  26th.  Death, 
December  13th,  1864. 

Land,  Lewis  J.,  Lieutenant,  Co.  B,  11th  Hlinois,  aged  28  years.  Fort  McAllister,  December  13th,  1864.  Fracture  of 
the  left  parietal  by  conoidal  ball.  Corjis  and  Beaufort  hospitals.  Removal  of  spiculm  from  the  brain  December  27th.  Death, 
January  4th,  1865. 

Lottz,  Philip,  Private,  Co.  H,  55th  New  York,  aged  24  years.  Williamsburg,  May  5th,  1862.  Fracture  of  the  left 
parietal  by  musket  ball.  Baltimore  and  New  York  hospitals.  Removal  of  fragments  of  bone  May  19th.  Death,  May  21st,  1862. 

Martin,  Edward,  Private,  Co.  D,  5th  Wisconsin.  Petersburg,  March  25th,  1865.  Fracture  and  penetration  of  the 
cranium  by  a piece  of  shell.  Corps  and  field  hospitals.  Removal  of  several  spiculae  from  the  left  parietal  bone  March  25tli. 
Death,  M.arch  27th,  1865. 

McGee,  George  F.,  Sergeant  Major,  2d  Michigan.  Petersburg,  April  2d,  1865.  Fracture  and  depi-ession  of  cranium  by 
a conoidal  ball.  Corps  ho.spital.  Removal  of  ball  and  spiculae  of  bone.  Death,  April  10th,  1865. 


260 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


McColley,  Patiuck,  Private,  Co.  E,  Gtli  New  Hampshire.  North  Anna,  May  18th,  1864.  Fracture  of  cranium  by  a 
colloidal  ball.  Corps  hospital.  Eemoval  of  pieces  of  bone.  Died  May  18th,  1864. 

McLaughlin,  George,  Private,  Co.  A,  ‘20th  Connecticut.  Atlanta,  August  20th,  1864.  Gunshot  fracture  of  squamous 
portion  of  left  temporal  bone.  Corps  hospital.  Removal  of  fragments  of  bone.  Died  Angust  28th,  1864. 

Maeston,  John,  Private,  Co.  D,  14th  New  York  Heavy  Artillery.  Fort  Steadman,  March  25th,  1865.  Fracture  of 
cranium  by  conoidal  ball.  Coi-ps  hospital.  Eemoval  of  spiculm  of  bone  March  25th.  Died  March  27th,  1865. 

Mykick,  Cromwell,  Sergeant,  Co.  B,  .4th  Ehode  Island.  Petersburg,  July  15th,  1864.  Fracture  of  cranium  by  a 
conoidal  ball.  Corps  hospital.  Removal  of  pieces  of  bone.  Death,  July  20th,  1864. 

Mills,  Fessendon  M.,  Private,  Co.  C,  17th  Maine.  Gettysburg,  July  2d,  1863.  Fracture  of  cranium  and  injury  of 
brain  by  a conoidal  ball.  Corps  hospital.  Eemoval  of  several  spiculm.  Death,  July  2d,  1863. 

McNealy,  James  a..  Private,  Co.  A,  20th  Maine.  Fredericksburg,  December  13th,  1862.  Gunshot  fracture  of  cranium. 
Corps  hospital.  Eemoval  of  spiculai  of  bone.  Death,  December  19th,  1862. 

Nortiiway,  Clement  L.,  Private,  Co.  A,  22d  Wisconsin.  Atlanta,  July  23d,  1864.  Gunshot  fracture  of  frontal  and 
penetration  of  the  dura  mater.  C orps  hospital.  Eemoval  of  fragments  of  bone.  Died  August  1st,  1864. 

Pejibroke,  Charles  P.,  Private,  Co.  D,  7th  Maine,  aged  20  years.  Wilderness,  May  6th,  1864.  Gunshot  fracture  of 
skull.  Corps  hospital.  Eemoval  of  depressed  bone.  Death,  May  6th,  1864. 

Rand,  Irwin  W.,  Sergeant,  Co.  H,  Gth  New  Hampshire.  Petersburg,  July  30th,  1864.  Gunshot  penetrating  wound  of 
cranium.  Corps  hospital.  Eemoval  of  pieces  of  both  tables.  Died  August  2d,  1864. 

Olinger,  Anthony',  Private,  Co.  A,  ICOth  Indiana.  Jonesboro’,  September  1st,  1864.  Fracture  of  right  parietal. 
Corps  hospital.  Eemoval  of  fragments  of  bone.  Died  September  21st,  1864. 

Q , J.,  Confederate.  Chancellorsville,  May  3d,  1863.  Fracture  of  parietal  by  conoidal  ball.  Richmond  hospital. 

Eemoval  of  eight  pieces  of  bone  May  10th.  Paralysis.  Death,  May  19th,  1863. 

Eees,  Charles  L.,  Private,  Co.  K,  95th  Pennsylvania,  aged  20  years.  Spottsylvania,  May  12th,  1864.  Fracture  of 
both  tables  of  fi’ontal  by  shell.  Corps  and  Washmgton  hospitals.  Eemoval  of  fragments  of  bone.  Death,  May  2Gth,  1864. 

Robertson,  William,  Private,  Co.  D,  7th  Michigan.  Winchester,  September  19th,  1864.  Gunshot  fracture  of  the 
left  parietal.  Corps  hospital.  Removal  of  several  spiculm  and  elevation  of  depressed  bone.  Death,  September  23d,  1864. 

Russell,  Henry,  Private,  Co.  D,  3Gth  Massachusetts.  Petersburg,  August  8th,  1864.  Gunshot  fracture  of  cranium. 
Corps  hospital.  Eemoval  of  spiculm  of  bone.  Death,  August  10th,  1864. 

Rutledge,  Charles,  Private,  Co.  B,  2d  Illinois  Artillery,  aged  19  years.  Accidentally,  March  19th,  1864.  Fracture 
of  the  right  parietal  by  conoidal  ball ; fragments  of  bone  removed  on  the  same  day.  Memphis  hospital.  Death,  March  21st, 
1864. 

Sachs,  Martin,  Private,  Co.  F,  147th  Pennsylvania,  aged  24  years.  December  21st,  1864.  Fracture  of  cranium  by 
shell.  Coi-ps  hospital.  Eemoval  of  fragments  of  bone.  Death,  December  22d,  1864. 

SiiEARD,  Eli,  Private,  Co.  K,  31st  Wisconsin.  Smithfield,  March  19th,  1865.  Gunshot  fracture  of  the  cranium,  with 
depression.  Corps  hospital.  Removal  and  elevation  of  the  depressed  pieces  of  bone.  Death,  March  26th,  1865. 

Smith,  George,  Private,  Co.  I,  51st  New  York.  North  Anna,  May  18th,  1864.  Fracture  of  cranium  by  a conoidal 
ball.  Coips  hospital.  Removal  of  spiculm  of  bone.  Death,  May  24th,  1864. 

Smith,  H.  A.  F.,  Private,  Co.  E,  12th  Massachusetts,  aged  25  years.  Petersburg,  June  18th,  1864.  Fracture  of  cranium 
by  a shell.  Regimental  and  corps  hospitals.  Fractured  pieces  were  elevated  and  removed.  Death,  June  25th,  1884. 

Spencer,  Edyvin  D.,  Private,  Co.  E,  50th  Pennsylvania.  Spottsylvania,  May  9th,  1864.  Gunshot  fracture,  with  de- 
pression of  the  left  parietal.  Corps  hospital.  Protruding  brain  tissue  and  also  seven  pieces  of  bone  were  removed.  Paralysis. 
Death,  May  9th,  1864. 

Scroggins,  Robert,  Private,  Co.  D,  7th  Indiana  Cavalry.  Colliersville,  Tennessee,  April  4th,  1865.  Fracture  of  left 
parietal  by  conoidal  ball.  Adams  Hospital,  Memphis.  Removal  of  fragments  of  bone.  Died  April  14th,  1865. 

Snyder,  F.,  Private,  Co.  E,  110th  Ohio,  aged  43  years.  Monocacy  Junction,  July  9th,  1864.  Fracture  of  the  cranium, 
with  slight  depression  by  conoidal  ball.  Frederick  hospital.  Eemoval  of  spiculm  of  bone.  Died  after  discharge  from  service, 
March  7th,  1886. 

Taler,  Calvin  C.,  Private,  Co.  G,  56th  North  Carolina,  aged  23  years.  Petersburg,  March  27th,  1865.  IVacture  of  both 
tables  of  the  frontal  by  conoidal  ball.  Corps  and  Washington  hospitals.  Removal  of  depressed  fragments  of  bone  April  11th. 
Death,  April  16th,  1865. 

Thomas,  William,  Private,  Co.  G,  12th  Indiana.  Atlanta,  August  14th,  1884.  Fracture  of  the  right  parietal  by  conoidal 
ball.  Eemoval  of  spiculm  of  bone.  Death,  August  15th,  1864. 

Tracey,  Aaron,  Private,  Co.  K,  31st  Maine.  Petersburg,  June  17th,  1834.  Fracture  of  the  cranium  by  conoidal  ball. 
Coi-ps  hospital.  Several  pieces  of  bone  wore  remov’od.  Died  June  17th,  1864. 

Unknown.  Monocacy  Jimction,  .July  9th,  1834.  Fracture  and  depression  of  the  cranium.  Frederick  hospital.  Re- 
moved of  the  deiiressed  IVagmeuts  July  10th.  Death,  July  12th,  1864. 


TREPHINING  AFTER  GUNSHOT  FRACTURES  .OF  THE  SKULL. 


261 


Upton,  George  E.,  Lieutenant,  Co.  F,  6th  New  Hampshire.  Petersburg,  July  30th,  1864.  Fracture  of  the  cranium  hy 
conoidal  hall.  Corps  hospital.  Removal  of  pieces  of  bone.  Death,  July  31st,  1864. 

Van  Dockkum,  Alexander,  Corporal,  Co.  A,  19th  U.  S.  Infantry.  Shiloh,  April  6th,  1862.  Fracture  of  the  left 
parietal.  Louisville  hospital.  Removal  of  loose  pieces  of  bone,  April  18th.  Death,  April  20th,  1862. 

Watson,  John,  Private,  Co.  I,  5th  New  Hampshire,  aged  21  years.  Fort  Steadman,  March  25th,  1865.  Fracture  of 
frontal  by  a conoidal  ball.  Corps  and  Washington  hospitals.  Removal  of  several  small  spiculte  of  depressed  bone  and  the  ball. 
Death,  May  3d,  1865. 

WakefhiLD,  William  W.,  Private,  Co.  H,  2d  Delaware.  Chancellorsville,  May  3d,  1863.  Comminuted  fracture  of  the 
external  and  depression  of  the  internal  table  of  the  frontal  bone  by  a fragment  of  shell.  Corps  hospital.  Removal  of  a portion 
of  the  external  table,  nearly  an  inch  in  diameter.  May  7th.  Death,  May  13th,  1833. 

WAT:pEBURY,  Peter  L.,  Lieutenant,  Co.  A,  143d  New  York.  Peach  Tree  Creek,  July  20th,  1864.  Gunshot  fracture  of 
the  cranium,  with  depression.  Corps  hospital.  Removal  of  depressed  bone.  Death,  July  24th,  1864. 

Whitmore,  George  D.,  Private,  Co.  F,  37th  Massachusetts,  aged  25  years.  Weldon  Railroad,  April  2, 1865.  Fracture 
of  temporal  and  parietal  by  a conoidal  ball.  Corps  and  Washington  hospitals.  Removal  of  several  fi-agments  of  bone  April  14th. 
Died  on  the  same  day. 

Wilber,  E.  A.,  Private,  Co.  I,  50th  Pennsylvania.  Petersburg,  October  27th,  1864.  Fracture  of  the  left  parietal.  Corps 
hospital.  Bone  elevated.  Died  while  on  the  way  to  a general  hospital. 

In  the  preceding  forty-five  pages,  three  hundred  and  eighty-five  instances  of  removal 
of  fragments  of  the  skull,  after  gunshot  fracture,  have  been  enumerated.  One  hundred  and 
forty-five  of  these  patients  died,  a mortality  rate  of  37.6  only.  Four-fifths  of  the  two 
hundred  and  forty  patients  included  in  the  lists  of  recovery  were  disabled. 

Trephining  after  Gunshot  Fractures  of  the  Skull. — The  determination  of  the 
conditions  under  which  operative  interference  is  likely  to  be  of  value,  after  gunshot  injuries 
of  the  head,  is  of  such  great  importance  that  I shall  record  all  the  facts  relating  to  the 
subject  that  have  been  reported,  and  detail  all  the  accounts  of  formal  operations  for  trephin- 
ing performed  during  the  war  that  I have  been  enabled  to  collect. 

The  following  cases  of  gunshot  fracture  of  the  skull,  in  which  trephining  was  practiced, 
had  a fatal  termination  : 

Case. — Private  Curtis  Brown,  Co.  K,  13th  New  Jersey  Volunteers,  was  wounded  at  the  battle  of  Antietam,  Maryland, 
September  17th,  1862,  by  a buckshot,  which  fractured  and  depressed  the  frontal  bone,  right  side,  a little  above  the  frontal 
eminence.  He  was  admitted  into  hospital  No.  1,  Frederick,  Maryland,  on  the  23d,  and  thence  transferred  to  the  Satterlee 
Hospital,  Philadelphia,  Pennsylvania,  on  the  27  th.  The  case  was  treated  as  a scalp  wound  until  the  22d  of  February,  when  convul- 
sions supervened.  On  the  following  day.  Acting  Assistant  Surgeon  D.  Kennedy  made  a crucial  incision  one  and  a half  inches  in 
length  near  the  tenninus  of  the  frontal  sinus,  applied  the  trephine,  and  removed  a button  of  bone,  and  the  missile,  which  was 
firmly  imbedded  in  the  diploic  structure;  also  the  loose  fragments  of  the  inner  table.  No  anmsthetic  was  used.  After  the 
operation  the  flaps  were  brought  into  apposition  with  the  silver  sutures,  a portion  of  the  longitudinal  incision  being  left  open. 
Cold  water  dressings  were  applied  to  the  head,  and  quiet  enjoined.  The  patient  rested  well  during  the  night  of  the  23d  without 
the  use  of  an  anodyne,  and  on  the  following  morning  sufiered  but  little  pain;  the  pupils  were  normal,  and  responded  readily  to 
light;  his  appetite  was  good,  but  the  pulse  rather  small  and  frequent.  On  the  morning  of  the  25th,  he  seemed  to  be  more  stupid, 
and  the  pupUs  were  less  responsive,  but  the  pulse  was  the  same.  The  bowels  being  costive,  an  injection  of  warm  castile  soap 
suds  and  ol.  ricini  was  administered.  On  the  26th,  he  suffered  a gi’eat  deal  of  pain  in  his  head,  and  seemed  indisposed  to  talk; 
the  pupils  failed  to  respond  to  light.  The  wound  had  no  inflammatory  symptoms,  but  was  suppurating  quite  freely.  On  the 
following  d.ay  there  was  less  pain;  the  wound  still  suppurated  quite  freely;  the  pulse  was  more  full  and  regular,  the  tongue 
slightly  furred,  and  the  appetite  improved.  Death  ensued  March  3d,  1863.  The  autopsy  revealed  the  aperture  made  by  the 
trephine  filled  with  granulations  springing  from  the  dura  mater.  A trilocular  abscess  occupied  the  upper  part  of  the  anterior 
lobe  of  the  right  hemisphere  contiguous  to  the  aperture  in  the  bone,  but  not  communicating  with  it,  nor  opening  through  the 
dura  mater.  It  contained  about  two  fluid  ounces  of  pus.  A portion  of  the  inner  surface  of  the  frontal  bone  in  the  vicinity  of 
the  abscess  had  been  removed  by  absorption.  The  medullary  substance  back  of  the  abscess,  from  above  the  middle  lobe  of  the 
cerebrum  to  a level  with  the  corpus  callosum,  was  softened  and  yellowish  from  the  development  of  pus.  Inflammation  of  the 
membranes  extended  a short  distance  back  of  the  abscess,  downward  fi’om  it,  and  at  the  side  of  the  longitudinal  fissure.  The 
specimens  were  contributed  by  Acting  Assistant  Surgeon  Joseph  Leidy,  and  are  numbered  1871  and  2219,  Sect.  I,  A.  M.  M. 
The  former  shows  the  vault  of  the  cranium,  from  which  a disk  has  been  removed  with  the  trephine;  two  small  fragments  of  the 
Inner  table  remain  attached,  slightly  depressed  at  their  free  edg(!S.  Caiies  and  exfoliation  of  the  superficial  lamella  exist 
externally;  internally,  the  entire  surface  of  the  frontal  and  the  anterior  half  of  the  right  parietal  show  traces  of  diseased  action, 
with  shght  ossific  deposit  around  the  edges  of  the  opening.  The  latter  specimen,  2219,  is  a wet  preparation  of  part  of  the  cerebrum, 
with  a small  abscess. 


262 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Flo.  133. — Depressed  gunshot  frac- 
ture of  the  right  parietal  bone,  Sj>ec. 
435(i,  Sect.  I,  A.  M.  M. 


Case. — Private  J B , Co.  D,  9tli  West  Virginia  Volunteers,  aged  18  years, 

was  wotinded  at  the  battle  of  Winchester,  Virginia,  July  20tli,  1804,  by  a musket  ball,  which 
fractured  and  depressed  the  right  parietal  bone,  near  its  posterior  superior  angle.  He  was 
admitted  into  the  General  Hospital  at  Cumberland,  Maryland,  on  July  23d.  During  the  night 
of  the  2Cth,  the  patient  had  two  convidsions  and  gradually  sank  into  a comatose  condition  until 
on  the  morning  of  the  27th,  he  was  entirely  insensible.  The  wound  of  scalp  was  discharging 
healthy  pus.  Surgeon  J.  B.  Lewis,  U.  S.  V.,  trephined  and  removed  the  depressed  portion  of 
bone,  giving  exit  to  about  an  ounce  of  bloody  pus.  A detached  fragment  of  the  inner  table, 
one  inch  square,  was  removed.  The  patient  did  not  rally  from  the  comatose  condition  and 
died,  on  the  29th,  from  softening  of  the  brain  and  extravasation  of  blood.  Fost-mortem  revealed 
a perforation  of  the  skull  at  the  angle  of  the  lambdoidal  suture  in  the  parietal,  which  consists  of 
one  bone  only  in  this  instance,  the  sagittal  suture  not  existing.  A fragment  of  the  inner  table, 
three-fourths  of  an  inch  in  length,  was  found  driven  into  the  brain.  Tli,e  pathological  specimen 
is  represented  by  the  cut.  The  disk  of  bone  removed  by  the  trephine  is  in,  situ  and  there  are  two 
radiating  fissures.  The  specimen  and  history  were  contributed  by  the  operator. 


Pig.  134. — Segment  of  frontal  bone,  carious  about 
the  aperture,  whence  fragments  have  been  removed. 
Spec.  3631,  Sect.  I,  A.  M.  M. 


Case. — Private  W.  M.  B , Co.  E,  83d  Pennsylvania  Volunteers, 

aged  20  years,  was  wounded  at  Petersburg,  Virginia,  June  20th,  18G4,  by  a 
conoidal  ball,  which  fractured  and  depressed  both  tables  of  the  frontal  bone  just 
below  the  fronto-pai’ietal  suture  and  to  the  left  of  the  median  line.  He  was 
immediately  admitted  to  the  1st  division.  Fifth  Corps,  hospital;  on  June  24th, 
sent  to  the  Mount  Pleasant  Hospital,  Washington,  and  thence,  on  the  27th, 
transferred  to  the  Satterlee  Hospital,  Philadelphia.  His  pulse  became  slow  and 
feeble,  and  on  July  14th,  his  condition  was  very  low.  A disk  of  bone,  one  and 
a half  inches  in  diameter,  was  removed,  exposing  the  meninges  of  the  brain. 
Pus  flowed  freely  from  the  opening.  The  wound  subsequently  became  gangrenous, 
and  death  ensued  on  July  26th,  1834.  The  post-mortem  examination  revealed  an 
abscess  in  the  left  anterior  lobe  of  the  brain,  with  pus  in  the  ventricles.  The 
pathological  specimen  is  figured  in  the  wood-cut.  The  opening  in  the  frontal  bone 
is  surrounded  by  a narrow  ring  of  porous  and  diseased  bone.  The  fractured  por- 
tion of  vitreous  table  measures  one  and  a half  by  two  inches.  Two  fr.agnients 
remain  in  situ  depressed  one  line.  These  fragments  are  covered  by  a thin,  granu- 
lar, mortar-like  layer  of  calcareous  matter.  The  specimen  was  contributed  by 
Acting  Assistant  Surgeon  G.  P.  Sargent. 


Case. — Private  L C , Co.  B,  2d  Pennsylvania  Reserves,  ^vas  wounded  at  Chantilly,  Virginia,  September  1st, 

1862,  by  a round  ball,  which  comminuted  and  depressed  the  right  parietal  bone,  two  inches  below  the  sagittal  suture.  He  became 
insensible  and  remained  so  for  about  fifteen  minutes,  when  he  recovered  and  walked  about.  He  was  admitted  to  the  Harewood 
Hospital,  Washington,  D.  C.,  on  the  4th,  having  full  power  over  his  limbs  and  a good  appetite.  Gradually  he  began  to  feel 
depressed,  then  confined  himself  to  his  bed,  and  finally,  on  the  7th,  was  seized  with  paraplegia.  On  the  evening  of  the  9th,  he 
had  become  unconscious.  A cathartic  was  administered,  which  operated  freely,  and  the  next  morning  the  patient  was  fully 
conscious  again  and  complained  of  pain  in  the  head.  At  five  o’clock  P.  M.,  of  the  following  day  he  was  unable  to  move,  and  his 
voice  thick  and  inarticulate.  His  left  side  was  nearly  insensible,  but  wann,  and  he  could  protrude  his  tongue  only  partially.  On 
examining  the  wound,  a depression  of  the  size  of  a twenty-five  cent  piece  was  found,  but  evidently  no  ball  lodged  in  the  brain. 

Chloroform  was  admininistered,  and  the  fragments  being  so  pressed  i^to  each  other, 
that  neither  elevator  nor  forceps  could  remove  them,  the  trephine  was  applied  by 
Surgeon  I.  Moses,  U.  S.  V.,  and  the  bone  sawed  nearly  through,  which  loosened 
the  pieces  so  that  they  were  readily  removed.  The  dura  mater  and  surface  of  the 
brain  were  torn.  Bleeding  from  a small  branch  of  the  temporal  artery  was  easily 
checked,  and  the  parts  were  covered  with  ice-cold  water.  Three  and  a half  hours 
after  the  operation  he  had  considerably  improved;  the  severe  pain  which  he  had 
complained  of  for  days  previous  to  operation  and  the  paraplegia  were  relieved. 
He  slept  soundly  on  the  night  of  the  11th,  but  on  the  following  morning  a constant 
gurgling  in  his  throat  could  be  heard.  Pus  and  blood  were  continually  discharged 
from  the  wound,  which  looked  well.  He  sank  rapidly,  became  comatose  on  the 
morning  of  the  13th,  and  died  in  the  afternoon  of  that  day.  The  pathological  speci- 
men, No.  131,  Sect.  I,  A.  M.  M.,  shows  a partially  trephined  segment  of  the  right 
parietal  bone,  with  five  fragments,  embracing  one  square  inch.  The  outer  table  and 
diploe  were  cut  through,  but  not  removed,  by  the  trephine  applied  on  the  sound  bone 
at  the  edge  of  the  fracture.  The  specimen  and  history  were  contributed  by  Surgeon 
I.  Moses,  U.  S.  V. 


Fig.  125. — Segment  of  parietiil  bone  with  frag- 
ments, from  a case  of  trephining  after  gunshot 
fiactura  Spec.  131,  Sect.  I,  A.  M.  M. 


Case. — Corporal  Benjamin  A.  Carson,  Co.  E,  97th  Indiana  Volunteers,  received,  near  Atlanta,  Georgia,  June  15th  to  27th, 
1864,  a gunshot  fracture  of  the  skull.  He  was  admitted  to  the  regimental  hospital.  During  the  following  night,  hernia  cerebri 
appeared,  and  on  the  next  day.  Surgeon  J.  H.  Hutchinson,  15th  Michigan  Volunteers,  applied  the  trephine,  while  the  patient  was 
under  the  influence  of  chloroform.  Carson  was,  on  June  29th,  sent  to  General  Hospital,  and  died  on  July  3d,  1864. 


TREPniNINQ  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


263 


Cask. — Private  P.  H , Co.  E,  9tli  Pennsylvania  Reserves,  aged  28  years,  was  wounded  at  the  battle  of  Fredericks- 

burg, Yirginia,  Docomber  13tb,  1862,  by  a conoidal  ball,  wbicli  fractured  and  depressed  the  posterior  portion  of  tbe  left  parietal 
bone.  He  was  unconscious  for  some  time  after  tlic  reception  of  the  injury.  On  December  15tb,  be  was  admitted  into  the  Stan- 
ton Hospital,  Washington,  D.  C.  A wound  of  scalp  was  discovered  through  which  could  be  felt  a portion  of  depressed  bone; 
tlu-ough  another  wound,  two  inches  anteriorly,  the  patient  stated  that  a portion  of  the  ball  had  been  extracted.  No  symptoms 
of  brain  lesion  wei’e  manifest,  the  patient  being  perfectly  conscious  and  answering  all  questions  correctly  and  intelligently.  Ice 
was  applied  to  the  head,  but,  toward  evening,  convulsions  ensued  followed  by  others  at  intervals  during  the  night.  The  next 
morning  a semi-comatose  condition  supervened,  continuing  until  the  17th,  when  it  deepened.  The  power  of  deglutition  was  lost, 
and  the  tongue  turned  to  the  left  side  of  the  mouth.  On  the  18th,  the  condition  being  unimproved,  an  operation  was  decided 
upon.  Accordingly  the  patient  was  etherized,  and  Surgeon  John  A.  Lidell,  U.  S.  V.,  applied  the  trephine  to  the  anterior  edge 
of  the  opening  in  the  cranium  and  removed  a disk  of  bone.  The  depressed  portion,  about  an  inch  long  and  three-fourths  of  an 
inch  wide,  and  six  fragments  of  bone  were  easily  detached.  One  of  the  latter  had  evidently  perforated  the  dura  mater,  its  re- 
moval being  followed  by  a discharge  of  disorganized  brain  substance.  After  the  operation,  the  coma  lightened  somewhat  and 
power  of  deglutition  and  consciousness  were  restored  ; the  loss  of  speech,  however,  continued.  The  improvement  was  of  short 
duration,  for  on  the  next  day  coma  and  paralysis  of  the  right  side  again  supervened,  with  convulsive  twitching  of  the  right  side 
of  face.  These  symptoms  increased  in  gravity  continuously,  the  patient  becoming  more  and  more  exhausted  until  the  23d,  when 
he  died.  At  the  post-mortem  examination,  a thick  brown-colored  pus,  to  the  amount  of  an  ounce  and  a half,  escaped  from  between 
the  dura  mater  and  the  brain.  Under  the  seat  of  injury  was  found  red  softening 
and  disorganization  of  the  brain  extending  to  the  depth  of  an  inch  and  a half. 

There  was  also  considerable  effusion  of  clear  serum  in  the  ventricles,  and  a sero- 
sanguinolent  effusion  at  the  base  of  the  brain.  The  cerebrum  generally,  includ- 
ing both  right  and  left,  hemispheres,  was  congested,  the  punctifonn  spots  being 
unusually  distinct.  The  dura  mater,  covering  the  convexity  of  the  left  hemisphere, 
showed  marks  of  recent  inflammatoi-y  action,  being  injected,  reddened,  rough- 
ened, and  of  a brown  color  in  the  neighboihood  of  the  fi-acture.  It  was  also  lined 
by  a thick  layer  of  false  membrane.  The  specimen  is  figured  in  the  wood-cut. 

The  fractured  portion  of  thb  inner  table  of  the  cranium  measures  three-fourths  by 
one  inch,  and  is  partly  included  in  the  disk  removed  by  the  trephine.  The  outer 
table  is  injured  to  a less  extent.  The  specimen  and  history  were  contributed  by 
Surgeon  J.  A.  Lidell,  U.  S.  V. 


Fig.  1‘26. — Segment  cf  left  parietal,  from  a pa- 
tient trephined  for  depressed  gunshot  fracture. 
Spec.  534,  Sect.  I,  A.  M.  M. 


Case. — Private  W H , Co.  B,  4th  Michigan  Volunteers,  was  wounded  at  the  battle  of  Fredericksburg,  Vir- 

ginia, December  13th,  1862,  by  a conoidal  ball,  which  caused  a gaping  ragged  wound  an  inch  and  a half  long,  antero-posteriorly 
over  the  left  parietal,  fracturing  the  bone.  A probe  could  be  passed  through  the  opening  so  as  to  touch  the  dura  mater.  He  was 
admitted  to  the  hospital  of  the  1st  division.  Fifth  Corps,  and  on  December  16th,  sent  to  Eckington  Hospital,  Washington,  D.  C. 
He  was  rational,  but  his  mind  was  confused  ; the  pulse  was  80  and  normal ; the  skin  moderately  warm  ; pupils  somewhat  con- 
tracted and  fixed  ; some  dysphagia,  but  no  paralysis  existed,  and  he  complained  of  a constant  tingling  in  his  right  arm  and  hand. 
On  the  19th,  his  memory  was  entirely  gone.  The  operation  of  trephining  was  decided  upon ; the  patient  was  etherized,  and 
Acting  Assistant  Surgeon  Henry  W.  Fisher  elongated  the  original  wound  and  made  another  section,  forming  a T shaped  incis- 
ion. Upon  turning  back  the  flaps  an  extensive  irregular  fracture  was  discovered,  also  a small  piece  of  bone  was  found  driven 
down  half  its  thickness  below  the  surface.  At  its  posterior  edge  a small  fragment  of  lead  was  impacted.  The  trephine  was 
applied  and  a button  removed,  revealing  extensive  comminution  of  the  internal  table  toward  the  vertex.  A tongue  of  bone, 
extending  from  the  opening  made  by  the  trephine  to  a radiating  fracture  was  removed  by  a Hey’s  saw,  and  two  irregular  fi’ag- 
ments  of  the  inner  table,  besides  numerous  small  spicu- 
ItB,  w-ere  removed.  The  dura  mater  was  discolored  but 
not  lacerated  save  by  a small  puncture  made  by  one  of 
the  spiculsB.  All  extraneous  substances  having  been 
removed,  the  wound  was  closed  and  cold  water  dress- 
ings were  applied.  On  December  20th,  the  patient  was 
semi-comatose,  but  quite  rational  when  spoken  to.  The 
next  morning  the  pupils  became  contracted,  the  coma 
deepened,  and  all  the  symptoms  of  compression  of  the 
brain  appeared.  Thinking  that  there  might  be  a clot 
under  the  dura  mater.  Dr.  Fisher  made  a small  crucial 
incision  in  the  membrane,  but  no  clot  was  found.  The 
wound  of  the  scalp  and  the  dura  mater  were  covered 
with  an  ash-colored,  semi-fluid,  sloughy  matter ; but  on 
cleaning  the  dura  mater  it  was  found  not  to  be  slough-  Fio.  127. — Calvaria  and  fragments  from  a case  of  trephining  after  gnnsliot 
ing,  but  roughened  and  livid.  No  improvement  took  Sect.  I,  A.  M.  M. 

place  and  the  patient  gradually  sank  until  three  o’clock  r.  M.,  December  2l8t,  when  he  died.  On  removing  the  calva- 
rium, the  membranes  were  found  congested,  but  without  change  of  texture,  save  the  roughening  and  discoloration  before  noted, 
immediately  about  the  wound.  On  removing  themembrane,  the  surface  of  the  cerebnim  was  found  to  bo  in  a disorganized  pulpy 
condition  for  a space  of  an  inch  and  a half.  The  convolutions  were  obliterated,  the  white  and  gray  portions  being  undistinguish- 
able,  and  the  tissue  a disorganized  sanious  mass,  so  thin  that  several  drops  ran,  by  their  own  gravity,  out  upon  the  table.  The 
rest  of  the  brain  was  healthy.  This  disorganization  was  found  to  extend  down  to  a level  with  the  lateral  ventricle  and  inward 
almost  to  the  outer  margin  of  the  ventricle.  The  adjacent  wood-cut  represents  the  specimen,  and  shows  the  vault  of  the 


264 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


cranium,  with  a disk  and  twelve  fi-agments  removed  by  the  trephine  fi-om  the  left  parietal  bone.  The  opening  of  the  operation 
measures  three-fourths  by  one  and  a quarter  inches,  and  a fissure  traverses  the  bone  diagonally  from  the  anterior  superior  to  the 
posterior  inferior  angle.  The  specimen  and  history  were  contributed  by  Acting  Assistant  Surgeon  S.  A.  Storrow. 

Case. — Corporal  J.  C.  H — 


Co.  E,  2d  New  Jersey  Volunteers,  aged  37  years,  was  wounded  at  the  battle  of  Spott- 
sylvania  Court-house,  Virginia,  May  14th,  1864,  by  a conoidal  ball,  which  entered  the  lower  part  of  the  occipital  bone,  fractured 

and  depressed  the  inner  table,  and  lodged  in  the  diploe,  plugging  up  the  lateral  sinus  on  the  right  side  of  the  brain.  He  was 

admitted  on  the  same  day  to  the  hospital  of  the  1st  division.  Sixth  Corps,  and  thence,  on  the  19th,  sent  to  the  Harewood  Hos- 
pital, AVashington,  D.  C.  On  the  21st,  the  parts  were  in  a healthy  condition,  with  a moderate  amount  of  suppuration,  and  the 
patient’s  constitutional  condition  was  remarkably  good.  Surgeon  E.  B.  Bontecou,  U.  S.  V.,  applied  the  trephine,  but  did  not 
remove  the  ball,  for  fear  of  hmmorrhage  from  the  latera]  sinus  and  immediate  death.  The  patient  did  not  exhibit  any  symptoms 
of  compression  until  the  26th,  when  he  was  seized  with  convulsions,  caused  by  the  depressed  portion  of  bone  and  the  pressure  of 

the  ball  on  the  brain.  The  trephine  was  again  applied,  and  the  depressed  bone 

was  removed,  but  the  ball  had  receded  fi’om  sight,  and  could  not  be  found. 

After  the  operation,  the  convulsions  ceased,  a passive  delirium  supervened  and 
continued  until  the  4th  of  June,  1864,  when  death  occurred.  The  autopsy 
revealed  a disorganized  pulpy  condition  of  the  posterior  lobe  of  the  brain,  emitting 
an  extremely  ofi'ensive  odor.  The  fracture  extended  from  orifice  of  entrance  to 
the  foramen  magnum.  The  ball  was  found  in  the  posterior  lobe  of  the  cerebru^r, 
at  the  depth  of  about  two  inches.  The  specimen  is  a large  section  of  the  cranium 
with  a conoidal  ball  suspended  in  a perforation  of  the  occipital  bene.  The  open- 
ing measures  one  inch  by  one  and  one-fourth  inches,  and  is  partly  caused  by  the 
operation  of  trephining.  A fissure  passes  downward  and  inward  to  the  foramen 
magnum.  The  specimen  and  history  were  contributed  by  Surgeon  E.  B.  Bontecou, 
U.  S.  V.,  and  are  further  illustrated  in  the  Surgical  Photograph  Series,  A.  M.  M., 
Volume  VII,  page  1. 


Fig.  128. — .Section  of  the  occipital  hone,  with  a 
musket  hall,  which  plugged  the  lateral  sinus.  Spec. 
3040,  Sect.  1,  A.  M.  M. 


K Co.  G,  6th  Ohio  Cavalry,  aged  21  years,  was  wounded  in  a cavalry  skirmish  near 


Case. — Private  P- 

Middleburg,  Virginia,  June  21st,  1863,  by  a carbine  ball,  which  fractured  the  right  parietal  bone  near  the  junction  of  the  coronal 
and  sagittal  sutures.  The  bone  was  depressed  one-sixth  of  an  inch.  A portion  of  the  ball  and  several  spicultc  of  bone  were 
removed  on  the  field.  The  patient  w'as  conveyed  to  Washington,  D.  C.,  and  admitted  into  Stanton  Hospital  on  the  24th,  being 
pC-rfectly  conscious,  but  complaining  of  headache.  The  pupils  were  normal,  deglutition  good,  pulse  accelerated  and  rather  feeble, 
and  the  left  lower  extremity  paralyzed.  An  ice  bag  was  applied  to  the  head,  an  enema  administered,  and  quiet  enjoined.  He 
passed  a very  I’estless  night  and  on  the  following  morning  became  delirious,  with  a pulse  at  120.  On  the  26th,  coma  was  pro- 
found, respiration  stertorous,  and  slower  than  natural,  the  skin  hot  and  dry,  and  the  pulse  ranging  from  65  to  80.  The  pupil  of 
left  eye  was  dilated  and  not  responsive  to  the  stimulus  of  light,  that  of  the  right  eye  was  closely  contracted,  and  the  conjunctiva 
injected  with  blood;  the  left  leg  and  arm  were  paralyzed,  the  micturition  involuntary.  Surgeon  John  A.  Lidell,  U.  S.  V.,  made 
an  incision  two  inches  in  length,  applied  the  trephine  on  the  light  edge  of  the  fracture  and  cut  out  a disc  of  bone,  and  removed, 
with  an  elevator,  two  fragments  of  depressed  bone;  one,  about  one  and  a half  inches  in  length  by  three-fourths  of  an  inch  in 
breadth,  embracing  both  tables  of  the  skull,  the  other  being  a small  fragment  of  the  inner  table.  The  dura  mater  at  the  posterior 
and  external  part  of  the  opening  was  found  to  be  lacerated  to  the  extent  of  half  an  inch,  and  a small  quantity  of  brain  tissue 
escaped.  The  longitudinal  sinus  having  been  uncovered,  a copious  stream  of  dark-colored  blood  came  away,  apparently  flowing 
from  the  open  mouths  of  the  small  veins  which  run  from  the  cranium  into  the  sinus.  The  bleeding  was  checked  by  a pledget  of 
lint,  saturated  with  a solution  of  persulphate  of  iron.  The  pupil  of  the  right  eye  expanded  to  the  natural  size  and  that  of  the 
left  diminished  and  responded  to  the  light.  The  engorgement  of  the  conjunctiva  of  the  right  eye  perceptibly  decreased,  the 
stertor  disappeared  and  the  breathing  became  more  natural ; the  pulse  lose  to  110,  but  consciousness  did  not  return.  Ice  was 

‘igain  applied  to  the  head  and  an  enema  was  ordered.  The  next  morning  respiration  was 
60  per  minute,  and  bronchial  rattles  were  audible  throughout  the  chest;  pulse  130,  and 
weak ; the  left  side  of  the  body  was  rigid,  while  the  right  side  was  moved  quite  freely. 
There  were  convulsive  twitchings  of  right  side  of  face,  which,  in  two  hours,  extended  ■ 
over  the  entire  light  side  of  the  body,  while  the  left  side  lost  its  rigidity,  but  was  not 
affected  by  convulsive  movements.  In  the  meantime  the  breathing  became  more  frequent 
and  feeble,  and  the  patient  died  at  five  o’clock  P.  M.,  June  27th,  1863.  At  the  autopsy, 
an  elongated  opening  in  the  calvaria  was  exposed,  half  an  inch  long  and  three-fourths  of 
an  inch  in  width,  commencing  one-fourth  of  an  inch  behind  the  coronal  suture  and  ex- 
tending backward  and  a little  to  the  right  of  the  median  line.  The  dura  mater  was 
lacerated  to  the  extent  of  half  an  inch  at  the  posterior  end  of  the  chasm  in  the  skull. 
On  raising  that  portion  of  the  dura  mater  which  covers  the  convex  surface  of  the  right 
hemisphere  of  the  cerebrum,  a quantity  of  coagulated  blood  was  found  m the  cavity  of 
the  arachnoid,  spread  out  over  the  convexity  of  the  right  hemisphere ; the  largest  quan- 
tity of  effused  blood  was  found  at  the  base  of  the  middle  and  posterior  lobes  of  the 
right  hemisphere.  The  effused  blood,  which  was  very  dark,  amounted,  in  all,  to  three  ounces,  and  came  from  the  longitudinal 
sinus.  The  whole  brain  showed  very  great  venous  congestion.  There  was  softening  of  the  brain  tissue  at  the  seat  of  injury, 
near  the  summit  of  each  cerebral  hemisphere,  but  it  was  more  marked  on  the  light  than  on  the  left  side.  The  pathological  speci- 
men is  No.  1333,  and  was  contributed,  with  the  history,  by  Surgeon  John  A.  Lidell,  U.  S.  V.  This  case  is  erroneously  reported 
as  a sabre  cut,  in  bound  MSS.  Div,  Surg.  E(  c.  S.  G.  O.  No.  63,  p.  22. 


Fig.  129. — Segment  of  vault  of  cranium 
trephined  near  the  longitudinal  sinus.  Spec. 
1333,  Sect.  I,  A.  M.  M. 


TREPHINING  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


265 


Case. — Private  J.  L- 


Fir:.  130. — Section  i f a skull  nuieh  shattered 
by  gunshot,  and  trephined.  Rptc.  2000,  Scot.  I, 

A.  M.  M. 


Co.  A,  122(1  Ohio  Volunteers,  aged  28  years, 
ivas  wounded  at  the  battle  of  Mine  Run,  Virginia,  November  27th,  1863,  by  a conoidal 
ball,  which  entered  the  frontal  bone,  just  above  the  inner  canthus  of  the  right  eye, 
passed  downward  and  inward,  and  made  its  exit  through  the  outer  wall  of  the  left 
antrum  of  Highmore.  He  was  treated  in  a field  hospital  for  several  days,  and  on 
December  4th,  admitted  to  the  3d  division  hospital  at  Alexandria,  Virginia.  His 
condition  had  been  good,  but  he  soon  became  comatose.  On  December  8th,  Surgeon 
E.  Bentley,  U.  S.  V.,  applied  the  trephine  and  removed  a disk  of  bone  from  the 
centre  of  the  frontal  bone  betwewi  the  superciliary  ridges.  Splinters  of  bone,  consti- 
tuting nearly  all  the  nasal  and  left  malar  bones,  were  removed  at  the  same  time.  No 
relief  was  afforded,  and  the  patient  died  on  December  13th,  1863.  The  pathological 
specimen,  which  shows  a section  of  skull  trephined  for  extensive  fracture  of  frontal 
and  facial  bones,  together  with  the  history,  was  contributed  by  the  operator. 

Case. — Private  M.  M , Co.  C,  48th  Pennsylvania  Volunteers,  aged 

45  years,  was  wounded  at  the  battle  of  Spottsylvania  Court-house,  Virginia,  May 
12th,  1864,  by  a conoidal  ball,  which  comminuted  and  depressed  the  left  parietal  bone 
near  the  upper  border  to  the  left  of  the  longitudinal  sinus.  He  was  admitted  to  the 
hospital  of  the  Ninth  Corps  and  thence  sent  to  the  Carver  Hospital,  Washington,  on 
tli^  14th,  somewhat  morose  and  taciturn,  and  at  times  manifesting  slight  symptoms  of 
compressions,  but  expressing  himself  quite  intelligibly.  On  the  evening  of  the  15th, 
he  became  decidedly  comatose.  On  the  following  morning  the  patient  was  placed 
under  the  influence  of  ether.  Acting  Assistant  Surgeon  J.  O.  French  trephined  the 
skull  over  the  afiected  region  and  removed  several  large  splinters  of  the  external  table. 

The  depressed  portion  was  of  an  irregular  quadrangular  shape,  measuiing  an  inch 
or  more  in  its  longest  diameter,  and  was  firmly  imbedded  in  the  brain.  The  mem- 
branes and  medullary  substance  of  the  brain  were  lacerated  by  the  depressed  frag- 
ments, accounting  for  the  slight  oozing  of  medullary  substance  and  blood  that  had 
existed  ever  since  his  admission.  Considerable  hmmorrhage  occurred  during  the 
operation,  which  was  controlled  by  dry  lint.  The  operation  relieved  the  patient 
from  his  comatose  condition,  and  he  became  quite  animated,  remaining  so  until  the 
18th,  when  coma  again  set  in.  Death  supervened  on  the  20th.  The  autopsy  revealed 
traces  of  meningeal  inflammation  and  infiltration  of  purulent  matter  in  the  region  of 
the  injury.  The  left  lateral  ventricle  was  distended  with  blood,  and  a small  piece  of 
bone  was  found  projecting  into  its  cavity.  The  pathological  specimen  is  a disk  and 
three  fragments  of  bone,  removed  from  the  cranium.  The  largest  fragment  is  from 
the  inner  table  and  measures  one  inch  in  diameter.  The  specimen  and  history  were 
contributed  by  Surgeon  O.  A.  Judson,  U.  S.  V. 

Case. — Private  A M , Co.  D,  155th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Fredericksburg, 

Virginia,  December  13th,  1862,  by  a conoidal  musket  ball,  which  entered  at  the  juncture  of  coronal  and  squamous  sutures,  and 
lodged.  He  was  admitted  to  the  Patent  Office  Hospital,  Washington,  D.  C.,  on  the  17th,  complaining  but  very  little  of  his 
wound,  and  was  able  to  walk  about  until  the  19th,  when  the  pain  became  so  severe  that  he  was  compelled  to  take  to  his  bed. 
He  became  restless,  showing  all  the  symptoms  of  febrile  excitement.  A lotion  of  lead  water  and  laudanum  was  ordered  to  be 
applied  to  the  wound,  and  an  anodyne  administered.  Up  to  this  time  he  had  not  been  delirious  and  was  able  to  give  rational 
answers  to  all  questions.  On  the  morning  of  the  20th,  he  was  comatose  and  all  the  symptoms  of  compression  of  the  brain  were 
well  marked;  his  eyeballs,  especially  the  right,  were  prominent  and  the  pupils 
fixed  and  contracted.  On  removing  the  dressing,  blood  and  brain  substance 
oozed  from  the  wound.  The  wound  of  the  scalp  was  then  enlarged  and  the 
skull  trephined ; spiculae  of  bone  were  removed,  causing  considerable  hsemor- 
rhage,  but  no  relief  to  the  patient.  He  died  a few  hours  after  the  operation. 

The  post-mortem  examination  revealed  cerebro-meningitis,  advanced  to  the 
stage  of  suppuration,  pus  having  collected  over  the  anterior  surface  of  the 
brain,  and  between  the  pia  mater  and  arachnoid.  The  ball  had  lacerated  the 
anterior  portion  of  the  middle  lobe  of  the  brain,  the  terminal  branches  of  the 
internal  carotid,  and  the  anterior  branch  of  the  temporal  artery.  There  was 
a large  clot  on  the  floor  of  the  middle  fossa  of  the  cranium.  A fragment  of 
the  ball  was  found  in  the  centre  of  the  middle  lobe  of  the  cerebrum,  and  the 
remaining  portion  was  imbedded  in  the  sphenoid  bone.  The  patliological 
specimen  is  figured  in  the  wood-cut.  The  opening  in  the  cranial  wall 
measures  one  inch  from  above  downward  and  is  three-fourths  of  an  inch 
wide  ; from  this  point  one  fissure  passes  downward  across  the  glenoid  cavity 
and  a second  forward  into  the  external  wall  of  the  right  orbit,  which  is  c<^m-  Fig.  132. — So^nent  of  cranium  and  p<(rtion  of  lower 

minuted.  The  ball  is  encrusted  with  calcareous  matter.  Acting  Assistant  "is"* 800^1^*^!  **'^'*" 

Surgeon  J.  H.  Jamar  contributed  the  specimen  and  history. 

34 


Fig.  131. — Disk  and  fragments  of  skull  re- 
moved by  trephining.  yect.  I,  A.  A. 

[Nat.  size.] 


266 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Private  Edward  Noi  ton,  Co.  I,  39th  New  Jersey  Volunteers,  aged  21  years,  was  wounded  at  Petersburg,  Virginia, 
April  2d,  1805,  by  a shell  which  fractured  the  right  parietal  bone.  He  was  conveyed  to  tbe  field  hospital  of  the  2d  division, 
Ninth  Corps,  thence  sent  to  City  Point,  Virginia,  where  he  remained  until  the  Cth,  when  he  Avas  conveyed  to  the  Fairfax  Sem- 
inary Hospital,  Virginia.  No  symptoms  of  compression  existed.  The  external  Avound  Avas  one  and  a half  inches  in  length  ami 
had  a bad  aiipcarance.  Water  dressings  Avere  applied  and  beef  tea  ordered.  On  the  Gth,  the  patient’s  appetite  failed,  deglutition 
became  ditficult,  and  symptoms  of  eflusion  appeared  on  the  ftdloAving  day.  Surgeon  D.  P.  Smith,  U.  S.  V.,  applied  the  trephine 
and  removed  a portion  of  the  cranium  and  several  fragments,  greatly  I'elieving  the  symptoms.  The  patient  talked  better  and 
answered  questions  correctly.  Hernia  cerebri  Avas  first  noticed  on  the  morning  of  the  11th,  and  on  the  12th,  a slight  heemorrhage 
occurred.  Coma  folloAved  ; the  protruding  hernia  Avas  removed,  but  death  ensued  on  April  14th,  1865.  The  case  is  reported  by 
Surgeon  David  P.  Smith,  U.  S.  V. 

Case. — Corporal  E.  B.  P , Co.  H,  14th  Connecticut  Volunteers,  aged  20  years,  Avas  Avounded  at  the  battle  of  Fred- 

ericksburg, Virginia,  December  13th,  1862,  by  a musket  ball,  Avhich  fractured  both  tables  of  the  os  frontis  in  the  median  line, 
one  inch  beloAV  the  anterior  extremity  of  the  sagittal  suture.  He  Avas  admitted  to  the  Armory  Square  Hospital,  Washington, 
on  the  20th.  Symptoms  of  compression  of  the  brain  appeared  in  a feAV  days.  An  examination  revealed  a piece  of  lead,  impacted 
in  the  os  frontis,  one-half  of  an  inch  beloAV  the  anterior  extremity  of  the  sagittal  suture.  On  the  29th,  Surgeon  D.  W.  Bliss, 
U.  S.  V.,  applied  the  trephine  over  the  seat  of  injury  and  removed  the  portion  of  bone  containing  the  fi-agment  of  lead,  giving 
exit  to  a large  quantity  of  sanguineous  pus.  Immediately  beneath  the  trephined  portion  of  bone,  a depressed  fragment  of  the 
inner  table  Avas  found,  measuring  three- fourths  of  an  inch  in  diameter,  which  Avas  I’emoved.  Cold  Avater  dressings  Avere  applied, 
cathartics  administered,  and  low  diet  ordered.  The  patient  lingered  in  a semi-comatose  condition  until  the  31st,  Avhen  death 
ensued.  The  autopsy  revealed  the  inner  talde  much  fractured,  and  spiculse  driven  into  the  substance  of  the  brain.  A large 
collection  of  pus  existed  beneath  the  dura  mater.  The  pathological  specimen  is  625,  Sect.  1^  A.  M.  M.,  and  Avas  contributed, 
Avith  the  history,  by  Surgeon  D.  W.  Bliss,  U.  S.  V. 

Case. — Private  W'illard  P , Co.  I,  120th  Nbav  York  Volunteers,  aged  18  years,  Avas  Avounded  near  Hatcher’s  Run, 

Virginia,  March  25th,  1865,  by  a conoidal  ball,  Avhich  fractured  and  depressed  the  right  ])arietal  bone  near  the  sagittal  suture. 
He  AA’as,  on  the  same  day,  taken  to  the  hospital  of  the  3d  division.  Second  Corps,  and  theKce  conveyed  to  Washington,  and 
admitted  to  the  Emory  Hospital,  on  the  5th  of  A])ril.  On  the  folloAving  day,  he  was  ]daced  under  the  inlluence  of  chloroform, 
and  Surgeon  N.  R.  Moseley,  U.  S.  V.,  trephined  and  elevated  the  fractured  portion  of  the  parietal  hone.  Cold  Avater  dressings 
and  compresses  Avere  applied,  enemas  administered,  and  nutiltious  diet  ordered.  On  the  13th,  the  patient  Avas  apparently  doing 
well,  but  death  supervened  on  April  17th,  1865,  from  exhaustion.  The  pathological  specimen  is  No.  4074,  and  shoAVS  a disk  and 
tAVO  fragments  of  bone  from  the  right  parietal.  The  fragments  are  chielly  from  the  inner  table,  and  include  one-half  square  inch 
of  surface.  The  specimen  and  history  Avere  contributed  by  Surgeon  N.  R.  Moseley,  U.  S.  V. 

Case. — Corporal  H.  L.  P , Co.  I,  1st  Massachusetts  Heavy  Ai  tillery,  aged  20  yeai's,  Avas  Avounded  at  Petersburg, 

Virginia,  June  17th,  18G4,  by  a conoidal  ball,  Avhich  struck  the  left  jiarietal  bone  at  its  posterior  superior  portion,  causing, 
apparently,  only  a Avound  of  the  scalp  tAvo  inches  in  length.  He  Avas  convej'ed  to  Washington,  and  admitted  to  the  IlarcAvood 
Hospital  on  June  21st,  and  thence  transferred,  on  the  27th,  to  the  Satterlee  Hospital,  Philadelphia.  He  appeared  to  be  perfectly 
Avell,  but  on  the  morning  of  the  3d  of  July,  he  Avas  found  speechless  and  paralyzed.  An  examination  revealed  the  cranium 
denuded  of  its  periosteum  and  several  small  pieces  of  lead  firmly  fixed  in  the  b(jno.  Acting  Assistant  Surgeon  W.  F.  Atlee 
applied  the  treplune  and  removed  a portion  of  the  outer  table  of  the  cranium  at  the  seat  of  injury.  Some  improvement  in  the 
motions  of  the  tongue  Avas  noticed  and  further  proceedings  Avere  suspended.  On  the  folloAving  d.ay  the  inner  table  Avas  trephined, 
revealing  an  OA’al  shaped  fissure  one  inch  in  its  long,  and  half  an  inch  in  its  short  diameter,  Avhich  Avould  admit  the  introduction 
of  a finely  pointed  quill  toothpick.  The  bone,  inclosed  by  the  fissure,  Avhich  Avas  loosened  and  depressed,  Avas  removed.  No 
relief,  liOAvever,  Avas  afforded,  and  death  occurred  July  7th,  from  compression  of  the  brain.  The  patient  had  been  perfectly 
rational  througbout  the  treatment.  An  autopsy  revealed  a large  abscess  filled  Avith  pus  extending  from  the  top  of  the  left  cerebral 
hemisphere  to  its  base.  Tbe  pathological  specimen  is  No.  3635,  Sect.  I,  A.  M.  M.,  and  Avas  contributed  by  Acting  Assistant 

Case. — Corporal  G.  H.  S , Co.  C,  18th  Massachusetts  Volun- 

teers, Avas  Avounded  at  the  battle  of  Chanccllorsville,  Virginia,  May  3d,  1883, 
by  a conoidal  musket  ball,  Avhich  fractured  and  depressed  the  fi’ontal  and 
the  left  parietal  bones  at  the  junction  of  coronal  and  sagittal  sutures,  one 
inch  from  the  median  line.  He  Avas  immediately  admitted  to  the  Fifth 
Corps  field  hospital,  and  transferred,  on  May  9th,  to  the  Finley  Hospital, 
Washington,  in  good  condition,  Avith  slight  cerebral  symptoms.  On  the 
15th,  he  Avas  placed  under  the  influence  of  ether ; the  trephine  Avas  then 
apjdied  and  the  external  table  elevated,  but  further  operation  Avas  sus- 
pended, as  no  fi’acture  or  depression  of  the  inner  table  could  be  discovered. 
On  the  next  morning  convulsions  occurred  and  continued  at  intervals. 
The  patient  became  insensible  and  the  pupils  dilated.  Erysipelas  of  the 
scalp  and  face  supervened ; and  these  symptoms  continued  unchanged  until 
May  17th,  1863,  Avhen  death  occurred.  The  post-mortem  examination 
revealed  a stellate  fracture  and  slight  depression  of  the  inner  table  of  the 
frontal  and  left  parietal  bones,  but  more  extensive  than  that  of  the  outer 
table.  The  brain  under  and  around  the  injury  Avas  considerably  discolored,  and  softened  in  both  hemispheres.  The  pathological 
specimen,  Avith  its  history,  Avas  contributed  b^'  Acting  Assistant  Surgeon  Alfred  Edelin. 


Surgeon  George  Kerr,  Avho  reports  the  case. 


TEBPHINING  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


267 


Case. — Private  Jacob  Smith,  Co.  D,  48tli  Peimsylvania  Volunteers,  aged  33  years,  was  wounded  in  the  engagement  near 
Fort  Steadman,  Virginia,  April  2d,  1865,  by  a conoidal  musket  ball,  which  struck  the  centre  and  upper  part  of  the  frontal  hone, 
making  a vertical  incision  of  the  scalp  two  inches  in  length.  The  pericranium  was  only  slightly  detached  and  no  fracture  was 
observable.  He  was  taken  to  the  hospital  of  the  2d  division.  Ninth  Corps ; on  April  4th,  sent  to  Carver  Hospital,  Washington, 
and  on  May  19th,  transferred  to  Mower  Hospital,  Philadelphia.  Three  days  later,  the  right  temporal  region  became  swollen, 
and  erysipelas,  attended  with  high  fever,  quick  pulse,  and  delirium,  supervened.  An  abscess  being  suspected,  an  incision  was 
made  in  the  temple,  but  none  could  be  found.  A brisk  cathartic  was  given,  and  the  face  and  head  dressed  with  sol.  sod.  sulph. 
On  May  24th,  the  left  side  of  the  head  became  involved  and  head  symptoms  developed  rapidly.  Chloroform  being  administered, 
a crucial  incision  was  made  by  Acting  Assistant  Surgeon  W.  P.  Moon,  and  the  bone  exposed,  when  the  slightest  perceptible 
fissure  in  the  external  table  was  discovered,  from  which  a thin  sanious  discharge  was  issuing.  Upon  removing  a portion  of  the 
two  tables  with  a trephine,  it  was  ascertained  that  the  fissure  extended  through  both  tables,  without  fracturing  or  depressing 
either.  Quite  an  amount  of  pus  escaped  from  the  orifice  and  considerable  disorganization  was  evident.  Death  occurred  on  May 
25th,  1865.  At  the  autopsy,  the  interior  lobes  were  found  greatly  congested,  with  formation  of  pus  over  a great  extent  of  the 
longitudinal  sinus.  All  the  vessels  of  the  membranes  were  much  enlarged  and  engorged,  and  at  the  point  of  injury  disorganiza- 
tion had  taken  place.  The  case  is  reported  by  the  operator.  Acting  Assistant  Surgeon  W.  P.  Moon. 

Case. — Lieutenant  W.  V , Co.  L,  1st  Maine  Heavy  Artillei-y,  aged  30  years,  was  wmunded  at  the  Battle  of  Spott- 

sylvania  Court-house,  Virginia,  May  17th,  1864,  by  a conoidal  ball,  which  fractured  and  depressed  both  tables  of  the  left 
pai-ietal  bone.  He  was  admitted  into  the  Emory  Hospital,  Washington,  on  the  22d,  in  a comatose  condition,  with  paralysis  of  the 
right  side.  The  scalp  was  lacerated  and  sloughing,  the  pericranium  torn,  and  spiculae  of  bone  had  been  driven  in  upon  the  dura 
mater.  The  membranes  of  the  brain  were  entire.  Surgeon  N.  R.  Moseley,  U.  S.  V.,  applied  the  trephine,  removed  two  fragments 
of  bone  and  elevated  the  depressed  portions.  Beef  tea  and  liquid 
stimulants  were  administered.  Inflammation  of  the  meninges 
supervened,  and  the  patient  died  on  the  24th  of  May,  1864. 

The  post-mortem  examination  revealed  a fracture,  extending  from 
the  opening  made  by  the  trephine  toward  the  left  parietal  bone. 

The  substance  of  the  brain  was  softened  and  congested  with 
dark,  livid  blood.  The  pathological  specimen.  No.  2317,  Sect. 

I,  A.  M.  !M.,  shows  a disk  and  five  small  fragments  of  bone 
removed  from  the  left  parietal.  The  disk  is  split  transversely. 

The  specimen  and  history  were  contributed  by  Surgeon  N.  R. 

Moseley,  U.  S.  V. 

Case. — Private  J W , Co.  K,  1st  Michigan  Volunteers,  aged  30  years,  was  wounded  at  the  battle  of 

Fredericksburg,  Virginia,  December  13th,  1862,  by  a missile  supposed  to  have  been  a musket  ball.  On  admission  to  the 
Hammond  Hospital,  Point  Lookout,  Maryland,  December  16th,  a lacerated  wound  of  the  scalp  was  found,  of  triangular  shape, 
with  the  apex  situated  anteriorly  on  the  inferior  border  of  the  right  parietal  bone,  an  inch  above  the  top  of  the  ear.  At  the  base 
of  the  wound  a fracture  and  depression  of  both  tables  of  the  skull  was  detected,  the  fracture  covering  an  irregular  space  of  about 
an  inch  in  diameter.  The  patient  experienced  little  or  no  uneasiness  from  the  injury,  and  all  symptoms  of  cerebral  lesion  were 
absent.  The  wound  was  dressed  with  cold  water,  and  rest  and  low  diet  ordered.  No  change  took  place  until  the  27th,  when 
the  man  became  drowsy  and  could  be  aroused  to  answer  questions  only  with  great  difficulty,  relapsing  immediately  into  a sleepy 
condition.  'The  pupils  were  somewhat  dilated,  and  he  complained  of  a feeling  of  numbness  in  the  whole  left  side  of  his  body; 
there  was,  however,  no  complete  paralysis;  pulse  about  60  and  natural.  Chloroform  was  administered,  the  seat  of  fracture 
exposed,  and  Acting  Assistant  Surgeon  Charles  L.  Hogeboom  applied  the  trephine  at  the  posterior  border  and  removed  several 
depressed  fragments.  The  symptoms  of  compression  disappeared,  and  the  case  progressed  favorably  until  the  5th  of  January, 
1863,  when  the  signs  of  compression  returned,  the  patient  becoming  partially  insensible  and  inclined  to  vomit.  The  breathing 
became  stertorous,  the  pupils  dilated,  and  the  pulse  weak  and  irregular.  He  sank  rapidly  and  died  on  the  following  day.  No 
marked  paralysis  existed  at  any  time,  the  nearest  approach  being  the  feeling 
of  numbness  mentioned  on  the  day  of  the  operation.  O^i  removing  the 
scalp,  at  the  autopsy,  two  fissures  were  discovered  diverging  from  the  seat 
of  the  fracture;  one  passing  from  near  where  the  trephine  was  applied 
backward  across  the  lateral  and  posterior  aspect  of  the  skull,  and  ending 
just  above  the  external  occipital  protuberance,  the  other  commencing  at  the 
anterior  border  of  the  opening  in  the  skull  and  passing  forward  and  down- 
ward for  the  distance  of  an  inch.  The  dura  mater  was  entire,  but  softened 
at  the  seat  of  the  fracture.  The  cerebral  substance  was  softened  to  the 
depth  of  one-fourth  of  an  inch  and  of  a yellowish  color.  There  was,  also, 
considerable  injection  of  the  vessels  of  the  membranes  and  of  the  substance 
of  the  brain.  The  ventricles  were  filled  with  serum.  The  specimen,  which 
is  illustrated  in  the  annexed  wood-cut  was  contributed,  with  the  history,  by 
Assistant  Surgeon  Chnton  Wagner,  U.  S.  A. 

Case. — Sergeant  A B , Co.  A,  5th  Michigan  Volunteers,  aged  24  years,  was  wounded  at  the  battle  of  Mine 

Run,  Virginia,  November  27th,  1863,  by  a conoidal  ball,  which  fractured  the  right  side  of  the  frontal  bone,  just  below  the 
temporal  ridge.  He  remained  in  the  field  hospital  until  the  4th  of  December,  when  he  was  transferred  to  the  3d  division  ho.spifal, 
Alexandria,  Virginia,  in  a perfectly  natural  condition.  He  continued  so  until  the  8th,  when  the  skull  was  trephined.  The  ball 


Fio.  135. — Calvaria  trephined  for  gunsliot  fmctnrc.  Spec. 
924,  Sect.  I,  A.  M.  M. 


Fig.  134. — Disks  and  fraginenfs  removed  from  left  parietal.  Spec. 
117,  Sect.  I,  A.  M.  M.  [Kat.  size.] 


268 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


liad  been  removed  on  the  field.  For  forty-eight  hours  after  the  operation,  lie  was,  at  intervals,  slightly  delirious;  he  recovered 
at  the  end  of  that  time,  and  continued  in  full  possession  of  his  mental  facullies  until  the  14th,  when  stupor  and  comasuiiervened  ; 
he  died  on  the  same  day.  The  pathological  specimen  is  No.  2G1‘J,  Sect.  I,  A.  ]\I.  M.  Fragments  have  been  removed  from  the 
cranium  for  a space  measuring  one  by  one  and  one-fourth  inches.  The  inner  surface  of  the  edge  of  the  opening  is  slightly 
cribriform.  There  is  no  fissuring.  The  history  and  specimen  were  contributed  by  Surgeon  E.  Bentley,  U.  S.  V. 

Ca.se. — Private  J.  H.  D , Co.  B,  2d  New  York  Heavy  Artillery,  received  at  Cold  Harbor,  Virginia,  on  the  7th  of 

June,  18G4,  a gunshot  fracture  of  the  right  jiarietal  bone  causing  slight  depression.  He  was  at  once  admitted  to  the  1st  division. 
Second  Corps,  hospital,  and  transferred  to  the  Fairfax  Seminary  Hospital,  Virginia,  on  June  8th,  complaining  of  headache. 
Surgeon  D.  P.  Smith,  U.  S.  V.,  a]iplied  the  trephine  and  removed  a disk  and  six  fragments  of  bone.  Water  dressings  were 
applied  to  the  wound,  which  suppurated  freely.  An  abscess  formed  in  the  brain,  and  the  patient  died  on  June  10th,  18G4.  The 
pathological  specimen  is  No.  3305,  Sect.  I,  A.  M.  M.,  and  was  contributed  by  the  operator. 


Case. — Pi  ivate  James  A.  Winn,  Co.  B,  13th  Tennessee  Cavalry,  aged  22  years,  was  wounded  at  Fort  Pillow,  Tennessee, 
April  12th,  18G4,  by  a rifle  ball  which  passed  from  right  to  left,  across  the  top  of  the  head,  fi-acturing  the  cranium.  On  the  14th 

he  was  admitted  into  the  general  hospital  at  Mound  City,  Illinois.  During 
the  night  of  the  ICthj  he  had  a severe  headache,  but  otherwise  was  doing 
well  until  twelve  o’clock  P.  SI.  of  the  19th,  when  he  became  delirious. 
Htemorrhage  from  the  middle  meningeal  artery  occurred,  causing  a loss  of 
about  twenty-four  ounces  of  blood.  Spasms  supervened.  On  the  following 
morning  the  patient  was  placed  under  the  influence  of  ether  and  chloroform, 
and  Surgeon  Horace  Wardner,  U.  S.  V.,  applied  the  trephine  over  the  left 
parietal  bone,  half  an  inch  to  the  left  of  the  sagittal  suture,  elevating  a 
piece  of  bone  one  inch  in  diameter.  Three  or  four  ounces  of  blood  were 
lost  during  the  operation.  Paralysis  of  both  extremities  of  the  right  side 
set  in,  and  the  convulsions  continued  until  twelve  o’clock  M.,  of  the  21st, 
when  death  supervened.  At  the  post  mortem  it  was  ascertained  that  the 
ball  had  passed  through  the  cranium,  but  the  missile  could  not  be  found. 
A piece  of  the  inner  table,  one  inch  in  length  and  three-fourths  of  an  inch 
in  width,  was  entirely  detached  and  was  adherent  to  the  dura  mater. 
Extensive  extravasation  of  blood  and  serous  effusion  of  water  to  the 
amount  of  three  ounces  existed  under  the  left  parietal  bone.  The  path- 
ological specimen  is  No.  3308,  Sect.  I,  A.  M.  M.,  and  was  contributed,  with 
the  history,  by  Surgeon  H.  Wardner,  U.  S.  V. 


Fig.  136. — Calvaiia  trephined  for  clepre.secd  fracture  by  a 
musket  ball.  Spec.  3308,  Sect.  I,  A.  M.  M. 

Case. — Private  Frederick  E , Co.  M,  4th  Pennsylvania  Cavalry,  aged  38  years,  was  wounded  near  Petersburg, 

Virginia,  November  25th,  18G4,  by  a conoidal  ball,  which  penetrated  the  right  parietal  bone  near  the  superior  border  and 
emerged  near  junction  of  the  occipital  and  parietal  bones.  He  was  admitted  to  the  hospital  of  the  2d  division,*  Cavalry  Corps, 
on  December  1st;  on  the  9th,  sent  to  the  Cavalry  Corps  Hospital,  Anny  of  the  Potomac,  and  on  the  15th,  transferred  to  the 
Aimory  Square  Hospital,  Washington.  On  December  16th,  he  was  placed  under  chloi’ofoim  and  his  skull  trephined  by 
Surgeon  D.  W.  Bliss,  U.  S.  V.  The  edges  of  the  wound  were  brought  together  with  straps,  and  the  patient  rallied  well  from 
the  operation.  During  the  following  day  he  complained  of  pain  in  the  head  and  was  slightly  delirious.  On  the  morning  of  the 
20th,  he  ate  a hearty  breakfast,  then  fell  into  a profound  stupor,  from  which  he  never  recovered.  Complete  paralysis  of  the  left 
arm  and  partial  paralysis  of  the  left  leg  supervened ; hernia  cerebi  i also  appeared,  and  death  occurred  on  December  20th,  18G4. 
The  pathological  specimen  is  No.  351G,  Sect.  I,  A.  M.  M.,  and  consists  of  a disk  of  bone  from  the  parietal  one  inch  in  diameter. 
The  specimen  and  history  were  contributed  by  Surgeon  D.  W.  Bliss,  U.  S.  V. 

Case. — Ihivate  H.  A , Co.  B,  3Gth  Illinois  Volunteers,  aged  22  yerrs,  was  wounded  at  Resaca,  Georgia,  May  14th, 

18C4,  by  a conoidal  ball,  which  fractured  and  slightly  depressed  the  right  parietal  bone  at  its  centre.  He  was  admitted  on  the 
same  day  to  the  hosjJtal  of  the  2d  division.  Fourth  Corps;  transferred  to  Chattanooga,  May  IGth,  and  thence  sent  to  Hospital 
No.  1,  Nashville,  Teiines.see,  on  the  19th.  He  complained  of  a dull  pain  in  the  head,  which  continued  until  the  18th  of  June, 

when  ho  became  comatose.  On  June  21st,  Acting  Assistant  Surgeon 
H.  C.  May  applied  the  trephine  over  the  seat  of  fracture,  and  removed 
several  fragments  of  necrosed  bone  from  the  meninges.  The  tissues 
had  been  destroyed  by  gangrene  over  a space  of  about  two  inches  in 
every  direction  from  the  wound,  which  was  granulating  finely.  The 
patient  never  fully  reacted  after  the  operation;  he  became  lethargic, 
sank  rapidly,  and  died  on  June  22d,  18G4.  At  the  autopsy,  the  mem- 
branes beneath  the  fracture  were  found  dark  colored  and  thickened. 
Beneath  this  and  in  the  substance  of  the  hemisphere  existed  a large 
abscess,  which  communicated  with  the  lateral  ventricles,  and  was  fiUed 
with  highly  oflbnsive  pus.  The  specimen  is  figured  in  the  wood-cut, 
and  consists  of  a disk  and  six  fragments  of  bone,  embracing  about  one- 
half  S([uare  inch  of  the  parietal  bone.  The  specimen  and  history  were 
contrilmt(‘d  by  Acting  Assistant  Surgeon  11.  C.  May. 


after  (run  li  t fraclure.  Spec.  33(52,  Sect.  I,  A.  3!.  3>. 


TREPHINIKG  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


269 


Case. — Private  James  Addison,  Co.  B,  19th  United  States  Colored  Troops,  received,  near  Petersburg,  Virginia,  August 
19th,  18G4,  a severe  gunshot  wound  of  the  cranium.  He  was  admitted  to  hospital  4th  division.  Ninth  Corps,  where  the  trephine 
was  applied,  and  three  inches  of  the  occipital  and  left  parietal  bone  were  removed.  He  died  on  August  19th,  1864. 

Case. — Private  James  Bans,  Co.  E,  17th  Maine  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of  Mine  Eun,_ 
Virginia,  November  27th,  1863,  by  a conoidal  ball,  which  fractured  and  depressed  both  tables  of  the  left  parietal  bone.  He  was 
admitted  into  the  3d  division  hospital,  Alexandria,  Virginia,  on  December  5th.  He  was  speechless;  still  could  be  aroused 
sufficiently  to  answer  by  signs,  but  would  immediately  relapse  into  stupor.  His  pulse  was  slow,  soft,  and  irregular ; bowels 
torpid,  and  deglutition  difficult.  On  the  following  day.  Surgeon  Edwin  Bentley,  U.  S.  V.,  removed  the  depressed  portion  of  bone 
with  the  trephine,  while  the  patient  was  under  the  influence  of  ether.  He  recovered  his  speech  after  the  operation,  and  com- 
plained of  pain  in  his  head.  On  the  10th  his  right  lung  became  painful ; stupor  gradually  supervened,  extensive  inflammation  set 
in.  and  death  ensued  on  the  13th  of  December,  1863.  The  autopsy  revealed  eflTusion  of  coagulable  lymph  and  serum  into  the  cavity 
of  the  arachnoid,  and  the  brain  softened  and  congested.  Acting  Assistant  Surgeon  \V.  G.  Elliott  reports  the  case. 

Case. — Private  Frederick  Buck,  Co.  D,  52d  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Fair  Oaks,  Virginia, 
May  31st,  1862,  by  a conoidal  ball,  which  penetrated  the  left  side  of  the  os  frontis,  and  lodged  in  the  brain  substance.  He  was 
admitted  to  the  hospital  of  Gen.  Casey’s  Division,  Fourth  Corps,  and  thence  transferred  to  the  general  hospital  at  Newport  News, 
Virginia,  on  June  4th,  1862,  in  a comatose  condition.  The  skull  was  trephined,  and  the  ball  and  fragments  of  bone  were 
removed,  but  death  ensued  on  June  9th,  1862.  The  case  is  reported  by  Surgeon  A.  B.  Shipman,  U.  S.  V. 

Case. — Private  Jasper  W.  Burton,  Co.  C,  7th  West  Virginia  Volunteers,  aged  23  years,  received,  near  Swift  Run, 
Virginia,  May  30th  and  31st,  1864,  a gunshot  depressed  fracture  of  the  frontal  bone.  He  was  admitted  to  the  hospital  of  the  3d 
division.  Second  Corps,  where  the  operation  of  trephining  was  performed  by  Surgeon  H.  A.  Martin,  U.  S.  V.  The  patient  died 
shortly  afterward. 

Case. — Private  Llenry  S.  Brandt,  Co.  K,  7th  Connecticut  Volunteers,  aged  32  years,  was  wounded  at  Bennuda  Hundred, 
Virginia,  June  2d,  1864,  bj'  a conoidal  ball,  which  fractured  and  depressed  the  cranium  over  the  longitudinal  sinus.  He  was 
admitted  on  the  4th  into  the  general  hospital  at  Hampton,  Virginia,  and  transferred  on  June  8th,  entering  DeCamp  Hospital, 
David’s  Island,  New  York  Harbor,  on  the  10th.  Coma  had  supervened  on  the  19th,  when  Assistant  Surgeon  Warren  Webster, 
U.  S.  A.,  applied  the  trephine,  and  removed  a portion  of  the  fractured  bone,  revealing  extensive  comminution  of  the  inner  table. 
Simple  dressings  were  applied,  but  death  occurred  a few  hours  after  the  operation,  from  compression  of  the  brain.  A post-mortem 
examination  revealed  the  brain  much  engorged. 

Case. — Private  John  Blood,  Co.  A,  7th  New  York  Artillery,  was  wounded  at  Deep  Bottom,  Virginia,  August  14th,  1864, 
by  a shell,  which  severely  injured  the  cranium.  He  was  admitted  to  hospital  1st  division.  Second  Corps,  where  the  trephine  was 
applied  and  pieces  of  bone  were  removed.  He  was  taken  on  board  of  a transport  on  August  18th,  1864,  but  died  shortly 
afteiAvard. 

Case. — Captain  Allen  A.  Burnett,  Co.  K,  37th  Wisconsin  Volunteers,  aged  38  years,  was  wounded  at  Petersburg, 
Virginia,  July  30th,  1864,  by  a shell,  which  fractured  the  frontal  bone,  right  side;  he  received  at  the  same  time  a wound  in 
the  left  shoulder.  The  skull  was  trephined  upon  the  field  by  Surgeon. W.  B.  Fox,  8th  Michigan  Volunteers,  and  the  patient 
was  sent  to  Washington,  entering  Armory  Square  Hospital  on  August  1st.  Hsemon’liage  occurred  on  August  14th,  from  one 
of  the  branches  of  the  cerebral  arteries  and  was  arrested  by  a ligature.  Plis  strength  gradually  failed,  and  death  occurred  on 
August  16th,  1864.  The  case  is  reported  by  Surgeon  D.  W.  Bliss,  U.  S.  V. 

Case. — Corporal  Orville  Bannister,  Co.  I,  8th  New  York  Heavy  Artillery,  aged  18  years,  was  wounded  at  the  battle 
of  Petersburg,  Virginia,  June  22d,  1864,  by  a piece  of  shell,  which  caused  a penetrating  fracture  of  the  cranium.  He  was 
admitted  to  the  2d  division.  Second  Corps,  hospital,  where  the  trephine  was  applied  by  Surgeon  S.  Hiram  Plumb,  82d  New 
York  Volunteers.  The  patient  was  transferred  to  the  Campbell  Hospital,  Washington,  June  28th,  and  died  on  July  1st,  1864. 

Case. — Corporal  George  C.  Chase,  Co.  F,  8th  New  York  Heavy  Artillery,  aged  21  years,  was  wounded  at  the  battle 
of  Cold  Harbor,  Virginia,  June  3d,  1864,  by  a fragment  of  shell,  which  fractured  the  cranium,  driving  about  sixty  fragments 
of  bone  through  the  dura  mater  to  the  depth  of  about  half  an  iuch  into  the  brain  substance.  He  was,  on  the  same  day,  admitted 
to  the  hospital  of  the  2d  division,  Second  Corps;  on  June  8th,  transferred  to  the  Columbian  Hospital,  Washington;  and  on 
June  19th,  sent  to  the  McDougall  Hospital,  New  York  Harbor.  Inflammation  of  the  brain  set  in,  and,  on  June  30th,  chills 
occurred.  On  July  4th,  fragments  of  bone  were  removed,  and  on  July  7th,  the  operation  of  trephining  was  performed.  Death 
occurred  on  July  7th,  1864. 

Case. — Private  Milford  Clark,  Co.  C,  12r)th  New  York  Volunteers,  aged  20  years,  was  wounded  at  Spottsylvania, 
Virginia,  May  18th,  1864,  by  a conoidal  ball,  which  struck  the  cranium  half  an  inch  above  the  frontal  eminence,  and  passed 
posteriorly  four  inches,  lacerating  the  scalp  in  its  course.  He  was  admitted  into  the  1st  division,  Second  Corps,  hospital  on  the 
same  day,  and  thence  sent  to  the  Armory  Square  Hospital,  Washington,  on  the  28th,  where  the  wound  was  carefully  examined 
and  a fissure  of  the  outer  table  one  inch  in  length,  discovered.  The  operation  of  trephining  was  at  once  instituted,  and  the 
depressed  portion- of  the  inner  table  elevated.  Death,  preceded  by  coma,  however,  ensued  on  June  25th.  Surgeon  D.  W.  Bliss, 
U.  S.  V.,  reports  the  case. 

Case. — Private  William  Cole,  Co.  I,  50th  Pennsylvania  Volunteers,  was  wounded  at  the  siege  of  Knoxville,  Tennessee, 
November  19th,  1863,  by  a conoidal  ball,  which  penetrated  the  brain.  lie  was  conveyed  to  the  field  hospital  of  the  Ninth 
Corps,  where  Surgeon  James  I’.  Prince,  3fith  Massachusetts  Volunteers,  treidiined  the  skull,  and  removed  a piece  of  bone  one 
inch  in  diameter.  Death  supervened  <ni  December  2d,  1863. 


270 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Case. — Drivatu  Joseph  Cowan,  Co.  G,  78th  Ohio  Volunteers,  was  wounded  at  Bear  Creek,  Mississippi,  Februaiy  5th, 
1864,  by  a shell,  which  fractured  the  cranium  at  its  vertex.  He  was  immediately  conveyed  to  a field  hospital  in  the  vicinity, 
wher  e Surgeon  W.  S.  Edgar,  32d  Illinois  Volunteers,  trephined  the  skull.  Death  took  place  on  February  Gth,  1864. 

Case. — Private  li.  F.  C , 18th  Mississippi  Regiment,  aged  28  years,  was  wounded  at  the  battle  of  Chancellors- 

ville,  Virginia,  May  3d,  1863,  by  a musket  ball,  which  penetrated  the  cranium  near  the  upper  edge  of  the  left  temporal 
bone.  Trephining  was  performed,  and  the  ball  removed  on  the  10th.  He  was  conveyed  to  the  Confederate  general  hospital  at 
Charlottesville,  Virginia,  and  the  case  progressed  well,  without  any  symptoms  of  constitutional  disturbance,  until  July  3d,  when 
he  was  seized  with  general  convulsions,  which  lasted  with  great  severity  for  some  fifteen  minutes,  and  were  succeeded  in  about 
an  hour  by  a second  attack.  There  was  no  perceptible  cause,  but  the  patient  had  complained  of  headache  all  the  morning.  The 
convulsions  recurred  frequently;  at  first  with  irregular  intervals  until  the  15th,  the  later  ones  being  slight.  On  the  5th,  a 
cathartic  and  enema  were  administered,  producing  a copious  discharge.  The  bowels  were  kept  regular  by  cathartics,  stimulating 
diet  given,  and  cold  applications  were  made  to  the  head.  There  was  loss  of  power  in  the  right  arm,  with  partial  paralysis  of  the 
right  side,  impaired  speech,  and  imperfect  ideas.  On  the  8th,  several  fragments  of  both  tables  were  removed  through  a straight 
incision  about  one  and  a half  inches  in  length,  and  on  the  following  day  a small  spicula  resting  on  the  brain  was  removed. 
His  speech  had  improved  by  the  11th,  memory  and  ideas  by  the  13th,  and  the  wound  was  nearly  healed,  but  again  began  to 
discharge  on  the  15th,  and  on  the  18th  it  was  examined,  and  a spicula  removed.  The  head  symptoms  seemed  to  increase  on 
the  19th,  and  patient  appeared  languid  and  confused,  and  was  disposed  to  keep  the  head  low;  the  wound  was  nearly  healed 
and  not  discharging.  A severe  rigor  occurred  at  three  o’clock  P.  M.  of  the  21st,  and  patient  seemed  to  be  suffering  pain;  wound 
discharging  a sanious  pus.  An  incision  was  made  over  the  seat  of  injury,  and  an  exploration  with  probe  revealed  a large  abscess, 
which  was  emptied  of  about  two  ounces  of  purulent  matter.  He  passed  a very  restless  night,  and  on  the  following  morning 
was  greatly  prostrated;  pulse  100  and  feeble;  extremities  cool;  anorexia  complete;  nausea.  Egg-nogg,  one  ounce  eveiy  two  hours, 
was  ordered,  and  under  its  influence  reaction  was  fully  established  at  five  o’clock  P.  M. ; face  flushed;  pulse  120.  Patient  died 
at  five  o’clock  A.  M.  on  the  23d,  without  any  marked  change  in  his  condition  during  the  night.  At  the  autopsy,  the  opening 
through  both  tables  of  the  frontal  bone,  over  the  seat  of  injury,  measured  one  and  one-fourth  inches  from  the  line  of  sagittal 
suture  at  supra-posterior  angle  of  the  left  half  of  the  frontal  bone.  A widely  separated  fissure  extended  from  the  lower  border 
of  the  oval  opening,  and  parallel  with  the  line  of  sagittal  suture,  down  to  the  supra-orbital  ridge;  thence  obliquely  through  the 
orbital  plate  of  the  foramen  ctecum.  The  frontal  sinus  was  found  filled  with  pus.  Upon  examining  the  brain  and  its  membranes, 
a spicula  of  bone  was  found  imbedded  in  the  dura  mater,  and  resting  upon  the  brain.  The  membranes  were  much  discolored 
and  injected  for  some  distance  around  the  seat  of  injury.  The  substance  of  the  brain  was  found  to  be  softened  for  an  inch  around 
the  circumference  of  the  ragged  opening  in  the  dura  mater.  A large  cerebral  abscess  two  and  a half  inches  deep  by  one  and  a 
half  inches  in  diameter  existed,  from  which  the  pus  had  been  evacuated.  Purulent  lymph  was  found  effused  over  the  pons 
Varolii,  and  an  abnormal  quantity  of  serous  fluid  in  the  lateral  ventricles. 

Case. — Private  Patrick  Condon,  Co.  B,  27th  Connecticut  Volunteers,  received  at  the  battle  of  Fredericksburg,  Virginia, 
December  13th,  1852,  a gunshot  fracture  of  the  right  side  of  the  cranium.  He  was  conveyed  to  Washington,  and  on  December 
25th  admitted  to  Douglas  Hospital,  where  the  skull  was  trephined.  He  died  on  December  28th,  1862. 

Case. — Private  Matthew  Cantwell,  Co.  B,  3d  Minnesota  Volunteers,  received,  on  Se{)tember  22d,  1862,  a gunshot  fracture 
of  the  left  side  of  the  frontal  bone,  exposing  the  brain.  He  was  admitted  to  the  post  hosj)ital  at  Fort  Ridgely,  Minnesota, 
where  trephining  was  performed.  He  died  on  October  11th,  1862. 

Case. — Private  Joseph  Cendant,  Co.  H,  48th  New  York  Volunteers,  aged  37  years,  was  wounded  at  Olustee,  Florida, 
February  20th,  1864,  by  a round  musket  ball,  which  fractured  and  depressed  the  frontal  bone  at  its  centre.  He  was  taken  on 
board  the  hospital  transport  Cosmopolitan  and  conveyed  to  Beaufort,  South  Carolina,  entering  Hospital  No.  4,  on  the  23d,  whence 
he  was  returned  to  his  regiment  on  April  19th,  1864.  On  April  24th,  he  was  admitted  into  the  Hampton  Hospital,  Fort  Monroe, 
Virginia,  from  Yorktown,  as  a convalescent  from  gunshot  wpund  of  forehead,  and  on  April  26th,  sent  north.  He  entered  DeCamp 
Hospital,  David’s  Island,  New  York  Harbor,  on  the  29th  of  April,  and  remained  there  until  October  30th,  when  he  was  trans- 
ferred to  the  Ladies’  Home  Hospital,  New  Yoik  City.  The  wound  had  entirely  healed;  but  the  patient  suffered  from  tertian 
intermittent  fever  and  epilepsy,  the  latter  resulting  from  depressed  bone.  About  four  weeks  after  his  admission  the  wound 
reopened,  and  on  December  29th,  the  patient  being  greatly  depressed  from  the  recurrence  of  convulsions.  Surgeon  Alexander  B. 
Mott,  U.  S.  V.,  cut  down  upon  the  anterior  and  middle  portion  of  the  frontal  bone,  when  it  was  found  that  the  external  table  had 
exfoliated  to  the  extent  of  a ten  cent  piece.  The  inner  table  was  trephined,  and  the  depressed  portions  of  bone  were  removed; 
but  no  relief  was  afibrded,  and  death  occurred  on  the  same  day,  a few  hours  after  the  operation.  The  case  is  reported  by 
Surgeon  A.  B.  Mott,  U.  S.  V. 

Case. — Private  Joseph  Dupont,  Co.  G,  37th  Wisconsin  Volunteers,  aged  32  years,  was  wounded  near  Petersburg, 
Virginia,  April  2d,  1865,  by  a conoidal  ball,  which  fractured  the  left  parietal  bone.  He  was  immediately  conveyed  to  the  field 
hospital  of  the  1st  division.  Ninth  Corps,  where  the  operation  of  trephining  was  performed  the  same  day  by  Surgeon  W.  C. 
Shurlock,  51st  Pennsylvania  Volunteers.  About  one-tenth  of  the  bone  was  removed.  He  was,  on  April  7th,  transferred  to 
Campbell  Hospital,  Washington.  The  wound  was  doing  well,  but  the  patient  was  sufiering  from  inflammation  of  the  right  lung 
and  pleura.  He  was  transferred  to  Stanton  Hospital  on  July  8th,  where  he  died  on  September  2d,  from  phthisis. 

Case. — Corporal  Joel  Duel,  Co.  D,  37th  Wisconsin  Volunteers,  was  wounded  near  Petersburg,  Virginia,  July  27th,  1864, 
by  a musket  ball,  which  fractured  and  depressed  the  cranium  at  the  junction  of  the  sagittal  with  the  coronal  suture.  He  was 
conveyed  to  the  field  hospital  of  the  3d  division,  Ninth  Corps,  where  the  operation  of  trephining  was  performed.  Death  super- 
vened on  July  29th,  1864,  the  day  following  the  operation.  The  case  is  reported  by  Surgeon  W.  C.  Shurlock,  51st  Pennsylvania 
Volunteers. 


TEEPIIININO  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


271 


Case.— Corporal  R.  J.  Doromus,  Co.  G,  7tli  New  Jersey  Volunteers,  aged  24  years,  received,  at  Petersburg,  Virginia, 
June  17th,  18C4,  a gunshot  depressed  fracture  of  skull,  just  posterior  to  the  junction  of  the  sagittal  and  coronal  sutures.  He  was 
admitted  to  the  hospital  of  the  3d  division.  Second  Corps;  on  the  21st  sent  to  the  Carver  Hospital,  Washington,  and  on  the  28th 
transferred  to  the  Mower  Hospital,  Philadelphia.  Until  July  Sd,  the  patient’s  health  was  excellent  and  no  fracture  was 
suspected;  after  that  a complete  state  of  stupor  ensued,  and,  on  July  Gth,  Acting  Assistant  Surgeon  J.  H.  Jamar  made  a crucial 
incision  through  the  scalp,  applied  the  trephine,  and  removed  one-fourth  of  an  inch  of  bone  from  the  point  of  depression.  A 
large  amount  of  pus,  mingled  with  blood,  escaped  through  the  opening  made  in  the  bone,  but  failed  to  relieve  the  symptoms  of 
compression.  Sinapisms  were  applied  to  the  feet  and  neck,  and  extract  of  helebore,  tartrate  of  antimony,  and  potassa,  calomel 
and  brandy  administered  internally.  The  patient  sank  rapidly,  and  died  a few  hours  after  the  operation,  J uly  Gth,  18G4.  The 
autopsy  revealed  two  ounces  of  pus  anterior  to,  and  to  the  left  of,  the  fracture ; also  considerable  softening  of  the  right  lobe. 
The  case  is  reported  by  Surgeon  J.  Hopkinson,  U.  S.  V. 

Case. — Private  George  W.  Derrick,  Co.  D,  4Cth  Pennsylvania  Volunteers,  was  wounded  near  Petersburg,  Virginia,  July 
30th,  1864,  by  a fragment  of  shell,  which  fractured  the  cranium.  He  was  admitted  to  the  hospital  of  the  2d  division.  Ninth 
Corps,  wlvere  the  skull  was  trephined.  He  died  August  4th,  1864. 

Case. — Private  John  Eisin,  Co.  E,  38th  Georgia  Regiment,  was  wounded  at  Cedar  Creek,  Virginia,  October  19th,  1864, 
by  a shrapnel  shot,  which  caused  a compound  fracture  of,  the  skull  and  middle  third  of  the  left  arm.  He  was  taken  prisoner, 
conveyed  to  Winchester,  Vii’ginia,  and  placed  in  the  depot  field  hospital  of  the  Nineteenth  Corps,  where  fragments  of  the 
cranium  were  elevated  and  splints  applied  to  the  aim.  Death  ensued  October  24th,  from  gangrene  of  the  brain. 

Case. — Private  Gottlieb  Feisel,  Co.  K,  47th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Pocotaligo,  South 
Carolina,  October  22d,  1862,  by  a fragment  of  shell,  which  apparently  inflicted  a wound  in  the  scalp  on  the  left  side  of  the 
cranium,  extending  three  inches  from  before  backward  over  the  coronal  suture.  He  was  admitted  into  the  general  hospital  at 
Hilton  Head,  South  Carolina,  on  the  following  day,  when  the  head  was  shaved,  and  the  edges  of  the  wound  were  brought  into 
apposition  and  secured  with  sutures  and  adhesive  straps.  No  symptoms  of  depression  appeared  until  the  morning  of  the  27th, 
when  convulsions  supervened.  Acting  Assistant  Surgeon  Thomas  T.  Smiley  made  a crucial  incision,  and  upon  dissecting  the 
flap  discovered  that  the  parietal  bone  had  been  fractured  and  a portion  been  driven  in  upon  the  brain.  The  trephine  was  applied 
and  a triangular  piece  of  the  internal  table,  one  by  one  and  a half  inches,  extracted.  The  dura  mater  was  not  ruptured.  The 
symptoms  of  compression  immediately  disappeared,  and  for  four  or  five  days  the  progress  was  favorable,  but  meningitis  super- 
vened, and  death  resulted  on  November  9th,  1862.  This  case  is  reported  by  the  operator.  Acting  Assistant  Surgeon  T.  T.  Smiley. 

Case. — Private  Frederick  Gothe,  Co.  H,  11th  Illinois  Volunteers,- was  wounded  near  Vicksburg,  Mississippi,  May  2Cth, 
1833,  by  a conoidal  ball,  which  fractured  the  cranium  at  the  junction  of  lambdoidal  and  sagittal  sutures.  He  was,  on  May  22d," 
admitted  to  the  regimental  hospital,  and  on  the  27th  sent  to  Jackson  Hospital,  Memphis,  Tennessee.  On  the  following  day  gre^at 
stupor,  inability  to  answer  questions,  and  profuse  dianlioea,  with  involuntary  discharges,  supervened.  Simple  dressings  were 
applied  to  the  wound,  and  diarrhoea  mixture  ordered.  On  June  1st,  no  change  in  condition  had  occurred,  and  on  June  3d,  the 
trephine  was  applied,  and  some  fragments  of  bone  were  removed,  giving  exit  to  an  ounce  of  pus  from  the  interior  of  the  cranium. 
The  operation  failed  to  relieve  the  symptoms;  diarrhoea  returned  on  the  Gth,  patient’s  strength  began  to  fail,  and  the  discharge 
from  the  wound  became  very  profuse.  Death  supervened  on  June  7th,  1863.  The  autopsy  revealed  an  extensive  abscess  at  the 
inner  border  of  the  left  hemisphere  of  the  posterior  lobe  of  cerebrum.  The  dura  mater  had  sloughed  off  at  the  junction  of 
sagittal  and  lambdoidal  sutures. 


Case. — Private  John  J.  Gay,  Co.  G,  64th  Georgia  Regiment,  was,  on  June  19th,  1864,  admitted  to  Jackson  Hospital, 
Richmond,  Virginia,  with  a gunshot  wound  of  head.  On  June  28th  the  skull  was  trephined,  but  death  occurred  on  the  following 
day,  June  29th,  1834. 

Case. — Priva  Vi  Hugh  Gonigan,  Co.  A,  39th  Illinois  Volunteers,  aged  37  years,  was  wounded  at  Petersburg,  Virginia, 
May  16th,  1834,  by  a rifle  ball,  which  extensively  lacerated  the  scalp  and  caused  a compound  comminuted  fracture  of  the 
os  frontis.  He  was  admitted  to  the  Tenth  Corps  field  hospital  on  the  18th,  and  sent  to  the  hospital  at  Hampton,  Virginia,  on  the 
19th.  On  the  22d,  Acting  Assistant  Surgeon  II.  13.  White  applied  the  trephine,  and  extracted  several  pieces  of  the  inner  plate, 
which  had  been  driven  in  upon  the  brain  substance.  Patient’s  general  condition  was  good,  though  he  was  somewhat  debilitated. 
On  the  24th  erysipelas  supervened,  and  doath  ensued  on  June  3d,  1864. 

Case. — Private  Gottlieb  Hagelburger,  Co.  F,  51st  Ohio  Volunteers,  was  wounded  at  the  battle  of  Chickamauga,  Georgia, 
September  19th,  1863,  by  a musket  ball,  which  struck  the  right  parietal  bone,  slightly  grooving  the  outer  table.  He  was 
admitted  to  the  hospital  of  the  3d  division,  Twenty-first  Corps,  and  thence  conveyed  to  Hospital  No.  8,  at  Nashville,  Tennessee, 
on  the  28th.  There  was  some  fever  and  slight  mental  disturbance,  but  no  contraction  or  change  in  the  pupils;  the  wound  was 
sloughing.  Water  dressings,  frequently  repeated,  and  snlph.  mag.  were  ordered.  The  symptoms  of  compression  gradually 
increased,  till  stertorous  breathing  set  in  on  the  morning  of  October  2d.  The  trephine  was  now  applied  over  the  scat  of 
fracture,  and  all  compressing  bone  removed,  giving  exit  to  a small  amount  of  pus.  The  operation  failed  to  relieve  the  symptoms, 
and  death  ensued  on  October  4th,  1833.  The  inner  table  presented  a stellate  fracture;  several  spiculm  of  bone  had  penetrated 
the  dura  mater,  and  were  imbedded  in  the  brain  substance.  The  case  is  reported  by  Acting  Assistant  Surgeon  L.  C.  Fonts. 

Case. — Private  . I ohn  Heise,  Co.  15,  23th  Illinois  Voluntoers,  received,  near  Atlanta,  Georgia,  .Inly  29th  to  August  ITth, 
18.54,  a gunshot  fracture  of  the  left  parietal  bone.  He  was,  on  August  l.Cth,  admitted  to  hospital  Fifteenth  Corp.s,  where,  on 
August  17th,  Surgeon  D.  P.  Halderruau  trephined  the  skull  while  the  |)atient  was  under  the  inllueiice  of  chloroform.  Death 
occurred  on  August  21  st,  18.>1. 


272 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Case. — Private  William  II.  Ililborn,  Co.  K,  SCtli  Now  York  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of 
Mine  Run,  Virginia,  November  27tb,  18G3,  by  a conoidal  ball,  which  fractured  the  angle  of  the  frontal  bone,  on  the  left  side  of 
the  head,  and  lodged.  He  was  admitted  to  the  1st  division.  Third  Corps,  hospital  on  the  same  day,  and  transferred  to  the  3d 
division  hospital,  Alexandria,  Virginia,  on  December  4th.  Four  days  later  the  skull  was  trephined,  but  the  patient  sank 
gi'adually  into  a comatose  condition,  and  died  on  the  13th.  The  autopsy  revealed  the  ball,  lying  impacted  between  the  hard  and 
soft  palates.  The  case  is  reported  by  Acting  Assistant  Surgeon  A.  G.  Smith. 

Case. — Sergeant  William  N.  Irvin,  Co.  B,  1st  battalion,  1st  Minnesota  Volunteers,  aged  25  years,  was  wounded  on  June 
18th,  18C4,  near  Petersburg,  Virginia,  by  a conoidal  ball,  which  entered  the  frontal  bone,  in  the  immediate  vicinity  of  the  lef 
frontal  eminence,  passed  inward,  and  lodged.  He  was  conveyed  to  the  field  hospital  of  the  2d  division.  Second  Corps,  and  on 
June  22d,  transferred  to  the  Carver  Hospital,  Washington.  On  June  25th,  he  was  placed  under  the  influence  of  ether,  and 
Surgeon  O.  A.  Judson,  U.  S.  V.,  removed  sequestra,  trephined  the  edge  of  the  fracture,  and  removed  several  pieces  of  cloth  and 
the  missile  from  the  interior  of  the  cranium.  The  liacture  was  neatly  circular,  and  about  one  inch  in  diameter.  Considerable 
swelling  existed  in  the  immediate  vicinity  of  the  wound,  and  the  left  upper  eyelid  was  ocdematous.  The  patient  reacted 
promptly,  and  appeared  to  be  quite  easy ; there  being  no  cerebral  symptoms  or  coma.  During  the  day,  however,  he  was 
attacked  with  delirium,  which  contiued  unabated  until  June  28th,  1864,  when  death  ensued.  The  autopsy  revealed  a compound 
comminuted  fracture  of  both  tables  of  the  os  frontis,  the  missile  having  passed  through  the  membranes  of  the  brain,  slightly 
wounding  the  left  hemisphere  of  the  cerebrum.  The  brain  was  completely  disorganized;  it  being  a reddish,  granular  mass. 
Both  lateral  ventricles  were  distended  with  pink  fluid.  A coating  of  lymph  was  found  covering  the  dura  mater  at  the  base  of 
the  brain.  The  case  is  reported  by  Surgeon  O.  A.  Judson,  U.  S.  V. 

Case. — Corporal  John  Johnson,  Co.  G,  8th  Iowa  Volunteers,  aged  20  years,  received,  at  Shiloh,  Tennessee,  April  6th, 
1832,  a compound  fracture  of  the  skull.  He  was  conveyed  to  the  field  hospital,  2d  division.  Thirteenth  Corps,  and  subsequently 
transferred  to  Paducah,  Kentucky.  The  skull  was  depressed,  and  the  patient  suffered  from  compression  of  brain  and  erysipelas. 
On  April  15th  the  operation  of  trephining  was  performed,  but  death  supervened  twenty-four  hours  after  the  operation. 

Case. — Private  A.  Kirl-patncTc,  Co.  II,  44th  Tennessee  Regiment,  received,  at  the  battle  of  Perryville,  Kentucky,  October 
8th,  1862,  a severe  gunshot  fracture  of  the  cranium,  with  large  depression.  He  was,  on  the  same  day,  admitted  to  the  Confederate 
hospital  at  Perryville,  where  the  skull  was  trephined,  and  several  spiculm  of  bone  were  removed.  He  died  on  October  30th, 
1862.  At  X\\(i  post-mortem,  examination,  many  spiculm  of  bone  and  abscesses  below  the  dura  mater  evere  discovered.  The  case 
is  reported  by  Surgeon  D.  W.  Yandell,  P.  A.  C.  S. 

Case. — Private  William  Lentz,  Co.  K,  14th  Iowa  Volunteers,  received,  at  Fort  Donelson,  Tennessee,  February  13th,  1862, 
a severe  gunshot  wound  of  head.  He  was  admitted  to  regimental  hospital,  where  the  operation  of  trephining  was  performed. 
No  particulars  are  reported.  He  died  on  March  6th,  1832. 

Case. — Captain  W.  W.  Liggett,  Co.  H,  12th  Ohio  Volunteers,  received,  at  the  battle  of  South  Mountain,  Maryland, 
September  14th,  1862,  a gunshot  fracture  of  the  top  of  the  arch  of  the  cranium.  The  dura  mater  was  badly  torn  by  the  missile. 
He  was  at  once  admitted  to  the  field  hospital  at  Middletown,  where  the  operation  of  trephining  was  performed  by  Surgeon  John 
McNulty,  U.  S.  V.,  on  the  same  day.  The  patient  W’as  rational  on  the  morning  following  the  operation,  but  died  on  September 
21st,  1862. 

Case. — Private  Charles  H.  Leonard,  Co.  H,  57th  Massachusetts  Volunteers,  aged  22  years,  was  wounded  at  the  battle 
of  the  Wilderness,  Virginia,  May  6th,  1864,  by  a conoidal  ball,  which  fi-actured  the  left  parietal  bone  at  its  eminence.  He  was 
conveyed  to  Washington,  and  entei-ed  Columbian  Hospital  on  May  11th.  TJie  wound  was  in  good  condition,  the  bone  being 
slightly  fractured  but  not  depressed,  but  the  patient  was  nearly  comatose  and  greatly  prostrated.  On  May  15th,  Acting  Assistant 
Surgeon  H.  D.  Vosburg  removed  portions  of  the  left  parietal  bone  with  the  trephine,  and  then  took  out  a fragment  of  the  inner 
table,  which  was  lying  loose  on  the  dura  mater.  Stimulants  and  nourishment  were  freely  administered,  but  the  coma  became 
gradually  more  complete,  and  the  patient  died  on  May  17th,  1864,  from  cerebritis. 

Case. — Corporal  Philander  D.  L , Co.  II,  1st  Maine  Heavy  Artillery,  aged  28  years,  was  wounded  at  the  battle  of 

Spottsylvauia  Court-house,  Virginia,  May  19th,  1864,  by  a conoidal  ball,  which  inflicted  apparently  only  a lacerated  wound  of 
the  scalp,  over  the  superior  anterior  angle  of  the  left  parietal  bone.*  He  was  conveyed  to  Washington,  and  on  the  23d,  admitted 
to  the  Araiory  Square  Hospital.  On  examination  the  external  table  was  found  to  be  fissured  and  denuded  of  periosteum.  Up  to 

May  30th  the  patient  did  not  show  any  symptoms  of  compression  of  the 
brain,  but  on  that  day  he  had  a chill.  On  the  31st  he.  was  placed  under 
the  influence  of,  ether.  Surgeon  D.  W.  Bliss,  U.  S.  V.,  then  applied  the 
trephine  over  the  seat  of  injury,  and  excised  a disk  one  inch  in  diameter, 
including  only  the  outer  table  and  diploii.  The  inner  table  of  the  skull 
was  found  to  be  intact,  but  friable  and  easily  broken.  Several  pieces  of 
this  were  removed,  as  was  also  a clot  which  had  formed  between  the  inner 
table  and  the  dura  mater.  Simple  dressings  were  applied  and  tonics 
administered,  but  pyaemia  set  in,  and  death  ensued  on  June  8th,  1864. 
The  specimen  is  represented  in  the  wood-cut,  and  consists  of  a disk  and 
five  fragments  of  bone.  The  largest  fragment  is  from  the  inner  table,  and 
measures  three-fourths  by  one  and  one-fourth  inches.  The  disk  is  one  inch 
ixi  diameter,  and  includes  the  outer  table  and  diploii  only.  The  specimen 
and  history  were  contributed  by  Surgeon  D.  W.  Bliss,  U.  S.  V. 

*Auother  repert  frcni  the  Ariin  ry  S<ii'.aro  Hcspilal  states  that  the  ianer  tahlc  was  dejiresscd  at  the  anterior  superior  angie. 


Fig.  138. — I>isk  and  five  fragments  from  left  parietal, 
removed  hy  trephining  after  gunshot  fracture  by  a musket 
ball.  Spec.  2383,  Sect.  I,  A.  M.  M.  [Nat.  size.] 


TKEPIIINTNG  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


273 


Cask. — Private  Franldin  Leliniaii,  Co.  F,  184tli  Pennsylvania  Volunteers,  aged  22  years,  was  wounded  before  Peter.sbnrg, 
Virginia,  October  1st,  18(54,  by  a conoidal  musket  ball,  wbicb  fractured  tbo  frontal  bone.  He  was  at  once  admitted  to  tbo  hospital 
of  the  2d  division.  Second  Corjis,  where  the  skull  was  trephined,  the  ball  removed,  and  cold  water  dressings  were  a]5pliod.  He 
was  conveyed  to  Washington,  and  admitted  on  the  8tb  into  the  Campbell  Hospital.  Death  resulted  on  Octobe*17tb,  1864. 

Cask. — Private  William  Lynch,  Co.  F,  122d  Illinois  Volunteers,  aged  22  years,  was  wounded  near  Nashville,  Tennessee, 
December  ICth,  1864,  by  a musket  ball,  wbicb  penetrated  tbe  frontal  bone.  He  entered  the  Cumberland  Hospital.  Nashville, 
Tennessee,  on  tbe  following  day,  and  w.as  on  tbe  18tb  transferred  to  Hospital  No.  4,  New  Alb.any,  Indiana.  Tbe  wound  evinced 
no  disposition  to  beal,  small  quantities  of  pus  escaping  continually  from  tbe  external  opening.  Tbe  patient  became  comatose, 
tbe  pupils  contracted,  and  secretions  scant.  On  January  3d,  18G5,  Acting  Assistant  Surgeon  Jobn  Sloan  trepbined  tbe  skull  at 
tbe  seat  of  injury.  Water  dressings  were  applied  to  tbe  wound,  and  stimukants  administered.  Tbe  operation  failed  to  relievo 
tbe  coma,  and  tbe  patient  died  on  Janu.ary  4tb,  1865.  Tbe  autopsy  revealed  an  eflusion  of  pus  from  tbe  seat  of  injury  to  tbe 
base  of  tbe  brain.  Tbe  case  was  reported  by  Acting  Assistant  Surgeon  S.  J.  Alexander. 

Cask. — Private  H.  S.  McC , Co.  A,  4tb  Georgia  Regiment,  aged  27  years,  w.as  wounded  at  tbe  battle  of  Cbancellorsville, 

Virginia,  M.ay  3d,  1863,  by  a conoidal  ball,  wbicb  fr.actured  tbe  frontal  bone  two  inebes  above  tbo  internal  cantbus  of  tin;  right 
eye.  Tbe  internal  table  was  comminuted.  He  was  admitted  into  Lincoln  Hospital,  Wasbington,  on  tbe  7tb,  being  rather  stupid, 
but  not  complaining  of  pain.  These  symptoms  continued  until  tbe  evening  of  tbe  14tb,  when  be  appeared  to  be  in  a comatose 
condition,  and  began  to  pass  bis  urine  involuntarily.  On  May  15tb,  at  four  o’clock  P.  M.,  bis  skull  was  treiibined,  and  tbe 
depressed  portions  of  tbe  outer  and  fragments  of  tbe  inner  table  were  removed,  giving  exit  to  a quantity  of  iluid  resembling 
pus  in  color  and  consistency.  Tbe  comatose  condition  was  relieved  by  tbe  operation,  but  de,atb  supervene<l  on  May  16tb.  Tbe 
patbologic.al  specimen  is  No.  1125,  Sect.  I,  A.  M.  M.  Tbe  vault  of  tbe  cranium  is  trepbined  just  internally  to  tbe  right  frontal 
eminence.  The  diameter  of  tbe  opening  is  tbree-fourtbs  of  an  inch.  Tbe  specimen  and  history  were  contributed  by  Acting 
Assistant  Surgeon  H.  M.  Dean. 

Cask. — Private  Hiram  McDaniels,  Co.  D,  149tb  Pennsylvania  Volunteers,  was  wounded  .at  Spottsylvania,  Virginia,  May 
lOtb,  1864,  by  a conoid.al  ball,  wbicb  fractured  tbe  cr.anial  bones.  He  was  admitted  to  tbe  held  hospital  of  tbe  4th  division. 
Fifth  Corps,  where  tbe  operation  of  trephining  was  performed.  On  May  12tb,  be  was  sent  to  general  bo.spital,  but  probably 
died  on  tbe  way,  as  no  further  information  can  be  obtained. 

Case. — ^Private  Dominick  McC.all,  Co.  E,  65tb  New  York  Volunteers,  aged  38  years,  was  woundial  at  tbe  b.attb!  of 
Winchester,  Virgini.a,  October  19tb,  1864,  by  a conoidal  ball,  wbicb  entered  neiir  tbe  posterior  fontanelle,  and  emerged  abont 
an  inch  posterior  to  the  foramen  magnum.  He  was  on  the  same  day  admitted  to  tbe  hospital  of  tbe  1st  division.  Sixth  Corp.s, 
where  the  skull  was  trephined..  On  October  23d,  be  was  sent  to  tbe  Patterson  Park  Hospital,  IJaltimore,  Maryland.  Simple 
dressings  were  applied,  and  nourishing  diet  administered.  He  appeared  to  suffer  from  compression  of  tbe  brain,  altbougb  no 
bone  could  be  seen  or  felt  pressing  on  the  brain.  On  tbe  evening  of  the  25tb  be  became  unconscious,  and  died  on  October  26tb, 
1834.  Tbe  case  is  reported  by  Acting  Assistant  Surgeon  M.  Kempster. 

Case. — Captain  J.  K.  Mclvor,  Co.  F,  8tb  South  Carolina  Regiment,  was,  on  September  17tb,  1863,  admitted  to 
tbe  hospital  at  Chester,  Penmsylv.ani.a,  with  a gunshot  fracture  of  tbe  frontal  bone.  On  October  4tb,  be  was  transferred  to  tbe 
hospital  at  Point  Lookout,  ^Maryland.  A resection  of  tbe  front.al  bone  was  performed,  but  death  from  compression  of  tbo  brain 
occurred  on  October  15tb,  1863. 

Case. — Private  Robert  McCormick,  Co.  E,  29tb  Pennsylv.ania  Volunteers,  aged  23  years,  received,  .at  Pine  Knob, 
Georgia,  June  1.5tb,  1834,  a gunshot  fracture  of  tbe  os  frontis.  He  was  conveyed  to  tbe  field  hospital  at  Cb.att.anoog.a,  and 
admitted  there  on  .June  20tb.  Tbe  skull  was  trepbined,  and  tbe  pieces  of  bone  were,  on  June  22d,  elevated  and  remov'ed  by 
Assistant  Surgeon  C.  C.  Byrne,  U.  S.  A.  Cold  water  dressings  were  applied,  but  tbe  case  terminated  fatally  on  June  3Utb,  1864. 
Tbe  case  is  reported  by  tbe  operator. 

Case. — Private  Michael  Murr.ay,  Co.  E,  56tb  Massachusetts  Volunteers,  received,  at  tbe  battle  of  Spottsylvania  Court- 
house, Virginia,  M.ay  12th,  1834,  a gunshot  wound  of  sc.alp;  ball  lodged  at  vertex  of  bead.  Fie  was  admitted  to  bosjutiil  of  tbe 
1st  division.  Ninth  Corps,  and  on  May  14tb  sent  to  Ninth  Corps  Hospital  at  F’redericksburg,  where  tbe  skull  was  ti'cpbined.  lie 
died  on  May  17 tb,  1864. 

Case. — Private  James  J.  Monaghan,  Co.  K,  42d  New  York  Volunteers,  aged  25  years,  was  wounded  at  the  battle  of 
Antietam,  Maryland,  September  17tb,  1862;  tbe  missile  fracturing  tbe  left  paiietal  bone  .about  two  inebes  from  tbe  s.agitt.al  suture. 
He  was  conveyed  to  the  Hoffman  Hospital,  where  bis  skull  was  trepbined.  On  September  25tb,  bo  was  transferred  to  FVedorick', 
Maryland,  in  a semi-conscious  condition;  pulse  80,  tongue  coated,  pu])ils  dilated,  skin  hot  and  dry;  right  arm  entirely  and  right 
leg  partially  paralyzed ; be  passed  urine  and  faeces  involuntarily.  On  tbe  following  d.ay  Ids  condition  was  tbe  same;  saline 
cathartics  were  ordered,  wbicb  operated  quite  freely,  and  on  September  27tb,  bis  pulse  was  140  and  we.akcr.  He  was  very 
restless  during  the  early  pai-t  of  the  day ; still  passed  urine  and  faeces  involuntarily;  quite  unconscious;  b.ad  a chill  at  two  o’clock 
P.  M.,  and  passed  a very  restless  night;  chills  recurred  on  tbe  f)llowiiig  morning;  pulse  140  and  easy  ; convergent  strabismus  of 
right  eye.  Considerable  haemorrhage  occurred  from  tbe  wound  during  tbe  morning;  later  in  tbe  d.ay  coma  supervened ; tbe 
countenance  became  almost  livid,  and  the  patient  dual  on  Septemb(!r  29tb,  1862,  in  a semi-comatose  condition. 

Case. — Private  A.  Nourse,  Co.  II,  12tb  Missouri  Volunteers,  received,  near  Kenesaw  Mountain,  Georgi.a,  .Tune  1.5tb,  1864, 
a gunshot  fracture  of  the  cranium.  He  was  at  once  adnntted  to  the  liospital  of  tbe  1st  division,  F'ifteentb  Corps,  when?  Surg(‘on 
A.  T.  Hudson,  26tb  Iowa  Volunteers,  trephined  the  skidl,  one  hour  after  tlie  recejition  of  tbe  injury.  Tbe  palicnt  died  on  tbe 
same  day,  .June  15tb,  1864. 

35 


274 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Lioiiteiiant  T1’lho»  B.  Newman,  Co.  A,  13tli  Virginia  Erginiciit,  aged  25  years,  was  wounded  at  the  l)attle  of 
Wincliester,  Virginia,  Senteinher  19tli,  18(54,  by  a piece  of  sliell,  whicli  fractured  the  left  ))arietal  hone  to  one-half  its  extent. 
J'he  scalp  was  e.xtensively  lacerated.  The  patient  was  at  once  aihnitted  to  the  dei)ot  held  hospital  at  Winchester,  where  the 
trephine  was  ai)iilfc‘d  hy  Surgeon  A.  Atkinson,  I*.  A.  C.  S.  The  dejn-essed  bone  was  tlien  elevated  and  all  loose  fragments  were 
removed.  Cold  water  dr<;ssiugs  were  applied  to  the  head,  and  generous  diet  ordered.  The  operation  failed  to  relieve  the  patient, 
who  had  been  unconscious  since  the  reception  of  the  injury,  and  death  ensued  on  September  27th,  1864,  from  compression  of  the 
brain. 

Case. — Corporal  James  15.  O’Keafe,  Co.  C,  68th  Pennsylvania  Volunteers,  aged  36  3'ears,  was  wounded  at  the  battle  of 
Mine  Run,  Virginia,  November  27th,  1863,  b_v  a conoidal  ball,  which  fractured  and  depressed  the  left  side  of  the  os  frontis  above 
the  outer  portion  of  the  superciliary  ridge.  He  was  conveyed  to  Alexandria,  Virginia,  and  admitted  into  the  3d  division  hospital, 
December  5th.  Twm  days  later  he  complained  of  intense  ])ain  in  the  head  ; his  skin  was  hot  and  dry,  the  pulse  frequent,  and 
his  bowels  wmre  constipated.  The  skull  was  trephined  by  Surgeon  Edwin  Bentley,  U.  S.  V.,  and  spiculm  of  bone  were  removed 
while  the  patient  was  under  the  inlluence  of  ether.  Simi)le  dressings  were  applied  to  the  W'ound,  cathartics  administered,  and 
low’  diet  ordered.  Extensive  suppuration  supervened,  and  death  followed  on  the  13th,  from  inflammation  of  the  brain  and  its 
membranes.  At  the  autopsy,  the  membranes  of  the  brain  w’ere  found  infiltrated  with  pus.  Coagulable  Ij’inph  and  serum 
existed  in  the  cavity  of  the  arachnoid,  and  the  brain  was  softened  and  congested.  Acting  Assistant  Surgeon  W.  G.  Elliott 
reports  the  case. 

Ca.se. — Adolph  Oehme,  Musician,  Co.  I,  32d  Indiana  Volunteers,  was  wounded  at  Liberty  Gap,  Tennessee,  June  26th, 
1863,  by  a conoidal  musket  liall,  which  fractured  and  depressed  the  left  j>arietal  bone  at  its  inferior  and  external  angle,  injuring 
the  brain  subst;mce.  He  was  admitted  into  the  field  hospital  at  Murfreesbon)’,  Tennessee,  on  the  same  day,  being  conscious, 
though  dull  and  unsteady'  in  his  gait.  Surgeon  I.  Moses,  U.  S.  V.,  trephined  the  skull,  removed  all  loose  fragments,  and  elevated 
others.  The  external  table  W’as  fractured  and  depressed  one  square  inch;  the  depression  of  the  inner  table  W’as  more  extensive. 
Ho  rallied  well  from  the  operation,  and  the  symptoms  w’ere  apparently  favorable  until  July  3d,  when  coma,  and,  shortly 
afterw’ard,  death,  supervened.  The  case  is  reported  by  the  operator. 

Case. — Pi  ivate  David  Piatner,  Co.  C,  39th  New  York  Volunteers,  was  wounded  at  the  battle  of  Cold  Harbor,  Virginia; 
June  1st,  1884,  by  a cotioidal  ball,  which  fractured  the  cranium.  He  was  on  the  same  day  admitted  to  hospital  of  the  1st 
division.  Second  Corps,  where  Surgeon  P.  E.  Hubon,  28th  Massachusetts  Volunteers,  trephined  the  skull.  The  result  is  not 
known,  but  the  patient  probably’  died. 

Case.- — Private  John  Quinlin,  Co.  H,  2d  Illinois  Cavalry,  aged  28  years,  received,  on  April  8th,  1864,  at  Pleasant  Hill, 
Louisiana,  a gunshot  fracture  of  both  tables  of  the  anterior  portion  of  the  left  parietal  bone.  He  was  admitted  into  tbe  field 
hosj)ital  of  the  cav.alry  division,  and  thence  conveyed  to  New  Orleans,  Louisiana,  and  admitted  into  the  Marine  Hospital  on 
A])ril  14th.  The  following  morning  he  comjdained  of  headache,  which  gradually’  increased,  and  (he  fiice  w’as  in  an  erysipelatous 
condition.  On  the  morning  of  the  20th,  vomiting  set  in,  and  in  the  afternoon  coma  supervened.  On  A])ril  21st,  Surgeon  Jacob 
Bockee,  U.  S.  V.,  performed  the  operation  of  trephining,  in  order  to  relieve  .sy’inptoms  of  compres.sion  supposed  to  have  been  caused 
by’  an  accumulation  of  pus  on  the  brain,  or  perhaps  by’  depression  of  the  internal  table.  The  bone  was  found  denuded  of 
])eriosteum  to  the  extent  of  three-cpiarters  of  .an  inch  in  width  by’  two  and  a half  inches  in  length.  Pus  to  the  extent  of  h.alf  an 
ounce  was  found  in  the  diploic  structure ; also  on  the  surface  of  the  hrain.  The  patient  was  comatose,  but  sensible  to  the  pain 
of  the  o])eration,  which  failed  to  relieve  the  sy’injrtoms.  He  w.as  delirious  and  noisy  during  the  following  night ; then  became 
quiet  and  continued  so  until  the  23d,  when  death  sui)ervened  from  inttammation  and  suppuration  of  the  brain  and  its  membranes. 
The  case  is  I’eported  by  the  operator,  Sui'geon  J.  Bockee,  U.  S.  V. 

C.VSE. — Private  I’hilip  R , Co.  I,  lOth  New  York  Volunteers,  was  wounded  at  the  battle  of  F'redericksburg,  Virginia, 

December  13th,  1862,  hy  a gunshot  rii.ssile,  which  fractured  and  dej)ressed  the  left  parietal  bone,  just  behnv  the  tuberosity’.  He 
was  .admitted  into  the  Ascension  Church  Hospital,  Washington,  on  the  17lh,  ji.artially’  insensible,  but  answering  when  spoken  to 
sharply.  The  ))Ui)ils  were  nearly  normal,  i)ulse  72,  ami  gradually’  becoming  slower  and  more  suggestive  of  approaching  coma. 
On  the  19th,  the  patient  was  placed  under  the  influence  of  chloroform,  and  Surgeon  J.  11.  Brinton,  U.  S.  V.,  assisted  by  Surgeon 
J.  C.  Dorr,  U.  S.  V.,  and  Dr.  Brodie  of  Edinborough,  performed  the  operation  of  trephining.  The  depressed  fragments  were 
elevated  and  removed,  causing  considerable  haemorrhage,  which  gradually  ceased  after  the  operation.  At  seven  o’clock  P.  M., 
the  pulse  was  68,  tlu’eady’  and  .sh.arp ; ])atient  semi-conscious  and  complaining  of  cold.  The  next  morning  the  pupils  were 
nearly  normal ; pulse  78;  breathing  natural,  but  bowels  not  open.  There  w.as  considerable  haemorrhage  at  noon,  which  was 
I’eadily  checked.  Afterward,  coma  gradually’  supervened,  the  ])upils  became  dilated  and  insensible  to  light,  and  involuntary 
urinations  occurred.  He  continued  to  sink  rapidly,  and  died  on  the  morning  of  December  22d,  1862,  in  a state  of  complete 
coma.  The  |)athological  specimens  are  Nos.  528,  965,  and  966.  The  former  shows  a section  of  the  vault  of  cr.anium,  with  one 
disk  and  seven  fragments  from  the  left  parietal  bone.  The  two  latter  are  wet  pre])arations  of  the  dura  mater  and  the  loft  cerebral 
hemisphere  containing  an  abscess.  The  specimens  were  contributed  by  Surgeon  J.  C.  Dorr,  U.  S.  V. 

Case. — Private  William  G.  Risher,  Co.  E,  139th  Pennsylvania  Volunteers,  aged  22  y’ears,  was  wounded  in  the  defences 
of  Washington,  July’  12th,  1864,  by  a conoidal  ball,  which  fractured  the  frontal  bone  three-fourths  of  an  inch  to  the  right  of  the 
median  line  and  half  an  inch  anterior  to  the  coronal  suture,  and  lodged.  He  was  admitted  to  Campbell  Hospital  on  the  13th 
in  a comatose  condition,  and  on  the  same  day  Acting  Assistant  Surgeon  E.  A.  Kemp  applied  the  trephine,  and  removed  the  ball 
and  fragments  of  hone  which  had  been  driven  two  inches  into  the  brain  substance.  Ice  was  applied  to  the  head,  ])urgatives 
administered,  and  abstinence  from  food  rigidly  enforced.  Death  supervened  on  July  15th,  1864.  The  case  is  reported  by 
Surgeon  .1.  H.  Baxter,  U.  S.  V. 


TREPHINING  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


Cask. — Sergeant  Willard  Robeck,  Co.  G,  5tli  Iowa  Cavalry,  was  treated  in  tlie  regimental  liosjiital  near  Fort  Donelson, 
Tennessee,  for  injury  and  compression  of  tbe  brain.  When  and  where  the  injury  was  veceived  cannot  be  definitely  ascertained, 
but  tbe  operation  of  ti'ej'bining  was  performed.  Death  occurred  April  24tli,  1833. 

Case. — Private  L.  Scliumpcrt,  Co.  F,  20th  South  Carolina.  Shell  fracture  of  the  left  temporal  bone,  July  18th,  1803. 
Trephining  August  10th.  Death,  August  11th,  1863.  Autopsy.* 

Case. — Corporal  Charles  Stotter,  Co.  C,  11th  Kansas  Volunteers,  received  at  the  battle  of  Prairie  Grove,  Arkansas, 
December  7th,  1802,  a gunshot  wound  of  the  head,  witli  fracture  of  the  jiosterioi'  portion  of  the  right  ])arietal  bone.  Ho  \vas 
admitted  into  the  regimental  hospital  on  the  following  day,  where  trephining  was  resorted  to.  Fungous  tecrescences  formed 
ni)on  the  brain  a few  days  later,,  and  were  removed  by  caustic  a])j)hcations.  About  the  twelfth  day  after  the  operation,  an 
abscess  was  developed  in  the  cerebral  substance,  and  death  resulted  therefrom  December  27th,  1802.  The  case  is  reported  hy 
Surgeon  George  W.  Hogeboom,  11th  Kansas  Volunteers. 

Case. — Private  John  Sperber,  Co.  A,  OCth  New  York  Volunteers,  aged  43  years,  was  wounded  at  the  battle  of  Antietam, 
Marj'land,  September  17th,  1862,  by  a conoidal  musket  ball,  which  fractured  and  depressed  the  cranium  at  the  junction  of  the 
occipital  and  parietal  bones,  driving  fragments  into  the  brain  substance.  Ho  was  admitted  to  the  field  hospital,  and  cold  water 
dressings  were  applied.  Convulsions  and  insensibility  ensued,  whereupon  Surgeon  C.  S.  Wood  tre|jhined  and  elevated  tin; 
depressed  portion,  removing  all  detached  fragments  of  bone.  The  lodgment  of  the  missile  was  not  ascertained.  Consciousnt'ss 
was  restored  by  the  operation,  but  convulsions  recurred,  and  the  patient  died  on  September  23d,  1802.  The  case  is  reported  by 
tlie  operator.  Surgeon  C.  S.  Wood,  66th  New  York  Volunteers. 

Case. — Private  G.  W.  Summers,  Co.  F,  11th  New  Hampshire  Volunteers,  was  wounded  near  Petersburg,  Virginia,  July 
22d,  1864,  by  a shell,  which  fractured  the  cranium.  He  was  immediately  conveyed  to  the  field  hospital  of  the  2d  division,  Nintli 
Corps,  where  the  operation  of  trephining  was  performed.  He  was  thence  sent  to  Washington,  but  death  supervened  on  the  30th 
wliile  on  the  way.  The  case  is  reported  by  Surgeon  Theodore  S.  Christ,  45th  Pennsylvania  Volunteers. 

Case. — Sergeant  Eugene  13.  Stinson,  Co.  F,  12th  Maine  Volunteers,  aged  28  yeans,  was  wounded  at  Winchester,  Virginia, 
September  19th,  1864,  by  a conoidal  ball,  which  fractured  the  frontal  bone,  about  half  an  inch  to  the  left  of  the  median  line,  and 
two  inches  below  the  coronal  suture.  He  was  admitted  to  the  hos])ital  of  the  1st  division,  Nineteentli  Corps,  on  the  same  day; 
on  September  22d  sent  to  the  depot  field  hospital  at  Winchester,  and  on  the  25th  transferred,  via  Sandy  Hook,  Maryland,  to  the 
Mower  Hospital,  Philadelphia.  In  the  course  of  ten  days  after  admission,  premonitory  head  syin])toms  of  a violent  and 
unmistakable  character  exhibited  themselves,  and  the  patient  became  rapidly  comatose.  On  October  12th  he  was  chloroformed. 
Acting  Assistant  Surgeon  W.  P.  Moon  then  made  a crucial  incision  through  the  integument,  trephined  the  frontal  bone  at  the 
margin  of  fracture,  to  the  left  of  the  median  line,  and  one  inch  below  the  coronal  suture,  elevated  the  depressed  bone,  and 
removed  a section  of  the  outer,  and  seven  spicula;  of  the  inner  table.  The  internal  table  was  fractured  and  driven  down  u])on 
the  membranes,  while  the  outer  table  was  only  slightly  indented,  neitlier  fissure  nor  fracture  being  perceptible.  The  patient 
reacted  promptly,  and  continued  to  improve  for  three  days.  The  pulse  became  fuller  and  more  regular,  the  coma  lessened,  and 
the  cerebral  symptoms  subsided.  On  the  fourth  day  he  had  a chill,  com|)lained  of  pain  in  the  epigastric  region,  and  his  respiration 
became  hurried.  The  next  day  he  began  to  sink  rapidly,  coma  returned,  and  death  followed  on  October  18th,  1804.  A.  post- 
mortem examination  revealed  an  abscess  in  the  left  hemisphere,  at  the  point  of  injuiy.  The  membranes  were  much  congested. 
The  case  is  reported  by  Acting  Assistant  Surgeon  W.  P.  Moon. 

Case. — Private  H.  L.  Smith,  Co.  13,  1st  Arkansas  Regiment,  received,  at  the  battle  of  Shiloh,  Tennessee,  Aj)ril  0th,  1802, 
a fracture  of  the  occipital  bone.  He  was,  on  April  17th,  admitted  into  Hospital  No.  6,  Louisville,  Kentucky,  the  wound  being  in 
a bad  condition.  On  the  22d  chloroform  was  administered,  and  Assistant  Surgeon  Benjamin  Howard,  U.  S.  A.,  ai)])lied  the 
trephine,  and  removed  some  loose  bone.  Partial  coma  supervened  and  continued  until  death,  which  occurred  on  April  25th,  1802. 

Case. — Lieutenant  William  D.  Sprouse,  Co.  B,  40th  Illinois  Volunteers,  was  wounded  near  Atlanta,  Georgia,  August  1.5th, 
1864,  by  a conoidal  ball,  which  fractured  the  left  parietal.  He  was  at  once  admitted  to  hospital  4th  division.  Fifteenth  Corp.s, 
where,  six  hours  after  the  reception  of  injury.  Assistant  Surgeon  William  Graham,  4(!th  Illinois  Volunteers,  trephined  the  skull; 
the  patient  being  under  the  influence  of  chloroform.  Ho  was  on  the  same  day  sent  to  the  hosjiital  of  the  Fifteenth  Corps,  at 
Marietta,  and  died  on  August  23d,  1634. 

Case. — Private  Isaac  Souls,  Co.  H,  23d  South  Carolina  Regiment,  aged  19  years,  received,  on  August  30th,  1862,  a gunshot 
fracture  of  the  frontal  bone,  near  the  anterior  fontanelle,  and  directly  on  the  median  line,  lie  was  admitted  into  the  Confederate 
hospital  at  Charlottesville,  Virginia,  and  on  September  5th,  the  trephine  was  applied  to  the  right  of  the  median  line,  to  avoid  the 
longitudinal  sinus.  Owing  to  the  existence  of  a lateral  deviation,  the  sinus  was  exposed  u])on  removing  the  disk  of  bone,  but  not 
injured.  One  week  after  the  operation,  severe  chills  set  in,  followed  by  fever  ; then  double  ])neumonia  made  its  appearance,  with 
symptoms  of  pyrnmia,  and  sixteen  or  seventeen  days  after  the  operation,  the  patient  died  suddenly  during  a fit  of  coughing,  from 
rupture  of  the  longitudinal  sinus,  and  profuse  hasmorrhage.  A post-mortem  examination  revealed  ulceration  of  the  coats  of  the 
siuiis,  with  small  spiculae  of  bone  resting  upon  it.  The  case  is  re|)orted  by  Assistant  Surgeon  B.  W.  Allen,  P.  A.  C.  S. 

Ca.se. — Private  William  Thompson,  Co.  E,  12th  Illinois  Infantiy,  was  wounded  at  Allatoona,  Georgia,  October  5th,  1804, 
by  a conoidal  ball,  which  fractured  the  external  table  of  the  right  ])arietal  bone.  He  was  on  the  same  day  admitted  to  the 
hospital  of  the  4th  division.  Fifteenth  Corps,  .and  on  the  9th  sent  to  the  general  hos])ital  at  Rome,  Georgia.  On  the  14th,  violent 
convulsions  occurred;  the  patient  was  placed  under  the  influence  of  chloroform  and  ether,  when  Surgeon  J.  H.  Grove,  U.  S.  V., 
applied  the  trephine,  and  removed  fragments  of  necrosed  bone,  giving  exit  to  a <]uantity  of  |>us  which  had  formed  beneath  the 
bone.  Consciousness  returned,  and  the  convulsions  subsided  soon  after  the  operation,  but  returned  on  the  following  <lay;  coma 
supervened,  and  death  occurred  on  October  10th,  1804. 


B'or  a fuU  history  of  tlii.s  case,  see  the  Manual  of  Military  .Surgery,  page  12111!,  by  Dr.  ,J.  J.  Chisolm.  18(it. 


276 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Josopb  A.  Tmcej',  Musician,  Co.  H,  18th  Connecticut  Volunteers,  aged  20  years,  was  wounded  at  Snicker’s  Ferry, 
Virginia,  July  20tli,  1804,  by  a conoidal  ball,  wbicb  fractured  the  right  parietal  bone.  He  was  conveyed  to  Sandy  Hook,  Mary- 
land, and  admitted  into  the  hospital  on  the  23d.  On  the  following  day  Assistant  Surgeon  James  Willard,  1st  Potomac  Homo 
Brigade,  applied  the  treidiine  and  elevated  the  dej)ressed  portion.  The  meninges  were  found  lacerated.  .Simple  dressings  were 
applied,  but  death  ensued  on  August  7tb,  1804. 

Case. — Private  Julius  Theobald,  Co.  D,  32d  Indiana  Volunteers,  was  wounded  at  Shiloh,  Tennessee,- April  Cth,  1862,  by 
a fragment  of  shell,  which  fractured  and  depressed  the  cranium.  He  was  admitted  to  the  General  Hospital,  No.  3,  Evansville, 
Indiana,  on  the  12th,  where,  on  the  following  day,  his  skull  was  trephined.  He  was  removed  by  his  friends  to  a private  house, 
and  died  on  the  3d  of  May,  1832.  The  case  is  reported  by  Surgeon  Daniel  Morgan,  U.  S.  V. 

Case. — Private  IF.  A.  Tatum,  Co.  B,  12th  Tennessee  Regiment,  aged  25  years,  was  wounded  near  Atlanta,  Georgia,  May 
17th,  1834,  by  a conoidal  ball,  which  struck  the  upper  edge  of  the  right  parietal  bone,  causing  depression  of  both  tables  of  the 
skull.  One  houi-  after  the  leception  of  the  injury,  the  trephine  was  applied,  and  all  spicute  of  bone  were  removed.  He  was 
admitted,  on  the  following  day,  to  the  Institute  Hospital  at  Atlanta.  He  was  fully  conscious,  free  from  all  pain,  and  able  to  walk 
about  the  ward.  On  May  20th,  the  pulse  was  70,  and  he  complained  of  slight  headache,  which  had  increased  by  the  23d.  On 
the  following  day  there  was  no  pain,  and  the  patient  was  apparently  doing  well.  From  this  time  he  gi’ew  chdl,  lost  his  appetite, 
became  totally  unconscious;  on  May  28th,  brain  substance  began  to  slough,  and  death  occurred  on  June  1,  18G4.  The  case  is 
reported  by  Surgeon  D.  C.  O’Keefe,  P.  A.  C.  S. 

Case. — Private  X , a Confederate  soldier,  was  wounded  at  Fort  Donelson,  Tennessee,  February  IGth,  1862,  by  a 

musket  ball,  which  entered  the  occipital  bone  one  inch  to  the  left  of  the  occipital  protuberance,  passed  between  the  tables, 
comminuting  and  depressing  the  internal,  and  made  its  exit  one  and  a half  inches  to  the  right  of  the  same  protuberance, 
without  iissuring  the  external  table.  Two  d.ays  later  he  was  admitted  to  the  Academy  Hospital,  Nashville.  He  seemed  drowsy 
and  dull,  but  was  not  comatose,  nor  did  paralysis  exist.  He  was  placed  under  the  influence  of  chloroform  and  ether,  the  scalp 
was  dissected  from  the  wound,  and  the  bridge  of  bone  between  wounds  of  entrance  and  exit  w-as  removed.  The  trephine  was 
then  applied  to  the  angles  of  the  wound,  and  fragments  of  the  inner  table  were  removed,  laying  bare  the  sinuses  and  thq 
torcular  Herophili,  without  injury  to  the  meninges,  and  leaving  an  opening  between  the  bony  margins  of  the  wound  of  sufficient 
size  to  admit  two  fingers  placed  side  by  side.  The  dura  mater  was  uninjured.  The  flaps  were  brought  together  by  silken 
sutures.  Cold  water  dressings  were  applied,  and  the  bowels  freely  evacuated.  Tincture  of  iron  was  given  to  control  the 
circulation.  The  patient  continued  perfectly  conscious ; his  mental  faculties  retained  their  accustomed  activity,  and  he  was  soon 
able  to  sit  11)5.  The  sutures  had  come  away,  the  wound  of  scalp  had  nearly  healed,  and  his  gen<u-al  condition  seemed  very 
promising,  when,  on  the  tenth  day  after  the  operation,  erysipelas  manifested  itself  on  the  nose,  and  extended  rapidly  over  the 
face  and  neck  to  the  lips  of  the  wound.  Delirium  set  in  on  the  twelfth  day,  and  death  supervened  two  days  subsequently, 
March  4th  1832.  The  case  is  reported  by  Surgeon  Eben  Swift,  U.  S.  A. 

Case. — Private  Ezra  O.  White,  Co.  D,  4th  Wisconsin  Volunteers,  received  in  the  engagement  at  Port  Hudson,  Louisiana, 
June  14th,  1833,  a gunshot  wound  of  the  cranium,  involving  the  brain.  He  was  on  June  IGth  admitted  to  St.  Louis  Hospital, 
New  Orleans,  Louisiana,  where,  on  June  18th,  t+ie  operation  of  trephining  was  performed.  No  relief  was  afforded,  and  death 
occurred  on  July  3d,  1863.  Surgeon  F.  Bacon,  U.  S.  V.,  reported  the  case. 

Case. — Private  P.  C.  Walker,  Co.  E,  4th  Delaware  Volunteers,  aged  24  j'ears,  was  wounded  at  Ream’s  Station,  Virginia, 
August  19th,  1864,  by  a shell,  which  fractured  the  skull  near  the  junction  of  coronal  with  the  sagittal  suture.  He  was  on  the 
same  day  admitted  to  the  hospital  of  the  4th  division.  Fifth  Corps,  and  thenCe  conveyed  to  Philadelphia,  and  admitted  to  the 
Mower  Hospital  August  29th.  The  wound  was  in  a healthy  condition,  but  the  face  was  swollen  and  oedematous,  with  symptoms 
of  erysipelas.  The  patient’s  general  health  was  good,  and  there  were  scarcely  any  symptoms  of  compression.  On  September 
9th,  Acting  Assistant  Surgeon  W.  P.  Moon  placed  the  patient  under  the  influence  of  chlorofoi-m,  made  a semi-lunar  incision 
through  the  integument,  and  trephined  the  skull.  A large  abscess  had  formed  between  the  membranes  of  the  brain  and  the 
cranium.  Death  from  meningitis  supervened  on  September  18th,  1864,  nine  days  after  the  operation.  The  case  is  reported  by 
Surgeon  J.  Hopkinson,  U.  S.  V. 

Case. — Sergeant  Lafayette  Young,  2d  Co.  of  Sharpshooters  attached  to  the  27th  Michigan  Volunteers,  aged  27  years, 
was  wounded  at  the  battle  of  the  Wilderness,  Virginia,  May  5th,  1864,  by  a conoidal  musket  ball,  which  fractured  the  skull  at 
the  sagittal  suture.  He  was  conveyed  to  Washington,  and  on  the  25th  admitted  to  the  Harewood  Hospital.  The  man’s  mind 
was  sound,  although  strabismus  of  the  left  eye  indicated  symptoms  of  compression  of  the  brain.  'Phe  left  leg  was  partially 
paralj’zed.  On  Slay  28th,  he  was  placed  under  the  influence  of  ether,  and  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  applied  the 
trephine  to  the  left  edge  of  the  wound,  removed  the  loose  bone,  and  elevated  the  depressed  ])ortions.  The  patient  improved 
under  antiphlogistic  treatment,  and  on  June  1st  healthy  suppuration  supervened.  Two  weeks  later,  the  left  leg  became  entirely 
free  from  j)aralysis.  On  July  1st  small  pieces  of  bone  were  removed,  and  the  wound  looked  unfavorable.  On  the  23d,  Young 
was  transferred  to  the  St.  Mary’s  Hospital,  Detroit,  Michigan,  affected  with  strabismus  of  the  left  eye  and  paralysis  of  the  left  leg. 
He  was  furloughed  on  August  2d,  but  died  before  the  expiration  of  his  leave  of  absence,  August  21st,  1864. 

Case. — Private  Albert  D.  Nelson,  Co.  D,  12th  New  Hampshire  Volunteers,  was  wounded  at  Ch.ancellorsville,  Virginia, 
klay  3d,  1863,  by'a  conoidal  ball,  which  fractured  and  depressed  the  squamous  portion  of  temporal  bone,  laying  the  seal))  open 
some  three  inches,  and  glanced  off.  The  trephine  was  at  once  applied  by  Surgeon  C.  S.  Wood,  66th  New  York  Volunteers,  and 
the  lower  fragments  were  removed,  the  depressed  portions  elevated,  and  water  dressings  applied.  He  was  then  conveyed  to 
hospital  of  the  1st  division.  Third  Corps,  and  on  May  6th  sent  to  Lincoln  Hospital,  Washington.  On  May  25th,  he  was 
transferred  to  Fort  Wood,  New  York  Harbor,  and  on  June  3d  to  IMcDougall  Hospital,  Fort  Schuyler,  whence  ho  deserted  July 
20th,  1863.  Promoted  corporal  b'chruary  .5th,  1K64.  Died,  of  disease,  at  Bristol,  New  Hampshire,  February  10th,  1865. 


TREPHINING  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL.  277 

The  following  cases  of  trephining  for  gunshot  fracture  resulted  in  recovery,  the 
patients  presenting  various  degrees  of  disability  : 

Case. — Corpora*!  J.  A.  B , Co.  C,  2d  Now  Hampsliire  Volunteers,  aged  21  yeai’s,  was  ■wounded  at  the  battle  of 

Gettysburg,  Pennsylvania,  July  2d,  1863,  by  a fragment  of  shell,  which  fractured  and  depressed  the  ujiper  portion  of  the  occipital 
bone  to  the  extent  of  two  inches  square.  He  was  admitted  into  the  Sattcrlee  Hospital,  Philadelphia,  on  the  ICth,  very  much 
debilitated,  and  complaining  of  pain  over  his  eyes.  His  mental  foculties  were  somewhat  sluggish,  but  not  to  any  marked  dcgi’cc. 

A fragment  of  bone  had  come  away  leaving  the  brain  exposed.  The  trephine  was  applied  and  the  largest  piece  of  depressed 
bone  removed.  On  January  9th,  1864,  another  portion  of  tin;  occipital  bone  of  an  oval  shape,  two  inches  in  its  long  diameter, 
and  including  both  tables,  was  removed  by  Acting  Assistant  Surgeon  L.  K.  Baldwin.  He  had  some  inllammation  of  the  brain 
aiid  erysipelas,  but  recovered  under  ordinary  treatment.  On  March  1st,  1864,  he  was  transferred  to  DeCamp  Hospital,  David’s 
Island,  New  York  Harbor,  where  ho  remained  until  Juno  7th,  1864,  when  he  was  discharged  from  the  service  by  reason  of 
vertigo  and  constant  pain  in  the  head.  The  itathological  specimen.  No.  430,  consists  of  a necrosed  fragment  of  the  occiitital  bone 
and  was  contributed  by  Acting  Assistant  Surgeon  L.  K.  Baldwin.  A communication  from  the  Commissioner  of  Pensions  dated 

January  2d,  1838,  states  that  B is  a pensioner,  and  that  his  disability  is  rated  as  total  and  permanent.  The  case  is  reported 

by  Acting  Assistant  Surgeon  T.  G.  Morton. 

Case. — Lieutenant  Samuel  11.  Berry,  Co.  D,  82d  Ohio  Volunteers,  was  wounded  in  an  engagement  at  Bull  Pasture 
Jloiintain,  Virginia,  May  8th,  1832,  by  a conoidal  ball,  which  passed  under  the  scalp  for  about  two  inches  on  the  surface  of  the 
left  parietal  bone  and  emerged.  There  was  no  depression  and  but  a slight  fracture  of  the  outer  table.  After  the  first  shock 
there  were  no  apparent  brain  symptoms  until  the  fifth  day,  when  pain  in  the  localit}^  of  the  wound  and  mental  aben-ation  super- 
vened. They  did  not  yield  to  treatment,  and  the  third  day  following  found  the  patient  in  a state  of  coma.  As  a last  resort  it 
was  determined  to  trephine,  which  was  done  on  the  ninth  day  after  the  injury  by  Surgeon  J.  Y.  Cantwell,  82d  Ohio  Volunteers. 

The  internal  table  was  now  found  to  be  extensively  fractured,  and  thirteen  spiculac  of  bjme  were  removed,  one  piece  having 
pierced  the  membranes  and  penetrated  the  substance  of  the  brain.  After  the  operation  there  was  a marked  improvement  in  the 
symptoms,  notwithstanding  the  patient  was  afterward  attacked  by  erysipelatous  inllammation  of  the  seal]")  and  face;  he  gi’adually 
and  finally  recovered,  and  was  discharged  fi’om  the  service  on  August  19th,  1862.  The  case  is  reported  by  the  operator. 

Case. — Private  David  B , Co.  E,  ICOth  Pennsylvania  Volunteers,- aged  33  years,  was  wounded  at  Petersburg, 

Virginia,  June  17th,  1864,  by  a conoidal  ball,  which  fractured  the  left  parietal  bone  at  the  central  portion  and  superior  border  of 
the  temporal  ridge.  He  was  admitted  on  the  same  day  to  the  field  hospital  of  the  Ninth  Corps,  and  thence  conveyed  to  Wash- 
ington, and  admitted  to  the  Ilarewood  Hospital  on  the  2d  of  July.  On  the  17th,  he  was  sent  to  the  Mower  Hospital,  Philadel- 
])hia.  On  admittance,  the  wound  appeared  to  be  only  one  of  the  scalp.  Cold  Avater  dressings  Avere  applied ; calomel,  tonics, 
anodynes,  and  light  diet  ordered,  and  the  patient  placed  in  a recumbent  position,  Avith  the  head  elevated.  On  July  20th,  ho 
evinced  a want  of  comprehension  Avhen  addressed,  and  hesitated  in  replying.  From  that  date  there  Avas  a groAving  tendency  to 
coma,  and  on  the  29th  he  Avas  completely  unconscious.  His  pupils  Avere  dilated,  respiration  Avas  labored,  and  pulse  sIoav  and 
soft.  On  the  30th,  ether  Avas  administered,  and  Acting  Assistant  Surgeon  D.  H.  AgneAV  ajjplicd  the  trephine  and  removed  a 
section  of  the  outer  and  four  small  fragments  of  the  inner  talde,  involving  one-third  of  a square  inch  of  surface.  A small  abscess 
Avas  found  forming  ontside  of  the  membranes.  Immediately  after  the  operation,  consciousness  and  intelligence  returned.  By 
the  1st  of  August  the  wound  had  commenced  to  granulate  ; the  patient  Avas  cheerful  and  his  appetite  improving.  In  two  Aveeks 
he  Avas  able  to  go  about  the  Avard,  though  suffering  from  pain  in  the  head  upon  exposure  to  the  sun.  He  was  discharged  from  • 

service  on  September  22d,  1864.  The  pathological  specimen  is  No.  3626,  Sect.  I,  A.  kl.  M.,  and  consists  of  four  small  fragments 
of  the  parietal  bone,  chiefly  from  the  inner  table.  The  specimen  and  history  Avere  contributed  by  Surgeon  J.  Hopkinson,  U.  S.  V. 

Case. — Private  LaAATence  Coffield,  Co.  E,  34th  Illinois  Volunteers,  aged  30  years,  Avas  Avounded  at  the  battle  of 
Murfreesboro’,  Tennessee,  January  1,  1863,  by  a conoidal  ball,  Avhich  struck  the  right  temple;  he  also  received  a Avound  of 
the  left  thigh.  He  Avas  on  January  5th  admitted  to  Hospital  No.  19,  Niishville,  Tennessee ; on  January  10th  sent  to  Hospital 
No.  10,  Louisville,  Kentucky,  and  on  .January  27th  to  Camp  Dennison,  Ohio.  No  treatment  is  recorded.  He  Avas  discharged 
from  the  service  on  August  14th,  1863,  but  reenlisted  in  Co.  H,  123d  Indiana  Volunteers,  on  February  24th,  1864.  He  served 
Avith  the  latter  regiment  until  August  0th,  1864,  Avhen  he  Avas  Avounded  near  Atlanta,  Georgia.  The  missile  entered  near  the 
occipital  protuberance,  passed  to  the  bone,  and  then  into  the  neck,  making  its  exit  near  the  ear.  He  Avas  admitted  to  the  field 
hospital  of  the  TAventy-third  Corps;  on  September  20th  sent  to  Hospital  No.  19,  Nashville,  Tennessee;  on  October  19th  to  the 
BroAvn  Hospital,  Louisville,  Kentucky,  and  on  December  19th  to  the  Main  Street  Hospital,  Covington,  Kentucky.  The  occipital 
bone  Avas  necrosed.  The-  patient’s  health  was  good,  but  the  muscles  of  the  face  and  tongue  Avere  partially  paralyzed.  On 
examination,  a fistula  Avas  found  on  the  right  side  of  the  head,  just  above  the  arch  of  the  malar  bone,  into  Avhich  a probe  conld 
be  passed  one  and  a half  inches,  to  the  skull.  A ball  Avas  found  imbedded  at  the  base  of  the  petrous  portion  of  the  temporal  bone; 
the  rim  (base)  of  the  missile  lying  just  inside  of  the  skull.  A sinus  extended  along  the  track  of  the  missile.  The  ball  had  been 
there  since  the  battle  of  ilurfreesboro’,  Tennessee,  January  1,  1833.  On  February  24th,  1835,  an  incision  Avas  nmde  by  Surgeon 
Nonuan  Gay,  U.  S.  V.,  the  trephine  applied  to  enlarge  the  opening,  and  the  ball  i-emoved.  Coffield  recovered  as  fast  as  could  bo 
expected;  Avas  on  June  10th  sent  to  Camp  Dennison,  Ohio,  and  on  July  .5,  186.5,  mustered  out  of  the  service.  The  case  is 
reported  by  the  operator.  Surgeon  Norman  Gay,  U.  S.  V.  This  soldier’s  name  is  imt  on  the  I’ension  List. 

Case. — Private  .John  F.  D , Co.  E,  178th  Noav  York  Volunteers,  aged  37  years,  Avas  accidentally  Avounded  on  .July 

12th,  1863,  by  a conoidal  ball,  Avhich  struck  the  parietal  bone  half  an  inch  posteriorly  to  the  coronal,  and  one  inch  to  the  left  of 
the  sagittal  suture.s,  passing  backward,  and  emerging  about  four  inches  from  the  ])oint  of  entrance.  He  Avas  admitted  into 
Armory  Square  Hospital,  Wasliingtoii,  the  next  day,  in  a somewhat  stupid  imd  restless  condition,  Avith  anxious  countenance. 


278 


WOUNDS  AND  IN.JUEIES  OF  THE  HEAD 


Partial  paralysis  of  arm,  and  paralysis  agitaiis  of  forearm  of  the  opposite  side  existed.  An  examination  of  the  wound  revealed 
depression  of  a small  portio)i  of  the  external  plate,  one-half  inch  in  length  by  one-qnai-ter  of  an  inch  in  width.  A fissure 

extended  one  inch  and  three-fourths  posteriorly  from  the  de])ressed  portion 
of  the  bone.  The  fracture  of  both  tables  could  he  readily  recognized  by 
the  pulsating  motion  of  the  lliiid  which  had  accumulated  in  the  cavity. 
Surgeon  D.  W.  lEiss,  U.  S.  V.,  applied  the  trephini'  over  the  depressed 
portion.  Great  difficulty  was  experienced  from  the  detached  portions  of 
the  inner  table  moving  under  the  trephine.  These  fragments  were  removed 
by  means  of  forceps.  The  dura  mater  was  abraded  at  several  points,  but 
not  torn  through.  After  the  operation,  the  wound  was  carefully  cleansed, 
water  dressings  were  apjdied,  the  patient  placed  in  a semi-recumbent 
position,  and  quiet  enjoined.  A gradual  improvement  took  jilace,  and  by 
July  29th  the  ease  presented  all  indications  of  a speedy  recovery.  Paralysis 
steadily  diminished.  He  was  sent  to  the  DeCamp  Hospital,  New  York 
Harbor,  October  29th,  1863,  and  transferred  to  the  Veteran  Kesei  ve  Corps, 
March  3d,  1865.  The  specimen  is  figured  in  the  wood-cut,  and  shows  a 
disk  and  five  fragments  of  hone.  One  and  a half  square  inches  of  the 
internal  table  were  removed.  The  specimen  and  history  were  contributed 
by  Surgeon  D.  W.  Bliss,  II.  S.  V. 

Ca.sk. — Private  John  E , Co.  C,  39th  New  York  Volunteers,  aged  35  years,  was  wounded  in  a melee  in  a railroad 

car,  near  Chicago,  Illinois,  November  16th,  1862,  by  a pistol  ball,  wdnch  caused  a comjionnd  fracture  of  both  tables  of  the 
osfi-ontis,  right  side,  near  the  border  of  the  temporal  bone.  He  arrived  at  Washington  on  the  20th,  and  was  admitted  to  Armory 
S<juare  Hospital,  being  quite  delirious.  There  was  much  tumefaction,  and  extensive  suppuration  had  already  commenced.  His 
strength,  ai)petite,  and  secretions  wen^  normal,  his  pulse  slightl}' accelerated  and  tense.  An  examination  revealed  awound  of  the 
seal]),  two  inches  in  length,  crossing  the  coronal  suture  at  right  angh'S,  two  inches  above  the  border  of  the  temporal  bone.  On 
the  moridng  after  admission,  the  delirium  was  so  intense  that  it  was  impossible  to  keep  the  patient  in  the  ward.  There  was 
occasional  difficulty  in  articulation  and  a tripiiing  of  the  left  foot  in  walking,  denoting  slight  hemi]degia.  The  memory  was 
somewhat  impaired,  but  lucid  intervals  occurred.  The  constitutional  symptoms  had  remained  the  same,  denoting  irritation 
rather  than  compression  of  the  brain.  On  the  22d,  the  tumefaction  having  somewhat  subsided,  a further  examination  revealed 
another  wound  of  the  seal]),  one  and  a half  inches  below  the  first,  and  a ball  imbedded  in  the  cranium.  Ether  W'as  administered 
and  an  incision  made  through  the  integument.  The  trephine  was  then  applied,  and  the  pm-tion  of  thecrainum 
containing  the  ball  was  removed,  as  also  a fragment  of  the  inner  table,  triangular  in  shape,  three-eighths  of  an 
inch  in  length  and  one-fourth  of  an  inch  in  width  at  the  base.  The  latter  was  found  driven  into  the  substance 
of  the  brain,  piercing  the  dura  mater  and  standing  point  downward,  its  broad  base  displacing  the  meningea 
media.  After  the  ojieration  the  patient  rose  from  the  table,  perfectly  sane,  and  walked  to  his  bed.  Cold  water 
dressings  were  apjilied,  laxatives  administered,  and  low  diet  ordered,  and  by  the  25th  he  was  improving 
rapidly,  there  having  been  no  delirium  since  the  oj)eration.  On  December  10th,  the  general  health  of  the  patient 
was  good,  and  the  wound  across  the  coronal  suture  had  nearly  closed  by  healthy  graimlations.  The  wound  of 
operation  had  healed  by  first  intention,  except  at  the  place  where  the  fia])s  met ; at  that  point  there  was  healthy 
granulation  going  on.  On  January  6th,  1863,  he  was  discharged  from  the  service,  having  entirely  recovered. 
The  specimen  removed  is  a disk  of  bone,  one-half  an  inch  in  diameter,  with  fracture  and  depression  of  both  tables,  and  was 
contributed  by  Surgeon  D.  W.  Bliss,  U.  S.  V.  It  is  figured  in  the  wood-cut. 

Cask. — Private  Charles  IM.  E , Co.  H,  17th  Pennsylvania  Cavalry,  aged  21  years,  was  wounded  at  Shepherdstown, 

Virginia,  August  25th,  1864,  by  a musket  ball,  which  entei'ed  the  right  parietal  bone  near  the  sagittal  suture  and  emerged  at  the 
jiosterior  superior  angle  of  the  left  ])arietal  hone,  ])roducing  a compound  comminuted  fracture.  The  ball  in  its  j)as8age  carried 
away  a j)iece  of  the  external  table  one  and  a half  inches  in  length,  and  half  an  inch  in  width,  and  depressed  the  inner  table.  He 
was  taken  to  Sandy  Hook,  Maryland,  and  thence  convej’ed  to  Annapolis  Junction  on  August  27th.  Complete  j)aralysis  of  the 
right  and  partial  of  the  left  leg  existed.  I’atient  w’as  debilitated  and  anaemic ; had  lost  considerable  blood,  and  was  much 
deju’essed,  i)hysically  and  mentally.  Acting  Assistant  Surgeon  Streeter  applied  the  trephine  to  the  external  table  and  removed 
fragments  of  the  fractmvd  and  deju'essed  inner  table,  leaving  the  brain  pulsations  distinctly  visible.  The  soft  parts  were  then 
brought  together  with  adhesive  stri])s,  and  cold  water  dressings  apjdied,  lint  and  diy  oakum  being  substituted,  when  the  wound 
began  to  supi)ui’ate.  The  pulse  daily  increased  in  frequency  and  strength  until  it  reached  72,  and  the  patient  regained  the  use 
of  his  limbs  sufficiently  to  walk  with  a cane.  On  October  10th,  he  was  transferred  to  Haddington  Hospital,  Philadelphia,  the 
wound  closing  with  healthy  granulations  and  bidding  fair  to  heal  rai)idly.  He  was  transferred  to  the  Veteran  Reserve  Corps  on 
March  2d,  1865,  and  discharged  June  28th,  1865.  The  pathological  specimen  is  No.  3600,  Sect.  I,  A.  M.  M.,  and  consists  of  a 
disk  and  six  fragments  of  dij)loe  and  vitreous  table  removed  by  the  trephine  from  the  left  parietal  bone.  The  case  is  reported  by 
Acting  Assistant  Surgeon  H.  S.  Streeter.  On  March  19th,  1866,  Pension  Examiner  J.  G.  Koehler  reports  that  the  patient  sutlers 
from  partial  paralysis  of  the  left  side  of  the  body.  He  rates  his  disability  one-half  and  temporary. 

Ca.se. — Private  Samuel  G , Co.  C,  183d  Pennsylvania  Volunteers,  aged  17  years,  was  wounded  at  the  battle  of 

Spottsylvania  Court-house,  Virginia,  May  12th,  1864,  hy  a conoidal  ball,  which  depressed  the  right  parietal  bone  at  its  posterior 
superior  angle.  A spicula,  one  and  one-fourth  inches  in  length  and  three-fourths  of  an  inch  in  breadth,  was  driven  in  upon  the 
dura  mater.  He  was  admitted  to  the  hos])ital  of  the  1st  division,  Second  Corps,  and  on  the  23d  sent  to  the  Armory  Square 
Hospital,  Washington.  Slight  ]).aralysis  of  the  left  leg  and  hand  existed.  The  juipils  were  normal,  but  the  tongue  protruded. 
There  were  also  slight  symi)toms  of  comju'ession.  On  the  following  day,  the  patient  was  j)laced  under  chloroform,  and  Surgeon 


Fiu.lto.— Disiv 
with  a depressed 
^^iiiishot  fracture 
in  its  centre. — 
tSpec.  422,  Sect.  I, 
A.  M.  M.  1. 


Fify.  139. — Dish  and  fragments  roint-vcd  fer  gunshot 
fracture  of  the  parietal  bone.  1474,  ^cct.  I, 


TKEPHINING  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


279 


D.  W.  Rliss,  IT,  S.  V.,,  fivpliined  tho  skull  and  removed  twelve  piece.s  of  bone.  Tlie  dura  mater  was  ruptnr('(l,  anil  tlie  pulsa- 
tions of  the  brain  were  distinctly  visible.  Simide  dressings  were  apjdied,  and  on  ISIay  ~9tli  the  patient  was  doing -well.  On 
July  17th,  he  was  transferred  to  l’hiladeli)hia  and  admitted  into  the  Mower  Hospital,  where  he  remained  until  .lainiary  28th. 
1865,  when  he  was  transferred  to  the  Veteran  Reserve  Corps.  The  ]>athological  specimen  is  No.  2375.  Sect.  I,  A.  JI.  IM.,  and 
consists  of  a disk  and  three  small  fragments  of  bone.  The  specimen  and  history  were  contributed  by  Surgeon  1).  W.  Rliss, 
U.  S.  V.  The  man  was  discharged  on  November  20th,  1865,  and  pensioned.  On  A])ril  10th,  1867,  Pension  Examiner  Thomas 
B.  Reed  reported  that  there  was  a large  depression  at  the  seat  of  injury  which  was  very  sensitive.  The  patient  said  that  he 
lost  seventeen  ])ieces  of  bone  and  could  not  bear  the  heat  of  the  sun,  and  suffered  from  headache,  dizziness,  impaired  memory, 
and  defective  eyesight,  and  was  gradually  growing  worse. 

C.vSE. — Private  E.  llemvg,  Co.  E,  38th  Georgia  Regiment,  was  wounded  at  the  battle  of  Antietam,  Maryland,  September 
17th,  1862,  by  a conoidal  ball,  which  struck  in  the  middle  of  the  right  ])arietal  hone,  carrying  away  a consiilerable  portion  ot 
both  tables.  The  wound  was  hurriedly  dressed  upon  the  held,  after  which  he  was  sent  to  hospital,  where  his  wound  soon  closed 
without  having  undergone  any  further  examination  for  sjiicula;  or  depressed  portions  of  bone.  Soon  after  the  wound  had  healed, 
he  was  attacked  with  ej)ilej)tic  hts,  which  coutimusl  at  uncertain  intervals  until  the  18th  of  May,  1864,  when  he  was  again 
admitted  to  a Confederate  hospital.  Ujion  examination  of  the  cicatri.x,  a very  marked  depression  was  found,  and  an  elastic, 
yielding  sense  of  touch  beneath  it.  The  epilepsy  continuing,  and  the  attacks  becoming  more  frequent,  it  was  decided  to  operate. 
Acting  Assistant  Surgeon  R.  R.  Ritchie,  1’.  A.  C.  S.,  administered  chloroform  and  made  a T incision,  the  first  j)art  lying  parallel 
with  the  sagittal  suture,  and  the  second  striking  it  at  about  its  ujiiter  third,  over  the  cicatrix  and  above  the  point  of  fluctuation. 
The  scalp  was  found  adhering  to  the  skidl,  and  abnormal  in  structure  and  thickness.  The  opening  through  the  inner  and  outer 
table  was  covered  with  a firm  cartilaginous  layer,  on  removing  which  considerable  hmmorrhage  from  within  took  place,  which 
was,  however,  promptly  controlled  by  the  application  of  a heated  needle  to  the  orifice  of  the  vessel.  The  trei)hine  was  first 
applied  above  the  opening  toward  the  corono-sagittal  suture;  after  the  removal  of  which  portion,  it  being  evident  that  the 
de|)ression  e,xtended  farther,  and  the  loss  of  substance  around  the  open  skull,  near  the  point  of  fluctuation,  i)recluding  the  idea 
of  elevating  the  depressed  bone,  the  trephine  was  again  applied,  ])osteriorly,  and  somewhat  beneath  the  first  jdace,  at  about  one 
inch  distance,  and  the  hone  having  been  removed,  the  edges  of  the  skull  between  tho  first  and  second  openings,  and  between 
either  and  the  point  where  both  tables  had  been  destroyed  b}'^  the  missile,  were  taken  away  by  means  of  Hey’s  saw,  leaving  a 
truncated  opening  of  about  half  an  inch  square.  Immediately  beneath  this  was  disclosed  a decided  convexity  and  fluctuation, 
combined  with  a peculiar  discoloration  of  the  dura  mater.  This  memliraue  was  carefully  divided,  revealing  the  ball  resting, 
point  downward,  on  the  brain,  and  giving  exit  to  about  four  ounces  of  a yellowish  serous  fluid.  All  pressure  being  removed, 
and  the  How  of  blood  arrested,  the  wound  was  closed  by  interrupted  sutures,  and  cold  water  dre.ssings  applied.  Patient  reacted 
Well  from  the  effects  of  the  chloroform,  and  did  unusually  well  until  the  morning  of  the  fifth  day,  when  he  had  another 
convulsion,  which  w’as  attributed  to  the  accidental  disturbance  of  the  bandage,  and  did  not  recur.  The  wound  healed  by  first 
intention,  and  there  was  every  probability  of  a com])lete  recovery.  Tho  case  is  reported  by  Sui'geon  B.  Roemer,  P.  A.  C.  S. 

Case. — Private  Charles  L , Co.  B,  55th  New  York  Volunteers,  aged  30  years,  was  wounded  at  the  battle  of  Malvern 

Hill,  Virginia,  July  let,  1862,  by  a conoidal  ball,  which  struck  the  right  frontal  bone  about  an  inch  above  the  right  suiierciliary 
ridge,  and  lodged.  He  was  conveyed  to  Washington,  and  admitted  into  the  Judiciary  Square  Hos])ital  on  the  4th.  On  the  10th, 
he  complained  of  constant  headache  and  nausea ; the  right  eye  was  injected,  but  the  tongue,  jnilse,  and  bowels  were  normal.  A 
])ortion  of  the  frontal  bone  was  depressed,  and  the  pulsations  of  the  brain  could  be  seen  fluctuating  u])  and  down  the  fissures 
of  the  fracture.  It  being  feared  that  the  depressed  ])ortions  might  irritate  the  dura  mater  and  give  rise  to  inflammation,  and  in 
view  also  of  the  constant  headache,  the  skull  was  trephined  on  the  11th  by  Acting  Assistant  Surgeon  David  W.  Cheever,  and 
two  large  j)ieces  and  some  splinters  of  depressed  bone  were  removed.  At  one  })oint  the  dura  mater  had  a de])ressiou  as  if  made 
hy  the  passage  of  the  hall ; otherwise  it  looked  uninflamed  and  healthy,  but  there  was  some  effusion  of  blood.  Water  dressings 
and  low  diet  were  ordered.  On  the  second  day  after  the  operation,  pain  was  felt  as  the  head  was  moved  aborit,  but  no  fever 
existed.  There  was  considerable  discharge  of  laudable  jms.  The  brain  was  still  seen  pulsating  on  the  ITdli,  but  not  so  plainly 
as  before.  On  the  20th,  his  condition  was  every  way  favorable;  the  jud.se  quiet,  tongue  clean,  skin  cool,  a|)petite  good,  no  pain 
in  head,  the  wound  closing,  and  granulations  seen  over  the  dura  mater.  He  recovered,  and  was  discharged  from  the  service 

January  4th,  1863.  A communication  from  the  Commissioner  of  Pensions,  dated  January  2d,  1868,  .states  that  L is  a 

pensioner,  and  that  his  disability  is  rated  at  one-half  and  temporary.  The  ])athological  specimen  is  No.  261,  Sect.  I,  A.  M.  M. 
The  disk  and  fragments  of  cranium  removed  by  tho  trephine  embrace  one-fourth  square  inch  in  surface.  The  siu'cimen  and 
history  were  contributed  by  Acting  Assistant  Surgi‘on  U.  W.  Cheever.  I’ension  Examiner  P.  Stewart,  of  Peekskill,  rej)orts  that 
the  patient  suffers  from  giddiness  and  vertigo. 

Ca.se. — Priv.'ite  G.  W.  McIntosh,  Co.  H,  40th  Indiana  Volunteers,  aged  31  years,  w’as  wounded  at  the  battle  of  Dallas, 
Georgia,  .June  4th,  1864,  by  a conoidal  musket  ball,  which  fractured  the  frontal  bone  just  above  the  left  eminence.  He  was  on 
the  same  day  admitted  to  the  hospital  of  the  2d  division.  Fourth  Corps;  thence  transfei'red  to  tlu^  Cuudjerland  Hos])ital, 
Nashville;  and  on  the  29th  sent  to  the  Totten  Hosj)ital,  Louisville,  Kentucky.  His  constitutional  condition  was  excellent.  Only 
simide  dressings  were  applied  to  the  wound,  but  small  pieces  of  bone  were  dischaiged  from  time  to  time.  The  patient  complained 
of  dizziness  and  headaclu-,  and  was  strongly  impressed  with  the  idea  that  the  ball  remained  in  tbe  wound,  of  which  there  seemc<l 
every  probability.  On  August  17th,  Acting  Assistant  Surgeon  D.,.J.  Griffith  admiiustered  chlorid’orm,  trephined  the  skull,  and 
removed  two  buttons  (d'bone,  but  failed  to  find  the  ball.  The  wound  healed,  and  McIntosh  was  fui-loughed  on  Se))tembei'  Ifllh, 
1865,  and  mu.stered  out  of  service  on  December  21.st,  186.5,  still  suffei  iug  from  headaclu;  and  dizziness,  especially  after  being 
exposed  to  the  heat  (d'  the  sun.  A communication  from  the  Commissioner  of  Pensions,  dated  IMarch  2()th,  1868,  states  that 
Private  McIntosh  is  a ])ensioner  at  $15  jier  month,  and  that  his  disability  is  rated  total  and  permanent.  The  report  of  E.xamining 
Surgeon  M.  Henidon,  of  Montgomery  County,  Indiana,  states  that  the  ball  cannot  be  extracted  without  injuring  the  membranes 
of  the  brain,  in  the  opinion  of  the  best  surgeons  of  the  country. 


280 


WOUNDS  AND  INJURIES  OF  THE  HEAD. 


Case. — I’rivcato  Jolm  McK , Co.  II,  105th  Pennsylvania  Volunteers,  was  wounded  at  Petersburg,  Virginia,  June 

14tli,  1804,  by  a conoidal  musket  ball,  which  struck  the  right  side  of  the  skull  very  obliquely,  and  produced  a slightly  depressetl 
fracture  of  the  right  patietal  bone.  He  was  admitted  into  the  Mount  Pleasant  Hospital,  Washington,  on  June  24th,  with  the 
report  that  the  progress  of  the  case  had  been  so  far  eminently  satisfactory.  After  admission,  he  was  found  to  be  insensible,  and 

a few  hours  subsequently,  convulsions  supervened  in  rapidly  recurring  paroxysms. 
Twelve  ounces  of  blood  were  taken  from  the  temporal  artery  without  apparent  benefit. 

A trephine  was  then  applied  to  the  seat  of  fracture,  and,  upon  the  removal  of  a button 
of  bone,  a ]iortion  of  the  inner  table  was  found  slightly  depressed.  This  was  elevated, 
and  the  patient  soon  afterward  regained  consciousness.  On  June  26th,  the  wound  in 
the  scalp  became  erysipelatous,  and  before  the  inflammation  subsided,  there  was 
extensive  loss  of  substance  of  the  integuments  and  pericranium,  denuding  a large 
portion  of  the  parietal  bone.  Necrosis  ensued,  and  involved  the  whole  thickness  of 
the  bone.  On  September  3d,  1864,  a portion  of  the  parietal,  three  inches  by  four, 
had  become  so  much  loosened  that  it  was  readily  removed.  Cicatrization  then  went 
on  rapidly,  and  on  December  2d,  18G4,  the  wound  had  contracted  to  an  ulcer  less  than 
an  inch  in  diameter.  The  patient’s  mental  faculties  were  impaired  somewhat,  the 
ward  physician  thought,  but  not  to  a great  extent.  A colored  drawing  was  made 
representing  the  appearance  of  the  parts  prior  to  the  separation  of  the  exfoliation. 
No.  74,  Surgical  Series  of  Drawings,  S.  G.  O.,  by  Hospital  Steward  P.  Baumgras, 

U.  S.  A.  It  is  copied,  in  chromo-lithography,  in  the  plate  opposite  page  207.  The 
exfoliation,  which  was  contributed,  with  a minute  of  the  hospital  record  of  the  case,  by  Assistant  Surgeon  C.  A.  McCall,  U.  S.  A., 
is  represented  in  the  accompanying  wood-cut,  taken  from  page  IG  of  Circular  6,  S.  G.  O.,  1835.  The  patient  was  discharged 
from  service  August  31st,  18G4,  and  from  the  hospital  February  1st,  1835.  He  was  pensioned;  the  examiner.  Dr.  Julius  Nichols, 
stating  that  ho  was  totally  disabled,  and  that  the  case  was  the  most  extraordinary  that  had  come  under  his  observation ; the  • 
jndsations  of  the  brain,  uncovered  by  dura  mater,  and  the  trunk  of  the  meningeal  artery  being  distinctly  visible.  He  went  to 
his  home  in  Montgomery  County,  Pennsylvania.  In  April,  1871,  he  wrote  to  the  compiler  of  this  volume  as  follows  : * * 

“ The  space  the  bone  was  taken  out  of  is  three  and  a half  by  two  inches.  In  feeling  the  place  lightly,  it  goes  all  through  my 
head.  It  is  all  healed  over  like  a thin  shell.  I am  compelled  to  lie  on  my  left  side  when  sleeping.  When  exposed  to  the  sun  a 
dull  pain  through  my  head  is  caused.  * * j l^iv’e  received  but  seven  dollars  a month.  My  pension  papers  call  for  eight  dollare.’ 

Case. — Sergeant  George  Oughiltree,  Co.  A,  12th  United  States  Infantry,  aged  22  years,  was  wounded  at  the  battle  of 
Gaines’s  Mill,  Virginia,  June  27th,  1832,  by  a conoidal  ball,  which  entered  the  skull  on  the  right  side,  on  a line  with  and  one 
inch  in  front  of  the  jiarietal  eminence,  and  fractured  and  slightly  depressed  the  internal  table,  'fhe  wound  bled  freely,  and  he 
was  rendered  insensible  for  a short  time.  When  sensibility  returned,  he  found  that  his  left  arm  was  completely  paralyzed.  He 
was  taken  prisoner,  and  conveyed  to  a Confederate  field  hospital,  where  he  was  accidentally  wounded  by  a round  ball,  which 
comminuted  the  tibia  and  fibula,  and  lodged  beneath  the  skin,  but  which  was  removed  by  a Confederate  surgeon.  Cold  water 
dressings  were  applied  to  the  wounds.  During  the  first  night  patient  had  three  or  four  convulsions.  The  paralysis  of  the  arm 
continued  for  eight  days  after  the  injury,  when  it  gradually  disappeared.  The  ball  still  remained  in  the  head,  but  no  brain 
sym))toms  appeared.  On  July  27th,  he  was  exchanged,  and  removed  to  a hospital  boat.  The  upper  end  of  the  lower  fragment 
of  the  tibia  was  protruding,  and  the  soft  parts  wore  in  such  a condition  as  to  render  amputation  through  the  upper  third  necessary, 
which  was  i)erformed  by  Dr.  Drake  while  the  patient  was  under  the  influence  of  ether.  At  the  same  time  the  skull  was 
trej)hined  by  Dr.  Pierson.  Several  pieces  of  necrosed  bone  were  removed  from  the  j)osterior  superior  angle  of  the  right  parietal 
bone.  A piece  of  ball,  irregular  in  shape,  was  also  removed  at  the  same  time.  The  removal  of  the  latter  was  followed  by  the 
discharge  of  about  two  drachms  of  healthy  jms  from  an  abscess  in  the  substance  of  the  brain.  He  was  subsequently  transferred 
to  Philadel])hia,  entering  Broad  and  Cherry  Streets  Ho.spital,  on  the  31st,  in  good  general  condition.  The  stump  looked  well, 
the  wound  of  head  was  discharging  healthy  pus,  and  the  brain  pulsations  w'ere  distinctly  visible.  A dry  dressing  was  applied 
to  the  stump,  and  a flax-seed  jjoultice  to  the  head.  He  was  ordered  a good  diet,  with  milk  punch  and  beef  tea.  In  a few'  days 
inflammation  of  the  stump  aj)peared,  followed  by  slight  sloughing  of  the  lower  flap,  and  a stimulating  poultice  was  a]iplied.  He 
imj)roved  rapidly.  The  stump  healed  by  granulation,  but  the  last  ligature  was  not  removed  until  two  months  later,  and  during 
that  time  two  small  i)ioces  of  exfoliated  hone  were  removed.  In  November,  the  stump  was  discharging  slightly,  and  brain 
pulsations  were  still  visible  in  the  wound  of  head.  On  April  22d,  1853,  he  was  sent  to  the  Ward  Hospital,  Newark,  New  Jersey, 
and  transferred  to  the  Veteran  Reserve  Corps  on  August  14th,  18G3.  He  was  perfectly  well,  and  wore  an  artificial  leg;  the 
opening  in  the  cranium  was  nearly  closed  by  new  deposit  of  bone.  A communication  from  the  Commissioner  of  Pensions  dated 
April  22d,  18G8,  states  that  Oughiltree  was  a pensioner,  and  that  his  disability  w'as  rated  as  total  and  permanent.  The  early 
history  of  the  case  is  reported  by  Acting  Assistant  Surgeon  John  Neill. 

Case. — Sergeant  F.  M.  Robinson,  Co.  I,  2d  Kentucky  Regiment,  aged  26  years,  was  wounded  on  May  14th,  1864,  by  a 
shell,  which  fractured  and  depressed  both  tables  of  the  cranium  at  the  right  jiarietal  eminence  to  the  extent  of  one-half  square 
inch,  and  denuded  the  skull  for  a space  as  large  as  the  palm  of  the  hand.  There  was  also  a severe  flesh  wound  near  the  inferior 
angle  of  the  scapula.  He  was  unconscious  for  fourteen  hours  following  the  injury,  but  when  admitted  into  the  Institute  Hospital, 
Atlanta,  Georgia,  on  the  17th,  he  was  conscious.  There  was  great  pain,  with  ecehymosis,  extending  around  the  light  eye  and 
over  the  face;  the  pupils  were  contracted;  pulse  slow  and  feeble;  skin  cool.  From  this  time  until  the  23d,  his  condition 
remained  about  the  same ; the  wound  did  not  suppurate,  and  he  suffered  great  pain  over  the  whole  head,  for  which  opiates  were 
freely  given.  On  the  25th,  suiipur.ation  was  established,  and  a soft,  fluctuating  tumor  formed,  extending  over  the  left  side  of  the 
scalp  and  left  eye.  On  the  30th,  the  wound  began  to  slough  badly,  with  a gangrenous  tendency.  On  June  8th,  he  had  a slight 
convulsion,  followed  by  another  on  the  flth,  but  on  the  10th,  he  was  very  cheerful,  his  pulse  being  regular,  appetite  good,  and 


Fig.  ]4J.. — Exfoliation  from  the  riglit  parietal 
bone.  Spec.  3452,  Sect.  I,  A.  W.  M.  ^ 


TREPHINING  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


281 


the  wound  looldiig  lioaltliy.  Late  at  night  of  tlie  lltli,  he  had  another  very  slight  convulsion.  On  the  following  day  chlorofonn 
was  administered,  and  the  depressed  plate  of  bone,  half  an  inch  square,  removed  by  sawing  through  a small  triangular  portion 
of  the  outer  table.  This  gave  free  access  to  the  de])rcssed  portion,  which,  with  several  .spicidae,  was  removed  by  forceps  and 
elevator.  About  a teaspoonful  of  pus,  with  disorganized  membranes  and  cerebral  substance,  was  removed  at  the  same  time. 
The  patient  was  very  cheerful  on  the  da.y  following  the  operation.  On  June  14th  he  had  another  slight  convulsion,  but  from 
that  date  he  steadily  improved,  and  on  the  30th  the  wound  was  in  a healthy  granulating  condition;  the  large  surface  of  denuded 
skull  seemed  to  be  diminishing  and  covering  over  slowly,  and  there  was  every  prospect  of  .speedy  recovery.  The  case  is  reported 
by  Surgeon  D.  C.  O'Keefe,  P.  A.  C.  S. 

Case. — Private  Jonathan  G.  S , Co.  D,  200th  Pennsylvania  Volunteers,  aged  28  years,  was  wounded  at  Fort 

Steadman,  Virginia,  March  25th,  1835,  by  a couoidal  ball,  which  fractured  the  cranium.  He  was  admitted  to  the  hospital  of  the 
3d  division.  Ninth  Corps,  and  thence  sent  to  the  Armory  Square  Hospital,  Washington,  where  he  arrived  on  March  28th.  An 
examination  revealed  a fracture  of  both  parietal  bones,  iniinediately  over  the  sagittal  suture  and  superior  longitudinal  sinus  on  a 
line  drawn  from  ear  to  car.  The  ])atient’s  intellect  appeared  unimpaired;  pulse  slow  and  tolerably  full.  He  was  unable  to  move 
his  lower  extremities,  but  the  sensation  remained  unaffected;  tickling  the  sole  of  the  foot  caused  involuntary  shrinking  of  the 
foot  and  leg.  He  voided  his  urine  and  faeces  without  difficulty.  On  the  30th,  Surgeon  D.  W.  Bliss,  U.  S.  V.,  a]q)lied  the 
trephine,  and  removed  a small  portion  of  sound  bone  and  several  detached  pieces,  which  were  lirmly  wedged  between  the  two 
parietal  bones,  and  had  partially  been  driven  beneath  the  internal  table.  Simple  dressings  were  ajqilied,  and  stimulants  and 
nourishing  diet  ordered.  After  the  operation,  patient  suffered  no  pain,  and  was  able  to  move  his  legs.  He  recovered,  and  was 
discharged  from  the  service  on  May  26th,  1835.  The  specimen  is  No.  4036,  Sect.  I,  A.  ISI.  M.,  and  consists  of  two  fragments  of 
bone  from  the  sagittal  suture,  about  one-half  square  inch  in  surface,  including  both  tables.  The  specimen  and  history  were 
contributed  by  Surgeon  D.  W.  Bliss,  U.  S.  V.  This  patient  was  pensioned,  and  in  October,  1865,  Pension  Examiner  .J.  L. 
Swesserott  reported  that  he  had  left  hemiplegia,  a largo  depression  along  the  sagittal  suture;  the  toes  of  the  left  foot  were 
constantly  cold  and  destitute  of  sens.ation.  In  April,  1871,  no  further  information  regarding  the  case  could  be  found  on  the  tiles 
of  the  Pension  Bureau. 

Case.— Private  William  J.  Scheetz,  Co.  C,  95th  Pennsylvania  Volunteers,  aged  25  year's,  was  worrnded  at  the  battle  of 
Cairres's  Mill,  Virgirria,  June  27th,  1862,  by  a cotroidal  ball,  ^vhich  entered  the  os  frontis  two  irrehes  anterior  to  the  coronal  suture, 
arrd  a little  to  the  right  of  median  hire,  and  fractured  both  tables.  He  was  conveyed  to  the  hospital  at  Annapolis,  Maryland, 
where  his  injur-y  was  treated  as  a wound  of  sc.alporrly.  He  was,  on  August  16th,  transferr-ed  to  Annapolis  Jrurction,  and  thence 
returned  to  duty  on  August  26th,  1862.  The  middle  of  March,  1863,  he  was  suddenly  seized  with  s3^nptotns  of  meningitis.  He 
was  taken  to  the  regimental  hospital,  and  thence  sent,  on  April  27th,  to  the  1st  division.  Sixth  Corps,  hospital,  where  he  arrived 
in  a conratose  condition.  Pie  remained  so  until  the  30th,  when  it  was  decided  to  operate . Ether  was  administered,  and  Surgeon 
E.  B.  P.  Kelly,  95th  Pennsylvania  Volunteers,  made  a orucial  incision  three  inches  long,  and  removed  nearly  two  inches  square 
of  the  os  frontis  with  trephine  arrd  Hey’s  saw.  A piece  of  bone  three-fourths  of  an  inch  in  length,  was  found  lirndy  imbedded 
irr  the  dura  mater,  arrd  was  with  some  difficulty  rerrroved  by  a pair  of  forceps;  a dark  coagulum  of  blood  was  also  taken  out. 
The  irrtegunrents  were  drawrr  together  by  five  irrterrupted  sutures,  and  cold-water  dressings  were  ordered  to  be  diligently  applied. 
Plalf  arr  hour  after  the  operatiorr,  patient  expressed  a sense  of  relief;  being  the  fir’St  word  spoken  irr  four  days.  l‘''orty-eight 
hours  afterward,  there  being  much  tumefaction  of  the  parts,  two  sutures  were  removed.  On  June  13th  he  was  transferri'd  to 
Lincoln  Hospital,  Washington.  Cicatrization  of  the  wourrd  was  almost  complete,  and  the  patient’s  general  health  was 
much  improved.  Orr  June  20th  he  was  transferred  to  !Mower  Hospital,  were  he  remained  until  the  25th  P''ebruary,  1864, 
wherr  he  was  transferred  to  the  Veteran  Reserve  Corps.  He  entered  the  general  hospital  at  Frederick,  Maryland,  on  the  29th  of 
August,  1864;  was,  on  September  8th,  transferred  tQ  Jarvis  Hospital,  Baltimore,  Maryland,  and  September  12th  sent  to 
McClellan  Plospital,  Philadelphia,  where  he  was  discharged  from  the  service  on  October  11th,  1864. 

Case. — A Confederate  Soldier  was  admitted  to  the  Confederate  hospital  at  Resaca,  Georgia,  with  a shell  wound  of  the  head, 
received  two  d.ays  previous.  The  missile  had  struck  just  above  the  left  ear,  dividing  the  integuments  two  inches  jierpendicularly. 
The  wound  was  immediately  opened,  revealing  a rectilinear  fracture  full  two  inches  in  length  ; at  the  upper  end  it  extended  at 
an  obtuse  angle  in  the  direction  of  the  junction  of  the  sagittal  and  harabdoidal  sutures;  at  the  lower  end  the  fracture  run  obliquely 
in  the  direction  of  the  mastoid  process  of  temporal  bone,  making  a line  fracture  of  at  least  four  inches.  The  whole  of  the 
posterior  fragment  was  depressed  the  entire  thickness  of  the  skull  bone;  there  was  also  a semi-lunar  fracture  anterior  to  the 
above,  having  a fragment  near  half  an  inch  in  width  partially  detached.  There  were  symptoms  of  compression  of  the  brain,  and 
the  p.atient  was  comatose  and  insensible.  On  the  fifth  day  after  the  reception  of  the  injury,  the  trephine  was  applied  in  such  a 
manner  as  to  cut  across  the  fragment  into  the  sound  bone  anterior  to  the  fracture.  A portion  of  loose  bone  was  removed,  the 
elevator  ajiplied,  and  the  depressed  bone  brought  to  its  natural  position.  On  the  surface  of  the  dura  mater  was  found  a collection 
of  coagulated  blood  and  fibrin,  which  was  removed;  no  anaisthetic  was  used.  As  the  dressings  were  applied,  consciousness 
returned,  and  the  patient  asked  several  questions  as  to  the  condition  of  his  head,  and  tlie  probability  of  a fatal  termination; 
thenceforward  improvement  was  uniform,  and  ultimately  the  recovery  was  perfect. 

Case. — Private  'VV.  H.  Underwood,  Co.  D,  44th  Indiana  Volunteers,  aged  19  years,  received  at  the  battle  of  Shiloh, 
Tennessee,  April  6th,  1862,  a gunshot  wound  in  the  head.  After  the  reception  of  the  injury,  he  walked  I'rom  tree  to  tree  until  he 
became  insensible;  revived  the  next  morning  by  a drink  of  water  from  a Confederate  soldier,  he  wallccd  to  an  encampment  near 
by,  and  was  thence  removed  to  a hospital  transport,  lie  lay  in  the  hold  of  the  boat,  very  near  the  furnace,  for  two  days  and  a 
half.  He  was  admitted  to  Hospital  No.  6,  Louisville,  Kentucky,  on  April  15th,  1862.  There  was  a wound  of  entrance  in  the  left 
temple,  with  apparently  no  corresponding  wound  of  exit;  but  a small  incision  was  found  in  the  middle  of  the  forehead,  from 
which  the  patient  stated  a ball  had  been  extracted  on  the  field.  On  the  outer  aspect  of  the  left  upper  eyelid  were  two  incisions, 
made  by  buckshot,  which  caused  so  much  swelling  as  to  entirely  close  the  eye.  He  complained  of  severe  pain  in  the  head,  and 
numbness  of  the  left  leg.  The  left  pujiil  was  dilated.  The  probe  was  introduced  into  the  wound  of  the  left  tenqde,  and  made 

36 


282 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


its  exit  tliniiiftii  tlio  small  incist'd  wound  at  tlio  middle  of  the  forehead ; hut  the  pain  caused  h}'  the  examination  was  so  excessive 
th;it  further  attempts  at  an  accurate  diagnosis  were  discontinued.  Ice  bags  were  ajtplied  to  the  scalp,  and  te])id  water  to  the 
wounds.  As  coma  gradually  supervened,  a more  thorough  examination  of  the  wound  was  deteriuuied  upon.  The  jtatieut  was 
jilaced  under  the  influence  of  chloroform,  a T-shajted  incision  made  over  the  os  fronti.s,  and  the  flaps  were  dissected  up  so  as  to 
ex])osc  tlie  main  seat  of  injury.  This  revealed  a well-marked  triangular  depression;  the  base  of  the  triangle  being  intact,  wliile 
its  apex  was  more  depressed  than  any  other  part  of  it.  The  point  of  the  ape.x  was  broken  oil’,  leaving  an  aperture  through  which 
an  ordinary  probe  coidd  be  introduced  readily.  From  either  side  of  the  depression,  a line  of  fracture  extended  to  the  squamous 
portion  ot  the  temporal  bones.  Near  the  aperture  in  the  jaws  of  the  triangular  fracture  was  a single  hair,  which  had  been  forced 
there  and  left  behind  in  the  track  of  some  foreign  body.  The  centre  pin  of  the  trephine  was  now  placed  so  as  to  include  parts  of 
the  trianguhar  depression  in  the  button  of  bone  which  was  removed.  The  brain  aiipeared  black  and  disorganized,  as  if  ploughed 
by  a foreign  body ; and  at  the  depth  of  about  one  and  three-fourths  inches  the  probe  struck  a bullet,  which  was  extracted  and 
proved  to  be  elongated  and  of  a cork-screw  shape.  The  elevator  was  then  applied  to  raise  the  depressed  portion  of  the  frontal 
bone,  but  ii  sprung  back  bj'  its  own  elasticity.  The  flaps  were  now  Tirought  together  again,  cold-water  dressings  applied,  and 
the  ))atient  taken  to  a quiet,  darkened  room.  The  coma  had  been  relieved  by  the  operation.  On  June  10th  the  wound  of 
operation  had  entirely  healed,  the  eyelid  and  track  of  the  ball  across  the  forehead  were  almost  well,  and  the  patient  complained 
of  nothing  but  weakness.  On  June  11th,  in  consequence  of  the  excitement  caused  by  the  arrival  of  his  sister,  a relapse  took 
place.  Delirium  occurred,  lasting  for  two  or  three  hours,  the  eyelids  became  rapidly  inflamed,  and  free  suppuration  recurred. 
Antijddogistic  treatment  was  at  once  resumed,  and  in  a few  days  the  unfavorable  symptoms  disuppeai'cd.  The  patient  was 
discharged  from  the  service  September  20,  1862.  lie  reeidisted,  however,  July  15th,  1863,  in  the  2d  Indiana  Cavalry,  and 
died  at  the  post  hospital  at  Macon,  Georgia,  of  intermittent  fever.  May  14th,  1835.  In  this  case,  the  course  of  the  ball  was  very 
remarkable.  After  striking  the  left  temple,  it  coursed  across  the  forehead,  until  it  reached  the  centre,  which  was  itideed  the  most 
);rominent  part,  and  gave  the  greatest  angle  of  divergence;  yet  strangely  enough,  at  this  point  the  ball  fractured  the  skull;  the 
triangidar  jwrtion  defined  by  the  fracture  yielding  so  as  to  let  the  ball  pass  inward,  and  then  springing  back,  left  a very  small 
aperture.  The  ball  which  the  patient  stated  was  removed  on  the  field,  was  evidently  only  a (lart  of  the  ball  extracted  from  the 
ceri’brum,  shaved  oil'  as  it  bored  its  way  through  the  skull.  The  case  is  reported  by  the  operator.  Assistant  Surgeon  13.  Howard,' 
U.  S.  A. 

CjVSE. — Private  II.  Tanducson,  Co.  C,  4th  Texas  Regiment,  was  wounded  at  the  battle  of  Gettj-sburg,  Pennsylvania, 
July  3,  1863,  by  a musket  ball,  which  fractured  the  anterior  superior  portion  of  the  right  parietal  bone,  making  a imliated 
depression  of  the  outer  table.  The  cicatrix  formed  regularly,  and  he  returned  to  his  comui.and.  Epilei>tic  fits  supervened  in 
September,  1863,  and  graduall^^  became  more  freq-aent  and  intense  until  March,  1864,  when  he  was  again  admitted  to  a hospital. 
At  that  time  the  cicati-ix  was  four  and  a half  inches  in  length,  pointing  obliquely  backward  under  an  angle  of  60°  with  the 
coronal  suture,  deepening  and  widening  in  its  centre,  and  jiresenting  a dejiression  of  three-eighths  of  an  inch  in  depth;  tin! 
scalj>  here  is  )'adiated,  as  if  the  covering  had  assumed  the  abnormal  condition  of  the  bone  beneath.  The  epileptic  paroxysms 
were  now  comjiosed  of  a number  of  successive  convulsions.  His  general  condition  previous  to  an  attack  was  marked  by  dejection 
of  s|)irits,  vertigo,  and  apathy,  his  bowels  habitually  costive,  ajipetite  wanting,  urine  scanty,  pulse  CO  and  feeble,  and  face 
pale.  Extravasations  being  sujiposed  to  exist,  it  was  decided  to  ajiply  the  trejihine.  Chloroform  having  been  administered. 
Surgeon  D.  Eoemer,  P.  A.  C.  S.,  made  two  incisions  in  the  foi'in  of  a "T ; one  nearly  j)arallei  with  the  coronal  suture,  upon  the 
np|)er  margin  of  the  parietal  bone,  about  half  an  inch  from  the  cicatrix,  and  uniting  with  it;  the  second  over  the  upper  third 
of  the  cicatrix  and  behind  it.  The  first  measured  three  and  a half  inches,  and  the  second  four  inches.  The  trephine  was 
ajqflied  at  the  iqiper  j)art  of  the  depression.  The  bone  came  away  with  the  trephine,  and  no  adhesions  of  the  dura  mater  existed. 
Immediately  below,  and  almost  in  the  centre  of  the  opening,  lay  a violet-colored,  circular,  and  somewhat  convex  extravasation, 
covered  by  tbe  dura  mater,  wliich  was  divided  by  a simj)le  cut.  No  haemorrhage  occurred  from  beneath  the  skull,  and  three 
small  arteries  of  the  scalj)  had  been  readily  controlled  without  ligation.  The  extravasation  being  removed,  the  wound  was 
closed  with  adhesive  straps,  and  cold  water  dressings  and  a cross-bandage  applied.  The  ])atient  reacted  well  from  the  effects 
of  the  chloroform,  and  walked  about  in  his  quarters  on  the  second  day.  The  wound  healed  by  first  intention.  Two  weeks 
after  the  (q)eration  he  expressed  himself  as  free  from  any  unpleasant  feelings.  The  condition  of  his  bowels  became  healthy,  his 
general  aspect  cheeiful,  and  the  jirognosis  was  highly  I'avorable  to  complete  recovery.  The  case  is  i-ecorded  by  the  operator, 
.Surgeon  13.  Eoemer,  P.  A.  C.  S. 

Case. — Corporal  Eredeiick  Weber,  Co.  E,  116th  New  York  Volunteers,  aged  22  years,  was  struck  at  the  battle  of  Cedar 
Creek,  Vii-giina,  October  lOth,  1864,  upon  the  upjier  portion  of  the  left  side  of  the  forehead  by  a conoidal  musket  ball,  which 
denuded  the  frontal  bone  near  the  coronal  suture  for  a considerable  space,  jn-odneing,  as  was  stated  by  the  attending  physician, 
an  hulentation  at  the  place  of  imjungement,  but  no  apparent  fracture.  The  man  was  insensible  for  some  time,  though  ]ierfect 
reaction  at  length  ensued.  He  was  on  the  following  day  admitted  to  the  depot  field  hospital;  on  October  22d,  transferred  to 
the  hospital  at  York,  Pennsylvania;  and  on  November  7th  furloughed  to  visit  his  friends  in  Buffalo,  New  York.  On  his  arrival 
at  that  place  he  was  attacked  with  pneumonia,  and  came  under  tlie  care  of  Acting  Assistant  Surgeon  S.  W.  Wefmore.  Upon 
examination  of  the  wound  of  the  head,  which  was  at  this  time  discharging  freely,  a fracture  in  the  external  table  was  discovered; 
a jiiece  measuring  one  and  a half  inches  by  two  and  one-fourth  inches  being  loose,  though  not  displaced.  Having  recovered 
from  pneumonia,  he  w.as,  on  December  1st,  admitted  into  the  hospital  of  the  city.  On  December  17th,  Acting  Assistant  .Surgeon 
,1.  F.  Miner  removed  the  irregvdar-shajied  loose  jiiece  of  bone  of  the  external  table,  as  well  as  fragments  of  the  internal  jflate. 
The  wound  afterward  healed  kindly  though  slowly,  and  the  man  was  discharged  from  seiA’ice  on  June  7th,  1865,  enjoying  then 
good  health,  with  the  exceiUion  of  an  occasional  pain  in  the  region  of  the  wound.  In  July,  1868,  he  was  a pensioner  at  .|8  per 
month,  his  disability  being  total  and  ])ermanent.  The  case  is  i'e])orted  by  Acting  Assistant  Surgeon  S.  W.  Wetmore.  Sub- 
sequently Dr.  II.  N.  Loomis  of  Buffido  reported  that  this  jiatieiit  had  a painful  cicatrix  depressed  half  an  inch,  and  suffered 
from  defective  vision  and  vertigo,  with  chronic  irrit.ability  of  the  brain,  which  unfitted  him  for  any  kind  of  labor.  Thereupon 
his  pension  was  increased  to  .$20  per  month. 


■An  account  of  tliis  case  will  be  fuiuid  in  tlio  Am.  Jour.  Med.  Sci..  1871,  Vol.  LXII,  N.  S.,  p.  385. 


TEEPIIINIKG  AFTER  GUNSHOT  FKACTUEES  OF  THE  SKULL. 


283 


CiVSK. — Private  Philip  A.  V.'- 


Co.  A,  COtli  Pennsvlvania  Volunteers,  aged  £1  years,  was  wounded  at  Petersburg 


V'irgiiiia,  July  bOth,  16G4,  by  a conoidal  ball,  wliicli  imbedded  itself  in  the  iutegunieiit  and  niuecles  of  the  left  side  of  the  bead, 
fracturing  and  depressing  a })ortion  of  the  skull  a little  above  and  to  the  left  of  the  occipital  ])rotuberauce.  The  missile  was 
removed  by  the  hand.  He  was  somewhat  stunned  by  the  blow,  but  arose  and  walJeed  to  the  hosjdtal  ot  the  3d  division.  Ninth 
Corps,  when  he  became  unconscious  and  remained  so  for  eighteen  hours.  On  the  following  day  he  returned  to  his  regiment,  not 
knowing  that  his  injury  was  severe,  but  he  was  returned  to  the  ho.spital,  whei-e  he  remaim'd  for  one  week.  He  suflered  severe 
headache  and  was  unable  to  see  or  hear  well.  On  August  11th,  he  was  admitted  into  the  Soldier’s  Rest,  branch  of  1st  Hivisiou 
Hospital,  x\lexandria,  Virginia.-  He  seemed  to  improve  for  two  days,  then  grew  worse,  complaining  of  pain  in  the  frontal  .-egiou 
of  the  head,  especially  over  the  left  orbital  ridge.  On  the  IGth,  ho  became  uncomseious  for  about  two  hours.  It  being  deemed 
advisable  to  remove  the  depressed  portion  of  the  bone,  ether  was  administered,  and  Assistant  Surgeon  Theodore  Artaud,  U.  S.  V., 
made  a crucial  incision,  half  an  inch  in  length,  directly  over  the  injurj',  and  dissected  up  the  oceipito-frontalis  muscle,  revealing 
an  indentation,  half  an  inch  in  length,  making  a very  regular  cup-sliaped  deiiression,  three-fourths  of  an  inch  in  diameter,  -with 
a slight  lissure  around  its  edge  and  an  irregular  one  across  its  centre.  The  trephine  was  applied  so  as  to  jiartially  cov(‘r  one  side 
of  the  depression,  and  a portion  of  the  skull  was  removed.  The  depressed  bone  was  then  i-emoved  by  the  elevato”,  exposing  the 
dura  mater,  whieh  was  found  to  be  healthy.  A circular  tent  was  apidied  over  the 
exposed  portion  of  brain,  the  wound  dressed  with  cold  water  dressings,  and  morphia 
given  to  (juiet  the  patient.  The  following  day  ho  was  able  to  sit  up,  and  by  the  £0th 
could  walk  about.  On  the  2Gth,  ho  was  seized  with  violent  signs  of  compression,  but 
was  soon  relieved  by  sinapisms  to  the  neck,  abdomen,  and  extremities.  Croton  oil 
was  given,  and  afterward  the  wound,  wliich  had  nearly  healed,  was  enlarged  and  kept 
open  with  tents  for  three  days,  with  but  slight  inconvenience  to  the  ])atient.  He  had 
slight  headache  on  the  morning  of  September  1st,  but  his  general  condition  was  good 
and  inijiroving.  He  ate  and  slept  well,  and  by  the  22d,  thcAvoimd  had  entirely  closed. 

He  occasionally  complained  of  slight  headache,  and  was,  to  all  appearances,  cured. 

He  was  transfiuTcd  to  Slough  Barracks,  branch  of3d  Division  Hospital,  on  Oetoberbth, 
remaining  until  May  10th,  18G5,  when  he  was  sent  to  the  Augur  Hospital,  Alexandria, 
and  thence,  on  the  20th,  transferred  to  the  McClellan  Hospital,  Philadelphia.  He  was 
discharged  from  the  service  on  July  Gth,  1865.  A communication  from  the  Commis- 
sioner of  Pensions,  dated  July,  1868,  states  that  W.  is  a ))ensioner  at  $8  per  month, 
liis  disability  being  rated  total  and  temporary.  The  specimen  Avas  contributed,  with 
an  history,  by  the  operatoi-,  Assistant  Surgeon  Theodore  Ai-taud,  U.  S.  V. 


Fig.  1'12. — Disk  aeU  fra^rinents  romevril 
after  a I'ractm-c  liy  a sj.-ent  ball.  Sjicc.  5U42, 
Sect.  1.  A.  JI.  JI.  f. 


Case.— Captain  Alvin  M.  W , Co.  K,  17th  Ncav  York  Volunteers,  Avas  Avounded  at  the  battle  of  Frodovieksburg, 

Virginia,  December  13tli,  1832,  by  a musket  ball,  Avhich  fractui-ed  the  left  parietid  lione  near  the  eminence.  He  Avalked  Avith 
some  assistance  to  the  ho9|ntal  of  the  Third  Corps,  a distance  of  more  than  a mile.  His  voice  became  thick  and  had  an 
umiatural  hesitancy  and  slowness.  The  middle  and  ring  finger  of  the  right  hand  Avere  jiaralj-zed,  hut  the  motion  and  sensibility 
in  th(!  iirst  and  fourth  fingers  Avere  oidy  slightly  impaired.  His  mental  faculties  Avere  clear.  He  comjdained  of  a slight  headache 
and  his  pulse  was  sIoav  and  full.  The  trephine  Avas  applied  by  Assistant  Surgeon  LcAvis  Tice,  17th  Ncav  York  Volunteers,  and 
a disk  of  bone  and  several  fragments  Avere  removed,  one  of  which  Avas  three-fourths  of  an 
inch  in  diameter.  The  edges  of  the  Avound  Avere  approxunated  by  adhesive  strips,  and 
cold  Avater  dressings  Avere ^pplied.  During  the  opia-ation,  blood  lloAved  profusely  from 
the  jierforation.  One  large  fragment  of  bone,  evidently  fi-om  the  inner  table,  lay  exactly 
beneath,  but  Avas  too  large  to  be  extracted  from  the  orifice.  The  dura  mater  Avas  found 
to  be  uninjured.  The  poAA-er  of  articulation  returned  immediately  after  the  operation, 
and  the  numbness  of  the  fingers  hecame  less  marked.  On  Januai-y  2d,  1863,  the  paralysis 
of  the  fingers  had  entirely  disappeared  and  the  AVound  Avas  healing  hy  granulation.  The 
jiatientAvas  mustered  outAvith  Ids  regiment  on  June  2d,  18G3.  The  pathological  specimen 
is  No.  4049,  Sect.  I,  A.  M.  M.,  and  Avas  contiibuted  by  the  operator.  The  Conmiissioner 
of  Pensions  reports  that  this  officer  Avas  jiensioned  at  $20  per  month.  A musket  ball  entered  the  upper  portion  of  the  right 
parietal  bone;  bones  liave  been  remoA'ed  so  that  an  irregular  opening  exists  of  the  size  of  a silver  dollar.  I’ension  Examiner 
T.  C.  Pitt  states  that  Ids  right  hand  and  tongue  Avere  partially  jiaralyzed.  Exercise  jiroduces  violent  throhbing  at  the  wound 
and  at  a point  opposite  on  the  back  of  the  head.  His  general  health  is  very  poor,  probably  owing  to  the  constant  irritation 
about  the  brain. 


Fig.  143. — Disk  and  fragment  from  a 
gunshot  depressed  fracture  of  the  leit 
parietal.  jS2)cc.  4041),  Sect.  I,  A.  M.  M. 


Case. — Private  Joseph  Wolf,  Co.  F,  7th  New  York  Heavy  Artillery,  aged  22  year.s,  was  wounded  on  April  3d,  18G5,  Ix^oro 
Petersburg,  ATrgiida,  by  a conoidal  ball,  which  entered  the  scalp  near  the  ])Osterior  suiierior  angle  of  the  right  jiarietal  bone, 
and  glanced  upAvard,  denuding  the  bone  of  periosteum  for  a space  one  inch  in  circumference. 

He  Avas  on  the  same  d.ay  admitted  to  the  hosidtal  of  the  1st  division.  Second  Corp.s,  and 
thence  conveyed  to  Washington,  where  he  entered  the  Armory  Square  Hospital  on  the  12th, 

Avith  comjiletc  paralysis  of  the  left  arm  and  leg.  He  Avas  slightly  comatose,  but  could  easily 
be  aroused,  and  ansAvered  questions  intelligently;  the  pupils  Avere  contracted.  An  examina- 
tion rcA’calcd  a fissure  extending  beyond  the  denuded  portion,  through  Avhich  pus  shnvly 
exuded,  but  no  depression  was  observed.  Ether  Avas  administered  on  the  14th,  and  Surgeon 
D.  W.  Bli.ss,  U.  S.  V.,  applied  the  trepliine.  U])on  removing  the  button  of  bone,  a similar 
fissure  through  the  internal  table  Avas  discovered.  The  dura  mater  protruded  through  the 
opening,  and,  upon  punctming  the  membrane,  about  three  ounces  of  sero-sangunieous  fluid 


Fig.  144. — Disk  and  fra^^monts  re- 
moved after  gunshot  fracture  (.f  tho 
right  parietal.  Sjjcc,  4Ll*5,  tScct.  1, 

A.  M.  M. 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


;:!84 


cscn))«l.  Tlic  o])or:;ti()n  ."fTorik'd  no  immcdir.te  roliof  to  flie  paticMit,  but  at  tho  end  of  r.ix  lionrs  lie  could  move  Ida  band  and 
foot,  and  on  the  following  day  could  raise  bis  bead.  On  the  20th,  the  wound  was  granulating  finely,  and  the  i^atient  doing  well, 
lie  could  move  bis  leg  and  ann  freely  on  the  2Gth,  and  was  able  to  stand  upon  bis  feet.  On  May  1st  tbe  paralysis  bad 
almost  disa]ipcared,  and  tbe  wound  was  entirely  covci-ed  with  granulations.  Two  days  later  a small  circle  of  necrosed  bone 
was  removed  from  tbe  external  table.  Tbe  jiaticnt  was  now  able  to  walk  about  tbe  ward,  and  on  tbe  2Gtb,  was  transferred 
to  tbe  Wbiteball  Hosiutal,  near  Dristol,  Pennsylvania,  wbcnce  be  was  discharged  from  tbe  service  on  June  20tb,  ISGb.  Ills 
claim  for  pension  was  “pending”  December  7tb,  1871.  Tbe  specimen  is  a disk  of  bone  with  a serrated  fragment  of  tbe  inner 
table-of  the  right  jiarietal  bone,  and  is  represented  in  tbe  wood-cut.  Tbe  disk  is  one  inch  in  difnneter,  and  is  traversed  by  tbe 
line  of  fracture.  Tbe  specimen  was  contributed  by  tbe  operator,  Surgeon  D.  W.  Bliss,  U.  S.  V. 

Case. — Private  George  A.  Shaffer,  Co.  D,  IfOtb  Pennsylvania  Volunteers,  aged  19  years,  was  wounded  at  P''ive  Forks, 
Virginia,  April  1st,  18G5,  by  a conoidal  ball,  wbicb  fractured  the  parietal  bones  at  tbe  junction  of  the  coronal  and  the  sagittal 
sutures,  tbe  fracture  extending  back  about  three  inches  over  the  sagittal  suture.  He  was  on  tbe  next  day  admitted  to  tbe 
bos])ital  of  tbe  Fifth  Corps,  and  on  April  4tb  sent  to  tbe  Lincoln  Hospital  at  Washington.  There  was  but  slight  evidence 
of  compression,  but  on  April  (itb,  be  complained  of  pain  in  the  bead;  the  pupils  became  dilated,  and  coma  supervened.  He  was 
jilnccd  under  tbe  influence  of  ether.  Surgeon  J.  C.  McKee,  U.  S.  A.,  then  made  a crucial  incision  at  right  angles  to  the  parietal 
suture  and  removed  the  fragments,  revealing  tbe  dura  mater  intact.  The  patient  was  kept  quiet  in  a recumbent  position,  cold 
ajiplications  were  made  to  the  head,  and  low  diet  ordered.  Ho  recovered,  and  was  discharged  from  the  service  on  a surgeon’s 
certificate  of  disability  on  June  24tb,  1865.  See  Photographs  of  Surgical  Cases,  Vol.  HI,  page  10.  He  is  a pensioner.  Tbe  case 
is  reiiortod  by  Surgeon  J.  C.  McKee,  U.  S.  A. 

Tlie  following  remarkaLlc  instances  of  patients  recovering  sufficiently  to  resume  tlicir 
military  duties  are  reported  ; 

Case. — Lieutenant  H.  S.  Robinson,  Co.  G,  3Gth  Massachusetts  Volunteers,  received,  at  Blue  Springs,  Tennessee,  October 
12tb,  1803,  a gunshot  depressed  fracture  of  tbe  right  jiarietal  bone.  He  was  admitted  into  the  hospital  at  Knoxville,  Tennessee, 
tbe  same  day,  where  a portion  of  bone  was  removed  by  Hey’s  saw.  He  recovered,  was  returned  to  duty  on  December  2Gtb, 
1803,  and  was  discharged  from  tbe  service  on  July  7tb,  1804.  He  was  a pensioner  in  1807.  Active  exertion  caused  headache 
and  a feeling  of  pressui’e  on  the  brain. 

Case. — Corporal  Pbincas  Bird,  Co.  C,  lOOtb  Pennsylvania  Volunteers,  aged  21  years,  was  wounded  at  tbe  siege  of 
Knoxville,  Tennessee,  November  20tb,  1833,  by  a conoidal  ball,  which  fissured  tbe  left  parietal  bone  without  depression.  Ho 
was  conveyed  to  Hospital  No.  5,  when',  on  November  25tb,  tbe  bone  was  trephined.  Hewas  furloughed  on  February  17tli,  1804. 
and  shortly  afterwards  returned  to  his  regiment.  On  October  1st,  he  was  admitted  into  tho  general  hospital  at  Pittsburgh, 
Pennsylvania,  and,  on  the  20th,  again  returned  to  duty.  lie  does  not  appear  to  have  been  an  applicant  for  pension. 

» 

Case. — Asa  D.  Broody,  bugler  of  the  7th  Indiana  Battery,  aged  20  years,  was  wounded  at  the  battle  of  Kenesaw 
^Mountain,  Georgia,  June  22d,  1834,  by  a conoidal  musket  ball,  which  fractured  and  depressed  the  right  temporal  bone.  Ho  was 
at  once  admitted  to  the  3d  division.  Fourteenth  Corps,  hospital,  and  thence  sent  to  Chattanooga,  Tennessee,  where  ho  arrived  on 
the  29th  of  the  month;  two  days  subsequently,  however,  he  was  transferred  to  Hospital  No.  2,  at  Nashville.  Ho  recovered,  was 
furloughed,  and  finally  returned  to  duty  on  September  19th,  1834.  This  soldier  was  discharged  the  service  December  7th,  1834, 
and  was  pensioned.  On  September  4th,  1863,  Pension  Examiner  J.  G.  Hendricks  reports  that  the  operation  of  trephining  had 
been  peiformed.  There  was  paralysis  of  the  left  arm,  and  the  flexor  tendons  of  the  fingers  were  contracted.  His  disability  is 
rated  total  and  permanent. 

Case. — Private  Robert  S.  Erwin,  Co.  B,  86th  Illinois  Volunteers,  aged  32  years,  was  wounded  at  Atlanta,  Georgia,  July 
20tb,  1864,  by  a conoidal  ball,  which  fractured  the  superior  portion  of  the  fronfal  bone,  and  lodged  in  the  cranium.  A portion  of 
the  fractured  bone  was  driven  into  the  substance  of  the  brain.  lie  was,  on  tlie  same  day,  admitted  to  tho  field  hospital  of  tho 
2d  division.  Fourteenth  Corps;  conveyed,  on  July  22d,  to  No.  2,  Chattanooga,  Tennessee,  and  thence  sent  to  Nashville,  where 
be  entered  Hospital  No.  1,  on  August  1st.  On  the  3d,  Acting  Assistant  Surgeon  John  Grant  made  a triangular  incision,  two  and 
a half  inches  in  length,  applied  tbe  trephine,  and  removed  the  fractured  bone.  Tho  soft  parts  were  swollen,  and  the  dura  mater 
lacerated.  There  was  a free  discharge  of  pus,  of  an  unhealthy  character,  but  the  patient’s  constitutional  condition  was  good. 
Simple  dressings  were  applied  to  the  wound.  Erwin  was  transferred  on  December  12th,  entered  Jefferson  Hospital,  Jefferson- 
ville, Indiana,  on  the  13th,  and  was  returned  to  duty  on  December  21st,  1834.  He  was  again  admitted  into  Jefferson  Banneks 
Hospital,  St.  Louis,  on  January  10th,  1835;  on  the  14th  of  April  sent  to  Small-pox  Hospital;  and  for  the  second  time  returned 
to  duty  on  June  3d,  1865.  This  soldier  was  discharged  the  service  August  IGth,  1835,  and  afterwards  pensioned.  On  Januaiy 
19th,  1870,  Pension  Examiner  I.  H.  Reeder  reports  that  the  patient  had  been  subject  to  frequent  attacks  of  epilepsy  since  he  was 
wounded,  which,  within  the  last  year  had  so  increased  in  frequency  and  violence  as  to  totally  disqualify  him  for  any  kind  of 
business  or  habor.  He  rates  his  disability  total  and  permanent. 

Case. — Private  Win.  H.  Freshwater,  Co.  G,  45th  Ohio  Volunteers,  aged  18  years,  was  wounded  atRcsaca,  Georgia,  May 
14th,  1864,  by  a conoidal  musket  ball,  which  fractured  the  left  jiarietal  bone.  He  was  admittial  to  the  hospital  of  tho  Twenty-third 
Corps  on  the  same  day.  The  trephine  was  applied  and  all  the  fragments  of  bone  were  carefully  removed.  He  was  sent  to  the 
field  hospital  at  Bridgeport,  Alabama,  on  the  21st ; transferred  to  Nashville  on  tho  23d;  to  Clay  Hospital,  Louisville,  on  the 27th  ; 
to  Dennison  Hospital  near  Cincinnati,  on  June  20th;  and  thence  to  Seminary  Hospital,  Columbus,  Ohio,  on  July  1st.  He 
recovered,  was  furloughed  on  July  7th,  I’eturned  on  August  8th,  and  was  sent  to  his  regiment  for  duty  on  August  11th,  1864. 
He  was  discharged  June  12th,  1835,  and  pensioned.  His  disability  is  rated  one-half  and  temporary. 


TREPIIINIKG  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


285 


C.\SE. — Private  Edward  Gordon,  Co.  11,  Gth  New  York  Cavalry,  was  wounded  while  on  picket  near  Yorktown,  Virginia, 
Se]nenibcr  18th,  1833,  hy  a conoidal  ball  which  fractured  and  depressed  the  left  parietal  hone  near  the  anterior  inferior  angle. 
He  was  admitted  to  the  Nelson  Hospital,  being  unable  to  speak,  j-et  able  to  walk,  and  scemingl}'  conscious.  The  trephine  was 
applied,  a button  of  bone  removed,  and  the  depressed  fragment  elevated.  While  lifting  the  depressed  bone,  the  left  side  of  his 
face  was  subject  to  violent  convulsions,  which  ceased  as  soon  as  the  fragment  had  been  removed.  A pretty  free  hmmorrhagefrom 
the  middle  meningeal  artery  ceased  spontaneously,  apparently  from  pressure  of  the  brain.  The  patient  recovered  rapidly  and 
was  returned  to  duty  on  December  10th,  1862.  He  is  not  a pensioner. 

Case. — Private  William  Hines,  Co.  A,  20th  Wisconsin  Volunteers,  was  wounded  at  Prairie  Grove,  Arkansas,  December 
7th,  1882,  by  a conoidal  ball,  which  inflicted  a slight  scalp  wound  midway  between  the  anterior  and  posterior  fontanelles,  three- 
fourths  of  an  inch  to  the  left  of  the  sagittal  suture,  and  slightly  indented  the  external  table.  The  injury  apparently  caused  no 
serious  inconvenience,  as  no  record  of  the  case  can  be  found  until  August  27th,  1863,  when  the  man  was  admitted  to  the  hospital 
at  Keoknk,  Iowa,  suffering  from  typhoid  fever.  He  was  discharged  from  service  on  November  12th,  1863.  It  seems  that  he 
afterward  re-enlisted  in  Co.  D,  2d  Wisconsin  Cavalry,  and  served  until  January  2d,  1865,  when  he  was  admitted  to  the  Adains 
Hospital,  Memphis,  Tennessee,  on  account  of  the  injury  received  at  Pi’airie  Grove.  The  state  of  the  patient  was  now-  approaching 
to  idiocy.  Involuntary  movement  of  the  extremities  had  existed  more  or  less  since  the  reception  of  the  injury,  and  the  patient 
complained  of  intense  pain  in  the  head,  which  was  greatly  aggravated  when  exposed  to  the  solar  rays.  The  scalp  wound  had 
healed,  and  an  indentation  of  the  skull  could  easily  be  detected,  sufficient  in  size  to  receive  one-half  of  a split  pea.  Cfn  the  fifth 
day  after  admission,  he  was  placed  under  the  influence  of  chloroform,  when  Assistant  Surgeon  J.  M.  Study,  U.  S.  V.,  made  a 
semi-lunar  incision  three  inches  in  length,  reflected  the  scalp  over  the  seat  of  injury,  and  placing  the  centre  pin  of  the  trephine 
in  the  indentation,  sawed  through  the  skull.  After  the  operation  the  patient’s  progress  was  rapid.  The  treatment  consisted  of 
cold  water  dressings  for  thirty-six  hours,  when  erysipelas  set  in,  and  tepid  water  dressings  were  substituted.  By  the  fifth  day 
the  erysipelas  had  entirely  subsided.  The  wound  suppurated  freely,  the  margin  began  to  heal  rapidly,  and  by  January  18th  the 
jiatient  was  going  about  the  ward,  and  expressed  himself  as  feeling  well  and  free  from  all  the  head  symptoms  which  had  existed 
prior  to  the  operation.  On  February  12th,  1835,  he  was  returned  to  duty  entirely  recovered.  The  case  is  reported  by  the  operator. 
This  man  was  discharged  the  service  November  15th,  1835,  and  pensioned.  On  September  16th,  1837,  Pension  Examiner  W.  A. 
Anderson  reports  that  the  patient  suffers  great  nervous  disability,  which  is  increased  upon  the  least  excitement.  He  is  also  blind 
in  the  right  eye,  the  result  of  a kick  by  a mule  at  Vicksburg,  Mississippi,  on  October  23d,  1864,  which,  in  addition  to  his  previous 
injury,  unfits  him  for  any  occupation.  His  disability  is  rated  total  and  permanent. 

Case. — Private  John  Jastram,  Co.  B,  39th  New  Jersey  Volunteers,  aged  18  years,  was  wounded  while  on  picket  on 
December  4th,  1864,  by  a conoidal  ball,  which  fractured  the  occipital  bone.  He  was  admitted  on  the  same  day  to  the  field 
hospital  of  2d  division,  Ninth  Corps,  where  Surgeon  L.  W.  Bliss,  51st  New  York  Volunteers,  trephined  the  skull.  On  the  7th, 
he  was  sent  to  City  Point,  Virginia,  where  he  remained  in  the  depot  field  hospital  of  the  Ninth  Corps  until  the  20th,  when  he 
was  transferred  to  the  McKim’s  Mansion  Hospital,  Baltimore,  Maryland.  On  January  9th,  1865,  he  was  sent  to  York,  Pennsyl- 
vania, where  he  remained  until  April  17th,  1865,  when  he  was  returned  to  duty.  Tliis  soldier  was  discharged  the  service  June 
20th,  1835.  On  December  14th,  1833,  Pension  Examiner  A.  W.  Woodhull  repoi-ts  that  the  man  complained  of  much  pain  in  the 
wound.  Upon  a change  of  weather  this  was  accompanied  by  dizziness  and  noises  in  the  head,  which  prevented  him  from  pursuing 
his  occupation.  He  rates  his  disability  one-half  and  permanent. 

Case. — Private  Riley  Jump,  Co.  D,  11th  Missouri  Volunteers,  aged  20  years,  was  wounded  at  Tupelo,  Mississippi,  July 
14th,  1864,  hy  a buckshot,  which  fractured  the  left  parietal  bone  and  lodged  between  the  tables.  He  was  admitted  to  the  hospital 
of  the  3d  division.  Sixteenth  Corps,  and  thence  conveyed  to  Memphis,  Tennessee,  where  he  entered  the  Adams  Hospital  on  July 
21st.  On  the  following  day  severe  and  fi-cquent  convulsions  occurred.  Acting  Assistant  Surgeon  S.  S.  Jessup  administered 
chloroform,  applied  the  trephine,  and  removed  the  buckshot  and  the  depressed  bone.  Several  convulsions  occurred  after  the 
operation,  but  were  easily  controlled  by  chloroform,  and  ceased  entirely  on  the  fourth  day.  Stimulants  and  full  diet  were  ordered, 
the  wound  healed  readily,  and  on  January  4th,  1835,  the  patient  was  returned  to  duty.  The  case  is  reported  hy  Surgeon  J.  G. 
Keenon,  U.  S.  V.  He  is  not  a pensioner. 

Case. — Private  A.  P.  Lowry,  Co.  I,  6th  Iowa  Volunteers,  aged  19  years,  was  wounded  in  a skirmish  on  the  Big  Black 
River,  Mississippi,  July  6th,  1833,  hy  a conoidal  ball,  which  struck  at  a point  two  inches  from  and  directly  above  the  right  e.ar, 
fractured  the  skull,  and  emerged  two  inches  above  and  behind  the  wound  of  entrance.  He  was  treated  in  the  regimental  hospital, 
where,  on  July  21st,  Assistant  Surgeon  William  S.  Lambert,  Gth  Iowa  Volunteers,  trephined  the  skull  and  removed  a large  piece 
of  bone  which  was  pressing  upon  the  brain.  He  experienced  immediate  relief  after  the  operation.  On  August  2d,  he  was 
admitted  to  St.  Mark’s  Hospital,  Paducah,  Kentucky,  and,  August  3d,  sent  to  Mound  City,  Illinois.  He  stated  that  the  first  fifteen 
days  after  injury  the  wound  was  dressed  with  poultices,  and  that  he  was  able  to  walk  about  until  July  10th,  when  the  wound 
became  greatly  inflamed.  On  admission  to  Mound  City  Hospital  the  wound  had  almost  healed,  and  his  health  and  appetite  were 
good.  He  was  furloughed  on  September  17th,  1833,  and  returned  to  duty  December  2d,  1863.  He  was  discharg(!d  July  16th, 
1864,  and  pensioned.  Pension  Examiner  Edward  Whinery  reports  that  the  disability  is  total  and  permanent,  but  that  the  degree 
may  become  less. 

Case. — Private  Reuben  Ramsay,  Co.  11,  93d  Pennsylvania  Volunteers,  aged  21  years,  was  wounded  at  the  battle  of 
Chancellorsville,  Virginia,  May  3d,  1863,  by  a conoidal  ball,  which  fractured  and  depressed  the  left  parietal  bone  to  the  extent  of 
a ten-cent  piece,  about  one  inch  above  and  .one  and  a half  inches  anterior  to  ear.  On  the  9th,  he  was  admitted  into  Hafewood 
Hospital,  Washington,  where  Acting  Assistant  Surgeon  O.  D.  Brooks  ajiplied  the  trephine,  and  removed  the  dejjresscd  jxirtions 
of  bone.  Cold  water  dressings  were  applied  to  the  wound,  and  by  June  22d  he  had  so  far  recovered  as  to  be  able  to  go  home  on 
furlough.  He  was  returned  to  duty  on  August  26th,  1863,  entirely  recovered.  He  is  not  a pensioner.  The  case  is  l eported  by 
the  operator.  Acting  Assistant  Surgeon  G.  1).  Brooks. 


286 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


CaSIC. — Private  Janit's  15.  Sawyer,  Co.  G,  27th  Micliigaii  Volunteers,  aged  25  years,  was  wonnded  in  an  engagement  near 
Petersburg,  Virginia.  Ctetober  27th,  1864,  hy  a musket  hull,  which  entered  the  frontal  sinus  above  the  left  eye.  He  was  admitted 
into  the  field  hos])ital  of  the  dd  division.  Ninth  Cor])s,  where  the  operation  of  trephining  was  i)erformed  hy  Surgeon  W.  B.  Fox, 
8th  Michigan  Volunteers.  He  was  suh,  equently  tramsferred  to  the  hospital  of  the  Ninth  Corps  at  City  Point,  and  thence,  on  the 
29th,  to  Washington,  entering  Harewood  Hospital  on  the  31st.  He  recoveri'd,  and  was  returned  to  duty  on  February  10th,  1865. 
He  is  not  recorded  as  a pensioner. 

C.\SK. — Private  Robert  W.  Thompson,  Co.  D,  99th  Pennsylvania  Volunteers;  aged  18  years,  was  wounded  at  the  battle  of 
the  Wilderness,  Virginia,  May  5th,  1864,  hy  a conoidal  ball,  which  fractured  and  de])ressod  the  upper  part  of  the  occipital  bone, 
and  lodged.  He  was  conveyed  to  Washington,  and  entered  .Judiciary  Square  Hosj)ital  on  the  11th.  On  the  following  day  he 
was  placed  under  the  induence  of  ether,  and  Assistant  Surgeon  Alexander  Ingram,  U.  S.  A.,  trephined  the  sknll,  and  removed 
the  depressed  jxu'tion  of  bone,  beneath  which  the  hall  and  a large  firm  clot  were  fonnd.  A piece  of  bone  one  inch  long  and  half 
an  inch  wide,  had  been  driven  in  upon  the  dura  mater.  The  patient’s  constitutional  condition  was  excellent.  On  the  14th,  the 
head  and  face  were  attacked  by  erysipelas,  which  caused  swelling  and  conqiletely  closed  the  eyes.  By  the  19th,  erysipelas  had 
entirely  disap])eared,  and  the  patient  was  nearly  well.  On  the  27th  of  June,  he  was  transferred  to  the  Satterlee  Hospital, 
I’hiladelphia,  and  on  the  31st  j)laced  on  duty  as  nurse;  his  wound  being  nearly  healed.  On  November  28th,  1864,  ho  was 
returned  to  duty.  He  is  not  a pensioner. 

Cask. — Sergeant  Major  George  W.  Wadsworth,  19th  Maine  Volunteers,  aged  22  years,  received,  at  the  battle  of  Gettys- 
burg, I’eiinsylvania,  July  3d,  1863,  a depressed  gunshot  fracture  of  the  cranium.  He  was  admitted  to  the  Seminary  Hospital, 
and  on  .July  7th  sent  to  Mower  Hospital,  Philadelphia.  At  intervals  convulsions  occurred,  supposed  to  have  been  caused  by 
depression  of  internal  table.  On  .July  22d  the  trephine  was  applied,  and  the  depressed  portion  of  bone  removed  by  Acting 
Assistant  .Surgeon  David  McLean.  On  Sei)tend)er  Kith,  a piece  from  the  outer  table  came  awa}’.  On  November  14th  the  wound 
had  nearly  healed,  and  on  December  4th,  1863,  the  patient  was  returned  to  duty.  He  was  promoted  to  Lieutenant,  and 
discharged  June  3Uth,  1863,  and  jiensioned.  I’ension  Examiner  Israel  Putnam  reports  that  the  patient  must  avoid  violent 
exercise  and  exj)osure  to  sun,  being  subject  to  vertigo. 

C.v.SK.— Private  Charles  E.  Wood,  Co.  1),  14lh  New  Yoik  Cavalry,  aged  18  years,  received,  near  Petersburg,  Virgini.a, 
.June  22(1,  1864,  a gunshot  fracture  of  the  mastoid  process  of  right  temporal  hone,  also  wound  of  right  arm  and  hii).  He  was 
admitted  to  hospital  3d  division.  Ninth  Corp.s,  where  .Surgeon  A.  F.  Whelan,  1st  Michigan  Sharpshooter.s,  excised  spicula;  of 
the  tenqioral  bone.  On  .Inly  2d  the  ])atient  was  sent  to  Mount  Plea.sant  Hospital,  Washington,  and  on  July  22d  to  Mower 
llosjutal,  l’hiladeli)hia,  whence  ho  was  returned  to  duty  September  27th,  1864.  He  is  not  a pensioner. 

Four  patients  recovered  sufficiently  to  be  returned  to  modified  duty  in  the  Veteran 
lleservc  Corps  : 

C.v.sK. — Private  .John  G.  Colgan.  Co.  F,  5th  New  Jersey  Volunteers,  aged  22  j-ears,  was  wounded  at  the  battle  of 
Chancellorsville,  Virginia,  May  3d,  1863,  by  a ])iece  of  shell,  which  struck  the  upper  jiortion  of  the  frontal  bone,  causing 
a fracture  with  dej.ression.  He  was  conveyed  to  Washington,  and  on  May  9th  admitted  to  Harewood  Hosj)ital,  where  the 
trephine  was  apiilied,  and  the  de])ressed  portion  of  hone  removed.  On  May  30th,  the  wound  was  doing  well,  and  on  June  24th, 
1863,  the  |)atient  was  transferred  to  Satterlee  Hospital,  Philadelphia,  where  he  was  assigned  to  the  2d  battalion.  Veteran  Reserve 
Corps.  This  .soldier  was  discharged  the  service  November  22d,  1865,  and  pen.sioned.  There  was  a large  cicatrix,  with 
depression  from  loss  of  the  outer  table  of  the  osfrontis,  near  the  junction  of  the  coronal  and  sagittal  sutures,  with  tenderness 
upon  pressure,  and  the  ]iatient  conq.lained  of  vertigo  when  exposed  to  the  sun,  or  when  undergoing  active  exercise.  His  disa- 
bility is  rated  one-half,  and  probably  permanent. 

Ca.se. — Ca])tain  .John  W.  Dempsey,  Co.  H,  82d  New  York  Volunteers,  received  at  the  battle  of  Bull  Run,  Virginia,  July 
21st,  1861,  a gunshot  fracture  of  tlie  skull.  He  w.as  captured  and  not  released  until  1863,  reaching  Washington  July  11th. 
The  skull  was  trephined.  He  was  furloughed  on  July  13th,  and  transferred  to  the  Veteran  Reserve  Corps  July  23d,  1863. 

Case. — Serge.ant  Frank  W.  Dougliiss,  Co.  C,  141st  Pennsylvania  Volunteers,  aged  20  years,  was  wounded  at  the  battle 
of  the  Wilderness,  Virginia,  M.ay  0th,  1864,  hy  a conoidal  ball,  which  fractured  and  depressed  the  frontal  bone  at  the  right  supra- 
orbital region.  He  was  conveyed  to  the  hospital  of  the  3d  division.  Second  Corps,  and  thence  sent  to  Washington,  and  admitted 
to  the  Campbell  Ilosjiital  on  IMay  13th.  Thence  ho  was  sent  to  the  West’s  Buildings  Hospital,  Baltimore,  on  the  10th,  and  finally 
transferred  to  York,  I’enn.sylvania,  on  May  21st.  On  .June  1st,  Surgeon  H.  Palmer,  U.  S.  V.,  trephined  the  skull  .and  removed 
thirty-four  pieces  of  bone.  He  recovered,  and  on  March  7th,  1865,  was  transferred  to  the  Veteran  Reserve  Corps.  The  case  is 
reported  hy  the  operator.  Surgeon  H.  I’ahner,  U.  S.  V.  Douglass  was  a pensioner  in  1809,  his  disability  being  regiirded  .as 
three-fourths  and  jiernianent.  The  examining  surgeon.  Dr.  Turner,  re])orts  that  both  tables  had  been  driven  in  u|)on  the  brain  ; 
that  the  patient  sutlers  pain,  is  incapable  of  much  exjiosure  to  the  sun,  and  is  afflicted  with  loss  of  memory  and  sometimes 
unconsciousness. 

Case. — I’rivate  Collis  H.  Smith,  Co.  E,  116th  New  York  Volunteers,  .aged  30  3-ears,  was  wounded  near  Fort  Darling, 
Virginia,  Mav  10th,  1864,  h3'  a conoidal  hall,  which  fractured  and  depressed  the  frontal  bone  near  the  longitudinal  sinus.  He 
was  conveyed  to  the  field  hospit.al  of  the  Eighteenth  Coips,  and  on  the  19th  sent  to  the  general  hospital  at  Hamj)ton,  Virgini.a. 
On  Mav  26th,  Acting  Assistant  Surgeon  H.  B.  White  ajqjlied  the  trephine  and  removed  several  pieces  of  bone,  giving  exit  to  a 
large  collection  of  ])us.  The  jiatient  was  in  a comatose  condition  and  the  external  |>arts  were  softened  and  much  contused.  The 
removal  of  the  boue  and  consequent  discharge  of  pus,  in  a manner  relieved  the  coma,  but  the  reaction  was  very  slow.  B3'  June 
3d,  the  wound  was  closed  and  healing  finely,  and  the  patient  was  doing  well.  On  October  15th,  he  w.as  sent  to  the  hosjdtal  at 


TREPinXlNG  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


Whitt'liiill,  Pennsylvania,  and  on  Jamiaiy  20tli,  1835,  he  was  transferred  to  the  Veteran  Reserve  Corps.  The  case  is  reported 
by  Assistant  iSiirgeon  Ely  McClellan,  IT.  8.  A.  This  soldier  was  discharged  the  service  iSepteniber  4th,  1835,  and  was  afterward 
jtensioned.  On  May  l'2th,  1830,  Pension  Examiner  George  I’age  reports  a depression  at  the  original  seat  of  injury.  The  patient 
sutfered  from  cephalalgia,  with  occasional  blindness  and  dizziness,  and  his  memory  was  somewhat  affected.  His  distibility  is  rated 
one-half  and  permanent. 

In  the  six  following  cases  of  recovery,  after  trephining  for  gunshot  injury,  the  men 
were  exchanged,  paroled,  or  furloughed : 

Case. — Private  Patriclc  Lane,  was  wounded  at  Irish  Bentf,  Louisiana,  April  14tli,  1863,  by  a conoidal  hall,  which  fractured 
and  depressed  the  right  parietal  bone  at  its  jtosterior  superior  angle  and  lodged,  carrying  with  it  portions  of  cap  and  hair. 
Simple  dressings  were  applied.  F'our  days  after  the  recejttion  of  the  injuiy,  epilepsy  supervened,  and  Surgeon  W.  N.  Trow'- 
bridge,  '23d  Connecticut  Volunteers,  removed  two  buttons  of  bone  with  the  trephine.  No  further  treatment  is  recorded,  hut  the 
report  of  Surgeon  W.  N.  Trowbridge  states  that  the  patient  recovered. 

Case. — Private  James  H.  Itichardson,  Co.  B,  19th  Louisiana  Regiment,  was  wounded  at  the  hatth'  of  Shiloh,  Tennessee, 
April  7th,  1832,  by  a round  musket  hall,  whicli  caused  a depressed  fracture  of  the  cranium.  He  was  admitted  into  Hosj)ital 
No.  3,  Evansville,  Indiana,  April  18th,  1882,  being  at  the  time  in  a state  of  general  paralysis.  The  o])eration  of  trephining  was 
soon  afterward  performed.  The  patient  improved  -slowly,  and  on  August  31st,  was  enabled  to  walk.  On  November  30th,  he 
was  transferred  to  Indianapolis,  Indiana,  and  paroled  on  November  26th,  186*2,  still  suffering  from  paralysis. 

C.\SE. — Private  John  Cotton,  Co.  G,  17th  Georgia  Regiment,  aged  23  years,  received  at  Cedar  Run,  Virginia,  August  9th, 
1862,  a gunshot  fracture  of  the  cranium,  near  the  left  parietal  jirotuherance.  The  internal  table  was  injured  to  a greater  extent 
than  the  external  plate.  Ho  was  admitted  into  the  Confederate  hospital  at  Charlottesville,  Virginia.  On  Sejitember  14th.  the 
trephine  was  applied,  and  several  pieces  of  bone  removed.  The  mind  was  not  .affected  by  the  operation,  but  there  was  slight 
paralysis  of  the  right  side  of  the  body.  Ten  days  after  the  operation,  erysipelas  supervened,  but  wuis  readily  subdueil.  The 
patient  did  well,  constantly  improving  until  October  9th,  1882,  when  he  was  furloughed.  The  wound  had  entirely  healed. 

Case. — Private  J.  IF.  Hambleton,  of  Lathatn’s  Virginia  Battery,  aged  37  years,  received,  at  Cedar  Run,  Virginia,  August 
9th,  1862,  a gunshot  depressed  fracture  of  the  cranium,  at  the  junction  of  the  left  temporal  with  the  jiarietal  bone.  When  he 
was  admitted  into  the  Confederate  hospital  at  Charlottesville,  Virginia,  on  August  11th,  his  mental  and  physical  faculties  were 
unimpaired.  On  the  24th  the  trephine  was  applied,  and  all  fragments  of  hone  were  i-emoved.  About  a week  after  the  oj)erati()u 
the  patient  had  a slight  attack  of  erysipelas  of  the  scalp,  hut  soon  recovcjred  from  it.  In  March,  1865,  he  had  entirely  recovered, 
but  was  injuriously  affected  when  exposed  to  the  heat  of  the  sun.  The  case  is  reported  by  Assistant  Surgeon  B.  W.  Allen,  1*. 
A.  C.  S. 

Case. — Private  J F , 9th  Louisiana  Regiment,  was  wounded  at  the  battle  of  Murfi’eesboro’,  Tennessee, 

December  29th  and  30th,  186'2,  by  a shell,  which  struck  over  the  right  parietal  hone,  causing  a contusion  without  lu'oducing  any 
external  wound,  but  dejwessing  nearly  one-half  of  the  bone,  leaving  a cavity  of  considerable  size.  When  admitted  to  the 
Lagrange  Hospital  his  health  was  very  j)Oor;  the  left  side  was  paralyzed  and  his  intellect  obtuse;  the  extremities  were 
oedematous.  The  trephine  was  applied  and  a button  of  bone  removed,  revealing  extensive  fracture  of  the  internal  table,  and  an 
osseous  tumor  of  nearly  an  inch  in  diameter,  whose  apex  was  removed  by  the  tre])hine.  The  dura  mater  was  in  very  good 
condition,  though  ti’aces  of  inflammation  were  evident.  A marked  improvement  manifested  itself  in  a few  days.  His  apjietite 
improved,  the  oedema  disap]teared,  and  he  was  soon  able  to  walk  about  the  ward. 

Ca.se. — Corporal  J.  A.  Gray,  Co.  I,  12th  Mississippi  Regiment,  was  wounded  at  the  battle  of  Chancelloi-sville,  Virginia, 
May  3d,  1863,  by  a fragment  of  shell,  which  struck  the  left  parietal  bone  at  the  posterior  superior  angle,  deiiressing  both  tables 
fully  half  an  inch,  lie  was  conveyed  to  Washington,  and  on  May  7th  admitted  to  St.  Aloysius  Hospital.  No  untoward 
symptoms  occurred  until  May  9th,  when  he  was  attacked  by  epileptiform  convuLsions,  with  comjdete  loss  of  consciousness.  On 
the  following  day  the  trephine  was  ai)plied,  and  a button  of  hone,  consisting  of  the  external  table  only,  was  removed  from  the 
interior  edge  of  the  fracture.  Ih-agments  of  the  external  table  were  then  removed  which  had  been  driven  backward  between 
the  tables  beyond  the  ])oint  of  fracture,  depressing,  to  a considm-able  extent,  the  inner  table,  which  presented  on  its  exposed 
surface  no  fracture  or  even  fissure.  It  being  deemed  that  the  r<'moval  of  the  fragments  would  permit  of  the  gradual  and 
spontaneous  elevation  of  the  inner  table,  and  it  being  impossible  to  elevate  it  at  the  time  without  a])]ilying  the  trejdiine  in  a new 
j>osition,  it  was  determined  to  leave  the  case  without  further  interference,  unless  .symptoms  of  convulsions  recurred.  Ice  was 
applied,  and  no  untoward  symptoms  occurred.  The  inner  table  partially  resumed  its  natural  ))osition,  and  became  covered  with 
new  granulations.  He  was  doing  well  on  July  27th,  1863,  and  was  sent  to  provost  marshal's  office  August  25th,  1863. 

The  following  thirty-six  cases  recovered  after  trephining  for  gunshot  fractures  of  the 
skull,  with  different  degrees  of  physical  disahility,  and  were  discharged  from  service: 

Ca.se. — Private  .lolin  II.  Ballai’d,  Co.  B,  42d  Indiana  Volunteers,  aged  23  y(‘ars,  was  wounded  at  Dallas,  Georgia,  May 
2.5th,  1864,  by  a conoidal  ball,  which  fractured  the  left  frontal  and  temporal  bones.  He  was  admitted  to  the  hospital  of  tlie  1st 
division,  F'ourteenth  Corps,  on  5Lay  '27th,  where  the  skull  was  trej)hiued,  and  thr(?e  inches  of  bone  were  removed.  He  was  sent 
to  the  field  hospital,  Chattanooga,  Tennessee,  on  .June  2d;  transferred  to  the  Cumberland  Hosj)ital,  Nashville,  on  the  3d;  and 
thence  furloughed  on  July  30th,  and  ordered  to  report  to  the  medical  director  at  the  ex])iration  of  his  leave.  On  September  13th 
he  was  admitted  to  general  hospital,  Evansville,  Indiana,  and  discharged  from  8ervic(!  on  F'ebruary  13th,  1865,  by  reason  of  loss 
of  vision  of  left  eye.  Th('  case  is  re])orted  by  Surgeon  G.  Perin,  U.  S.  A.  Ballard  was  pensioned.  On  l'’ebruary  '23d,  1885 


28S 


WOUNDS  AND  INJUDJES  OF  THE  HEAD, 


IV'iisiou  Exjuiiiiicr  1!.  J.  D;:v.  of  Evansville,  Indiana,  reports  tliat  tlic  wound  lias  several  times  reopened,  and  that  a piece  of  load 
was  removed.  The  man  sull'ers  from  pain  in  head  and  dizziness. 

Case. — Coi'pcral  W.  \Y.  Liarlow,  Co.  15,  1st  Maine  Cavalry,  aged  23  years,  was  wounded  at  Dinwiddle  Court-house, 
Virginia,  March  31st,  18G5,  by  a eonoidal  musket  ball,  which  caused  a compound  fracture  of  outer  table  of  the  os  frontis,  left 
side,  with  comp.ound  comminution  of  inner  table.  He  was  admitted  into  the  Cavalry  Corps  Hospital  at  City  Point,  Virginia,  oil 
the  following  day,  and  transferred  on  April  4lh  to  Wa.shington,  per  hospital  steamer  Thomas  Powell,  entering  Mount  Pleasant 
Hospital  on  the  same  day.  The  case  progressed  favorably  until  the  morning  of  the  7th,  when  the  patient  had  convulsions, 
followed  by  intense  headache.  The  fractured  portion  of  the  outer  table  was  then  i-emovcd.  On  the  following  day  ether 
and  chloroform  were  administered,  anti  Assistant  Surgeon  H.  Allen,  U.  S.  A.,  removed  two  largo  pieces  of  the  inner  table 
through  the  opening  which  had  been  enlarged  by  the  trephine.  Small  fragments  of  bone  came  away  from  time  to  time,  but  the 
case  jtrogressed  favorably,  and  on  June  ICth,  18C5,  the  patient  was  discharged  from  the  service  and  pensioned.  His  disability 
is  total. 

Case. — Captain  A.  V.  Barber,  Co.  C,  31st  Ohio  Volunteers,  aged  25  years,  was  wounded  near  Atlanta,  Georgia,  August 
8th,  18G4,  by  a ball,  which  entered  two  inches  above  the  left  oibital  plate,  fracturing  the  frontal  bone.  He  was  admitted  to  the 
field  hospital  of  the  3d  division,  Fourtcetilh  Corps,  on  the  same  day,  and  on  August  27th  was  transferred  to  the  hospital  at 
Chattanooga,  Tennessee.  On  September  ICth,  the  patient  was  sent  to  the  OlBcers’  Hospital,  at  Lookout  Mountain.  Trephining 
was  resorted  to,  and  a poi  tion  of  bone  one  inch  in  diametei’  was  removed.  The  wound  gradually  healed ; a cartilaginous  septum 
taking  the  place  of  the  removed  disk  of  bone.  He  resigned  on  December  15th,  18G4,  and  is  not  a pensioner. 

Case. — Private  Lorenzo  Beaver,  Co.  E,  7Gth  New  York  Volunteers,  aged  24  yeare,  was  wounded  at  Gettysburg,  July  1st, 
1SG3,  by  a piece  of  shell,  which  fractured  the  cranium.  He  was  conveyed  to  Seminary  Hospital,  Gettysburg,  thence  was  sent  to 
JlcKim’s  Mansion  Hospital,  at  Baltimore,  where  ho  received  a furlough  on  October  17th.  At  its  expiration  he  entered  the  post 
hospital,  Albany,  New  York.  The  operation  of  trephining  had  been  performed  some  time  previously,  but  at  what  date  cannot  be 
exactly  ascertained.  He  was  transferred  to  Baltimore,  leadmitted  into  McKim’s  Mansion  Hospital  on  December  9th,  and  was 
transferred  to  Jarvis  Hospital,  Baltimore,  where  he  was  disch.arged  the  service  on  February  5th,  18G4.  On  !May  ICth,  18G4, 
Pension  Examiner  S.  D.  Will.ard  reports  that  the  man  suffers  from  dizziness  on  bending  or  stoojjing.  Being  unable  to  bear 
exposure  to  the  sun,  and  subject  to  e])ilcpsy,  he  was  entirely  unable  to  labor.  His  disability  is  rated  total  and  permanent. 

Case. — Private  Wesley  Bonnett,  Co.  D,  111th  New  York  Volunteers,  was  wounded  at  the  battle  of  Gettysburg, 
Pennsylvania,  July  3d,  18G3,  by  a eonoidal  musket-ball,  which  fractured  the  right  parietal  bone.  A few  pieces  of  bone, 
and  the  ball,  which  was  split  in  its  long  diameter,  were  removed  on  the  field.  He  had  received  in  the  same  engagement 
a penetrating  wound  of  the  lower  lobe  of  right  lung.  He  was  taken  to  the  regimental  hospital,  thence  sent  to  Letterman 
Hospital,  and  on  September  8th,  1863,  admitted  to  Mower  Hospital,  Philadelphia.  The  wound  of  chest  had  entirely  healed,  and 
the  patient’s  health  was  good.  He  stated  that  he  had  been  attacked,  about  four  days  after  the  reception  of  the  injury,  by 
epileptiform  convulsions,  which  continued  at  intervals  of  two  days  until  July  IGth,  when  they  ceased;  but  on  September  5th 
they  returned  with  increased  violence.  On  Se])tember  9th,  eight  small  fragments  were  removed.  On  September  IGth,  a 
convulsion  threatened,  but  was  warded  off  by  counter  irritation  and  half  a grain  of  morphia.  On  the  20th  convulsions  suddenly 
occurred,  and  recurred  twice  afterward  on  the  2Gth  and  the  27th,  followed  each  time  by  slight  fever.  On  September  COth,  the 
patient  was  doing  well  with  the  exception  of  some  headache  occasionally,  and  the  wound  was  healing  kindly.  He  was 
discharged  from  the  service  on  November  2d,  1833.  From  January,  18G4,  to  May,  1868,  with  the  exception  of  one  interval  of 
fort}’  days,  he  had  two  or  three  convulsive  seizures  a week.  On  Jlay  25th,  18C8,  the  trephine  was  applied  by  Dr.  Darwin 
C’olvin,  and  some  depressed  bone  removed,  A large  piece  of  scmii-osseous  material  was  removed  by  Hey’s  saw,  and  also  two 
sinirs  of  bone,  which  dipped  down  so  that  some  jiressure  must  have  been  constant  upon  the  brain.  In  July,  1868,  the  wound 
had  closed  with  healthy  granulations,  and  the  patient  was  nearly  well.  A complete  history  of  the  operation  is  published  in  the 
Kcio  Yorlc  Medical  Journal,  vol.  7,  page  422.  The  man  is  not  a pensioner. 

Case. — Private  Sterling  Bunnel,  Co.  G,  Gth  Connecticut  Volunteers,  aged  22  years,  was  wounded  at  Bermuda  Hundred, 
Virginia,  May  20th,  18G4,  by  a eonoidal  ball,  which  fractured  the  right  frontal  bone,  near  its  union  with  the  parietal.  He  was 
admitted  on  the  following  day  into  the  hospital  at  Hampton,  Virginia,  and  tlience  transferred,  on  June  3d,  to  the  Knight  Hospital, 
New  Haven,  Connecticut,  whei’e  he  arrived  on  the  7th.  HaDinofrhage  had  occurred  the  day  previous,  and  the  patient  was  very 
feeble.  The  wound  looked  healthy,  and  the  case  progressed  favorably  until  the  morning  of  the  12th,  when  severe  haemorrhage 
recurred  from  a branch  of  the  anterior  temporal  artery.  The  bleeding  vessel  was  ligated,  and  the  haemorrhage  ceased.  On 
Juno  IGth,  the  wound  became  unhealthy,  red,  and  tumefied,  and  flax-seed  and  charcoal  poultices  were  applied,  and  morphine  in 
small  doses  and  stimulants  were  ordered.  Gangrene  became  fully  developed  on  the  following  day.  During  the  next  day  the 
slough  was  dissected  and  bromine  applied.  The  gangrene  was  entirely  arrested,  and  by  the  30th  healthy  granulation  had  set  in. 
During  the  afternoon  of  Jfdy  2d,  severe  convulsions,  followed  by  loss  of  consciousness,  supervened.  The  wound  was  carefully 
examined,  but  no  depression  could  be  discovered.  An  accamulation  of  pus  being  diagnosed.  Acting  Assistant  Surgeon  S.  D. 
Wilcoxson  applied  the  trephine.  No  pus  was  found,  but  a light  depression  of  the  inner  table  was  discovered  and  elevated. 
Low  diet  and  perfect  quiet  were  enjoined.  No  unlavoi-able  symptoms  recurred.  The  patient  was  furloughed  on  August  Gth,  and 
returned  at  the  expiration  of  his  leave,  when  the  wound  was  reexamined,  and  a portion  of  bone  removed.  From  that  time 
rapid  improvement  took  place,  and  on  Sejitember  3d,  18G4,  he  was  discharged  from  the  service ; his  term  of  service  having 
expired.  The  case  is  reported  by  the  operator.  Acting  Assistant  Surgeon  S.  D.  Wilcoxson.  On  October  20th,  18G4,  Pension 
Examiner  Henry  Pieiqiont  reports  that  the  wound  had  not  perfectly  healed.  The  right  eye  was  affected,  and  pulsation  was 
jdainly  visible.  Any  excitement,  or  even  a short  walk,  caused  severe  pain.  His  disability  is  rated  total  and  temporary. 
Further  information  states  that  in  18G9  Bunnel's  disability  was  considered  total.  A portion  of  the  skull  four  and  three-fonrths 
by  one  and  three-fourths  inches  was  missing.  The  jmlsations  of  the  brain  were  plainly  visible,  and  excitement  caused 
severe  pain. 


TREPHINING  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


289 


Case. — Pi-ivate  William  Burt,  Co.  G,  2il  New  York  Heavy  Artillery,  aged  30  years,  was  wounded  near  Petersburg, 
Virginia,  Juno  17tli,  1804,  by  a conoid.al  ball,  wbicli  fractured  and  depressed  the  left  parietal  bone.  He  was  admitted  to  the 
Second  Corps  field  hospital  at  City  Point,  on  June  19th,  and  conveyed  to  the  Campbell  Hospital,  Washington,  on  the  28th.  He 
was  in  a stupid  condition,  and  the  i-ight  arm  and  leg  had  become  paralyzed.  On  the  following  day.  Surgeon  A.  F.  Shehlon,  U. 
S.  V.,  removed  about  one  and  a half  inches  square  of  depressed  bone  with  the  trephine.  The  patient  rallied  after  the  operation, 
and  continued  to  improve.  By  the  20th  of  July  he  had  regained  the  use  of  the  paralyzed  parts.  On  the  28th  he  was  transferred 
to  the' Lovell  Hospital,  Portsmouth  Grove,  Rhode  Island,  where  he  remained  until  the  24th  of  August,  when  he  was  sent  to  the 
JIcDougall  Hospital.  Fort  Schu3-ler,  New  York  Harbor,  lie  was  discharged  the  service  on  December  15th,  18G4.  On  August 
IJth,  1865,  Pension  Examiner  E.  Bradle.y  reports  that  the  patient’s  hearing  and  ej’esight  are  very  poor.  There  was  partial 
hemiplegia  of  the  right  side,  accompanied  bj'  anemia  and  weakness  to  such  a degree  as  to  incapacitate  him  for  anj'  manual  labor. 
It  appears  that  this  man’s  health  continued  to  deteriorate,  as  his  pension  was  subsequentlj'  increased. 

Case.— Private  George  W.  Burton,  Co.  E,  5th  Wisconsin  Volunteers,  aged  21  j'ears,  received,  near  Petersburg,  Virginia, 
Api'il  2d,  1865,  a compound  fracture  of  the  occipital  bone,  and  also  a fracture  of  the  left  tibia.  He  was  admitted  to  hospital  1st 
division.  Sixth  Corps,  where  the  skull  was  trephined,  and  a portion  of  the  left  tibia  excised.  He  was,  on  April  lOth,  admitted  to 
Broad  and  Cherrj'  Streets  Hospital,  Philadelphia,  and  on  !May  8th  sent  to  Satterlee  Hospital,  where  he  was  discharged  from  the 
service  July  24th,  1865.  He  was  pensioned,  and  in  Julj',  1865,  Pension  Examiner  E.  A.  Smith  rated  his  disability  total  and  per- 
manent. The  pulsation  of  brain  was  still  visible.  The  leg  was  unhealed  and  the  tibia  necrosed. 

Case. — Lieutenant  William  0.  Capers,  Co.  C,  14th  Tennessee  Regiment,  received,  at  the  battle  of  Perryville,  Kentucky, 
October  8th,  1862,  a severe  gunshot  fracture  of  skull,  with  depression.  He  was  admitted  to  a Confederate  held  hospital  near 
Perr^’ville,  where  the  skull  was  trephined.  Ho  was  discharged  October  24th,  1862. 

Case. — Private  George  W.  Coates,  Co.  F,  8th  Minnesota  Volunteers,  aged  18  years,  was  wounded  at  Murfreesboro’, 
Tennessee,  December  7th,  1864,  by  a conoidal  ball,  which  fractured  and  depressed  the-right  parietal  bone  near  the  coronal  suture. 
He  entered  the  general  hospital  at  the  above  place  on  the  following  day.  The  wound  was  hot  and  painful.  Violent  and  frequent 
epileptic  convulsions  commenced  on  the  third  day  after  the  injury.  On  the  11th  he  was  gi’owing  stuj)id,  with  tonic  spasm  of  the 
muscles  of  tlie  jaw  and  neck,  and  irregular  and  depressed  pulse.  He  was  placed  under  the  inhuence  of  chloroform,  and  Surgeon 
Samuel  D.  Turney,  U.  S.  V.,  trephined  a portion  of  the  inner  table.  Considerable  haemorrhage  from  the  veins  of  the  diploii 
ensued.  He  reacted  promptlj'.  A silver  plate  was  inserted,  and  water-dressings  were  applied,  and  cathartics  administered,  'riio 
convulsions  diminished  in  frequency  and  violence,  and  finally  ceased  entirely.  On  February  16th,  1865,  the  patient  was  trans- 
ferred to  Hos])ital  No.  2,  Nashville,  Tennessee,  and  furloughed  on  February  28th,  1865.  On  April  2d  he  was  admitted  to  the 
hospital  at  Murfreesboro’,  and  was  discharged  from  service  July  4th,  1865.  The  case  is  reported  by  the  operator.  On  August  2d, 
1865,  Pension  Examiner  S.  Willey  reported  that  the  patient  was  weak  and  anaemic.  The  right  limbs  were  smaller  than  the  left, 
the  pupils  were  dilated,  and  there  was  inability  to  distinguish  objects  with  the  left  eye.  His  disability  is  rated  total  and  temporary. 
[In  a letter  of  December,  1873,  Dr.  Turney  disclaims  the  superstition  of  silver  plate.  See  Second  Sure/kal  Volume,  p.  283,  Case 
815,  and  Note  5.] 

Case. — Private  Andrew  Cole,  Co.  D,  145th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Fredericksburg,  Vir- 
ginia, December  13th,  1862,  by  a conoidal  ball,  which  fi-actured  the  frontal  bone,  right  side,  near  the  coronal  suture.  Another  ball 
jiassed  through  the  muscular  substance  of  the  thigh.  He  was  admitted  to  Plarewood  Hospital,  Washington,  December  17th,  1862. 
On  December  23d,  the  skull  was  trephined,  and  loose  fragments  of  bone  were  removed.  No  inflammation  existed,  and  wound 
suppurated  freely ; several  pieces  of  bone  were  removed  at  dift'erent  periods,  but  in  March,  1863,  the  wound  had  neail^'  healed 
He  was  discharged  December  21st,  1833,  and  pensioned.  In  February,  1864,  Pension,  Examiner  D.  E.  Belknap  reports  that  the 
wound  is  still  open  and  discharging,  and  that  more  bone  will  probably  come  away.  The  disability  is  rated  total. 

Case. — Private  Russell  M.  Cool,  Co.  E,  9th  Illinois  Volunteers,  aged  19  years,  was  wounded  at  Fort  Donelson,  Tennessee, 
February  15th,  1862,  by  a conoidal  musket  ball,  which  fractured  and  depressed  a portion  of  both  tables  of  the  left  parietal  near 
the  junction  with  the  occipital  bone.  He  was  conveyed  to  Mound  City,  Illinois,  and  entered  the  hospital  at  that  place  on  the 
20th,  when  Surgeon  E.  C.  Franklin,  U.  S.  V.,  performed  the  operation  of  trephining,  being  obliged  to  apply  the  trephine  in  three 
places  before  the  depressed  bone  could  be  elevated.-  Fourteen  pieces  were  removed;  the  largest  was  the  size  of  a five-cent 
piece.  All  the  symptoms  of  compression  were  manifest;  pulse  65;  breathing  stertorous.  Twenty -four  hours  after  operation  the 
pulse  was  85,  the  breathing  natural,  and  the  appetite  good.  Cold  water  dressings  were  applied.  In  about  a week  sloughing 
commenced  and  increased  the  size  of  the  wound  to  five  inches  in  length,  by  one  incli  in  breadth.  Two  weeks  after  admission. 
Cool  was  furloughed.  He  returned  to  the  hospital  on  June  21st,  and  was  discharged  the  service  on  the  following  daj'.  In  the 
early  part  of  1866,  he  was  examined  by  Pension  Examiner  Thomas  S.  Stanway,  who  states  that  “ a little  to  the  left  of  the 
junction  of  the  parietal  and  occipital  bones  a depression  is  found,  which  would  hold  about  two  drachms  of  fluid.  The  man’s 
health  was  good,  but  exposure  to  the  sun’s  raj^s  would  affect  him.”  On  September  27th,  1867,  Pension  Examiner  T.  S.  Stanway 
reported  that  partial  amaurosis  of  the  left  eye  had  occurred,  and  that  the  disability  increased  upon  exposure  or  fatigue.  His 
disability  is  rated  total. 

Case. — Private  Owen  Fitzpatrick,  Co.  B,  63d  New  York  Volunteers,  aged  48  years,  was  wounded  at  the  battle  of  the 
Wilderness,  Virginia,  May  5th,  1864,  by  a musket  b.all,  which  struck  anterior  to  the  superior  angle  of  the  occij)ital  bone, 
fracturing  both  tables  of  the  skull  and  depressing  a portion  of  the  Inme  to  the  extent  of  one-fourth  of  an  inch.  He  was  conveyed 
to  Alexandria,  Virginia,  and  entered  the  3d  division  hospital  on  May  12th.  Little,  if  any,  constitutional  disturbance  existed;  the 
patient  ate  and  slept  well  and  was  able  to  walk  about.  On  the  16th,  he  was  placed  under  the  influence  of  chloroform  and  ether, 
equal  parts,  and  Surgeon  Edwin  Bentlej’,  U.  S.  V.,  trephined  the  skull,  removed  a few  small  fragments,  and  elevated  the 
depressed  bone.  No  hajmorrhage  followed  the  operation.  Cold  wat(^r  dressings  were  a])])lieil,  tin?  h(!ad  slightly  elevated,  and 
(juiet  and  abstemious  diet  strictly  enjoined.  The  case  progressed  without  any  untoward  symj>toms.  On  June  2541],  some  small 


290 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


pieces  of  skull  and  shreds  of  cloth  were  removed  from  the  wound.  On  September  26th,  the  wound  had  entirely  healed  and  the 
patient  received  a furlough  of  thirty  days,  at  the  expiration  of  which  he  returned.  On  December  20th,  1864,  he  was  discharged 
fi’om  the  service  on  surgeon’s  certificate  of  disability,  by  reason  of  dizziness  and  headache  which  supervened  any  exercise.  A 
communication  from  the  Commissioner  of  Pensions,  dated  January  3d,  1868,  states  that  Fitzpatrick  is  a pensioner,  and  that  his 
disability  is  rated  as  one-half  and  permanent.  The  case  is  reported  by  Surgeon  E.  Bentley,  U.  S.  V.  On  Januaiy  28th,  1870, 
Pension  Examiner  J.  W.  Toward  reports  from  the  National  Military  Asylum  at  Augusta,  Maine,  (of  which  institution  the  patient 
was  an  inmate,)  that  there  was  a deep  indentation  at  the  seat  of  the  wound.  There  was  complete  loss  of  sight  of  left  eye  and 
the  vision  of  the  right  eye  was  much  impaired.  The  patient  suffered  from  headache,  dizziness,  temporary  loss  of  sight  of  right 
eye,  and  was  unable  to  remain  in  the  sun  or  perform  any  labor  requiring  stooping  or  much  exertion.  Since  he  was  wounded  he 
was  subject  to  fits  of  an  epileptifonn  character,  which  supervened  upon  unusual  exertion.  His  disability  is  rated  total  and 
permanent. 

Case. — Corporal  E.  Eugene  Flagg,  Co.  K,  94th  Illinois  Volunteers,  was  wounded  at  the  battle  of  Prairie  Grove,  Arkansas, 
December  7th,  1862,  by  a conoidal  musket  ball,  which  fractured  and  depressed  the  cranium  two  inches  posterior  to  the  coronal, 
and  one  and  one-fourth  inches  to  the  left  of  the  sagittal  suture.  Assistant  Surgeon  Archibald  E.  Stewart,  94th  Illinois  Volun- 
teers, trephined  the  skull,  and  removed  all  fragments  of  bone,  on  the  field.  The  patient  was  immediately  admitted  to  the  field 
hospital  at  Prairie  Grove.  In  the  beginning  of  January,  1863,  his  condition  was  favorable  and  daily  improving,  but  the  right 
leg  was  partially  paralyzed.  He  was  transferred  to  the  general  hospital  at  Springfield,  Missouri,  on  February  15th,  and  discharged 
from  service  February  20th,  1863.  The  case  is  reported  by  Surgeon  Ira  Russell,  U.  S.  V.  On  May  21st,  1867,  Pension  Examiner 
H.  Conkling  reports  that  the  patient  at  times  suffers  from  pain  in  the  head  and  paralysis  of  the  left  leg.  The  left  eye  was  also 
affected.  His  disability  is  rated  two-thirds  and  permanent.  Further  information  in  1869,  regarding  this  man’s  pension,  mentions 
the  paralysis  of  the  leg  and  the  affection  of  the  eye. 

Case. — Private  Joseph  Freeland,  Co.  A,  30th  U.  S.  Colored  Troops,  aged  18  years,  w'as  wounded  before  Petersburg,  Virginia, 
July  30th,  1864,  by  a shell,  which  fractured  the  cranium.  He  was  at  once  admitted  into  the  hospital  4th  division,  Ninth  Corps, 
where,  on  August  2d,  Surgeon  David  Mackay,  28th  U.  S.  Colored  Troops,  trephined  the  skull,  and  removed  one  and  onc-fourth 
inches  of  right  parietal  bone,  while  the  patient  was  under  the  influence  of  chloroform.  He  was,  on  August  3d,  transferred  to 
hospital  for  colored  troops  at  City  Point,  where  he  remained  until  August  8th,  when  he  was  transferred  to  L’Ouverture  Hospital, 
Alexandria.  The  left  arm  and  leg  were  paralyzed.  He  was  discharged  the  service  on  June  8th,  1865.  On  May  15th,  1866, 
Pension  Examiner  B.  Gesuer  reports  that  there  was  general  paralysis  of  the  side.  He  rates  the  patient’s  disability  total  and 
permanent. 

Case. — Private  Brazilla  Grant,  Co.  A,  6th  New  Jersey  Volunteers,  was  wounded  at  the  battle  of  Williamsburg,  Virginia, 
May  5th,  1862,  by  a musket  ball,  which  fractured  and  carried  away  a portion  of  both  tables  of  the  parietal  bone  near  the  central 
part  of  the  sagittal  suture.  The  brain  was  involved.  For  several  weeks  he  remained  in  the  field  hospital.  On  June  12th,  1862,  he 
was  admitted  into  the  Wood  Street  Hospital,  Philadelphia.  The  wound  healed,  and  the  patient  was  discharged  from  service  on 
August  8th,  1862,  in  consequence  of  a pai-tial  paralysis  of  the  right  side.  The  case  is  reported  by  Assistant  Surgeon  C.  W. 
Honter,  U.  S.  V.  On  January  25th,  1867,  Pension  Examiner  W’’.  S.  Combs  reports  that  the  operation  of  trephining  had  been 
performed.  The  result  was  a complete  paralysis  of  the  left  side,  incapacitating  the  patient  for  any  kind  of  manual  labor.  He 
rated  his  disability  total  and  permanent.  A communication  from  the  Commissioner  of  Pensions,  dated  December  9th,  1869,  stated 
that  Grant  receives  a pension  of  |)15  per  month,  and  that  his  disability  is  rated  permanent. 

Case. — Private  Thomas  Hailey,  Co.  K,  7th  Minnesota  Volunteers,  hged  24  years,  was  wounded  on  August  9th,  1864, 
during  a skirmish  on  the  Tallahatchie  River,  Mississippi,  by  a conoidal  ball,  which  struck  the  left  parietal  bone  half  an  inch  from 
the  sagittal  suture,  depressed  both  tables  for  a space  of  one  inch  in  diameter,  and  lodged.  He  was  conveyed  to  Memj)his, 
Tennessee,  and  entered  the  Jackson  Hospital  on  the  12th.  The  lower  extremities  were  paralyzed.  'I'he  pulse  was  85,  feeble  and 
compressible,  and  his  spirits  were  verj’  much  depressed,  'rhe  soft  parts  around  the  injury  were  extensively  lacerated,  and  the 
depressed  bone  was  so  wedged  that  it  was  impossible  to  move  it  with  an  elevator.  A few  hours  after  admission,  he  was  ])laced 
under  chloroform,  and  Acting  Assistant  Surgeon  Samuel  S.  Jessup  trephined  the  skull  anteriorly  and  externally  to  the  point  of 
injury,  and  removed  the  depressed  bone.  The  lips  of  the  incision  were  then  brought  together  again  by  sutures.  The  patient 
reacted  promptly.  Ice  water  dressings  were  applied  to  the  wound,  drastic  purgatives  administered,  and  the  patient  placed  on  low 
diet.  The  paralytic  condition  ceased  within  a week  after  the  operation,  and  progress  was  rapid.  On  October  6th,  he  Was 
furloughed,  the  wound  being  nearly  healed.  He  reported  at  the  general  hospital  at  Fort  Snelling,  Minnesota,  on  November  30th, 
1864,  and  was  discharged  from  the  service  on  April  29th,  1885.  He  was  examined  in  1867,  by  Pension  Examiner  Otis  Ayer. 
There  was  a depression  about  an  inch  and  a half  long,  an  inch  wide,  and  five-eighths  of  an  inch  deep,  midway  between  the 
frontal  and  occipital  bones;  had  pain  in  head,  perverted  sensation  in  the  limbs,  and  j)hysical  exercise  produced.a  mental  condition 
in  which  he  Avas  unable  to  recognize  his  most  intimate  friends.  He  is  a pensioner. 

Case. — Private  Franklin  Harris,  Co.  E,  145th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Fredericksbiu-g, 
Virginia,  December  13th,  1832,  by  a conoidal  ball,  which  fi-actured  both  tables  of  the  left  parietal  bone,  depressing  the  inner 
table;  ho  also  received  flesh  wounds  of  left  shoulder  and  right  hand.  Hu  was  taken  to  the  field  hosjuta!  of  Hancock’s  division. 
Second  Corps,  where,  on  December  22d,  the  trephine  Avas  applied,  and  fragments  were  removed  and  the  edges  of  bone  elevated. 
The  patient  improved  gradually;  Avas  transferred  to  Broad  and  I’rime  Streets  Hospital,  Philadelphia,  on  January  6th,  1863,  and 
thence  sent  to  South  Street  Hosjjital,  on  January  11th.  The  brain  pulsations  Avere  distinctly  visible.  Small  pieces  of  bone  came 
aAvay  nearly  eA'ery  day,  but  the  scalp  Avas  granulating  freely,  and  disposed  to  close  over  the  opening.  On  January  26th,  there 
being  a boggy  feeling  in  the  A’icinity  of  the  Avound,  and  consider’able  discharge  from  betAveen  it  and  the  bone,  free  incisions  Avere 
made  in  the  scalp  by  Acting  Assistant  Surgeon  J.  Walter  Tiyon.  By  February  15th  the  discharge  of  pieces  of  bone  had 
ceased;  the  patient  had  become  drowsy  and  listless,  but  the  discharge  from  beneath  the  seal))  continued.  Iron,  quinine,  and 


TEEPniNING  AFTER  GUNSHOT  FEACTUEES  OF  THE  SKULL. 


291 


beef  tea  were  ordered.  The  patient’s  general  condition  was  much  improved,  and  the  wound  had  nearly  closed  by  the  23d  of 
March,  but  he  complained  of  much  pain  over  the  left  eyebrow.  He  was  discharged  fi'om  the  service  on  May  Cth,  18C3.  He  is 
not  a pensioner. 

Case. — Private  Philip  L.  Hart,  Co.  B,  7th  Connecticut  Volunteers,  was  wounded  in  the  engagement  at  James  Island, 
South  Carolina,  June  16th,  1832,  by  a shell,  which  fractured  the  cranium,  and  injured  the  right  thumb,  causing  loss  of  first  joint. 
He  was  probably  treated  in  a field  hospital  until  end  of  December,  1862,  when  he  was  conveyed  per  steamer  Star  of  the  South 
to  New  York  City,  entering  St.  Joseph’s  Hospital,  Central  Park,  January  1st,  1863.  He'  suffered  from  cephalalgia,  occasional 
attacks  of  vertigo,  and  impairment  of  intellect.  He  was  discharged  February  2d,  1863,  and  pensioned.  In  May,  1864,  Pension 
Examiner  J.  W.  Ellswoith  reports  that  the  operation  of  trephining  has  apparently  been  performed;  that  the  patient-has  pain  in 
the  head  when  exposed  to  the  sun.  Partial  loss  of  thumb  inteiferes  materially  with  his  work.  The  disability  is  one-third  and 
permanent. 

Case.— Private  Alvan  A.  Hasty,  Co.  K,  38th  Massachusetts  Volunteers,  was,  on  June  17th,  1863,  admitted  to  Sj.  Louis 
Hospital,  New  Orleans,  Louisiana,  with  a gunshot  wound  of  the  cranium.  The  operation  of  trephining  was  performed.  The 
patient  recovered;  was  furloughed  on  September  6th,  and  discharged  December  15th,  1863,  and  pensioned.  Pension  Examiner 
George  Stevens  Jones  reports  that  he  suffers  from  pain  m the  head,  vertigo,  and  nausea,  which  increases  by  over  exertion  or 
exposure  to  heat,  and  rates  the  disability  two-thirds  and  probably  permanent. 

Case. — Corporal  William  H.  Hurst,  Co.  I,  150th  Pennsylvania  Volunteers,  aged  22  years,  was  wounded  before  Peters- 
burg, Virginia,  July  15th,  1834,  by  a piece  of  shell,  which  fractured  the  left  parietal  bone,  without  known  depression.  He  was, 
on'  the  same  day,  admitted  to  the  hospital  of  the  1st  division.  Fifth  Corps,  and  on  August  6th  conveyed  to  the  Grant  Hospital, 
Willet’s  Point,  New  York  Harbor,  where  he  remained  until  September  21st,  when  he  was  sent  to  the  Cuyler  Hospital,  German- 
town, Pennsylvania.  On  May  10th,  1865,  he  was  transferred  to  the  Mower  Hospital,  Philadelphia.  Only  simple  dressings  had 
been  applied  to  the  wound  up  to  this  time.  It  seems  that  at  this  latter  hospital  the  operation  of  trephining  was  performed.  The 
man  recovered,  and  was  discharged  from  service  on  June  7th,  1865.  On  June  9th,  1865,  Pension  Examiner  H.  L.  Hodge  reports 
that  the  injury  to  the  skull  had  been  followed  by  necrosis,  cephalalgia,  loss  of  memory,  and  absent-mindedness.  Ho  rates  the 
patient’s  disability  one-half  and  probably  permanent.  A communication  from  the  Commissioner  of  Pensions,  dated  March,  1868, 
states  that  Hurst  is  a pensioner,  at  four  dollars  per  month,  and  that  his  disability  is  rated  one-half  and  permanent. 

Case. — Sergeant  Monroe  Holloway,  Co.  I,  67th  Ohio  Volunteers,  aged  25  years,  was  wounded  in  an  engagement  at  Fort 
Wagner,  near  Charleston,  South  Carolina,  August  18th,  1863,  by  a fragment  of  shell,  which  fractured  the  right  parietal  bone  at 
the  posterior  inferior  angle,  causing  a slight  depression.  He  was  rendered  insensible  by  the  shock,  but  soon  recovered,  and  was 
carried  to  the  hospital  on  Morris  Island.  In  about  forty-eight  hours  convulsions  supervened,  and  continued  for  a week  or  more. 
Fragments  from  both  tables  were  then  removed,  exposing  the  brain,  and  the  convulsions  ceased.  On  the  1st  of  September,  he 
was  sent  to  Hospital  No.  1,  Beaufort,  South  Carolina;  the  wound  being  dressed  in  the  ordinary  manner.  On  October  2d,  he 
was  transferred  by  steamer  to  the  McDougall  Hospital,  New  York  Harbor.  As  late  as  December  the  wound  had  not  closed,  but 
convulsions  had  not  recurred  since  the  date  of  operation  ^ no  paralysis  existed;  and  the  patient  was  able  to  walk  about ; indeed, 
he  declared  that  he  felt  well.  On  February  12th,  1884,  he  was  sent  to  the  DeCamp  Hospital,  and  on  June  21st,  1864,  discliarged 
from  service  at  his  own  request.  On  August  29th,  1866,  Pension  Examiner  W.  Eamsey  reports  that  the  operation  for  trephining 
had  been  performed,  and  that  the  patient  then  complained  of  pain  in  the  head,  and  dizziness.  He  was  compelled  to  avoid  mental 
as  well  as  physical  labor.  His  disability  is  rated  one-half  and  permanent. 

Case. — Private  Ambrose  F.  Jackson,  Co.  Gff  7th  Rhode  Island  Volunteers,  received,  at  the  battle  of  Fredericksburg, 
Virginia,  December  13th,  1862,  a gunshot  injury  of  the  cranium.  He  was  admitted  to  the  hospital  of  the  2d  division.  Ninth 
Corps;  on  December  20th,  sent  to  Carver  Hospital,  Washington,  and  on  January  6th,  1863,  to  Lovell  Hospital,  Portsmouth 
Grove,  Rhode  Island,  where  he  was  discharged  on  June  10th,  1883.  On  March  7th,  1867,  Pension  Examiner  A.  E.  Ames  reports 
that  the  patient  had  been  trephined.  He  suffered  from  headache  and  dizziness,  and  his  memory  was  so  much  impaired  that  he 
could  not  recollect  the  day  or  the  year  he  was  wounded.  He  recommends  that  the  patient  should  have  a full  pension. 

Case. — Private  Hezekiel  Jackson,  Co.  K,  39th  U.  S.  Colored  Troops,  aged  24  years,  was  wounded  near  Petersburg,  Vir- 
ginia, July  30th,  1864,  by  a shell,  which  fractured  the  right  parietal  bone.  He  also  received  a wound  of  right  leg.  He  was 
admitted  to  hospital  4th  division.  Ninth  Corps,  where  the  operation  of  trephining  was  performed,  on  August  2d,  by  Surgeon 
David  Mackay,  29th  U.'S.  Colored  Troops.  One  and  a half  inches  of  bone  were  removed.  He  was,  on  the  same  day,  trans- 
ferred to  hospital  for  colored  troops  at  City  Point,  Virginia,  where  he  remained  until  August  8th,  when  he  was  sent  to  L’Ouver- 
ture  Hospital,  Alexandria,  Virginia.  The  left  arm  had  become  paralyzed.  He  was  discharged  from  service  April  7th,  1865,  and 
pensioned.  Pension  Examiner  Wm.  H.  Clendenin  reports  that  he  has  occasional  headache,  but  no  paralysis  or  loss  of  memory. 
The  wound  of  leg  is  entirely  healed,  leaving  no  disability. 

Case. — Private  J.  W.  Jenkins,  Co.  F,  48th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Antietam,  Maryland, 
September  17th,  1862,  by  a piece  of  shell,  which  caused  a punctured  fracture  of  the  anterior  superior  portion  of  the  left  parietal 
bone,  and  depressed  the  inner  table.  He  was  admitted  into  Capitol  Hospital,  Washington,  on  the  23d,  and  thence  transfeired  to 
the  De  Camp  Hospital,  David’s  Island,  New  York  Harbor,  on  the  28th.  On  October  3d,  Acting  Assistant  Surgeon  William  K. 
Cleveland  applied  the  trephine  ^o  the  point  of  fracture,  and  removed  two  pieces  of  the  depressed  internal  table  an  inch  and  a 
quarter  in  diameter.  A few  drops  of  pus  escaped.  With  the  exception  of  a slight  headache,  there  had  been  no  symptoms  to 
denote  the  presence  of  pus.  Patient  made  an  excellent  recovery,  and  was  discharged  from  the  service  on  December  4th,  1862. 
The  case  is  reported  by  Surgeon  S.  W.  Gross,  U.  S.  V.  On  December  23d,  1869,  Pension  Examiner  D.  L.  Beeser  reports  that 
the  parts  are  well  closed  by  a film  tissue,  and  that  the  patient  alleges  to  suffer  neuralgic  pains  and  vertigo  at  times.  His  general 
appearance  was  good,  and  he  seemed  robust  and  healthy.  He  rates  his  disability  at  one-third.  His  claim  for  a pension  was 
pending  at  the  above  date. 


292 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — Private  John  R.  Kell,  Co.  G,  22cl  Illinois  Volunteers,  received,  at  the  battle  of  Belmont,  Missouri,  November  7th, 
18G1,  a depressed  fracture  of  both  tables  of  the  occipital  bone,  about  one  inch  to  the  right  of  lateral  sinus.  He  was  conveyed 
by  steamer  to  Mound  City,  Illinois,  and  entci'ed  the  hospital  at  that  place  on  the  13th.  Surgeon  E.  C.  Franhlin,  U.  S.  V.,  applied 
the. trephine,  removed  the  depressed  bone,  and  pared  off  the  suppurating  edges  of  the  scalp.  A spicula  of  the  inner  table  was 
found  driven  into  the  substance  of  the  bi’ain.  The  case  progressed  favorably,  and  on  January  22d,  1863,  Kell  was  fuiloughed. 
He  subsequently  returned  to  his  regiment,  and  was  discharged  from  the  service  by  reason  of  epilepsia  on  July  16th,  1862.  He 
is  not  a pensioner. 

Case. — Private  Joseph  Loughrey,  Co.  G,  22d  Indiana  Volunteers,  was  wounded  at  the  battle  of  Perryville,  Kentucky, 
October  8th,  1862,  by  a musket  ball,  which  struck  the  parietal  bone  near  the  temporal  ridge  and  above  the  ear,  and  comminuted 
both  tables,  depressing  the  external  table  one-fourth  of  an  inch.  On  the  14th,  he  was  admitted  into  Hospital  No.  4,  New  Albany, 
Indiana.  The  wound  was  doing  well,  and  there  were  no  indications  of  injur.y  to  the  brain.  He  continued  to  improve  for  two 
weeks,  when  he  became  restless  at  night  and  slightl.v  delirious.  On  October  28th,  symptoms  of  compression  appeared,  and  an 
operation  became  necessary.  Two  sections  of  the  injured  bone  were  removed  Avith  the  trephine.  The  inner  table  was  found  to 
be  greatly  comminuted,  but  there  was  no  evidence  of  pus  having  formed  in  the  brain.  For  several  days  he  had  Avild  delirium, 
which  finally  gave  Avay  to  active  purgation.  He  recovered,  Avith  the  exception  of  a slight  nervous  derangement,  and  Avas  dis- 
charged December  4th,  1862.  The  case  is  reported  by  Acting  Assistant  Surgeon  M.  N.  Elrod.  On  January  21st,  1863,  Pension 
Examiner  George  W.  Mears  reports  that  the  wound  had  healed,  and  that  the  man,  although’  previously  weak,  then  labored 
without  inconvenience  or  pain  in  the  head.  He  rated  him  as  not  disabled.  A communication  from  the  Commissioner  of  Pensions, 
dated  January  3d,  1888,  states  that  Loughrey  is  not  entitled  to  a pension,  having  been  rejected  by  the  examining  surgeon  Jul.v 
17th,  1863. 

Case. — Private  Thomas  A.  Moore,  Co.  K,  33d  Missouri  Volunteers,  aged  23  years,  Avas  Avounded  at  the  battle  of  Helena, 
Arkansas,  July  4th,  1863,  by  a conoidal  ball,  Avhich  fractured  and  depressed  both  tables  of  the  frontal  bone  above  the  right  frontal 
eminence.  He  Avas  conveyed  to  Memphis,  Tennessee,  and  admitted  into  the  Gn.voso  Hosjiital  on  the  7th,  Avith  slight  symptoms 
of  compression.  Acting  Assistant  Surgeon  S.  Leslie  performcvl  the  operation  of  trepliining,  leaving  an  opening  an  inch  and 
three-fourths  by  one  inch.  The  depressed  portion  of  bone  Avas  much  comminuted,  and  a portion  of  the  ball  Avas  Avedged  into  the 
fracture.  A large  quantity  of  blood  Avas  found  in  the  brain.  The  folloAving  day  the  patient  Avas  doing  Avell.  Water  dressings 
and  low  diet  were  ordered.  On  the  9th,  and  again  on  the  11th  and  12th,  haemorrhage  occurred  from  the  Avound,  amounting  to 
tAvelve  or  thirteen  ounces  ; otherwise  the  case  progressed  Avithout  any  untoAvard  symptoms,  and  on  September  1st  Moore  received 
a furlough  for  thirty  days,  at  the  expiration  of  Avhich  he  Avas  admitted  into  the  Jefferson  Barracks  Hospital,  St.  Louis,  Missouri. 
He  Avas  discharged  the  service  December  14th,  1863.  Acting  Assistant  Surgeon  S.  Leslie  reports  the  case.  On  December  18th, 
1866,  Pension  Examiner  J.  Bates  reports  that  the  patient  suffered  from  headache,  frequent  giddiness,  and  a conscious  fiiilure  of 
memory.  He  Avas  unable  to  perform  any  manual  labor.  His  disability  is  rated  total  and  permanent. 

Case. — Private  LeAvellyn  Mowry,  Co.  B,  25th  Massachusetts  Volunteers,  aged  18  years,  was  wounded  at  Cold  Harbor, 
Virginia,  June  3d,  1834,  by  a conoidal  ball,  Avhich  entered  over  the  left  eye  at  the  outer  margin  of  the  superciliaiy  ridge,  frac- 
tured the  bone  and  lodged.  He  Avassent  to  Washington,  and  on  June  8th  Avas  admitted  to  Finley  Hospital.  On  November  1st, 
he  Avas  transferred  to  the  hospital  at  Readville,  Massachusetts,  and  on  December  20th,  1864,  Avas  discharged  the  service.  The 
vision  of  the  left  eye  Avas  impaired.  On  June  10th,  1868,  Pension  Examiner  John  G.  Metcalf  reports  that  he  finds  an  ulcer, 
five  inches  from  the  old  cicatrix,  four  inches  above  the  right  eye,  of  a triangular  shajAe,  Avith  equal  sides,  one  inch  long.  The 
frontal  bone  Avas  rough,  and  at  tAvo  points  a pi'obe  could  he  passed  throu|rh  the  outer  table.  In  September,  1868,  a portion  of 
both  tables  of  the  frontal  bone,  at  the  bottom  of  the  ulcer,  had  been  removed  by  the  trephine.  The  ulcer  discharged  piAjfusely, 
and  the  patient  Avas  very  feeble.  On  October  2d,  1868,  Dr.  Metcalf  states  that  the  Avound  had  healed,  leaving  an  indentation 
iibout  three-fourths  of  an  inch  deep.  The  patient’s  disability  is  rated  total  and  permanent. 

Case. — Corporal  Ii’a  B.  NeAvkirk,  Co.  E,  5th  Wisconsin  Volunteers,  aged  23  years,  was  Avoimded  May  5th,  1864,  at  the 
battle  of  the  Wilderness,  Virginia,  by  a conoidal  ball,  Avhich  fractured  and  depressed  the  osfrontis  above  the  superciliary  ridge. 
He  Avas  admitted  into  Judiciary  Square  Hospital,  Washington,  on  the  11th.  Tavo  days  later  he  Avas  placed  under  ether,  Avhen 
Assistant  Surgeon  Alexander  Ingram,  U.  S.  A.,  made  an  incision  one  and  a half  inches  in  extent  from  the  point  of  entrance, 
reflected  the  flaps,  applied  the  trephine,  and  removed  all  the  tlepressed  bone,  a portion  of  Avhich  Avas  pressing  on  the  dura  mater. 
The  parts  were  bi’ought  into  apposition^  and  tAvo  sutures  applied.  The  patient’s  constitutional  condition  Avas  very  good.  Ice 
Avater  dressings  Avere  applied,  and  saline  cathartics  administered.  No  untoAvard  symptoms  occurred,  and  on  J uly  16th  the  patient 
’AVas  returned  to  his  regiment.  He  Avas  discharged  July  30th,  1864.  He  is  not  a pensioner. 

Case. — Private  William  G.  Parker,  Co.  A,  76th  Noav  York  Volunteers,  aged  32  years,  was  Avounded  at  the  battle  of  Cold 
Harbor,  Virginia,  June  2d,  1864,  by  a conoidal  ball,  Avhich  fractured  the  cranium.  He  Avas,  on  the  following  day,  admitted  to 
the  hospital  of  the  4th  division.  Fifth  Corps,  Avhere  the  operation  of  trephining  Avas  performed.  On  June  12th,  he  Avas  sent  to 
the  Campbell  Hospital,  Washington,  Avhere  he  Avas  discharged  from  the  service  on  July  10th,  1835.  Ho  is  not  a pensioner.  The 
case  is  reported  by  Assistant  Surgeon  J.  S.  Billings,  U.  S.  A. 

# 

Case. — Private  Joseph  R.  Phillips,  Co.  H,  2d  Michigan  Cavalry,  temporarily  assigned  to  the  27th  Michigan  Sharpshoot- 
ers, aged  43  years,  Avas  Avounded  at  the  battle  of  Spottsylvania  Court-house,  Virginia,  May  12th,  1864,  by  a conoidal  ball,  Avhich 
fractured  the  superior  portion  of  the  right  parietal  bone.  He  Avas,  on  the  same  day,  admitted  to  the  hospital  of  the  Ninth  Corjis, 
and  thence  conveyed  to  Washington,  Avhere  he  entered  HareAvood  Hospital  on  the  25th.  'Phe  skull  Avas  tre])hined  and  simple 
dressings  Avere  ap)»lied.  He  recovered  rapidly,  Avas  furloughed  on  June  28th,  and  discharged  from  the  service  on  October  22d, 
1834,  by  reason  of  exjnration  of  term  of  service.  He  is  not  a pensioner. 


TREPniNINO  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


293 


Case. — Corporal  Geoi-ge  W.  Pliillips,  Co.  15,  30tli  Ituliana  Volunteers,  aged  21  years,  was  wounded  during  llie  siege  of 
Nasliville,  Tennessee,  December  ICtli,  18C4,  by  a shell,  which  fractured  the  cranium  at  the  ])ostcrior  fontanelle.  I’ortions  of  the 
bone  were  removed  on  the  field,  while  the  patient  was  ii.  a state  of  partial  insensibility.  lie  was  admitted  to  the  hospital  of  the 
3d  division.  Fourth  Corps,  and  thence  conveyed  to  Nashville,  where  he  was  admitted  to  Hospital  No.  3 on  the  following  day. 
On  January  8th,  1865,  he  was  transferred  to  the  Jefferson  Hospital,  Jeffersonville,  Indiana,  and  thence  sent  to  Columbus,  Ohio, 
entering  Tripler  Hospital  on  the  24th.  The  patient  stated  that  the  skull  had  been  trephined,  and  a silver  plate  inserted  one 
month  after  the  reception  of  the  injury,  and  that  complete  paralysis  of  the  left  side  had  existed  for  two  months.  When  admitted 
to  Tripler  Hospital  he  could  use  his  arms,  but  had  to  go  on  crutches,  on  account  of  want  of  control  over  lower  limbs.  His 
general  health  was  good.  Cold  water  dressings  were  applied.  He  was  discharged  from  the  service  on  May  2Cth,  18G5,  the  wound 
having  healed,  except  a small  sinus.  There  was  a crucial  cicatrix  two  inches  long  from  before  backward,  and  one  inch  wide, 
a de])rcssion  one-fourth  of  an  inch  at  its  greatest  depth,  and  partial  paralysis  of  the  left  side.  In  July,  1868,  Phillips  was  a 
pensioner,  his  disability  being  rated  total  and  permanent.  The  case  is  repoi  ted  by  Acting  Assistant  Surgeon  J.  M.  Abraham. 
The  patient  applied  for  an  increase  of  pension  on  November  25th,  1868,  but  his  claim  was  not  admitted.  On  January  8th,  1869, 
Pension  Examiner  S.  C.  Sapp  reported  that  the  patient’s  mind  was  impaired,  and  that  lie  could  not  bear  exposure  to  heat  without 
falling  over.  He  rates  his  disability  permanent. 

Case. — Private  John  Shaffer,  Co.  D,  18th  Missouri  Volunteers,  aged  38  years,  was  wounded  at  the  battle  of  Shiloh, 
Tennessee,  April  7th,  1862,  by  a conoidal  ball,  which  fractured  the  left  parietal  bone,  near  the  sagittal  suture.  He  was  taken 
prisoner,  and  probably  remained  in  the  hands  of  the  enemj'  until  October  3d,  1863,  when  he  was  admitted  to  the  Washington 
Hospital,  Memphis,  Tennessee.  He  recovered,  and  was  returned  to  duty  October  27th,  1863.  On  December  26th,  he  was  again 
admitted  to  Hospital  No.  4,  Louisville,  Kentucky ; March  19th,  1864,  transferred  to  St.  Louis,  Missouri,  and  on  September  4th 
sent  to  Simon  Hospital,  Mound  City,  Illinois.  The  records  of  the  latter  hospital  state  that  the  trephine  had  been  api)lied,  and 
a large  portion  of  the  parietal  bone  removed  prior  to  admission.  No  particulars  as  to  date  and  mode  of  operation  can  be  obtained. 
The  wound  was  discharging,  and  the  patient  w'as  suffering  from  headache  and  epilepsy.  On  the  22d  of  the  same  month  he  was 
transferred  to  Jefferson  Barracks,  Missouri,  and  discharged  from  the  service  March  1st,  1865.  He  is  not  a pensioner. 

Case. — Private  M.  F.  Sheffler,  Co.  E,  39tli  Illinois  Volunteers,  was  wounded  at  Fort  Wayne,  August  15th,  1863,  by 
a conoidal  ball,  which  struck  the  frontal  bone  near  the  coronal  suture,  one  and  a half  inch  from  the  apex  of  the  frontal 
bone.  The  injury  at  the  time  was  considered  a slight  scalp  wound,  which  healed  rapidly.  The  patient  was  placed  on  light 
duty,  and  no  bad  symptoms  were  perceptible  from  continuous  daily  labor.  In  January,  1864,  he  began  to  experience  a feeling 
of  numbness  in  his  privates,  nates,  and  right  limb,  which  increased  and  finally  extended  to  the  left  limb,  and  at  the  same  time 
he  began  to  suffer  from  difficulty  in  voiding  urine.  Under  the  impression  that  he  had  the  gravel,  he  was  subjected  to  a bathing 
process  for  a period  of  seven  weeks,  without  any  beneficial  results.  He  consulted  Drs.  Fox  and  Johnson  of  Washington,  who 
pronounced  his  disability  to  be  a general  disease  of  the  spine.  On  his  second  visit  he  told  Dr.  Johnson  that  he  had  been  wounded 
in  the  head,  and  the  doctor  informed  him  that  an  operation  would  be  necessary  to  procure  relief.  In  November,  1867,  the  case 
came  under  the  observation  of  Dr.  C.  M.  Clark,  who  decided  on  an  operation,  which  he  performed  on  December  9th,  1867. 
Ether  was  administered  to  the  patient,  and  a crucial  incision  made  through  the  scalp  and  the  flap  turned  back;  the  periosteum 
was  scraped  off,  when  the  bone  immediately  over  the  fracture  seemed  loose  in  texture,  and  blood  began  to  ooze  from  the  wound. 
The  trephine  was  applied  by  Surgeon  C.  M.  Clark,  39th  Illinois  Volunteers,  so  as  to  cover  all  the  depression,  and  a button  of 
bone.one  inch  in  diameter  and  one-fourth  of  an  inch  in  thickness  was  removed.  The  patient  was  allowed  to  recover  from  the 
anajsthetic  before  the  section  was  complete;  sensation  and  motion  returned  the  instant  it  was  lifted,  and  he  walked  unaided  to 
his  bed.  On  the  following  day  a mild  aperient  was  given;  he  rested  well,  but  had  a slight  chill  in  the  morning.  On  the  12th 
there  was  still  slight  numbness  about  the  perineum;  the  wound  had  united  except  at  point  of  incision,  where  there  is  slight 
suppuration.  His  strength  gradually  increased,  and  on  December  24th,  walked  a distance  of  three  miles.  He  went  home  on 
January  14th,  1868,  entirely  recovered.  He  is  upt  a pensioner. 

Case. — Private  Nelson  J.  Ward,  Co.  K,  62d  Ohio  Volunteers,  aged  19  years,  was  wounded  at  the  battle  of  Appomattox 
Court-house,  Virginia,  April  9th,  1865,  by  a conoidal  ball,  which  fractured  and  depressed  the  left  j)arietal  bone.  He  was 
immediately  coTiveyed  to  the  field  hospital  of  the  Twenty-fourth  Corps,  where  the  depressed  portion  of  bone  was  removed  with 
the  trephine  by  Surgeon  S.  A.  Richardson,  13th  New  Hampshire  Volunteers.  On  April  10th,  he  was  transferred,  and  on  the 
17th  entered  the  hospital  at  Point  of  Rocks,  Virginia.  He  was,  on  May  16th,  sent  to  the  West’s  Buildings  Hospital,  Baltimore; 
on  May  22d,  to  the  Jarvis  Hospital;  on  July  24th,  to  the  Hicks  Hospital,  and  finally  discharged  from  the  sei-vice  on  August 
26th,  1865,  and  pensioned.  In  J une,  1866,  Pension  Examiner  G.  W.  Livesay  reports  that  the  man  has  freciuent  attacks  of 
epilepsy,  sometimes  several  within  twenty-four  hour.s,  and  that  the  disability  is  permanent. 

Hernia  Cerebri. — Tins  complication  was  observed  not  infrequently: 

Case. — Private  W.  A.  Baden,  Co.  E,  1st  Maryland  Cavalry,  was  wounded  in  an  engagement  October  12th,  1863,  by  a 
conoidal  ball,  which  struck  the  left  parietal  bone  about  midway  between  top  of  the  ear  and  the  vertex,  glanced  a little  down- 
ward and  backward,  and  made  its  exit  in  a track  of  one  and  a half  inches  in  length.  He  was  admitted  to  the  Chimborazo 
Hospital,  Richmond,  Virginia,  October  19th,  1863,  at  which  time  he  could  give  no  account  of  himself,  seemed  timid,  shy,  and 
easily  agitated.  On  October  22d,  the  scalp  was  freely  incised  from  the  wound  of  entrance  to  that  of  exit;  the  cranium  was 
found  to  be  fractured,  comminuted,  and  depressed.  Portions  of  bone  were  removed  with  probe  and  force])s.  Five  days  later, 
hernia  cerebri,  of  the  size  of  a common  marble,  appeared ; the  divided  edges  of  the  meninges  could  be  distinguished  upon  the 
base  of  the  cerebral  protuberance.  On  October  26th,  tlie  ])rotnuled  brain  began  to  disappear  by  sujipuration,  and  had  disa])])ea.red 
entirely  by  October  31st,  when  the  patient  was  somewhat  mpre  intelligent.  On  November  3d,  an  abscess  appeariMl  over  llu! 
occipital  bone  a little  to  the  left  of  the  median  line  and  about  four  inches  from  vertex,  which  was  ojicned.  On  examination,  a 


294 


WOUNDS  AND  INJURIES  OF  THE  UEAD 


fracture  of  the  occipital  bone  was  discovered.  Tlie  outer  table  was  elevated  and  a piece  of  lead  was  found  closely  impacted 
between  the  plates;  all  attempts  to  remove  it  without  trephining  proved  inetfectual.  The  ball  had  been  split  when  impinging 
upon  the  parietal  bone  and  a portion  of  it  had  passed  within  the  cranium,  making  its  partial  exit  through  the  occiput.  On 
January  31st,  18G4,  the  patient  was  doing  well,  all  the  wounds  in  the  scalp  had  cicatrized;  a depression  in  the  parietal  bone 
marked  the  site  of  fracture  and  a projection  of  outer  table  of  the  occipital  bone  existed,  the  lead  still  remaining  between  the 
tables  of  the  bone.  The  patient  recovered,  but  remained  somewhat  childlike  and  was  easily  confused  in  mind.  He  was 
discharged  on  October  4th,  18G4. 

Case. — Private  Thomas  Haley,  Co.  D,  91st  New  York  Volunteers,  aged  28  years,  was  wounded  at  Petersburg,  Virginia, 
March  29th,  1865,  by  a piece  of  shell,  which  fractured  the  frontal  bone  just  above  the  right  eye,  causing  hernia  cerebri.  He 
was  admitted  to  the  hospital  of  the  1st  division.  Fifth  Corps,  on  April  2d;  sent  to  City  Point,  and  thence  conveyed  to  Washing- 
ton and  admitted  to  the  Armory  Square  Hospital  on  April  10th,  1865.  Simple  dressings  were  applied  to  the  wound.  On  April 
27th,  a piece  of  the  orbital  bone  which  had  become  loose  was  removed,  otherwise  the  case  progressed  well,  and  on  July  18th, 
1865,  Haley  was  transferred  to  New  York  for  muster  out.  He  is  not  a pensioner. 

Case. — Private  William  H.  Hogan,  Co.  K,  14th  Virginia  Infantry,  was  accidentally  wounded  on  January  15tb,  1863,  by 
the  discharge  of  a musket.  The  missile  entered  on  the  postero-lateral  portion  of  the  right  side  of  the  head,  passed  forward  and 
upward  across  the  parietal  protuberance  and  emerged,  exposing  the  skull  for  a distance  of  three  inches,  and  fracturing  the 
parietal  bone.  lie  was  admitted  to  the  Chimborazo  Hospital,  Richmond,  Vii’ginia,  on  January  23d.  His  mental  faculties  were 
perfect,  and  there  Was  very  little  constitutional  disturbance  and  no  paralysis.  A triangular  portion  of  the  bone  had  been  removed, 
through  which  opening  the  brain  was  protruding.  He  stated  that  when  wounded,  there  was  complete  paralysis  of  the  left  side. 
Cold-water  dressings  were  applied  to  the  wound,  and  a compress  to  the  protruding  portion  of  the  brain,  which  caused  it  to  slough. 
The  bowels  were  kept  open,  and  the  patient  kept  on  light  diet.  The  bone  became  necrosed  along  the  whole  track  of  the  bull, 
and  was  removed,  exposing  the  brain  for  two  inches,  after  which  the  wound  healed  rapidly,  with  a depressed  cicatrix.  The 
patient  was  returned  to  duty  on  July  21st,  1863,  perfectly  cured,  with  the  exception  of  an  occasional  headache. 

Case. — Sergeant  Borden  Joline,  Co.  G,  1st  New  Jersey  Cavalry,  was  wounded  near  Sulphur  Springs,  Virginia,  bn 
October  12th,  1863,  by  a conoidal  ball,  which  entered  the  cranium  directly  over  the  right  eye,  about  two  inches  above  the 
superciliary  ridge.  Ift  entered  the  Judiciary  Square  Hospital,  Washington,  on  the  14th,  and  was  furloughed  for  forty  days. 
On  March  18th,  1864,  he  entered  Ward  Hospital,  Newark,  New  Jersey,  his  general  health  being  good.  A small  opening  still 
remained  at  the  wound  of  entrance,  discharging  a slight  quantity  of  pus.  There  was  no  swelling,  redness,  or  inflammation  of 
the  parts.  On  May  3d,  Acting  Assistant  Surgeon  James  B.  Cutler,  made  a crucial  incision  at  the  tvound  of  entrance,  reflected 
back  the  flaps,  and  extracted  the  ball,  which  was  partially  impacted  in  the  skull,  and  partly  in  contact  with  the  substance  of  the 
brain.  The  missile  was  very  irregular  and  misshapen.  Cold  water  was  kept  applied  to  the  wound,  the  head  was  kept  elevated, 
and  strict  antiphlogistic  treatment  employed.  Hernia  cerebri  formed,  three  or  four  days  after  the  operation,  with  a profuse 
discharge  from  the  wound.  The  hernia  was  pared  off  on  a level  with  the  scalp,  but,  on  July  6th,  it  reappeared,  when  slight 
pressure  was  applied.  By  August  23d,  there  was  no  hernia  or  discharge.  The  wound  was  entirely  closed,  with  no  impairment 
whatever  of  the  mental  faculties,  and  the  patient  was  doing  remarkably  well.  On  August  26th,  1864,  he  was  transferred  to 
Trenton,  New  Jersey,  to  be  mustered  out  of  service.  This  man’s  name  is  not  on  the  pension  roll. 

Case. — Private  David  Jones,  Co.  A,  1st  Virginia  Regiment,  was  admitted  to  the  1st  division  hospital,  Alexajidria, 
Virginia,  on  May  3d,  1863,  with  a gunshot  wound  of  the  head.  The  missile,  a musket-ball,  entered  one-fourth  of  an  inch  above 
the  middle  of  the  right  supra-orbital  arch,  fractured  the  outer  table  of  the  frontal  bone,  and  taking  a semicircular  course,  lodged 
above  the  right  ear,  whence  it  was  extracted.  The  left  upper  eyelid  was  very  much  swollen,  completely  closing  the  eye;  and 
there  were  symptoms  of  fever,  with  considerable  pain.  Cold-water  dressings  were  applied,  and  the  swelling  gradually  subsided. 
On  May  20th,  an  incision  was  made,  and  a quantity  of  pus  evacuated,  which  relieved  the  parts  and  improved  the  condition  of 
the  patient.  On  June  2d,  a piece  of  bone  came  away,  and  on  June  12th  erysipelas  attacked  the  oi  bital  region.  The  wound  was 
laid  freely  open  down  to  the  frontal  bone,  which  was  found  to  be  denuded  of  periosteum.  On  June  23d,  the  erysipelas  extended 
all  over  the  face,  forehead,  and  right  side  of  scalp;  the  tongue  was  furred,  bowels  loose,  and  appetite  poor.  Through  the  wound 
protruded  a large  tumor,  the  size  of  an  orange,  caused  by  thickening  of  the  periosteum.  A solution  of  sulphate  of  iron  was 
applied  to  the  infected  parts.  The  symptoms  being  of  a typhoid  character,  the  patient  was  treated  with  fresh  breeze  day  and 
night,  beef  tea,  brandy,  and  flax-seed  enema.  On  July  1st,  the  tongue  had  become  moist  and  the  stools  more  natural.  On  July 
6th,  the  tumor  was  dissected,  and  isinglass  plaster  applied.  The  edges  of  the  wound  were  then  gradually  approximated,  and  a 
steady  improvement  followed.  He  was  sent  to  the  provost  marshal  on  July  20th,  1863.  The  case  is  reported  by  Surgeon  W. 
A.  Conover,  U.  S.  V. 

Case. — Lieutenant  Charles  Kennedy,  Co.  I,  28th  Pennsylvania  Volunteers,  aged  25  years,  was  wounded  at  the  battle 
of  Chancellorsville,  Virginia,  May  2d,  1863,  by  a fragment  of  shell,  which  produced  a wound  two  inches  long  and  one  inch 
wide,  removing  the  superior  portion  of  the  occipital  bone  one  inch  to  the  right  of  the  median  line,  destroying  the  membranes  so 
that  the  substance  of  the  brain  protruded  about  one  and  a half  inches.  On  May  7th,  he  was  admitted  to  Armory  Square 
Hospital,  Washington.  The  wound  had  a burnt  and  black  appearance,  and  the  pulsation  of  the  brain  was  very  distinct  with 
every  beat  of  the  heart.  The  patient’s  intellect  was  greatly  impaired,  and  there  was  total  loss  of  vision,  so  that  he  could  not 
distinguish  day  from  night.  The  pulse  was  at  60  and  full,  and  there  was  partial  loss  of  power  in  the  lower  extremities.  After 
admission  to  hospital,  the  hair  was  closely  shaven  around  the  wound,  and  the  dead  tissue  was  removed  by  sponging  with  tepid 
water.  Ilis  bowels  were  constipated  for  seven  days  from  the  date  of  the  injury,  and  he  had  scarcely  any  sleep.  Cathartics, 
injections,  and  anodynes  were  administered.  On  May  11th,  twelve  leeches  were  applied  to  each  temple,  and  three  behind  each 
ear.  On  the  following  day  the  symptoms  were  greatly  ameliorated.  On  May  13th,  spicqja;  of  bone  were  removed,  and  also  on 


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TREnilNING  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


295 


tlie  ir.tli,  wlicn  the  fungus  had  receded  somewhat,  and  a liealthy  granulation  was  progressing.  Ilis  a]ipetit(!  was  good,  no  fever, 
vision  pai'tially  restored,  and  able  to  get  out  of  bed.  He  continued  to  improve,  and  on  June  lOth  the  fungus  had  entirely 
retracted,  and  vision  was  restored.  The  intellect  was  perfect  and  the  general  health  good.  On  June  20th,  Lieutenant  Kennedy 
went  home  on  leave  of  absence.  He  was  subsequently  admitted  to  the  Officers’  Hosj)ital  at  Philadelphia.  On  September  9th, 
1833,  the  wound  had  entirely  healed.  On  November  12th,  he  was  ordered  before  an  examining  board  at  Annapolis,  and  was 
returned  to  duty  January  12th,  18C4.  On  May  5th,  1864,  he  was  admitted  to  the  field  hospital  at  Lookout  Mountain,  being 
again  returned  to  duty  about  July,  1864.  He  was  discharged  the  service  July  20th,  1864,  and  afterward  pensioned.  Pension 
Examiner  Wilson  Jewell,  under  date  of  April  19th,  1865,  reported  that  the  patient  suffers  from  cephalalgia,  vertigo,  and  weak- 
lu'ss,  when  exposed  to  the  sun  or  much  excited.  His  disability  was  rated  one-third  and  temporary.  It  was  subsequently 
stated  by  Dr.  C.  C.  McGlaughlin,  late  surgeon  95th  Pennsylvaida  Volunteers,  that  he  attended  Lieutenant  Kennedy  in  his  last 
illness,  and  that  he  died  December  15th,  1865,  from  the  effects  of  a wound  in  his  head.  The  plate  opposite  illustrates  the 
appearance  of  the  wound  in  May  and  June,  1863. 

Case. — Private  P.  E.  A.  Williams,  Co.  I,  Palmetto  Sharpshooters,  aged  23  years,  was  wounded  in  an  engagement  near 
Petei’sburg,  Virginia,  June  19th,  1864,  by  a conoidal  ball,  which  impinged  upon  the  superior  portion  of  the  frontal  bone,  left 
side.  The  wound  was  one  inch  and  a half  in  length  antero-posteriorly,  and  one  inch  in  width.  The  inner  edge  was  half  an  inch 
from  the  median  line ; the  outer  table  was  grooved  by  the  ball,  leaving  the  borders  nearly  smooth  ; the  inner  table  was  broken 
into  numerous  spiculae,  some  of  them  pressing  directly  upon  the  dura  mater,  and  some  of  the  smaller  ones  penetrating  the  brain. 
He  was  stunned  by  the  injury,  but  soon  recovered  consciousness,  and  again  became  comatose.  The  loose  spiculae  of  bone  were 
removed,  and  simple  water  dressings  applied.  He  was  sent  to  the  Jackson  Hospital,  Richmond.  His  condition  remMned  critical 
for  weeks.  For  two  weeks  symptoms  of  coma  continued.  Spiculm  were  removed  as  soon  as  they  became  detached,  and  the 
wound  was  kept  carefully  cleaned.  By  August  14th,  his  general  coudition  had  improved;  most  of  the  spiculat  had  come  away, 
leaving  a large  orifice,  with  clean  edges.  The  dura  mater  was  exposed  and  perforated  by  small  orifices.  Two  months  after  the 
reception  of  injury,  when  all  the  circumstances  attending  the  case  indicated  recovery,  the  cerebral  substance  began  to  protrude 
through  the  opening,  but  was  not  followed  by  .any  serious  symptoms.  Compress  was  applied,  and  in  two  weeks  the  hernia 
cerebri  had  receded,  and  healthy  granulation  had  sprung  up.  He  was  discharged  from  hospital  about  the  middle  of  September, 
1864,  and  returned  to  South  Carolina.  The  wound  remained  open,  discharging  more  or  less  until  December,  1865,  when  it 
finally  cicatrized  firmly.  In  March,  1866,  the  orifice  was  filled  with  bony  or  cartilaginous  matter,  slightly  depressed  in  the 
centre;  the  cicatrix  is  fair,  mostly  destitute  of  hair;  his  mind  is  unimpaired,  but  occasionally  he  suffers  from  slight  vertigo  ou 
stooping  suddenly,  or  after  much  mental  exertion.  The  case  is  reported  by  Confederate  Surgeon  F.  S.  Parker.  * 

Case. — Private  Richaid  H.  Baldwin,  Co.  H,  4th  New  York  Artillery,  aged  26  years,  was  wounded  near  Petersburg, 
Virginia,  October  2d,  1864,  by  a conoidal  ball,  which  fractured  the  frontal  and  parietal  bones,  left  side.  He  was  sent  to  hosj)ital 
of  the  1st  division.  Second  Corps,  and,  on  October  3d,  was  sent  to  the  Second  Corps  Hospital.  Hernia  cerebri  supervened,  and 
death  occurred  October  28th,  1864. 

Case. — Private  James  M.  Bartin,  7th  Georgia  Regiment,  received,  at  the  battle  of  Bull  Run,  Virginia,  July  21st,  1861, 
a gunshot  fracture  of  the  cranium.  He  was  conveyed  to  a Confederate  hospital  at  Culpeper,  Virginia.  Hernia  cerebri  super- 
vened, and  death  occurred  August  11th,  1861. 

Case. — ^Private  Otto  Bockel,  Co.  B,  6th  New  Hampshire  Volunteers,  aged  18  years,  was  wounded  near  Petersburg, 
Virginia,  July  19th,  1864,  by  a conoidal  ball,  which  fractured  the  left  temporal  and  parietal  bones.  He  was  conveyed  to  the 
field  hospital  of  the  2d  division.  Ninth  Corps,  w'here  several  spiculm  of  bone  tvere  removed;  thence  he  Avas  transferred  to 
Philadelphia,  entering  the  Mower  Hospital  on  July  22d.  A fungous  groAVth,  or  hernia  cerebri,  of  the  size  of  a pigeon’s  egg, 
protruded  through  Avhat  appeared  to  be  an  aperture  in  the  cranium  made  by  a large  trephine.  The  patient  seemed  to  be  in  full 
possession  of  his  mental  faculties;  Avas  cheerful,  had  a good  appetite,  and  his  general  health  Avas  unimpaired.  No  signs  of  com- 
f)ression  Avere  developed.  Damp  compresses  of  patent  lint,  saturated  Avith  lime-Avater,  Avere  bound  as  firmly  as  consistent  upon 
the  fungus  groAvth.  Absolute  quiet,  a recumbent  position,  and  light  diet  Avere  ordered.  On  August  3d,  the  hernia  had  increased 
to  the  size  of  a psllet’s  egg,  and  Avas  taking  on  a vascular  condition.  Tlie  general  condition  Avas  but  slightly  changed,  the  pupils 
Avere  natural,  consciousness  seemed  nearly  perfect,  and  pulse  70  and  full.  Dr.  Morton  examined  and  made  an  incision  in  the 
hernia.  One  of  the  small  branches  of  the  cerebral  artery  became  divided  and  bled  freely  for  some  time.  No  change  Avas  per- 
ceptible on  tbe  7th,  except  that  the  patient  became  more  feeble  and  lost  his  appetite ; but  by  the  12th  his  appetite  had  again 
improved,  and  he  seemed  quite  as  Avell  as  usual.  The  hernia  steadily  increased,  and  the  patient’s  health  beginning  to  be  com- 
promised, it  was  decided  to  remove  the  protruding  massj  Avhich  was  noAV  the  size  of  an  ordinary  orange.  Accordingly,  on 
August  20th,  Acting  Assistant  Surgeon  \V.  P.  Moon  passed  a double-threaded  curved  needle  beloAV  the  cranial  tables,  inclosing 
each  half  of  the  neck  of  the  tumor,  and  after  gently  tightening  the  ligatures,  the  excrescence  Avas  shaved  off'  to  a level  with  the 
external  table.  The  patient  exhibited  little  sense  of  suffering  during  the  operation,  but  experienced  a sense  of  relief  on  that  side 
of  the  head.  No  antesthetic  Avas  used.  Moderate  pressure  Avas  noAV  applied  by  means  of  a compress  saturated  with  lime-Avater. 
On  the  22d,  the  patient,  though  rational,  began  to  fail.  Incoherency,  Avith  a tendency  to  coma,  Avere  manifest  on  the  25th, 
AVhile  the  gi’OAVth  seemed  disposed  to  reappear.  On  the  following  day  the  patient  Avas  rapidly  sinking.  Motion  atid  sensation  of 
the  right  side  Avere  lost,  and  the  respiration  became  labored.  Death  ensued  on  August  28th,  1864.  A post-mortem  revealed  in 
the  left  hemisphere  a large  abscess,  from  tAvo  and  a half  to  three  inches  in  diameter,  Avith  softening  of  the  surrounding  tissue. 
All  the  vessels  of  the  brain  Avere  considerably  congested.  A large  trephine  had  been  employed  to  remove  the  cranial  fracture  at 
the  seat  of  injury.  The  case  is  reported  by  tlie  operator. 

Case. — Private  James  E.  Bridge,  Co.  C,  156th  New  York  V(dunteers,  aged  20  years,  Avas  Avounded  at  Fisher’s  Hill, 
Virginia,  September  22d,  1864,  by  a conoidal  musket  ball,  which  fractured  the  occipital  bone  above  and  to  the  left  of  the 


296 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


protuberance.  He  was  admitted  to  tbe  liospital  of  tlie  1st  division,  Nineteenth  Corps,  and  on  October  sent  via  Sandy  Hook 
Maryland,  to  the  National  Hospital  in  Baltimore,  where  he  was  admitted  on  October  3d.  Hernia  cerebri  existed  at  that  time. 
By  the  removal  of  detached  fragments  of  bone  at  the  dressings  of  the  wound,  the  brain  substance  became  exposed.  Death 
ensued  on  October  18th,  1864. 

Cask. — Corporal  Edward  Briner,  Co.  B,  9th  New  York  Volunteers,  aged  23  years,  a very  robust  man,  was  wounded  at 
the  battle  of  Fredericksburg,  Virginia,  December  13th,  1862,  by  a conoidal  musket  ball,  which,  crossing  the  coronal  suture, 
fractured  the  right  temporal  and  carried  away  a portion  of  the  parietal  bone  two  and  a half  inches  in  length  and  half  an  inch  in 
width,  exposing  the  membranes  of  the  brain.  He  was  immediately  admitted  to  the  held  hospital,  and  on  December  18th  was 
transferi’ed  to  the  Armory  Square  Hospital,  Washington.  The  pulsations  of  the  middle  meningeal  artery  were  visible.  The 
wound  discharged  healthy  pus,  and  the  case  progressed  satisfactorily  until  December  26th,  when  the  patient  became  restless, 
and  stupor  ensued,  terminating  in  coma  <m  the  29th.  A hernia  cerebri  half  an  inch  in  diameter  appeared  the  next  day.  On 
January  3d,  1863,  the  patient  had  so  far  recovered  that  he  could  answer  questions  correctly.  The  hernia  was  then  excised. 
Hemiplegia  supervened  on  the  5th,  and  hernia  of  the  size  of  a walnut  again  protruded.  Though  the  power  of  prehension  was 
lost,  the  patient  would  eat  with  avidity  whatever  was  placed  in  his  month.  On  the  7th,  an  attempt  was  made  to  excise  the 
hernia,  but  a severe  hemorrhage  occurred  from  the  small  branches  of  the  meniTigea  media,  which  was  with  difficulty  arrested 
by  compression,  and  the  operation  was  abandoned.  Hasmorrhage  recurred  on  the  next  day,  and  death  ensued  January  8th, 
1863.  The  case  is  reported  by  Surgeon  D.  W.  Bliss,  U.  S.  V. 

Case. — Private  Joseph  Butterfield,  Co.  H,  120th  New  York  Volunteers,  aged  16  years,  was  wounded  before  Petersburg, 
Virginia,  September  25th,  1864,  by  a conoidal  ball,  which  extensively  fractured  the  left  parietal  bone.  He  was  admitted  to  tbe 
hospital  of  the  3d  division.  Second  Corps,  where  he  remained  until  about  October  29th,  when  he  was  conveyed  to  W’'ashington, 
and  admitted  into  the  Armory  Square  Hospital.  A large  hernia  cerebri  had  already  formed.  The  subsequent  treatment  was  of 
a simple  character.  Death  occurred  December  13th,  1864.  The  case  is  reported  by  Surgeon  D.  \V.  Bliss,  U.  S.  V. 

Case. — Private  Albert  Colchier,  Co.  D,  114th  Pennsjdvania  Volunteers,  was  wounded  at  the  battle  of  Chancellorsville, 
Virginia,  May  3d,  1863,  by  a gunshot  missile,  which  lacerated  the  scalp  and  fractured  the  cranium,  causing  the  cerebrum  to 
protrude.  He  was  admitted  to  the  hospital  of  the  Third  Corps,  where  fragments  of  bone  were  removed  from  the  wound,  but 
death  occurred  on  May  8th,  1863. 

Case. — Corporal  Abraham  C , Co.  D,  93d  Pennsylvania  Volunteers,  aged  24  years,  was  wounded  at  the  battle  of 

Spottsylvania  Court-house,  Virginia,  May  12th,  1864,  by  a conoidal  ball,  which  penetrated  the  right  parietal  bone  near  its 
posterior  inferior  angle.  He  was  admitted  to  the  2d  division.  Sixth  Corps,  field  hospital,  and  thence  was  conveyed  to  Washing- 
ton, and  admitted  to  Carver  Hospital,  May  19th.  He  was  very  emaciated;  the  wound  sloughed  and  discharged  foetid  pus,  and 
hernia  cerebri  had  appeared.  His  pulse  was  50  and  full,  the  pupils  dilated,  the  tongue  coated,  and  his  bowels  constipated.  On 
the  same  day  spiculffi  were  removed  from  the  brain,  giving  exit  to  several  ounces  of  pus.  Delirium  follow’ed  and  continued  until 
the  27th,  when  death  supervened.  The  pathological  specimen  is  No.  2900,  Sect.  I,  A.  M.  M.  From  the  vault  of  the  cranium 
fragments  have  been  removed  for  a space  of  three  inches  upw'ard  and  forward,  and  from  one  to  one-half  inch  in  width,  at  the 
upper  extremity  of  which  four  fragments  of  the  inner  table  remain  attached,  depressed  two  lines  at  the  free  edge.  One  fissure 
passes  downward  into  the  mastoid  portion  of  the  temporal,  and  a second  passes  upward  and  backward  to  the  posterior  fourth  of 
the  sagittal  suture.  The  specimen  and  history  were  contributed  by  Acting  Assistant  Surgeon  R.  E.  Price. 

Case. — Private  Patrick  Conway,  Co.  — , 12th  Illinois  Volunteers,  was  wounded  near  Fort  Donelson,  Tennessee,  February 
14th,  1862,  by  a conoidal  musket  ball,  which  penetrated  the  frontal  bone,  near  and  to  the  right  of  the  left  eminence  and  lodged, 
forcing  spiculae  of  bone  upon  the  membranes.  He  was,  on  February  17th,  admiited  to  a hospital,  being  conscious  but  unable  to 
articulate  distinctly.  He  could  not  raise  his  voice  above  a whisper,  and  was  unable  to  walk  or  stand  in  an  erect  position.  On 
examination  the  ball  was  found  at  the  inner  edge  of  the  skull,  lying  upon  the  membranes,  and  was,  with  difficulty,  removed, 
together  with  some  fragments  of  bone,  which  had  penetrated  the  membranes.  After  the  operation  the  patient  was  able  to  speak 
with  distinctness,  and  seemed  improved.  On  February  20th,  he  was  worse  and  somewhat  morose.  The  wound  dischai’ged 
slightly  and  a small  quantity  of  brain  substance  was  oozing  out.  There  was  slight  hernia  cerebri,  with  some  heat  about  the 
head;  pulse  rapid,  full  and  compressible.  On  February  22d,  he  became  unconscious  and  refused  nourishment.  Payalysis  of  the 
right  side  occurred,  and  death  ensued  on  February  24th,  1862. 

Case. — Corporal  Clarence  C , Co.  G,  123d  New  York  Volunteers,  aged  24  years,  was  wounded  at  the  battle  of 

Chancellorsville,  Virginia,  May  3d,  1863,  by  a piece  of  shell,  which  comminuted  the  parietal  bone,  near  its  posterior  superior 
angle.  A state  of  temporary  insensibility  supervened  in  the  course  of  an  hour.  He  remained  on  the  field  for  three  days,  was 
conveyed  to  the  field  hospital,  and  thence  sent  to  the  2d  division  hospital,  Alexandria,  on  June  15th  ; being  at  the  time  in  a state 
of  heavy  stupor.  The  wound  suppurated  freely,  and  presented  near  its  centre  a pulsating  tumor,  covered  by  granulations ; 
hemiplegia  of  the  left  side  supervened,  and  the  patient  voided  the  urine  and  faeces  involuntarily;  the  three  smaller  toes  of  the  left 
foot  were  partially  gangrenous.  While  dressing  the  w'ound,  Acting  Assistant  Surgeon  T.  H.  Stillwell  removed  a fragment  of  the 

external  table,  one-fourth  of  an  inch  in  diameter.  On  the  afternoon  of  the  16th,  C recovered  from  his  stupor  and  conversed 

rationally,  though  with  difficult  articulation.  On  the  18th,  he  again  sank  into  a lethargic  state,  in  which  he  perspired  freely.  On 
the  20th  and  on  the  22d,  he  was  again  rational  for  a few  hours.  Two  small  pieces  of  bone  were  removed,  one  of  which  was  a 
portion  of  the  internal  table.  On  the  24th,  his  breathing  was  stertorous  all  day,  but  at  night  a marked  improvement  in  his 
condition  took  place;  the  slough  had  fallen  from  one  of  his  toes,  disclosing  a healthy,  granulating  surface;  he  began  to  regain 
power  over  the  paralyzed  leg,  void  the  excrements  at  will,  and  could  talk  without  difficulty.  On  the  30th  and  31st,  he  suffered 
from  convulsive  attacks  of  nervous  delirium.  One-fourth  of  a grain  of  morphia  was  administered  every  half  hour.  By  August 
5th,  the  paralysis  of  the  left  side  had  so  far  ceased  that  he  could  Hex  his  extremities  and  extend  his  leg,  though  not  with 


IIEKNIA  CEEEBm  AETEE  GUNSHOT  FEACTUEES  OF  THE  SKULL. 


297 


precision.  From  tliis  date,  nothing  unfavorable  occurred  until  September  7th,  when  he  again  experienced  attacks  of  delirium. 
On  the  27th,  after  a slight  chill,  he  fell  into  a state  of  insensibility.  A tumoi',  which  had  formed  at  the  wound  beneatli 
the  scalp,  was  opened,  and  upon  its  discharging  about  an  ounce  of  blood,  sensibility  was  at  once  restored.  Again  a state  ot 
unconsciousness  ensued  on  the  3Cth,  and  though  in  a measure  relieved  by  the  adniinistiation  of  purgatives,  it  was  evident  that 
dissolution  was  near.  Death  occurred  on  October  2d.  At  the  autopsy,  a circular  opening  one  inch  in  diameter  was  found,  just 
above  the  right  parietal  eminence,  with  the  edges  rounded  off  and  beveled  at  the  expense  of  the  inner  table.  There  was  also  an 
opening  in  the  dura  mater,  through  which  a hernia  cerebri  appeared.  Upon  removing  the  skull  cap,  three  small  fragments  of 
the  inner  table,  depressed  one-fourth  of  an  inch  at  their  free  edge,  were  observed  attached  and  agglutinated  by  new  ossific 
deposit,  traces  of  which  could  also  be  seen  in  the  immediate  vicinity.  A cerebral  abscess  was  found  extending  from  the  hernia 
cerebri  to  the  right  lateral  ventricle  containing  about  two  ounces  of  very  ofi'ensive  lead-colored  pus.  The  pathological  sjieeimens 
are  Nos.  1724  and  1725,  Sect.  I,  A.  M.  M.,  and  were  contributed,  with  the  history,  by  Acting  Assistant  Surgeon  T.  H.  Stillwell. 

Case. — Private  Thomas  Deshler,  Co.  I,  103d  Ohio  Volunteers,  was  accidentally  wounded  at  Carter  Station,  Virginia, 
September  22d,  1863,  by  a musket  ball,  which  enteied  just  below  and  in  front  of  the  left  ear,  carried  away  a jiortion  of  the 
temporal  bone  and  probably  made  its  exit  above  and  in  front  of  the  ear.  He  was  admitted  into  the  regimental  hospital  at  Bull’s 
Gap,  Virginia,  on  the  same  day.  3 he  biain  protinded  i'uan  the  wound  and  about  one  ounce  dropped  off.  Ho  was  partially 
conscious,  for  the  most  part,  until  his  death  on  S(pt(.mber  24th,  1863.  There  was  no  post-mortem  examination.  The  case  is 
reported  by  Surgeon  L.  D.  Griswold,  103d  Ohio  Volunteers. 

Case. — Corporal  Jerry  Green,  Co.  A,  C8th  United  States  Colored  Troops,  waas  wounded  at  Fort  Blakely,  Alabama, 
April  9th,  1865,  by  a shell,  which  fractured  the  left  temporal  and  the  frontal  bone.  He  was  admitted  to  hospital,  1st  division. 
Army  of  the  West  Mississippi,  in  a comatose  condition.  The  brain  protruded  and  the  left  side  was  paralyzed.  He  died 
April  13th,  1865. 

Case. — Private  Thomas  H , Co.  I,  5Cth  Pennsylvania  Volunteers,  aged 

23  years,  was  wounded  at  the  battle  of  Petersburg,  Virginia,  June  22d,  1864,  by  a 
conbidal  ball,  which  fractured  the  right  parietal  bone  at  its  anterior  supei  ior  angle. 

He  was  admitted  to  the  4th  division.  Fifth  Corps,  hospital,  and  thence  conveyed  to 
Washington,  and  admitted,  on  July  1st,  into  the  Finley  Hospital.  On  the  4th, 
fragments  of  bone  were  removed  from  a space  measuring  two  inches  downward 
from  the  sagittal  suture  by  one  in  width.  Two  days  later,  hernia  cerebri  appeared 
at  the  opening.  The  details  of  the  further  progress  of  the  case  are  not  recorded, 
but  death  resulted  on  July  11th,  five  days  after  the  appearance  of  the  hernia  and 
twenty  days  from  the  date  of  injury.  At  the  autopsy,  the  edges  of  the  opening  in 
the  bone  were  found  necrosed  and  cilbrifonn.  The  dura  mater  and  par  ts  of  the 
cerebral  substarree  in  the  vicinity  were  congested  and  filled  with  coagulated  blood. 

The  specimerr  is  figured  in  the  wood-cut,  (Fig.  145,)  and  was  contributed,  with  the 
history,  by  Surgeorr  G.  L.  Pancoast,  U.  S.  V. 

Case. — Private  Andrew  W.  Pless,  Co.  B,  46th  Illinois  Volunteers,  aged  19 
years,  was  wounded  in  the  engagement  near  Fort  Blakely,  Alabama,  April  8th, 

1865,  by  fragments  of  shell,  which  fractured  the  cranium  and  injured  the  right 
shoulder.  He  was  admitted  to  the  hospital  of  the  Thirteenth  Corps  on  the  same 
day,  and,  on  April  15th,  was  sent  to  the  St.  Louis  Hosjrital,  New  Orleans,  Louisiana. 

Hernia  cerebri  supervened,  and  death  occurred  on  April  23d,  1865.  The  case  is  reported  by  Surgeon  A.  McMahon,  U.  S.  V. 

Case. — Private  Arthur  H , Co.  F,  40th  New  York  Volunteers,  aged  28  years,  was  w ounded  at  the  battle  of  Spottsyl- 

vania  Court-house,  Virginia,  May  10th,  1864,  by  a conoidal  ball,  which  entered  the  cavity  at  the  middle  ])ortion  of  the  right 
branch  of  the  coronal  suture  and  lodged  in  the  brain,  from  which  it  was  removed  on  the  field.  He  was  conveyed  to  Washington, 
and,  on  the  12th,  admitted  to  the  Douglas  Hospital.  At  the  dressing  of  the  wound.  May  13th,  some  pieces  of  bone  were  removed, 
and  the  finger  could  be  passed  deeply  into  the  cerebral  substance.  Paralysis  of  the  left  side  ensued,  and,  at  times,  involuntary 
discharge  of  the  faeces  and  urine  occurred.  The  tongue  was  drawn  to  the  left  or  paralyzed  side.  Hernia  cerebri  appeared,  the 
protruding  part  occasionally  becoming  strangulated  and  sloughing.  The  patient  retained  the  possession  of  his  mental  faculties 
in  a remarkable  degree,  answering  all  questions  addressed  to  him  with  accuracy.  Death  supervened  on  June  20th,  1864,  forty- 
one  days  after  the  reception  of  the  injury.  At  the  autopsy,  the  fractured  portion  of  the  outer  table  was  found  to  measure  two 
inches  in  length  by  one  in  width ; that  of  the  inner  table  somewhat  less.  Two  small  fragments  of  the  inner,  and  two  of  the 
outer,  remained  ; the  rest  had  been  removed.  The  suirounding  bone  was  cribriform  and  slightly  carious,  and  the  edges  rounded 
off,  showing  an  attempt  at  repair.  No  evidence  of  meningeal  inflammation  existed ; there  was,  however,  extensive  softening  of 
the  right  hemisphere,  involving  the  thalamus  opticus  and  corpus  striatum  ; the  lateral  ventricles  were  filled  with  serum.  The 
case  is  reported  by  Assistant  Surgeon  William  Thomson,  U.  S.  A.  The  specimen  is  No.  3566,  Sect.  I,  A.  M.  M. 

Case. — Private  George  Hopkins,  Co.  G,  8th  Ohio  Volunteers,  aged  32  years,  was  wounded  before  Petersburg,  Virginia, 
June  17th,  1864,  by  a conoidal  musket  ball,  which  fractured  and  depressed  the  frontal  bone,  left  side.  He  was  admitted  to  the 
Ninth  Corps  field  hospital,  where  spiculai  of  bone  were  removed  and  water  dressings  applied.  He  was  thence  conveyed  by 
steamer  to  Washington,  and  admitted,  on  June  24th,  into  the  Emory  Hospital.  On  June  27th,  coma;  on  .lune  30th,  delirium  ; 
and  on  July  1st,  hernia  cerebri  supervened,  which  latter  was,  on  July  3d,  removed  and  cauterized  with  nitrate  of  silver.  Death 
occuiTcd  on  July  8th,  1864. 

38 


Fig.  145. — Internal  view  of  a skull-cap,  with 
a large  aperture,  through  which  a fungus  cerebri 
protruded.  Spec.  3*.2G4,  Sect.  I,  A.  M.  M. 


298 


WOUNDS  AND  INJUEIES  OF  THE  HEAD, 


Case. — Private  William  H-ulhard,  Co.  B,  2d  Maryland  Regiment,  aged  24  years,  received,  on  September  30th,  18G4,  a 
gunshot  fracture  of  the  right  parietal.  He  was  admitted,  on  October  3d,  1864,  to  Chimborazo  Hospital,  No.  2,  Richmond, 
Virginia.  The  brain  gradually  protruded  from  the  wound,  and  death  occurred  on  October  4th,  1864. 

Case. — Sergeant  Austin  Hudson,  Co.  F,  GOth  Ohio  Volunteers,  was  wounded  near  Petersburg,  Virginia,  July  15th,  1864, 
by  a conoidal  ball,  which  entered  near  the  anterior  superior  angle  of  the  left  parietal  bone,  ploughing  through  bone  and  brain  to 
the  lambdoidal  suture.  He  was  admitted  to  the  hospital  of  the  3d  division.  Ninth  Corps.  The  brain  protruded.  Death  occurred 
July  15th,  1864. 

Case. — Private  John  Irvin,  Co.  D,  88th  Pennsylvania  Volunteers,  aged  20  years,  was  wounded  at  the  battle  of  Spott- 
sylvania,  Virginia,  May  10th,  1864,  by  a conoidal  ball,  which  fractured  the  left  parietal  bone.  He  was  immediately  admitted 
to  the  regimental  hospital,  transferred  to  2d  division.  Fifth  Corps,  hospital  on  the  12th,  and  sent  to  the  Emory  Hospital,  Wash- 
ington, on  the  13th.  An  examination  revealed  a lacerated  wound  of  the  scalp  and  pericranium,  three  inches  long  and  one  and 
a half  inches  at  its  widest  point.  The  fracture  of  the  parietal  bone  extended  from  the  lambdoid  suture  along  the  median  line, 
two  inches  by  one-half  inch.  The  posterior  end  of  the  fractured  portion  of  the  cranium  was  depressed.  On  the  13th,  the 
patient’s  right  side  was  paralyzed  and  his  mind  wandering ; the  pulse  was  normal,  and  the  appetite  good.  He  was  placed  under 
the  influence  of  ether  and  chloroform.  Surgeon  N.  E.  Moseley,  U.  S.  V.,  then  enlarged  the  wound  by  a straight  incision,  and 
removed  a piece  of  bone  about  two  inches  in  length ; several  sm.aller  fragments  were  taken  out.  Water  dressings  were  applied  to 
the  wound,  but  no  marked  improvement  took  place.  On  May  18th,  hernia  cerebri  supervened,  the  breathing  became  stertorous, 
and  the  pulse  accelerated.  Death  ensued  on  May  31st,  1864.  The  case  is  reported  by  Surgeon  N.  R.  Moseley,  U.  S.  V. 

Case. — Corporal  Edward  Jones,  Co.  A,  8th  Ohio  Volunteers,  was  wounded  at  Gettysburg  July  3d,  1863,  by  a conoidal 
ball,  which  entered  the  cranium  at  the  articulation  of  the  nasal  with  the  frontal  bone,  passed  through  the  superior  and  posterior 
portion  of  the  left  orbit,  and  displacing  the  os  unguis,  emerged  through  the  articulation  of  the  frontal  and  malar  bones.  The 
eye  had  apparently  escaped  serious  injury.  He  was  admitted  to  the  Seminary  Hospital,  Gettysburg;  thence  was  sent  to  Bedloe’s 
Island  Hospital,  New  York  Harbor.  Partial  insanity  supex’vened,  and  the  extreme  inflammation  consequent  upon  the  injury 
disorganized  the  structures  of  the  eye.  On  October  29th,  he  was  transferred  to  De  Camp  Hospital ; thence,  on  December  23d, 
to  McDougall  Hospital,  and  on  December  30th  to  Camp  Dennison,  Ohio.  There  was  at  this  time  a free  discharge,  supposed  to 
be  from  the  wounded  appendages  of  the  eye ; but  his  strength  was  good.  On  January  10th,  1864,  he  was  seized  with  vomiting 
and  hiccough ; the  tongue  became  dry,  with  red  border  and  dark  centre ; bowels  torpid,  and  general  condition  typhoid.  He 
complained  of  occasional  pain  in  the  front  part  of  his  head ; was  drowsy  and  disinclined  to  talk.  Two  weeks  later  he  became 
unconscious ; paralysis  of  the  right  side  supervened,  attended  with  involuntary  evacuation  of  urine  and  fseces.  Meantime  the 
discharges  from  the  left  orbit  had  nearly  ceased.  About  February  10th,  he  sank  into  a well  marked  coma.  Beneath  the  inflamed 
superior  palpebra,  a sharp  edge  of  bone  could  be  felt,  and  at  the  internal  canthus  quite  a prominence  was  observed,  produced 
by  another  portion  of  displaced  bone.  On  the  morning  of  the  16th,  the  indications  denoting  compression  of  the  brain  were 
strongly  marked.  On  the  next  day  Acting  Assistant  Surgeon  W.  C.  Cole  made  an  incision  to  the  bone  from  the  external 
canthus  of  the  left  eye  to  the  upper  point,  to  tie  the  anterior  branch  of  the  temporal  artery.  A second  incision  was  carried  from 
the  internal  canthus  obliquely  upward,  and  dissection  made  of  the  flap,  which  included  the  upper  eyelid.  This  disclosed  a 
fracture  of  the  orbital  plate  of  the  frontal  bone  and  the  displacement  of  the  os  unguis,  and  between  them  a hernia  cerebri  one 
inch  in  diameter,  which  was  removed,  opening  a cavity  within  the  anterior  lobe  of  the  left  hemisphere,  from  which  escaped 
about  six  ounces  of  a semi-transparent  fluid,  apparently  disorganized  serum.  The  flap  was  brought  down  and  secured  by  a 
stitch  at  each  side,  with  a tent  placed  in  the  aperture.  Prompt  reaction,  with  full  consciousness,  ensued  before  the  patient'Avas 
removed  from  the  operating  table.  He  was  then  carried  to  bed,  and  a nurse  was  appointed  to  apply  cold  water  dressings  and 
carefully  watch  him.  In  the  course  of  two  days  the  paralysis  passed  off,  and  the  involuntary  evacuations  ceased ; the  jxulse 
rose  from  55  to  85,  and  the  tongue  became  natural.  The  discharge  from  the  wound  soon  changed  to  a thick  healthy  looking 
pus,  and  for  ten  days  all  the  functions  of  life  were  harmoniously  performed.  But  on  the  morning  of  the  27th  he  complained  of 
pain  in  the  back  part  of  the  head ; the  face  became  flushed,  the  tongue  dry  and  red,  and  the  pulse  more  frequent.  Two  grains 
of  calomel,  with  one  grain  of  ipecac,  were  now  given  every  four  hours.  By  the  next  day  the  pulse  was  120,  and  he  was  unable 
to  answer  any  questions.  Veratrum  viride  was  carefully  administered.  He  sank  steadily,  and  died  on  the  afternoon  of  the  28th. 
At  the  autopsy,  the  meninges  and  brain,  as  viewed  in  situ,  showed  marked  venous  congestion,  but  the  arachnoid  membrane  had 
evidently  suffered  most  from  inflammation.  A cavity,  lined  with  a thick  firm  cyst,  was  found  in  the  anterior  superior  part 
of  the  left  hemisphere,  communicating  with  the  orbit  of  the  eye ; the  ventricles  were  empty,  and  a deposit  of  lymph  covered 
the  upper  surface  of  the  tentorium.  The  case  is  reported  by  Acting  Assistant  Surgeon  W.  C.  Cole. 

Case. — Private  N.  B.  Jones,  Co.  I,  3d  North  Carolina  Regiment,  aged  30  years,  was  wounded  in  the  battle  of  Winchester, 
Virginia,  September  19th,  1864,  by  a conoidal  ball,  which  comminuted  the  skull.  The  brain  substance  was  loosened,  and 
protruded  through  the  aperture  in  the  cranium.  He  was  immediately  conveyed  to  the  depot  field  hospital  of  the  Nineteenth 
Corps.  Brain  symptoms  were  fully  developed,  and  on  the  following  day  Assistant  Surgeon  G.  M.  Burdette,  P.  A.  C.  S.,  removed 
all  loose  fragments  of  bone.  Cold  applications  were  made  to  the  head,  but  progress  was  very  unfavorable,  and  death  ensued  on 
September  28th,  1864,  from  “ laceration  of  brain  substance,  with  cerebritis  and  meningitis.” 

Case. — Corporal  W.  O.  K , Co.  F,  3d  Indiana  Cavalry,  aged  29  years,  was  wounded  at  Funkstown,  Maryland, 

July  8th,  1863,  by  a fragment  of  shell,  which  comminuted  the  os  frontis  a little  to  the  right  of  the  median  line,  and  half  an 
inch  above  the  orbit.  He  remained  insensible  only  a few  hours  after  the  reception  of  the  injury.  The  wound  was  then  enlarged, 
a number  of  fragments  of  bone  were  removed,  and  cold  water  dressings  applied.  On  the  18th,  he  was  admitted  into  the  general 
hospital  at  Frederick,  Maryland,  with  the  wound  in  a healthy  condition,  and  no  functional  or  cerebral  derangement.  A 


ITEENIA  CEEEBRI  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


299 


hernia  about  tlie  size  of  a pullet’s  egg  was  protruding  from  the  opening,  which  was  surrounded  by  healthy  granulations, 
lie  complained  of  slight,  dull,  heavy  lieadache ; the  tongue  was  slightly  furred ; bowels  constipated,  but  the  appetite  fair. 
Aperients  were  ordered,  which  entirely  relieved  the  headache.  He  was  somewhat 
morose,  but  conversed  readily.  No  paralysis  existed.  On  the  24th,  Ids  appetite  and 
general  condition  were  most  excellent.  The  hernia  showed  a disposition  to  slough, 
and  the  soft  parts  were  granulating  finely.  On  the  27th,  the  hernia  had  sloughed 
away,  and  profuse  suppuration  supervened,  parts  looking  healthy.  Headache  again 
came  on,  which  continued  for  several  days,  and  on  the  23d  the  patient's  appetite 
began  to  fail.  On  the  7th,  the  wound  w'as  suppurating  profusely,  and  the  granulations, 
which  nearly  covered  the  opening,  were  pushed  outward  by  the  hcrida.  Fluctuations 
were  well  marked  on  the  10th.  The  abscess,  w’hich  evidently  communicated  with 
the  brain,  was  freely  opened,  giving  exit  to  half  an  ounce  of  pus.  On  the  12th,  he 
became  quite  delirious  ; the  right  pupil  was  contracted,  wdiile  the  left  was  somewhat 
dilated  ; pulse  slow  and  feeble ; no  appetite,  August  14th,  subsultus  teudinum  set 
in,  and  the  patient  died  at  half-past  one  o’clock  the  following  morning.  Thepost- 
rnortem  revealed  the  entire  brain  substance  softened,  and  the  left  lateral  ventricle 
filled  with  pus.  The  pathological  specimen  is  represented  in  the  adjacent  w'ood-cut. 

Fragments  have  been  removed  from  a space  two  inches  in  diameter,  including  the 
right  frontal  eminence.  From  the  inner  table  the  removal  of  bone  has  been  more 
extensive,  including  the  posterior  walls  of  both  frontal  sinuses.  The  anterior  walls 
of  the  sinuses  are  comminuted,  and  the  fragments  are  consolidated  by  new  ossific 
deposit,  and  depressed  from  one-fourth  to  one-half  an  inch  at  their  upper  and  free 
edges.  From  the  upper  part  of  the  opening  a fissure  runs  outward  to  the  extremity 
of  the  right  great  ala  of  the  sphenoid.  The  specimen  and  history  were  contributed 
by  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A. 

Case. — Private  Charles  H.  K , Co.  I,  12th  Massachusetts  Volunteers,  was  wounded  at  Antietam,  September  17th, 

1832,  by  a musket  ball,  which  fractured  and  depressed  both  tables  of  the  frontal  bone.  He  was  sent  to  the  regimental  field 
hospital,  thence  was  conveyed  to  Baltimore,  and  admitted  into  the  Newton  University  Hospital  on  the  20th.  Thu  ball,  with  the 
fragments  of  the  external  table,  had  been  removed.  The  patient  was  suffering  from  slight  symptoms  of  compression  of  the  brain, 
which  gradually  increased.  On  the  23d,  Surgeon  C.  W.  Jones,  U.  S.  V.,  after  having  enlarged  the  external  opening,  remcived 
several  large  depressed  pieces  of  the  internal  table,  to  the  manifest  relief  of'  the  patient.  During  the  removal  of  the  fragments, 
slight  haemorrhage  occurred  fi’om  the  superficial  enlargement  of  the  wound,  and,  at  the  conclusion  of  the  operation,  the 
pulsations  of  the  meningeal  artery  were  distinctly  visible  beneath  the  dura  mater.  The  edges  of  the  seal])  were  bi  ought  together 
by  adhesive  strips,  and  the  head  elevated  by  pillows.  He  conversed  coherently,  his  breathing  was  easy  and  natural,  and  the 
edges  of  the  scalp  commenced  to  adhere  by  granulation.  Fine  days  after  the  opei  ation  the  wound  was  slightly  elevated,  and  in 
the  centre  could  be  seen  the  somewhat  darkened  dura  mater.  Slight  comj)ression  was  used;  but,  on  the  following  morning,  the 
protrusion  of  the  brain,  covered  by  the  dura  mater  was  greatly  increased,  having,  in  its  progress,  broken  up  all  the  adhesions 
fonned  at  the  edges  of  the  wound.  The  patient  was  depressed,  dull,  and  slightly  comatose.  Convulsion's  shortly  after  ensued, 
and  death  occurred  October  3d,  1832,  ten  days  after  the  operation  and  two  days  after  the  appearance  of  the  hernia  cerebri. 
The  pathological  specimen  is  No.  410,  Sect.  I,  A.  M.  M.  The  nine  small  fragments  removed  from  the  frontal  bone  consist  chieliy 
of  diploe  and  vitreous  table,  and  include  one-fourth  square  inch  of  surface.  The  specimen  and  history  were  contributed  by  the 
operator.  Surgeon  C.  W.  Jones,  U.  S.  V. 

Case. — Private  T.  L , Co.  C,  25th  New  York  Volunteers,  aged  34  years,  was  wounded  at  the  battle  of  Fredericks- 
burg, Virginia,  December  13th,  1802,  by  a conoidal  musket  ball,  which  struck  the  osfrontis  about  one  inch  above  the  right  orbit, 

fracturing  and  depressing  both  tables  for  a space  one  inch  in  diameter.  He  was  stunned  for  a moment,  but  soon  recovered^  was 
taken  to  a field  hospital,  and  thence  admitted  into  Hammond  Hospital,  Point  Lookout,  Maryland,  December  15th,  apparently 
doing  well  in  every  respect.  His  appetite  was  good,  bowels  regular,  and  he 
was  able  to  walk  about  as  usual.  Cold  water  dressings  were  applied,  and 
absolute  rest  and  low  diet  ordered.  The  case  progressed  favorably  until  the 
23d,  when  violent  pain  in  the  head  supervened.  On  the  next  day  he  became 
8tuj)id  and  drowsy,  understanding,  with  difficulty,  questions  put  to  him.  The 
pupils  were  slightly  dilated,  but  no  paralysis  or  loss  of  sensation  e.xisted.  It 
being  decided  that  an  operation  Was  imperative,  the  patient  was  placed  uiuhu’ 
the  influence  of  chloroform,  and  Assistant  Surgeon  C.  Wagner,  U.  S.  A., 
applied  the  trephine  on  the  anterior  border  of  the  fracture,  and  removed  a 
number  of  fragments  of  bone.  One  piece,  measuring  three-fourths  of  an  inch 
in  length  by  oue-h.alf  inch  in  width,  had  lacerated  the  dura  mater  and  imbedded 
itself  in  the  brain  substance,  and  was,  with  great  difficulty,  extracted.  The 
dura  mater  was  much  congested.  ■ After  the  operation,  the  patient  was  free 
fi-om  all  pain  and  the  brain  symptoms  had  entirely  disappeared ; but,  on  the 
28th,  hernia  cerebri  appeared  and  rapidly  increased,  the  patient  sinking  into  insensibility,  with  widely  dilatcul  i)U])ils,  cold  skin, 
and  slow,  feeble  pulse.  He  died  on  the  following  morning  in  a state  of  con)j)lete  coma.  At  the examination  tbe 
hernia  was  of  a dark  color,  very  soft,  and  j)rotruding  an  inch  and  a half.  'J'he  dura  mater  was  softened,  and  covered  with  a 
slimy  exudation  near  the  seat  of  injury.  Its  laceration  corre.sponded  very  nearly  in  extent  with  the  ojaming  in  the  skull.  The 
membranes  of  the  whole  of  this  side  were  much  congested ; the  anterior  iioi  tion  of  tlun  ight  cercdu-.-il  h(!mis)ihere  was  disoi'gaiiized. 


Fig.  147. — Segment  of  skull  tropliincd  after  fracture 
by  u musket  ball.  Sjkc.  UUd,  Sect.  I,  A.  M.  AI. 


Fig.  14(). — Section  of  a skull  trephined  after 
a fracture  hy  a shell  fragment.  &pec.  3834, 
Sect.  I,  A.  M.  M, 


300 


WOUNDS  AND  INJUraES  OF  THE  HEAD 


soft,  of  a greenish  color,  and  infiltrated  with  veiy  otfensive  pus.  The  posterior  portion  presented  a more  normal  apparancc  on 
the  surface,  but  on  cutting  it  a small  abscess  was  found.  The  left  cerebral  hemisphere  and  membranes  wei'c  comparatively 
healthy.  The  specimen  is  represented  in  the  adjoining  wood-cut.  The  os  frontis  shows  two  fissures,  one  commencing  at  the 
posterior  and  outer  border  of  the  opening  in  the  skull,  and  running  downward  and  backward  across  the  tempor  al  r idge  for  the 
distance  of  an  inch  ; the  other  commencing  an  iirch  anterior  to  the  first,  passes  downward  iirto  the  roof  of  the  orbit,  along  its  outer 
border  for  the  distance  of  half  an  inch.  The  piece  of  bone  between  the  fractures  is  quadqirrgular  in  shape,  and  has  beeir  forced 
outwar’d  at  its  detached  borders  for  the  distance  of  a quarter  of  arr  inch  from  the  surface  of  the  skull,  remaining  stOl  attached  at 
its  ittferior  sur  face.  The  specimetr  and  hi.story  were  contributed  by  Assistant  Sur’geon  C.  Wagner,  U.  S.  A. 

Case. — Sergeant  D.  M.  Livingston,  Co.  I,  27th  Georgia  Regiment,  was  admitted  to  Jackson  Hospital,  Richmond,  Virginia, 
on  June  20th,  1864,  with  a gunshot  fracture  of  the  cranium.  Hernia  cerebri  supervened,  and  death  occurred  June  27th,  1864. 
The  case  is  reported  by  Surgeon  J.  G.  Cabell,  P.  A.  C.  S. 

Case. — Sergeant  James  L , Co.  I,  153d  New  Yor'k  Volunteers,  aged  19  years,  was  wounded  at  tbe  battle  of  Cedar 

Creek,  Virginia,  October  19th,  1864,  by  a conoidal  ball,  which  entered  the  cranium  at  the  superior  border  of  the  occipital  bone, 
just  to  the  left  of  tbe  median  line,  and  lodged  in  the  left  hemisphere  of  the  brain  ; his  left  elbow  joint  was  also  fi-.actured.  On 
the  21st  he  was  admitted  into  the  depot  field  hospital  of  the  Nineteenth  Corps,  at  Winchestei’,  Virginia ; thence  was  transferred  to 
the  Jarvis  Hospital,  Baltimore,  which  he  entered  on  October  26th.  The  ball  and  several  pieces  of  dead  bone  were  extracted,  and 
cold-water  dressings  applied.  Hernia  cerebri  followed,  and  death  occurred  on  November  20th,  1864.  The  autopsy  revealed  the 
))ortio'n  of  scalp  surrounding  the  wound  in  a very  unhealthy  condition.  The  skull  caj)  was  unusually  thick.  The  ball  had 
carried  with  it  a number  of  small  pieces  of  bone.  Surrounding  the  spinal  cord  were  found  about  four  ounces  of  purulent  fiuid. 
The  elbow  joint  was  comminuted.  The  pathological  specimens  are  Nos.  3729  and  3725,  Sect.  I,  A.  M.  M.  The  former  represents 
a segment  of  the  cranium  ; fragments  have  been  removed  from  an  elliptical  opening,  measuring  one  and  a half  inches  fi’om  below 
downward,  by  one  inch  in  width.  The  edges  of  the  opening  are  necrosed  and  beveled  at  the  ex])ense-of  the  inner  table,  and 
there  are  traces  of  attempt  at  repair.  The  latter  specimen  is  a wet  preparation  of  the  cerebrum,  in  the  left  hemisphere  of  which  a 
conoidal  ball  remained  lodged  for  more  than  a month  before  death.  The  specimens  are  contributed  by  Acting  Assistant 
Surgeon  B.  B.  Miles. 

Case. — Private  James  L , Co.  1, 12th  Mississippi  Regiment,  aged  26 years,  was  wounded  at  the  battle  of  Spottsylvania, 

Virginia,  May  10th,  1864,  by  a fragment  of  shell,  which  produced  a comminuted  fracture  of  a portion  of  the  left  parietal  and 
temporal  bones.  He  was  conveyed  to  Washington,  and  on  the  14th  .admitted  into  the  Carver  Hospital,  suffering  constant  and 
excruciating  pain  in  the  head.  He  was  obliged  to  lie  upon  his  left  side  in  a recumbent  position,  and  remained  perfectly  quiet. 

Simple  dressings  were  regularly  applied  to  the  wound,  .and  a restricted  diet, 
enjoined.  A hernia  cerebri  aj)peared  at  the  seat  of  fr.acture.  Unconsciousness 
supervened,  the  breathing  became  slow  and  stertorous,  and  .as  the  coma  deepened, 
large  quantities  of  laudable  pus  were  discharged  from  the  wound.  He  died  on 
the  20th  of  the  month.  At  the  autofjsy  the  fractured  surface  was  found  to 
measure  three  and  one-half  inches  downward  ami  backward,  by  one-half  inch  in 
width,  from  which  fragments  had  been  removed.  One  fissure  run  from  the 
anterior  inferior  angle  of  the  p.arietal,  nearly  to  the  sagittal  suture,  and  a second 
crossed  the  lambdoidal.  There  was  no  attempt  at  repair.  Uie  specimen  is 
represented  in  the  .adjoining  wood-cut,  and  was  contributed  by  Acting  Assistant 
Surgeon  0.  P.  Sweet. 


Fig.  148. — .Segment  of  skull  fractured  by  a piece 
of  shell.  Spec.  2901,  Sect.  I,  A.  M.  M. 


Case. — Major  Thomtis  McClurken,  30th  Illinois  Volunteers,  received,  at  the  battle  of  Belmont,  Missouri,  November  7th, 
1861,  a gunshot  fracture  of  the  cranium.  Three  inches  of  the  skull  were  shot  away,  and  the  brain  substance  protruded.  He 
died  on  November  15th,  1861. 


Case. — Private  Jacob  Morford,  Co.  A,  29th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Gettysburg,  Penn- 
sylv.ania,  July  2d,  1863,  by  a conoidal  musket  btill,  which  fractured  the  frontal  bone  immediately  above  the  nose,  and  a little  to 
the  left  of  the  median  line,  crushing  the  bone  and  driving  the  fragments  into  the  brain.  He  tvas  admitted  to  the  field  hospital  at 
Gettysburg  on  the  following  day.  Several  small  pieces  of  bone  were  removed,  and  cold  water  dressings  applied.  He  complained 


Fig.  149.— Internal  view  of  the  skull-cap  tre- 
phined alter  gunshot  fracture.  Spec.  1359,  Sect  I 
A.  M.  M.  ’ 


of  severe  pain  in  his  head,  and  would 
answer  questions  irrationally.  His 
jiulse  was  somewhat  excited,  but  the 
tongue  was  natural  and  the  eyesight 
unimpaired,  although  a portion  of  the 
orbital  process  had  been  removed.  He 
would  leave  his  tent  at  night,  under  the 
impression  that  he  was  acting  as  picket. 
He  remained  in  this  condition  until  July 
17th,  when  again  several  pieces  of  bone 
were  removed,  leaving  an  opening  large 
enough  to  admit  the  index  finger,  which 
could  be  passed  in  almost  its  entire 
length,  without  meeting  with  any  resist- 
ance or  producing  any  considerable 
pain,  a considerable  portion  of  the  brain 


Fig.  ]50 — Exterior  view  of  the  specimen, 
illustrated  by  the  cut  opposite. 


HERNIA  CEREBRI  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


301 


being  softened.  A small  fungus  projected  from  the  brain.  After  the  removal  he  expressed  himself  relieved,  and  the  pain  in  his 
bead  ceased  almost  entirely,  and  he  became  more  rational.  On  July  19th,  he  was  taken  to  the  Seminary  Hosjiital.  Coma 
supervened,  which  was  relieved  for  a time  by  the  application  of  water  dressings,  but  hernia  cerebri  appeared,  and  death  occurred 
on  August  IGth,  1863.  The  specimen,  represented  in  the  adjoining  wood-cut,  is  the  vault  of  the  cranium.  Two  disks  inter- 
secting each  other  have  been  removed  by  the  crown  of  a three-foui-th  inch  trephine,  the  entire  opening  measuring  one  and  one- 
fourth  by  three-fourths  of  an  inch.  There  is  a slight  stellate  fissuring  of  the  inner  table. 

Case. — Private  Amer  Moore,  Co.  G,  2d  United  States  Artillery,  aged  20  years,  was  wounded  in  a skirmish  near  Culpeper, 
Virginia,  on  September  13th,  1863,  by  a carbine  ball,  which  struck  the  vertex  of  the  cranium  at  the  centre  of  the  coronal  suture, 
passed  directly  backward  along  the  sagittal  a distance  of  three  inches,  and  lodged.  The  missile  was  extracted  the  same  day. 
Both  tables  of  the  skull  were  fractured,  leaving  an  opening,  through  which  pulsations  of  the  brain  could  be  seen.  The  dura 
mater  was  uninjured.  Complete  paralysis  of  the  lower  extremities  and  of  the  left  aim  existed.  He  was  admitted  into  the 
Armory  Square  Hospital,  Washington,  on  September  14th,  and  on  the  following  day  a plate  e)f  bone,  three-fourths  by  one-fourth 
of  an  inch,  and  several  small  pailieles,  were  extracted  by  Acting  Assistant  Surgeon  E.  Brooks.  Creasote  w'asli  and  permanganate 
of  potash  W’ere  used  to  dress  the  wound,  which  looked  well.  The  general  condition  of  the  patient  was  apparently  good  on 
September  21st,  when  an  oblong  ])iece  of  lead  was  removed  from  beneath  the  scalp;  but  hernia  cerebri  followed  this  operation, 
and  death  occuiTed  on  October  10th,  1863.  The  case  is  reported  by  Surgeon  D.  W.  Bliss,  U.  S.  V. 

Case. — Captain  Thomas  Moyer,  7th  Georgia  Regiment,  received,  at  the  battle  of  Bull  Run,  Virginia,  July  21st,  1861,  a 
shell  fracture  of  the  cranium.  He  was  admitted  to  a Confederate  hospital  at  Culpeper,  Virginia,  on  July  23el.  Hernia  ce’rebi-i 
ensued,  and  death  occurred  August  5th,  1861. 

Case. — Private  J.  A.  Nichols,  Co.  B,  12th  South  Carolina  Regiment,  was  admitted  to  Jackson  Hospital,  Richmond, 
Virginia,  on  August  18j;h,  1864,  with  a gunshot  fracture  of  the  cranium.  Hernia  cerebri  complicated  the  case,  which  resulted 
fatally,  August  24th,  1864. 


Case. — Lieutenant  William  A.  O- 


-,  Co.  B,  25th  Connecticut  Volunteers,  aged  28  years,  was  wounded  at  Irish  Bend, 


Louisiana,  April  14th,  1863,  by  a conoidal  ball,  which  entered  the  frontal  bone  beneath  the  supra-oibital  arch,  passed  downward, 
anil  lodged  in  the  antrum  of  Highmore.  He  was  conveyed  to  New  Orleans,  and 
admitted  into  the  University  Hospital  on  the  17th,  being  at  that  time  in  a semi- 
comatose  condition.  He  continued  so  for  many  days,  at  times  answering  questions 
very  correctly,  but  manifesting  symptoms  of  mental  disturbance.  The  light  eyelid 
was  swollen  to  such  an  extent  as  to  prevent  anj’  view  of  the  eyeball.  On  the  22d,  a 
fragment  of  bone,  which  had  become  entirely  detached,  was  removed.  When  the 
tumefaction  of  the  eyelid  disappeared,  it  was  found  that  the  sight  of  the  eye  was 
uninjured.  An  abscess  discharged  its  contents  through  an  opening  just  beneath  the 
supra-orbital  arch.  During  the  first  two  weeks  of  May  the  patient  was  very  com- 
fortable, but  about  the  15th  of  the  month  he  began  to  decline.  Hernia  cerebri 
appeared  through  the  opening  in  the  frontal  bone,  but  was  readily  reduced,  and  its 
recurrence  prevented  by  a few  turns  of  a roller.  The  original  wound  having  quite 
firmly  cicatrized,  the  hernia  was  afterward  prevented  from  appearing  exteinally.  On 
the  morning  of  the  20th  the  patient  became  suddenly  worse ; coma  supervened,  and 
death  ensued  on  May  21st.  At  the  autopsy,  the  meninges  were  found  much  inflamed, 
and  a portion  of  the  cerebral  substance,  about  the  size  of  the  opening  in  the  frontal  bone, 
was  completely  disorganized  to  the  depth  of  about  three-fourths  of  an  inch.  No  jnis 
was  discovered  in  the  ventricles.  The  specimen  is  represented  by  the  cut,  and  consists 
of  a segment  of  the  frontal  bone  and  two  fragments.  The  opening  in  the  os  frontis 
is  nearly  quadrilateral,  measuring  one  inch  from  right  to  left,  and  one  and  one- 
fourth  inches  from  above  downward.  A fissure  of  the  external  table  extends  to  the  temporal  ridge.  The  specimen  and 
history  were  contributed  by  Assistant  Surgeon  P.  S.  Conner,  U.  S.  A. 


FIO.  151. — Sog-incnt  cf  frontal  beno  fractured 
by  a musket  ball,  which  is  shown  in  silu. 
Spec.  12U7,  Sect.  I,  A.  M.  M. 


Case. — Private  Philip  P , Co.  A,  1st  Maryland  Regiment,  aged  29 

years,  was  wounded  at  the  battle  of  Gettysburg,  Pennsylvania,  July  1st,  1863, 
by  a musket  ball,  which  fi'actured  both  tables  of  the  right  parietal  bone  at  its 
eminence.  He  was  convej'ed  to  Seminary  nos])ital,  Gettysburg,  and  thence, 
on  .July  17th,  transferred  to  the  general  hospital  at  Chester.  The  wound  was 
in  a healthy  condition.  On  the  28th,  several  fi’agments  of  bone  were  removed, 
leavhig  an  opening  one-half  by  three-fourtlis  of  an  inch,  through  which  the 
pulsations  of  the  brain  could  be  distinctly  seen.  On  August  8th,  the  wound 
began  to' slough.  Hernia  cerebri  supervened  and  gradually  increased  to  the 
size  of  an  egg.  All  the  sympton)^  of  compression  of  the  brain  and  paraplegia 
sinistra  followed.  The  patient  began  to  fail  rapidly,  and  died  on  August  2l8t, 
1863.  The  specimen  is  figured  in  the  wood-cut,  (Fig.  152,)  and  exhibits  the 
aperture  left  after  the  removal  of  the  depressed  fragments  of  the  right  parietal 
bone.  The  edges  of  the  opening  are  necrosed,  and  slight  de])osits  of  new 
ossific  matter  appear  on  the  inner  surface.  The  specimen  and  history  were 
contributed  by  Acting  Assistant  Surgeon  J.  A.  Draper. 


Eio.  1.52. — Socinent  of  skull,  fractured  by  a musket 
ball.  Spec.  2012,  Sect.  J,  A.  JM.  M. 


302 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


Case. — Lieutenant  John  II.  Porter,  Bradford’s  Battalion,  Tennessee  Cavalry,  aged  27  years,  was  wounded  at  Fort  Pillow, 
Tennessee,  April  12th,  1864,  by  a conoidal  ball,  which  entered  at  the  upper  portion  of  the  left  side  of  the  forehead,  and  in  its 
passage  chipped  out  a part  of  the  frontal  and  left  parietal  bones,  exposing  the  meningeal  artery  and  the  brain  to  the  extent  of  an 
inch.  He  was  conveyed  by  steamer  to  Mound  City,  Illinois,  and  admitted  to  the  hospital  at  that  place  on  April  14th.  He  was 
unable  to  speak,  though  quite  rational,  and  would  follow  his  friends  at  will  with  his  eyes.  In  the  progress  of  the  case,  periods 
of  quiet  and  great  restlessness  alternated.  On  April  19th,  the  wound  commenced  to  discharge,  and  on  the  22d  the  patient  could 
eat  a little,  but  was  still  unable  to  speak ; the  bowels  were  costive.  The  discharge  from  the  head  increased,  and  on  the  27th 
considerable  brain  matter  protruded.  For  a day  or  two  he  seemed  better,  but  on  May  4th  he  became  delirious,  and  remained  in 
that  condition  until  death  supervened,  June  21st,  1864. 

Case. — Private  James  Ringwood,  Co.  A,  14th  Connecticut  Volunteers,  was  wounded  at  the  battle  of  Cold  Harbor, 
Virginia,  June  7th,  1864,  by  a conoidal  ball,  which  caused  a compound  comminuted  fracture  of  right  temporal  and  parietal  bones. 
He  was  at  once  admitted  to  the  hospital  of  the  1st  division,' Second  Corps.  His  left  side  was  paralyzed,  and  a portion  of  the 
brain  protruded  from  the  opening;  the  discharge  of  fasces  was  involuntary.  Dr.  A.  Garcelon  removed  a portion  of  the  bone.  No 
further  history  can  be  obtained ; but  the  man  probably  died  in  transit  to  a general  hospital. 

Case. — Private  William  Rogers,  Co.  G,  7th  Ohio  Volunteers,  aged  23  years,  W'as  wounded  at  the  battle  of  Port  Republic, 
Virginia,  June  9th,  1862,  by  a conoidal  ball,  which  struck  the  os  frontis,  one  inch  above  the  edge  of  the  right  orbit,  and  about 
half  an  inch  from  the  median  line.  He  was  rendered  insensible  for  a few  moments,  but  soon  recovered  sufficiently  to  walk  from 
the  field.  He  was  admitted  to  Cliffburne  Hospital,  Washington,  on  the  15th.  The  wound  was  healthy  in  appearance,  and  dis- 
charged a thin,  sero-purulent  fluid;  the  pulsation  of  the  brain  was  distinctly  visible,  and  splinters  and  loose  fragments  of  bone 
could  be  felt.  Absolute  quiet  was  enjoined,  and  light  diet  and  simple  dressing,  with  aperients,  ordered.  On  the  17th  he 
complained  of  increasing  pains.  Assistant  Surgeon  John  S.  Billings,  U.  S.  A.,  enlaiged  the  wound  of  entrance,  and  removed  the 
fragments  of  bone  with  forceps.  The  ball  could  not  be  found,  it  having  evidently  entered  the  brain.  The  wound  was  left  open, 
and  lightly  dressed  with  wet  lint.  The  patient  felt  better  the  ne.xt  day.  The  second  day  after  operation,  he  complained  of 
slight,  ptu'sistent  pain  in  the  back  of  the  head,  which  continued  until  the  20th,  when  a small  fungus  growth  made  its  appearance 
in  the  wound.  Suppur.ation,  which  had  previously  been  profuse  and  healthy,  was  much  diminished,  and  the  pain  increased. 
The  fungus  was  readily  detached  with  the  handle  of  the  scalpel,  and  its  removal  gave  exit  to  an  ounce  of  pus,  which  somewhat 
relieved  the  pain.  Hernia  cerebri  again  appeared  on  the  27th,  and  death  took  place  on  the  evening  of  the  28th.  The 
patient  W'as  never  delirious,  and  could  answer  questions  correctly  up  to  an  hour  before  his  death.  The  autopsy  revealed  the  ball, 
much  fissured  and  twisted  upon  itself,  lying  in  a sac  of  false  membrane,  about  one  inch  beneath  the  dura  mater.  The  whole 
anterior  lobe  was  broken  down,  and  of  a pultaceous  consistence,  dark  sanious  pus  filling  the  ventricular  cavity.  The 
adventitious  tissue,  which  formed  the  bulk  of  the  hernia  and  the  cyst  containing  the  ball,  was  soft,  and  under  the  microscope 
was  seen  to  be  composed  of  interlacing  fibres,  containing  large  cells  in  its  meshes.  The  history  of  the  case  was  contributed  by 
Assistant  Surgeon  John  S.  Billings,  U.  S.  A. 

C.\SE. — Private  James  Seely,  Co.  D,  55th  Ohio  Volunteers,  aged  21  years,  was  wounded  near  Atlanta,  Georgia,  July  20th, 
1864,  by  a conoidal  ball,  which  struck  the  right  side  of  the  frontal  bone,  one  inch  above  the  supra-orbital  ridge,  fracturing  both 
tables.  He  was  admitted  into  the  field  hospital  at  Chattanooga,  Tennessee,  on  the  20th,  and,  on  August  10th,  transferred  to 
Nashville,  entering  Hospital  No.  1 the  following  day.  A hernia  cerebri  protruded  through  the  fracture.  There  was  a slight 
discharge  of  pus  from  the  \vound.  Patient  suffered  from  pain  in  the  head,  irritability  of  stomach,  and  constipation  of  the 
bowels.  His  tongue  was  coated,  pulse  intermittent  and  pupils  slightly  dilated.  On  the  24th,  he  was  placed  under  the  inttuence 
of  chloroform,  and  Acting  Assistant  Surgeon  M.  L.  Herr  removed  several  spiculae  of  bone  and  excised  the  sharp  edges,  wliich 
were  encroaching  upon  the  brain,  through  a crucial  incision  two  inches  in  extent.  Spicute  of  bone  were  found  forcibly  driven 
between  the  inner  table  of  the  skull  and  the  dura  mater.  Cold  water  dressings  were  applied  to  the  wound,  a compress  jdaced 
over  the  hernia,  and  low  diet  prescribed.  Death  supervened  on  September  7th,  1864.  At  the  po£t-7j:o?'teJi  examination  a hwge 
abscess  in  the  br.ain  was  found,  extending  into  the  lateral  ventricle,  containing  about  five  ounces  of  pus.  The  case  is  reported 
by  Surgeon  B.  B.  Breed,  U.  S.  V. 

Case. — Private  George  Taylor,  Co.  B,  157th  Pennsylvania  Vohmteers,  aged  18  years,  was  wounded  at  the  battle  of  the 
Weldon  Railroad,  Virginia,  August  20th,  1864,  by  a round  musket  ball,  which  entered  the  cranial  cavity  through  the  right 
lambdoid  suture  at  a point  about  two  inches  from  the  median  line.  He  was  admitted  to  the  hospital  of  the  4th  division.  Fifth 
Corps;  thence,  was  sent  to  City  Point,  and,  on  August  28th,  was  admitted  to  the  3d  division  hospital  at  Alexandria,  Virginia. 
Hernia  cerebri  protruded  through  the  opening.  The  treatment  consisted  in  the  use  of  colff  water  applications  to  the  head  and 
counter  irritation  to  the  feet.  The  patient  died,  however,  on  August  29th,  1864.  At  ihe  autopsy,  seventeen  hours  after  death, 
the  j)erforation  of  the  skull  was  found  to  be  circidar  and  larger  at  the  inner  than  at  the  outer  table;  the  dura  mater  was  firmly 
adherent  along  the  longitudinal  fissure,  especially  on  the  right  side;  the  arachnoid  of  the  same  side  was  thickened  by  numerous 
tufts  of  lymph,  with  but  little  effusion  beneath  it.  The  meninges  at  the  base  of  the  brain  around  the  pons  Varolii,  over  the 
fourth  ventricle  and  about  the  crura  cerebelli  were,  likewise,  thickened  and  adherent  to  the  brain.  The  brain  itself  was  hardened 
and  pale,  except  in  the  vicinity  of  the  wound,  where  it  was  of  a rich  cream  color  and  evidently  degenerating  into  pus.  On 
section  the  lateral  ventricles  were  found  filled  with  a fluid,  containing  floating  tufts  of  lymjih,  a thick  deposit  of  which  laid  upon 
the  choroid  plexuses  and  walls  of  the  ventricle.  A round  ball,  half  sliced  open,,  and  a disk  of  bone  had  lodged  at  a depth  of 
one  and  a half  inches  in  the  right  posterior  occipital  lobe,  a little  below  the  digital  cavity,  which  had  been  involved  in  the 
inflammation.  The  case  is  reported  by  Surgeon  E.  Bentley,  U.  S.  V. 

Case.— Charles  T , Co.  H,  63d  New  York  Volunteers,  aged  17  years,  was  admitted  to  Hospital  No.  1,  Frederick, 

Maryland,  on  September  28th,  1832,  with  a fracture  of  the  skull.  He  was  wounded  at  Antietam,  September  17th,  1862,  by  a 
conoidal  musket  ball,  which  struck  at  the  lower  anterior  angle  of  the  right  ])aiielal,  fractured  both  tables  of  the  cranium,  and 


HEENIA  CEEEBKI  AFTER  GUNSHOT  FRACTURES  OF  THE  SKULL. 


303 


lodged  ui)dcr  the  scalp  in  tlie  occipital  region.  The  scalp  was  lacerated,  and  a dark  pulsating  mass  protruded  in  the  wound. 
The  left  side  of  the  body  was  paralyzed.  The  patient’s  mental  faculties  were  unimpaired.  On  September  29th,  flaps  of 
integument  were  reflected  by  a T -shaped  incision.  The  ball  and  a" number  of  fragments  of  bone  were  removed,  some  of  the 

latter  being  embedded  in  the  brain  substance. 

The  inner  table  was  found  badly  splintered, 
but  the  fracture  of  the  external  table  was 
still  more  extensive.  The  protruding  cere- 
bral mass  was  shaved  otf.  The  rough  edges 
of  the  fractured  bone  were  smoothed  by  cut- 
ting forceps.  The  following  day  the  paralysis 
■was  more  complete  than  before  the  operation. 

There  was  severe  headache.  The  pulse  was 
slow  and  weak.  On  October  3d,  the  fungus 
W’as  sprouting  and  sloughing.  The  left  arm 
was  powerless ; the  paralysis  of  the  left  leg  was 
less  complete.  On  October  4th,  the  hei'nia  was 

Fro.  1.53.— Gunshot  fracture  of  the  right  again  sliced  off  and  gentle  compression  was 
r.arict.nl,  follovcd  bj- necrosis.  Interior  view.  , .r-i  • • i ...  i 

.SiJcc.  3859,  Sect.  I,  A.  M.  M.  applied.  There  was  great  irritability  and 

restlessness.  On  October  21st,  the  patient 
had  improved.  His  appetite  was  voracious.  He  was  less  irritable  and  the  hemiplegia  was  much  less  complete.  He  was  very 
sensitive  to  cold.  ife  temperature  of  the  left  side  was  lower  than  that  of  the  right.  The  fungus  was  of  the  size  of  a pigeon’s 
egg.  On  November  17th,  a dilatation  of  the  left  pupil  was  first  noticed.  Sensation  in  the  left  leg  and  partial  control  of  the 
muscles  had  returned.  Since  the  last  report  the  tumor  of  the  brain  had  continued  to  grow  and  slough  away,  so  that  it  remained 
about  the  same  size.  On  December  7th,  the  report  states  that  little  change  had  taken  place,  except  a gradual  amelioration  of  the 
hemiplegia,  and  improvement  in  regard  to  the  fretfulness  and  iiritability.  On  this  day  there  was  a severe  chill.  After  this  the 
patient  never  regained  his  accustomed  readiness  and  clearness  of  mind.  The  discharge  from  the  wound  became  watery, 
unhealthy,  and  more  copious.  There  was  an  exacerbation  of  fever  every  afternoon.  On  December  17th,  there  was  a severe 
convulsion  which  lasted  half  an  hour,  and  was  terminated  by  death.  At  the  autopsy,  an  irregular  portion  of  the  right  parietal, 
four  inches  in  diameter,  was  found  to  be  necrosed  and  detached.  The  dura  mater  was  much  thickened  in  the  vicinity  of  the 
fracture,  and  was  adherent  to  the  margins  of  the  healthy  bone.  Except  in  the  immediate  vicinity  of  the  hernia,  the  brain  matter 
appeared  to  be  in  a healthy  state.  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  reported  the  case. 

Case. — An  unknown  soldier,  belonging  to  the  125th  Ohio  Volunteers, 'was  brought  to  the  field  hospital  at  Chattanooga, 
Tennessee,  on  June  25th,  1864,  with  a gunshot  fracture  of  the  cranium,  allowing  a fungous  mass  of  the  brain  substance  to 
protrude.  He  was  unconscious  until  the  time  of  his  death,  which  occurred  on  June  30th,  1864. 

Case. — An  unknown  Confederate  soldier,  belonging  to  the  Cist  North  Carolina  Regiment,  was  brought  into  the  hospital  at 
Fort  ISIonroe,  Virginia,  October  4th,  1864,  with  a gunshot  fracture  of  the  cranium,  received  on  September  29th,  1864.  He  was 
insensible,  and  brain  substance  protruded  from  the  wound.  Simple  dressings  were  applied,  but  death  resulted  on  October  5th,  1864. 

Case. — Private  Edward  V , Co.  D,  55th  Ohio  Volunteers,  was  wounded  at  the  battle  of  Bull  Run,  Virginia,  August 

29tli,  1862,  by  a conoidal  ball,  which  struck  half  an  inch  above  the  right  eyebrow,  and  the  same  distance  from  the  median  line 
of  the  os  frontis,  comminuting  and  carrying  away  both  tables  to  the  extent  of  one  and  one-fourth  to  two  and  one-fourth  inches. 
He  was  wounded  while  in  the  act  of  discharging  his  gnn,  staggered  considerably  under  the  shock,  but  recovered  immediately, 
so  that  he  fired,  loaded,  and  fired  a second  time  before  he  fell.  He  lay  on  the  field  for  six  days,  during  which  time  a considerable 
amount  of  brain  matter  oozed  from  the  wound.  He  was  afterward  conveyed  to  Washington,  and  admitted,  on  the  7th  of 
September,  into  the  Emory  Flospital,  where  the  wound  was  dressed  for  the  first  time.  Half  of  the  plates  composing  the  frontal 
sinus  were  found  turned  in  upon  the  brain,  and  about  one-third  of  the  ball  was  battered  up  against  the  fractured  edge  of  the 
bone.  When  the  missile  and  fragments  of  bone  were  removed  a large  quantity  of  foetid  pus  and  a teaspoonful  of  cerebral  matter 
exuded.  The  most  remarkable  feature  of  the  case  was  that  there  were  no  symptoms  of  injury  to  the  brain,  either  in  articulation, 
memory,  sight,  or  animation.  The  wound  was  dressed  with  adhesive  strips  to  keep  the  eyebrow  from  falling  on  the  cheek.  On 
the.  morning  of  the  8th,  a hernia  cerebri,  an  inch  in  diameter,  made  its  appearance,  pulsating  with  the  heart’s  action.  The 
depressed  walls  of  the  frontal  sinus  were  now  removed  by  Assistant  Surgeon  J.  D.  Hall,  24th  New  York  Volunteers,  the  operation 
being  attended  with  slight  haemorrhage,  a plentiful  discharge  of  pus,  and  the  escape  of  a teacupful  of  softened  brain  matter. 
On  the  9th,  the  tongue  was  covered  with  a thick  white  fur;  lips  red,  pulse  nearly  normal.  No  change  occurred  until  the  19th, 
except  that  the  wound  became  more  painful,  though  it  continued  perfectly  healthy.  The  hernia  had  gradually  receded  when,  on 
the  20th,  a colliquative  diarrhoea  set  in,  ■which,  though  arrested  by  astringents  and  opiates,  greatly  reduced  his  strength ; his 
mind,  however,  continued  perfectly  clear.  Tonics,  with  nourishing  diet,  were  administered,  but  he  failed  to  rally,  and  died  on  the 
morning  of  the  25th.  At  the  autopsy  a large  clot  was  found  between  the  dura  mater  and  the  skull,  at  the  coronal  suture;  and 
the  meninges  and  brain  exhibited  a much  greater  degree  of  congestion  and  inflammation  than  any  recent  symptoms  had  indicated. 
The  ventricles,  on  section,  were  found  filled  with  serum  and  pus.  The  pathological  specimen  is  No.  276,  Sect.  I,  A.  M.  M. 
The  cranium  shows  an  extensive  fracture  of  the  right  supra-orbital  arch ; a small  fragment  of  the  bone  is  attached.  The  entire 
arch  is  removed,  leaving  an  opening  into  the  cranium,  two  and  one-half  inches  long  and  one  and  one-fourth  wide,  extending  from 
the  inner  angle  of  the  orbit  to  the  anterior  inferior  angle  of  the  right  parietal.  The  orbital  plate  of  th(!  right  superior  maxilla  is 
fractured  and  depressed  and  a fissure  an  inch  long  extends  down  the  body  of  the  bone.  The  specimen  and  history  were 
contributed  by  Surgeon  William  Clendenin,  U.  S.  V. 


Fig.  154. — External  vieiv  of  gunshot  frac- 
ture of  right  parietal,  followed  by  necrosis. 


304 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


Case. — First  Lieutenant  Nicliolas  Woolmar,  Co.  C,  26tli  Wisconsin  Volunteers,  .aged  28  years,  wa.s  wounded  in  an 
engagement  at  Atlanta,  Gcorgi.a,  July  20tli,  1864,  hy  a conoidal  musket  ball,  which  fractured  the  right  parietal  bone.  He  was 
admitted  to  the  hospital  of  the  3d  division.  Twentieth  Corps;  on  the  28th  of  the  month,  was  tr.ansferrcd  to  the  general  hospital 
at  Chattanooga,  and  three  days  later,  was  sent  to  the  Officers’  Hospital  at  Nashville.  Paralysis  supervened,  and  death  resulted 
on  August  21st,  1864.  At  the  autopsy,  a hernia  cerebri  was  discovered  protruding  through  the  dura  mater.  Surgeon  J.  E. 
Ilerhst  reported  the  case. 

Of  the  fifty-one  preceding  cases  reported  as  examples  of  hernia  cerebri,  forty-four 
had  a fatal  result.  Of  the  seven  survivors,  whose  histories  are  first  recorded,  four 
recovered  with  the  full  integrity  of  their  intellectual  faculties,  while  three  suffered  so  much 
from  vertigo  and  headache  as  to  be  incapable  of  much  mental  ei^rtion.  Of  the  forty-four 
fatal  cases,  eight  would  appear  to  have  been  simply  examples  of  primary  protrusion  of  brain 
substance  from  extensive  gunshot  fractures,  and  thirty-six  legitimate  illustrations  of  -the 
condition  described  by  surgeons  as  fungus  or  hernia  of  the  cerebrum.  Four  of  the  fifty- 
one  patients  were  trephined,  and  in  twenty-five  cases  fragments  of  bone  were  removed,  the 
projectile  also  being  extracted  in  four  instances.  The  details  of  treatment  will  be  discussed 
hereafter.  • 

CoNTRE-Coup. — I have  admitted,  on  page  214,  that  the  fissures  of  the  sphenoid  and 
frontal  orbital  plate  of  specimen  1318,  figured  by  wood-cut  110,  must  be  regarded  as 
examples  of  fracture  by  contre-coup,  unless  they  were  accidentally  produced  after  death.  1 
regard  the  latter  hypothesis  as  much  the  most  probable.  The  case  of  Private  L.  B.  Pollard, 
Co.  G,  12th  Maine,  of  which  an  abstract  is  given  on  page  178,  is  regarded  by  the  pension 
examiner  as  an  instance  of  fracture  by  contre-coup  after  gunshot  injury  of  the  skull.  As 
the  pensioner  still  survives,  this  diagnosis,  has,  of  course,  not  been  verified.  I am  indebted 
to  the  examiner  for  the  following  letter,  stating  the  grounds  of  his  diagnosis  : 

Augusta,  Maine,  November  23cZ,  1870. 

Sir  : Perh.aps  this  case,  by  a strict  rendeiing,  would  not  be  classed  as  contrc-coup,  yet  it  was  one  where  much  of  the 
damage  was  done  by  transmitted  force,  and,  therefore,  in  a gener.al  way,  coming  under  that  head.  My  record  states  the  following; 
A ball  nearly  spent,  as  we  may  suppose,  penetrated  the  skull  in  the  middle  of  the  forehead,  just  at  the  edge  of  the  hair,  and  there 
lodged  without  entering  any  farther.  In  addition  to  the  local  injury  thus  accomplished  there  was  an  extensive  fracture  of  the 
right  parietal  bone.  Although  not  directly  opposite  to  the  point  where  the  fo)’ce  was  applied,  I believed  it  to  have  occurred  under 
similar  mechanical  conditions,  and  thus  classified  it  as  I did.  My  record  is  not  as  full  concerning  details  as  would  be  the  case  in 
records  of  [compound?]  fracture. 

Very  respectfully,  • 

(Signed)  JAMES  B.  BELL. 

Dr.  George  A.  Otis,  etc.,  etc. 

All  of  the  cases  of  alleged  fracture  by  contre-coup  after  gunshot  injury  of  the  skull, 
in  which  I have  been  able  to  examine  the  evidence,  are  as  unsatisfactory  as  those  already 
referred  to.  Assistant  Surgeon  Woodhull,  U.  S.  A.,  regards^  the  case  recorded  on  page 
213  (Fig.  109)  as  probably  an  instance  of  fracture  by  contre-coup  ; but  I cannot  share  his 
opinion.  The  preparation  (No.  2871)  plainly  presents,  I think,  direct  fractures  only. 
There  are  three  other  specimens  in  the  Army  Medical  Museum,  which  have  been  regarded 
as  examples  of  fracture  by  contre-coup,  from  the  impact  of  gunshot  projectiles.  These 
specimens  are  represented  in  Photographs  214,  215,  and  216  of  the  Surgical  Series,^  and 
their  imperfect  histories  are  as  follows  : 

“Photograph  No.  214.  Cranium  Perforated  hy  a Mushet  BalL — This  cranium  was  presented  to  the  Army  Medical 
Museum  by  Surgeon  Jerome  B.  Green,  U.  S.  V.,  and  is  numbered  830  of  the  Surgical  Section.  A musket  ball  entered  at  tlie 
centre  of  the  left  branch  of  the  coronal  suture,  and  passed  out  at  the  posterior  inferior  angle  of  the  right  parietal  bone,  the 

^Catalogue  of  the  Surgical  Section  of  the  Army  Medical  Museum,  Washington,  1866,  page  12. 

^Photographs  of  Surgical  Cases  and  Specimens.  Proparcd  by  order  of  the  Surgeon  (Icneral  by  Brevet  Bicutenaut  (lolouel  GkoUGE  A.  OTIS,  U.  S.  A., 
Curator  of  the  Anny  Medical  JMuseuin,  Wasliiugton,  1869.  Vol.  V.  I’uge  14. 


GUNSHOT  FRACTURES  OF  TTI]';  SKULL  ]!Y  CONTRK-COUP. 


305 


opening  of  eiitr, '11100  being  tlirop-tbiirtlis  of  an  inch,  iiiul  that  of  exit  one  and  one-fourtli  inches  in  diameter.  There  is  a fractnre 
of  the  right  orbital  plate  of  the  frontal,  of  the  squamous  portion  of  the  right  temporal,  and  of  the  body  of  the  riglit  siqicrior 
maxilla,  ascribed  to  the  effect.s  of  contrc-coup.  A fracture  of  the  occipital  bone  extends  from  the  opening  of  exit  to  the  right 
jugular  foramen.  The  frontal  suture  remains  distinct,  though  the  skull  is  that  of  a middle-aged  man.  The  specimen  is  helieved 
to  have  come  from  the  Twelfth  Army  Corps  hospital  after  the  second  battle  of  Bull  Run."  “ PllOTOGltAfll  No.  Sl.^.  Perfora- 
tion of  the  Cranium  by  a Aluslct  Ball. — This  cranium  was  picked  up  on  the  first  Bull  Run  battle-field  by  Dr.  F.  Schafhirt, 
and  presented  to  the  Army  Medical  Sluseum.  It  is  No.  3251  of  the  Surgical  Section.  It  displaj-s  a fracture  caused  by  a 
musket  ball,  which,  entering  at  the  right  fronto-parietal  suture  and  temporal  ridge,  and  fractured  the  frontal  bone  in  a long 
fissure,  which  runs  in  front  one  inch  above  the  orbits,  and  downward  through  the  greater  wing  of ’sphenoid  and  squamous 
portion  of  the  left  temporal  into  the  mastoid  process.  One  fissure  branches  off  above  the  left  orbit  and  downward  through  the 
maxillary  sinus.  Another  fissure  passes  posteriorly  from  the  wound  of  entrance  and  iqtward  through  the  right  to  the  left  pariet.al 
protuberance.  Another  fissure  down#ard  through  the  right  auditory  meatus  has  divided  the  petrous  hone.  Yet  another  fissure 
passes  backward  through  the  upper  portion  of  right  temporal  into  the  occiput.  The  ball  passed  out  at  the  upper  part  of  occipital 
near  the  inter-parietal  suture.”  “JPnOTOGltAPll  No.  210.  Gunshot  Fracture  of  Skull.— a piost-mortcm  examination  of  the 
body  of  an  unknown  soldier,  at  Lincoln  Hospital,  September  22d,  1854,  it  was  ascertained  that  a conoidal  mu.sket  ball  had 
entered  about  one  and  one-half  inches  above  the  left  ear,  causing  a compound  comminuted  fr.acture  of  the  squamous  jiortion  of 
the  temporal  bone.  The  ball  was  found  imbedded  in  the  lower  portion  of  the  parotid  gland.  The  vessels  of  the  meninges  of 
the  bi'ain  were  very  much  injected.  The  middle  lobe  of  the  left  hemisphere  was  softened  to  the  middle  corner  of  the  lateral 
ventricle,  which  contained  a small  quantity  of  fluid  I’esembling  blood.  The  specimen  was  contributed  to  the  Army  Medical 
Museum  by  Acting  Assistant  Surgeon  H.  M.  Dean,  and  is  No.  3254  of  the  Surgical  Section.  It  is  a section  of  the  cranium, 
shdwing  penetration  and  fr.acture  of  the  left  temporal  bone  just  above  the  meatus  auditorius  externus,  which  is  entered  by  the 
fissure,  together  with  a connected  fracture  of  the  occipital,  which  has  been  regarded  as  an  indirect  fracture  by  contrc-covp,  caused 
by  a conoidal  ball,  which  is  attacheil  to  the  aperture  of  entrance.  The  opening  is  just  above  the  root  of  the  zygoma  :ind  is 
three-fourths  of  an  inch  in  diameter.  The  condyle  of  the  lower  jaw  and  the  posterior  half  of  the  glenoid  fossa  are  carried  aw.ay, 
together  with  the  e.xtremity  of  the  petrous  portion  of  the  temporal  bone,  the  line  of  fracture  passing  through  the  internal  meatus 
auditorius.  From  the  left  jugular  foramen  two  lines  of  fracture  pass  to  the  foramen  magnum,  one  in  front  of  and  the  other 
behind  the  condyle.  The  occipital  is  traversed  by  a fracture  which  runs  from  the  foramen  magnum  to  the  angle  of  the  right  parietal.” 

Another  case  of  alleged  fracture  by  contre-coup  of  both  orbital  plates  of  the  frontal 
by  the  transmitted  shock  from  the  perforation  of  the  occipital  by  a pistol  ball,  has  been 
much  commented  on  : 

Case. — A.  L , aged  55  years,  was  shot  in  the  head,  at  Washington,  on  the  evening  of  April  14th,  1865,  by  a largo 

round  ball,  from  a Derringer  pistol,  in  the  hands  of  an  assassin.  Dr.  Charles  A.  Leale  being  close  at  hand,  went  instantly  to 
the  wounded  man,  whom  he  found  “ in  a profoundly  comatose  condition,”  * * the  breathing  “ exceedingly  stertorous.” 

(These  and  other  (piotations  in  the  first  part  of  this  abstract,  are  taken  from  a rejiort  comjiiled  by  Dr.  Leale,  from  lujtes  made  at 
the  time.)  No  pulsation  was  perceptible  at  the  right  wrist.  When  the  head  was  examined,  “I  passed  my  lingers  over  a large 
firm  clot  of  blood,  situated  about  one  inch  below  the  superior  curved  line  of  the  occij)ital  bone  and  an  inch  and  a half  to  the  left 
of  the  median  line  of  the  same  hone.  The  coagulum,  I easily  removed,  and  passed  the  little  finger  of  my  left  hand  through  the 
])erfectly  smooth  J)pening  made  by  the  ball,  and  found  that  it  had  entered  the  encejdialon.  As  soon  as  I removed  my  finger,  a 
.slight  oozing  of  blood  followed,  and  his  breathing  became  more  regular  and  less  stertorous.”  After  the  administration  of  a 
small  quantity  of  brandy  and  water,  of  which  a mouthful  appeared  to  have  pa.ssed  into  the  stomach,  the  ](atient  was  removed  to 
a neighboring  house,  with  the  assistance  of  Acting  Assistant  Surgeons  C.  S.  Taft  and  A.  F.  A.  King,  and  others.  His  clothing 
was  removed,  and  he  was  placed  in  bed.  His  extremities  were  cold.  H(‘  was  covered  with  warmed  blankets,  and  bottles  of  bot 
water  were  applied  to  the  lower  extremities.  It  was  now  about  eleven  o’clock  at  nigbt,  tbe  wound  baving  been  inflicted  about 
half  pa.st  ten.  His  family  physician.  Dr.  Robert  K.  Stone,  and  Surgeon  General  Barne.s,  and  Assi.stant  Surgeon  General  Crane, 
arrived  presently,  and  assuming  charge  of  the  case,  proceeded  to  examine  the  i)atient  and  the  wound.  The  ]mlse  was  very 
feeble  and  vaccillating,  from  40  to  48  ; the  respiration  was  oppre.ssed  and  labored  ; the  surface  was  cold.  Ovci-  the  left  eyelid 
there  was  slight  ecchymosis.  ‘’The  jmpil  of  that  eye  was  slightly  dilated,  the  rlrjht*  |)upil  was  contracted;”  both  were  irrespon- 
sive to  light.  Sinapisms  were  applied  to  the  surface.  A few  drops  of  brandy  and  water  j)laced  into  the  fauces  was  not  swallowed, 
and  the  attempt  to  administer  internal  stimulants  was  not  insisted  on.  It  was  observed  that  when  blood  and  cerebral  matter 
oozed  unimpededly  from  tbe  wound  the  condition  of  the  pulse  and  respiration  improved.  The  Surgeon  General  accordingly  keirt. 
the  external  wound  open  by  means  of  a silver  j)robe,  until,  a Ndlaton’s  probe  being  brought,  he  made  an  exploration  of  the 
course  of  the  ball.  A splinter  obstructed  the  track  at  the  depth  of  about  two  and  a half  inches.  An  inch  and  a half  further  on 
the  bulb  came  in  contact  with  a foreign  body,  which  proved  to  be  the  disk  from  the  occii»ital  forced  out  by  the  ball ; passing 
beyond  this  the  ball  was  detected,  at  a distance  of  over  six  inches  from  the  entrance  wound.  Drs.  Stone  and  Crane  having  also 
distinctly  felt  the  hall  at  this  depth  in  contact  with  the  bulb  of  tbe  probe,  it  was  decided  that  no  attempt  should  lx?  made  to 
remove  it  or  tbe  foreign  bodies,  furtber  than  “ to  keep  the  opening  free  from  coagula,  which,  when  allowed  to  form  and  remain 
for  a veiy  short  time,  would  produce  signs  of  increased  comj)ression,  the  breathing  becoming  profoundly  stertorous  and  inter- 
mittent, and  the  pulse  more  feeble  and  irregular.”  Notwithstanding  the  free  oozing  from  the  external  orifice,  there  was  evidently 
much  internal  bleeding  going  on.  as  was  indicated  by  the  excessive  extravasation  into  the  orbits,  accompanied  by  great  ecchy- 
mosis of  the  eyelids.  The  protracted  death-struggle  ceased  at  twenty  minutes  past  seven  o’clock  on  the  morning  of  A))ril  15th, 
18)’;.  At  noon,  an  au*opsy  was  made  in  the  pre.sence  of  tin;  .Surgeon  General  and  others,  by  Assistant  Surgeon  .1.  J.  Woodward, 
U.  S.  A.,  aided  by  Assistant  Surgeon  Edward  Curtis,  U.  S.  A.  The  following  is  an  extract  from  tiie  oflicial  report  to  the 

* Dr.  J.  Asiiiiurst,  JI!.,  (Am.  Jour.  .Med.  Sci.  187;i,  Vol.  LXVI,  p.  I;j8.)  in  a most  interesting  analysis  of  the  mceliaiiism  i f the  injiin,' in  tins 
■jase.  points  oat  the  misprint  tlmt  oeenireil,  at  tliis  p .int.  in  tlie  first  issue  of  tliis  work. 

.’ill 


WOUNDS  AND  INJURIES  OF  THE  HEAD, 


8on 

Surgeon  General  by  Dr.  Woodward,  compiled  the  same  day  from  notes  taken  at  the  time  of  the  post-mortem  examination  : “ The 
eyelids  and  surrounding  parts  of  the  face  were  greatly  ecchymosed  and  the  eyes  somewhat  protuberant  from  efi'usion  of  blood 
into  the  orbits.  There  was  a gunshot  wound  of  the  head,  around  which  the  scalp  was  greatly  thickened  by  haemorrhage  into 
its  tissues.  Tlie  ball  cntei'ed  through  the  occipital  bone  about  an  inch  to  the  left  of  the  median  line  and  just  above  the  left 
lateral  sinus,  which  it  opened.  It  then  penetrated  the  dura  mater,  passed  through  the  left  posterior  lobe  of  the  cerebrum,  entered 
the  left  lateral  ventricle,  and  lodged  in  tlie  white  matter  of  the  cerebrum  just  above  the  anterior  portion  of  the  left  corpus 
striatum,  where  it  was  found.  The  wound  in  the  occipital  bone  was  quite  smooth,  circular  in  shape,  with  beveled  edges,  the 
opening  through  the  internal  table  being  larger  than  that  through  the  external  table.  The  track  of  the  ball  was  full  of  clotted 
blood  and  contained  several  little  fragments  of  bone,  with  a small  piece  of  the  ball  near  its  external  orifice.  The  brain  around 
the  track  was  pultaceous  and  livid  from  capillary  hscinorrhage  into  its  substance.  The  ventricles  of  the  brain  were  full  of 
clotted  blood.  A thick  clot  beneath  the  dura  mater  coated  the  right  cerebral  lobe.  Ther^was  a smaller  clot  under  the  dura 
mater  of  the  left  side.  But  little  blood  was  found  at  the.  base  of  the  brain.  Both  the  orbital  plates  of  the  frontal  bone  were 
fractured,  and  the  fragments  pushed  up  toward  the  brain.  The  dura  mater  over  these  fractures  was  uninjured.  The  orbits 
gorged  with  blood.”  * * * Basing  his  remarks  on  an. account  of  this  case  and  of  the  post-mortem  examination  published  by 

Acting  Assistant  Surgeon  C.  S.  Taft,*  Pi'ofcssor  T.  Longmore,  of  Notley,  observes  : The  autopsy  showed  that  the  jirojectile  had 
penetrated  the  occipital  bone  one  inch  to  the  left  of  the  longitudinal  sinus  ; had  driven  before  it,  for  about  three  inches,  the  piece 
of  bone  which  it  had  punched  out,  as  it  were;  and  that,  leaving  this  fragment  behind,  it  had  itself  then  passed  on  obliquely 
across,  from  loft  to  light,  through  the  brain  substance  to  the  anterior  lobe  of  the  right  hemisphere,  in  wdiich  it  lodged,  immediately 
over  the  right  orbit.  The  ball  did  not  strike  the  anterior  part  of  the  cranium,  its  force  having  been  expended  before  reaching  so 
far;  yet,  at  the  autopsy,  according  to  the  report  of  the  post-mortem  appearances  furnished  by  Acting  Assistant  Surgeon  C.  S. 
Taft,  Xo  the  Philadelphia  Medical  peporter,  “ the  orbitar  plates  of  loth  orbits  wore  found  to  be  the  seats  of  comminuted  frac- 
ture, the  fragments  being  forced  inward,  and  the  dura-mater  covering  them  remaining  uninjured.  This  double  fracture  was 
decided  to  have  been  caused  by  contre-coup.  If  the  term  ‘contro-coup’  be  limited  to  its  precise  signification  of  'counter-stroke’ — 
i.  e.,  the  impression  made  by  the  stroke  on  the  part  of  the  cranium  opposite  to  that  directly  struck  by  the  ball — will  the  force  of 
contre-coup  explain  the  fractures  in  this  instance'?  It  seems  very  difficult  to  conceive  that  the  orbitar  plates  could  be  fractured 
by  such  a counter-stroke,  while  the  portion  of  the  cranial  arch  opposite  to  that  which  received  the  primary  blow,  including  the 
expanse  of  the  frontal  bone  and  the  several  processes  within  which  the  orbitar  plates  are  held,  and  by  which  they  are  so  strongly 
protected  in  all  directions  laterally  I’emained  entire  and  unchanged.  I am  inclined  rather  to  attribute  the  lesions  mentioned  to  a 
transmitted  undulatory  stroke  or  sudden  impulse  of  the  brain-substance  itself,  against  the  thin  bony  layers  constituting  the  orbitar 
plates.  I am  in  possession  of  the  notes  of  a case  in  which  a similar  fracture  took  place  in  one  orbitar  jdate,  from  a ball  passing 
along,  only  grooving,  the  upper  surface  of  the  hemisidiere  lying  over  the  plate  hroken.  In  this  instance  there  was  no  reason  to 
doubt  that  the  impulse  communicated  to  the  brain  substance  by  the  passage  of  the  projectile  had  been  continued  on  with  sufficient 
force  to  the  orbitar  plate  to  effect  its  fracture.”! 

The  explanation  offered  by  Dr.  Longmore  of  the  cause  of  fracture  of  the  orbital 
plates,  in  this  remarkable  case  is,  in  the  writer’s  opinion,  more  satisfactory  than  the 
hypothesis  that  the  fractures  were  produced  by  contre-coup.  The  unusually  thin  orbital 
plates  on  either  side  were  exposed  to  the  impulse  of  the  cerebral  pulp.  Even  if  they  were 
not  fully  protected  from  the  vibrations  in  the  vault  of  the  cranium,  by  the  dense  supra- 
orbital ridges,  it  might  be  inferred  that  the  force  would  be  transmittedpnainly  to  the  right 
orbital  region,  or  that  opposite  the  entrance  perforation.  Whereas  both  orbital  plates  were 
fractured.  That  the  fragments  inclined  upward  toward  the  brain  rather  than  downward 
and  forward,  was  probably  due  to  the  pressure  of  the  blood  extravasated  within  the  orbits. 
It  may  be  safely  asserted  that,  abstracting  the  fractures  of  the  inner  without  injury 
to  the  outer  table,  no  incontestable  instance  has  been  produced  of  counter-stroke  fracture 
of  the  skull  from  gunshot,  a negative  result  which  the  laws  governing  the  transmission  of 
forces  would  lead  us  to  anticipate. 

Summary. — Excluding  those  immediately  fatal  on  the  field,  the  cases  of  gunshot 
injuries  of  the  cranium  which  were  reported  during  the  War,  numbered  forty-three  hundred 
and  fifty.  The  results  are  set  forth  in  the  table  to  be  found  on  the  next  page  (Table  VI], 
which  is  a statistical  statement  of  the  different  divisions  of  gunshot  injuries,  treated  of 
from  page  95  to  this  point. 

* The  Medical  and  Surgical  Reporter,  Philadelphia,  Vol.  XII,  p.  453.  Among  many  other  inaccuracies,  the  reporter  describes  the  ball  as  passing 
into  the  right  hemisphere.  Put  this  error  does  not  affect  the  argument  of  Professor  Longmore. — COMPILER. 

t The  Lancet,  London,  180.5,  Vol.  1,  p.  049.  Professor  Longmore  adds  a report  of  a most  interesting  autopsy  made  by  Deputy  Inspector-General 
11.  Lawson,  in  an  analogous  case,  in  which  the  left  orbital  plate  was  fractured  after  a fracture  of  the  left  parietal  by  a musket-shot.  This  is  the  only  other 
instance  I know  of  in  which  the  occurrence  of  this  rare  injury  is  referred  to  by  writers  on  gunshot  injuries  of  the  head,  and  is  well  worth  the  reader’s 
attention. — COMPILER. 


GUNSHOT  INJURIES  OF  THE  CRANIUM. 


307 


Table  VI. 


PlCSuUs  of  Four  Thousand  Three  Hundred  and  Fifty  Gunshot  Injuries  of  the  Cranium 

reported  during  the  War  of  the  Rehellion. 


INJURIES. 

Cases. 

/ 

Recovered. 

Died. 

0 

C 

u 

OJ 

% 

5 

C 

a ^ 

c -3 

.2  42 

rt 

P? 

REMARKS. 

d 

C3 

pH 

» 

328 

273 

55 

16.8 

260  Union,  68  Confederate 

95 

138 

128* 

10 

8.7 

Ill  Union,  27  Confederate 

128 

20 

1 

19 

95. 

141 

19 

12 

7 

36.8 

4 examples  given 

159 

Fracture  of  both  tables  without  known  depression. 

2,911 

1,  001 

1,826 

84 

64.6 

40  liistories  selected 

161 

3G4 

231 

129 

4 

35.8 

164  liistories  selected 

167 

486 

68 

402 

16 

85.5 

Abstracts  of  93  given 

190 

Perforating  fractures 

73 

14 

56 

3 

80. 

Abstracts  of  26  given 

206 

9 

9 

100. 

Abstracts  of  all  given ; 6 U.,  3 C. 

212 

Coiitre-coup  (?) 

0 

1 

1 

• 

50. 

1 Union,  1 Confederate 

304 

Aggregates 

4, 350 

1,729 

2,  514 

107 

*Two  of  these  died  from  inter- 
current diseases. 

The  results  of  contusions  have  been  fully  considered  on  page  126,  fractures  of  the 
outer  table  on  page  140,  of  the  inner  table  on  page  150. 

The  large  ratio  of  mortality  of  the  'fractures  of  both  tables  without  hnow7i  depression,” 
in  comparison  with  the  fatality  of  the  cases,  in  which  depressed  fracture  was  unquestioned, 
must  attract  attention.  The  explanation  of  this  apparent  anomaly  is  that  many  speedily 
fatal  cases,  in  which  no  accurate  diagnoses  were  rendered,  were  included  with'  the  deaths 
without  known  depression. 

Of  cases  reported  as  "gunshot  contusions  of  the  skull,”  and  of  the  so-called  "fractures 
of  the  outer  table  alone,’’'  and  of  linear  fissure  of  both  tables,  there  must  have  been  many  in 
which  symptoms  were  obscure  and  diagnosis  difficult  and  fallible.  The  fractures  confined 
to  the  inner  table  could  only  be  observed  after  death,  except  in  such  extraordinary  cases  as 
that  recorded  on  page  149,  where  a segment  of  bone  exfoliated  and  revealed  the  fracture  of 
the  inner  table.  Doubtless  among  the  cases  enumerated  as  contusions  there  were  those  in 
which  the  inner  table  may  have  been  fractured. 

It  will  be  observed  that  the  mortality  was  slightly  less,  when  the  missile  passed  com- 
pletely through  the  cranial  cavity,  making  an  aperture  of  exit,  than  when  it  penetrated  and 
lodged. 

Abstracting  the  one  hundred  and  seven  cases  in  which  the  results  could  not  be  ascer- 
tained, there  remain  four  thousand  two  hundred  and  forty-three  cases,  with  a general  mor- 
tality of  59.2  per  cent.* 

* In  the  Surgical  report  in  Circular  No.  G,  S.  t>.  O.,  I860,  p.  9,  I liave  referred  to  seven  hundred  and  four  cases  of  gunshot  fractures  and  injuries  of 
the  cranial  bones,  the  results  of  which  were  then  determined.  Among  these  there  were  five  hundred  and  five  deaths,  or  a mortality  of  71.7  per  cent.  In 
the  report  of  tlie  surgerj-  of  the  Ilritish  Armj-  in  tlie  Crimea,  already  cited.  Staff  Surgeon  T.  1’.  JlATrUEW  enumerates  (op.  cit,,  Vol.  II,  p.  28G)  oiglit 
hundred  and  ninety-eight  gunshot  wounds  of  the  head,  of  which  two  hundred  and  thirty  are  classified  as  contusion  or  fracture  or  penetration  or  perfora- 
tion of  bones  of  the  cranium.  Of  these,  one  hundred  and  seventy  were  mortal,  or  73.9  per  cent.  M.  ClIENU,  in  his  Crimean  report  (op.  cit.,  p.  134), 
classifies  two  thousand  seven  hundred  and  seventy-four  wound.s  of  the  head  under  the  four  divisions  of:  fractures,  undetermined  wounds,  simple  wounds. 


308 


WOUNDS  AND  TN.TURIUS  OF  THE  HEAD 


JIecapitulation  and  General  Observations. — Leaving,  for  the  moment,  the  gunshot 
injuries  of  the  cranium,  we  may  now  sum  up  the  injuries  of  the  head  from  all  causes,  in 
order  to  engage  in  those  general  observations  that  apply  to  them  in  common,  and  such 
special  remarks  as  have  been  deferred. 

The  whole  number  of  cases  of  injuries  of  the  head  from  all  causes,  reported  to  this 
Office  during  the  war,  by  name,  was  twelve  thousand  nine  hundred  and- eighty,  which  were 
classified  in  Table  VII. 


Table  VII. 


Naivure  and  Results  of  Twelve  Thousand  Nine  Hundred  and  Eighty  Injuries  of  the  Head 
from  all  Causes,  as  reported  during  the  War. 


INJURIES. 

Cases. 

Deaths. 

Disciiauges. 

Duty. 

Resuet 

UXKXOWX. 

282 

6 

08 

208 

49 

13 

12 

24 

28 

1 

10 

17 

18 

2 

4 

12 

c 

5 

1 

331 

21 

309 

1 

Concussions  from  blows,  falls,  railway  accidents,  etc 

72 

14 

43 

13 

2 

Fractures  of  Skull  from  similar  causes. 

.105 

57 

28 

17 

3 

Guihsliot  Wounds  of  the  Sctilp 

7, 739 

162 

1, 170 

3,089 

2,  712 

328 

173 

100 

138 

10 

06 

62 

20 

19 

1 

19 

7 

12 

Gunshot  Fractures  without  known  Depression 

2,911 

1,820 

051 

309 

125 

Depressed  Gunshot  Fractures  of  the  Skull 

3C4 

129 

190 

42 

3 

486 

402 

65 

19 

73 

56 

17 

■ 

9 

9 

2 

1 

1 

Agojreg.ates 

12, 980 

2, 774 

2,  539 

4, 821 

2,  840 

From  these  twelve  or  thirteen  thousand  cases,  some  particulars  have  been  given  in  the 
foregoing  pages  of  the  histories  of  twenty-five  hundred  and  thirty-two  patients.  Analyses 
of  the  abstracts  of  the  three  hundred  and  eighty-three  cases  in  the  first  five  subdivisions 
have  been  given  on  pages  15,  23,  31,  and  34.  The  results  of  five  hundred  and  eight  injuries 
from  miscellaneous  causes,  recorded  in  the  next  three  classes  of  Table  VII,  are  summed  up 
on  pages  61  and  69. 


and  contusions,  with  a fatality  of  seven  hundred  and  sixty-four,  or  27.5.  Of  gunshot  fractures  of  the  cranium,  M.  CllEXU  gives  seven  hundred  and 
tliirty-onc  cases,  with  five  Imndred  and  forty-one  deaths,  cr  a mortality  of  74  per  cent.  In  the  Austro-Franco- Italian  war  of  1859,  M.  CllEXU  (op.  cil., 
T.  II,  p.  424)  tabulates  seven  hundred  and  seventy-nine  wounds  of  the  head  from  all  causes,  witli  four  hundred  and  fifty-six  deaths,  a mortality  of  58.53. 
These  are  elassified  as  contused,  complicated,  .and  undetermined  wounds,  contusions  and  unspecitied  (sans  indications)  injuries.  There  wore  two 
hundred  and  thirty  .three  contused  wounds  by  musket  balls,  with  two  deaths,  and  twelve  from  sliell  fragments,  with  three  deaths.  There  were  fifty-two 
contusions  from  musket  balls,  with  three  deaths,  and  eleven  from  cannon  balls  or  shell  fragments,  all  of  which  were  fatal.  There  were  forty-tlyce 
undetermined  wounds  from  small  projectiles,  and  ten  from  large  mi.ssiles,  with  four  deaths.  There  were  two  hundred  and  twelve  complicated  wounds 
from  musket  balls  and  twenty-two  from  cannon  balls  or  shell  fragments,  with  a mortality  of  one  hundred  and  eleven,  cr  altogether  five  hundred  and 
ninety-five  cases  of  gunshot  injuries  of  the  head,  with  one  hundred  and  tliirty-four  dc.aths,  cr  22.5  per  cent.  Of  the  total  number  of  gunshot  injuries,  it 
would  appear  that  two  hundred  and  thirty -seven  were  attended  by  fractures  or  grave  injuries  of  tiie  skull,  with  a mortality  of  one  hundred  and  fourteen 
cases,  or  48  per  cent.  Inspector  General  JIOUA'I'  reports,  from  the  Xew  Zealand  War,  thirty-six  gunshot  wounds  of  the  head  among  the  ofBcers  and  men 
of  the  liritish  Army.  Of  twenty  patients  with  scalp  wounds,  all  recovered  .and  were  discharged  to  duty ; five  cases  of  injury  of  the  cranial  bones,  with 
two  recoveries  and  three  discharges  for  disability,  and  eleven  fatal  fractures  of  the  cranium,  with  wounds  of  the  brain. 


RECAPITULATION  AND  GENERAL  OBSERVATIONS. 


309 


In  the -earlier  part  of  the  chapter,  commencing  on  page  95,  ivith  Abstract  1095,  and 
ending  with  Abstract  1422,  on  page  126,  memoranda  of  three  hundred  and  twenty-eiglit 
gunshot  contusions  of  the  bones  of  the  skull  are  noted,  the  results  being  analyzed  on  that 
and  the  two  succeeding  pages,  to  which-  the  reader  must  be  referred  for  the  conclusions  that 
have  been  derived  from  a study  of  the  individual  cases.  On  page  140  is  a summary  of  the 
one  hundred  and  thirty-eight  cases  of  alleged  gunshot  fracture  of  the  outer  table  alone. 
From  page  150  to  page  159,  the  gunshot  fractures  of  the  inner  table  alone  are  discussed. 
Then  follow  a large  number  of  cases  of  gunshot  fractures  of  the  cranium,  without  known 
depression,  and  of  depressed  or  penetrating  or  perforating  fractures;  of  these,  only  selected 
abstracts  are  printed,  the  summaries  of  the  subdivisions  being  brief,  as  this,  the  most 
important  part  of  the  subject,  is  yet  to  be  considered  in  the  closing  observations.  The 
cases  in  which  operations  were  performed  are  included  in  the  aggregates  of  Table  VII. 
It  will  be  best,  therefore,  to  give  a separate  table  of  operations,  and  then  to  sum  up  tlie 
remaining  cases  of  gunshot  fracture  before  proceeding  to  a more  general  discussion  of  the 
head  injuries  referred  to  in  the  foregoing  observations. 

Table  VIII. 

Results  of  Nine  Hundred  Cases  of  Injuries  of  the  Skull  in  which  Operations  were  performed- 


OCEUATIONS. 


Extraction  of  missiles 

Ligations 

Removal  of  bone  splinters  or  elevation  of  de- 
pressed bone 

Formal  trepanning 

Operations  for  bernia  cerebri 

Abstracting  from  the  twenty-nine  hundred  and  eleven  cases  of  fracture  without  known 
depression  the  eighteen  hundred  and  twenty-six  fatal  cases,  there  remains  one  thousand 
and  eighty-five  cases,  of  which  two  hundred  and  sixty-two  were  subjected  to  some  form  of 
operative  interference,  and  eight  hundred  and  twenty-three  were  treated  without  a resort  to 
such  measures.  Of  these  eight  hundred  and  twenty-three  cases,  two  hundred  and  sixty- 
nine  were  returned  to  duty,  fifty-seven  went  to  modified  duty  in  the  Veteran  Reserve 
Corps,  two  hundred  and  seven  were  discharged,  one  hundred  and  thirty-five  either 
exchanged,  paroled,  retired,  furloughed,  or  released,  thirty  deserted,  and  in  one  hundred 
and  twenty-five  instances  the  ultimate  result  could  not  be  ascertained.  Of  the  two  hundred 
and  sixty-nine  cases  of  patients  returned  to  duty,  the  names  of  two  hundred  and  thirty- 
four  do  not  appear  on  the  pension  rolls;  their  histories  present  few  particulars  of  interest; 
but  in  thirty-five  cases  of  pensioners  are  some  among  which  a few  of  the  reports  of  the 
Pension  Examiners  are  of  interest; 

Nitscuke,  a..  Sergeant,  Co.  A,  26th  Wisconsin  Volunteers,  aged  23  years.  Resaca,  Georgia,  May  15th,  1864.  Treated  at 
Briflgeport  and  Milwaukee.  Duty,  March  15th,  1885;  discharged  .lune  24th,  1865.  Examiner  .lames  Diefendorf,  M.  1)., 
reports,  July  6th,  1835,  his  disability  at  three-fourths  and  probably  permanent,  and  that  the  ball  split  on  the  frontal  bone, 
separated  in  three  parts,  and  destroyed  a square  inch  of  cranial  parietes. 


Cases. 

£ 

Deaths. 

o 

c- 

Ui 

o ^ 

IlEMAKKS. 

175 

89 

83 

3 

48.3 

The  missiles  extracted  from  beneath 
the  scalp  or  soft  parts  are  not  reck- 
oned in  this  table. 

33 

21 

12 

36.3 

454 

275 

176 

3 

39.0 

220 

95 

124 

1 

56.  () 

29 

7 

22 

75.8 

310 


WOUNDS  AND  INJUKIES  OF  THE  HEAD 


Kyax,  P.,  Private,  Co.  F,  27th  Indiana  Volunteers.  Gettysburg,  July  3d,  1863.  Fracture  of  left  pariejal  by  fragment  o 
shell.  Treated  at  Camp  Letterman,  McDougall,  and  De  Camp  Hospitals.  Duty,  February  20tb,  1864;  discharged  October 
10th,  1864.  Examiner  J.  T.  Dodds  reports,  January  10th,  1865,  that  there  is  a sulcus,  showing  a loss  of  osseous  tissue  one  inch 
and  a half  long  and  three-fourths  of  an  inch  wide,  and  that  the  applicant  stated  that  he  suffered  from  vertigo  and  pain  on  stooping. 

Brown,  NatHjVNIEl,  Private,  Go.  D,  154th  New  York  Volunteers,  aged  29  years.  Chancellorsville,  May  3d,  1863. 
Treated  at  hospital  of  Eleventh  Corps,  Carver,  and  De  Camp.  Duty,  May  11th,  1864;  discharged  June  11th,  1865.  Examiner 
Thomas  J.  King,  M.  D.,  reports  portion  of  frontal,  about  one  inch  in  diameter,  carried  away;  fistulous  opening  remains;  several 
pieces  of  bone  exfoliated;  discharge  still  continues  from  opening;  the  pensioner  suffers  from  vertigo. 

Sawyer,  J.  II.,  Private,  Co.  K,  11th  New  York  Battery.  Gettysburg,  July  3d,  1863.  Treated  at  Seminary,  McDougall 
and  De  Camp  Hospitals.  Duty,  February  11th,  1834;  discharged  December  6th,  1864.  Examiner  Samuel  C.  Wait,  M.  D., 
reports  that  the  bullet  struck  the  middle  of  the  left  frontal  bone;  necrosis  and  discharge  of  piece  of  bone;  paralysis  of  left  side 
for  four  weeks,  and  headache;  cannot  bear  heat  of  sun  nor  warming  influence  of  exercise  or  labor  without  severe  headache, 
dizziness,  and  confusion  of  thought ; was  of  opinion  that  the  bullet  Avas  still  in  the  head. 

Harris,  George,  Private,  Co.  D,  35th  Indiana  Volunteers,  aged  20  years.  Kenesaw  Mountains,  June  18th,  1864. 
Fracture  of  left  parietal  by  conoidal  musket  ball.  Treated  in  Corps,  Nashville,  Louisville,  and  Evansville  Hospitals.  Duty, 
November  16th,  1864;  discharged  September  30th,  1865.  Examiner  E.  E.  Hawn,  M.  D.,  reports  April  27th,  1869,  mental 
faculties  greatly  impaired;  is  almost  an  idiot. 

Thompson,  Helim,  Corporal,  Co.  E,  44th  New  York  Volunteers,  aged  24  years.  Gettysburg,  July  2d,  1863.  Fracture 
of  nasal  and  temporal  bones,  and  wounds  of  right  shoulder  and  leg.  Treated  at  regimental  hospital  and  at  York,  Pennsylvania, 
and  returned  to  duty,  April  4th,  1865;  discharged  June  3d,  1865.  Examiner  George  W.  Cook,  M.  D.,  reports,  March  27th, 
1888,  deafness  in  right  ear,  inability  to  close  right  eye,  closure  of  nasal  duct  and  paralysis  of  right  cheek. 

SiLLOWAY,  Benjamin  W.,  Private,  Co.  B,  7th  New  Hampshire  Volunteers,  aged  39  years.  Chapin’s  Farm,  October 
7th,  1864.  Fracture  of  frontal  by  conoidal  ball.  Treated  at  Tenth  Corps  hospital  and  Fort  Monroe.  Duty,  January  8th,  1865; 
discharged  July  20th,  1865.  Examiner  William  G.  Perry,  !M.  D.,  reports,  January  12th,  1867,  that  about  a square  inch  of  the 
bone  was  gone ; that  he  cannot  stoop  Avithout  becoming  dizzy ; had  headache  most  of  the  time. 

The  remaining  twenty-eight  pensioners  are  reported  as  suffering  from  vertigo,  head- 
ache, and  other  causes,  disabling  them  from  mental  or  physical  exertion. 

Of  the  fifty-seven  sent  to  the  Veteran  Reserve  Corps,  from  the  group  of  eight 
hundred  and  twenty-three  cases,  six  were  subsequently  pensioned. 

Esselstine,  L.  W.,  Sergeant,  Co.  L,  1st  Ncav  York  Cavalry,  aged  26  years.  Nbav  Market,  Virginia,  !May  15th,  1864. 
Fracture  of  left  mastoid  process  by  musket  ball.  Treated  at  Frederick,  Baltimore,  and  Elmira.  Transferred  to  Veteran  Eeserve 
Corps,  January  3d,  1865;  discharged  July  24th,  1865.  Examiner  J.  K.  Stanchfield,  M.  D.,  states,  April  23d,  1868,  that  he  is 
deprived  of  the  sense  of  hearing  and  poAver  to  close  the  eye,  and  that  the  facial  muscles  of  the  left  side  of  the  face  are 
paralyzed. 

The  five  other  pensioners  of  this  class  suffer  from  cephalalgia,  loss  of  memory, 
partial  paraplegia,  and  vertigo.  The  histories  of  the  fifty-one  patients  who  were  not 
pensioned  present  few  particulars  of  interest.* 

Of  the  series  of  two  hundred  and  seven  patients  of  this  group  discharged  for  disability, 
thirty  were  pensioned.  A few  abstracts  are  selected ; 

Kruger,  B.,  Private,  Co.  A,  8th  Ncav  York  Volunteers.  Bull  Eun,  August  29th,  1862.  Fracture  of  zygomatic  process 
of  left  temporal.  Treated  at  Fairfax  Seminary,  Washington,  and  Philadelphia.  Discharged  December  18th,  1862.  Examiner 
Charles  Phelps,  M.  D.,  reports  that  the  sense  of  heai’ing  of  left  ear  is  entirely  destroyed,  and  that  there  is  constant  and  profuse 
otorrhoea. 

Kahler,  Leavis,  Private,  Co.  I,  13th  Ncav  Jersey  Volunteers,  aged  44  years.  Chancellorsville,  May  3d,  1863.  Fracture 
of  occipital  bone  by  conoidal  ball,  Avhich  lodged  beneath  the  mastoid  process  in  sterno-mastoid  muscles.  Treated  at  Washington 
and  discharged  November  7th,  1863.  Examiner  T.  B.  Smith,  M.  D.,  November  9th,  1863,  reports  that  the  missile  has  not  been 
removed  and  that  it  is  the  cause  of  constant  irritation  and  stiffness  of  neck.  Examiner  Philip  Leidy,  M.  D.,  March  Cth,  1867, 
states  that  there  is  vertigo,  dimness  of  vision,  and  pain  in  head,  and  that  the  poAver  of  locomotion  is  someAvhat  interfered  with. 

Wainwright,  James  A.,  Private,  Co.  I,  15th  Netv  Jersey  Volunteers,  aged  34  years.  Cedar  Creek,  October  19th,  1864. 
Fracture  of  frontal  bone  by  conoidal  ball.  Treated  in  field,  at  Baltimore,  and  Philadelphia.  Discharged  June  16th,  1865. 
Examiner  Alfred  Edeline,  M.  D.,  reports  tliat  there  is  dimness  of  vision  and  discharge  of  offensive  matter  from  nostrils.  The 
pensioner  claims  that  the  missile  has  not  been  extracted.  The  second  finger  of  right  hand  has  been  amputated  for  gunshot 
Avound,  leaving  the  other  fingers  contracted. 

*Ouc  of  these  invalided  men  had  suffered  from  erysipelas  of  the  scalp;  another  had  survived  a copious  hsemorrhage  from  the  temporal  arterjq  on 
the  thirteenth  day  after  the  injury,  necessitating  the  ligation  of  the  vessel ; and  three  had  endured  protracted  convalescence  because  of  necrosis  of  the 
skull,  with  frequent  exfoliations. 


GUNSHOT  INJURIES  OF  THE  CRANIUM. 


311 


Cuimss,  Robert  G.,  Private,  Co.  D,  34tli  Massachiiscfts  Volunteers,  aged  18  years.  New  Market,  May  15tli,  18G4. 
Fracture  of  frontal  bone  by  conoidal  musket  ball.  Treated  at  Cumberland  and  Worcester.  Discliarged  June  2d,  18GG.  There 
is  loss  of  bony  structure  and  his  disability  is  rated  three-fourths  and  permanent. 

CoUNTEitMiNE,  CHARLES  F.,  Private,  Co.  C,  14Ctli  New  York  Volunteers,  agetl  £0  years.  Five  Forks,  April  1st,  1865. 
Fracture  of  the  left  parietal  bone  by  conoidal  ball.  Treated  in  field  and  at  Washington,  and  discharged  July  31st,  1865. 
Examiner  M.  D.  Benedict,  July  31st,  1865,  reported  that  the  inner  table  was  depressed,  and  that  the  pensioner  suffered  from 
partial  paralysis. 

Duxnixg,  Eugexe  H.,  Private,  Co.  I,  140th  New  Y'ork  Volunteers,  aged  21  years.  Wilderness,  May  5th,  1864. 
Treated  in  field,  Washington,  and  Baltimore,  and  discharged  July  9th,  1SC5.  Examiner  B.  L.  llorey,  M.  D.,  July  13th,  1869, 
reports  that  he  believes  that  the  inner  table  is  depressed,  and  that  the  pensioner  suffers  from  vertigo  and  defective  vision. 

Hill,  Gilliam,  Private,  Co.  G,  31st  Illinois  Volunteers,  aged  26  years.  Kenesaw  Mountain,  Georgia,  June  27th,  1864. 
Fracture  of  frontal  bone,  and  injury  of  right  eye  by  conoidal  musket  ball.  Treated  in  field.  New  Albany,  and  Quincy,  and 
discharged  May  11th,  1835.  Examiner  John  W.  Mitchell,  April  25th,  1866,  reports  that  there  is  a cavity  in  the  skull  correspond- 
ing to  the  size  of  the  bullet,  and  that  exertion  causes  headache,  vertigo,  and  dimness  of  vision. 

ICKERMAX,  Frederick,  Private,  Co.  I,  34th  Illinois.  Jonesboro’,  September  1st,  1864.  Fracture  of  parietal  by  musket 
ball.  Treated  in  field,  Chattanooga,  and  Nashville,  and  discharged  July  12th,  1865.  Examiner  D.  Trask  Etter,  M.  D.,  January 
14th,  1869,  reports  that  the  membrane  of  the  drum  of  the  left  ear  is  desti'oyed. 

Luce,  Albert,  Private,  Co.  B,  17th  United  States  Infantry,  Gettysburg,  July  2d,  1863.  Fracture  of  the  cranium. 
Examiner  Edward  F.  Upham,  June  6th,  1866,  reports  that  the  jaws  cannot  be  separated,  and  that  there  is  evidence  of  chronic 
softening  of  the  optic  nerves. 

The  remaining  twenty-one  pensioners  suffered  in  some  instances  from  exfoliation  and 
in  most  from  cerebral  irritability.  Of  the  one  hundred  and  seventy-seven  soldiers  who 
were  not  pensioned,  about  one-third  were  discharged  b'ecause  of  the  expiration  of  their  term 
of  service  and  the  rest  for  such  physical  disabilities  as  vertigo,  headache,  mental  imbecility, 
epilepsy,  deafness,  or  defective  vision.  The  reports  of  these  cases  record  no  unusual  or 
peculiar  symptoms  or  circumstances. 

The  reports  of  forty-nine  instances  of  recovery  after  gunshot  fracture  of  the  cranium 
without  known  depression, — cases  of  Confederate  prisoners  treated  in  Union  hospitals  and 
transferred  to  the  Provost  Marshal  General  for  exchange, — afford  little  material  for  com- 
ment. hlearly  all  of  the  patients  were  very  young  men.*  The  duration  of  treatment  in 
hospitals  averaged  about  two  and  a half  or  three  months.  One  of  the  cases  was  complicated 
by  a perforating  wound  of  the  thorax  ; another  by  several  flesh  wounds,  and  a third  by 
variola.  The  confinement  of  these  prisoners  secured  for  them  the  advantages  of  absolute 
rest,  and,  usually,  of  restricted  diet.  As  far  as  can  be  gleaned  from  the  reports,  the 
general  treatment  in  the  majority  of  cases  appears  to  have  been  expectant  or  mildly 
antiphlogistic.  The  local  measures  were  the  shaving  of  the  scalp  in  the  vicinity  of  the 
wound  and  the  application  of  cold-water  dressings,  except  in  one  instance,  of  an  inflamed 
scalp  wound,  which  was  advantageously  poulticed. 

The  cases  of  ten  Confederate  prisoners  reported  as  “ paroled,”  and  of  five  whose 
surgical  histories  are  terminated  by  the  entry  “released,”  were  of  the  same  general  charac- 
ter of  those  of  the  series  just  adverted  to,  and  call  for  no  remark,  except  that  in  one 
instance  (Private  W.  U.  Denmark,  9th  Georgia  Regiment,  aged  18  years)  nearly  resembling 
that  of  Bemis  (page  162,  ante)  in  the  extent  of  the  wall  of  the  cranium  destroyed,  there 
was  no  cerebral  disturbance  from  first  to  last. 

In  the  Confederate  Surgical  records,  histories  are  found  of  seventy-one  cases  of 
recovery  from  gunshot  fractures  of  the  cranium  without  known  depression.  Fifty-seven 
of  the  patients  were  furloughed,  nine  were  retired,  and  five  were  sent  to  modified  duty. 


*The  oldest  was  Private  W.  Randall,  Co.  K,  lOtli  South  Carolina  Re^menf,  aged  38  years,  wounded  at  Snake  Creek  Gap,  October  15tli,  1804. 
The  next  in  age  was  Lieutenant  J.  N,  Moore,  48th  Virginia  Infantry,  wounded  Jtily  f)th,  1804,  at  Monocaey,  aged  30  years.  Tiio  rest  were  from  20  to 
25  years  of  age. 


312 


WOUNJJS  ANU  JN,JUIUES  OF  THE  llEAH 


With  few  exceptions  all  of  these  patients  sufferecl  from  very  grave  disabilities,  ^ix  of 
them  were  utterly  disabled  by  complete  hemiplegia,  and  others  labored  under  partial 
paralyses.  Two  of  them  were  blind,  one  was  totally  deaf,  and  one  was  affected  by 
asphasia.  Others  had  epilepsy.  The  gravity  of  the  disabilities  under  which  these  officers 
and  men  were  released  from  duty  indicates  tlie  stringency  of  the  examinations  for  discharge 
from  service  in  the  Confederate  armies.*  The  series  of  thirty  cases  of  deserters  from 
hos})itals  comprises  none  of  any  especial  interest.  In  one  instance,  deafness  had  resulted 
from  the  injury  ; but  this  is  the  solitary  example  of  any  complication  of  note. 

Of  the  undetermined  cases  from  the  Union  army,  a number  probably  proved  fatal  in 
transit  to  hospital  ; others,  perhaps  slightly  wounded,  most  likely  went  home  ; the  Confed- 
erate cases  cannot  be  traced  further,  because  the  records  of  the  southern  hospitals  are  only 
fragmentary. 

The  group  of  three  hundred  and  sixty-four  cases,  included  in  Tables  VI  and  VII, 
as  depressed  gunshot  fractures,  comprises  all  those  examples  of  depression  that  are  not 
'included  among  fractures  of  the  inner  table,  linear  fissures,  penetrating  and  perforating 
fractures,  and  cases  of  smash  or  of  alleged  fracture  l)y  counter-stroke.  Doubtless  this  group 
should  receive  large  additions  from  that  of  fractures  without  known  depression.  In  these 
divisions  there  are  slight  discrepancies  in  the  figures  representing  the  final  disposition 
made  of  cases,  discrepancies  arising  from  the  fact  that  the  tables  were  computed  at  different 
dates,  and  that  cases  entered  as  undetermined  in  one  appear  accounted  for  in  the  other. 
The  successive  transfers  of  patients  from  hospitals  near  the  seat  of  operations  to  those 
more  remote  made  it  often  difficult,  as  has  already  been  remarked,  to  ascertain  the  ultimate 
results,  except  in  cases  of  death,  which  were  separately  entered  on  alphabetical  registers, 
so  that  the  aggregates  of  mortality  may  be  relied  upon  as  nearly  accurate. 

Some  remarks  have  been  already  offered  on  pages  193  and  196  regarding  the  group 
of  four  liundred  and  eighty-six  penetrating  gunshot  fractures,  and  abstracts  of  ninety-three 
cases  are  there  given,  while  many  others  are  cited  under  the  headings  removal  of  fragments, 
page  215,  and  trephining , page  261. 

The  perforating  gunshot  fractures  and  the  examples  of  smash  and  of  alleged  contre- 
coup  are  subdivided  and  commented  upon  on  pages  206,  211,- 212,  and  304. 

“ Nxdlum  capitis  vulnus  contemnendum  ” was  the  warning  of  Hippocrates.  “ Nam 
veluti  magna  et  gravia  capitis  vidnera  non  sequitur  mors,  sic  et  levia  scepexmmero  mortis 
causcB  sint  ” amplified  Galen.  “ No  injury  of  the  head  is  too  slight  to  he  despised,  or  too 
grave  to  he  despaired  of,"  paraphrased  Liston,  a text  fully  exemplified  in  the  preceding  pages. 

* For  example,  Surgeons  F.  N.  Patterson,  E.  1^1.  AVaters,  and  J.  B.  Thomas,  P.  A.  C.  S.,  constituting  the  retiring  medical  examining  beard,  at 
Ilicliniond,  in  1865,  Iiave  under  consideration  the  case  of  Private  James  F.  Blackwell,  Co.  E,  ICth  Virginia  regiment,  whom  Captain  Gover  certifies  to 
have  been  severely  wounded  in  both  thighs,  at  the  battle  of  Sharpsburg,  September  17th,  18G*i.  This  man  was  enlisted  June  19th,  1861,  to  ser\'e  twelve 
months.  His  application  and  Captain  Covers  certificate  are  approved  by  Major  C.  H.  Clarke,  commanding  regiment,  Brigadier-General  M.  D.  Corse, 
I^Iajor-General  G.  E.  Picket,  and  Lieutenant-General  J.  Longstreet,  and  the  Beard  finds:  That  the  patient  is  “permanently  disabled  from  any  service  in 
consequence  of  gunshot  wound  of  the  superior  and  posterior  portion  cf  the  right  thigh;. ball  passing  behind  the  femur,  and,  coming  out,  reentered  on  the 
inner  side  of  middle  of  left  thigh,  severing  femoral  artery,  and  fracturing  femur,  and  finally  making  its  exit  two  inches  above  the  superior  border  of  the 
patella.  Left  limb  is  considerably  atrophied.  He  is  therefore  retired.”  This  paper  is, approved  by  Assistant  Adjutant  General  W.  H.  Taylor,  by  order 
of  General  R.  E.  Lee;  but  the  Board  is  respectfully  reminded  of  Par.  \TI,  G.  O.  71,  A.  and  I.  G.  O.,  1864,  and  instructed  that  “if  unfit  for  duty  in  the 
field,  but  capable  of  performing  duty  in  some  department  of  the  scr\ffcc,  the  Board  will  specify  for  what  position  ho  is  best  qualified,  and,  if  he  has  here- 
tofore been  detailed  upon  any  light  diity^  tlic  Board  will  state  how  and  when  employed,  and  if  his  ser\dces  are  still  desirable  in  such  position.”  The 
medical  examining  board  near  Petersburg,  consisting  of  Simgeons  H.  H.  Hubbard,  G.  W.  Langdun,  L.  P.  AVarren,  B.  F.  Ward,  and  C.  B.  McGuire,  I\  A. 
C.  S.,  had  before  them  in  lilarch,  1865,  among  others.  Private  James  Aycock,  of  Captain  D.  T.  Hardin's  company  (C),  of  the  15tli  North  Carolina  regiment, 
whose  application  being  according  to  rule,  and  endorsed  by  the  company,  regimental,  brigade,  divisi(m,  and  corps  commanders,  is  favorably  considered  on 
the  ground  that  "a  gunshot  wound  of  the  left  parietal  bone,  fracturing  it,  and  succeeded  by  paralysis  of  the  right  arm,  received  at  South  Anna  bridge, 
July  4th,  1863,  while  in  the  scr\'ice  of  the  Confederate  States  and  in  the  line  of  duty”  disabled  him  “from  all  duty.”  This  finding  is  approved  by 
Assistant  Adjutant  General  Venable,  by  order  of  General  Lee;  but  the  Board  is  reminded  by  an  endorsement  similar  to  that  already  quoted  of  the  desira- 
bleness of  assigning  the  applicant  to  “any  light  duty”  in  preference  to  retirement. 


LIGATIONS  OF  THE  CAROTID. 


313 


The  complications  that  may  be  present  in  injuries  of  the  head  arc  htemorrhage, 
concussion,  compression,  cerebral  irritation,  foreign  bodies,  extravasations,  meningitis, 
encephalitis,  and  purulent  infection.  I need  not  speak  of  concussion its  signs  are  well 
known,,  and  no  light  has  been  thrown  on  its  obscure  pathology  by  the  observations  liere 
collected.  External  and  intra-cranial  hgemorrhages  have  been  considered  on  pages  16,  80, 
101,  255,  and  289,  and  abstracts  of  fifty-three  cases  of  extravasation  of  blood  within  the 
skull  have  been  printed.  All  but  three  of  these  cases  were  fatal.  In  ten,  trephining,  and 
in  nine,  removal  of  fragments,  were  practiced,  with  success  in  only  three  instances.  Hence 
it  may  be  concluded  that  in  intra-cranial  bleeding  due  to  gunshot  injury,  the  fortunate 
results  obtained  by  Keate  and  Tatum  can  be  but  rarely  anticipated,  though  the  teachings 
of  Brodie  and  of  Hewett  regarding  the  management  of  extravasations  due  to  other  causes 
are  not  invalidated.^ 

Ligations. — In  a few  cases  of  gunshot  wounds  of  the  head,  haemorrhage  was  con- 
trolled by  tying  the  arterial  trunks,  with  a larger  measure  of  success  than  attended  these 
operations  in  wounds  of  the  face  (p.  392),  neck  (p.  419),  and  spine  (456). 

Ligations  of  the  Common  Carotid.- — -To  arrest  bleeding  in  cases  of  gunshot  fractures 
of  the  skull,  this  vessel  was  tied  seven  times.  The  ligation  by  Surgeon  E.  Bentley,  U. 
S.  V.,  to  arrest  bleeding  from  the  middle  meningeal,  is  noted  on  page  255.  The  particu- 
lars of  six  other  cases  are  reported  as  follows : 

Private  J.  S.  Hayden,  Co.  D,  2d  Iowa  Volunteers,  was  wounded  at  the  capture  of  Fort  Donelson,  February  14tli,  1862, 
by  a musket  ball  wbich  strucdv  the  loft  ear,  carried  away  the  antilragus,  perforated  the  temporal  bone,  and  made  its  exit  at  the 
niasseter  muscle  on  tbe  right  side,  dividing  the  duct  of  Steno.  He  was  sent  to  Third  Street  Hospital,  at  Cincinnati,  where, 
on  JIarch  2d,  in  an  effort  to  remove  fragments  of  tbe  petrous  bone,  there  was  copious  bsemorrliage,  which  was  treated,  but  not 
arrested,  by  the  free  employment  of  persulphate  of  jron.  Haemorrhage  recurred  on  the  8th,  and,  on  March  22d,  chloroform  was 
given,  and  Surgeon  John  Jloore,  U.  S.  A.,  tied  the  carotid.  Ligature  came  away  on  the  twelfth  day.  The  patient  rapidly 
regained  his  strength,  and  was  discharged  convalescent  July  23d,  1862.  He  was  last  heard  from  in  1868.  He  had  facial 
paralj'sis.  Professor  J.  A.  Murphy  reports  the  case. 

Private  John  Brooks,  Co.  I,  57th  Pennsylvania  Volunteers,  aged  17  years,  was  Wounded  at  the  battle  of  the  Wilderness, 
May  6,  1864,  by  a conoidal  musket  ball,  which  entered  ovei'  the  left  eai-,  jiassed  forwards,  making  an  irregular  opening  through 
the  temporal  bone  large  enough  to  admit  the  introduction  of  two  fingers  into  the  cavity  of  the  skull,  and  escaped  three  inches 
anterior  to  the  wound  of  entrance.  The  membranes  of  the  brain,  however,  were  not  injured.  He  was  treated  in  a field  hospital 
and,  on  Jlay  15th,  was  sent  to  the  Columbian  Hospital  at  IV^ashington.  He  was  ])ale,  emaciated,  and  complained  of  acute 
cephalalgia  ; otherwise,  his  bodily  functions  were  nonnal.  On  the  17th,  the  headache  had  increased,  and  the  pupils  had  become 
contracted.  E.xpectant  treatment  was  used,  notwithstanding  which,  delirium  gradually  came  on,  and,  on  May  20th,  the  patient 
was  comatose  and  unable  to  swallow-.  Tbe  pulsations  of  the  heart  were  rapid  and  feeble  ; the  pulse  at  the  wrist,  imperceptible. 
He  remained  in  tins  condition  sixty  hours,  when  it  was  found  that  if  fluids  were  placed  in  his  mouth  in  small  quantities,  he 
would  swallow  them.  From  this  time  he  slowly  improved.  On  Juno  2d,  the  patient  was  able  to  sit  up,  but  his  bow’els  were 
constipated,  he  voided  his  urine  unconsciously,  and  his  mental  faculties  were  much  impaired.  He  was  unable  to  articulate,  bad 
no  recollection  of  the  past  or  jiroper  pei'ception  of  present  things,  and  stared  vacantly  around  the  tent.  His  appetite  was  ravenous. 
The  pupil  of  the  right  eye  did  not  respond  to  light ; otherwise,  there  was  no  paralysis.  At  this  date,  a hmmorrhage  occurred 
from  the  posterior  wound  to  the  amount  of  about  two  ounces,  followed  by  great  improvement  in  all  the  symptoms.  Hmmorrhage 
recun-ed  every  two  or  three  days,  and  was  not  altogether  checked  until  the  18th  of  June,  as  it  seemed  to  aid  much  in  restoring 


‘On  this  subject  consult:  COLQCnocx,  G.,  De,  cerehri  concussione,  Edinburgi,  3800;  Haetman,  A.  II.,  Dc  commotione  ccrehri,  Grj’phia:,  184G; 
Eageaxge,  De  la  comm,  du  cerveau,  These  de  Paris,  1808,  No.  239;  JIOUNIEU,  Dc  la  commotion  cerebral,  These  dc  Paris,  1834,  No.  119;  llEl’IQUET,  De 
la  commotion  du  cerreau,  These  de  Paris,  1818,  No.  3f);  IIuuxs,  V.,  Die  chirurgischen  Krankheitcn  und  Verletzungcn  des  Gchirns  and  seiner  Umhiill- 
ungen,  TUbingen,  18.19,  Hand  I;  GAMA,  Traite  des  plaies  de  tete  ct  de  V cncephalite,  Paris,  1855,  2“'  edition;  Lauciee,  S.,  Diet,  de  Med.  ou  Hep.  Gen.  dcs 
Sci.  Med.,  1‘aris,  1834,  'P.  VIII,  p.  453;  Dleuyteex,  Le^ns  Orales,  Paris,  18:19,  T.  VI,  p.  170;  JlAVEE,  C.,  Dc  commotione  cerebri,  ISerol.,  181(i;  Mai.eii, 
I>.;  Dc  commotione  cerebri.  Argent,  1777 ; P.txo,  Memoire  sur  la  commotion  (Memoires  dc  la  Sociele  de  chirurgie  de  I’aris.  1852). 

“ .See  Jlr.  PuESCOrr  IIewett's  remarks  in  Holme's  System  of  Surgery,  2d  ed.,  1870,  Vol.  II,  ]).  2.58;  Sir  P.EX.IAMIN'  G.  liEODlE  (Med.  Chir.  Trans., 
Vol.  XIV,  p.  385)  says:  “blood  is  seldom  ])Ourcd  out  in  any  considerable  quantity  between  the  dura  mater  and  the  bone,  except  in  consequence  of  a 
laceration  of  the  middle  meningeal  artery,  or  one  of  its  principal  branches;  and  it  is  very  rare  for  tliis  accident  to  occur,  except  as  a consequence  <.f 
fracture.  If,  therefore,  we  find  the  patient  lying  in  a state  of  stupor,  and,  on  examining  tlie  head,  we  discover  a fracture,  witli  or  without  depression, 
extending  in  the  direction  of  the  middle  meningeal  artery,  altliough  the  existence  of  an  extravasation  on  the  surface  i f the  dura  mater  is  i:ot  thereby 
reduced  to  absolute  certainty,  it  is  rendered  highiy  probable ; und  tlie  surgeon,  under  these  cireumst:inccs,  would  neglect  his  duty  if  he  omitted  to  tipply 
the  trcivhine;  and  where  no  fracture  is  discoverable,  yet,  if  there  is  otlier  evidence  of  the  injury  h:»ving  fallen  on  that  I'art  of  the  cranium  in  which  the 
middle  meningeal  artery  is  situateil,  the  use  of  the  trephine  may  be  resorteil  to  on  spccuhition,  rather  than  that  the  i)aticnt  should  be  left  to  die  witiiout  an 
ntteinjit  being  made  f.jr  his  iireseivation.” 

Jt) 


314 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


his  mental  faculties.  On  the  latter  date,  an  atteinjit  was  made  to  ligate  the  tempoi'al  artery  ; and  this  failing,  the  common  carotid 
was  ligated  at  its  upper  portion,  on  Juno  20th,  by  Surgeon  T.  R.  Crosby,  U.  S.  V.  The  bleeding  still  continuing,  the  posterior 
wound  was  enlarged,  and  some  small  fragments  of  exfoliated  bone  were  removed;  the  wound  was  then  plugged  with  lint,  which 
entirely  arrested  the  hmmorrhage.  It  was  estimated  that  fifty  ounces  of  blood  had  been  lost  durlngthclasthannorrhage.  Liberal 
diet  was  prescribed,  and  the  patient  gained  rapidly  in  flesh.  The  ligature  came  away  on  the  tenth  day  after  the  operation,  and 
the  wound  united,  except  at  the  point  of  ligation,  where  a fistulous  opening  remained,  which  disch, urged  daily  a small  tnnount  of 
pus.  On  August  15th,  blood  was  found  to  ooze  from  the  place  of  ligation;  and,  the  patient  having  lost  about  twenty  ounces,  the 
artery  was  cut  down  upon  by  Surgeon  Crosby  and  ligated  below  the  onio-hyoid  muscle.  The  vessel  was  found  dilated  to  more 
than  double  its  normal  size,  and  firmly  attached  to  it,  on  the  inner  side,  was  a well-formed  clot.  Low  diet  was  ordered;  tincture 
of  aconite  was  given  to  keep  the  heart’s  action  as  much  reduced  as  was  consistent  with  the  safety  of  the  patient.  On  September 
15th,  the  wound  had  fully  healed,  and,  on  November  15th,  the  patient  was  furloughed,  apparently  entirely  restored  in  his  bodily 
functions.  He  was  discharged  from  service  on  J une  8th,  1865.  The  case  is  reported  by  Surgeon  T.  E.  Crosby,  U.  S.  V.,  and 
is  figured  as  No.  284,  .Surgical  Photographs,  A.  M.  M.,  Vol.  VI,  p.  34. 


Corporal  A.  J.  Peckham,  Co.  I,  115th  New  York  Volunteers,  aged  30  years,  received  a shot  fracture  of  the  occipital,  at 
Cold  Harbor,  Juno  3d,  1864,  the  ball  entering  at  the  right  of  the  protuberance,  and  emerging  at  the  right  meatus  auditorius. 

He  was  conveyed  to  Alexandria,  and,  on  June  Gth,  on  his  admission  to  3d  division  Hospital, 
in  an  anmmic  state,  the  wound  was  swollen  from  extravasation  under  the  scalp.  On  the  8th, 
Surgeon  E.  Bentley,  U.  S.  V.,  gave  chloroform  and  ligated  the  common  carotid  opposite  (he 
thyroid  cartilage.  The  bleeding  continued  after  the  operation,  and  the  wound  was  filled 
with  lint  saturated  with  a solution  of  persulphate  of  iron.  The  patient  lingered  until  .June 
13th,  1864,  and  died  from  syncope. 


Fig.  1*. — Coagulum  in  distal  porticn 
cf  the  left  carotid  si.v  days  after  liga- 
tion. Spec.  317S1,  .Sect.  1,  A.  M.  M. 


Private  Taylor  McIntosh,  Co.  H,  40th  Indiana  Volunteers,  aged  18  years,  was 
wounded  at  Mission  Ridge,  November  25th,  1863,  by  a conoidal  ball,  which  ente.red  at 
the  centre  of  the  frontal  bone,  an  inch  and  a half  above  the  supra-orbital  ridge,  passed 
through  the  right  orbit,  and  emerged  near  the  angle  of  the  lower  maxilla.  He  was  admitted 
on  the  next  day  to  the  field  hospital  of  the  2d  division.  Fourth  Corps.  He  was  stupid  and 
had  partial  convulsions  at  first,  but  subsequently  regained  his  senses,  although  he  was  still 
dull  and  restless.  The  right  eyelid  and  the  right  side  of  the  face  were  swollen  and  ecchy- 
mosed.  Cold  applications  were  made  to  the  wound.  December  10th,  evacuation  of  abscess 
in  eyelid.  By  December  15th,  he  was  able  to  make  his  wants  Iniown  and  complained  of  pain 
in  the  eye  and  head.  On  the  16th,  haemorrhage  to  the  amount  of  sixteen  ounces  occurred 
from  the  wound  of  exit  ; and,  on  the  17th,  the  right  common  carotid  artery  was  ligated  above 
the  omo  hyoid  on  account  of  the  recurrent  haemorrhage.  He  sank,  and  died  December  19th, 
1863,  from  exhaustion.  Surgeon  A.  McMahon,  64th  Ohio  Volunteers,  reports  the  case. 

Private  Hiram  B , Co.  A,  142  Pennsylvania,  aged  18  years,  received  a gunshot 

fracture  of  the  zygoma  and  mastoid  process  of  the  temporal  bone,  left  side,  on  the  Weldon 
Railroad,  August  21st,  1864.  He  was  at  once  conveyed  to  the  hospital  of  the  first  division. 
Fifth  Corps,  and,  on  the  24th,  was  transferred  to  Lincoln  Hospital,  Washington.  The  wound 
extended  from  within  a half  inch  of  the  outer  canthus  of  the  left  eye  to  just  posterior  to  the 
left  mastoid  process.  Cold-water  dressings  were  applied.  On  the  26th,  arterial  hsemorrhage 
occurred,  which  was  checked  by  filling  the  wound  with  lint  soaked  in  a solution  of  persul- 
phate of  iron.  It,  however,  recurred  on  the  next  day,  and  Assistant  Surgeon  J.  C.  McKee, 
U.  S.  A.,  administered  ether  and  ligated  the  left  common  carotid  artery  above  the  omo-hyoid, 
an  inch  and  a half  below  the  bifurcation.  Anodynes  and  stimulants  were  administered,  but 
the  patient  sank  under  the  repeated  and  copious  haemorrhages,  and  death  ensued  September 
2d,  1864.  At  the  autopsy,  the  meatus  auditorius  was  found  to  be  cut  across.  It  was  impos- 
sible to  detect  from  what  artery  or  arteries  the  haemorrhage  proceeded.  Both  lungs  were 
anaemic.  The  adjoining  wood-cut  (Fig.  1*)  represents  a portion  of  the  aorta,  the  commence- 
ment of  the  left  subclavian,  the  common  carotid,  and  its  bifurcation.  A firm  fibrinous  coagu- 
lum  extends  from  the  seat  of  ligature  to  the  bifurcation.  The  coagulum  on  the  proximal  side 
of  the  ligature  is  much  shorter,  occupying  less  than  half  an  inch.  The  drawing  is  of  the 
natural  size  of  the  vessels,  shrunken  in  alcohol.  The  notes  of  the  case,  and  specimen,  were 
contributed  by  Acting  Assistant  Surgeon  H.  M.  Dean. 


Private  William  C.  Andrews,  Co.  A,  30th  Iowa  Volunteers,  aged  19  years,  was  wounded  by  a fragment  of  shell,  in 
the  left  temporal  region,  at  Vicksburg,  Deoember  28th,  1882.  He  was  treated  in  a field  hospital  until  January  17th,  1863, 
when  ho  was  admitted  to  Lawson  Hospital,  St.  Louis.  On  January  18th,  haemorrhage  amounting  to  twelve  ounces  occurred  from 
the  middle  meninge.al  artery,  which,  all  other  means  failing,  was  arrested  by  Assistant  Surgeon  C.  T.  Alexander,  U.  S.  A., 
ligating  the  left  common  carotid  artery.  The  haemorrhage  did  not  recur.  Andrews  was  discharged  from  the  service  May  28th, 
1863.  In  March,  18J3,  he  was  a pensioner,  his  disability  being  rated  as  total  and  temporary.  Pension  Examiner  A.  C.  Roberts, 
M.  D.,  reports  that  he  had  a dizziness  and  faintness  on  exertion  or  stoojiing,  and  partial  anaesthesia  of  the  left  side  of  the  face, 
being  compelled  to  keep  his  room  in  the  cold  winters  of  Madison,  Iowa,  from  liability  of  freezing  the  left  ear  and  face.  Andrews 
remained  intolerable  health  on  June  1th,  1872,  nearly  ten  years  from  the  date  of  the  operation. 


LIGATIONS  OF  AETEKIES, — SCALPING. 


315 


Of  the  seven  operations  above  referred  to,  three  of  the  four  ligations  of  the  left 
common  trunk  were  successful,  and  the  three  ligations  on  the  right  side  were  fatal — or 
57.1  per  cent.  Among  face  wounds,  fifty-five  cases,^  among  wounds  of  the  neck  and 
spine,  twenty-three  cases,  of  ligations  of  the  common  carotid  will  be  found,  or  a total  of 
eighty-five  operations,  with  sixty-three  deaths,  or  a mortality  of  74.1  per  cent. 

Ligation  of  the  External  Carotid. — One  case  is  reported  among  the  head  injuries  : 

Private  Francis  L.  Whitney,  Co.  B,  36th  Massachusetts  Volunteers,  aged  24  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  June  3d,  1864,  by  a conoidal  ball,  which  fractured  the  external  angle  of  the  right  orbit  and  the  zygomatic  arch, 
passed  inward  and  downward,  and  lodged  behind  the  right  inasseter  muscle.  He  was  admitted  to  the  hosjiital  of  the  2d  division. 
Ninth  Corps,  and  on  June  Sth  was  sent  to  the  Emory  Hospital  at  Washington.  He  had  lost  considerable  blood,  was  anaemic, 
comatose,  and  suffered  extreme  pain,  moaning  constantly.  Haemorrhage  was  arrested  by  compress  to  the  external  carotid,  but 
recurred  on  the  14th.  The  patient  was  placed  under  the  influence  of  ether  and  chloroform,  when  persulphate  of  iron  was  applied 
to  the  bleeding  vessels,  and  the  orifice  plugged  up  with  a styptic.  The  ball  could  not  be  found.  Haemorrhage  recurred  on  June 
16th,  1864.  The  external  carotid  artery  was  now  tied  a little  above  the  omo-hyoid  muscle,  and  the  ball  was  extracted  from 
behind  the  masseter.  The  man  died  on  the  table  from  nervous  exhaustion  and  anaemia.  No  anaesthetic  had  been  employed  at 
the  second  operation.  Acting  Assistant  Surgeon  W'’.  A.  Ensign,  the  operator,  reported  the  case. 

Ligations  of  the  Superficial  Temporal.— ELib  vessel,  or  its  principal  branches,  was 
tied  twenty-two  times  for  gunshot  wounds  of  the  scalp,  alone  or  attended  by  contusions  of 
bone  or  cranial  fractures.  Twenty  cases  have  been  enumerated."  Two  are  here  noted. 
Of  the  twenty-two,  two  were  fatal  from  hgemorrhage,  three  from  other  causes  : 


Private  Eobert  Faucett,  Co.  B,  Sth  Michigan  Volunteers,  aged  45  years,  received  a gunshot  flesh  wound  of  the  scalp, 
on  the  right  side,  at  Spottsylvania,  May  6th,  1864.  On  May  10th.,  there  was  hsemorrhage  fi-om  the  wound  of  about  three 
ounces,  and,  other  means  failing  to  control  it.  Surgeon  I.  I.  Hayes,  U.  S.  V.,  applied  a single  ligature  to  the  proximal  end  of  the 
wounded  vessel.  The  bleeding  did  not  recur,  and  the  man  was  transferred,  convalescent,  to  W^hitehall,  whence  he  was  transferred 
to  the  Veteran  Reserve  Corps,  January  23,  1865. 

Private  Josiah  Forbes,  Co.  L,  1st  Vermont  Cavalry,  aged  19  years,  received  a gunshot  scalp  wound  at  Burke’s  Station, 
June  24th,  1864.  The  wound  became,  inflamed  and  irritable  and  arterial  bleeding  took  place,  to  arrest  which,  the  right  superficial 
tempor.al  ai’tery  was  tied,  at  the  Baxter  Hospital,  Burlington,  Vermont,  in  July.  The  patient  recovered  and  remrned  to  duty, 
September  29,  1864.  Assistant  Surgeon  S.  L.  Thayer,  U.  S.  V.,  the  operator,  reported  the  case. 


In  connection  with  wounds  of  the  scalp,  an  allusion  to  the  custom  of  North  American 
Indians,  of  scalping  their  victims,  must  not  be  omitted.  This 
is  practiced  by  making  two  elliptical,  or  four  straight,  incisions 


in  the  region  of  the  vertex,  and  tearing  off  the  ovoid  or  rectan- 
gular portion  of  integument  thus  enclosed.  This  is  tanned, 
with  the  hair  attached,  and  worn  as  a decoration.  Crushing 
in  the  skull  with  a tomahawk  is  practiced,  unless  the  van- 
quished is  supposed  to  be  already  dead.  Mr.  T , a conduc- 

tor on  the  Pacific  Railroad,  while  hunting  near  Cheyenne,  in 
1869,  was  attacked  by  Sioux,  scalped,  and  left  for  dead.^  The 
wound  (Fig.  2*)  cicatrized  in  about  three  months,  without  exfo- 
liation. The  opportunit}^  of  skin-grafting  was  not  improved. 

Foreign  Bodies. — Many  remarkable  instances  of  the  removal 


Fig.  2*. — Granulating  surface  a month  after 
evulsion  of  a portion  of  the  scalp.  (From  a 
photograph.) 

of  balls'’  and 


other 


foreign  bodies  from  under  the  scalp,  or  within  the  cranium,  have  been  recorded. 


* Dr.  Love’s  ligation  of  the  carotid  for  bleeding  in  a wound  of  the  face,  fatal  from  distal  haemorrhage  (case  of  Private 
Copeland.,  p.  347),  is  omitted  in  the  summaries  on  pages  392  and  423,  being  included  in  the  Statement,  p.  394. 

2 Namely,  on  page  81,  successful  cases  of  Private  Fuller.  Lieutenant  Smitli,  and  Corponil  Taylor;  on  page  82,  cases 
of  Lieutenant  Gilmore,  Privates  Hartley,  Mullen,  Keesc,  Corporals  Talmadge,  Kullman,  and  Private  I).  Jones;  also,  cases 

of  Privates  L.  Jones,  page  83;  Newcombe,  page  101 ; Sergeant  R.  D , page  ICO;  I'rivatcs  Wlicclcr,  page  22.5;  Miller, 

page  241;  Allen,  page  244;  Taylor,  page  250;  Runnel],  page  288;  Corporal  E.  Jones,  page  298;  Private  Rrooks,  page  313. 

3 See  Case  5 in  rroceediings  of  the  Second  Anniversary  of  the  Nchrasha  State  Med.  Soc.,  June,  1870,  Omaha,  Nebraska, 

1870,  p.  22. 

^ Since  tlie  case  of  Underu'oed,  p.  281,  was  put  in  type,  Or.  R.  Howard  has  published  (Am.  Jour.  Med.  Sci.,  October, 

1871,  N.  S.  ,\  ol.  LXII,  p.  385)  an  extended  account  of  it.  He  states  that  he  has  “ hunted  up  a long  list  of  wonderful  recoveries 
after  various  injuries  of  the  head,”  but  “has  failed  to  find  another  case  than  the  above  in  which  a missile  out  of  reacJi  and 
out  cf  sight  has  been  discovered  and  removed  from  the  brain  by  trephining — a permanent  rc<-o>  ery  afterward  resulting.”  He 
explains  the  recovery  as  due  to  “neither  skill  nor  attention,  but  the  will  of  Providence  alone." 


Fig. 3*. — Portion  of  bul- 
let extracted  from  tlie 
anterior  lobe  cf  tlic  Icit 
cerebral  hemisphere.— 
(.After  H«)ward.] 


316 


WOUNDS  AND  INJUKIES  OF  THE  HEAD, 


Of  one  Imnclred  and  eighty-six  cases  of  halls  penetrating  the  cranial  cavity,  one 
hundred  and  one  were  fatal ; in  eighty-five  cases  of  removal,  there  were  forty-three 
recoveries ; of  one  hundred  and  one  cases  in  which  the  foreign  body  was  not  removed, 
fifty-nine  were  fatal. 

Contre-Coup. — Consult  the  cases  on  pp.  43,  213,  304,  and  the  authorities  in  the  note.^ 
Trcphmmg . — Besides  the  two  hundred  and  twenty  cases  of  trephining  already  printed 
and  enumerated  in  Table  VIII,  page  309,  the  nine  following  observations  have  been 
found  on  miscellaneous  papers  received  since  the  preceding  sections  were  placed  in  type  : 

Private  George  W.  Hamilton,  Co.  C,  4Cth  Indiana  Volunteers,  received,  at  Jackson,  Mississippi,  July  12tli,  1863,  a 
gunshot  fracture  of  the  cranium.  He  was  taken  to  the  field  hospital,  where  Surgeon  J.  L.  Dickon,  47th  Indiana,  performed  the 
ojjeration  of  trephining.  He  was  afterward  treated  in  the  Jefl’erson  Barracks  Hospital,  and  discharged  on  November  30th,  1863. 
He  did  not  apply  for  a pension  until  February  7th,  1872.  Pension  Examiner  J.  M.  .lustice  reports,  August  7th,  1872,  that 
Hamilton’s  disability  is  one-lmlf  and  permanent.  He  also  states  that  the  upper  portion  of  the  right  parietal  bone,  to  the  extent 
of  two  inches  in  length  and  one  and  a half  inches  in  width,  is  gone,  leaving  the  dura  mater  exposed. 

The  following^  is  the  only  example,  that  has  come  to  my  knowledge,  of  hyperostosis 
following  gunshot  contusions  of  the  cranial  bones,  as  described  by  Mr.  Hewett : 

Thomas  S was  struck,  at  Petersburg,  in  1864,  by  a shell  fragment  on  the  right  parietal,  near  the  middle  of  the 

sagittal  suture.  There  was  no  marked  depression,  and  the  constitutiomd  symptoms  were  slight  and  soon  abated.  Two  years 
afterward  he  had  an  epileptic  convulsion,  which  recurred  in  three  months,  and  tlienwith  increasing  frequency,  until  the  paroxysms 
were  diurnal.  In  1871,  Dr.  J.  T.  Gilmore,  formerly  chief  medical  officer  of  the  1st  Division  of  General  Longstreet’s  Corps, 
deteimined  to  trephine.  The  ]>erforation  measured  nearly  .one  inch  in  thickness.  Meningitis  followed,  and  was  controlled  by 
purgatives,  mercurials,  and  veratrmn  viride.  The  patient  regained  p)erfect  health,  and  at  the  end  of  1871  epilepsy  had  not 
I'eturned. 

John  Berry',  a stout  and  healthy  civilian,  at  St.  Louis,  Missouri,  on  April  27th,  1864,  fell  fiom  a horse,  while  in  a state  of 
drunkenness,  striking  his  head  against  a curbstone.  Soon  after  the  accident,  he  was  received  into  the  Gratiot  Street  Hospital.  On 
examination,  the  wound  of  the  scalp  'was  found  to  be  about  two  and  a half  inches  in  length  over  the  right  parietal  hone,  and  the 
bare  bone  was  detected  with  some  depression.  Five  days  after  the  injury  a trej)hinewas  applied,  and  several  pieces  of  bone  were 
i-emoved.  Three  days  after  tlie  operation,  erysipelas  supei  vened ; for  this,  tincture  of  iron,  quinine,  and  whiskey  were  administered, 
and  the  local  application  of  tincture  of  iodine  was  used.  The  patient  convalesced  rapidly.  On  iMay  30th,  he  was  able  to  walk  about 
town  and  take  full  diet.  About  one  month  later  he  was  discharged  from  the  hospital.  Iveportedby  Surgeon  B.  B.  Breed,  U.  S.  V. 

A soldier  of  the  4th  U.  S.  Heavy  Artillery  (colored)  w'as  struck  on  the  head  ^vith  a spade,  causing  a compound  fracture 
of  the  left  parietal  bone,  with  compression  of  the  brain.  He  was  at  once  carried  to  the  regimental  hospital  at  Columbus,  Ken- 
tucky. Three  hours  after  the  reception  of  the  injury,  trephining  was  performed  and  the  depressed  bone  was  elevated.  He  was 
very  drowsy  for  several  days  after  the  injury  ; pupils  irregularly  contracted  and  dilated  ; the  pulse  at  one  time  falling  as  low  as 
twenty-seven  ; there  was  vomiting,  obstinate  constipation,  and  bloody'  discharge  from  ears  and  nose.  At  date  of  the  report 
February  28th,  1864,  he  was  improving.  Surgeon  James  Thompson,  4th  U.  S.  Heavy  Artillery',  reported  the  case. 

An  unknown  soldier  (German),  while  engaged  in  a drunken  brawl  at  Washington,  in  June  or  July,  1861,  received  a blow 
on  the  head  from  the  butt  of  a musket.  He  was  admitted  to  the  Washington  Infirmary'.  Assistant  Surgeon  J.  W.  S.  Gouley, 
U.  S.  A.,  enlarged  the  wound,  which  was  linear,  and  made  an  incision  across  it,  bringing  the  fractured  left  parietal  into  view. 
There  was  apparently'  but  slight  depression  of  the  outer  table.  The  inner  table  proved  to  be  fractured  in  a stellate  form  and 
driven  in  about  one-eighth  of  an  inch.  The  crown  of  a large  trephine  having  been  applied,  a disk  of  bone,  including  all  the 
fragments,  was  removed.  The  patient  had  comatose  symptoms.  As  soon  as  the  operation  was  performed  ho  regained  conscious- 
ness, but  again  lapsed  into  a state  of  stupor.  On  the  following  morning,  he  answered  questions  coherently.  Eecovery  took 
place  without  further  untoward  symptoms.  Reported  by  the  operator. 

I’rivate  John  H.  Miller,  Co.  I,  134th  New  York  Volunteers,  received  a blow  upon  the  head  at  the  battle  of  Gettysburg, 
.luly  1st,  1803,  from  a sword  in  the  hands  of  his  captain.  He  was  taken  to  the  Seminary  Hospital,  simple  dressings  applied,  and 
on  the  10th  sent  to  Newark,  New  Jersey,  and  furloughed  August  20th,  1863.  While  on  furlough  he  came  under  the  treatment 
of  Dr.  John  D.  Wheeler,  of  West  Fulton,  New  York,  who  reports  some  depression  of  the  edges  f)f  the  fractured  bone,  which  caused 
compression  of  the  brain  and  hemiplegia  of  the  right  side.  The  patient  had  convulsions  regularly  once  a week,  and  these  symptoms 
becoming.more  aggravated,  on  November  24th  Drs.  IVheeler  and  S.  B.  and  H.  Wells  performed  trephining.  He  was  discharged 
I'rom  the  service  Jlay  30th,  1864.  He  applied  for  a pension.  The  Examining  Surgeon,  Dr.  J.  Neill,  reports  that  there  was  a deep 
indentation  an  inch  in  diameter  along  the  middle  of  the  left  parietal  bone,  and  rated  his  disability  as  three-fourths  and  permanent. 

WitAN,  Bcclicrchcs  sur  les  fractures  de  la  base  du  erdne,  (Archives  generalcs  de  medecinc,  1844,  Tom.  VI,  4'“'  serie.);  Boketus,  Theoph., 
Scpulchretum  lih.  IV,  Sect,  li,  obserratio  A'  Geneva;,  1100 ; Celsus,  A.  C.,  Pc  re  medica  libri  octo,  Lugduni,  159i2 ; CHOPAIIT,  Memoire  sur  les  lesions  de 
la  tetc  par  contre-coup,  Paris,  1771;  Gedia,  Memoire  sur  Ic  contre-coup,  Paris,  1778;  Goi'PlL,  Dissertation  sur  les  contre-coups  dans  les  Blessures  de  la 
Tele,  Paris,  1815;  SlhuiiE,  Traite  des  lesions  de  la  iete  p>ar  contre-coup,  jMeaux,  1773;  .SaboI'RAVX,  Memoire  sur  les  contre-coups  dans  dcs  lesions  de  la 
tctc,  1770;  W'AGXER,  P.,  De  contra  fissura,  .Icna,  1708,  in  Haller's  Disp.  Chir.,  'P.  I,  p.  15;  VERlTh,  De  la  guerison  dcs  fractures  da  rocker,  These  de 
J'aris,  1807,  Xo.  -59. 

2 GILMOUE.  Report  of  the  Surgery  of  Mobile  County  for  1871,  j>.  31 : IlEWETl',  in  Holmes's  System  of  Surgery,  1870,  Vol.  II,  je  248,  Rath.  Cat. 
It.  C.  S , Vol.  II.  p.  108,  MSS.  Surg.  Cal.  A.  JI.  M..  Spec.  513,5,  licet.  2. 


TREPHINING  OF  THE  CRANIUM. 


3]  7" 


Private  William  H.  Edwards,  Co.  U,  3d  Iowa  Cavalry,  aged  23  j-ears,  of  good  physical  condition,  was  admitted  into  the 
hospital  at  Keokuk,  Iowa,  January  31st,  lbt)4,  with  a fracture  of  the  left  parietal  bone  near  its  eminence,  caused  by  a blow  from 
a navy  revolver,  at  Memjihis,  January  t;3d,  11:04.  He  was  comatose  and  delirious;  the  soft  parts  were  greatly  lacerated  and 
contused;  there  was  a slight  discharge  of  pus  and  blood;  there  was  a circular  depression  of  the  fractui'ed  bone  less  than  one-half 
an  inch  in  diameter.  The  opeiation  of  trephining  being  deemed  advisable,  Acting  Assistant  Surgeon  1).  S.  SIcGuigan  made  a 
crucial  incision  three  inches  by  four  and  removed  three  large  pieces  of  depressed  bone,  measuring  from  one-half  to  an  inch  in 
diameter,  from  the  inner  table,  and  half  an  ounce  of  coagulum  situated  on  the  dura-mater.  The  patient  reacted  well,  with  a 
complete  return  of  all  his  mental  faculties.  Occasional  epileptic  fits  followed  the  operation,  and  there  was  copious  discharge  of 
laudable  pus;  on  February  20th,  hernia  cerebri,  as  large  as  a hen's  egg,  appeared  ; lime-water  and  chloride  of  soda  were  applied 
without  success,  and  saturated  solution  of  sulphate  of  iron  was  substituted  ; the  hernia  gradually  declined,  and  he  was  discharged 
December  19tb,  1804.  He  applied  for  a pension,  but  his  claim  was  rejected.  The  case  is  reported  bj'  the  operator. 

Private  John  ilcTye,  Co.  G,  Gth  Tennessee  ’\’olunteers,  was  struck  on  the  head  with  a j)iece  of  steel,  knocked  insensible, 
and  robbed,  on  February  7th,  1863.'  He  w as  admitted  into  Hospital  No.  1,  Murfreesboro’,  on  the  same  day.  The  propriety  of 
trephining  was  considered,  but  the  operation  was  not  performed.  He  apiparently  recovered,  and  the  wound  gave  him  no  trouble, 
and  on  March  23d  he  was  transferred  to  Hospital  No.  23,  Nashville,  where  he  was  treated  for  diarrhoea ; on  Ajnil  7th,  while 
applying  for  a pass,  he  was  suddenh'  attacked  with  convulsions,  and  an  examination  revealed  a depression  over  the  fronto-jiari- 
etal suture  sufiiciently  large  to  insert  the  little  finger;  after  consultation,  a T-shaped  incision  w'as  made,  the  trephine  aj)plied,  ;md 
three  pieces  of  bone  removed.  On  the  8th,  he  rested  well,  pulse  124,  tongue  slightly  colored,  and  appetite  poor;  on  the  Oth,  he 
was  very  much  depressed  in  spirit ; on  the  10th,  he  commenced  sinking ; the  parts  around  the  wound  became  much  swollen,  and 
he  died  on  April  11th,  1833. 

Private  George  Philips,  Co.  G,  1st  Iowa  Cavalry,  received,  at  Austin,  Texas,  December  24th,  1864,  a fracture  of  the  left 
parietal  bone,  extending  from  the  temporal  to  the  right  parietal  bone ; another  fracture  parallel  to  and  of  equal  length,  one  inch 
posterior,  along  the  occipital  suture  of  left  side;  the  middle  piece  of  bone  was  fractured  at  right  angles  to  the  other  two  at  its 
centre  and  depressed  about  three-fourths  of  an  inch.  Trephining  was  performed  by  Acting  Assistant  Surgeon  John  Morris.  The 
compression  was  relieved.  The.j)atient  died  on  the  day  of  injury.  The  case  is  reported  by  the  operator. 

Of  one  hundred  and  ninety-six  cases  of  trephining  for  the  results  of  gunshot  injury,  of 
which  one  hundred  and  ten,  or  56  per  cent.,  resulted  fatally,  the  dates  of  operation  were 
accurately  ascertained  in  one  hundred  and  sixty-two.  Of  these  forty-six  were  primary, 
ninety-nine  intermediary,  and  seventeen  secondary  operations.  The  comparative  mortality 
rates  were  : primary,  thirty-two  fatal,  or  69.6  per  cent.;  intermediary,  hfty-six  fatal,  or 
56.6  per  cent. ; secondary,  four  fatal,  or  23.5  per  cent.  If  the  thirty-four  operations,  of 
which  eighteen  were  unsuccessful,  were  included  in  the  intermediary  and  secondary  groups, 
where  they  probably  belong,  the  differences  in  favor  of  the  latter  operations  would  be 
diminished,  but  not  removed. ‘ 

As  to  the  degree  of  fatality  according  to  the  part  of  the  cranium  perforated,  the 
results  of  one  hundred  and  fifty-two  operations  for  the  efi’ects  of  shot ’fractures  limited  to 
one  cranial  bone,  give  the  following  results  ; trejihining  of  parietal  in  eighty-five  cases, 

* AknKMANN,  D.,  Benicrkungen  iiber  die  Durchhohrung  des  processus  masto'idcus  in  gewissen  Fallen  der  Tauhheit^  Gottingen,  179;^;  Breyer,  F., 
De  trepanatione  cranii  in  morbis  capitis,  Tubiug^e,  lb3] ; BILLROTH,  Til.,  Historische  Studien  ubcr  die  Beurthcilung  und  Behandlung  der  ScliussivuridoL 
vom  15,  Jahrhundcrl  his  auf  die  neutsie  Zeit,  Berlin,  1859,  p.  29;  Baket,  F.  G.,  Essai  sar  la  necessite  dc  V operation  du  trepan  dans  les  plaies  dc  tele 
par  armes  d feu,  Fans,  1815;  BERLIN,  A.,  Dc  cranii  trepanatione  fiuadam,  Berolini,  1828;  Celinski,  De  trepanatione  cranii,  Diss.,  Bcruliui,  J833; 
COXSTAIT,  11.,  Xonnulla  de  terehratione  cranii  lusionibus  capitis  adltihenda,  Vratislaviaj,  1865;  Dale,  T.  F.,  Depressed  Fracture  of  the  Cranium 
successfully  treated,  North  Med.  and  Surg.  Jour.,  Vol.  X,  p.  164;  DORSEY,  J.  S.,  Fracture  of  the  Skull  and  \Vound  of  the  Brain,  J^liila.  Med. 
Jifuseum,  Vul.  II,  p.  282,  18U6;  FlOUUEXS,  Considerations  sur  V operation  du  trepan,  Faris,  1830;  FISCIIEU,  II.,  Klinisches  und  e.xpcrimentcllcs  zur  Lehre 
von  der  I'rejjanation,  Berlin,  1865;  GUILD,  J.,  Case  of  Epilepsy  cured  by  Trephining,  Am.  Jour.  Med.  Sci.,  Vol.  IV,  p.  96,  1829;  IBeCKERT,  C.  A., 
De  trepanatione,  adjectis  observationibus  hue  spcctantibus,  Diss.,  Wirceburgi,  1826;  IlAYAVOOD,  G.,  Epilex}sy  successfully  treated  by  Trephining,  Am.  Jour. 
Med.  Sci.,  Vol.  XXII,  p.  517,  1838;  JIOLSTOK,  J.  G.  F.,  Trephining  for  Epilepsy,  Am.  Jour.  Med.  Sci.,  Vol.  XVII,  p.  541,  1849;  JUDKIXS,  W.,  Chronic 
Injuries  if  the  Brain  rclicced  by  an  Operation  with  the  Trephine,  Transyl.  Med.  Jour.,  Vol.  II,  p.  135,  1829;  KauzmanX,  M.  F.,  Dc  noco  irepanationis 
instrumento,  Diss.,  Erlangen,  1802;  Kerxer,  Til.,  De  perforatione  capitis,  Vratisluviae,  18.56;  Lefori’,  DeVutilite  et  des  indications  de  la  trepanation 
du  crane  dans  les  lesions  traumatiques  de  la  tete  {Gaz.  llehd.,  1867,  Nos.  19,  20,  24);  Ludwig,  G.  F.,  De  novo  trejjario  pruccipue  pro  orbitw  vulneribus 
atque  de  indole  worborum  verrialium,  Tubingae,  1811;  Le  Buux'a,  Biblioteka  umiijctnosci  lebarskich,  Chirurgia  Operacyjna,  ^Varzsa\va,  1868;  Laurey, 
M.  l\.,  £tude  sur  la  Trepanation  du  erdne  dans  les  Lesions  traumatiques  de  la  tete,  Faris,  1869;  LOUVRIER,  J.,  Abhandlungcn  iiber  die  Durchhohrung 
des  Schddels,  Wien,  1800;  Lauffs,  J.,  Devariis  Irepanationis  methodis,  Berloni,  1826;  LEISNIG,  A.  F.,  Uber  Trepanation,  WUrzburg,  1844;  i\lAL.vvAL, 
Frecis  d'obs.  sur  le  trepan  in  Mem.  de  V Ac.  roy.  de  Chir.,  1743 ; MOTT',  V.,  Memoir  on  the  Subsequent  Treatment  of  Injuries  of  the  Head,  Trans.  FhysicS- 
Med.  Soc.  of  New  York,  Vol.  1,  p.  223,  1817 ; Nesemanx,  U.,  De  terehratione  cranii  in  htsionibus  capitis  adhibenda,  Vratislavia?,  1858;  NORRIS,  G.  W., 
lieporlof  Casts  of  Injuries  of  the  Head,  Am.  Jour.  Med.  Sci.,  Vol.  IX,  p.  304,  1831;  Fare,  A.,  Fractured  Skull  successfully  trephined,  Chapman's 
Phila.  Med.  Jour.,  Vol.  VHI,  1824;  Kichter,  G.  A.,  tjber  Kopf vcrletzungen  und  die  'Treqmnaiion,  Tubingen,  1863;  BosER,  W..  Zur  Trcpanaiionslr.hre, 
in  pamphlets,  v.  224;  BOGElts,  D.  L.,  Epilepsy  from  Depressed  Bone,  cured  by  Trephining,  N.  Y.  Med.  and  I*hys.  Jour.,  V<1.  V,  p.  18-6;  liOLAXD, 
De  trepanatione  cranii,  Berolini,  1844 ; '1 EXTOR,  C.,  Vber  die  Nichtnothwendigkeit  der  Trepanation  bci  ScJiddcleindrache.n,  V»  iir/burg,  1835 ; \T:i.I’I:au, 
Plaies  de  tete,  Dc  l operation  du  trepan,  Faris,  1854;  VroLIK,  Bcnierkuvgen  uber  dU  Weisewie  die  OeJJiiung  in  dem  Schddcl,  nach  der  Trc2)anation, 
^der  andcrern  Knochenverlust  ausgefullt  wird,  Amsterdam,  1837;  WarelnsiiEIN,  Tldse  de  Paris,  1861,  No.  58,  Du  trepan  tn  Anglelerre ; WIRMAXSKI. 
J.,  De  cranii  trepanatione,  Berolini,  1831;  WEEDS,  J.  F.,  Case  of  Cerebral  Abscess.  Nashville  Jour,  of  Med.  and  Sci.,  April,  1872. 


318 


WOUNDS  AND  INJURIES  OF  THE  HEAD 


forty  fatal,  or  47.1  per  cent.  ; forty-six  of  frontal,  twenty-seven  fatal,  or  58.7  per  cent.  ; 
twelve  occipital,  six  fatal,  or  fifty  per  cent.  ; nine  temporal,  three  fatal,  or  33.3  per  cent.^ 
Hernia  cerebri.- — Sixty-one  cases  were  reported,  with  eleven  recoveries.* 

The  varieties  in  form  of  fractures  produced  by  falls,  blows  with  various  blunt  weapons, 
small  and  large  projectiles,  are  usually,  but  not  invariably,  sufficiently  distinctive  to  bo 
recognized.  The  sword  incisions,  which  cannot  strictly  be  called  fractures,  though  I have 
thus  classified  them  (See  Plate  II  and  Figs.  1,  2,  3,  5),  bayonet  punctures  (Fig.  8),  fissures 

from  falls  on  the  vault  (Figs.  12 
and  14),  are  characteristic ; the 
fractures  caused  by  blows  often 
map  out  the  form  of  the  weapon 
(Figs.  15,  21,  24),  as  in  the 
calvaria  represented  by  Fig. 

The  clean  perforations  made  by 
small  projectiles  striking  the 
skull  perpendicularly  at  close 
range  (see  Circular  3,  S.  G.  0., 

1871,  Figs.  4 and  5),  contrast 
with  the  irregular  fractures  pro- 
duced by  the  oblique  impact  of 
the  same  projectiles  with  lower 
velocities,  and  with  the  effects  of  shell  fragments  (Figs.  146 
and  148).  The  adjoining  cut  (Fig.  d'-")  represents  a calvaria 
contributed  by  Surgeon  J.  T.  Flodgen,  U.  S.  V., — case  of  Private  James  M- 


no.  4*. — Calvaria,  showing  the  shell  fracture 
near  the  vertex.  Spec.  1013,  Sect.  I,  A.  IM. 


Fiq.  5*. — Skull  of  a Pampa  Indian  fractured 
by  the  bolas,  a ball  attached  to  a cord,  a Pata- 
gonian weapon.  Spec.  972,  Sect.  I.  A.  ]\I.  M. 


24th 


Texas  Cavalry,  wounded  by  a shell  fragment  at  Arkansas  Post,  January  11th,  1863,  with 

injury  of  dura-mater  ; died  February  8th,  1863.  Figure  &'■' 
represents  a pistol  liall  perforation  at  close  range  (see  Catalogue 
of  the  Surgical  Section  of  the  Museum,  page  25).  It  is  a 
popular  notion  that  leaden  balls  sometimes  flatten 
against  the  skull  without  fracturing  it.  This  is  prob- 
ably erroneous.  There  is  greatvariety  in  the  mallea- 
bility of  the  lead  used  for  projectiles  ; but  the  mo- 
mentum necessary  to  produce  flattening  in  the  softest  shot  flattened  on 

•L  ° . the  frontal  bone. 

will  generally  suffice  to  overcome  the  resistance  of  4473. 
the  hardest  bone.  The  projectile  represented  in  the  cut  (Fig.  7*)  weighed  only  thirty 
grains,  but  fractured  and  depressed  the  frontal  hone. 


Fig.  6*. — Internal  view  of  segment  of 
left  parietal  perforated  by  a pistol  ball, 
the  inner  table  beveled,  but  not  fissured. 
Spec.  3220,  Sect.  I,  A.  M.  U. 


• In  the  surgical  report  in  Circular  No.  G,  S.  G.  O.,  1865,  page  16,  1 stated  that  “Surgeon  1).  W.  Bliss,  U.  S.  V.,  alone  has  reported  eleven  successes 
after  the  use  of  the  elevator  or  trepliine.”  It  is  true  that  Dr.  Bliss  has  reported  eleven  cases,  but  I find  on  examining  them  that  his  success,  though 
gratifying,  was  not  uniform.  Doubtless  his  success  was  overestimated,  as,  subsequently,  in  regard  to  the  efficacy  of  cundurango  in  cancer,  from  reporting 

cases  before  the  cures  were  confirmed.  He  had  eleven  cases  bf  trephining,  with  six  recoveries,  viz:  1.  R , p.  59;  2.  Morton,  p.  125,  fatal;  3. 

P , p.  266,  fatal;  4.  E , p.  268,  fatal;  5.  Clark,  p.  269,  fatal;  6.  L , p.  272,  fatal;  7.  D — , p.  277;  8.  E , p.  278;  9.  G , p. 

278;  10.  S , p.  281;  11.  Wolfe,  p.  283;  besides  four  cases  of  removal  of  fragments,  namely:  i.  Wagner,  p.  238;  2.  1C , p.  248,  fatal;  3. 

IVIcConnville,  p.  255,  fatal;  4.  Kennedy,  j).  294,  or  fifteen  cases,  with  eight  recoveries. 

2 AURUNI5TIIV,  Surgical  Hor/iTi*,  Vol.  II,  1830,  p.  51;  Allex,  J.  A.,  Fungus  cerebri  successfully  treated  by  Excision,  New  England  Med.  Jour. 
Vol.  VIII,  p.  323,  1819;  Buck,  G.,  Researches  on  IJcrnia  Cerebri  following  Injuries  of  the  Head,  N.  V.  Jour.  Med.  and  Surg.,  Vol.  IV,  p.  348,  1840; 
COliviNUS,  J.  r.  C.,  De  hernia  cerebri,  Argentorati,  1749;  DETMOLU,  W.,  Abscess  in  the  Substance  of  the  Brain;  Hernia  Cerebri,  the  Lateral  Ve.niricles 
opened  by  an  Operation,  Am.  Jour.  Med.  Sci.,  Vol.  XIX,  p.  86,  1850;  IlENNEX,  op.  cit.,  3d  ed.,  p.  316,  case  XLVII;  IIEUSTIS,  J.  W.,  Case  of  Hernia 
cerebri  cured.  Am.  Jour.  Med.  Sci.,  Vol.  Ill,  p.  350,  1829;  Hill,  .T.,  Cases  in  Surgery,  Edinburgh,  J872,  p.  64;  LOUIS,  Sur  le  tumeur  fongeusc  de  la  Dure 
Mere,  Mem.  dc  VAcad.  royal  de  Chirurgie,  Nouv.  6d.,  Paris,  1819,  T.  V,  p.  9;  SOLOMOXS,  De  cerebri  tumoribus,  Diss.,  Edinburgh,  1810;  STANLEY,  Cases 
of  hernia  cerebri,  in  Med.  Chir.  Transactions,  Vol.  Ill;  Held,  De  hernia  cerebri,  Diss.,  Giessae,  1777. 


REMOTE  RESULTS  OF  INJURIES. 


319 


The  closure  of  the  orifice  made  by  the  trephine  is  generally  completed  by  the 
formation  of  a tough  fibroid  substance,  with  scanty,  if  any,  deposition  of  callus.  Hence  the 
old  surgeons  used  to  protect  these  apertures  by  a metallic  or  leathern  disk.  The  destruction 
of  the  pericranium  and  injury  to  the  dura  mater  is  assigned  by  physiologists  as  the  cause 
of  the  absence  of  callus  formation.  The  practical  corollary  is  that  it  would  be  well  to 
reflect,  and  preserve  the  pericranium  over  the  space  interested  by  the  crown  of  the 
trephine.  Klenke^  re|Torts  cases  in  which  these  membranes  were  preserved  and  the  bone 
was  regenerated.  The  Museum  can  add  one  instance  to  the  rare  observations  of  the 
appearances  of  the  perforations  in  the  skull  in  those  who  have  long  survived  trephining : 

A son  of  J.  II.  W , of  Wasliington,  a precocious  lad  of  about  twelve  years,  received,  in  1842,  a compound  depressed 

fracture  of  tlie  right  side  of  the  frontal  bone,  cau.scd  by  a blow  from  a stone.  The  integuments  were  drawn  together  by  adhesive 
strips,  and  ab.solute  rest,  low  diyt,  and  conlinenient  in  a dark  room  were  enjoined  by  his  medical  attendant,  Dr.  Thornton.  He 
recovered  apparently  without  any  untoward  symptoms ; hut  a few  weeks  afterward,  Dr.  Borrows  was  called  to  see  him  ou  account 
of  an  epileptiform  convulsion.  This  was  ascribed  to  gastric  derangement,  and  was  treated  as  an  ordinary  fit.  A few  months 
after  convulsions  recurred,  and  continued  with  periodicity  weekly.  Fully  three  months  now  elapsed  before  any  other  sign  of 
cerebral  disorder  was  manifested.  At  last  there  was  dulness  of  mind,  vertigo,  and  greater  frequency  in  the  recurrence  of  the 
spasms.  About  three  years  after  the  accident,  Dr.  Nathan  R.  Smith  trephined  at  the  depressed  part.  The  youth  was  comparatively 

well  for  six  months  afterward,  when  e])ilepsy 
recurred,  and  he  gradually  became  idiotic.  He 
lived  till  1863.  Physicially  he  was  well  devel- 
oped. These  reminiscences  of  the  case  were 
furnished  orally  by  Dr.  Joseph  Borrows.  The 
specimen  was  contributed  by  Professor  Johnson 
Elliot,  of  the  Georgetown  Medical  College. 

Thetrephine  aperture  is  0.625  inches  in  diameter, 
and  is  closed  by  a tough  diaphanous  membrane, 
having  a tendinous  lustre,  and  appearing  under 
the  microscope  as  formed  of  layers  of  superim- 
posed horny  epithelium.  There  is  a falciform 

projection  from  the  posterior  surface  of  themem-  9»._i,iteriorview  of  s.anie  specimen, 

brane,  which  musthavepressed  upon  the  cerebral  shoving  the  fibroid  septum,  with  its  falci- 
mass.  No  notes  of  the  autopsy  were  preserved.  ferin  prcjcction. 


Fig.  8*. — Fxterior  view  of  trepliine  orifice 
eigliteen  jears  after  operation.  Sj>cc.  5024, 
Sect.  I,  A.  JI.  St. 


Surgeon  Andrews,"  1st  Illinois  Light  Artillery,  differs  from  Guthrie,  and  Irom  the 
opinions  commonly  accepted,  in  regarding  wounds  of  the  anterior  lobes  as  less,  instead 
of  more,  fatal  than  those  of  other  parts  of  the  brain. 


* ■NVagner  {Uber  den  Ilcilungsprozess  vach  Eesection  und  Extirpation  dev  Knochen,  Berlin,  1853,  8.  23)  refers  to  the  paucity  cf  notices  of 
dissections  of  persons  who  have  sur\nvcd  trephining  for  a long  period.  Consult  DUBREUII.  {Presse  Medicate^  1837);  Guexsbuug  {Deutsche  Klimlc, 


Fig.  10*. — Kxterior  view  of  a segment  of  the 
rigid  side  of  the  fnintal  bone,  deeply’  indented. 
Spec.  2019,  Sect.  J,  A.  M.  31. 


1850,  No.  8);  Klexke  {Physiologic  dcr  Enizuiu 
Leipzig,  1842,  S.  197) ; HOICIT.VXSKI  {Lchrbuch 
dcr  Pathologischen  Anatomic,  AVien,  185^  15.  I, 
S.  179) ; Jameson,  Case  in  which  the  Osseous 
Dish,  removed  by  trephine,  was  regenerated,  Mary- 
land Medical  liccordcr,  Vol.  I,  p.  152,  1829 ; 
IIUNAULD,  Sur  les  os  du  erdnede  I'hommcin  Mem. 
de  VAcad.  dcs  Sciences,  1730;  VERlxf:,  De  la 
guerison  des  fractures  du  rocher,  Thhe  de  Paris, 
18G7,  No.  59;  Ollier,  Traite  experimental  et 
Clinique  de  la  regeneration  des  os,  Paris,  18G7 ; 
AAgaroux,  Opuscule  sur  la  regeneration  dcs  os, 
Paris,  1788. 

Opportunities  of  examining  the  repair  of 
depressed  fractures  of  tlic  skull,  after  the  lapse  of 
many  years,  arc  not  very  common.  Ilcncc  the 
interest  attaching  to  the  specimen  represented  by 
the  wood-cuts  (FIGS.  10*  and  11*J.  The  case  is 
reported  on  page  1G5  ante,  and  the  specimen  is 
described  at  page  10  of  the  Catalogue  of  the 
‘Surgical  Section  of  the  Aluscum. 


nnd  Degeneration  in  Organischen  Geweben, 


Fig.  11*. — Interior  view  cf  the  foregoing  speci- 
men. Spec.  2GI9,  Sect.  1,  A.  31.  31. 


* Andrews  {Complete  llecord  of  the  Surgery  of  the  Dattles  fought  near  Vichshurg,  December  27///,  28///,  29///,  and  3(!///,  18C2,  C'liieago,  18G3,  p.  32) 
relates  five  cases  of  cranial  fmeture  with  tlie  following  comments  : “ (5f  those  five  fractures  two  were  from  bullets  penetrating  the  brain  and  tlircc  from 
pieces  of  shell  or  ohlique  bullets.  They  all  died,  without  exception  ; only  one  was  trepanned,  and  lie  without  benefit.  The  general  result  in  military 
surgery  is  that  gunshot  fractures  of  the  cranium  arc  fatal,  and  that  trepanning  is  very  seldom  useful.  A few  unrecorded  cases  of  recovery,  however, 
came  to  my  knowledge,  and  it  is  worthy  of  notice  that  these  were,  without  exception,  wounds  of  the  anterior  lobe  of  the  bruin,  which,  for  some  reason. 


seems  to  sustain  injury  with  less  mortality  than  any  other  part.” 


320 


WOU^’l)S  AND  IN.TURIP:S  of  the  head CONCLEDED. 


liivvi't  LiiHiteiiaiit  Colonel  J.  G.  F.  IIolstox,  Surgeon  U.  S.  V.,  1^’otessor  of  Anatomy  of  the  Georgetown 
Medical  College,  gives  the  following  views  of  o])erative  interference  in  wounds  of  the  head:  *‘I  Avill  hriidlj  state 
my  views  of  trephining  under  the  thr(‘(‘  heads  of  primary,  intermediary,  and  subsequent  opei’ations.  Primary 
operations  are  indicat(‘d  : 1st.  Wliere  the  scali)  is  wounded  and  the  subjacent  hone  hroken  in.  so  as  to  press  upon  a 
portion  of  the  brain  that  cannot  be  relieved  in  any  other  way;  for,  in  this  case,  the  brain  has  already  sutiered  and 
will  sulfer  still  further  injury,  if  not  relieved  : commonly,  some  portions  may  be  picked  away  by  the  forceps,  so  as  to 
render  the  operation  of  trephining  unnecessary,  as  by  means  of  the  lever  the  depressed  bone  may  be  elevated.  In 
these  cases,  it  has  been  my  practice  to  remove  all  depressed  bone,  a little  more  or  less  making  no  dilference.  I have 
preferred  the  chisel  for  such  removal,  as  the  sharp  edge  of  the  chisel  will  cut  cleaner  and  with  less  irritation  than 
the  saw,  the  teeth  of  which  tear  the  tissues,  and  give  almost  as  much  shock  f(»r  every  tooth,  as  the  chisel  and  mallet 
do  at  every  blow.  The  chisel  I have  had  made  by  Tiemann,  is  of  the  form  indicated  (Fig.  I'i*),  the  projecting 
blunt  tooth  of  the  cutting  edge  pressing  aside  the  dura  mater  and  jireventing  injury  to  this  structure.  *2d.  Where  a 
missile,  clothing,  etc.,  had  entered  the  brain,  and  by  cautious  sounding  detected  near  the  orifice.  Where  they  are 
not  so  found,  I should  make  no  curious  explorations  of  the  interior  of  the  cranium,  believing  that  the  patient  may  be 
more  severely  hurt  by  the  exploration  than  by  the  original  injury.  1 should  content  myself  in  such  cases  by 
ri'inoving  all  extraneous  spiculm  of  bone  and  other  detrimental  matter  that  may  be  about  the  orifice  of  the  w’ound.  3d. 
Where  there  is  no  external  wound,  but  evidently  a large  compression  of  bone  on  the  brain.  If  symptoms  of  com- 
pression are  gradually  there  can  be  no  doubt  but  we  should  relieve  the  brain  of  pressure;  in  this  case, 

probably  blood  has  been  poured  out  from  one  of  the  meningeal  arteries.  I consider  such  oj)erutions  intermediary  as 
are  performed  on  the  patient  before  he  has  I’ccovered  from  the  immediate  injury  inflicted.  These  operations  are  by  no 
means  as  successful  as  the  first,  and  are  generally  done  in  such  cases  as  have  not  had  proper  attention.  Hut  there  is 
one  condition,  which  happens  occasionally,  where  a certain  part  of  the  skull  has  been  struck  without  external  wound, 
llolstoii’s  or  witliout  any  sign  of  compression  coining  on  immediately.  After  several  days,  coma  begins  to  manifest  itself,  and 
cliisel.  liere  we  have  probably  to  deal  with  suppuration;  which,  if  not  speedily  provided  with  an  outlet,  will  sink  deeply. 
Subsequent  operations  are  such  as  are  performed  for  the  removal  of  some  difficulty  left  behind,  such  as  epilepsy,  paralysis,  etc.  I 
liave  four  times  successfully  operated  on  epileptics.  The  patients  all  recovered  of  the  operation,  and  all  were  cured  of  the 
epilepsy.  As  regatxls  success,  I would  reckon  first  the  subsequent,  next  the  primary,  and,  lastly,  the  intermediary  operations, 
which  are  least  successful  of  all.  These  are  the  rules  that  guide  us  in  private  ])ractice,  but  I found  in  niy  experience  in  the 
Army  that  they  did  not  hold  good.  The  injuries  of  the  head  are  there  so  much  more  violent,  that  I am  inclined  to  think  no 
intervention  to  be  the  safer  practice.  I believe  I have  seen  more  injuries  of  the  head  recover  Vvithout  trephining  than  with,  so 
that  it  is  an  open  question  with  me,  wdiether  trojdiining  should  not  be  either  entirely  abandoned,  or  left  to  the  judgment  of  one 
specially  qualified  in  the  matter.  In  private  practice,  the  trephine  is  as  successful  as  (ttlier  operative  proceedings,’* 

XoTE. — The  following  authorities  may  he  consulted  on  'Wounds  and  Injuries  of  the  Head:  Andual,  Clinique  de  la  Charite^  Tom.  Y ] Bauciikt, 
Dr.v  lesions  traumatiques  dc  I'cncephale.  Thhe  de  coneours  pour  Vagrtjation,  I’aris  18G0  ; BaUDE.ns,  M.  L.,  Clinique  des  plaics  d'armes  d feu,  l^aris, 
1836;  Elements  de  Chirurgie,  Paris,  18j8,  Tom.  11;  llELL,  I>.,  Sgstcni  of  Surgery,  \^aj1.  Ill,  178o;  IlERCllOX,  Obsercations  rcinurquahles  dc. 

fractures  du  crane.  {Bulletin  dc  la  Socidte  anatomique,  ISOo);  IlEUEXGEU  DE  CARPI,  l)c  fractura  cran/j, l.o2J  ; BICIIAT,  Menwire  sur  Ics  jdaics  de  la 
tele,  Paris;  DoilX,  De  renuntiatione  vulnerurn,  Lipshc,  1711 ; 130IXET,  Des  signes  immediate  dc  la  contusion  du  cerveau.  {Archives  gei.eralcs  dc  medc- 
ci^e,  5““^  serie,  Tom.  II  ct  111  ,1837);  COIUEL,  Traite  dcs  plaics  delete,  Alcn<jon,  1G77 ; BOTALLUS,  L.,  Op.  Omnia,  de  Vainer,  scloj),  1382;  BoVEli, 
J/a/acZje5  Tom.  IV,  edition ; IMilOT,  Ilistoire  dc  V^tat  et  des  l*rogrts  de  la  Chirurgic  ?lilitairc  cn  France,  Bosan^on,  1817;  BUODIE, 

8lR  BEX.i.,  On  Injuries  of  the  Head ; BUOW.NSCHWEIG,  Dis  ist  dat  Buck  der  Cirurgia  llandwucrclcung  dcr  Wundtartznei,  Strasshurg  ; Caspaki,  Die 
Kopfcerletzungen,  Leipzig,  1823;  CiiassaigXac,  Dcslciions  traumatiques  de  I'cncephale,  {These  pour  Ic  concoars  d'agregation  cn  chirurgic,  Paris, 
1842);  CllAUVEL,  Des  f ractures  du  crane  {These  de  ParD,  1864,  121);  COI.LES,  Practical  Precepts  on  Injuries  of  the  Head,  Iluhlin,  1814;  COOPER, 
Samuel,  Diet,  of  Pract.  Surg.,  7th  and  Sth  editions.  1838  and  1861) ; COOPER,  Sir  A.,  Lectures  on  the  Principles  of  Surg.,  V(-l.  I,  London,  1824  ; Dease, 
Obsercations  on  ^youndsofthcIIegd,V^lQ',  L.V^roiTE,  Traite  complct  de  chirurgic,  Tom.  II,  Paris,  1722 ; IJENOXVILLIERS,  Compendium  de  chirurgic, 
Tom.  II,  Paris,  1864;  These  de  concours  pour  Vagrigation,  Paris,  1839;  PES.VUI.T,  Oeuvres  Chirurgicales,  Tom.  II  ; DeSPORTES,  Plaies  d'armes  d feu, 
Paris,  1749,  p.  388;  DE  VIGO,  JOIIX,  Practica  in  arte  chirurgica  copiosa.  Horn,  1514  ; DiONIS,  Cours  d'oj^erations  chirurgicales,  Edition,  1740; 
DUCIILSxe,  Joseph,  Sclopetarius,  Lugdun,  1376;  Dupre  de  lTsle,  Traite  des  lesions  de  la  tele,  Paris,  1770;  LiCilORX,  W.,  De  capitis  hesionihus, 
Krlang,  1815 ; Eltze,  Diss.  defract.  basii  craiiii,  Berlin,  1826  ; Eaurice  d’Ac^BAPEXDEXTE,  (Euvres  chirurgicales,  Lyon,  1674  ; EAIiRICIUS  IllLDAXUS, 
Observations  Medico-chirnrgicalcs.  cent.  6 ; Feiuu  Al.l’IlOXSO,  De  Tor menta riorum  sive  Archihusorum  vHnerum  ct  cura,  Uom,  1552 ; GAMA,  Traite  des 
plaics  de  tete  ct  de  I'cncephalite,  Paris,  1855,  edition ; Garexgeot,  Operations  chirurgicales,  Tom.  Ill,  1751,  2'"®  edition;  (iERARD,  These  dc  Stras- 
bourg, 1802;  Gersdorf,  Fcldbiich  der  M'undtartznci,  Strasshurg,  1517;  GOOCn,  B.,  Cases  and  Practical  lic.marks  in  Surgery,  London,  1758;  GUIL- 
I.EMEAU,  (Euvres  dt  chirurgic,  1C49 ; Gutiiuie,  On  Injuries  of  the  Head.  London,  1842 ; IIaller,  Disputationes  chirurgicic  sclcctic,  Tom.  I,  Vonetiis, 
1755:  IlEXXEN,  Op.  cit.  p.  281;  IlEWETT,  P.,  Lectures  on  Injuries  of  the  Head,  Medical  Times  and  Gazette,  Vol.  11,  1855,  and  Med.  (’hir.  Trans.,  Vol. 
XXXVJ,  1853  ; IllLDAXUS,  Centuria  2.  Observat.  2,  p.  77  IIILLS,  Cases  in  Surgery,  1762  ; HIPPOCRATES,  De  Vulneribus  ca2)ilrs,  1578  ; JOLIEU,  Doctrine 
des  anciens  sur  le.s  plaies  delete  {These  de  Paris,  1811);  Larrey,  Clinique  chirurgicale,  Tom.  1 ct  V ; Lauriol,  Considerations  sur  lis  fractures 
delahasedu  crane  {These  de  Montpellier,  1851,  99);  Ledrax,  Observations  de  chirurgic,  Tom.  I,  1751;  Lombard,  licmarqucs  sur  less  lesions  de  la 
tele,  1796;  LOSIUS,  Observ.  Me.dic.  1,  lib.  I ; Mag.VTUS,  De.  rara  medicatione.  vulnerurn,  Venctiis,  1()76;  Malgaigxe,  De  la  theorie  ct  du  traitement  dcs 
plaies  de  fete  {Gazette  medicalc,  1836);  Maxxe,  Obs.  de  chir.  au  sujet  d'uue  plaie  d la  tele,  Avignon,  1729;  Marchettis,  Observationum  medico 
chirurgorum  radorum  sylloge,  Amstclodam,  1665 ; Marciial  DK  Calvi,  Annales  de  la  chirurgic,  Paris,  1842,  Tom.  V ; MarjoLIX,  Dect!  cn  30  vol.  {tete}, 
1844 ; I^IaslUvURAT-L.vgi^mard,  Ee.chymoscs  palpehrales  ct  orbilaircs  {Archio.  gener.  de  medicine,  1841,  Tom.  XI,  5'"®  serie) ; Matzger,  De  Ixsionibus 
cajyitis,  1774;  MICIIEL,  These  de  Paris,  1854,  No.  95,  QueJque.s  considerations  sur  Ic  crane  surtout  au  jjoint  de.  vue  de.s  fractures  ; 3IIXDKRER,  Mcdicina 
militaris  seu  libcllus  castrensis,  Augsburg,  1620;  Nouiiault,  Traites  des  jylaie.s  de  Tele;  OCIIWADT,  Kriegs-chirui'gische  Erfahrungen  auf  dem 
adrninistrativen  und  technischen  Ge.bicte  u'iihre.nd  des  Krieges  gegen  Ddncmark,  Berlin,  1865;  PARE,  (Euvres  completes,  Tom.  II,  Edition  Malgaigno, 
1840;  Petit  (J.  L.',  (Euvres  chirurgicaless,  T'om.  I,  p.  4:i,  1774;  PERCY,  Manuel  de  Chirurgicn  d'Annh;  Platneu,  Institutiones  chiriirgicvc,  Lipsi;e, 
1745 ; Pott,  P.,  Obs.  on  the  Nat.  and  Con.  of  Wounds  and  Cont.  of  the  Head,  London,  1760;  QUESXAY,  Mem.  de.  V Acad,  de  chirur.,  1743  ; llAXBY,  Method 
of  treating  Gun'.hot  Wounds,  London,  1744;  KiCHET.  Anatomic  medico-chirurgicale,  Paris,  I860;  KOfllAULT,  Traite  des  jdaies  dc  tete,  Turin,  1720; 
S.VUCEROTTE,  Mem.  dc  V Acad,  de  chirur.,  Tom.  IIP,  Saviard,  Nouveau  recueil  d' observations  chirurgicales,  Paris,  1702;  SCIIMIDT,  Kopf verle.tzungen, 
Hamburg,  1838;  SCULTETUS,  Armatne.ntarium  CJtirurgicale.,  1593;  SCIIMUCKER,  Chirurgische  Wahrnehmungen,  Berlin,  1759;  SERRES,  Annuaire 
m6  lico-chi rurgical  des  hopitaux,  1849;  SHARP,  W.,  Practical  Observafioris  on  Injuries  of  the  Head,  Loudon,  1841  ; Teubeler,  De.  vulneribus  cerebri- 
non  semper  Halle,  1760;  TULPIUS,  N.,  Observationes  Medicae,  Lugduni,  Bat.  1716;  "VAX  SwiEfEN,  BocrUaavi  aphorismi  ; Wf.PI'I'.R,  J.  J.. 

Ohse.rvationes  dc  affect,  capitis,  Scaphusii,  1727 ; Yoxge,  of  the  Brain  proved  curable,  London,  1682. 


CHAPTER  II. 


WOUNDS  AND  INJURIES  OF  THE  FACE. 


The  number  of  cases  reported  of  wounds  and  injuries  of  the  face  that  came  under 
treatment  was  nearly  ten  thousand,  or  a proportion  of  rather  more  than  three-fourths,  as 
compared  with  the  lesions  of  the  cranium  and  its  soft  parts.  It  will  be  unnecessary  to 
discuss  the  wounds  of  the  face  in  such  detail  as  those  affecting,  or  liable  to  affect,  the  brain, 
injuries  of  the  head  affecting  the  brain  having  been  already  fully  considered.  The  chapter 
will  be  divided  into  three  sections  ; the  first  devoted  to  the  incised,  punctured,  lacerated, 
and  miscellaneous  wounds,  the  second  to  gunshot  wounds,  and  the  third  to  plastic  operations 
for  deformities  resulting  from  wounds  and  injuries  of  the  face. 


Section  I. 

INCISED  WOUNDS,  CONTUSIONS,  AND  MISCELLANEOUS  INJURIES. 


The  cases  grouped  under  this  heading  number  several  hundreds ; but  few  are  reported 
sufficiently  in  detail  to  possess  much  surgical  interest.  The  most  serious  cases  referable  to 
this  class  were  the  burns  and  scalds,  which  will  be  separately  considered  in  a future  chapter. 
The  instances  of  sabre  and  bayonet  wounds  will  be  enumerated,  and  a tabular  statement 
of  the  other  cases  belonging  to  this  Section  will  be  given. 

Sabee-cuts. — Thirty-seven  cases  of  sword  wounds  of  the  face  were  reported.  In  four 
instances  only  were  the  facial  bones  incised  or  denuded,  and  but  a single  case  had  a fatal 
result.  Tliere  was  no  example  of  grave  injury  to  the  vessels  or  nerves.  Twenty-eight 
ot  the  thirty-seven  wounded  men  were  returned  to  duty,  at  intervals  of  from  one  to  one 
hundred  and  eighty  days.  Three  patients  were  discharged,  one  was  sent  to  the  provost 
marshal  for  exchange,  one  deserted,  one  died,  and  three  are  not  accounted  for. 

41 


322 


WOUNDS  AND  INJURIES  OF  THE  FACE, 


[Chap.  II. 


BAlilfETT,  Robert,  Private,  Co.  F,  Oth  United  States  Cavalry,  aged  34  years.  Mower  Hospital.  Duty,  September 
13th,  1863. 

Brand,  Adam,  Private,  Co.  C,  4tli  New  York  Cavalry.  Aldie  Gap,  June  17th,  1863.  Alexandria  Hosjiital.  Duty, 
June  29th,  1833. 

Brown,  Charles,  Sergeant,  Co.  F,  Oth  New  York  Cavalry.  Rappahannock  River,  October  11th,  1863.  Regimental 
hospital.  Duty,  October  11th,  1863. 

Busiijian,  Henry,  Private,  Co.  B,  8th  New  York,  aged  22  years.  Bull  Run,  July  21st,  1861.  Duty  six  months  after 

injury. 

Carter,  Cornelius,  Corporal,  Co.  C,  4th  Iowa  Cavalry.  Hospital  steamer,  Jefferson  Barracks,  and  Keokuk  hospitals. 
Duty,  March  Oth,  1864. 

Comstock,  Mark,  Private,  Co.  L,  1st  United  States  Cavalry.  Upperville,  June  21st,  1863.  Emory  Hospital.  Duty, 
July  3d,  1863. 

Drake,  William  H.,  Private,  Co.  A,  6th  Ohio  Cavalry.  Upperville,  June  21st,  1863.  Field  and  Emory  hospitals. 
Duty,  July  13th,  1863. 

Fink,  Michael,  Private,  Co.  B,  1st  Potomac  Home  Brigade,  aged  45  years.  Frederick,  March  24th,  1864.  Frederick 
hospital.  Duty,  April  2d,  1864. 

Flynn,  Andrew,  Private,  Co.  A,  6th  Michigan  Cavalry,  aged  32  years.  Gettysburg,  July  2d,  1863.  York  hospital. 
Duty,  December  4th,  1863. 

Freeman,  Moses  H.,  Private,  Co.  G,  6th  Ohio  Cavalry.  Upperville,  June  21st,  1863.  Emory  Hospital.  Duty, 
November  27th,  1863. 

Haynes,  William  G.,  Private,  Co.  B,  I3th  Indiana.  Deserted  House,  Virginia,  January  30th,  1863.  Regimental 
hospital.  Duty,  April  23d,  1863. 

Jones,  Samuel  D.,  Private,  Co.  G,  2d  Massachusetts  Cavalry,  aged  28  years.  Gainesville,  Virginia,  May,  1884. 
Alexandria  hospital.  Duty,  August  1st,  1864. 

Kelly,  Thomas  J.,  Corporal,  Co.  K,  6th  Michigan  Cavalry,  aged  21  years.  Trevillian  Station,  June  11th,  1864.  Field 
and  Mount  Pleasant  hospitals.  Duty,  September  13th,  1864. 

Mandel,  Frederick,  Quartermaster  Sergeant,  Co.  E,  2d  Virginia  Cavalry,  aged  31  years.  Harper’s  Farm,  April  6th, 
1865.  Field  and  Annapolis  hospitals.  Duty,  April  26th,  1865. 

McDonald,  William,  Private,  Co.  II,  148th  Pennsylvania.  Wounded  by  an  officer,  October  19th,  1863.  Regimental 
hospital.  Duty,  November  Oth,  1863. 

Newhall,  Walter  J.,  Captain,  Co.  A,  3d  Pennsylvania  Cavalry.  Gettysburg,  July  1st,  1863.  Duty. 

Northway,  Delos  R.,  Captain,  Co.  A,  6th  Ohio  Cavalry.  Aldie,  Virginia,  June  17th,  1863.  Duty. 

Ringer,  Jacob  A.,  Sergeant,  Co.  A,  50th  Ohio,  aged  37  years.  Chattanooga,  October  8th,  1864.  Nashville,  Louisville, 
and  Madison  hospitals.  Duty,  February  17th,  1865. 

Rod<jers,  William  C.,  Private,  Baltimore  Battery.  Moorfield,  August  7th,  1864.  Sabre-cut  of  face,  with  injury  of  nasal 
bones.  New  Creek  hospital.  Transferred  to  post  commander,  August  25th,  1864. 

Simon,  Lyon  B.,  Private,  Co.  I,  18th  Pennsylvania  Cavalry,  aged  25  years.  Gettysburg,  July  1st,  1863.  York 
Hospital.  Duty,  December  15th,  1863. 

Sny'DER,  M.  JI.,  Sergeant,  Co.  F,  6th  Pennsylvania  Cavalry,  aged  26  years.  Near  Culpeper,  August  1st,  1863.  Wash- 
ington hospital.  Duty,  September  30th,  1863. 

Stokes,  Francis,  Sergeant,  Co.  A,  72d  Indiana  Mounted  Infantry.  Atlanta,  1864.  Duty,  five  weeks  after  injury. 
Straus,  Charles,  Private,  Co.  H,  5th  New  Jersey.  Rappahannock,  January,  1863.  Also  gunshot  wound  of  leg. 
Returned  to  duty. 

Tempest,  Martin,  Private,  Co.  A,  8th  Indiana  Cavalry,  aged  28  years.  Cuyler  Hospital.  Duty,  March  13th,  1865. 
Thorne,  George  H.,  Private,  Co.  H,  26th  Massachusetts.  June  30th,  1803.  Barracks,  New  Orleans.  Duty,  October 
17th,  1863. 

Tompkins,  Aaron  B.,  1st  Sergeant,  Co.  G,  1st  New  Jersey  Cavalry,  aged  21  years.  Amelia  Springs,  April  5th,  1865. 
Field  and  Annapolis  hospitals.  Duty,  May  8th,  1805.  Three  wounds. 

Welton,  John  A.,  Corporal,  Co.  D,  4th  Pennsylvania  Cavalry.  Upperville,  June  21st,  1863.  Field  and  Emory 
hospitals.  Duty,  August  13th,  1863. 

Williams,  John,  Private,  Co.  F,  3d  Wisconsin  Cavalry,  aged  27  years.  Madison,  July  30th,  1864.  Harvey  Hospital. 
Duty,  March  2d,  1865. 

Three  patients  appear  to  have  been  more  seriously  hurt,  and  were  discharged : 

Todd,  Richard,  Private,  Co.  A,  59th  New  York.  Cold  Harbor,  May  31st,  1864.  Sabre-cut,  taking  off  half  of  nose ; 
also,  shell  wound  of  mouth,  and  gunshot  wound  of  thigh.  Discharged  from  service  August  15th,  1864. 

Waffle,  Allen,  Private,  Co.  M,  3d  New  York  Light  Artillery,  aged  20  years.  Accidental.  April  5th,  1865.  Sabre- 
cut  left  eye.  Field  and  Patterson  Park  hospitals.  Mustered  out  May  27th,  1865. 

Durbin,  John,  Private,  Co.  C,  18th  Pennsylvania  Cavalry,  aged  36  years.  Hanover  Junction,  June  30th,  1803.  Sabre- 
cut  of  face,  near  outer  canthus  of  right  eye,  causing  loss  of  sight  of  right  eye,  and  sympathetic  affection  of  left  eye.  Field, 
McKim’s  Mansion,  Cuyler,  and  Satterlee  hospitals.  Discharged  from  service  June  Oth,  1865. 


INCISED  AND  PUNCTUEED  WOUND  OF  THE  FACE.  323 

111  the  following  case  of  a Confederate  prisoner,  the  patient  recovered  and  was 
released  : 

Kissiclc,  Henry,  Priv.ite,  Co.  C,  2d  Kentucky  Cavalry,  ayed  31  years.  Cyntliiana,  June  12tli,  1864.  Covington  hospital. 
Military  prison,  June  27th,  1864. 

Of  two  other  cases  of  this  category,  one  patient  deserted  and  one  died  : 

Watson,  William,  Private,  9th  Indiana  Cavalry,  aged  49  years.  April  9th,  1864.  Indianapolis  hospital.  Deserted 
May  7th,  1864. 

Martin,  J.  TV.,  Private,  Co.  D,  6th  Virginia.  Sahre-cut  of  cheek,  through  zygoma.  Eichinond  hospital.  Died  June 
30tll,  1862. 

In  the  three  following  cases,  the  terminations  cannot  be  ascertained  : 

Lawson,  John  C.,  Private,  Co.  E,  6th  Ohio  Cavalry.  Eaid  in  Virginia,  May,  1864.  Field  hospital.  Termination 
unknown. 

Pike,  Philip  C.,  Private,  Co.  A,  1st  Alabama  Cavalry.  Campaign  in  North  and  South  Carolina,  between  January  28th 
and  March  22d,  1865.  Severe  sabre-cut  of  face.  Field  hospital.  Termination  unknown. 

Clark,  Nelson,  Private,  Co.  F,  122d  Ohio.  Manchester,  Virginia.  Sabre-cut  of  left  side  of  face,  about  one-half  inch 
external  to  angle  of  mouth.  Termination  unknown. 

Bayonet  Wounds. — Twenty-seven  cases  of  bayonet  wounds  of  the  face  were 
reported.  Eleven  returned  to  duty,  eleven  were  discharged,  and  one  died,  and  four  of  the 
wounded  were  not  accounted  for  : 

' Alvis,  John,  Corporal,  Co.  B,  28th  United  States  Colored  Troops,  aged  21  years.  Petersburg,  October  27th,  1864. 
Punctured  wound;  loss  of  right  eye.  Field  and  Alexandria  hospitals.  Discharged  June  10th,  1865. 

Dim,  Frederick,  Private,  Co.  C,  188th  Pennsylvania.  Drury’s  Blulf,  June  14th,  1864.  Fracture  of  lower  jaw.  New 
York  and  Philadelphia  hospitals.  Discharged  May  4th,  1865. 

Gorman,  Michael,  Corporal,  Co.  I,  Second  Veteran  Eeserve  Corps.  January  18t.h,  1865.  Punctured  wound  under  i-ight 
eye.  Elmira  hospital.'  Duty  February  11th,  1865. 

Willard,  Henry  C.,  Corporal,  Co.  B,  13th  New  Hampshire.  Petersburg,  June  13th,  1864.  Mustered  out  of  service 
J une  21st,  1865. 

Corbett,  Michael,  Private,  Co.  C,  13th  New  Hampshire.  Petersbui'g,  June  25th,  1864.  Mustered  out  of  service 
December  19th,  1865. 

Gaycorn,  John,  Private,  Co. — , Vermont  Volunteers.  Lee’s  Mills.  - April  16th,  1862.  Bayonet  wound  of  face,  acci- 
dentally. Eeturued  to  duty. 

Eoark,  John,  Private,  Co.  A,  30th  Massachusetts.  Baton  Eouge,  February,  1862.  Discharged  Jqne  5th,  1863. 

Merdeer,  Millorn,  Private,  Co.  B,  21st  United  States  Colored  Troops,  aged  26  years.  October  28th,  1865.  Hilton 
Head  hospital.  Duty  November  22d,  1865. 

Barr,  Joseph,  Private,  Co.  C,  97th  Pennsylvania.  Deep  Bottom,  August  16th,  1864.  Virginia  and  Philadelphia 
hospitals.  Discharged  June  20th,  1865. 

WYhttaker,  Matthew,  Private,  Co.  F,  32d  Ohio.  Bayonet  wound.  McDowell,  May  8th,  1862. 

Moran,  Tiiojias,  Private,  Co.  F,  13th  Missouri.  Bayonet  wound  of  face.  Fair  Oaks,  May  31st,  1862. 

Sullivan,  Daniel,  Private,  Co.  I,  69th  New  Yoi-k.  November,  1864.  Field  hospital.  Duty  November  11th,  1864. 

Gould,  Charles  G.,  Captain,  Co.  II,  5th  Vermont,  aged  18  years.  Petersburg,  April  2d,  1865.  Field  hospital.  Mustered 
out  of  service  June  19th,  1865. 

White,  Charles,  Private,  Co.  E,  23d  United  States  Colored  Troops.  Petersburg,  July  30th,  1864.  Field  hospital. 
Duty  September  17th,  1864. 

Beldon,  II.,  Corporal,  Co.  B,  41st  Ohio.  Murfreesboro’,  December,  1862.  Field  hospital. 

Burnham,  G.  W.,  Lieutenant,  Co.  G,  6th  Maine.  Fredericksburg,  May  3d,  1863.  Washington  hospital.  Eesigned 
March  20th,  1864. 

Houston,  Eiciluid,  Private,  Co.  C,  31st  Illinois.  Belmont,  November  7th,  1861.  Punctured  wound  under  eye.  Died 
April  22d,  1862. 

Leonard,  Solomon,  Private,  Co.  G,  179th  New  York.  Petersburg,  Juno  30th,  1864.  Field  hospital.  Duty  August 
9th,  1864. 

L^vng,  ilASON,  Private,  Co.  G,  14th  New  York,  aged  37  years.  Petersburg,  July  30th,  1864.  Punctured  wound  of  left 
eye;  also  gunshot  wound  of  scalp.  Field,  Washington,  and  New  York  hospitals.  Transferred  to  Veteran  Eeserve  Corps, 
March  20th,  1865. 


324 


WOUNDS  AND  INJUEIES  OF  THE  FACE, 


[Chap.  II. 


Beerschnider,  JoHif,  Private,  Co.  A,  4th  New  York  Cavalry.  Punctured  wound,  with  loss  of  right  eye.  Georgetown 
hospital.  Discharged  February  2d,  1863. 

Smith,  John,  Private,  Co.  H,  17th  New  York,  aged  25  years.  New  York  City,  July,  1863.  Punctured  wound  of  the  left 
eye.  Desmarres  Hospital,  Washington.  Simple  dressings  applied.  Sight  of  eye  greatly  diminished.  Frequent  an<l  protracted 
attacks  of  asthma.  Condition  of  eye  unimproved.  Discharged  February  26th,  1864. 

Brauy,  Peter  S.,  Private,  Co.  K,  3d  Kentucky.  Chickamauga,  September  20th,  1863.  Nashville  hospital.  Duty 
September  26th,  1864. 

Hank,  David,  Pi-ivate,  Co.  B,  17th  Ohio  Volunteers,  Cumberland  hospital,  Nashville.  Returned  to  duty  January  18th, 

1864. 

Sagee,  Andrew,  Private,  Co.  D,  73d' Pennsylvania,  aged  49  years.  Bird’s  Ferry,  Virginia.  Punctured  wound,  causing 
evacuation  of  humors  of  left  eye.  Rhode  Island  and  Philadelphia  hospitals.  Returned  to  duty  May  27th,  1864. 

Edele,  F.,  Private,  Co.  E,  98th  Pennsylvania  Volunteers,  aged  44  years.  Maryland  hospital.  Returned  to  duty  January 
29th,  1864. 

Henderson,  Randsor,  Private,  Co.  B,  4th  Maryland  Volunteers.  Belle  Island,  Febi-uary  22d,  1864.  Washington, 
Maryland,  and  Pennsylvania  hospitals.  Discharged  June  9th,  1865. 

Fox,  Joseph,  Sergeant,  Co.  G,  148th  Pennsylvania,  aged  20  years.  August  25th,  1864.  Lincoln  hospital.  Duty 
September  24th,  1864. 

Besides  these  sabre  and  bayonet  wounds,  there  were  incised,  punctured,  contused, 
and  lacerated  wounds  of  the  face,  from  stabs,  blows,  kicks,  railway  accidents,  and  other 
causes,  which  may  be  summed  up  as  follows : 

Table  IX. 


Results  of  Sixty  four  Cobses  of  Fractures  of  the  Rones  of  the  Face  from  Various  Causes. 


region. 

Cases. 

Duty. 

Discharged. 

Died. 

Unknown. 

Upper  Maxillary 

11 

4 

4 

1 

2 

Inferior  Maxillary 

\ 

39 

25 

8 

1 

5 

3 

2 

1 

10 

5 

4 

1 

1 

1 

Aggregates 

04 

37 

17 

3 

7 

There  were  also  reported  two  hundred  and  seventy-one  flesh  wounds  of  the  face  from 
similar  causes,  as  follows : 

Table  X. 


Results  of  Two  FLundred  and  Seventy-one  Cases  of  Injuries  of  the  Soft  Tissues  of  the  Face 

from  Miscellaneous  Causes. 


CHARACTER. 

Cases. 

Duty. 

Discharged. 

Died. 

Unknown. 

35 

29 

>5 

1 

Contusions 

154 

95 

45 

2 

11 

24 

15 

2 

Incised  Wounds  (not  sabre) 

34 

27 

5 

1 

1 

24 

8 

13 

3 

Aggi'egates 

271 

167 

83 

3 

18 

Sect,  n.] 


GUNSHOT  WOUNDS  OF  THE  FACE. 


325 


Section  II. 


GUNSHOT  WOUNDS. 


Gunshot  wounds  of  the  face,  comprising  those  of  the  external  ear,  of  the  eyes,  the 
nose,  the  cheeks  and  lips,  the  buccal  cavity  with  the  teeth  and  tongue,  and  the  jaws,  while 
causing,  often,  great  disfigurements,  have  not  a high  ratio  of  mortality.  Secondary 
haemorrhage,  or  suppuration  and  necrosis  following  the  lodgment  of  balls  in  the  spongy 
bones  of  the  nasal  and  supra-maxillary  regions,  are  among  the  more  common  causes  of 
fatality  in  gunshot  wounds  of  the  face.  Wounds  of  the  auricle  presenting  little  importance, 
will  be  summed  up  in  the  tabular  statement  at  the  end  of  the  chapter.  They  are  more 
commonly  associated  with  wounds  of  the  neck  than  of  the  face.  Gunshot  injuries  of  other 
parts  of  the  face  will  be  considered  according  to  region ; but,  as  they  are  so  frequently 
complex,  precise  classification  is  impracticable. 

Gunshot  Wounds  of  the  Orbital  Region. — These  include  the  wounds  of  the  eyelids, 
often  accompanied  by  much  loss  of  tissue  or  by  blepharoptosis  or  ectropion  ; or  of  the  eye- 
brows, frequently  followed  by  amaurosis  ; of  the  globe  of  the  eye  or  of  both  eyes,  involving 
traumatic  cataract,  or  staphyloma,  or  entire  evacuation  of  the  humors,  and  fractures  of  the 
bones  composing  the  orbit.  We  will  commence  with  the  most  serious  cases,  those  in  which 
both  eyes  were  destroyed  : 

Case. — Private  William,  V , Co.  E,  1st  Texas  Regiment,  was  wounded  at  the  battle  of  Arkansas  Post,  January 

lltli,  1863,  by  a fragment  of  shell.  The  missile  entered  the  right  side  of  the  face, 
destroyed  both  eyes  and  fractured  the  left  wing  of  the  sphenoid  and  the  petrous  portion  of 
the  left  temporal.  He  was  left  on  the  field  until  cared  for  by  the  Union  surgeons.  After 
a light  dressing  had  been  placed  over  the  shocking  laceration,  and  anodynes  had  been 
administered,  he  was  conveyed  to  the  hospital  transport  steamer  D.  A.  January,  and 
conveyed  to  St.  Louis  and  placed  in  the  City  Hospital.  On  admission  it  was  found  that 
the  nasal,  lachrymal,  body  of  the  ethmoid,  the  turbinated  bones,  the  vomer,  and  the  upper 
parts  of  both  superior  maxillaries  had  been  carried  away.  Both  malar  bones  were 
separated  and  dislocated  backward.  The  soft  parts  of  the  face  were  erysipelatous  or 
sloughing.  Inflammation  had  extended  to  the  brain.  He  survived  this  terrible  injury 
thirteen  days,  death  coming  to  his  relief  on  January  23d,  1863,  the  day  after  he  entered 
the  hospital  at  St.  Louis.  The  patient  was  under  the  care  of  Surgeon  .John  T,  Hodgen, 

U.  S.  V.,  who  forwarded  the  specimen,  which  is  represented  in  the  wood-cut  (Fig.  1.65), 
with  a memorandum  of  the  case,  to  the  Army  Medical  Museum.  A fracture  traverses  the 
body  of  the  sphenoid  and  petrous  ])ortion  of  the  left  tenij)oral  bone,  and  a second  fissure 
divides,  longitudin.ally,  the  palatine  process  of  the  right  superior  maxillaiy.  The  frontal 
sinuses,  which  are  very  large,  .are  freely  exposed,  and  the  cranial  cavity  is  opened  through 
the  ethmoid,  the  opening  measuring  three-fourths  by  one-lialf  inch. 


Fig.  IS.'j. — Destruction  of  the  eyes  and 
orbital  region.  Spec.  101  ti,  Sect.  I,  A. 
M.  M. 


326 


WOUNDS  AND  INJURIES  OF  THE  FACE, 


[CnAi>.  II. 


Case. — Sorgeant  Jefferson  Coates,  Co.  11,  7tli  IVisconsiii  Volunteers,  aged  20  years,  was  w’ouuded  at  Gettysbui-g,- July 
2d,  1863,  by  a conoidal  ball,  which  entered  immediately  behind  the  outer  angle  of  the  right  eye,  passed  through  the  orbital  plate 
at  the  junctioll  of  the  malar  and  frontal  bones,  through  the  great  wing  of  the  si)henoid,  and  emerged  at  a ))oint  corresponding  to 
the  place  of  entrance,  producing  a wound  not  less  than  an  inch  and  a half  in  diameter,  and  tearing  away  neai'ly  the  whole  of 
the  orbital  jdate.  The  wound  of  entrance  was  about  half  an  inch  in  diameter.  He  was  admitted  to  the  Seminary  Hospital, 
Gettysburg,  and,  on  July  8th,  transferred  to  the  Satterloe  Hospital,  Philadeljdna.  When  admitted,  the  tunics  of  the  right  eye 
were  hanging  out  and  much  tumefied,  about  as  large  as  a black  walnut,  and  covered  witli  a mass  of  slough;  there  w’as  complete 
eversion  of  the  right  lower  lid  ; otherwise  the  lids  of  both  eyes  were  uninjured.  The  left  eye  was  shrunken,  its  contents  evacuated, 
and  the  upper  lid  was  overlapped  by  the  lower.  In  other  respects,  with  the  exception  of  a slight  inflammation,  the  tunics  of 
this  eye  were  healthy  in  appearance.  In  its  passage,  the  ball  had  apjiarently  passed  immediately  beneath  the  cribriform  plate 
of  the  ethmoid,  destroying  a portion  of  the  latter  and  the  lachrymal  bones,  and  probably  severing  the  optic  nerves.  There  was 
a profuse  discharge  of  pus  from  both  wounds,  and  a little  through  the  laceration  in  the  tissues  of  the  left  eye.  The  sense  of 
smell  was  entirely  destroyed.  The  patient  was  in  a tolerably  good  condition,  but  restless ; his  appetite  was  moderate,  tongue 
slightly  furred,  and  pulse  about  90.  Flaxseed  dressings  were  applied.  On  July  10th,  what  appeared  to  be  the  external 
angular  process  of  the  frontal  bone  was  taken  from  the  left  wound;  also  several  small  spiculoe  from  the  right  side.  On  the  11th, 
the  wounds  looked  better;  on  the  13th,  a small  bone,  probably  from  the  orbital  portion  of  the  great  wing  of  the  sphenoid,  left 
side,  was  extracted.  On  the  17th,  the  slough  separated  entirely  from  the  right  eye,  which  presented  a much  imj)roved  condition. 
No  symptoms  of  cerebral  disturbance  had  appeared.  On  the  19th,  there  was  considerable  oedema  of  the  left  eye,  and  the 
inflammation  was  more  marked.  On  J uly  21st,  a thin  plate  of  bone  was  discharged,  from  the  nose,  apj)arently  a piece  of  the 
perpendicular  plate  of  the  ethmoid.  Qadema  of  the  upper  lid  had  much  increased,  though  with  very  little  pain.  July  24th:  the 
oedema  of  the  left  eye  was  rapidly  disappearing  under  a watery  discharge,  which  tasted  salty.  July  25th:  another  small  piece 
of  bone  came  away  from  the  left  wound.  There  was  still  a profuse  discharge ; the  right  wound  was  much  smaller,  and  the  left 
was  granulating  finely.  Night  sweats  occurring,  quinine  in  solution  with  aromatic  sulphuric  acid  was  given  every  three 
hours.  The  right  eye  was  less  congested,  and  tlie  protruding  portion  was  rapidly  disappearing  under  the  action  of  sulphate  of 
copper  in  crystal.  The  patient  was  in  good  spirits.  August  1st:  the  discharge  from  the  left  eye  was  but  small,  and  healthy 
granulations  were  springing  up ; the  discharge  from  the  nose,  and  the  night  sweats  had  ceased.  August  8th : the  wound  of 
entrance  had  healed ; that  of  exit  was  rapidly  closing.  The  patient  was  discharged  on  September  22d,  1864,  and  pensioned. 
Acting  Assistant  Surgeon  M.  J.  Grier,  'who  reports  the  case,  states  that  after  the  insertion  of  the  artificial  eyes  there  will  be  very 
little  deformity. 

Case. — Private  William  Brown,  Co.  D,  119th  Pennsylvania  Volunteers,  aged  24  years,  was  wounded  at  Cold  Harbor, 
Virginia,  June,  1864,  by  a conoidal  ball,  which  entered  the  light  temple  two  inches  from  the  orbit,  and  emerged  through  the  right 
eyeball.  He  was  admitted  to  hospital  1st  division,  Sixth  Corps;  on  June  11th,  transfeiTcd  to  Campbell  Hospit.al,  Washington, 
and  on  .July  23d,  sent  to  Satterlee  Hospital,  rvhence  he  was  discharged  June  28th,  1865.  The  right  eye  was  totally  destroyed, 
and  the  sight  of  the  left  eye  was  lost.  In  IMarch,  1868,  he  was  a pensioner  at  .$25  per  month,  his  disability  being  rated  total  and 
permanent.  Dr.  .T.  A.  McAi-thur  reports  that  Brown  was  under  his  care  at  Soldiers’  Home,  Philadelphia,  until  January  27th, 
1869,  when  he  died  of  phthisis  puhnonalis.  At  the  time  of  his  death,  he  suffered  from  total  blindness. 


Case. — Priv.ate  Charles  C , Co.  H,  30th  North  Carolina  Regiment,  aged  30  yeai-s,  received  at  the  b.attle  of  the 

Wilderness,  May  7,  1864,  a gunshot  wound  of  the  fiice.  The  missile  entered  the  left  temple,  passing  obliquely  anteriorly, 
and  emerging  one  inch  below  the  left  eye,  severely  fracturing  and  comminuting  the  sujierior  maxilla,  and  completely  destroying 

the  nasal  bones.  He  was  among  the  captured  wounded  sent  on  hospital 
transports  to  Washington,  and  on  May  14th  was  admitted  to  Carver  Hospit.al. 
He  was  very  low,  and  in  a com.atose  state,  requiring  considerable  exei-tion  to 
arouse  him  sufliciently  to  partake  of  food  and  stimulants,  which  were  freely 
administered.  He  took  a quart  of  milk  punch  daily.  Detei'gcnt  lotions  were 
applied  to  the  Avound.  The  contents  of  the  left  orbit  were  evacuated,  and 
the  vision  was  destroyed  in  the  right  eye.  Inllammation  gradually  extended 
to  the  brain;  but  without  any  very  violent  symptoms.  The  patient  survived 
twenty  days,  death  resulting  May  27th,  1864.  Acting  Assistant  Surgeon  J. 
E.  Winants  reported  the  ease  and  sent  the  specimen,  figured  in  the  wood-cut 
(Fig.  156),  to  the  Army  Medical  Museum.  The  right  malar,  the  bodies  of 
both  superior  maxillaries,  both  lachrymal  bones,  the  body  of  the  ethmoid, 
with  the  turbinated  bones,  the  left  great  ala  of  the  sphenoid,  and  the  left 
external  angular  process  of  the  frontal  with  the  orbital  plate  have  been  c.arried 
aw.ay.  The  left  parietal  is  fissured  from  the  anterior  inferior  angle  to  the 
parietal  emiuence.  The  left  ])alate  bone  is  fractured  across,  tbe  sphenoid  cells 
are  exposed,  and  the  cranial  cavity  is  freely  opened.  The  edges  of  d.e  fractured 
bones  are  slightly  necrosed  ami  shoev  traces  of  an  attempt  at  repair. 


Camekon,  .Joseph,  Sergeant,  Co.  A,  13th  Ohio  Cavalry,  aged  25  3'ears.  Gunshot  fracture  of  facial  bones.  Conoidal 
ball  enteriKl  one-half  inch  below  external  canthus  of  right  eye,  ]).asscd  under  the  nose,  and  emerged  .at  the  outer  angle  of  left  ej-e, 
carrying  awaj"  a considerable  portion  of  orbital  plate.  Petersburg,  Virginia,  July  30th,  1864.  Conijdete  loss  of  sight  in  both 
ej’es.  Discharged  Januaiy  2d,  1865,  and  pensioned. 


Sect.  II.] 


GUNSHOT  WOUNDS  OF  THE  EYES. 


327 


.Case. — Private  John  T.  Cole,  Co.  A,  lOtli  Veiinont  Volunteers,  aged  24  years,  was  wounded  at  Petersburg,  April  2d, 
186.U,  by  a colloidal  ball,  which  entered  just  above  the  left  zygoma,  passed  through  the  orbit,  and  emerged  through  the  outer 
and  upper  portion  of  the  light  orbital  structure,  destroying  lioth  eyes.  He  was,  on  the  following  da}',  admitted  to  the  depot  field 
hospital  at  City  Point ; on  April  7th,  sent  to  the  Lincoln  Ilosjiital,  AVashington,  and,  on  May  2(5th,  transferred  to  the  Sloan 
Hospital,  Montpelier,  Vermont.  At  this  time  the  wound  of  entrance  had  healed  and  the  general  health  of  the  patient  was  good, 
but  lying  on  the  left  side  would  cause  headache ; the  sense  of  smell  was  entirely  destroyed.  Cold  water  dressings  were  applied ; 
during  the  treatment,  small  pieces  of  bone  were  taken  from  the  wound  of  entrance.  Otherwise  the  case  progressed  well,  and, 
on  June  12th,  1865,  Cole  was  discharged  from  service  and  pensioned  at  $25  per  month. 

Case. — Private  William  II.  Davis,  Co.  C,  51st  Ohio  Volunteers,  aged  22  years,  was  wounded  near  Kenesaw  Mountain, 
Georgia,  June  20th,  1864,  by  a conoidal  ball,  which  entered  the  inner  canthus  of  the  right  eye,  passed  through  the  base  of  the 
nose  and  left  eye  and  emerged  at  the  left  temple,  destroying  both  eyes.  He  was  admitted  to  the  hospital  of  the  2d  brigade,  3d 
division.  Fourth  Corps;  on  June  25th,  sent  to  field  hospital  at  Chattanooga,  Tennessee;  on  July  11th,  to  Hospital  No.  8,  Nash- 
ville ; on  July  22d,  to  Totten  Hospital,  Louisville,  Kentucky,  and  on  August  3d,  to  Camp  Chase,  Ohio,  where  he  was  discharged 
from  the  service  October  27th,  1864,  and  pensioned. 

Case. — Sergeant  Philip  Gottman,  Co.  E,  74tli  New  York  Volunteers,  received,  at  the  battle  of  Gettysburg,  July  2d,  1863, 
a gunshot  wound  of  the  left  temple,  the  missile  destroying  in  its  course  both  eyes.  He  also  received,  in  the  same  engagement, 
two  wounds  of  the  left  thigh  and  one  of  the  right.  He  was  admitted  to  the  field  hospital,  and  on  July  8th,  sent  to  the  Jarvis 
Hospital,  Baltimore,  where  he  was  discharged  the  service  December  15th,  1863.  The  wounds  had  all  healed,  but  the  patient 
was  totally  blind.  He  was,  in  March,  1868,  a pensioner  at  $25  per  month. 

Case. — Privmte  H.  C.  Green,  Co.  F,  2d  New  York  Cavalry,  was,  on  January  28th,  1864,  admitted  to  regimental  hospital, 
with  a gunshot  fracture  of  the  temporal  bone.  A conoidal  ball  entered  upon  the  right  side  of  the  head,  about  one  and  a half 
ipches  from  the  angle  of  the  right  eye,  and  emerged  near  the  outer  angle  of  the  left  eye.  He  was,  on  June  29th,  left  in  the  hands 
of  the  enemy,  but  was  afterward  exchanged,  and  on  October  5th,  1864,  discharged  from  the  service.  Examiner  Cyrus  Porter, 
M.  D.,  reports,  October  5th,  1834,  that  he  is  entirely  blind. 

. Case. — Private  John  Miller,  Co.  I,  7th  New  York  Heavy  Artillery,  aged  42  years,  was  wounded  at  Hatcher’s  Run,  April 
2d,  1865,  by  a conoidal  ball,  which  entered  the  anterior  part  of  the  right  temporal  region,  traversed  both  orbits,  and  emerged  at  a 
corresponding  point  on  the  oi)posite  side  of  the  head.  He  was  sent  to  the  hospital  at  Fort  Monroe  on  April  13th,  and  on  July 
15th,  was  transferred  to  the  Ira  Harris  Hospital,  Albany,  and  discharged  November  30th,  1865,  and  pensioned.  He  was  totally 
blind,  and  the  orbits  were  filled  with  profuse  granulations  of  a flabby,  spongy  character.  There  was  slight  ectropion  of  both 
eyelids,  the  lashes  I'esting  against  the  contents  of  the  sockets  of  the  eyes,  giving  rise  to  considerable  irritation.  Vide  Card 
Photographs,  Vol.  VI,  page  9. 

Case. — Private  Elisha  R , Co.  F,  67th  Indiana  Volunteers,  received,  at  the 

battle  of  Carrion  Crow  Bayou,  Louisiana,  November  3d,  1863,  a gunshot  compound 
comminuted  fracture  of  the  facial  bones.  The  missile  entered  posterior  to  the  right 
external  angular  process  of  the  frontal  bone,  passed  forward  and  inward,  destroying 
the  right  eye,  and  carried  away  the  nasal  and  lachrymal  and  the  orbital  processes  of 
the  superior  maxilla,  and  emerged  through  the  internal  canthus  of  the  left  eye.  He 
was,  on  November  9th,  admitted  to  the  University  Hospital,  New  Orleans.  Simple 
dressings  were  applied  to  the  wound.  The  patient  died  November  22d,  1833.  The 
post  mortem  examination  showed  an  abscess  in  the  right  anterior  lobe  of  the  cerebrum. 

The  lesions  about  the  orbit  are  represented  in  the  adjacent  wood-cut  (Fig.  157).  The 
orbital  poitions  of  the  right  malar  and  upper  maxilla  are  wanting,  and  the  greater 
part  of  the  turbinated  bones  are  comminuted  and  removed.  The  frontal  sinuses  and 
sphenoidal  cells  are  freely  opened.  The  specimen  and  notes  of  the  case  were  con- 
tributed by<Assistant  Surgeon  P.  S.  Conner,  U.  S.  A. 

Case.  Private  Daniel  Stansbury,  Co.  I,  od  Maryland  Volunteens,  aged  36  years,  was  wounded  near  Petersburg,  Virginia, 
June  1/th,  18o4,  by  a conoidal  ball,  w’hich  injured  the  skull  and  destroyed  both  eyes.  He  was  admitted  to  field  hospital.  Ninth 
Corps;  on  June  25th,  sent  to  DeCamp  Hospital,  New  York  Harbor,  and,  on  August  11th,  transferred  to  Newton  University 
Hospital,  Baltimore.  He  was  discharged  from  the  service  on  May  16th,  1835,  and  pensioned. 

Case.'  Private  John  W.  AAilliams,  Co.  F,  16th  United  States  Infantry',  was  wounded  at  Chickamaiiga,  Georgia,  Septtnib(!r 
20th,  1863,  by  a fragment  of  shell,  which  caused  a wound  of  the  right  side  of  scalp,  destroyed  the  right  eye,  and  graztul  the 
orbital  ridge.  He  was  admitted  to  the  1st  division  hospital  at  Annapolis,  and  discharged  from  service  December  21st,  1833,  and 
pensioned.  Examiner  H.  Lenox  Hodge,  M.  D.,  reports,  February  15th,  1864,  that  the  humors  of  the  right  eye  have  been 
evacuated  and  that  the  left  eye  was  probably  torn  from  its  proper  position  by  the  blow.  The  pensioner  suffers  from  total  blindness. 

Case.  Private  Henry  Zimmerman,  Co.  I,  42d  New  York  Volunteers,  was  wounded  at  Antietam,  8ej)tend)er  17th,  1862, 
the  missile  having  passed  through  the  head  from  temple  to  temple.  , Ho  was  convoy/M  to  the  hospital  of  the  Second  Corp.s  at  the 
Hoffman  House,  and  on  October  1st,  was  admitted  to  Camp  A Hospital,  Frederick.  Total  loss  of  vision  resulted,  and  the  ]>atient 
was  discharged  the  service  on  December  19th,  1832,  and  pensioned.  Subsequent  information  avers  that  the  patient’s  lower  jaw 
was  anchylos<!d.  His  disability  is  rated  total  and  permanent. 

Case.  Sergeant  William  H.  I erdon,  Co.  A,  40th  New  York  Volunteers,  agcid  25  years,  was  woundiul  in  the  engagement  at 
Hatchei'’s  Run,  Virginia.  March  25th,  1865,  by  a conoidal  ball,  which  entered  tin?  right  temporal  region  near  outer  angle  of  right 
eye,  and  pa.ssing  tlirough  the  orbital  portion  of  the  sphenoid  bones  on  both  sides,  sevei'cd  in  its  course  the  optic  nei’ves  of  both 


328 


WOUNDS  AND  INJURIES  OF  THE  FACE. 


[Chap.  II. 


eyes.  Tlie  point  of  exit  was  directly  opposite  the  point  of  entrance.  He  was,  on  the  following  day,  admitted  to  the  depot  field 
hospital  of  the  Second  Corps,  at  City  Point,  and  on  March  29th,  transferred  to  the  Armory  Square  Hospital,  complaining  of  much 
pain  in  the  head.  He  could  not  tolerate  opium  or  morphine.  Nervines  were  given  every  hour,  till  quiet  was  procured,  and 
good  wine,  in  small  quantities,  allowed.  On  Ajiril  26th,  the  wound  was  nearly  healed,  but  the  patient  was  entirely  blind.  On 
Jlay  15th,  1865,  he  was  transferred  to  New  York,  where  he  was  discharged  June  13th,  1865,  and  pensioned. 

Case. — Private  Marion  F.  Johnston,  Co.  F,  116th  New  York  Volunteers,  aged  20  years,  was  wounded  at  Winchester, 
Virginia,  September  19th,  1864,  by  a musket  hall,  which  struck  the  left  orbital  ridge,  and  emerged  just  above  the  malar  process  of 
the  right  superior  maxillary  hone,  destroying  both  eyeballs.  He  was  admitted  to  the  depot  field  hospital,  and  thence  transferred, 
on  October  11th,  to  Hospital  No.  1,  at  Frederick.  He  had  almost  lost  his  sight,  but  did  not  present  any  cerebral  symptoms,  and 
the  ^vounds  of  entrance  and  exit  discharged  laudable  pus.  Several  spicula;  of  bone  were  removed  from  the  wound  of  exit.  On 
October  14th  epistaxis,  amounting  to  two  ounces,  took  place,  and  the  conjunctivitis  partially  subsided,  but  the  vision  was  not  yet 
restored.  The  patient  made  now  a rapid  recovery,  and  was  furloughed  on  the  1st  of  November,  1864.  At  the  expiration 
of  his  leave,  he  was,  on  January  3d,  1865,  admitted  into  the  hospital  at  Buffalo,  New  York,  iind  discharged  from  service  on 
April  3,  1865.  He  has  been  pensioned  at  the  rate  of  twenty-five  dollars  per  month,  his  disability  being  rated  total  and  per- 
manent. The  case  is  reported  by  Acting  Assistant  Surgeon  R.  W.  Mansfield. 

Biggs,  Jacob,  Private,  Co.  F,  81st  Indiana  Volunteers,  aged  23  years.  Gunshot  wound  of  face;  loss  of  both  eyes. 
Marietta,  Georgia,  June,  1864.  Admitted  to  Hospital  No.  14,  Nashville,  Tennessee,  July  8th,  1864.  Sent  to  hospital  at  New 
Albany,  Indiana,  July  25th,  1864.  Discharged  May  2d,  1865,  and  pensioned. 

Barrett,  ST'EVESTEit,  Private,  Co.  E,  2d  Connecticut  Artillery,  aged  19  years.  Cold  Harbor,  June  1st,  1864.  Destruc- 
tion of  both  orbits  by  conoidal  ball.  Alexandria  hospital.  Died  July'  22d,  1864. 

Benjamin,  John  I’.,  Corporal,  Co.  H,  170th  New  York  Volunteers,  aged  19  years.  North  Anna  River,  May  27th,  1864. 
Fracture  of  temporal,  with  injury  to  both  eyes.  Field,  Washington,  and  New  York  hospitals.  Died  October  4th,  1864. 

Collins,  Edwin  F.,  Private,  Co.  F,  0th  Connecticut  Volunteers.  Near  Richmond,  October  7th,  1864.  Loss  of  both 
eyes.  Field  hospitals.  Died  October  16th,  1864. 

Davenport,  C.  C.,  Private,  Co.  H,  2d  Louisiana  Regiment.  Gunshot  wound,  destroying  both  eyes.  Chancellorsville, 
Virginia,  May  3d,  1883.  Admitted  to  Louisiana  Hospital,  Richmond,  Virginia.  Furloughed,  for  sixty  days,  June  13th,  1863. 

Griselle,  Balthasar,  Private,  Co.  E,  44th  Illinois  Volunteers.  Gunshot  wound  of  forehead,  with  loss  of  both  eyes. 
Franklin,  Tennessee,  December  17th,  1884.  Admitted  to  Hospital  No.  3,  Nashville,  Tennessee.  Died  January  6th,  1865. 

Garvan,  J.  L.,  Private,  Co.  K,  17th  South  Carolina  Regiment.  Gunshot  wound  of  face,  destroying  both  eyes.  Admitted 
to  hospital  at  Petersburg,  Virginia,  November  10th,  1864.  Died  November  12th,  1864. 

Haase,  Henry,  Sergeant,  Co.  H,  29th  Alabama  Regiment,  aged  25  y'ears.  Nashville,  December  15th,  1864.  Fracture  of 
frontal,  with  destruction  of  eyes.  Field  and  Nashville  hospitals.  Died  December  18th,  1864. 

Henson,  Jonathan,  Private,  Co.  G,  Gth  United  States  Colored  Troops.  New  Market,  September  19th,  1864.  Fracture 
of  frontal,  malar,  and  nasal  bones,  resulting  in  the  loss  of  both  eyes;  also  perforating  wound  of  abdomen.  I’ortsmouth  hospital. 
Died  October  1st,  1864. 

Hendrickson,  William  C.,  Sergeant,  Co.  F,  3d  Kentucky  Volunteers.  Gunshot  wound  of  face.  Ball  entered  half  an 
inch  below  outer  angle  of  right  eye,  and  emerged  at  outer  angle  of  left  eye,  destroying  both  ey'es  and  impairing  sense  of  smell. 
Chickamauga,  September  20th,  1863.  Discharged  December  5th,  1863,  and  pensioned. 

Hodgdon,  John  ISI.,  Sergeant  Major,  13tli  New  Hampshire  Volunteers.  Gunshot  wound  of  face,  ball  destroying  the 
sight  and  fracturing  the  lower  jaw.  Discharged  June  14th,  1865,  and  pensioned. 

Kooken,  Jefferson,  Private,  Co.  1, 123d  Ohio  Volunteers,  aged  44  years.  Missile  entered  at  external  angle  of  left 
eye  and  emerged  at  external  angle  of  right  eye,  producing  blindness.  Discharged  May  28th,  1865,  and  pensioned. 

Merritt,  J.  J.,  Private,  Co.  C,  24th  Georgia  Regiment,  aged  30  y'ears.  Gunshot  wound  of  face;  ball  passing  through  and 
destroying  both  eyes.  Gettysburg,  July  2d,  1863.  I’aroled  September  5th,  1863. 

Mudge,  William  R.,  Private,  Co.  11,  2d  Massachusetts  Volunteers.  Gunshot  wound  of  face.  Both  eyes  lost.  Chanccl- 
lorsville,  Virginia,  May  3d,  1883.  Discharged  and  pensioned. 

McDaniels,  John,  Co.  C,  2d  North  Carolina  Regiment,  aged  25  years.  Gunshot  wound  of  face.  Missile  passed  through 
both  orbits,  from  side  to  side,  destroying  both  eyeballs.  South  iMountain,  Maryland'  September  14th,  1862.  Eyesight 
entirely  lost.  Sent  to  Fort  McHenry,  probably'  for  exchange. 

Ruoher,  James,  Private,  Co.  A,  2d  United  States  Cavalry,  aged  20  years.  Winchester,  September  19th,  1864.  Fracture 
of  parietal  and  frontal  bones ; both  eyes  destroyed.  Field  and  Baltimore  hospitals.  Died  December  6th,  1864. 

Roose,  Simon  J.,  Private,  Co.  F,  145th  Pennsylvania  Volunteers,  aged  28  years.  Gunshot  wound  of  face.  Missile  entered 
outer  canthus  of  right  eye,  jiassed  under  the  nasal  bones,  and  emerged  at  the  external  canthus  of  left  eye,  completely  destroying 
both  eyes.  Gettysburg,  Pennsylvania,  July  2d,  1863.  Mental  aberration  supervened,  but  in  September  his  condition  gradually 
improved.  Discharged  October  28th,  1863.  Not  a pensioner. 

Shoemaker,  Thom.\s  W.,  Private,  Co.  K,  40th  New  York  Volunteers,  aged  21  years.  Conoidal  ball  entered  at  external 
angle  of  right  eye,  passed  through  the  nose  and  lodged,  destroying  the  right  eyeball  entirely.  Inflammation  and  loss  of  sight  of 
left  ey'c.  Discharged  February  18th,  1865,  and  pensioned. 


Sect.  II.] 


GUNSHOT  WOUNDS  OH  THE  EYE. 


329 


SiiELON,  John  M.,  Private,  Co.  A,  110th  Pennsylvania  Volunteers,  aged  30  years.  Gunshot  wound  of  face.  Conoidal 
ball  entered  external  canthus  of  left  ej-e,  and  emerged  at  outer  angle  of  right  eye,  destroying  both.  Artificial  eyes  inserted. 
Discharged  January  24th,  18(55,  and  |)ensioued. 

Sanderson,  Geoi:ge  W.,  Private,  Co.  G,  186th  New  York  Volunteers,  aged  36  years.  Shell  wound  of  superior  maxilla. 
Petersburg,  Virginia,  April  2d,  1865.  Discharged  Juno  5th,  1865.  Both  eyes  involved;  total  blindness.  He  is  a pensioner. 

Ungeeer,  Jacor,  Private,  Co.  B,  15th  New  York  Artillery,  aged  31  years.  Gunshot  wound  of  face;, missile  destroying 
both  eyes.  Petersburg,  June  19th,  1864.  Discharged  April  25th,  1855.  Not  a pensioner. 

WiNTRESS,  David  H.,  Piivate,  Co.  C,  139th  New  York  Volunteers.  Gunshot  wound  of  face.  Conoidal  ball  entered 
left  check  one  inch  below  the  eye,  jiassed  through  and  emerged  near  the  temporal  bone,  destroying  in  its  course  both  eyes. 
Discharged  July  28fh,  1863.  It  is  stated  that  sixty-five  pieces  of  bone  were  removed  from  the  wound.  He  is  a jiensioner. 

Y'engling,  John,  Private,  Co.  C,  24th  Indiana  Volunteers,  aged  35  years.  Fracture  of  right  nasal  bone  and  orbital 
process  of  same  side;  both  eyes  destroyed.  Champion  Hills,  Mississippi,  May  16th,  1863.  Discharged  July  7th,  1863.  Not  a 
pensioner. 

Of  the  foregoing  thirty-nine  cases  of  destruction  of  both  eyes  by  gunshot  injury, 
eleven  were  fatal.  Twenty-two  of  the  survivors  were  pensioned.  Several  of  the  fatal 
cases  were  complicated  by  other  serious  wounds. 

The  next  category  comprises  cases  in  which  only  one  eye  was  destroyed. 

Case. — Private  Peter  Bice,  Co.  B,  57tli  New  York  Volunteers,  aged  30  years,  was  wounded  at  Gettysburg,  July  2d,  1863, 
by  a conoidal  musket  ball,  which  entered  at  the  upper  margin  of  the  zygoma  of  the  right  side,  passed  through  tlie  apex  of  the 
right  orbit,  and  emerged  at  about  the  centre  of  the  lower  margin  of  the  left  orbit.  He  was  admitted  to  the  regimental  hospital 
on  the  same  day,  and  thence  conveyed  to  the  Turner's  Lane  Hospital,  at  Philadelphia,  on  July  11th.  Ordinary  dressings  were 
applied  to  the  wound,  and  cathartics,  stimulants,  and  tonics  administered.  By  July  30th,  the  wound  had  healed,  and  the  patient 
complained  only  of  stifl'uess  of  the  jaw.  The  vision  of  the  left  eye  was  good,  while  that  of  the  right  was  entirely  destroyed.  On 
November  3d,  1863,  he  was  transferred  to  the  Veteran  Reserve  Corps.  The  case  is  reported  by  Assistant  Surgeon  C.  H.  Alden, 
U.  S.  A.  Pension  Examiner  Lathrop,  IM.  D.,  reports,  December  19th,  1866,  that  the  lens  of  the  right  eye  is  opaque,  and  that 
the  lachrymal  duct  of  the  left  eye  is  obliterated,  and  the  visual  power  much  impaired. 

Case. — Sergeant  George  Prince,  Co.  I,  3d  New  Jersey  Cavalry,  aged  28  years,  was  wounded  at  Winchester,  September  19th, 
1864,  by  a conoidal  ball,  which  fractured  the  bones  of  the  face.  The  missile  entered  just  below  the  zygomatic  process,  on  the 
light  side,  passed  through,  carrying  away  the  inferior  and  superior  turbinated  bones,  emerged  about  one  inch  below  the  left  eye, 
and  destroyed  the  right  eye.  He  was  conveyed  to  the  field  hospital,  cavalry  corps;  transferred  to  Baltimore,  October  28th,  and 
on  the  following  day  was  admitted  into  the  Newton  University  Hospital.  On  November  28th,  he  was  transferred  to  Haddington 
Hospital,  Philadelphia.  Anodyne  dressings  were  applied  to  the  wound,  and  spiculte  of  bone  removed  from  time  to  time.  On 
May  11th,  1865,  he  was  admitted  into  the  Satterlee  Hospital,  and  on  July  22d  transferred  to  Ward  Hospital,  Newark,  New 
Jersey,  whence  he  was  discharged  the  service  August  30th,  1865.  A.  M.  M.,  Surgical  Photographic  Series  No.  312.  He  was 
pensioned  and  was,  for  a long  time,  a messenger  of  the  Treasury  Department  of  Washington.  His  general  health  was  good  in 
June,  1871,  when  he  came  to  the  Surgeon  General’s  Office  for  examination.  There  were  frequent  exfoliations  from  the  ethmoid 
and  turbinated  bones,  and  a constant  suppuration  from  a cloaca  in  the  site  of  the  left  lachrymal  sac. 

Case. — Private  W’illiam  Bittinger,  Co.  G,  12th  Pennsylvania  Volunteers,  was  wounded  before  Richmond,  June  28th,  1862, 
by  a conoidal  ball,  which  destroyed  the  left  eye,  and  passing  obliquely  outward,  fractured  the  orbit,  and  emerged  at  a point  two 
inches  above  and  behind  the  left  eye.  He  was  conveyed  to  Baltimore  July  25th,  and  placed  in  McKim’s  Mansion;  transferred 
on  September  19th  to  West’s  Buildings,  and  on  April  29th,  1863,  to  the  York  Hospital  in  Pennsylvania.  On  October  21st,  he 
was  i-eturned  to  Baltimore,  and  admitted  into  the  Patterson  Pai  k Hospital,  and  in  July,  1864,  transfeired  to  Harrisburg,  to  be 
mustered  out  of  service.  Pension  Examiner  Rahter,  ]\I.  D.,  reports,  April  23,  1869,  that  the  bones  of  the  left  orbit  are  all  broken 
away,  leaving  great  defonnity.  What  remains  of  the  eyelid  is  everted,  exposing  the  sensitive  conjunctiva. 

Ca.se. — Private  Thomas  Breen,  Battery  L,  1st  Illinois  Artillciy,  aged  29  years,  was  woundtHl  near  Cumherland,  Maryland, 
on  August  1st,  1834,  by  a conoidal  musket  ball,  which  entered  at  the  inner  canthus  of  the  right  eye,  passed  downward  and 
backward,  through  the  bones  of  the  face,  and  lodged  in  the  fauces,  whence  it  was  ejected  in  coughing.  He  was  admitted  to  the 
hospital  at  Cumberland,  much  depressed  from  the  shock,  as  well  as  from  the  loss  of  blood.  Upon  examination  of  the  wound,  it 
was  found  that  the  missile  had  carried  away  a portion  of  the  inner  wall  of  the  orbit,  the  superior  maxillary,  the  nasal  bones,  and 
the  vomer.  The  eye  seemed  to  have  escaped  the  injury.  The  detached  fragments  of  bone  were  I'cmovcd,  cold-water  dressings 
applied,  and  e.xpectant  treatment  was  used.  On  the  following  day,  there  was  a sanious  discharge  from  the  wound,  some  of  which 
passing  into  the  stomach,  induced  more  or  less  vomiting.  The  tumefaction  increased  until  suppuration  was  established,  on  the 
Gth,  when  there  was  marked  subsidence  of  the  febrile  .symptoms.  TJie  right  eye  was  <lisorganized.  The  ])atient  was  discharged 
February  20th,  1865,  liis  wound  having  healed.  In  July,  1868,  the  pension  examiner  reports  him  in  good  health,  with  the  loss 
of  his  eye  as  a disability. 

C.\SE. — Private  William  II.  Nims,  Co.  l).61st  New  York  Volunteers,  was  wounded  .June  17th,  1^64,  in  front  of  Petersburg, 
and  was  admitted  into  the  hospital  of  the  1st  division.  Second  Corps,  and  thence  sent  to  Columbian  College  IIos|iital,  at 
Washington,  Jun<!  22d,  1831.  He  was  struck  by  a fragment  of  shell,  which  evacuated  the  humors  of  the  right  eye,  and 
ractured  the  musal  bones  and  right  superior  maxilla.  The  treatment  coiisisted  in  the  removal  of  fragments  of  bone,  and  adjust- 

42 


330 


WOUNBS  AND  INJURIES  OP  THE  FACE, 


[Chap.  II. 


ment  of  the  lacerated  soft  parts.  On  April  25tli,  1865,  there  was  a small  fistula,  communicating,  probably,  with  a necrosed 
fragment  of  the  spongy  bones.  Surgeon  Thomas  E.  Crosby,  U.  S.  V.,  who  bad  directed  the  patient’s  treatment,  bad  removed 
all  accessible  dead  bone,  bad  continued  to  keep  the  nasal  canal  pervious,  and  so  coaptated  the  lacerated  parts  about  the  orbits 
as  to  secure  a cic.atrix,  showing  as  little  deformity  as  the  gravity  of  the  injury  would  permit  one  to  hope  for.  A pbotograj)b  of 
tlie  patient  was  made  at  the  Army  Medical  Museum  (Vol.  1,  ]>.  32,  Snrrj.  Scries).  The  patient  was  discharged  from  service  and 
l)ensioned  April  26tb,  1865.  In  1887,  Pension  Examiner  G.  W.  Avery,  reported  that  this  pensioner  continued  to  suffer  greatly, 
and  that  the  very  unple.asant  deformity  induced  by  bis  wound,  made  it  impracticable  for  him  to  obtain  employment.  Thus  bis 
mutilation  was  a doubly  cruel  one. 

Case. — Private  Jonas  Err.ay,  Co.  II,  lOtb  New  York  Cavalry,  aged  23  years,  was  wounded  near  Sbepberdstown,  July 
16tb,  1863,  by  a conoidal  musket  ball,  which  entered  the  frontal  bone  one  inch  above  the  right  superciliary  ridge,  near  the  median 
line,  passed  downward  and  outward,  and  lodged  in  the  superior  maxillary  bone.  Insensibility,  of  four  or  five  hours’  duration, 
followed  the  injury.  The  patient  remained  at  the  field  hospital  until  the  30th,  and  was  then  conveyed  to  Hospital  No.  1,  at 
Frederick.  The  wound  had  nearly  cicatrized,  but  the  pulsations  of  the  brain  were  plainly  visible;  the  sight  of  the  right  eye  was 
destroyed,  and  sensibility  on  that  side  of  the  face  was  lost.  On  the  2d  of  August,  pain  in  the  head  supervened,  due,  in  a measure, 
to  the  irritation  produced  by  the  injured  eye,  with  which,  moreover,  the  sound  eye  sympathized.  The  pain  continuing  unabated. 
Acting  Assistant  Surgeon  John  H.  Bartholf  extirpated,  on  August  11th,  the  right  organ  of  vision.  The  headache  still  continued 
until  the  20th,  and  giddiness  was  produced  by  the  least  exertion;  the  power  of  feeling  and  of  smell  in  the  right  nostril  had,  by 
this  time,  somewhat  improved.  On  the  28th  of  the  month,  the  socket  of  the  right  eye  was  granulating  healthily,  and  there  was 
only  little  discharge  from  the  original  wound.  On  October  1st,  the  wound  had  so  far  healed  that  the  pulsations  of  the  brain 
ceased  to  be  visible.  On  November  3d,  the  missile  was  detected  behind  the  last  mohar  tooth  and  extracted  by  the  dressing 
forceps.  The  sensibility  of  the  fifth  pair  of  nerves  was  now  restored  but  the  mobility  of  the  jaw  remained  limited.  The  patient 
was  discharged  from  service  on  November  16th,  1833.  The  pathological  specimen.  No.  3970,  Sect.  I,  A.  M.  M.,  exhibits  the 
cornea  and  lens  of  the  right  eye.  The  vitreous  humor  in  great  part  remains  opaque  and  of  a yellowish  white  color.  A collection 
of  clotted  blood  fills  the  anteiior  portion  of  the  cavity,  protruding  through  the  iris.  The  case  is  reported  by  the  operator.  Acting 
Assistant  Surgeon  John  H.  Bai'tholf.  Pension  Examiner  J.  K.  Stanchfield,  M.  D.,  reports,  December  21st,  1863,  that  the 
opening  in  the  forehead  is  not  yet  closed  and  sometimes  discharges. 

Case. — Colonel  Patrick  K.  Guiney,  9th  Massachusetts  Volunteers,  was  wounded  at  the  battle  of  the  Wilderness,  May  5th, 
1864,  by  a conoidal  musket  ball,  which  entered  just  above  tlie  inner  angle  of  the  left  eye  and  passed  across  the  orbit  and  behind 
the  malar  bone  and  zygoma  to  near  the  ear,  where  it  lodged.  The  missile  fissured  the  frontal  bone  at  the  inner  extremity  of  the 
supra-orbital  ridge  quite  deeply,  and  must  have  penetrated  the  frontal  sinus.  The  eye  was  destroyed,  and,  in  removing  the  ball, 
Steno’s  duct  was  severed.  He  was  admitted  to  the  hospital  of  the  1st  division.  Fifth  Corps,  and,  on  Iilay  12th,  sent  to  Wash- 
ington, where  he  received  a leave  of  absence  on  May  14th,  1864.  He  was  mustered  out  of  service  on  .Tune  21st,  1884,  and 
pensioned.  For  a year  after  the  reception  of  the  injury  a s.alivary  fistula  continued  to  discharge,  when  one  day  the  discharge 
ceased  suddenly  with  a sensation  of  an  electric  thrill.  No  discharge  recurred,  but  the  thrill  is  renewed  whenever,  in  shaving, 
the  razor  touches  the  cicatrix.  Although  the  wound  was  not  immediately  connected  with  the  brain  it  has  affected  it  in  its 
functions.  He  is  unable  to  concentrate  his  thoughts  for  any  length  of  time  without  suffering  from  dizziness  and  confusion  of  ideas, 
the  dizziness  becoming  so  decided  at  times,  as  to  neces.sitate  the  grasping  of  objects  near  him  for  support.  Since  the  war,  w’hile 
serving  as  Assistant  District  Attorney  at  Boston,  he  has  been  obliged  to  bathe  his  head,  during  the  session  of  the  court,  to  enable 
him  to  attend  to  his  duty.  He  is  now,  February  1st,  1870,  wholly  unfitted  to  attend  to  his  duties  by  reason  of  pneumo-hydro- 
thorax.  The  case  is  reported  by  Dr.  P.  A.  O’Connell,  late  Surgeon  9th  Massachusetts  Volunteers. 

Case. — Private  John  F.  Lord,  Co.  I,  1st  iMaine  Cavalry,  aged  24  jmars,  was  wounded  at  the  battle  of  the  Wilderness, 
May  6th,  1884,  by  a conoidal  musket  ball,  which  entered  the  left  eye  and  lodged  at  the  left  temple.  He  was  at  once  admitted  to 
the  hospital  of  the  2d  division,  Cavalry  Corps,  thence  conveyed  to  Washington,  and  admitted,  on  the  11th,  into  the  Emory 
Hospital,  where  the  missile  was  extracted  and  the  wound  dressed  in  the  usual  manner.  On  IMay  16th,  lie  was  transferred  to  the 
De  Camp  Hospital,  New  York,  and  thence,  on  June  2d,  sent  to  the  Cony  Hospital  at  Augusta,  klaine.  On  February  16th, 
1835,  he  was  discharged  from  service  and  jicnsioned.  Examiner  John  L.  Allen,  M.  D.,  reports,  October  22d,  1866,  that  there  is 
a depression  of  the  skull  over  the  left  eye,  resulting  in  paralysis  of  left  side  and  upper  and  lower  extremities.  He  c.an  but  just 
drag  himself  about. 

Case. — Private  Jade  Kemp,  Texas  Partisan  Eangors,  aged  35  years,  was  wounded  at  La  Fourche  Crossings,  Louisiana, 
June  21st,  1883,  by  a conoidal  ball  passing  from  right  to  left  obliquely  and  backward,  carrying  away  the  nose  from  root  to  the 
end  of  the  osseous  portion,  just  missing  the  right  eye  and  destroying  the  left.  The  ball  emerged  near  the  outer  angle  of  the  left 
orbit.  Portions  of  brain  tissue  escaped.  Cold  w’ater  dressings  were  applied,  and  opiates  and  stimulants  given.  Six  weeks  after 
the  reception  of  the  injuryho  was  returned  to  the  hands  of  tlie  Confederates.  He  had  been  able  to  walk  about  the  ward  for  two 
weeks;  the  wound  tvas  doing  well^  giving  promise  of  entire  recovery.  The  case  is  reported  by  Surgeon  W.  N.  Trowbridge, 
23d  Connecticut  Volunteers. 

Case. — Private  George  Guptill,  Co.  K,  29th  Maine  Volunteers,  aged  24  years,  was  wounded  at  the  battle  of  Cedar  Creek, 
October  19th,  1884,  by  a ball  which  passed  through  the  upper  lid  of  the  left  eye,  penetrated  the  orbital  i)late  and  lodged,  evacu- 
ating the  humors  of  the  globe.  He  was  sent,  on  October  23d,  to  Satterlee  Hospital,  Philadelphia.  Strict  attention  wms  paid  to 
his  diet,  and  his  room  was  darkened.  Several  loose  pieces  of  bone  were  removed.  No  attempt  was  made  to  find  the  ball.  The 
patient’s  pulse  was  decidedly  cerebral,  slow  and  irregular.  Erysipelas  supervened.  In  the  beginning  of  November,  he  com- 
plained of  p.ain  and  twitchings  of  the  muscles  of  the  feet  and  occasional  headache.  Toward  the  end  of  November,  he  began  to 
improve,  and  was  discharged  from  the  service  on  January  7th,  1865.  The  wound,  which  had  been  kept  open  as  long  as  discharge 
issued,  had  closed,  and  he  was,  to  all  a))pearances,  well.  Iii  July,  1868,  the  Pension  Commissioner  stated  that  Guptill  was  a 
pensioner  at  $8  per  month,  his  disability  being  rated  total  and  permanent.  'I'lie  case  is  reported  by  Surgeon  I.  I.  Hayes,  U.  S.  V. 


Sect.  II.] 


GUNSHOT  WOUNDS  OP  THE  EYE. 


331 


Case. — Private  James  Neilson,  Co.  H,  llStli  Pennsylvania  Volunteers,  aged  28  years,  was  wounded  in  an  engagement  at 
Slicplierdstown  Ford,  Maryland,  September  20tb,  18G2,  by  a conoidal  musket  ball,  wbicli  entered  the  mastoid  process  of  the 
right  temporal  bone,  and  emerged  at  the  external  canthus  of  the  left  eye,  destroying  the  organ,  and  tearing  the  lower  lid  so  that 
it  hung  down  over  the  face,  even  with  the  tip  of  the  nose.  He  lay  on  the  field  in  an  insensible  condition  from  morning  until  night, 
when  he  was  taken  to  the  Fifth  Corps  hospit.al.  Thence  ho  was  transferred,  on  the  27th,  to  the  Broad  and  Cherry  Streets  Hos- 
pital, Philadelphia,  and  on  October  3d,  to  the  Cuyler  Hospital,  at  Germantown.  When  the  inflammation  had  subsided,  Acting 
Assistant  Surgeon,  J.  M.  Leedom,  stitched  the  lower  eyelid  with  a lead  suture.  It  soon  united,  and  relieved  the  deformity  very 
much.  The  patient  being  subject  to  fainting  fits,  almost  epileptic  in  their  character,  bromide  of  potassium  was  administered,  and 
after  a few  weeks  the  fits  ceased  to  occur.  He  was  transferred  to  the  Veteran  Eeserve  Corps  on  May  12th,  1864.  In  November, 
1867,  Neilson  was  able  to  follow  his  usual  vocation  of  carpet  weaving.  There  was  a sero-purulent  discharge  from  the  eye, 
especially  in  d.amp  weather,  and  he  was  still  subject  to  liiinting  spells,  when  under  any  undue  emotion,  or  when  exposed  to  great 
heat.  Tlie  reporter.  Dr.  Leedom,  tried  to  introduce  an  artificial  eye,  but  whenever  it  was  inserted,  a fainting  spell  was 
brought  on. 

Case. — Corporal  John  H.  Seldon,  Co.  IT,  21st  Connecticut  Volunteers,  aged  24  years,  was  wounded  at  Petersburg,  July 
30th,  1864,  by  a conoidal  musket  ball,  which  entered  the  left  temporal  region,  passed  through  the  left  orbit,  and  emerged  through 
the  right  nostril.  The  left  eye  was  entirely  destroyed.  He  was  taken  to  the  hospital  of  the  1st  division.  Eighteenth  Corps,  and 
thence  conveyed  to  Washington,  and  placed  in  the  Campbell  Hospital.  On  August  28th,  he  was  sent  to  the  Ladies'  Home,  New 
York,  where  he  remained  under  treatment  until  November  30th,  when  he  was  transferred  to  the  Knight  Hospital,  at  New  Haven. 
He  was  discharged  fi’om  service  February  10th,  1865.  In  1869  he  was  a pensioner,  his  disability  being  rated  as  total.  Mastica- 
tion was  difficult,  his  sense  of  smell  was  affected,  and,  beside  the  loss  of  his  left  eye,  vision  in  the  right  eye  was  impaired.  His 
mind  had  become  so  affected  as  to  unfit  him  for  mental  application,  and  he  complained  of  a dull  pain  in  the  head. 

tCASE. — Private  Thomas  Thatcher,  Co.  K,  12th  Ohio  Volunteers,  was  wounded  at  Bull  Run  Bridge, 
August  27th,  1862,  by  a round  musket  ball,  which  entered  the  inner  angle  of  the  right  eye,  destroying 
that  organ,  passed  obliquely  downward  and  lodged  at  the  angle  of  the  left  inferior  maxilla.  He  was 
admitted  to  the  Mansion  House  Hospital,  Alexandria,  where  the  ball  was  removed.  The  patient  recovered 
and  was  discharged  December  24th,  1862.  The  specimen  and  history  of  the  case  were  contributed  to  the 
FIG.  158.— Round  Army  Medical  Museum  by  Surgeon  J.  E.  Summers,  U.  S.  A.  The  ball,  figured  in  the  wood-cut  (Fig.  158), 
™fs*  of* fnSal  bones  roughened  and  jagged,  .and  there  are  bony  particles  embedded  in  the  furrows.  No  application  from  this 
4 t appears  upon  the  Pension  Records,  hence  it  may  be  hoped  that  his  recovery  was  so  complete  that  he  did 

jl.  M.  ’ ’ not  require  assistance. 

Case. — Priv.ate  George  I’hompson,  Co.  F,  6th  Missouri  Volunteers,  was  wounded  at  Arkansas  Post,  January  11th,  1863, 
by  a pistol  ball,  which  entered  the  inner  portion  of  the  right  supra-orbital  ridge,  near  the  base  of  the  nose,  and  passing  outward 
and  slightly  downward,  fractured  the  orbital  plate,  and  lodged  in  the  frontal  sinus.  He  was  conveyed  by  ste.amer  to  Memphis, 
and  placed  in  Hospital  No.  3,  on  .January  23d.  At  the  dressing  of  the  wound,  the  course  of  the  missile  was  tr.aced  along  the 
fracture  as  far  as  the  bottom  of  the  orbit,  beyond  which  it  was  not  considered  prudent  to  explore.  The  globe  of  the  eye  was 
disorg.anized  and  destroyed.  For  a considerable  time  inflammation  ran  very  high,  and  the  pain  was  exceedingly  severe.  The 
swelling,  however,  after  two  or  three  weeks,  gradually  subsided.  The  wound  remained  very  painful  afterwiird,  and  renewed 
treatment  was  nocessaiy  to  allay  the  pain.  Extirpation  of  the  disorganized  eyeball  was  considered  at  this  time,  but  the  operation 
was  rejected.  Acting  Assistant  Surgeon  Thomas  T.  Smiley,  in  his  comments  upon  the  case,  declares  his  conviction  that  this 
should  have  been  done,  as  thereby  the  missile,  and  ]irobably  splinters  of  bone  at  the  bottom  of  the  orbit  as  well,  might  hav'e  been 
removed.  The  patient  was  discharged  from  service  on  April  3d,  1863,  though  not  entirely  cured,  yet  still  able  to  travel.  In 
March,  1869,  Examining  Surgeon  W.  \V.  Potter  reports  this  pensioners  disability  as  three-fourths  and  permanent. 

Case. — Colonel  J.ames  Washburn,  116th  Ohio  Volunteers,  was  wounded  near  Snicker’s  Ferry,  .July  18th,  1864,  by  a conoidal 
ball,  which  entered  the  comer  of  the  left  eye  and  emerged  from  below  the  right  oar.  The  right  side  became  paralyzed  and  the 
face  grew  di.storted  from  contraction  of  the  facial  muscles.  The  left  eye  was  entirely  destroyed.  He  was  mustered  out  on  July 
5th,  1865,  and  pensioned,  his  disability  being  rated  total  and  i)ermancnt. 

Case. — Private  John  A.  Lasell,  Co.  C,  60tli  New  York  Volunteers,  aged  24  years,  received,  at  the  battle  of  Gettysburg,  ’ 
.July,  1863,  a gunshot  wound  of  the  eye  and  head.  He  was  conveyed  to  the  field  hospital,  where  ho  remained  until  July  10th, 
when  ho  was  transferred  to  New  York,  entering  McDougall  Ho.spital  on  the  12th.  Ho  died  August  23d,  1864.  Assistant  Surgeon 
H.  M.  Sprague,  U.  S.  A.,  reports  the  case. 

Case. — Private  S.  C.  Kennin'iham,,  Co.  IC,  12th  Virginia  Regiment,  received,  on  July  15th,  1863,  a gunshot  wound  of  the 
eye.  He  was  admitted  to  No.  1 Hospital  ;it  Richmond,  soon  after  the  reception  of  the  injury,  and  died  the  day  of  his  admission. 

Case. — Private  M.  JF.  Sexton,  Co.  C,  13th  South  Carolina  Rc'giment,  received  a gunshot  wound  of  the  left  eye  by  a conoidal 
ball.  He  was  admitted  to  the  Jackson  Hospital  at  Richmond,  on  July  29th,  1884,  where  he  died  on  September  30th,  1864. 

Ca.se. — Private  A.  B.  Wilson,  Co.  F,  10th  Temiessee  Volunteers,  aged  29  years,  while  being  taken,  iii  a state  of  intoxica- 
tion, to  the  guard-house  at  Fort  Gillem,  near  Nashville,  on  Se])t<'mber  20th,  1864,  was  accidentally  wounded  by  a conoidid  musket 
ball,  .at  the  angle  of  the  nasal  and  malar  bones,  three-fom-ths  of  an  inch  below  the  inner  canthus  of  tlie  left  eye,  jiassed  dee]ily 
beneath  the  nasal  bones,  upward,  outward,  and  backward,  and  (‘merged  at  tlie  junction  of  the  I'rontal  and  the  right  jiarietal  bones, 
two  inches  from  the  median  line.  Ho  was  immediately  conveyed  to  Hosjdtal  No.  8,  Nashville,  in  an  unconscious  state.  'J'he 
brain  substance  and  bloody  serum  issued  from  the  wound  of  exit,  as  well  as  entmnee.  The  right  eye  was  destroyed  ; its  njiiier 
lid  being  nearly  severed  from  it.s  connoclions.  The  usual  dressings  were  ajiplied,  and  the  treatment  in  the  main  was  ex))ectant. 


332 


WOUNDS  AND  INJURIES  OF  THE  FACE 


[Chap.  II. 


During  the  day  the  pulse  rose  from  7G  to  80,  the  respirations  numbered  16,  and  consciousness  was  partially  restored.  On  the22d 
he  had  become  fully  conscious,  and  complained  of  pain  in  the  head.  The  next  morning  the  pulse  was  96,  and  the  respirations 
20.  He  was  still  conscious,  though  mental  effort  was  dull;  but  shortly  afterwai'd  he  sank  into  a state  of  coma.  The  brain  sub- 
stance now  exuded  freely.  He  died  on  September  24th,  1864.  At  the  autopsy,  on  dividing  the  integuments  between  the  wounds 
of  entrance  and  exit,  the  nasal  and  frontal  bones  were  found  badly  fractured,  and  several  large  fragments  of  the  frontal  were 
detached.  Further  examination  disclosed  extensive  disorganization  of  the  encephalon. 

Case. — Private  Louis  W , Co.  K,  10th  Vermont  Volunteers,  aged  33  years,  was  wounded  at  tl;e  battle  of  Cold  Harbor, 

Virginia,  June  1st,  1864,  by  a conoidal  musket  ball,  which  entered  the  frontal  bone  above  the  nasal  eminence,  carried  away  both 
sinuses  and  a portion  of  the  left  orbital  ()late,  destroyed  the  left  eye,  and  escaped  near  the  angle  of  the  left  I'amus  of  the  lower 
jaw.  He  was  conveyed  to  Washington,  and  admitted,  on  the  9th,  into  the  Lincoln  Hospital.  Death  occurred  June  16th,  1864. 
At  the  autopsy,  an  opening  was  found  in  the  frontal  sinus,  measuring  three-fourths  by  half  an  inch,  through  which  a grayish 
slough,  involving  the  brain,  and  exhaling  a gangrenous  odor,  was  observed.  Upon  the  removal  of  the  frontal  portion  of  the 
calvarium  to  a level  with  the  orbital  region,  a fragment  of  the  wall  of  the  sinus  was  found,  adherent  to  the  dura  mater,  beneath 
which  membrane  extravasation  of  venous  blood  existed.  There  was  also  a general  enlargement  of  the  veins  of  the  cerebrum. 
The  optic  commissure  and  nei've  were  found  lacerated,  and  the  tuber  cinereum  in  a sloughing  condition.  Some  twelve  ounces  of 
venous  blood  exuded  from  the  meningeal  vein,  especially  from  several  points  along  the  falx  cerebri  and  falx  cerebelli.  The  heart 
was  fatty  on  the  right  side,  but  the  lungs  and  other  organs  were  perfectly  sound.  The  pathological  specimen  is  No.  2574,  Sect. 
I,  A.  iM.  M,  and  was  contributed,  with  its  history,  by  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A. 

Abbott,  Haklin,  Private,  Co.  F,  77th  New  York  Volunteers,  aged  24  years.  Spottsylvania,  May  10th,  1864.  Fracture 
of  edge  of  left  orbital  arch  and  laceration  of  integuments  of  eyebrow.  Left  eye  destroyed  and  sight  of  right  eye  impaired. 
Washington,  Philadelphia,  New  York,  and  Albany  hospitals ; transferred  to  Veteran  Reserve  Corps.  Discharged  August  4th, 
1865;  pensioned. 

Ackerly,  D.ARIUS,  Corporal,  Co.  K,  19th  Michigan  Volunteers.  Thompson’s  Station,  Tennessee,  March  5th,  1863.  Bridge 
of  the  nose,  right  eye,  and  a portion  of  the  temporal  bone  carried  away  by  a conoidal  ball ; also  wound  of  left  thigh.  Taken 
prisoner,  exchanged,  and  treated  at  Annapolis  and  Camp  Chase.  Discharged  October  23d,  1863. 

Adajis,  Erastus,  Private,  Co.  M,  1st  Maine  Heavy  Artillery,  aged  41  years.  Petersburg,  June  18th,  1864.  Fracture  of 
left  side  of  frontal  bone.  City  Point,  Rhode  Island,  and  Maine  hospitals.  Total  loss  of  right  and  partial  loss  of  left  eye.  Dis- 
charged July  14th,  1865,  and  pensioned. 

Austin,  L.,  Private,  Co.  A,  24th  New  York  Cavalry,  .aged  21  years.  Petersburg,  June  18th,  1864.  Conoidal  ball  entered 
above  the  left  eye  and  lodged  under  the  right  ear.  Field,  Washington,  and  Philadelphia  hospit.als.  Left  eye  destroyed.  Dis- 
charged June  14th,  1885,  and  pensioned. 

Adams,  George,  Private,  Co.  I,  9th  New  Hampshire  Volunteers.  Petersburg,  July  25tlt,  1864.  Gunshot  wound  of  face. 
Admitted  to  Emory  Hospital,  Washington,  August  1st,  1864.  Removal  of  spicula  of  bone.  Discharged  November  20th,  1864, 
with  loss  of  right  eye  and  partial  loss  of  sight  of  left  eye,  and  pensioned. 

Adams,  Thomas,  Private,  Co.  K,  13th  Ark.ansas  Regiment,  aged  24  years.  Franklin,  Tennessee,  November  30th,  1864. 
Gunshot  fr.acture  of  superior  maxilla;  eye  destroyed.  Sent  to  Provost  Marshal  June  9th,  1865. 

Ames,  John  F.,  Private,  Co.  G,  91st  New  York  Volunteers,  .aged  24  years.  Gravelly  Run,  Virginia,  March  21st,  1865. 
Gunshot  fracture  of  left  nasal  and  superior  maxillary  bones.  Entire  destruction  of  left  eye.  Ligation  of  left  common  carotid 
artery.  Discharged  July  3d,  1865,  and  pensioned.  A.  M.  M.  Photograph  Series,  No.  283. 

Abbott,  Joel,  Private,  Co.  D,  12tli  New  Jersey  Volunteers.  Chancellorsville,  May  3d,  1863.  Gunshot  wound,  fracturing 
orbital  plate  and  destroj'ing  left  eye.  Sight  of  right  eye  sympathetically  impaired.  Washington,  Delaware,  and  New  Jersey 
hospitals.  Discharged  December  11th,  1863,  and  pensioned. 

Board.m.vn,  Mok.vnd,  Private,  Co.  B,  9th  Illinois  Volunteers,  aged  41  years.  Shiloh,  April  6th,  1862.  Fiacture  of  m.alar 
and  frontal  bones  and  destruction  of  eye.  City  hospital,  St.  Louis.  Great  dishgur.ation.  Discharged  September  23d,  1882. 

Bradley,  J.  C.,  Private,  Co.  G,  14th  Alabama  Regiment.  Destruction  of  left  eye  .and  audition,  left  side,  by  gunshot  missile. 
Treated  in  Richmond  hospitals,  and  furloughed  July  19th,  1864. 

B)-itt,  J.  J.,  Sergeant,  Co.  D,  43d  North  C.arolina  Regiment,  aged  27  years.  Winchester,  September  19th,  1864.  Destruc- 
tion of  vision  of  left  eye  by  a fragment  of  shell.  Tiiken  prisoner  and  treated  in  field  and  Baltimore  hosjntals.  Sent  to  Provost 
Marshal  for  exchange  April  8th,  1885. 

Burke,  Albert  J.,  Corporal,  Co.  I,  117th  New  York  Volunteers,  aged  28  years.  Petersburg,  July  9th,  1864.  Destruc- 
tion of  right  eye  by  explosion  of  shell.  Fort  Monroe,  Rhode  Island,  and  New  York  hospitals.  Deafness  of  right  ear.  Discharged 
March  1st,  1885,  and  pensioned. 

Bur.meister,  Henry,  Sergeant,  Co.  A,  9th  Illinois  Volunteers.  Shiloh,  April  6th,  1862.  Fracture  of  right  orbital  arch 
and  destruction  of  left  eye.  Quincy,  Illinois,  hospital.  Exfoli.ation  of  bone.  Repulsive  deformity.  Discharged  September 22d, 
1862,  and  pensioned. 

Butkr,  IF.  C.,  Sergeant,  Co.  C,  15th  Virginia  Regiment.  Gunshot  wound  through  right  oihit;  also  wound  of  thigh. 
How.ard  Grove  Hospital,  Richmond.  Furloughed  June  29th,  1864. 

Byrne,  Dudley’,  1‘rivate,  Co.  A,  88th  New  York  Volunteers.  Antietam,  September  17th,  1862.  Loss  of  right  eye. 
Philadelphia  hospital.  Discharged  Januaiy  5th,  1863,  and  ])ensioned.  There  was  great  defoiaurty,  and  the  sense  of  smelling  was 
gone.  Neuralgic  trouble  also  existed. 

Barksdale,  llezekiah  I).,  Private,  Co.  E,  6th  Arkansas  Regiment.  Fracture  of  right  orbital  ridge;  eye  destroyed.  Admitted 
to  Confederate  hospital,  Dalton,  Georgia.  Tlie  result  of  the  case  is  not  recorded. 


Sect.  II.] 


GUNSHOT  WOUNDS  OF  THE  EYE. 


333 


Balders,  Charles,  Corporal,  Co.  K,  134th  New  York  Volunteers,  aged  31  years.  Gettysburg,  July  1st,  18G3.  Fracture 
of  frontal  bone  over  left  eye  by  conoidal  ball ; eye  destroyed ; also  wound  of  right  arm.  Pennsylvania  ami  New  York  hospitals. 
Discharged  January  31st,  1865,  and  pensioned. 

Belcher,  Char^,es,  Private,  Co.  K,  6th  Pennsylvania  Volunteers.  Antietain,  September  17th,  1862.  Fracture  of  frontal 
bone.  Corps  and  W'ashington  hospitals.  Destruction  of  left  eye  and  partial  deafness  of  left  ear.  Discharged  November  3d, 

1862,  and  pensioned. 

Blxby,  Philip,  Private,  Co.  E,  92d  New  York  Volunteers.  Fair  Oaks,  May  Slst,  1862.  Fracture  of  fi-ontal  bone  above 
left  orbit;  missile  lodged,  destroying  sight.  Field  and  New  York  hospitals.  Discharged  October  29th,  1862. 

Bradden,  Isaac  H.,  Private,  Co.  B,  24th  Indiana  Volunteers,  aged  21  years.  Champion  Hills,  Mississippi,  May  16th, 

1863.  Gunshot  wound;  missile  entered  at  the  external  canthus  of  left  eye,  passed  under  the  bones,  and  emerged  through  the 
internal  ear,  fracturing  orbital  plate  of  malar  bone,  destroying  eye,  and  causing  entire  deafness  of  ear.  Memphis,  St.  Louis, 
and  Madison  hospitals.  Discharged  July  26th,  1864,  and  pensioned.  Great  deformity. 

Browist,  John,  Private,  Co.  G,  2d  Delaware  Volunteers.  Antietam,  Maryland,  September  17th,  1862.  Gunshot  wound 
of  face.  Conoidal  ball  entered  right  ear,  and  emerged  from  right  eye,  completely  destroying  the  globe.  Admitted  to  Satterlee 
Hospital,  Philadelphia,  October  29th.  The  lower  lid  became  everted.  Discharged  January  20th,  1863,  and  pensioned. 

Bennett,  IF.  B.,  Co.  B,  49th  North  Carolina  Regiment.  Gunshot  injury  of  bones  of  face  and  destruction  of  right  eye. 
Admitted  to  Chimborazo  Hospital,  Richmond,  Virginia.  Furloughed  for  sixty  days. 

Bechet,  J.  Z.,  a Confederate  soldier.  Gunshot  fracture  of  bones  of  face.  Missile  entered  arch  of  nose  and  passed  through 
right  orbit,  destroying  the  eye.  Admitted  to  Howard  Grove  Hospital,  Richmond,  Virginia.  Furloughed  for  sixty  days, 
July  14th,  1864. 

Boxxell,  Charles,  Private,  Co.  A,  64th  Illinois  Volunteers,  aged  18  years.  Gunshot  injury  of  occipital  and  frontal 
bones,  with  destruction  of  right  eye.  Nashville,  Tennessee,  December  18th,  1864.  Admitted  to  McDougall  Hospital,  New 
York,  January  12th,  1865.  Discharged  June  26th,  1865,  and  pensioned. 

Barxes,  Thomas  G.,  Private,  Co.  H,  67th  New  York  Volunteers,  aged  21  years.  Conoidal  ball  entered  frontal  bone 
to  left  of  median  line,  traversed  the  sinus,  and  lodged  in  nasal  foramen ; also  wound  of  left  thigh,  two  inches  above  knee. 
Admitted  to  Patent  Office  Hospital,  Washington,  December  11th,  1862;  sent  to  Ladies’  Home  Hospital,  New  York,  January,  1863. 
Aqueous  humor  of  left  eye  ran  out.  Discharged  May  18th,  1863.  He  is  not  a pensioner. 

Baggott,  \V.  H.,  Private,  Co.  K,  3d  Tennessee  Cavalry,  aged  18  years.  Conoidal  ball  entered'  and  destroyed  left  eye, 
and  emerged  at  mner  angle  of  right  eye.  Pulaski,  Georgia,  September  25th,  1864.  Discharged  July  13th,  1865,  and  pensioned. 

Ballstetter,  Charles,  Co.  E,  74th  Pennsylvania  Volunteers.  Conoidal  ball  entered  near  left  ear,  passed  through 
lower  jaw,  obliquely  through  the  upper,  and  destroyed  the  right  eye.  Bull  Run,  Virginia,  August  29th,  1862.  Discharged 
February  24th,  1863.  He  is  not  a pensioner. 

Bolton,  S^amuel  M.,  Private,  Co.  D,  11th  Maine  Volunteers,  aged  32  years.  Missile,  a buckshot,  penetrated  and 
destroyed  the  right  eyeball.  Bermuda  Hundred,  June  2d,  1864.  Ball  removed.  Discharged  April  21st,  1865,  and  pensioned. 

Berg,  John,  Pilvate,  Co.  A,  117th  New  York  Volunteers,  aged  25  years.  Gunshot  wound  of  face.  Missile  carried 
away  right  eye.  Fort  Fisher,  North  Carolina,  January  15th,  1865.  Discharged  June  22d,  1865,  and  pensioned. 

Carpenter,  J.  D.,  Private,  Co.  M,  16th  North  Carolina  Regiment.  Chancellorsville,  May  3d,  1863.  Fracture  of  cranium, 
with  loss  of  vision  of  left  eye.  Treated  in  Richmond  hospital  until  June  18th,  1863,  when  he  was  furloughed. 

Clifton,  Perry  C.,  Private,  Co.  B,  20th  Indiana  Volunteers,  aged  40  years.  Bull  Run,  August  29th,  1862.  Fracture 
of  temporal  and  orbital  bones  and  destruction  of  left  eye.  Alexandria  hospital.  Discharged  October  31st,  1862,  and  pensioned. 
Vision  of  right  eye  impaired.  Great  deformity. 

Clinton,  Thomas,  Private,  Co.  K,  1st  United  States  Artillery,  aged  25  years.  Accidentally  shot  March  9th,  1865. 
Loss  of  left  eye.  Field  and  Frederick  hosjiitals.  Vision  of  light  eye  impaired.  Discharged  July  22d,  1865,  and  pensioned. 

Craig,  James  A.,  Private,  Co.  D,  198th  Pennsylvania,  aged  44  years.  Gravelly  Run,  March  29th,  1865.  Fracture  of 
temporal  bone  and  bones  of  face  ; right  eye  destroyed.  Field,  Washington,  and  Philadeljihia  hospitals.  Impaired  vision  of  left 
eye.  Discharged  July  27th,  1865,  and  pensioned. 

Crew,  John,  Private,  Co.  F,  12th  United  States  Infantry.  Before  Richmond,  latter  part  of  June,  1862.  Fracture 
of  cranium  and  loss  of  right  eye  by  conoidal  ball.  Baltimore  hospitals.  Discharged  December  30th,  1862,  and  pensioned. 

Coffman,  H.  C.,  Private,  Co.  F,  3d  Arkansas  Regiment,  aged  19  years.  Fracture  of  skull  and  loss  of  the  left  eye.  Vision 
of  right  eye  impaired.  Petersburg  hospital.  Recovered. 

Cole,  Charles,  Corporal,_  Co.  A,  103d  Ohio  Volunteers,  aged  22  years.  Rcsaca,  May  14th,  1864.  Fracture  of  orbital 
and  frontal  processes  of  malar  and  anterior  and  middle  roots  of  zygomatic  process  of  temporal ; vision  and  audition  of  left  side 
destroyed.  Field,  Chattanooga,  and  Nashville  hospitals.  Discharged  February  25th,  1865,  and  pensioned. 

COLGROVE,  Franklin,  Private,  Co.  H,  10th  Illinois  Volunteers,  aged  31  years.  Bcntonville,  March  21st,  1865.  Fracture 
of  light  temporal  and  destruction  of  light  eye  by  conoidal  ball.  Field,  New  Berne,  New  York,  and  Madison  hospitals.  Dis- 
charged May  26th,  1865,  and  pensioned. 

COPENSPIRE,  Ch.uiles,  Private,  Co.  K,  60th  Now  York  Volunteers,  aged  20  years.  Winchester,  September  19th,  1864. 
Fracture  of  left  temporal  and  upper  jaw ; left  eye  destroyed.  Field  and  Philadelphia  hospitals.  Several  pieces  of  upper  jaw 
removed.  Discharged  June  2d,  1885,  and  pensioned. 


334 


WOUNDS  AND  INJURIES  OF  THE  FACE, 


[Chap.  II. 


Chase,  Reuben,  Private,  Co.  A,  37th  Massachusetts  Volunteers,  aged  24  years.  Shell  wound,  fracturing  maxillary  and 
malar  bones,  causing  total  loss  of  right  eye.  HatcheFs  Run,  Virginia,  February  7th,  1865.  Admitted  to  Campbell  Hospital, 
Washington,  March  19th,  1865.  Sent  to  Satterlee  Hospital,  Philadelphia,  April  6th.  Discharged  July  6th,  1865,  and  pensioned. 

Curd,  J.  L.,  Private,  Co.  H,  49th  Virginia  Regiment,  aged  22  years.  Gunshot  wound  of  face.  Ball  entered  near  external 
angle  of  left  eye,  destroying  the  eye,  passed  through  superior  maxilla,  and  emerged  below  outer  corner  of  right  eye,  impairing 
its  usefulness.  Seven  Pines,  Virginia,  July,  1862.  Retired  from  the  service. 

Chisholm,  John  W.,  Private,  Co.  D,  46th  Pennsylvania  Volunteers,  aged  21  years.  Conoidal  ball  entered  at  outer  angle 
of  left  eye,  destroyed  the  eyeball,  and  emerged  on  right  side,  one  inch  below  the  eye.  Peach  Tree  Creek,  July  20th,  1864. 
Discharged  July  27th,  1865.  He  is  not  a pensioner. 

Ceawley,  David,  Private,  Co.  C,  107th  New  York  Volunteers,  aged  23  years.  Conoidal  ball  struck  nasal  bone,  and 
passed  through  left  eye.  Chancellorsville,  Virginia,  May  3d,  1863.  Discharged  August  29th,  1864.  Total  loss  of  left  eye,  and 
I)artial  loss  of  sight  of  right  eye.  He  is  not  a pensioner. 

Caetee,  John  W.,  Lieutenant,  Co.  A,  23d  U.  S.  Colored  Troops,  aged  42  years.  Gunshot  wound  of  face.  Missile 
entered  outer  angle  of  left  eye,  fractured  nasal  bones,  and  emerged  from  inner  angle  of  right  eye.  The  left  eye  was  destroyed. 
Petersbui'g,  Virginia,  July  30th,  1864.  Discharged  February  6th,  1865,  and  pensioned. 

Connolly,  Beenaed,  Private,  Co.  B,  65th  New  York  Volunteers,  aged  22  years.  Gunshot  fracture  of  malar  bone,  with 
loss  of  use  of  right  eye,  and  sympathetic  aft'ection  of  the  left  eye.  Cedar  Creek,  Virginia,  October  19th,  1864.  Can  but  partially 
open  the  mouth.  Discharged  July  24th,  1865,  and  pensioned. 

Caeutiiees,  William  L.,  Private,  Co.  G,  2d  West  Virginia  Volunteers,  aged  25  years.  Conoidal  ball  entered  left 
antrum,  and  emerged  through  the  left  orbit,  tlisorganizing  the  eye.  Farmville,  Virginia,  April  6th,  1865.  Discharged  July 
26th,  1865,  and  pensioned. 

Ceaey,  Peospee,  Private,  Co.  F,  13th  Michigan  Volunteers,  aged  41  years.  Gunshot  fracture  of  nasal  bone;  missile 
destroying  right  eye.  Bentonville,  North  Carolina,  March  19th,  1865.  Discharged  July  26th,  1865,  and  pensioned. 

Castelvecchio,  Raeaele,  Sergeant,  Co.  A,  39th  New  York  Volunteers.  Gunshot  fracture  of  superior  maxilla.  Sight 
of  right  eye  destroyed.  Bristow  Station,  Virginia,  October  15th,  1863.  Recovered,  and  was  discharged  and  pensioned. 

Dance,  Chaeles  W.,  Private,  Co.  G,  66th  New  York  Volunteers.  Antietam,  September  17th,  1862.  Destruction  of 
left  eye  by  conoidal  ball.  Field  and  Philadelphia  hospitals.  Discharged  November  28th,  1862,  and  pensioned. 

Daniels,  Asa  B.,  Private,  Co.  F,  5th  Michigan  Volunteers,  aged  17  years.  HatcheFs  Run,  March  25th,  1865.  Fracture 
and  depression  of  frontal  bone  by  conoidal  ball ; right  eye  destroyed.  Field,  Washington,  and  Philadelphia  hospitals.  Discharged 
June  9th,  1865,  and  died  December  13th,  1865. 

Davis,  Cyeus,  Private,  Co.  G,  9th  New  York  Cavalry,  aged  22  years.  Smithfield,  Virginia,  August  29th,  1864.  Wound 
of  right  temporal  region ; right  eye  destroyed.  Sandy  Hook,  Annapolis,  and  Buffalo  hospitals.  Discharged  July  17th,  1865, 
and  pensioned.  Will  probably  become  totally  blind. 

Dennis,  Geoege  W.,  Corporal,  Co.  E,  90th  Pennsylvania  Volunteers.  Fredericksburg,  December  13th,  1862.  Left 
eye  destroyed.  Field,  Washington,  and  Philadelphia  hospitals.  Discharged  May  15th,  1863,  and  pensioned. 

Dingee,  Nathan,  Private,  Co.  D,  107th  Pennsylvania  Volunteers,  aged  21  years.  Gettysburg,  July  1st,  1863.  Loss 
of  left  eye.  Camp  Letterman  and  Philadelphia  hospitals.  Discharged  May  8th,  1865,  and  pensioned. 

Donovan,  John  E.,  Private,  Co.  D,  2d  Wisconsin  Volunteers,  aged  26  years.  Bull  Run,  July  21st,  1861.  Fracture 
of  external  part  of  left  orbit;  also  flesh  wounds  of  right  leg,  left  heel,  chest,  i-ight  arm,  and  shoulder  and  right  forearm.  Taken 
prisoner,  exchanged,  and  treated  in  Washington  and  New  York  hospitals.  Vision  of  left  eye  and  hearing  of  right  ear  entirely 
lost.  Headache,  giddiness,  and  weakness.  Discharged  October  19th,  1862,  and  pensioned. 

Doyle,  Baenaed,  Private,  Co.  C,  38th  Indiana  Volunteers,  aged  25  years.  Kenesaw  Mountain,  June  6th,  1864. 
Fracture  of  cranium.  Loss  of  left  eye.  Savannah,  New  York,  and  Madison  hospitals.  Discharged  June  11th,  1865,  and 
pensioned. 

Deake,  Ethan  A.,  Private,  Co.  G,  7th  Illinois  Volunteers.  Farmington,  Mississippi,  May  9th,  1862.  Loss  of  left  eye. 
Field  hospit.al.  Discharged  November  3d,  1862. 

Daniel,  J.  li.„  Private,  Co.  B,  1st  Virginia  Regiment.  Gunshot  wound  of  face.  Missile  entered  ball  of  left  eye  and 
emerged  at  angle  of  inferior  maxilla.  Spottsylvania,  May  16th,  1864.  Admitted  to  hospital  at  Farmville,  Virginia.  Furloughed, 
for  sixty  days,  September  2d,  1864. 

Dimmaey,  Joseph,  Private,  Co.  E,  29th  Connecticut  Volunteers,  aged  47  years.  Gunshot  wound  of  left  side  of  face; 
destruction  of  left  eye.  Bermuda  Hundred,  September  8th,  1864.  Discharged  October  28th,  1865,  and  pensioned. 

Daniel,  Moses,  Private,  Co.  B,  8th  Tennessee  Regiment.  Gunshot  fracture  of  superior  maxilla,  right  eye  destroyed. 
Franklin,  Tennessee,  November  30th,  1864.  Transferred  to  Provost  Marshal  January  31st,  1865. 

Doyle,  John,  Corporal,  Co.  C,  6tli  Wisconsin  Volunteers,  aged  25  years.  Gunshot  wound  of  face.  Conoidal  ball 
entered  beneath  the  left  eye  and  emerged  at  back  of  left  ear,  destroying  the  left  eye.  Hatcher’s  Run,  Virginia,  February  6th, 
1885.  Discharged  August  22d,  1865. 

Duval,  Alvay  S.,  Private,  Co.  C,  111th  Illinois  Volunteers,  aged  28  years.  Gunshot  wound  of  face,  missile  cutting 
outer  canthus  of  right  eye,  fracturing  orbital  process  of  malar  bone,  and  destroying  the  sight  of  the  eye.  Atlanta,  Georgia,  J uly 
22d,  1864.  Discharged  March  8th,  1865.  He  is  not  a pensioner. 


Sect.  II.] 


GUNSHOT  WOUNDS  OF  THE  EYE. 


335 


Dunx,  Jajies  W.,  Private,  Co.  A,  8tli  Illinois  Volunteeis.  Gunshot  wound  of  face.  Missile  entered  left  zygomatic 
process,  passed  slightly  upward  and  backward  and  emerged  on  opposite  side  just  above  the  zygoma.  The  optic  nerve  of  the 
right  eye  was  earned  away  and  the  eye  forced  forward.  Vicksburg,  Mississippi,  June  22d,  1863.  Insensible  for  three  days. 
Fragments  of  bone  thrown  off.  Gangrene.  Mustered  out  July'  30th,  1864,  and  pensioned. 

Delamater,  Joseph  W.,  Private,  Co.  H,  124th  New  York  Volunteers.  Gunshot  wound  of  face ; left  eye  lost;  also 
wound  of  right  hand.  Chancellorsville,  Virginia,  May  3d,  1863.  Died  May  25th,  1863. 

Ecke,  Henry,  Private,  Co.  H,  6th  Wisconsin  Volunteers.  Gunshot  fracture  of  nasal  bone  and  extirpation  of  left  eye. 
Antietam,  Maryland,  September  17th,  1862.  Transferred  to  Invalid  Corp.s,  November  15th,  1863 ; afterward  discharged  and 
pensioned. 

Eaton,  Oliver  P.,  Private,  Co.  G,  86th  Illinois  Volunteers.  Jonesboro’,  September  1st,  1864.  Fracture  of  frontal  and 
destruction  of  right  eye  by  conoidal  ball.  Field,  Chattanooga,  and  Nashville  hospitals.  Discharged  ISIay  30th,  1865,  and 
pensioned. 

Egan,  Barney,  Private,  Co.  F,  Olst  New  York  Volunteers.  Port  Hudson,  June  14th,  1863.  Loss  of  sight  of  left  eye. 
Port  Hudson  and  Baton  Kouge  hospitals.  Eight  eye  sympathetically  affected.  Discharged  November  21st,  1863,  and  pensioned. 

Egan,  John,  Private,  Co.  M,  13th  New  York  Cavalry,  aged  20  years.  Piedmont,  October  19th,  1864.  Left  eye  torn 
out  by  ball ; also  wound  of  left  arm.  Field  hospital.  Eight  eye  and  nervous  system  generally  affected.  Discharged  August 
2d,  1865,  and  pensioned. 

Ellis,  IF.,  Private,  Co.  F,  19th  Virginia  Eegiment.  Fracture  of  frontal  and  loss  of  left  eye.  Confederate  hospital,  Eich- 
mond.  Deserted  October  29th,  1862. 

Everly,  Frederick,  Private,  Co.  F,  15th  Missouri  Eegiment,  aged  20  years.  Springhill,  December  26th,  1862. 
Fracture  of  left  malar,  temporal,  and  palate  bones,  and  injury  of  right  eye  and  left  ear.  Nashville,  Jeffei’sonville,  and  Evans- 
ville hospitals.  Hearing  of  left  ear  lost.  Discharged  iMay  11th,  1865. 

Elder,  Willi,AM,  Private,  Co.  F,  03d  Pennsylvania,  aged  21  years.  Wilderness,  May  5th,  1864.  Fracture  of  frontal 
and  temporal  bones,  eye  destroyed;  also  wound  of  right  foot.  Field  and  Washington  hospitals.  Amputation  of  foot.  Died 
May  30th,  1864. 

Ende,  Henry,  Private,  Co.  C,  83d  Pennsylvania  Volunteers,  aged  17  years.  Cold  Harbor,  Virginia,  June  1st,  1864. 
Fracture  of  left  temporal  bone,  also  wound  of  right  eye.  Field,  Alexandria,  and  York  hospitals.  Died  August  24th,  1864, 
from  inflammation  of  brain. 

Free,  James,  Private,  Co.  K,  55th  New  York  Volunteei's,  aged  19  years.  Fair  Oaks,  May  31st,  1862.  Loss  of  right 
eye.  Washington  hospital.  Died  July  8th,  1862,  of  typhoid  fever. 

Fitzgerald,  Charles  II.,  Sergeant,  Co.  C,  138th  Pennsylvania  Volunteers,  aged  32  years.  Winchester,  September  19th, 

1864.  Loss  of  right  eye.  Eegimental,  Sandy  Hook,  and  Philadelphia  hospitals.  Left  eye  sympathetically  affected.  Discharged 
February  14th,  1865,  and  pensioned. 

Fitzrjerald,  James,  Private,  Co.  G,  5th  Louisiana  Eegiment,  aged  18  years.  Eappahannock  Station,  November  7th, 
1863.  Fracture  of  ft’ontal  and  orbital  bones,  loss  of  vision  of  left  eye.  Taken  prisoner,  and  treated  at  Washington  hospital. 
Transferred  to  Old  Capitol  Prison  for  exchange  April  14th,  1864. 

Finch,  Egbert,  Sergeant,  Co.  B,  1st  Michigan  Sharpshooters,  aged  22  years.  North  Anna  Eiver,  May  25th,  1864. 
Fracture  of  frontal,  temporal,  and  malar  bones,  right  side,  by  conoidal  ball.  Field  and  Washington  hospitals,  Vision  of  right 
eye  destroyed.  Discharged  October  3,  1864,  and  pensioned. 

Fowler,  J.  O.,  Private,  Co.  F,  1st  Wisconsin  Volunteers.  Perryville,  October  8th,  1862.  Loss  of  left  eye.  Perryville 
and  Louisville  hospitals.  Vision  of  right  eye  impaired.  Discharged  December  20th,  1862,  and  pensioned. 

Funk,  David,  Corporal,  Co.  I,  5th  Pennsylvania  Eeserves.  Fredericksburg,  December  13, 1862.  Fracture  of  cranium, 
and  sight  of  left  eye  destroyed.  Field,  Washington,  and  Philadelphia  hospitals.  Amaurosis  of  right  eye.  Discharged  March 
3d,  1863,  and  pensioned. 

Goi’F,  John,  Private,  Co.  E,  11th  Ohio  Cavalry.  Fracture  of  frontal  bone,  and  destruction  of  right  eye.  Eegimental 
hospital.  Left  eye  sympathetically  affected.  Discharged  December  4th,  1865.  Pension  claim  pending. 

Greenleaf,  James  M.,  Private,  Co.  C,  145th  Pennsylvania  Volunteers.  Fredericksburg,  December  13th,  1862.  Frac- 
ture of  frontal  bone,  and  loss  of  right  eye;  also  fracture  of  lower  jaw.  Field  and  Washington  hospitals.  Discharged  April  6th, 
1863,  and  pensioned. 

Grier,  Sylvanus,  Private,  Co.  K,  124th  New  York  Volunteers.  Chancellorsville,  May  3d,  1863.  Loss  of  right  eye. 
Field  hospital.  Discharged  November  1st,  1864.  Left  eye  subsequently  became  very  defective.  Pensioned. 

Gunst,  Peter,  Private,  Co.  I,  2d  Michigan  Volunteers,  aged  21  years.  Petersburg,  June  17th,  1864.  Loss  of  light  eye. 
Also  fracture  of  ring  finger  of  right  hand,  necessitating  amputation.  Field  and  Washington  hospitals.  Discharged  July  28th, 

1865,  and  pensioned. 

Godwin,  H.  TV.,  Sergeant,  Co.  C,  5th  North  Carolina  Eegiment,  aged  26  years.  Gunshot  wound  of  face.  Ball  entered 
the  right  eye,  completely  destroying  it,  and  remained  imbedded  in  the  bony  structure  of  the  face.  Cedar  Creek,  Virginia,  October 
19th,  1864.  Sight  of  left  eye  impaired. 

Grover,  John,  Private,  Co.  C,  11th  Connecticut  Volunteers,  aged  23  years.  Gunshot  wound  of  left  side  of  face;  loss  of 
left  eye.  Drury's  Bluff,  Virginia,  Jlay  16th,  1864.  Eeturned  to  duty  December  15th,  1864.  He  is  not  a pensioner. 

Gunther,  John,  Private,  Co.  A,  16th  Michigan  Volunteers,  aged  27  years.  Eappahannock  Station,  Virginia,  November 
7th,  1883.  Shell  wound,  destroying  globe  of  left  eye.  Washington  hospital.  Discharged  M.arch  20th,  1864,  and  pensioned. 


336 


WOUNDS  AND  INJURIES  OF  THE  FACE, 


[Chap.  II. 


Gailey,  Andrew,  Private,  Co.  G,  lOItli  Ohio  Volunteers,  aged  44  years.  Gunshot  fracture  of  left  malar  hone;  eye 
destroyed.  Franklin,  Tennessee,  November  SOth,  1864.  Discharged  May  18th,  1865. 

Genung,  Calvin,  Private,  Co.  A,  109th  New  York  Volunteers,  aged  44  years.  Gunshot  fracture  of  malar  bone  tind 
destruction  of  right  eye.  Weldon  Railroad,  Virginia,  August  19th,  1864.  Spiculat  of  bone  removed  at  various  times.  Discharged 
January  25th,  1865.  A.  M.  M.,  Photographic  Series,  Vol.  II,  page  1.  He  is  a pensioner. 

Gier,  John,  1st  Missouri  Cavalry,  aged  40  years.  Gunshot  fracture  of  jaw ; destruction  of  right  eye.  Fair  Oaks, 
Virginia,  October  13th,  1804.  Transferred  to  Veteran  Reserve  Corps,  and  discharged  J uly  28th,  1865.  He  is  not  a pensioner. 

Gailey,  IVilliam  R.,  Sergeant,  Co.  C,  40th  Indiana  Volunteers.  Chattanooga,  November  25th,  1863.  Fracture  of 
frontal  and  left  malar  bones,  with  loss  of  left  eye.  Field  hospital.  Died  December  23d,T863. 

Groves,  J.  P.,  Captain,  Co.  B,  1st  Louisiana  Regiment.  Monocacy,  July  9th,  1864.  Fracture  of  temporal  and  orbital 
bones,  with  loss  of  left  eye.  Frederick  hospital.  Died  July  18th,  1864. 

Haight,  W.  J.  T.,  Private,  Co.  K,  151st  New  York  Volunteers,  aged  20  years.  Monocacy  Junction,  July  9th,  1864. 
Fracture  of  right  temporal  and  loss  of  right  eye  by  conoidal  ball.  Frederick,  Baltimore,  and  Philadelphia  hospitals.  Discharged 
April  18th,  1865,  and  pensioned. 

Harman,  H.  V.,  Captain,  Co.  G,  2d  North  Carolina  Regiment.  Fracture  of  left  temporal  and  orbital  bones;  sight  of  left 
eye  destroyed.  Baltimore  hospitals.  Sent  to  post  prison  at  Fort  McHenry,  June  9th,  1865. 

Harper,  Robert,  Private,  Co.  M,  102d  Pennsylvania  Volunteers,  aged  22  years.  Wilderness,  May  5th,  1864.  Fracture 
of  right  frontal  with  depression,  and  destruction  of  right  eye,  by  conoidal  ball.  Washington  and  Pittsburgh  hospitals.  Discharged 
November  14th,  1864,  and  pensioned. 

Haven,  Francis  M.,  Private,  Co.  H,  17th  Kentucky  Volunteers,  aged  20  years.  Shiloh,  April  6th,  1862.  Fracture  of 
frontal  bone,  with  loss  of  right  eye.  Discharged  August  29th,  1862. 

Hemmer,  Peter,  Corporal,  Co.  I,  30th  Indiana  Volunteers.  Murfreesboro’,  December  31st,  1862.  Loss  of  left  eye. 
Field,  Nashville,  and  Louisville  hospitals.  Discharged  September  24th,  1864,  and  pensioned. 

Henry,  Edwin,  Private,  Co.  A,  2d  United  States  Artillery,  aged  32  years.  City  Point,  July  23d,  1864.  Fracture  of 
frontal  bone  and  loss  of  right  eye.  Field  and  New  York  hospitals.  Discharged  January  12th,  1865,  and  pensioned. 

Hill,  Isaac,  Private,  Co.  C,  24th  Virginia  Regiment,  Gettysburg,  July  1st,  1863.  Fracture  of  frontal  and  destruction  of 
left  eye.  Taken  prisoner.  Gettysburg  and  Baltimore  hospitals.  Paroled  September  25th,  1863. 

Houts,  George  W.,  Lieutenant,  7th  Missouri  Cavalry,  aged  37  years.  Jefferson  City,  October  6th,  1864.  Fracture  of 
orbital  and  temporal  bones  and  loss  of  left  eye  by  conoidal  ball.  Jeflerson  City  hospital.  Returned  to  duty  November  3d^  1864 ; 
discharged  April  20th,  1865,  and  pensioned. 

Havens,  Morton,  Lieutenant,  Co.  H,  7th  New  York  Heavy  Artillery,  aged  26  years.  Gunshot  fracture  of  left  superior 
maxilla,  with  loss  of  left  eye.  Petersburg,  Virginia,  June  16th,  1864.  Transferred  to  Veteran  Reserve  Corps  November  11th, 
1864 ; discharged  and  pensioned. 

Huffman,  J.  D.,  Private,  Co.  E,  7th  Pennsylvania  Volunteers.  Gunshot  wound  through  nose  and  loss  of  one  eye. 
Admitted  to  Georgetown  College  Hospital  September  6th,  1862.  Discharged  December  3d,  1862.  He  is  not  a pensioner. 

Huntsinger,  Henry  J.,  Private,  Co.  A,  48th  Indiana  Volunteers.  Gunshot  wound  of  right  eye  and  fracture  of  lower 
jaw.  Admitted  to  Hospital  No.  2,  Paducah,  Kentucky,  November  1st,  1862.  Discharged  December  26th,  1862,  with  loss  of 
right  eye,  and  pensioned.  In  February,  1869,  he  was  losing  the  sight  of  his  left  eye. 

Holm,  John  H.,  Private,  Co.  D,  80th  Hlinois  Volunteers.  Gunshot  fracture  of  nasal  bones  and  injury  of  right  eye; 
sight  destroyed.  Day’s  Gap,  Alabama,  April  30th,  1863.  Returned  to  duty  September  7th,  1863;  discharged  and  pensioned. 

Holley,  John,  Private,  Co.  G,  58th  Massachusetts  Volunteers,  aged  17  years.  Gunshot  fracture  of  malar  bone  and  loss 
of  left  eye.  Cold  Harbor,  Virginia,  June  3d,  1864.  Returned  to  duty  January  23d,  1865;  discharged  and  pensioned. 

Hinds,  Peter,  Private,  Co.  E,  17th  New  York  Volunteers,  aged  45  years.  Gunshot  fracture  of  right  malar  bone  and 
destruction  of  right  orbit.  Jonesboro’,  Georgia,  September  1,  1864.  Discharged  May  22d,  1865.  Not  a pensioner. 

Hoover,  Thomas  A.,  Corporal,  Co.  D,  107th  Pennsyh'ania  Volunteers,  aged  16  years.  Gunshot  wound  of  face.  Missile 
entered  just  below  the  inner  angle  of  left  eye,  crushed  through  the  superior  maxilla  back  of  nasal  bones,  passed  transversely 
backward  through  right  eye,  destroyed  it,  and  emerged  three-fourths  of  an  inch  in  front  of  upper  lobe  of  right  ear.  Gettysburg, 
Pennsylvania,  July  1st,  1863.  Intense  tumefaction  of  right  side  of  face  supervened.  Lower  eyelid  everted.  August  7th, 
wounds  had  healed.  Transferred  to  Invalid  Corps,  December  31st,  1863.  Not  a pensioner. 

Hewitt,  Edward  G.,  Private,  Co.  H,  15th  Massachusetts  Volunteers.  Gunshot  wound  of  face.  Missile  entered  under 
left  eye,  fracturing  the  bone  badly.  Fair  Oaks,  Virginia,  May  31st,  1862.  Missile  not  recovered.  Left  eye  nearly  blind.  A 
sinus  opened  near  left  ear,  discharging  pieces  of  bone  and  pus.  Discharged  February  18th,  1863,  and  pensioned. 

Haskins,  John  C.,  Private,  Co.  B,  24th  Texas  Cavalry,  aged  24  years.  Fragment  of  shell  struck  left  side  of  face,  carrying 
away  the  entire  malar  bone  and  destroying  left  eye.  Arkansas  Post,  January  11th,  1863.  Recovered  and  sent  to  prison  May 
4th,  1863. 

Helper,  John,  Private,  Co.  L,  14th  Pennsylvania  Cavalry,  aged  23  years.  Conoidal  ball  entered  near  the  external 
angle  of  the  left  orbit,  passed  through  the  ball,  inward  and  downwai’d  through  the  posterior  nares,  and  lodged  opposite  the  angle 
of  the  right  inferior  maxilla,  in  the  sterno-cleido-mastoid  muscle.  Greenbrier,  Virginia,  August  26th,  1863.  Missile  removed. 
Transferred  to  Veteran  Reserve  Corps.  Not  a pensioner. 


Sect.  II.] 


GUNSHOT  WOUNDS  OF  THE  EYE. 


337 


Hill,  George,  Sergeant,  Co.  G,  64tli  Oliio  Volunteers.  Chattanooga,  November  25th,  1863.  Musket  hall  entered  left 
eye,  destroying  it,  and  emerged  on  right  side  of  face,  near  angle  of  jaw,  fracturing  the  superior  maxilla.  Vision  of  right  eye 
impaired.  Cumberland  Hospital.  Discharged  August  17th,  1864,  and  pensioned. 

Ilsley,  Natii.,\js'IEL,  Private,  Co.  I,  35th  Massachusetts,  aged  27  years.  Cold  Harbor,  June  5th,  1864.  Fracture  of 
frontal  bone  and  loss  of  left  eye.  Field,  Washington,  and  Portsmouth  hospitals.  Secondary  haemorrhage.  Returned  to  duty 
October  13th,  1864;  discharged  June  9th,  1865,  and  pensioned. 

Jesse,  T.  S.,  Private,  Co.  A,  29th  Virginia  Regiment.  Fracture  of  spine  of  scapula  and  orbital  process  of  frontal  bone 
right  side  ; right  eye  involved.  Richmond  hospital;  no  result  recorded. 

Joiixsox,  John,  Private,  Co.  H,  49th  Ohio  Volunteers,  aged  19  years.  Buzzard  Roost,  May  9th,  1864.  Fracture  of  left 
temporal  and  destruction  of  left  eye.  Field,  Louisville,  Camp  Dennison,  and  Columbus  hospitals.  Right  eye  impaired;  vertigo. 
Discharged  June  2d,  1865,  and  pensioned. 

Jones,  Edwin  R.,  Private,  Co.  E,  7th  Illinois  Volunteers,  aged  23  years.  Allatoona,  October  5th,  1864.  Fracture  of 
outer  edge  of  right  supra-orbital  ridge,  with  loss  of  eye,  by  conoidal  ball.  Field,  Nashville,  Jeffersonville,  and  Springfield 
hospitals.  Removal  of  fragments.  Returned  to  duty  February  28th,  1865;  discharged  ^lay  13th,  1865,  and  pensioned. 

Joyce,  Patrick,  Private,  Co.  A,  115th  New  York  Volunteers,  aged  25  years.  Petersburg,  June  29th,  1864.  Fiaclure 
of  frontal  bone  at  left  orbital  ridge,  with  loss  of  left  eye.  Field,  Point  Lookout,  and  Washington  hospitals.  Transferred  to 
Veteran  Reserve  Corps  February  25th,  1865;  discharged  June  28th,  1865,  and  pensioned. 

Jacobs,  John  JV.,  Private,  Co.  F,  54th  North  Carolina  Regiment,  aged  30  years.  Gunshot  wound  of  face.  Mi.ssile 
destroyed  the  right  eye  and  passed  out  at  the  angle  of  the  superior  maxilla,  fracturing  the  bone.  Fisher’s  Hill,  Virginia, 
September  22d,  1864.  Examined,  to  be  retired,  March  14th,  1865. 

Jones,  John,  Private,  Co.  B,  3d  South  Carolina  Battery.  Missile  entered  the  superior  maxillary  of  left  side  about  one 
and  a half  inches  in  front  of  the  ear  and  passed  out  just  back  of  the  outer  angle  of  right  eye,  destroying  the  globe  of  tlx;  l ight 
and  the  sight  of  the  left  eye.  South  Mountain,  Maryland,  September  14th,  1862.  Loss  of  sensation  in  left  cheek ; difficulty  in 
opening  mouth.  The  pupil  of  left  eye  contracted  and  not  sensible  to  light.  Returned  to  duty  December  13th,  1862. 

Kenyon,  Paris,  Private,  Co.  B,  105th  Illinois  Volunteers.  Atlanta,  August,  1864.  Fracture  of  left  supra-orbital  ridge 
and  nasal  bones;  eye  destroyed.  Field  hospital.  Died  August  16th,  1864. 

Kenyon,  Elias  W.,  Private,  Co.  A,  154th  New  York  Volunteers,  aged  34  years.  Pine  Knob,  June  15th,  1864.  Frac- 
ture of  frontal  bone  and  destruction  of  right  eye.  Field,  Nashville,  and  Louisville  hospitals.  Vision  of  left  eye  impaired. 
Discharged  December  28th,  1864,  and  pensioned. 

Kerr,  Michael,  Private,  Co.  D,  7th  Rhode  Island  Volunteers.  Fredericksburg,  December  13th,  1862.  Fracture  of 
frontal  bone,  with  loss  of  left  eye.  Field  and  Washington  hospitals.  Vision  of  right  eye  very  imperfect.  Discharged  from 
service  February  5th,  1863,  and  pensioned. 

Kiles,  Jacob  B.,  Private,  Co.  F,  110th  Ohio  Volunteers,  aged  20  years.  Cold  Harbor,  June  3d,  1864.  Loss  of  left  eye. 
Field,  Washington,  York,  and  Philadelphia  hospitals.  Discharged  June  14th,  1865,  and  jHnisioned. 

Kimberlin,  John,  Private,  Co.  E,  9th  Illinois  Volunteers,  aged  20  years.  Fort  Donelson,  February  15th,  1862.  Loss 
of  left  eye.  Cincinnati  hospital.  Discharged  August  14tli,  1862,  and  pensioned. 

Kuhn,  Oliver,  Private,  Co.  L,  198th  Pennsylvania  Volunteers,  aged  19  years.  Hatcher’s  Run,  March  29th,  1865. 
Fracture  of  portions  of  malar  and  sphenoid  bones  and  destruction  of  right  eye.  Field,  Washington,  and  Philadelphia  hospitals. 
Discharged  June  28th,  1865,  and  pensioned. 

Killing sworth,  P.  D.,  Private,  Co.  I,  51st  Georgia  Regiment.  Gunshot  woinid  of  face.  Missile  destroyed  the  right  eye 
and  fractured  upper  and  lower  jaw.  Chancellorsville,  Virginia,  May  3d,  1863.  Retired  from  service  April,  1865.  Can  open  the 
mouth  but  little  and  is  unable  to  masticate. 

Kenyon,  David,  Private,  Co.  C,  3d  Maryland  Volunteers.  Gunshot  wound  of  left  side  of  face.  Destruction  of  left  eye 
and  fracture  of  left  superior  maxillary  bone.  Antietam,  Maryland,  September  17th,  1862.  Discharged  April  16th,  1863,  and 
pensioned.  ^ 

Kemp,  Charles,  Private,  Co.  B,  11th  Connecticut  Volunteers.  Gunshot  fracture  of  superior  malar  bone;  left  eye 
destroyed.  Antietam,  Maryland,  September  17th,  1862.  Discharged  February  6th,  1863.  Sense  of  smell  destroyed.  He  is  a 
pensioner. 

Lemon,  Moses  W.,  Lieutenant,  Co.  I,  14th  New  York  Heavy  Artillery,  aged  34  years.  Washington,  March  Ist,  1865. 
Fracture  of  temporal  bone  with  loss  of  left  eye.  Washington  hospital.  Discharged  May  6th,  186-5,  and  pensioned. 

Lindsay,  Joseph,  Private,  Co.  C,  72d  Pennsylvania  Volunteers,  aged  27  years.  Malvern  Hill,  July  Ist,  1862.  Frac- 
ture of  temporal  and  loss  of  right  eye.  Baltimore  hospital.  Discharged  November  16th,  1862,  and  pensioned. 

Lynde,  James  H.,  Lieutenant,  Co.  I,  14th  New  York  Heavy  Artillery.  Fort  Steadman,  February  25th,  1865.  Fracture 
of  frontal  bone,  with  loss  of  right  eye.  Field  and  City  Point  hospitals.  Discharged  August  26th,  1865,  and  pensioned. 

Lewi.S,  H.  B.,  Private,  Co.  A,  121st  New  York  Volunteers,  aged  18  years.  Gunshot  wound  of  face,  with  loss  of  right 
eye.  Ball  entered  middle  of  right  eyebrow  and  exit  through  mouth.  Chancellorsville,  Virginia,  May  3d,  1863.  Returned  to’ 
duty  September  9th,  1863.  Discharged  and  pensioned. 

Lomas,  WTlliam,  Pi-ivate,  Co.  H,  2d  Pennsylvania  Heavy  Artillery,  aged  30  j'ears.  Gunshot  wound  of  face,  left  eye 
destroyed.  Petersburg,  Virginia,  Juno  18th,  1864.  Removal  of  several  spiciila;  of  bone.  The  lower  eyelid  is  drawn  to  a 
V shape  and  attached  to  the  mtilar  bone.  Discharged  May  16th,  1865.  Not  a pensioner. 

43 


338 


WOUNDS  AND  INJURIES  OF  THE  FACE, 


[Chat.  II. 


Lynch,  Patimck,  Private,  Co.  F,  Gtli  Vermont  Volunteers,  aged  35  years.  Gunshot  wound  of  face.  Musket  ball  entered 
left  cheek  in  front  of  ear  and  emerged  at  the  side  of  the  nose.  Charlestown,  Virginia,  August  21st,  1864.  Left  eye  completely 
gone ; riglit  eye  very  weak.  Discharged  May  5th,  1865,  and  pensioned. 

Leech,  Albeut  G.,  Private,  Co.  H,  2d  Vermont  Volunteers,  aged  25  years.  Gunshot  wound  of  face.  Conoidal  ball 
entered  at  right  supra-orbital  arch,  destroyed  eye  and  passed  into  mouth.  Cedar  Creek,  Virginia,  October  19th,  1864.  Paralysis 
of  right  side  of  face;  mastication  and  speech  difficult.  Discharged  May  12th,  1865,  and  pensioned. 

Lackey,  Wiliaam  J.,  Private,  Co.  II,  102d  Pennsylvania  Volunteers,  aged  35  years.  Gunshot  wound  of  face.  Conoidal 
ball  outered  just  anterior  to  inner  angle  of  right  eye,  fractured  the  nasal  bones,  passed  directly  through  left  eye  and  emerged 
Just  j>osterior  to  its  outer  angle.  Cedar  Creek,  Virginia,  October  19th,  1864.  November  22d,  the  wound  had  nearly  healed. 
Discharged  February  27th,  1835,  and  pensioned. 

Larimer,  Isaac,  Sergeant,  Co.  K,  35th  Illinois  Volunteers.  Missile  entered  the  right  malar  bone,  close  under  orbit, 
fractured  and  destroyed  a ])ortion  of  orbital  process,  passed  through  palate  bone  into  the  mouth,  grazed  ramus  of  left  inferior 
maxilla,  and  emerged  through  left  side  of  neck.  Discharged  Sej)tember  27th,  1864.  Loss  of  vision  of  left  eye.  He  is  a pensioner. 

Lippincott,  Deni.s,  Private,  Co.  D,  5th  United  States  Infantry.  Gunshot  fracture  of  superior  maxillary  and  nasal 
bones;  loss  of  right  eye.  Valverde,  New  Mexico,  February  21st,  1862.  Discharged  June  25th,  1862,  and  pensioned. 

McCoy,  John  P.,  Private,  Co.  H,  77th  Illinois  Volunteers,  aged  22  years.  May  16th,  1863.  Loss  of  right  eye.  Mem- 
])his  hospital.  June  15th,  secondary  hmmorrhage  from  temporal  artery.  Returned  to  duty  July  20th,  1863.  Partial  blindness 
of  left  eye.  Discharged  March  7th,  1835,  and  pensioned. 

McEwinG,  Henry,  Private,  Co.  D,  2d  Michigan  Volunteers.  Petersburg,  December  11th,  1864.  Loss  of  right  eye. 
Field,  City  Point,  Baltimore,  and  Philadelphia  hospitals.  Ball  extracted.  Left  eye  sympathetically  affected.  Discharged  June 
23d,  1865,  and  pensioned. 

Marion,  Thomas,  Private,  Co.  I,  108th  Ohio  Volunteers,  aged  25  years.  Kenesaw  Mountain,  .June20th,  1864.  Fracture 
of  frontal  bone,  and  loss  of  left  eye.  Field,  Nashville,  Louisville,  and  Gamp  Dennison  hospitals.  Discharged  May  31st,  1865, 
and  pensioned. 

Masters,  Aquii.la,  Sergeant,  Co.  E,  14th  Ohio  Volunteers,  aged  23  years.  Chickamauga,  September  20th,  1863. 
Fracture  of  right  temporal  bone,  with  loss  of  vision  of  right  eye.  Field,  Chattanooga,  Nashville,  and  Columbus  hospitals. 
Discharged  July  11th,  1834,  and  pensioned. 

Mieler,  John  W.,  Private,  Co.  K,  55th  Pennsylvania  Volunteers.  Pocotaligo,  South  Carolina,  October  22d,  1862. 
Fracture  of  frontal  and  temjioral  bones,  ivith  loss  of  right  eye,  Hilton  Head  hospital.  Hearing  of  right  ear  impaired.  Dis- 
charged December  14th,  1832,  and  pensioned. 

Miller,  William  II.,  Private,  Co.  B,  3d  New  York  Artillery,  aged  23  years.  Honey  Hill,  November  30th,  1864, 
Injury  of  frontal  and  temporal  bones,  and  destruction  of  right  eye.  Hilton  Head  hospital.  Dischai-ged  May  9th,  1865,  and 
pensioned. 

Morgan,  James  E.,  Corporal,  Co.  K,  15th  Iowa  Volunteers,  aged  22  years.  Cedar  Bluff,  September  2d,  1864.  Fracture 
of  frontal  and  nasal  bones,  with  injury  to  left  eye.  Field  and  Keokuk  hospitals.  Nearly  complete  loss  of  vision  of  left  eye,  and 
impaired  hearing  of  left  ear.  Discharged  July  26th,  1865,  and  pensioned. 

MooitE,  William,  Private,  Co.  F,  119th  Pennsylvania  Volunteers,  aged  36  ye.ars.  Rappahannock  Station,  Virginia, 
November  7th,  1863.  Loss  of  left  eye.  Washington  and  Philadelphia  hospitals.  Incipient  and  progressive  amaurosis  of  right 
eye.  Discharged  Mai'ch  22d,  1835,  and  pensioned. 

Murphy,  Hugh,  Private,  Co.  D,  17th  Wisconsin  Volunteers,  aged  30  years.  Bentonville,  North  Carolina,  March  21st, 
1865.  Fracture  of  angle  of  left  orbit,  and  destruction  of  left  eye.  Field,  New  Berne,  New  York,  and  Madison  hospitals, 
Discharged  May  23d,  1835,  and  pensioned. 

McMiller,  John,  Private,  Co.  A,  82d  Iowa  Volunteers,  aged  28  years.  Gunshot  wound  of  face.  Missile  struck  the 
right  maxillary  bone,  and  siilitting,  passed  through  the  right  eye  and  right  frontal  sinus.  Pleasant  Hill,  Louisiana,  April  9th, 
1864.  The  two  pieces  of  ball  were  extracted.  Dischargod*February  14th,  1865.  Pension  of  eight  dollars  per  month  granted 
February  14th,  1865.  Softening  of  the  brain  supervened.  Constant  headache  and  other  cerebral  symptoms. 

Muckel,  William,  Piiv.ate,  Co.  H,  3d  New  York  Volunteers,  aged  21  years.  Gunshot  wound  of  left  side  of  face, 
destruction  of  eye.  Petersburg,  Virginia,  July  30th,  1864.  Transferred  to  Veteran  Reserve  Corps,  May  4th,  1865.  Disch.arged 
and  pensioned. 

My'ers,  Michael,  Sergeant,  Co.  F,  72d  Illinois  Volunteers,  aged  42  years.  Gunshot  fracture  of  nasal  bone,  with  loss 
of  left  eye.  Franklin,  Tennessee,  November  30th,  1864.  Discharged  May  0th,  1865,  and  pensioned. 

Marcy,  Edward,  Private,  Co.  D,  91st  Ohio  Volunteers,  aged  41  years.  Gunshot  wound  of  face.  Conoidal  ball  entered 
left  malar  bone  and  emei'ged  through  right  malar  bone,  destroying  sight  of  left  eye.  Winchester,  Virginia,  September  19th,  1864. 
Transferred  to  Vetenan  Reserve  Corps,  February  10th,  1865.  He  is  not  a pensioner. 

Minkler,  George  W.,  Private,  Co.  C,  128tli  New  York  Volunteers,  aged  21  years.  Gunshot  fracture  of  superior 
maxilla  and  nasal  bones.  Cedar  Creek,  Virginia,  October  19th,  1864.  Blepharo-conjunctivitis  of  left  eye.  Loss  of  use  of  right 
eye.  Discharged  May  20th,  1865,  and  pensioned. 

Miner,  Henry,  Private,  Co.  C,  10th  Vermont  Volunteers,  aged  36  years.  Gunshot  fracture  of  nasal  bones;  missile 
))assed  through  ball  of  left  eye.  Winchester,  Virginia,  September  19th,  1884.  Ball  extracted  fiom  cavity  of  eye.  Left  eye 
completely  gone,  right  eye  very  weak.  Discharged  Ajiril  6th,  1865,  and  pensioned. 


Sect.  II.]  . GUNSHOT  WOUNDS  OF  THE  EYE.  339 

Menghani,  W.  T.,  Private,  Co.  K,  21st  North  Carolina  Eegiraent,  aged  21  years.  Gunshot  wound  of  orbit ; missile  carried 
away  the  eye  and  emerged  from  the  nose.  Fort  Fisher,  North  Carolina,  January  13th,  1865.  Released  June  28th,  1865. 

Millaed,  Isidore,  Private,  Co.  H,  10th  Missouri  Cavalry,  aged  29  years.  Missile  entered  anterior  to  meatus  auditorius 
externus,  passed  forward  and  downward  and  emerged  at  rigid  orifice  of  anterior  nares,  destroying  sight  of  right  eye.  Selma, 
Alabama,  April  2d,  1865.  Discharged  May  31st,  1865.  Not  a pensioner. 

IMoerison,  Ht?Gii,  Sergeant,  Co.  C,  100th  Pennsylvania  Volunteers.  Gunshot  wound  of  face.  Missile  entered  behind 
left  mastoid  process  and  emerged  through  left  eye,  carrying  away  the  eye.  South  Mountain,  Maryland,  September  14th,  1862. 
Discharged  November  27th,  1862.  Left  side  of  face  paralyzed.  Great  deformity.  Cannot  shut  the  right  eye.  He  is  a pensioner. 

SIaetix,  Thomas  B.,  Priv.ate,  Co.  E,  96th  Illinois  Volunteers.  Gunshot  wound  of  face.  Conoidal  musket  ball  entered 
right  eye,  completely  destroyed  the  eyeball  and  fractured  the  orbital  and  nasal  bones.  Chickamauga,  Georgia,  September 
20th,  1863.  Several  haemorrhages  occurred,  which  were  controlled  by  pressure  at  first,  and  afterward  by  ligation  of  right 
common  carotid  immediately  above  the  omo-hyoid  muscle.  Died  December  19th,  1863. 

McGrady,  Jacob,  Private,  Co.  F',  37th  North  Carolina  Regiment.  Gettysburg,  July,  1863.  Gunshot  wound  of  eye. 
Gettysburg  hospital.  Died  July  14th,  1863. 

Noblet,  Peter,  Sergeant,  Co.  I,  28th  Wisconsin  Volunteers,  aged  26  years.  Gunshot  fracture  of  nasal  bones;  conoidal 
ball  passed  transversely  and  destroyed  the  right  eye.  Spanish  Fort,  Alabama,  March  30th,  1835.  Mustered  out  September  23d, 
1885,  and  pensioned. 

Nichols,  Norman  J.,  Private,  Co.  G,  2d  Vermont  Volunteers.  Gunshot  wound  of  face.  Conoidal  musket  ball  entered 
at  outer  angle  of  right  eye,  fractured  malar  bone  and  emerged  under  the  inferior  maxilla.  Wilderness,  Virginia,  May  5th,  1864. 
Sight  of  right  eye  destroyed.  Discharged  May  27th,  1865,  and  pensioned. 

Nash,  J.  P.,  Private,  Co.  A,  21st  Virginia  Regiment,  Gettysburg,  July  2d,  1833.  Loss  of  right  eye.  Farmville  hospital. 
Retired  from  service  June  3d,  1864. 

Ne.vle,  Fielding,  Adjutant,  98th  New  York  Volunteers,  aged  36  years.  Petersburg,  June  25th,  1864.  Loss  of  right 
eye.  Point  of  Rocks,  Fort  Monroe,  and  Annapolis  hospitals.  Discharged  November  26th,  1864. 

O’Donnell,  James,  Sergeant,  Co.  A,  7th  Illinois  Volunteers.  Gunshot  fracture  of  right  malar  bone,  eye  destroyed. 
Allatoona,  Georgia,  October  5th,  1884.  Returned  to  duty  February  9th,  1865.  Discharged  and  pensioned. 

OiVKBALL,  Ned,  Private,  Co.  D,  2d  Indian  Home  Guards,  aged  23  years.  Conoidal  ball  entered  at  the  right  eye  and 
emerged  posterior  to  the  left  side  of  mouth.  Fort  Gibson,  Cherokee  Nation,  April  7th,  1884.  Lo.ss  of  right  eye.  Returned  to 
duty  May  31st,  1835.  Not  a pensioner. 

Packard,  Albert  H.,  Captain,  Co.  G,  31st  Maine  Volunteers.  Wilderness,  May  6th,  1834.  Penetrating  fractuD!  of 
cranium  by  musket  ball,  which  lodged  in  brain  substance ; eye  destroyed.  Field  and  Washington  hospitals.  Died  May  16th,1864. 

Peeler,  John,  Private,  Co.  K,  134th  New  York  Volunteers.  Gunshot  wound  of  face.  Missile  struck  the  margin  of  tlie 
auditory  canal  of  right  side,  passed  forward  and  inward  through  the  socket  of  the  right  eye,  and  lodged  just  within  the  internal 
angle  of  the  orbit.  Gettysburg,  Pennsylvania,  July  1,  1863.  Ball  removed  August  3d.  Eye  was  completely  destroyed.  Died 
August  23d,  1863. 

Perciiteld,  W.  j..  Private,  Co.  H,  82d  Indiana  Volunteers,  aged  39  years.  Gunshot  wound  through  apex  of  nose  and 
destruction  of  right  eye.  Atlanta,  Georgia,  August,  1834.  Disclnii'ged  June  14th,  1865,  and  pensioned. 

Purdy,  Elum,  Private,  Co.  H,  84th  Illinois  Volunteers,  aged  22  years.  Gunshot  fracture  of  zygoma;  right  eye 
destroyed.  Buzzard  Roost,  May  9th,  1834.  Returned  to  duty  January  24th,  1865;  discharged  and  pensioned. 

Pott,  Henry,  Private,  Co.  D,  75th  Illinois  Volunteers,  aged  20  years.  Gunshot  wound  of  face.  Conoidal  musket  ball 
carried  away  nasal  bones,  destroyed  left  eye,  and  fractured  zygomatic  process  of  malar  bone.  Lovejoy  Station,  September  3d, 
1864.  Discharged  January  25th,  1865,  and  pensioned. 

Powers,  J.  T.,  Private,  Co.  D,  20th  North  Carolina  Regiment.  Gunshot  wound  of  face  and  loss  of  right  eye.  Discharged 
November  30th,  1862. 

Peck,  George  G.,  Corporal,  Co.  D,  7th  Massachusetts  Volunteers,  aged  32  years.  Fredericksburg,  May  3d,  186.3. 
Fracture  of  frontal  bone  and  loss  of  sight  of  left  eye.  Field  and  Washington  hospitals.  Discharged  December  19th,  1863,  and 
pensioned. 

Pradt,  John  C.,  Priv’ate,  Co.  A,  3d  Wisconsin  Cavalry.  Baxter  Springs,  Kansas,  October  0th,  1863.  Fracture  of  cra- 
nium and  entire  destruction  of  left  eye.  Post  hospital.  Fort  Scott.  Returned  to  duty  December  11th,  1863;  discharged  August 
17th,  1837,  and  pensioned. 

Pearce,  James  M.,  Private,  Co.  M,  11th  Pennsylvania  Reserves.  Bull  Run,  Virginia,  August  29th,  1862.  Gunshot 
wound ; ball  entered  right  orbit,  destroyed  the  right  eye,  passed  through  the  face,  fracturing  the  nasal  and  maxillary  bones,  and 
emerged  from  the  opposite  side,  in  the  cervical  region  of  the  neck.  Washington  hospital.  Discharged  October  30th,  1862,  and 
pensioned. 

Raab,  George,  Private,  Co.  B,  9th  Pennsylvania  Reserves.  Antietam,  September  17th,  1862.  Fracture  of  frontal  bone, 
with  loss  of  right  eye.  Discharged  November  15th,  1862,  and  pensioned. 

Rader,  David,  Captain,  Co.  A,  23th  Indiana  Volunteers.  Morganzia,  September  29th,  1863.  Fracture  of  right  temporal 
bone  and  destruction  of  right  eye.  New  Orleans  hospital.  Returned  to  duty  November  6th,  1863;  discharged  March  11th, 
1864,  and  pensioned. 

Ransoji,  Sutton,  Piivate,  Co.  E,  1st  United  St.ates  Colored  Cavahy,  agcM  20  years.  Bermuda  Hundred,  June  17lh, 
1864.  Fracture  of  temjioral  and  destruction  of  left  eye.  Point  Lookout  hospital.  Returned  to  duty  November  14th,  1864. 


340 


WOUNDS  AND  INJURIES  OF  THE  FACE, 


[Chap.  II. 


Redding,  Williaji  A.,  Private,  Co.  A,  fitli  New  Hampshire  Volunteers.  Bull  Run,  August  30th,  1862.  Loss  of  left 
eye  and  ileraugement  ot  intellect.  Washington  Iiospital.  Vision  of  right  eye  impaired.  Discharged  June  27th,  1863,  and  pen- 
sioned. 

Reese,  ClIADEES,  Captain,  Co.  D,  20th  Indiana  Volunteers.  Gettysburg,  July  2d,  1863.  Loss  of  right  eye.  Gettys- 
burg and  Washington  hospitals.  Discharged  October  22d,  1863. 

Regeing,  Ciiristopiieu,  Private,  Co.  G,  3d  Michigan  Volunteers,  aged  35  years.  Wilderness,  May  6th,  1864.  Fracture 
of  temjioral  bone,  with  loss  of  right  eye.  Field,  Washington,  and  Detroit  liospitals.  Headache,  vertigo,  and  mental  aberration. 
Discharged  August  29th,  1864,  and  jtensioned. 

Reynolds,  Daniel  M.,  Corporal,  Co.  F,  49th  Pennsylvania  Volunteers,  aged  21  years.  Spottsjdvania,  May  10th,  1804. 
Fracture  of  frontal  and  nasal  boties  and  destruction  of  right  eye.  Field,  Washington,  and  New  York  hospitals.  Imperfect  vis- 
ion of  left  eye.  Returned  to  duty  July  28th,  1884;  discharged  December  22d,  1864,  and  pensioned. 

Riley,  Michael,  Co.  K,  35th  Massachusetts  Volunteers.  Antietam,  September  17th,  1862.  Loss  of  left  eye.  Frede- 
rick hospitals.  Discharged  December,  1862,  and  pensioned. 

Roe,  Joseph,  Corporal,  Co.  C,  91st  New  York  Volunteers,  aged  28  years.  South  Side  Railroad,  April  2d,  1865.  Frac- 
ture of  nasal  and  malar  bones  and  loss  of  left  eye.  P'ield  and  Washington  hospitals.  Discharged  August  3d,  186.5,  and  pen- 
sioned. 

RoGEiiSON,  Andi:ew  B.,  Lieutenant,  Co.  A,  20th  Illinois  Volunteers,  aged  27  years.  Chattanooga,  July  10th,  1864. 
Fracture  of  temporal  and  nasal  bones  and  destruction  of  right  eye.  Chattanooga,  and  Nashville  hospitals.  Senses  of  taste  tind 
smell  nearly  destroyed.  Discharged  May  15th,  1865,  and  jiensioned. 

Iioss,  J.  A.,  Private,  Co.  C,  36th  North  Carolina  Regiment,  aged  23  years.  Destruction  of  left  eye.  Point  Lookout  hos* 
pital.  Transferred  to  provost  marshal  April  8th,  1885. 

RuTTEn,  E.,  Private,  Co.  E,  2d  Maryland  Volunteers,  aged  19  years.  August  19th,  1804.  Wound  ofleft  temple,  involv- 
ing eye  and  nose.  Richmond  hospital.  Returned  to  duty  October  19th,  1804. 

Rogehs,  Alvin,  Private,  Co.  C,  77th  Illinois  Volunteers.  Gunshot  fracture  of  facial  hones.  Conoidal  ball  struck  just 
over  the  left  eyebrow,  passed  downward,  destroying  the  eye,  and  lodged  in  the  superior  maxilla.  Vicksburg,  Mississippi,  May 
22d,  1863.  Vision  of  right  eye  also  impaired.  Discharged  July  10th,  1833,  and  pensioned. 

Reynolds,  D.  M.,  Lieutenant,  Co.  E,  184th  Pennsylvania  Volunteers,  aged  21  years.  Conoidal  ball  entered  at  inner 
angle  of  right  eye,  and  passed  through  eye  and  cheek  ; another  ball  lodged  near  head  of  tibia.  Deep  Bottom,  Virginia,  August 
14th,  1864.  Discharged  December  24,  1804.  Not  a pensioner. 

Rothenbeegei!,  IL,  Sergeant,  Co.  D,  48th  Pennsylvania  Volunteers,  aged  21  years.  Gunshot  wound  of  face.  Conoidal 
ball  entered  at  the  inner  canthus  of  left  eye,  passed  downiward  and  backward,  and  lodged  outside  of  angle  of  inferior  maxilla. 
Petersburg,  April  2d,  1805.  Missile  removed.  Left  eye  was  entirely  destroyed.  Returned  to  duty  July  0th,  1865.  Discharged 
and  pensioned. 

Ross,  John  M.,  Private,  Co.  H,  8th  Pennsylvania  Volunteers.  Gunshot  wound  of  face.  Missile  entered  the  left  eye, 
passed  obli(|uely  through  sujierior  maxilla,  and  emerged  oj)i)osite  and  m^arthe  mastoid  process.  Fredericksburg,  December  13th, 
1802.  Discharged  January  24th,  1863.  Left  eye  destroyed.  I’ensioned. 

Richaedson,  John,  Private,  Co.  B,  14th  Illinois  Volunteers.  Gunshot  wound  of  face.  Missile  entered  through  inferior 
eyelid,  near  the  external  angle  of  left  eye,  passed  between  the  eyeball  and  external  wall  of  orbit,  and  lodged.  Shiloh,  Tennessee, 
April  0th,  1862.  Ball  removed  six  weeks  after  reception  of  injury.  Discharged  September  29th,  1862.  Loss  of  vision  of  left 
eye,  and  difficulty  of  hearing.  He  is  a pensioner. 

SiiAEFFEE,  Petee,  Private,  Co.  M,  12th  Ohio  Cavalry,  aged  18  years.  Accidentally,  near  Lexington,  June  11th,  1864. 
Perforating  fracture  of  cranium  ; loss  of  left  eye.  Lexington  hospital.  Died  June  12th,  1864. 

Sanders,  Henry  C.,  Private,  Co.  B,  2Cth  Maine  Volunteers,  aged  20  j'ears.  Spottsylvania,  Virginia,  May  8th,  1864. 
Fracture  of  cranium,  and  loss  of  left  eye,  by  conoidal  ball,  which  lodged.  Field,  Washington,  and  New  York  hospitals.  Dis- 
charged May  26th,  1805,  and  ])ensioned. 

Schuler,  Joseeii  A.,  Sergeant,  Co.  C,  3d  Michigan.  Mine  Run,  Virginia,  November  27th,  1803.  Fracture  of  angular 
process  of  temporal  hone,  and  destruction  of  left  eye.  Regimental  and  Fairfax  hospitals.  Transferred  to  Veteran  Reserve 
Corps,  March  25th,  1864.  Incipient  cataract  of  right  eye.  Discharged  June  17th,.  1804,  and  pensioned. 

SiiAitP,  Matthew,  Private,  Co.  I,  82d  Pennsylvania  Volunteers,  aged  36  years.  Sailors  Creek,  Virginia,  April  Gth, 
1865.  Fracture  of  frontal  bone,  with  loss  ofleft  eye.  Field,  City  Point,  and  Washington  hospitals.  Discharged  June  14th, 
1865,  and  jiensioned. 

Shaver,  William  IL,  Private,  Co.  H,  3d  New  York  Artillery.  Petersbuig,  September  13th,  1864.  Fracture  of  frontal 
bone,  and  destruction  of  right  eye.  Fort  Monroe,  and  New  York  hospitals.  Discharged  June  27th,  1835. 

Sheley,  George  A.,  Lieutenant,  Co.  M,  1st  Michigan  Light  Artillery.  Cumberland  Gap,  Vhginia,  June  18th,  1804. 
Fracture  of  frontal  bone,  with  loss  of  right  eye;  also  fracture  of  right  scapula,  and  flesh  wounds  of  right  arm  and  right  hip. 
Detroit  hospital.  Discharged  October  15th,  1864. 

Shively,  David  L.,  Private,  Co.  E,  114th  Pennsylvama  Volunteers.  Gettysburg,  July  2d,  1863.  Loss  of  right  eye; 
also  fracture  of  right  clavicle.  Gettysburg,  Baltimore,  and  Philadelphia  hospitals.  Discharged  May  14th,  1864,  and  pensioned. 
Complete  paralysis  of  right  up])er  extremity. 


Sect.  II.] 


GUNSHOT  WOUNDS  OF  THE  EYE. 


341 


Sickles,  Willi.\m,  Private,  Co.  G,  73d  Ohio  Volunteers,  aged  20  years.  Eesaca,  May  lOth,  ISOl.  Fractureof  craninni, 
■with  loss  of  left  eye.  Field,  Chattanooga,  Nashville,  Louisville,  Camp  Dennison,  and  Columbus  hospitals.  Discharged  June 
13th,  1865,  and  pensioned. 

Slack,  Aldex  S.,  Corporal,  Co.  I,  3d  Vermont  Volunteers,  aged  26 years.  Winchester,  September  19th,  1864.  Fracture 
of  frontal  bone,  with  loss  of  right  eye;  also  fracture  of  right  leg.  Field,  Baltimore,  Brattleboro’,  and  Montpelier  hospitals. 
Discharged  June  12th,  1865,  and  pensioned. 

Slocum,  Warren,  Private,  Co.  G,  111th  New  York  Volunteers,  aged  21  years.  Wilderness,  May  5th,  1864.  Fracture 
of  frontal,  orbital,  and  maxillary  bones,  and  destruction  of  left  eye.  Field,  Washington,  Chester,  and  New  York  hospitals. 
Discharged  September  5th,  1864,  and  pensioned.  Has  constant  pain  in  head,  with  frequent  attacks  of  vertigo. 

Statler,  Eudolpii,  Private,  Co.  I,  33d  Missouri  Volunteers,  aged  20  years.  Pleasant  Hill,  April  9th,  1864.  Fracture 
of  orbital  bones,  with  loss  of  left  eye.  Field  and  Memphis  hospitals.  Eeturned  to  duty  November  17th,  1864. 

Stewart,  IF.  N.,  Private,  Co.  G,  43d  North  Carolina  Eegiment.  Sitottsylvania,  May  10th,  1864.  Loss  of  left  eye. 
Eetired  March  6th,  1865.  Had  constant  pain,  headache,  and  vertigo,  and  loss  of  sense  of  taste  and  smell.  Had  also  oecasional 
attacks  of  epilepsy. 

Stukes,  Patrick,  Private,  Co.  F,  28th  Massachusetts  Volunteers,  aged  28  years.  Spottsylvania,  May  12th,  1H()4. 
Fracture  of  frontal  bone  and  loss  of  left  eye.  Had  previously  received  wounds  of  abdomen  and  foot.  Field,  Washington, 
Eeadville,  and  Worcester  hosj)itals.  Discharged  July  21st,  1865,  and  pensioiu^d. 

Stratton,  Isaac,  Sergeant,  Co.  F,  7th  Ohio  Volunteers.  Gettysburg,  July  3d,  1863.  Fracture  of  left  supra-orbital 
arch,  with  loss  of  left  eye.  Seminary  and  York  hospitals.  October  1st,  removal  of  fi'agments  of  ball.  Eeturned  to  duty 
October  21st,  1863.  Killed  near  Dallas,  Georgia,  May  25th,  1864. 

Smith,  Elias,  Private,  2d  Iowa  B.attery.  Gunshot  wound  of  left  orbit ; loss  of  sight.  Vicksburg,  Mississip[)i,  May  22d, 
1863.  Eeturned  to  duty  September  28th,  1863.  Not  a pensioner. 

Shafer,  Anthony,  Corporal,  Co.  K,  23d  Pennsylvania  Volunteers,  aged  22  years.  Conoidal  ball  passed  through  nose 
and  emerged  at  the  outer  corner  of  the  right  orbit,  entirely  destroying  the  right  eye.  Co'd  Harbor,  Virginia,  June  1st,  1864. 
Discharged  October  14th,  1864.  Not  a pensioner. 

S.MITH,  Andrew  J.,  Private,  Co.  C,  7th  Wisconsin  Volunteers.  Conoidal  ball  struck  right  eye,  p.assed  downward,  tmd 
lodged  in  left  side  of  neck.  Gettysburg,  Pennsylvania,  July  1st,  1863.  Ball  extracted  by  an  incisiem  in  left  side  of  neck. 
Eight  eye  destroyed.  Transferred  to  Veteran  Eeserve  Corps  September  9th,  1863.  Not  a pensioner. 

Shannon,  Ja.mes  J.,  Corporal,  Co.  B,  83d  Ohio  Volunteers.  Gunshot  wound  of  left  eye.  Arkansas  Post,  January  1 1th, 
1863.  Died  January  19th,  1863. 

Seal,  Zachariah,  Private,  Co.  B,  15th  New  Jersey  Volunteers.  Gunshot  wound  through  eye  and  fracture  of  jaw. 
Discharged  March  9th,  1863,  and  pensioned. 

Slocum,  John  A.,  Private,  Co.  H,  ISOih  Pennsylvania  Volunteers,  aged  20  years.  Gunshot  fracture  of  nasal  bone. 
Conoidal  ball  struck  the  outer  angle  of  left  eye,  cutting  the  eyelid,  and  causing  the  loss  of  sight.  Also  fracture  of  cuboid  bone 
by  shell.  Gettysburg,  Pennsylvania,  July  1st,  1863.  Eeturned  to  duty  December  12th,  1884.  Discharged  and  j)ensioned. 

Stiner,  Joseph,  Private,  Co.  H,  203d  Pennsylvaida  Volunteers,  aged  21  years.  Gunshot  injury  of  j;iw ; right  eye 
destroyed.  Fort  Fisher,  North  Carolina,  Jtvnuary  15th,  1865.  Discharged  April  23d,  1865,  and  pensioned. 

SiiEPLER,  Peter,  Sergeant,  Co.  B,  6th  Pennsylvania  Eeserve  Corps.  Gunshot  fracture  of  right  orbit;  eye  torn  out; 
under  lid  carried  away.  Spottsylvania,  Virginia,  May  10th,  1864.  Discharged  July  17th,  1865.  Ai>pearance  re|)ul.sive.  Not 
a pensioner. 

Semich,  Juliu.S,  Private,  Co.  A,  26th  Wisconsin  Volunteer.s,  aged  25  years.  Missile  entered  outer  angle  of  right  mbit, 
(hestroyed  right  eye,  passed  through  both  superior  maxillary  bones  and  lodged  at  st'cond  upper  mohir,  left  side.  Atlanta, 
Georgia,  July  20th,  1864.  TransfeiTed  to  Veteran  Eeserve  Corps,  Decend)Pr  20tli,  1864.  Discluirged  and  pensioned. 

Senior,  John,  Private,  Co.  B,  35th  Massachusetts  Volunteers.  Antietam,  Seiitember  17th,  181)2.  Gunshot  fracture  of 
superciliary  ridge  and  frontal  bone.  Baltimore  ho.spital.  Discharged  November  2()th,  1862,  and  pensioned.  Vertigo  and 
impaired  vision  of  the  right  eye. 

Staclcley,  D.  II.,  Private,  Co.  H,  59th  Alabama  Eegiment,  aged  25  years.  Gunshot  wound  of  face.  Conoidal  hall  entered 
over  outer  angle  of  orbit,  passed  downward  and  backward,  and  emerged  at  angle  of  inferior  maxilla  of  opposite  side.  Eight 
eye  destroyed.  Spottsylvania,  May  16th,  1864.  Furloughed  June  7th,  1864,  nearly  recovered. 

Syates,  Sylvester,  Private,  Co.  A,  18th  Georgia  Eegiment,  aged  19  years.  Missile,  conoidal  b:ill,  entered  right  eye,  and 
pas.sed  out  of  left.  Burksville,  Virginia,  April  6lh,  1865.  Eelea.sed  May  7th,  186.5,  on  taking  the  oath  of  allegiance. 

Sutton,  Sylvester,  Private,  Co.  A,  14th  Michigan  Volunteers,  aged  21  years.  Atlanta,  Georgia,  August  7th,  1864. 
Fracture  of  temporal,  frontal,  and  malar  bones,  with  loss  of  vision  of  Tight  eye.  Field,  Chattanooga,  Jell'ersonville,  and  Detroit 
hospitals.  Discharged  March  2d,  1865  ; died  September  7th,  1866. 

Sweet,  Linford,  Private,  Co.  A,  49th  New  York  Volunteers,  aged  24  years.  Antietam,  September  17th,  1862. 
Destruction  of  left  eye,  nose,  malar  and  turbinated  bones.  Antietam  and  Smoketown  hospitals.  Great  disfiguration.  Dis- 
charged December  6th,  1862,  and  pensioned. 

Tiiompkins,  Thomas,  Corporal,  Co.  B,  14th  Wisconsin  Volunteers.  Gunshot  fracture  of  facial  bones.  Missile  entered 
left  side  of  nose,  one-half  inch  below  inner  canthus,  and  emerged  one-half  inch  in  front  of  right  ear.  Eight  eye  destroyed. 
Corinth,  Mississippi,  October  3,  1862,  Discharged  March  31st,  1863.  Not  a i)ensioner. 


342 


WOUNDS  AND  TNJITPJES  OF  THE  FACE, 


[Chap.  II. 


Tate,  Samitel  G.,  Private,  Co.  I,  4tli  United  States  Cavalry.  Fracture  of  frontal  bone,  with  loss  of  right  eye.  Louis- 
ville hospital.  Eeturned  to  duty  March  11th,  1803.  Discharged  April  22d,  1863,  and  pensioned. 

UzELMEYER,  JOHN,  Private,  Co.  I,  1st  Delaware  Volunteers,  aged  20  years.  Wilderness,  May  5th,  1804.  Fracture  of 
external  table  of  frontal  bone,  with  loss  of  left  eye.  Field,  Washington,  and  Chester  hospitals.  Transferred  to  the  Veteran 
Deserve  Corps,  May  Cth,  1865.  Discharged  September  15th,  1865,  and  pensioned. 

An  unknown  soldier  of  the  3d  Alabama,  admitted  to  Washington  hospital,  April  24th,  1865,  from  City  Point.  Conoidal 
ball  lodged  in  orbit  of  left  eye.  Died  April  30th,  1865. 

VoSBUiiG,  Stephen  II.,  Sergeant,  Co.  F,  63d  New  York  Volunteers,  aged  24  years.  Gunshot  wound  of  face.  Conoidal 
ball  traversed  base  of  nose,  destroying  right  eye.  Cold  Harbor,  Virginia,  June  1st,  1864.  Transferred  to  Veteran  Deserve  Corps 
April  5th,  1865.  Discharged  and  pensioned. 

Wclton,  G.  IF.,  Private,  Co.  F,  12th  Virginia  Degimeiit.  Loss  of  ej’^e.  Dichmond  hospital.  Furloughed  September 
7th,  1864. 

White,  Charles  F.,  Private,  Co.  F,  114th  New  York  Volunteers,  aged  21  years.  Cedar  Creek,  Virginia,  October 
19th,  1864.  Fracture  of  skull,  and  destruction,  also,  of  right  eye.  Great  dishguration.  Baltimore  and  Philadelphia  hospitals. 
Transferred  to  the  Veteran  Deserve  Corps.  Discharged  June  15th,  1865,  and  pensioned. 

Whitlock,  John,  Private,  Co.  A,  1st  New  Jersey  Volunteers,  aged  21  years.  Spottsylvania,  Virginia,  May  11th,  1864. 
Fiacture  of  orbital  and  temporal  bones,  with  loss  of  right  eye.  Field,  Washington,  and  Philadelphia  hospitals.  Discharged 
May  19th,  1865,  and  pensioned. 

Will,  George  F.,  Private,  Co.  I,  77th  New  York  Volunteers,  aged  22  years.  Wilderness,  May  6th,  1864.  Fracture 
of  orbital  and  temporal  bones,  with  loss  of  left  eye.  Washington,  Philadelphia,  New  York,  and  Albany  hospitals.  Sympathetic 
affection  of  l ight  eye.  Discharged  December  13th,  1864,  and  pensioned. 

Williams,  Alexander  N.,  Private,  Co.  A,  85th  Indiana  Volunteers.  Atlanta,  Georgia.  Fracture  of  temporal,  with 
loss  of  left  eye.  Field,  Chattanooga,  and  Nashville  hospitals.  Transferred  to  Veteran  Deserve  Corps  December  21st,  1864. 

WiTHEY',  Lemon  B.,  Private,  Co.  C,  136th  New  York,  aged  25  years.  Gettysburg,  July  2d,  1863.  Fracture  of 
mahar  bone,  and  loss  of  left  eye.  Gettysburg,  York,  and  Alexandria  hospitals.  Spiculffi  extracted.  Discharged  May  25th, 
1865,  and  pensioned. 

Williams,  Asbury^,  Private,  Co.  D,  23d  Indiana  Volunteers.  Vicksburg,  May  19tb,  1863.  Fracture  of  cranium  at  base 
of  brain,  with  loss  of  left  eye.  Field  hospital.  Died  June  8th,  1863. 

"Wait,  Eli,  Corporal,  Co.  B,  5th  Minnesota  Volunteers.  Gunshot  wound  of  face.  Missile  entered  orbit  of  right  eye, 
destioying  the  sight,  crossed  the  face  under  the  nose,  and  lodged  in  antrum  of  left  side.  Vicksburg,  Mississippi,  1863.  Trans- 
ferred to  Veteran  Desei've  Corps,  and  returned  to  duty  December  7th,  1863.  Not  a pensioner. 

Works,  Wi!IGHT,  Private,  Co.  B,  COth  New  York  Volunteers,  aged  20  years.  Gettysburg,  Pennsylvania,  July  3d,  1863. 
Gunshot  wound  of  facial  bones,  with  loss  of  eye.  Demoval  of  spiculae  of  bone  and  lead  at  various  times.  Deturned  to  duty 
June  28th,  1864.  Discharged  and  pensioned. 

Walker,  A.,  Private,  Co.  Iv,  Palmetto  Sharpshooters,  South  Carolina.  Gunshot  fracture  of  facial  bones  and  loss  of  left 
eye.  Petersburg,  Virginia,  October  7th,  1864.  Furloughed  for  sixty  days,  November  4th,  1864. 

Walton,  Mathew,  Corporal,  Co.  K,  61st  Ohio  Volunteers,  aged  24  years.  Gunshot  fracture  of  facial  bones,  with  loss 
of  right  eye.  Peach  Tree  Creek,  Geoigia,  July  20th,  1864.  Left  eye  impaired.  Discharged  March  20th,  1865,  and  pensioned. 

Williams,  Orm.yndo  M.,  Private,  Co.  E,  5th  Vermont  Volunteers,  aged  21  years.  Gunshot  fracture  of  bones  of  face; 
left  eye  destroyed.  W^ilderness,  Virginia,  May  6th,  1864.  Ball  remained  in  wound  for  three  or  four  years,  when  it  was  finally 
removed  from  the  throat  by  the  patient  during  a choking  6t.  Discharged  November  16th,  1864,  and  pensioned. 

Wilford,  James  M.,  Sergeant,  Co.  D,  4th  Tennessee  Dcgiment.  Gunshot  fracture  of  nasal  bone ; right  eye  destroyed. 
Franklin,  Tennessee,  November  30th,  1864.  Sent  to  provost  marshal  January  7th,  1835. 

Weeks,  George  M.,  Sergeant,  Co.  C,  56th  Massachusetts  Volunteers,  aged  21  years.  Gunshot  wound  of  face.  Conoidal 
ball  entered  at  junction  of  right  malar  and  frontal  bones,  traversed  orbit  and  nasal  cavities,  and  emerged  at  inner  angle  of  left 
orbit.  Petersburg,  Virginia,  September  30th,  1864.  Loss  of  right  eye.  Deturned  to  duty  January  23d,  1865 ; afterward 
discharged  and  pensioned. 

Watson,  Thomas  J.,  Private,  Co.  H,  115th  Illinois  Volunteers,  aged  19  years.  Gunshot  wound  of  face.  Buckshot 
entered  half  an  inch  to  outside  of  right  eye,  passed  inward  and  downward,  and  emerged  from  cheek,  near  left  angle  of  mouth, 
knocking  out  several  teeth;  also  fracture  of  right  ulna  in  lower  third.  Docky  Face,  IMay  9th,  1864.  Discharged  October 
7tb,-  1864.  Vision  of  right  eye  destroyed;  that  of  left  slightly  impaired,  as  also  mastication  and  speech.  Flexion  of  fingers 
imperfect.  Ho  is  a pensioner. 

Of  the  foregoing  series  of  two  hundred  and  fifty-four  cases  of  gunshot  injury  of  one 
eye,  twenty  were  fatal,  the  mortality  being  due  to  grave  complications  involving  the  brain 
or  branches  of  large  vascular  trunks.  In  forty-one  of  these  cases,  vision  in  the  uninjured 
eye  became  affected  sympathetically,  and  in  four  instances  was  ultimately  lost.  The 


Sect.  II.]  GUNSHOT  WOUNDS  OF  THE  EYE.  343 

aggregate  of  gunsliot  injuries  of  tlie  eye  reported,  from  which  the  preceding  abstracts  were 
selected,  is  set  forth  in  the  following  table  : 

Table  XI. 


Table  of  Eleven  Hundred  and  Ninety  Cases  of  Gunsliot  Wounds  of  the  Eye. 


EXTENT  OF  INJURY. 

Cases. 

Died. 

Duty. 

Discharged. 

Unknown. 

Destroying  sight  of  both  eyes 

63 

17 

44 

2 

Destroving  sight  of  right  eye T. . . 

393 

12 

87 

286 

8 

Destroying  sight  of  left  eye 

387 

24 

95 

253 

10 

Destroying  sight ; side  not  given 

4.5 

11 

9 

17 

8 

Injuring  sight  of  riglit  ej^e - 

25 

9 

13 

3 

20 

8 

8 

4 

Injuring  sight  j side  not  stated 

G 

1 

2 

3 

106 

71 

24 

11 

Undetermined  cases  j left  eye 

116 

83 

20 

13 

Undetermined  cases;  side  not  stated 

29 

16 

7 

6 

Aggregate 

1, 190 

64 

379 

679 

68 

In  ninety-one  cases  where  the  eye  was  destroyed,  the  sight  of  the  remaining  eye  was 
impaired  or  sympathetically  affected.  The  table  does  not  include  cases  of  burns  of  the 
face  reported,  not  unfrequently  caused  l^y  magazine  explosions  or  the  premature  ignition 
of  cartridges,  when  it  often  happened  that  grains  of  powder  were  driven  beneath  the 
conjunctiva  and,  unless  promptly  removed,  became  encysted  and  indelibly  disfigured  the 
sclerotica while  yet  more  serious  consequences,  as  corneal  oj^acity,  traumatic  cataract, 
or  general  ophthalmitis,  were  not  uncommon.  Systematic  writers  on  ophthalmology  class 
with  gunshot  wounds  of  the  eye,  cases  of  injuries  of  that  organ  from  bits  of  gravel  or 
other  hard  bodies  thrown  up  by  bursting  shells  or  by  the  impact  of  large  projectiles  on 
masonry.  Such  instances  were,  probably,  infrequent  in  the  late  war,  as  no  specific  details 
of  any  examples  are  found  recorded.*]*  The  intrusion  of  fragmeilts  of  percussion  caps  into 
the  eye  was  also  a rare  accident,  but  nineteen  instances  being  mentioned  in  the  large 
series  of  reports  classified  as  gunshot  injuries  of  the  eye.  In  three  of  the  cases,  the  side 
on  which  the  injury  was  inflicted  was  not  reported ; in  ten,  the  right,  and  in  six,  the  left 
eye  was  involved.  Five  of  the  patients  were  returned  to  duty,  with  little  impairment  of 
vision,  one  was  placed  on  modified  duty  in  the  Veteran  Reserve  Corps,  eight  were 
discharged,  and  five  remain  unaccounted  for.  It  can  be  gleaned  from  the  scanty  details 
given,  that  the  men  who  were  returned  to  duty  had  non-penetrating  injuries  of  the  cornea 
or  of  the  exposed  part  of  the  globe  ; that  the'  eye  was  lost  when  the  foreign  body  had 
entered  the  posterior  chamber,  and  that  the  only  recoveries  after  penetration  of  the 

■ * Captain  Worden  received  an  injury  of  this  sort  in  the  famous  action  witli  the  Merriinac,  and  it  used  to  be  said  in  the  army  that  he  should  blusli 

with  a pardonable  pride  whenever  he  looked  in  the  min'or. 

t Lord  Nelson  lost  an  eye  from  this  cau.se  at  the  siege  of  Calvi,  as  related  in  a letter  to  his  wife,  August  18tli,  ITM.  TyUKKi.l.  (Vol.  I,  p.  367), 
Ammon  (Zeitschrifl,  15.  Ill,  ,S.  103),  Dr.  I.  I.  IlAYES  (3d  Am.  cd.  of  Lavvuencic  On  the  Eye,  p.  182),  and  Ma'ITIIEW  (Surf/.  Uisl.  of  liril.  Army  in  Ih^ 
Crimea,  p.  310),  record  similar  eases. 


344 


WOUNDS  AND  INJURIES  OF  THE  FACE 


[Chap.  II. 


{interior  chamber  were  those  in  which  the  copper  fragment  was  immediately  extracted.* 
The  injuries  of  the  eye  from  pistol  and  musket  balls  and  from  fragments  of  large  projectiles 
were  very  varied  in  their  nature.  (Jommouly  destructive  of  vision,  they  were  seldom 
dangerous  to  life,  unless  associated  with  fractures  involving  the  cranial  cavity.  There 
were  twenty-five  examples,  of  which  some  particulars  have  been  given,  of  recovery  after 
the  evulsion  of  both  eye-balls  by  shot  traversing  the  orbits.  There  were  two  instances 
[Zimmerman  and  Ferdon,  p.  327,  ante)  of  recovery  after  the  passage  of  musket  balls 
behind  the  orbits,  from  temple  to  temple,  the  total  blindness  that  ensued  indicating  the 
probable  division  of  the  optic  nerves  anteriorly  to  their  decussation.  Specimen  1,108,  of 
the  Museum  (see  Fig.  103,  p.  205)  illustrates  how  bullets  may  readily  pursue  this  course 
without  involving  the  anterior  cerebral  lobes.  The  percentage  of  recovery,  where  a single 
eye  was  torn  from  its  socket  by  a bullet,  was  large,  and  the  secondary  lesions  of  the  brain 
or  of  the  opposite  eye  were  less  frequent,  after  this  rude  mode  of  extirpation,  than  in  cases 
in  which  buckshot  or  small  pistol  balls  lodged  within  the  globe.  No  case  is  recorded 
explicitly  of  the  lodgment  of  a ball  in  the  orbit,  without  injury  to  the  globe,  unless  the 
case  of  Kichardson  (p.  340,  ante)  may  have  been  of  that  nature.  Hennen  met  with  an 
instance  of  this  sort  during  the  retreat  of  Sir  John  Moore’s  army  to  Corunna,  and  has 
described  it  in  his  fifty-second  observation.  (Op.  cit,  p.  346.)  The  flattened  bullet  was 
extracted  by  dressing  forceps,  and  there  was  but  slight  irritation  of  the  eye,  “although  he 
underwent  a very  distressing  march  that  night.” 

The  eyelids  rarely  escaped  injury  in  gunshot  wounds- of  the  contents  of  the  orbit;  but 
in  a few  instances  the  globe  was  emptied  by  a musket  ball,  with  slight  lesion  of  the  lids. 
Eversion  and  inversion  of  the  lids,  ancyblepharon  and  symblepharon,  and  various  adhesions 
of  the  remnants  of  the  lids  to  the  margins  of  the  orbit  followed  in  many  of  this  class  of  cases. 
A tew  instances  are  illustrated  by  photograjJis  in  the  Museum  ;-j-  others  will  be  described 
with  the  cases  of  blepharoplasty,  in  the  next  section  of  the  chapter. 

Missiles  seldom  penetrated  or  destroyed  the  eyeball  without  injuring  the  bones  forming 
the  orbit.  In  the  foregoing  pages  of  this  section,  many  instances  have  been  cited  of 
extensive  fractures  of  the  facial  bones,  associated  with  gunshot  wounds  of  the  eye,  and 
in  the  preceding  chapter  may  be  found  examples  of  fractures  involving  the  frontal  sinuses 
(p.  164,  Pigs.  74  and  75)  and  upper  osseous  boundary  of  the  orbit.  Unless  the  lesions  of 
bone  extended  to  the  cranial  cavity  the  results  were  seldom  fatal.  In  many  instances  of 
these  distressing  species  of  injuries,  recovery  took  place,  or  the  fatal  result  was  long  deferred 
unless  complicated  with  cerebral  mischief ; the  fractures  of  the  external  walls  of  the  frontal 
and  maxillary  sinuses  were  not  dangerous,  though  followed  by  necrosis,  with  interminable 
exfoliations  and  frequent  abscesses.  There  was  no  carefully  reported  case  of  amaurosis 
induced  by  the  division  of  the  supraorbital  nerve  by  balls,  and  nothing  in  the  reports  to 
sanction  the  assertion  of  MacKenzie  [Am.  ed.,  1855,  p.  416)  that  the  “wind  of  a ball  has 
been  known  to  produce  amaurosis.”  The  “wind  of  balls”  has  long  been  wafted  out  of  the 
domain  of  military  surgery. 


* On  percussion  caps  lodged  in  the  eyeball,  consult  CiiOMrTON's  account  of  seven  cases  treated  by  Barton,  cf  Manchester  {London  Med.  Gazette, 
Vol.  XXI,  p.  171) ; Am.  Jour,  of  Med.  Sciences,  fur  a case  of  successful  removal  cf  a fragment  from  the  iris  by  Dr.  N.  B.  Smith;  Dr.  J.  Hays  {loc.  cit., 
p.  182);  SlTfiVF.NART  {Ann.  d'Oe.,  T.  I,  p.  439);  CUNIER  {ihid.,  p.  440);  Lawson  {Injuries  of  the  Eye,  p.  289)  gives  six  cases.  StoEBER  (in  W.  \V. 
Cooper's  Wounds  and  Injuries  of  the  Eye,  London,  18G9,  p.  391). 

t See  Photographs  of  Surg.  Cases  and  Specimen.^,  A.  &I.  M.,  Vol.  I,  p.  32;  Ihid.  Vol.  IF,  p.  2;  Ihid.  Vcl.  II,  p.  18;  Ihid.  Vol.  VI,  p.  0;  Ihid.  Vol. 
VII,  i>.  8;  Card  Photographs  of  Surgical  Cases,  A.  M.  M.,  Vol.  I,  p.  4;  Ihid.  Vol.  I,  p.  4;  Ihid.  Vol.  I,  p.  10;  Ibid.  Vol.  I,  p.3;  Ihid.  Vol.  I.  p.3;  Ihid, 
Vol.  I.  p.  3;  Ihid.  Vol.  I,  p.  4. 


Sect.  II.] 


GUNSHOT  WOUNDS  OF  THE  EYE. 


345 


Gunsliot  contusions  of  tlio  globe  of  the  eye  were  not  unfrcqucntly  followed  by 
traumatic  cataract.  I have  searched  in  vain  in  the  records  for  such  instances  of  recovery 
from  this  lesion  as  Larrey  recorded  [Clin.  Chir.  T.  1®,  p.  403),  of  recovery  of  perfect  vision, 
or  even  of  useful  vision,  after  unquestionable  instances  of  wounds  of  the  crystalline.'^ 

A general  survey  of  the  accounts  of  gunshot  injuries  of  the  eye,  reported  during  the  war, 
instructs  us  that  whenever  foreign  bodies  are  lodged  in  the  globe,  they  should  be  extracted 
at  all  hazards.  If  it  is  impracticable  to  find  them,  the  globe  should  be  extirpated  in  order 
to  preserve  the  other  eye.  When  general  opthalmitis  has  followed  a gunshot  injury,  a 
free  horizontal  incision,  evacuating  the  contents  of  the  eyeball,  should  not  be  long  delayed. 
Absolute  rest,  and  strict  diet,  and  every  precaution  that  may  conduce  to  the  preservation 
of  the  remaining  eye,  should,  with  sedulous  solicitude,  be  enjoined  by  the  surgeon.  In  the 
cases  complicated  by  fractures  of  the  orbital  region,  it  was  plainly  shown  that  it  was 
unwise  to  remove  fragments  of  bone  primarily,  unless  they  were  so  detached  as  to  serve 
as  foreign  bodies. 

In  the  dressing  of  gunshot  wounds  of  the  eyelids,  often  exhibiting  much  loss  of  tissue, 
favorable  results  were  obtained  by  the  careful  readjustment  of  the  mutilated  parts,  with 
coaptation  by  the  twisted  suture,  the  contused  edges  of  the  wound  being  pared  in  some 
instances.  But  this  method  of  reunion,  so  very  serviceable  in  wounds  about  the  face, 
was  not  very  generally  employed.  In  cases  attended  by  destruction  of  the  puncta  or  of 
the  lachrymal  canals,  some  of  them  having  been  under  the  observation  of  pension  examiners 
or  army  surgeons  for  six  or  seven  years,  little  or  no  diminution  in  the  overflow  of  tears 
took  place,  a result  conflicting  with  the  assertions  of  oculists  who  have  obliterated  the 
puncta  with  alleged  success  in  cases  of  epiphora  or  stillicidium. 

Artificial  eyes  were  furnished  to  a few  of  the  mutilated  soldiers;  but,  in  most 
instances,  the  destruction  of  tissue  in  gunshot  injuries  involving  the  globe  of  the  eye, 
made  it  inadvisable  to  attempt  the  insertion  of  a glass  eye.f 

Gunshot  Fractures  of  the  Facial  Bones. — Among  the  abstracts  of  wounds  of 
the  orbital  region,  many  examples  of  injuries  of  the  adjacent  bones  have  been  cited. 
The  following  one  hundred  and  thirty-eight  abstracts  relate  mainly  to  cases  involving  the 
upper  and  lower  maxillae  chiefly;  but  strict  classification  has  not  been  attained  in  this 
series  of  complicated  cases: 

Case. — Private  James  Berks,  Co.  K,  138th  Pennsylvania  Volunteers,  aged  60  years,  received,  at  the  battle  of  Locust 
Grove,  November  27th,  1863,  a gunshot  wound  of  the  face,  right  side.  The  missile  entered  over  the  right  angle  of  the  jaw,  and 
emerged  beneath  the  symphysis,  comminuting  the  jaw  between  both  wounds.  Several  spiculac  of  bone  were  removed  on  the 

* Consult  Laruey,  Scarpa,  IIky,  IIennen,  Vicq-u’Azyr  on  this  disputed  iioint. 

t Obsen'ations  on  {gunshot  wounds  of  the  eye  may  be  found  in  Beer,  Lehre  der  Augenkrankheiten,  Wien,  1792,  B.  1,  S.  95 ; in  IlEXNEN,  Prin- 
ciples of  Military  Surgery^  3d  ed.,  Loudon,  J829,  p.  344  ; GUTIIRIR,  Commentaries,  etc.,  p.  523 ; W.  W.  COOPER,  On  Wouyjds  and  Injuries  of  the  Eye, 
Loudon,  1809,  p.  59;  BELL,  System  of  Operative  Surgery,  London,  1814,  2d  ed.,  p.  452;  THOMSON,  Observations  in  the.  British  Military  Hospitals  in 
Belgium,  Edinboro’,  1816,  p.  05  ; MacleOD  {op.  cit.),  p.  223 ; DixoN,  in  Holmes's  System  of  Surgery,  Vol.  Ill,  p.  89,  2d  ed. ; Leooukst  {op.  cit.),  p.  305 ; 
Annales  d' Oculistique,  T.  Ill,  p.  73,  Bruxelles,  1840;  WALKER,  Oculists'  Vade-mecum,  London,  1843,  p.  323;  McUae,  Medical  lieport  of  the  Campaign 
in  the  Punjauh,  p.  48  ; Demours,  Traite  des  Maladies  des  Yeux,  Baris,  1818,  PI.  52,  fig.  1 ; Penin,  Ann.  d'  Oc.,  T.  XX,  p.  105 ; ISCHKNSCIINIED,  ibid., 
T.  XXX,  p.  107 ; Careon  DU  ViLLARDS,  Gazette  Med.  de  Paris,  T.  VI,  c.  1 ; Playne,  Opthalmic  Hospital  Reports,  London,  Vol.  I.  p.  210;  Meni^RK, 
V Uotel-Dieu  de  Paris,  enjuillctlBMO,  Paris,  1830;  MACKENZIE,  A Practical  Treatise  on  the  Diseases  of  the  Eye,  Am.  cd.,  1855,  p.  412;  Stellwao 
and  SOELHERG  WELLS,  in  their  recent  treatises,  add  nothing  to  our  information  on  the  subject ; StOEBER,  Ann.  d'  Oc.,  T.  Ill,  p.  70 ; Crompton,  Lorahm 
Medical  Gazette,  Vol.  XXI,  p.  175 ; Castelnau,  Archives  General  de  Medicine  ; LAWSON,  Injuries  of  the  Eye,  Orbit,  and  Eyelid,  London.  1807,  p.  282  ; 
Gama,  Traite  des  plaits  de  tete  ei  de  Vencephalite,  2d  cd.,  I^aris,  1835,  p.  340 ; liAWRENCE,  On  the  Diseases  of  the  Eye,  Am.  ed.,  Phila.,  1854,  p.  182 ; 
DEVal,  Chirurgie  Oculaire,  Paris,  1844,  p.  500;  Besmarrks,  Traite  des  Maladies  dcs  "Yeux,  I^aris,  1854,  20  ed.  T.  I.  p.  152;  WAi/rON,  Operative 
Opthalmic  Surgery,  London,  1853,  p.  95;  Matthew,  Surg.  Hist,  of  the  War  in  the  Crimea,  Vol.  II,  p.  309;  Fardkau,  Jour.  Gen.  de  Med.  et  de 
Chir.,  T.  24,  Paris,  1809,  p.  287 ; Denonvilliers  ET  OOSSELIN,  Compendium  {op.  cit.),  T.  HI,  p.  413,  Paris,  1801  ; Platner,  Institutiones  Chirurgie, 
Lipsia?,  1758,  p.  322 ; BaUDENS,  Cliniques  de  Plaies  d' Armens  a Feu,  p.  107 ; Lohmeyeu,  Die  Schusswunden,  Zweite  Ausgabc,  1809,  8.  99 ; BECK,  Die 
Schusswunden,  8.  139;  OCHWADT,  Kriegschirurchische  Erfahrungen,  8.  354;  UOSAS,  Handbuch  der  thcorctischen  und  pructischen  Augenheilkunde, 
Wien,  1830,  B.  I,  8.  421 ; DiETKUICII,  Archives  G4n4rales  de  Medicine,  October,  1820,  i>.  295;  IlILL,  Cases  in  Surgery,  Case  V ; GarENOEOI’,  Traite 
des  Operations  de  Chirurgie,  T.  3®,  p.  155. 

44 


346 


WOUNDS  AND  INJUKIKS  OF  THE  FACE 


[Chap.  II. 


field.  He  was,  on  December  4tb,  admitted  to  2d  division  hospital,  Alexandria.  On  admission,  the  right  side  of  the  jaw  had 
fallen  in  consideiahly,  and  the  patient  was  weak  and  anaemic.  Opiates,  stimulants,  and  tonics  were  administered,  and  chicken 
broth,  beef  tea,  and  farina  ordered.  Secondary  hmmorrhage  from  one  of  the  external  carotid  arteries  occurred  December  10th, 
amounting  to  ten  ounces  of  blood,  which  was  controlled  by  the  application  of  peisulj)hate  of  iron.  The  patient  stated  that  he 
had  recurrent  haemorihages.  The  horizontal  ramus  of  the  lower  jaw  is  gone,  and  he  can  eat  Huid  food  only.  He  was  discharged 
the  service  March  7th,  1864,  and  pensioned  on  March  15th.  Examining  Surgeon  H.  L.  Hodge  reports  that  he  has  great 
difficulty  in  swallowing  and  very  imperfect  speech.  His  mind  is  weakened ; disability  total,  probably  permanent.  The  case  is 
recorded  by  Acting  Assistant  Surgeon  J.  G.  McKee. 

Case. — Private  William  H.  Batchelder,  Co.  I,  16th  Maine  Volunteers,  aged  22  years,  was  wounded  at  the  battle  of 
Gettysburg,  July  1st,  1863,  by  a conoidal  ball,  which  caused  a compound  comminuted  fracture  of  the  right  lateral  half  of  the 
inferior  maxilla,  and  fractured  a portion  of  the  superior  maxilla.  The  ball  entered  the  right  side  of  the  face  slightly  above  and 
to  the  outside  of  the  right  wing  of  the  nose,  passing  downward  and  backward,  shattering  the  body  of  the  right  superior  maxilla 
and  the  first  and  second  molars,  with  the  alveolar  process  of  the  inferior  maxilla,  grazing  the  side  of  the  tongue  in  its  passage. 
He  was  sent  to  the  2d  division  hospital.  First  Corps.  The  ball  was  removed  at  the  lower  side  of  the  mouth.  Secondary 
hatmorrhage  from  the  dental  or  facial  artery  occurred  J uly  8th,  amounting'  to  about  twenty  ounces  of  blood,  which  was  arrested 
by  the  application  of  styptics,  .and  pressure.  On  July  Iflth,  he  w.as  transferred  to  York  Hospital,  Pennsylvania.  The  patient 
was  put  under  chloroform,  and  seven  teeth,  consisting  of  five  upper  and  two  lower,  were  removed,  besides  many  jiieces  of  the 
superior  maxilla.  Cold  water  dressings  were  applied  to  the  wound.  He  was  restless,  and  much  pained,  and  had  bad  appetite. 
There  was  considerable  discharge  of  pus  in  the  mouth,  the  granul.ations  filling  the  gaps  in  the  jaws.  On  August  21st,  the  wound 
of  entrance  had  closed,  with  some  depression  of  the  cic.atrix.  He  could  open  the  mouth  one-half  of  an  inch,  but  was  unable  to 
close  it  with  force;  spoke  rather  plainly,  but  could  not  speak  when  first  wounded.  He  looked  rather  pale,  had  good  appetite,  and 
slept  under  morphia.  He  complained  of  paroxysms  of  pain  at  the  root  of  the  neck  and  shoulders,  which  yielded  to  wet  cups 
and  morphia ; these  paroxysms  continued  with  variiible  intensity,  and  extending  to  the  back  of  the  head,  until  about  the  21st  of 
September,  at  wbich  time  it  refused  to  yield  to  treatment.  On  the  22d,  his  face  flushed,  pulse  frequent,  irregular,  and  severe 
headache.  Cups  were  applied  to  the  back  of  the  neck  and  cold  applic.ations  to  the  head,  which  gave  temporary  relief.  On  the 
23d,  his  condition  was  unchanged,  save  slight  drowsiness.  On  the  24th,  drowsiness  increased,  and  blisters  were  applied  to  the 
back  of  the  neck.  On  the  25th,  coma,  snoring,  and  death.  Necrotomy  showed  some  emaciation,  and  some  congestion  of  the 
dura  mater.  The  arachnoid  presented  an  opaque  appearance,  most  marked  at  the  base  of  the  brain;  that  portion  of  the  brain 
resting  upon  the  basilar  portion  of  the  occipital  bone  was  deeply  red,  softened,  and  at  one  point  presented  a spot  of  badly 
organized  lymph,  and  possibly  some  pus.  The  ventricles  were  distended  by  several  ounces  of  very  clear  serum.  The  case  is 
ref)orted  by  Surgeon  Henry  Palmer,  U.  S.  V. 

Case. — Sergeant  George  R.  Burroughs,  Co.  G,  12th  New  Jersey  Volunteers,  aged  23  years,  was  wounded  at  the  battle 
of  Cold  Harbor,  June  3d,  1864,  by  a conoid.al  ball,  which  fivactured  the  ramus  of  the  inferior  maxilla.  The  missile  entered  at 
the  middle  of  the  ramus  on  the  right  side,  and  emerged  below  the  angle  on  the  left  side,  wounding  the  lingual  and  facial  arteries. 
He  was,  on  June  15th,  admitted  to  Harewood  Hospital,  Washington.  Secondary  hajraorrhage  from  the  lingual  and  facial  arteries 
occurred  June  17th,  amounting  to  eighteen  ounces  of  blood.  Hatmorrhage  recurred  on  the  20th.  Free  incisions  were  made  in 
the  course  of  the  wound,  and  coagulated  blood  and  pus  cleaned  out  thoroughly;  the  haemorrhage  thereupon  ceased.  The  consti- 
tutional treatment  throughout  was  supporting.  Died  Juno  22d,  1864.  Patient  seemed  to  have  died  fi’om  exhaustion  superinduced 
by  profuse  and  protracted  suppuration,  rather  than  from  the  immediate  effects  of  the  haemorrhage.  The  case  is  reported  by 
Surgeon  R.  B.  Bontecou,  U.  S.  V. 

Ca.se. — Private  James  P.  Bonham,  Co.  D,  5th  New  York  Volunteers,  aged  22  yeai's,  of  a nervo-sanguine  temperament, 
and  who  had  always  enjoyed  perfect  health,  was  wounded  at  the  second  battle  of  Bull  Run,  Virginia,  August  30th,  1862,  by  a 
conoidal  ball,  which  entered  the  left  cheek  midway  on  a line  drawn  from  the  middle  of  the  margin  of  upper  lip  to  that  of  the  lobe 
of  the  ear,  passed  along  the  body  of  the  inferior  maxilla,  breaking  out  both  upper  and  lower  anterior  and  posterior  molars, 
causing  a compound  fracture  of  the  sujierior  maxilla,  and  then  striking  the  palate  bone  at  its  posterior  edge,  glanced  off  in  an 
oblique  direction  downward  and  forward  to  the  right,  and  lodged  in  the  lingual  muscles.  He  was  admitted,  on  the  next  day,  to 
the  Armory  Square  Hospital,  Washington,  in  an  exhausted  condition.  Stimulants  and  nourishing  diet  were  given.  The  ball 
could  not  be  found.  Spiculae  of  bone  were  removed,  and  cold  water  dressings  applied.  On  September  6th,  the  wound  was 
suppurating  freely.  On  September  12th,  secondary  haemorrhage  occurred,  probably  from  the  tonsillar  or  palatine  arteries,  which 
was  restrained  by  cold  applications.  On  October  17th,  an  incision  was  made  one  inch  in  front  of  the  angle  of  the  infeiior  maxilla 
at  the  lower  posterior  edge  of  the  gland,  and  the  bullet  extracted.  It  was  found  to  be  much  flattened  and  bent,  and  thickly  set 
with  minute  spicitlaj  of  bone.  Fomentations  were  applied  to  promote  suppuration.  On  October  26th,  the  wounds  in  the  cheek 
and  fauces  were  closed,  and  on  the  31st,  the  parts  had  assumed  nearly  their  normal  condition.  He  was  discharged  from  service 
March  31st,  1863.  Surgeon  D.  W.  Bliss,  U.  S.  V.,  reports  the  case.  He  is  a pensioner,  his  disability  being  rated  one-third  and 
permanent. 

Case. — Private  Henry  Baine,  Co.  C,  188th  Pennsylvania  Volunteers,  aged  19  years,  received  at  the  battle  of  Cold  Harbor, 
Virginia,  June  3d,  1864,  a gunshot  wound  of  head  and  face,  conoidal  ball  entering  in  front  of  the  meatus  auditorius,  left  side,  and 
emerging  at  nasal  eminence,  involving  loss  of  left  eye  and  partial  destruction  of  internal  maxillary  artery.  He  was  admitted  to 
the  Emory  Hospital,  Washington,  on  June  10th,  1864.  Face  much  swollen;  vision  destroyed.  Cold  water  dressings  were 
a|iplied  and  tonics  administered.  Patient  did  well  until  the  evening  of  June  15th,  when  secondaiy  hajmorrhage  took  place. 
He  lost  from  four  to  six  pounds  of  blood,  necessitating  operation.  On  June  16th,  at  ten  A.  M.,  Surgeon  N.  R.  Moseley,  U.  S.  V., 
ligated  the  common  carotid  artery,  in  superior  carotid  triangle,  just  below  origin  of  internal  maxillary  artery.  He  died  on  June 
26,th,  1864,  from  exhaustio:n  and  debility.  The  case  is  reported  by  tbe  operator. 


SECT.  IT.] 


GUNSHOT  FRACTUKES  OF  TITE  FACIAL  BONES. 


347 


Case. — Private  Cyrus  W.  BeanioiulorfVr,  Co.  A,  84tli  Pennsylvania  Volunteers,  aged  20  years,  was  wounded  at  the  li.-ittli; 
of  the  Wilderness,  Virginia,  May  6th,  1864,  hy  a conoidal  hall,  which  entered  the  left  side  of  the  face  about  half  an  inch  above 
the  angle  of  the  mouth,  taking  a downward  and  backward  course,  and  emerged  from  the  left  side  of  the  neck,  about  three  inches 
below  the  ear,  and  lodged  in  the  left  shoulder.  The  upper  jaw  sustained  no  injury,  exce])t  the  bn-aking  off  of  the  first  bicuspid. 
The  left  side  of  the  under  jaw  was  very  much  broken,  and  was  resected  on  the  field,  ft-om  the  joint  to  a point  between  the  two 
bicuspids.  On  iMay  12th,  1864,  hajmoiThage  occurring,  the  primitive  carotid  artery  was  ligated  just  above  the  clavicle  by  Henry 
McLain,  formerly  surgeon  2d  New  York  Volunteers.  He  was  admitted  to  the  1st  division  hospital,  Alexandria,  Virginia,  May 
25th,  and  on  June  20th  transferred  to  Philadelphia,  entering  Satterlee  Hospital  on  the  22d.  His  general  health  was  good,  and 
the  wounds  were  almost  entirely  healed.  Cerate  dressings  were  applied.  He  was  discharged  from  service  November  29th,  1864. 
On  October  5th,  1866,  Pension  Examiner  George  P.  Lineaweaver  reports  that  the  muscles  of  the  left  side  of  the  neck  are  so 
contracted  that  he  cannot  turn  his  head.  His  disability  is  rated  total.  Surgeon  I.  I.  Hayes,  U.  S.  V.,  reports  the  case. 

Case. — Private  George  Brown,  Co.  I,  25th  Massachusetts  Volunteers,  aged  41  years,  received  a gunshot  wound  of  the 
face  at  the  battle  of  Goldsboro’,  North  Carolina,  December  14th,  1862.  He  was  on  December  20th  admitted  to  Stanley  Hospital, 
New  Berne,  North  Carolina.  Secondary  luemorrhage  occurred  January  7th,  and  recurred  on  the  9th;  the  loss  of  blood  amounted 
to  about  thirty-two  ounces.  Cold  water  dressings  were  applied  to  the  wound,  and  stimulants  and  tonics  ordered.  Patient  died 
January  18th,  1863.  The  autopsy  revealed  an  extensive  comminution  of  the  malar  bone,  the  zygomatic  arch,  the  antrum,  and 
the  petrous  portion  of  the  temporal  bone  ; also  laceration  of  the  external  carotid  artery.  The  case  is  reported  by  Acting  Assistant 
Sui'geon  J.  B.  Uphain. 

Case. — Private  Daniel  Cox,  Co.  F,  15th  Indiana  Volunteers,  aged  25  years',  was  wounded  at  the  battle  of  Missionary 
Ridge,  November  25th,  1863,  by  a musket  ball,  which  entered  anterior  to  left  angle  of  jaw,  fracturing  lower  maxilla,  passing 
under  tongue,  and  out  a little  below  and  to  the  right  of  the  great  horn  of  the  hyoid  bone ; also  injuring  the  sublingual  artery. 
He  was  admitted  to  the  field  hospital,  Chattanooga,  Tennessee.  Profuse  bleeding  from  sublingual  ar  tery  ; wound  rugged  ; lost 
foirr  pirrts  of  blood.  November  29th,  Sur  geon  A.  McMahon,  U.  S.  V.,  made  arr  incisiorr  fr  orrr  point  of  exit  of  ball  dowrr  the  neck 
orr  inside  of  sterno-rnastoid,  exposed  sheath,  with  descendens  troni  rrerve,  and  ligated  right  cotnmorr  car'otid  artery  just  above  onro- 
hyoid.  All  bleeding  irrstantly  ceased.  On  December  1st,  slight  hajrrrorrhage ; corrtrolled  by  persulphate  of  irorr.  December  2d, 
harmorrhage.  December  3d,  hjemorrhage;  ligation  of  left  external  carotid;  rto  aneesthetic  was  rrsed.  December  6th,  weak ; 
muscffi  volitantes.  December  9th,  frorh  this  time  did  well.  January  28th,  1864,  feels  as  well  as  ever;  maxilla  not  united.  Left 
Chattanooga  as  well  as  ever,  save  ft-orn  inconvenience  of  deformed  jaw  and  inability  to  masticate.  Cox  was  admitted  into 
Hospital  No.  19,  Nashville,  Tennessee,  and  discharged  June  25th,  1864,  and  pensioned.  February  3d,  1866,  the  wound  was 
still  discharging  pus.  His  disability  is  rated  three-fourths  arrd  permanent. 

Case. — Brazilla  S.  Cobb,  Co.  C,  lOth  Maine  Volurrteers,  aged  41  years,  was  wounded  at  the  battle  of  Cedar  Mourrtain, 
Virginia,  August  9th,  1862,  as  he  was  kneeling  orr  his  right  krree  to  discharge  his  gttn.  The  missile,  a small  rifle  or 
revolver  ball,  struck  him  in  the  mouth,  driving  irr  eight  teeth,  passed  to  base  arrd  outer  side  of  right  tonsil,  and  lodged  apparently 
irr  the  deeper  muscles  of  the  neck,  in  the  region  of  the  great  vessels.  He  was  admitted  irrto  the  2d  division  hospital  at  Alex- 
arrdria,  Virginia,  August  12th,  1862,  and  was  transferred  to  Satterlee  Hospital,  Philadelphia.  The  treatment  consisted  of  Dover’s 
powders,  arrd  local  applicatiorrs  of  equal  parts  of  chloroform  and  tincture  of  aconite,  to  the  ear,  filling  the  outer  ear  with  loose 
cotton,  bathing  the  surface  of  the  face  arrd  head  with  croton  oil.  He  at  first  had  profuse  hcemorrhage  from  the  right  ear  as 
well  as  from  the  mouth,  which  recurred  several  times,  with  inflammation  of  the  tonsils  and  fauces,  accompanied  by  tenderness 
of  the  right  cheek,  extendirrg  back  to  the  anterior  edge  of  the  trapezius.  He  suffered  irrtensely  from  paitr  of  the  right  side 
of  the  face  and  ear,  occasioning  high  fever  arrd  arterial  action,  with  intense  pairr  in  the  head.  He  was  dischar’ged  from  service 
Decenrber  30th,  1862,  and  pensioned,  his  disability  being  rated  one-half,  arrd  perhaps  not  permarrertt.  Acting  Assistant  Sur-geon 
W.  P.  Morgarr  reports  the  case. 

Case. — Private  V.  F.  Clark,  Co.  G,  98th  Vir’gitria  Regiment,  received,  June  23d,  1864,  a gunshot  wound,  which  fractured 
the  inferior  maxilla.  A considerable  portion  of  bone  was  lost.  He  was  admitted  to  the  Confederate  hospital  at  Far-mville, 
Virginia.  Secondary  harmorrhage  occurred,  and  on  October  4th  he  was  firrloughed  for  sixty  days. 

Case. — Private  W.  B.  Copeland,  Co.  B,  61st  Alabama  Regiment,  aged  34  years,  was  wounded  at  the  battle  of  Winchester, 
Virginia,  September-  19th,  1864,  by  a conoidal  ball,  which  entered  just  below  the  angle  qf  the  left  eye  and  lodged  in  the  neck, 
two  inches  to  the  r-ight  of  the  fifth  cervical  vertebra.  He  was  admitted  to  tire  depot  field  hosirital  at  Winchester  on  the  same  diiy. 
Orr  October  1st,  the  ball  was  removed.  On  the  7th,  the  comnton  carotid  artery  was  ligated  by  Surgeorr  W.  S.  Love,  C.  S.  A. 
Hajmorr-hage  recurred,  five  hour-s  after  ligation,  from  the  posterior  orifice,  continuing  until  the  8th,  when  he  died.  Acting  Staff 
Surgeon  N.  F.  Graham  reports  the  case. 

Case. — B.  P.  Cox,  Dance’s  Battery,  aged  25  years,  received,  October  7th,  1864,  a gunshot  wound.  The  missile,  a 
conoidal  ball,  entered  the  right  side  of  the  face,  below  the  middle  of  the  zygoma,  and  passed  out  at  the  posterior  edge  of  the 
symphysis  of  the  chin.  Secotrdary  hcemorrhage  occurred,  which  was  arrested  by  compression.  October  30th,  1864,  good  prospect 
of  speedy  recovery. 

Case. — Coiporal  Charles  A.  Chapman,  Co.  E,  11th  New  Hampshire  Volunteers,  aged  18  years,  was  wounded  at  the  battle 
of  Fredericksburg,  December  13th,  1862,  by  a conoidal  ball,  which  shattered  the  superior  and  inferior  maxilla,  left  side.  He 
was,  on  December  20th,  admitted  to  Carver  Hospital,  Washington.  ''TIk;  ball  was  extracted  near  the  clavicle.  On  .January  5th, 
secondary  hcemorrhage  occurred  from  the  branches  of  the  internal  maxillary  artery,  iimounting  to  sixteen  ounces  of  blood, 
which  w:is  controlled  by  compression.  He  was  discharged  February  lltli,  1863.  He  wiis  pensioned,  his  disability  being  rated 
total. 


348 


WOUNDS  AND  INJURIES  OF  THE  FACE, 


[Chap.  II. 


Cask. — Sorgoant  D.arclay  Cooper,  Co.  B,  126th  Ohio  Volunteers,  was  wounded  at  the  battle  of  the  Wilderness,  May  5th, 
1864,  by  a musket  ball,  whicli  entered  close  to  the  mastoid  ])rocess  of  the  right  teinpoial  bone,  passed  through,  and  lodged  under 
the  integuments  in  the  malar  bone,  beneath  the  left  eye,  escaping,  in  its  passage,  all  the  larger  vessels,  but  leaving  an  opening 
in  the  palate.  He  also  received  a gunshot  wound  of  the  scrotum.  He  was  taken  prisoner,  and  receiving  but  little  attention,  the 
wound  of  the  scrotum  became  very  uidiealthy ; vermin  gathered  in  it,  and  one  testicle  became  exposed.  He  states  that  he  was 
operated  upon  by  a rebel  surgeon  for  the  wound  of  scrotum,  after  which  the  parts  healed.  The  wound  of  the  face  soon  healed, 
leaving  an  opening  in  the  palate  about  the  size  of  a large  pea.  He  was  exchanged,  and  admitted  to  the  post  hospital  at  Camp 
Chase,  Ohio,  on  January  25th,  1865,  and  returned  to  duty  on  February  21st,  1865.  An  operation  was  subsequently  performed 
for  the  purpose  of  closing  the  opening  in  the  palate,  but  without  success;  haemorrhage  occurred  for  several  days,  but  finally 
succumbed  under  the  use  of  styptics.  He  was  discharged  from  the  service  June  25th,  1865.  His  speech  was  somewhat  defective, 
and  he  had  difficulty  in  swallowing.  Pension  Examiner  A.  H.  Hewetson,  M.  D.,  reports  the  case. 

Case. — Private  Elisha  K.  DeForest,  Co.  K,  86th  New  York  Volunteers,  received,  at  Chancellorsville,  May  3d,  1863,  a 
gunshot  wound.  The  missile  entered  the  upper  lip,  passed  through  the  tongue,  and  emerged  from  the  middle  of  the  sterno- 
cleido-mastoid  muscle,  at  its  external  border.  He  was,  on  May  4th,  admitted  to  the  hospital  of  the  2d  division,  Third  Corps, 
and  on  the  6th  transferred  to  Washington,  and  on  May  8th  admitted  into  the  Mount  Pleasant  Hospital.  Half  diet  was  ordered, 
and  the  patient  enjoined  to  keep  quiet,  and  his  head  elevated.  On  May  12th  secondary  htemorrhage  occurred  suddenly,  after 
walking  across  the  ward,  and  the  patient  died  in  a few  minutes.  May  12th,  1863.  The  autopsy  showed  that  a part  of  the  common 
carotid  artery  had  been  destroyed  by  the  ball.  The  case  is  reported  by  Assistant  Surgeon  C.  A.  McCall,  U.  S.  A. 

Case. — Private  John  Downey,  Co.  E,  73d  New  York  Volunteers,  aged  20  years,  was  wounded  at  the  battle  of  Gettys- 
burg, July  1st,  1863,  by  a conoidal  ball,  which  entered  behind  and  above  the  lobe  of  the  right  ear,  passed  horizontally  across, 
carrying  away  the  alveolar  process  of  the  superior  maxilla,  and  lodged  two  inches  from  the  tragus  of  the  left  ear,  one  and  a half 
inches  from  the  base  of  the  occipital  bone.  He  was  taken  to  a field  hospital,  where  the  operation  of  exsection  was  performed.  He 
was  admitted  into  the  Seminary  Hospital,  Gettysburg,  July  2d,  1863,  and  transferred  to  Turner’s  Lane  Hospital  on  the  11th, 
when  a large  abscess  burst  in  the  posterior  part  of  the  cavity  of  the  mouth.  The  fractured  surface  of  bone  was  discharging  pus 
freely,  also  slightly  at  the  external  orifice,  the  wound  of  the  upper  lip  was  healed,  pain  very  slight.  The  treatment  consisted  of 
cold  water  dressings,  nourishing  diet,  and  on  July  13th,  extraction  of  ball.  On  the  20th,  a slough  formed  in  the  external 
wound;  the  discharge  was  foul.  Simple  dressings  were  continued,  with  injections  of  Labarraque’s  solution  into  the  wound. 
On  the  night  of  August  6th,  profuse  haemorrhage  from  the  external  wound  occurred,  which  was  arrested  by  pressure  upon  the 
external  carotid,  and  the  free  application  of  persulphate  of  iron.  The  amount  of  blood  lost  was  thirteen  ounces.  August  11th, 
he  was  transferred  to  Christian  Street  Hospital  in  an  improving  condition.  The  dressing  was  removed  from  the  external  wound, 
which  presented  a clean,  healthy  surface.  The  discharge  was  free.  The  treatment  was  continued,  with  the  free  use  of  stimu- 
lants. By  October  1st,  the  wound  and  general  health  of  patient  were  improving.  A small  splcida  of  bone  was  removed.  He 
was  discharged  from  the  service  November  22d,  1864.  The  case  is  reported  by  Assistant  Surgeon  C.  H.  Alden,  U.  S.  A.  The 
]iatient  is  not  a pensioner. 

Case. — Private  William  W.  Davis,  Co.  E,  114th  Pennsylvania  Volunteers,  aged  20  years,  was  wounded  at  the  battle  of 
Chancellorsville,  May  3d,  1863,  by  a conoidal  ball,  which  fractured  the  upper  maxilla.  Tne  missile  entered  the  mouth  and 
emerged  at  the  middle  of  the  left  cheek,  tearing  out  two  inches  of  outer  angle  of  mouth  and  destroying  seven  upper  teeth  and 
corresponding  alveolar  process.  He  was,  on  May  8th,  admitted  to  Mount  Pleasant  Hospital,  Washington.  Simple  dressings 
were  applied  to  the  wound.  May  14th,  secondary  htemorrhage  occurred  from  the  facial  artery,  amounting  to  about  two  ounces 
of  blood,  which  was  controlled  by  pressure.  On  June  1st,  he  was  transferred  to  Philadelphia,  and  admitted  into  the  Satterlee 
Hospital,  whence  he  was  transferred  to  the  2d  battalion.  Invalid  Corps,  September  4th,  1863.  He  is  a pensioner;  has  very 
considerable  deformity,  and  neuralgic  pains  in  face  in  damp  weather.  Disability,  three-fouitbs  and  permanent.  The  case  is 
reported  by  Assistant  Surgeon  C.  A.  McCall,  U.  S.  A. 

Case. — Private  Dennis  Edwards,  Co.  A,  11th  Massachusetts  Volunteers,  aged  30  years,  was  wounded  at  the  battle  of 
Chancellorsville,  Virginia,  May  3d,  1863,  by  a gunshot  missile,  wliich  ft-actured  the  inferior  maxilla.  He  was  admitted  into  the 
hospital  of  the  1st  division.  Third  Corps,  and  from  thence  was  admitted  into  Carver  Hospital,  at  Washington,  on  May  t)th,  1863. 
There  was  htemorrhage  from  the  facial  artery,  which  recurred.  The  treatment  consisted  of  compress  and  cold  applications. 
He  died  on  May  9th,  1863,  of  hajmorrhage. 

Case. — Private  James  Edgar,  Co.  G,  81st  Pennsylvania  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of  Gettys- 
burg, July  2d,  1863,  liy  a conoidal  ball,  which  fractured  the  inferior  maxilla.  The  missile  entered  the  left  side  of  the  neck 
one-half  of  an  inch  below  the  ear,  fracturing  the  lower  maxilla  in  two  places,  and  crossing  beneath  the  tongue,  emerged  at  the 
right  angle  of  the  mouth.  He  was,  on  July  10th,  admitted  to  Broad  and  Cherry  Streets  Hospital,  Philadelphia.  On  admission, 
the  patient  was  exhausted  from  want  of  food  and  rest.  Injections  of  milk  punch  and  beef  essence  were  administered.  Several  *' 
spiculffi  of  bone  were  removed,  and  Barton’s  bandages  applied  to  the  fractured  jaw.  Secondary  haemorrhage  from  the  left 
lingual  artery  occurred  July  lOth,  and  recurred  on  the  11th  and  12th,  amounting  to  about  twenty  ounces  of  blood,  which  was 
controlled  by  pressure.  Pulse  100  and  feeble ; the  wound  of  entrance  gaping  and  indolent,  and  tongue  swollen.  As  soon  as  the 
patient  could  take  liquor  by  stomach  he  improved  rapidly.  No  attempts  made  to  keep  the  parts  in  apposition  until  the  close  of 
the  sixth  week.  On  September  10th,  the  union  was  quite  firm,  with  very  little  deformity.  On  September  26th,  an  abscess, 
which  had  formed,  discharged  pus  freely  with  fragment  of  ball.  A small  portion  of  bone  was  found  necrosed.  On  October  1st, 
the  patient  was  convalescent,  with  no  deformity.  He  was  returned  to  duty  January  12th,  1864.  The  case  is  reported  by  Acting 
Assistant  Surgeon  William  V.  Keating.  He  is  a pensioner.  On  November  10th,  1869,  Pension  Examiner  N.  B.  Reber  reports 
that  the  left  side  of  the  face  is  paralyzed;  he  is  unable  to  close  the  left  eye,  rendering  it  sometimes  very  weak  and  sore,  which 
the  right  eye  sympathizes  with  arrd  deranges  visiorr.  The  torrgue  is  partially  paralyzed  arrd  has  growrr  fast  to  the  jaw,  renderirtg 
nrasticatiorr  irnpossilrle  arrd  deghrtitiorr  difficult.  He  uses  soft  food  arrd  lirprids  entirely.  Speech  imperfect.  The  woutrd  irr  the 
jaw  still  contirnres  to  di.scharge  interarally.  He  r-ates  his  disability  as  permanent. 


Sf.ct.  II.] 


GUNSHOT  FRACTURES  OF  THE  FACIAL  BONES. 


349 


Private  Hiram  FHzfjcrahl,  Co.  E,  3<l  Virginia  Cavalry,  aged  24  years,  was  wounded  at  Old  Cliurdi,  "Nlrginia, 
Hay  29tli,  IStU,  by  a conoidal  ball,  wliicli  fractured  the  inferior  maxilla.  The  missile  passed  from  a point  midway  between  the 
angle  of  ibo  month  on  the  left  side,  to  the  neck  below,  and  behind  the  angle  of  the  jaw  on  the  right  side.  lie  was,  on  .June  .5tb, 
admitted  to  Lincoln  Hospital,  Washington.  Secondary  hsemoriliage  from  the  branches  of  the  facial  and  internal  maxillary 
arteries  occurred  June  bth,  and  recurred  on  the  6th,  amounting  to  three  pints  of  blood,  which  was  controlled  by  approaching 
syncope  and  injections  of  ice  water  into  the  mouth.  The  patient  liv'cd  seven  hours  atter  the  last  visible  haunorrhage,  but  never 
rallied,  although  stimulants  were  freely  administered.  The  case  is  re])orted  by  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A. 

Ca.se. — Corporal  K.  J.  F , Co.  F,  GOth  New  York  Volun- 

teers, aged  22  years,  was  wounded  at  the  battle  of  Fredericksburg,  May 
:id,  1863,  by  a conoidal  ball,  which  fractured  the  superior  and  inferior 
maxilla.  The  ball  entered  the  ala  of  the  nostril,  .and  passed  downward 
and  backward,  splitting  the  ramus  of  the  inferior  maxilla,  and  emerged 
by  two  openings  in  front  and  below'  the  pinna  of  th(^  right  ear.  The 
superior  maxilla  of  right  side  was  destro3'ed,  and  the  right  portion  of  the 
inferior  fractured  and  comminuted,  and  fissures  running  into  the  orbital 
process.  He  was,  on  May  7th,  admitted  to  C.arver  Hospital,  Washington. 

Cold  water  dressings  and  bandages  were  applied.  Slight  luemorrhage 
from  the  internal  maxillarj-  artery  occurred  tat  ten  and  eleven  o'clock 
p.  M.,  May  9th,  wduch  yielded  to  compression ; it  again  i-ecurred  ])ro- 
fusely  .at  twelve  o’clock,  amounting  to  about  fifty  fluid  ounces  of  blood ; 
attempts  at  compression  of  the  carotid  artery  were  unsuccessful,  the 
p.atient  being  unmanageable  from  fear ; during  tbe  remainder  of  the 
night  and  the  day  following,  he  was  kept  in  a sitting  posture,  and  ice 
retained  in  his  mouth,  and  strictly  forbidden  to  speak.  At  two  o’clock 
P.  M.  on  the  11th,  his  pulse  being  on  the  increase,  six  drops  of  the  tinc- 
ture of  aconite  W'as  ordered.  The  hemorrhage  returned  in  the  evening, 
the  p.atient  became  frantic  with  .alann,  and  prevented  .all  attempts  atcom- 
j)ression.  He  died  immediately'.  The  autopsy  revealed  great  comndnu- 
tion  of  the  superior  .and  inferior  maxilla,  and  that  the  h.'cmonh.age 
proceeded  from  the  trunk  of  the  intern.al  maxillary  artery.  The  bone 
is  figured  in  the  wood-cut  (FiG.  130).  The  case  is  reported  by  Acting  Assistant  Surgeon  E.  F.  Bates.  Specimen  2222,  A. 
M.  M.,  is  a prep.aration  of  the  right  common  carotid  artery  from  this  case,  with  an  orifice  near  the  origin  of  the  intern.al  maxilhuy. 

Case. — Corporal  Ebenezer  Gallagher,  Co.  F,  52d  Ohio  Volunteers,  .aged  25  years,  received  a gunshot  wound  of  the  face, 
ly  a conoidal  ball.  He  was  admitted  to  the  field  hos])ital  at  Chattanooga,  Tennessee,  July  2d,  1864,  and  died  July  4th,  from 
secondary  hatmorrhage.  The  case  is  reported  by  Assistant  Surgeon  C.  C.  Byrne,  U.  S.  A. 

Case. — Priv.ate  J.  Greyer,  Co.  K,  50th  Georgia  Regiment,  received,  June  Ist,  1864,  a gunshot  fracture  of  the  inferior 
maxilla.  The  ball  entered  at  tbe  left  angle  .and  escai)ed  from  the  mouth.  He  was  adndtted  to  the  Receiving  and  Wayside 
Hospital,  Richmond.  Secondary  ha?morrhage  occurred  June  13th,  which  was  controlled  by  jiersulphate  of  iron.  The  patient 
recovered. 

Case. — Private  Robert  M.  Gilson,  Co.  M,  6th  Ohio  Cavalry,  aged  18  y'ears,  was  wounded  in  the  engagement  at  Hatcher's 
Run,  Virginia,  December  9th,  1864,  by  a conoidal  ball,  which  jieifbr.ated  both  jaws  near  the  angles.  He  was  conveyed  to  the 
hospital  of  the  cavalry  corps,  at  City  Point,  Virginia,  and  on  December  16th  was  admitted  to  the  Armory  Square  Hospital, 
Washington.  Secondary  hemorrhage  took  place,  and  patient  died  on  the  day  of  admission.  Surgeon  D.  W.  Bliss,  U.  S.  V., 
reports  the  case. 

Case. — Private  Jared  Goodrich,  19th  New  York  Battery,  aged  43  years,  was  wounded  at  Sjiottsylvania,  Virginia,  May 
12th,  1864,  by  a conoidal  ball,  which  fractured  the  lower  jaw,  right  side.  He  was  admitted  to  the  Stanton  Ho.spital,  Washing- 
ton, on  the  20th.  Simple  dres.sings  were  applied,  and  tonics  and  stimulants  .administered.  He  died  May  27th,  1864,  from 
exhaustion  and  secondary  haemorrhage.  The  case  is  reported  by  Surgeon  John  A.  Lidell,  U.  S.  V. 

Case. — Corporal  John  lleiser,  Co.  I,  C3d  Pennsvdvania  Volunteers,  aged  27  years,  received,  at  the  battle  of  Deep  Bottom, 
Virginia,  August  14th,  1864,  a gunshot  wound  of  the  face.  Conoidal  ball  entered  at  superciliaiy  l idge  of  right  orbit,  ))assing 
inwards,  and  emerged  from  neck,  behind  angle  of  inferior  maxilla.  When  .admitted  to  the  Emory  Hospital,  Washington,  on 
August  17th,  1864,  he  was  feeble,  and  much  exhausted  from  exposure  on  the  field,  and  during  transportation.  On  August  25th, 
bleeding  ])rofusely,  cbloroform  and  ether  were  administered,  .and  the  right  common  carotid  artery,  through  an  incision  about  two 
inches  in  length,  was  ligated  by  Surgeon  N.  R.  Moseley,  11.  S.  V.  Cold  water  dressings  were  .applied,  and  tonics  and  stimu- 
lants were  administered.  He  died  on  August  30th,  1864,  from  exhaustion  and  constitutional  irritability.  The  case  is  reported 
by  the  operator. 

Case. — Private  J.  11.  Uancoeh,  Co.  K,  30th  Georgia  Regiment,  was  wounded  at  the  battle  of  Cold  Harbor,  Virginia, 
June  1st,  1864,  by  a conoidal  hall,  which  entered  over  the  second  right  lower  molar  tooth,  passed  downward  and  forward, 
cutting  the  end  of  the  tongue  and  fr.acturing  the  inferior  maxilla,  at  its  symphysis,  and  emerged  one-half  inch  helow  the  .angle  of 
the  mouth.  He  was  coinayed  to  Receiving  and  Wayside  Hospital,  at  Richmond,  Virginia,  tbe  same  (hy,  where  spicula  of  bone 
were  removed  on  the  following  dav’.  On  .Line  8th  and  10th  capillary  hmmorrhage  occurred,  which  was  controlled  by  the  apj)!!- 
cation  of  ice  and  persulphate  of  iron.  On  June  12th  he  was  transferred.  No  further  information  can  be  obtained. 


Fin.  l.">fl. — fiunsliet  fnictureof  the  inferior  maxilla.  Spec. 
1210,  Sect.  I,  A.  M.  M. 


350 


WOUNDS  AND  INJUIIIES  OF  THE  FACE 


[Chap.  II. 


Case. — Private  K.  Daj’toii  Harvey,  Co.  K,  167th  New  York  Volunteers,  was  wounded  at  the  battle  of  Gettysburg,  Penn- 
sylvania, July  1,  18G3,  by  a round  ball,  whieh  entered  in  front  of  the  left  ear  and  passed  out  of  the  right  cheek.  lie  was 
conveyed  to  the  Seminary  Hospital  the  same  day,  and  on  July  11th  was  admitted  to  the  McClellan  Hospital,  Philadelphia. 
Secondary  limmorrhage  occurred  on  the  IGth,  which  was  arrested  by  means'  of  persulphate  of  iron  and  pressure.  He  was 
discharged  from  service  December  2d,  1863.  There  was  total  deafness  in  the  lelt  ear,  and  the  mental  functions  were  impaired. 
Surgeon  Lewis  Taylor,  U.  S.  A.,  reports  the  case.  The  man  was  pensioned,  but  died  October  31st,  1864,  from  inflammation  of 
the  brain. 

Case. — Private  William  M.  Hersha,  Co.  K,  8th  Michigan  Volunteers,  aged  20  3’ears,  was  wounded  at  the  battle  of  Cold 
Harbor,  June  3d,  1864,  by  a conoidal  ball,  which  fractured  the  inferior  maxilla,  right  side.  He  was  convej’ed  to  the  hospital 
of  the  3d  division.  Ninth  Corps,  and  transferred  to  Washington,  and  on  the  9th  admitted  into  Lincoln  Hospital.  On  the  13th, 
he  was  transferred  to  York  Hospital,  Pennsylvania,  where  he  was  admitted  on  the  14th.  Simple  dressings  were  applied  to  the 
wound.  Sloughing  of  the  arteiy  occurred  June  28th,  and  secondary  luemorrhage  followed,  amounting  to  thirty -five  ounces  of 
blood,  which  all  efforts  failed  to  arrest.  Patient  died  June  28th,  1864.  The  case  is  reported  by  Surgeon  Henry  Palmer,  U.  S.  V. 

Case. — Sergeant  L.  D.  Inskeep,  Co.  E,  122d  Ohio  Volunteers,  aged  23  j'ears,  was  wounded  at  the  battleof  Cold  Harbor, 
June  3d,  1864,  by  a conoidal  ball,  which  entered  below  the  left  ej'e,  and  jrassed  out  between  the  shoulders.  He  was  on  June 
7th  admitted  to  Lincoln  Hospital,  Washington.  Secondary  haemorrhage  occurred  June  13th.  Tonics  and  stimulants  were 
administered.  Patient  died  June  14th,  1864.  The  case  is  reported  by  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A. 

Case. — Private  Samuel  Jacoby,  Co.  C,  48th  Indiana  Volunteers,  was  wounded  at  the  battle  of  Corinth,  Mississippi, 
October  3d,  1862,  by  a gunshot  missile,  which  entered  the  left  cheek,  passed  through  the  inferior  maxilla,  and  emerged  above 
the  clavicle,  wounding  the  carotid  arteiy.  He  was  treated  in  the  regimental  hospital  until  October  13th,  1862,  when  he  was 
admitted  to  the  Mound  City  Hospital,  Illinois.  Secondary  hmmorrhage  occurred  from  the  common  carotid  artery  October  13th. 
The  patient  died  October  13th,  1862.  The  autopsy  showed  that  the  cellular  tissue  about  the  wound  of  exit  was  infiltrated  so  as 
to  form  a firm  fibrous  ring  about  the  orifice.  The  mouth  was  full  of  clotted  blood,  and  there  was  an  opening  in  the  carotid,  just 
below  its  bifurcation,  one-half  of  an  inch  in  length.  The  ball  passed  through  the  pharjmx  and  the  root  cc  tongue.  The  case  is 
reported  by  Surgeon  E.  C.  Fraidilin,  U.  S.  V. 

Case. — Private  George  W.  Lundy,  Co.  F,  7th  Michigan  Cavalrv,  aged  25  years,  received,  at  the  battle  of  Gettysburg, 
July  3d,  1863,  a pistol-shot  wound.  The  missile  entered  the  superior  maxilla  below  the  left  eye  and  through  the  ala  nasi  muscle, 
passed  close  to  the  bifurcation  of  the  carotid  artery,  under  the  meatus  auditorius  externus,  and  emerged  a little  behind  and  below 
the  ear.  He  was  on  the  same  day  conveyed  to  the  Seminai'y  Hospital,  Gettysburg.  Secondary  haemorrhage  occurred  July 
15th,  which  caused  death  immediatel}'.  On  post-mortem  examination,  the  ball  was  found  to  have  passed  in  close  proximity  to 
the  bifurcation  of  the  carotid  artery,  contusing  the  coats,  which  caused  inflammation  and  ulceration,  and  during  a fit  of  coughing 
the  artery  ruptured  at  bifurcation,  causing  death.  The  case  is  reported  by  Surgeon  Henry  Janes,  U.  S.  V. 

Case. — Private  David  Loziei-,  Co.  K,  1st  Maine  Cavalry,  aged  24  j’ears,  was  wounded  at  the  bfittle  of  South  Side  Eailroad, 
March  31,  1865,  by  a fragment  of  shell,  which  fractured  the  inferior  maxilla.  He  was  on  April  4th  admitted  to  Judiciary"  Square 
Hospital,  Washington.  Secondary  haemorrhage  from  a branch  of  the  left  carotid  artery  occurred  April  10th,  amounting  to  ten 
ounces  of  blood.  The  patient  died,  before  assistance  could  reach  him.  The  case  is  reported  by  Surgeon  E.  Griswold,  U.  S.  V. 

Case. — Private  Alvin  G.  King,  Co.  B,  11th  New  Hampshire  Volunteers,  aged  32  years,  was  wounded  at  the  battle  before 
Petersburg,  September  30th,  1864,  by  a conoidal  ball,  which  entered  above  the  arch  of  the  zygoma,  fracturing  the  superior 
maxilla,  and  cutting  away  a portion  of  the  malar  bones,  all  on  the  left  side.  He  was  on  the  same  day  conveyed  to  the  hospital 
of  the  2d  division.  Ninth  Corps.  On  October  2d,  he  was  admitted  into  the  field  hospital.  Ninth  Corps,  and  transferred  to  the  2d 
division  hospital,  Alexandria,  where  he  was  admitted  October  12th.  Cold  water  dressings  were  applied  to  the  wound.  Secondary 
haemorrhage  from  a branch  of  the  internal  maxillary  artery  occurred  October  19th,  amounting  to  forty-eight  ounces  of  blood. 
Styptics  were  applied,  and  stimulants  and  tonics  administered.  Haemorrhage  recurred  every  six  hours.  Patient  died  October 
21st,  1864.  The  post-mortem  examination  revealed  the  ball  embedded  in  the  posterior  nares.  The  case  is  reported  by  Surgeon 
Edwin  Bentley,  U.  S.  V. 

Case. — Private  D.  W.  Kilburn,  Co.  I,  1st  Maine  Volunteers,  aged  22  years,  was  wounded  at  the  battle  of  Spottsylvania, 
Virginia,  May  19th,  1864,  by  a conoidal  ball,  wliicli  entered  angle  of  mouth,  making  its  exit  near  posterior  border  of  sterno- 
cleido-mastoideus  muscle,  wounding  facial  and  external  carotid  arteries.  He  was  admitted  to  the  Finley  Hospital,  Washington, 
on  May  28th,  1864.  On  May  29th  chloroform  was  administered,  and  the  right  carotid  artery  was  ligated  by  Acting  Assistant 
Surgeon  J.  C.  Nelson.  Severe  haemorrhage  ensued  after  ligation.  The  patient  continued  to  do  well  until  the  evening  of  June  1st, 
when  he  complained  of  severe  pain  in  region  of  head  and  chest;  also  great  dyspneea.  He  died  on  June  2d,  1864,  from 
asphyxia. 

Case. — Private  John  Lynn,  Co.  F,  37th  Wisconsin  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of  South  Side 
Kailroad,  April  2d,  1865,  by  a conoidal  ball,  which  entered  the  body  of  the  left  malar  bone,  passed  through  the  buccal  cavity, 
and  made  its  exit  through  the  body  of  the  inferior  maxilla,  near  its  right  angle,  comminuting  both  bones.  He  was  conveyed  by' 
steamer  to  Washington,  and  admitted  iuto  Harewood  Hospital  April  5th.  The  treatment  of  the  patient  was  rendered  somewhat 
dillicult  from  the  fact  that  the  passage  of  the  ball  through  the  buccal  cavity  had  produced  intense  pharyngitis  and  mdema  of  the 
adjacent  tissues,  so  that  the  food,  though  carefully  selected,  could  only  be  with  difficulty  administered ; while  the  particles  of 
food  and  salivary  secretions  could  only  effectually  be  removed  by  syringing  through  both  wounds  of  entrance  and  exit.  Second- 
ary hsemorrhage  from  the  internal  ma.xillary  and  facial  arteries  occurred  April  9th,  amounting  to  thirty  ounces  of  blood.  The 
sinking  of  the  patient  was  so  decided  as  to  be  beyond  the  control  of  any  operative  measures  or  medical  treatment.  The 
l)atient  died  April  9th,  1865.  The  post-mortem  examination  showed  that  the  facial  artery,  at  the  point  where  it  passes  over  the 
inferior  maxilla,  had  been  laid  o|)en.  The  case  is  reported  by  Surgeon  Iv.  B.  Bontecou,  U.  S.  V. 


Skct.  II.] 


GUNSHOT  FRACTURES  OF  THE  FACIAL  BONES. 


351 


Case. — ^Private  Charles  G.  Lincoln,  Co.  C,  22d  Massachusetts  Volunteers,  received  at  the  battle  of  Fredericksburg, 
Virginia,  December  13th,  1SG2,  a gunshot  fracture  of  tlie  superior  maxillary.  He  was  conveyed  to  the  hospital  of  the  1st  divis- 
ion, Fifth  Corps,  the  same  day,  and  on  December  17th  ^vas  admitted  to  the  Eckington  Hospital,  Washington.  Secondary 
haemorrhage  occurred,  and  the  patient  died  on  December  24th.  Assistant  Surgeon  S.  A.  Storrow,  U.  S.  A.,  reports  the  ciise. 

Case. — Private  Adam  Mv'ers,  Co.  C,  130th  Pennsylvania  Volunteers,  aged  23  years,  received  at  the  battle  of  Antietam, 
September  17th,  1862,  a gunshot  comminuted  fracture  of  the  upper  and  lower  jaws,  and  laceration  of  the  lingual  artery  and  its 
branches.  He  was  conveyed  to  the  hospital  of  the  3d  division.  Second  Corps,  and  on  September  20th,  transferred  to  Harrisburg, 
Pennsylvania,  where  he  was  admitted  into  tlie  Walnut  Street  Hospital.  Stitnulants  and  tonics  were  administered,  and  styjjtics 
ajtplied  to  control  the  hmmorrhage.  Pymmia  supervened  September  24th.  The  condition  of  the  patient  was  bad,  and  no  ap])arent 
etfect  was  produced  by  treatment.  The  j)atient  died  September  29th,  1832. 

Ca.se. — Sergeant  George  B.  Merchant,  Co.  K,  4th  Ohio  Volunteers,  aged  33  years,  received  at  the  battle  of  Spottsylvania, 
Virginia,  May  10,  1834,  a gunshot  wound  of  neck,  with  fracture  of  inferior  maxilla.  He  was  admitted  to  Douglas  Hospital, 
Washington,  on  May  13th,  1864.  General  health  good.  Secondary  haemorrhage  occurred,  to  the  amount  of  eighteen  fluid  ounces, 
probably  from  internal  maxilla.  On  May  15th  the  right  common  carotid  was  ligated  by  Assistant  Surgeon  William  Thomson, 
U.  S.  A.  On  May  31st,  ligature  came  away.  He  recovered,  and  was  returned  to  duty  on  June  19th,  1884.  The  case  is  reported 
by  the  operator.  The  i)atient  is  a pensioner.  Examiner  L.  M.  Whiting  I'eports,  Se))tember  20th,  1864,  that  more  than  half  of 
the  ramus  of  the  right  side  of  the  lower  jaw  is  gone,  and  that  there  is  very  limited  use  of  the  right  arm,  owing  to  some  injury 
during  the  ligation.' 

Case. — Private  J.  Morris,  Co.  I,  50th  Georgia  Regiment,  was  wounded  at  the  battle  of  Cold  Harbor,  June  1st,  1864,  by 
a conoided  ball,  which  entered  at  the  left  angle  of  the  inferior  maxilla,  and  (anerged  from  the  mouth,  producing  extensive  com- 
minution of  the  inferior  maxilla.  He  was  admitted  to  the  Receiving  and  Wayside  Ilosiiital,  at  Richmond,  Virginia,  the  same  day, 
where  spiculm  of  bone  were  removed  by  incision  along  the  ramus  of  the  jaw.  The  wound  was  closed  by  wire  sutures.  On  June 
13th,  haemorrhage  occurred,  which  was  controlled  by  the  application  of  persulphate  of  iron.  Food  was  given  him  through  a tube 
up  to  the  14th,  and  on  the  15th  he  was  furloughed  for  sixty  days.  No  further  information. 

Case. — Private  John  B.  Mcllroy,  Co.  C,  45th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Cold  Harbor, 
Virginia,  June  3d,  1864,  by  a conoidal  ball,  which  entered  the  upper  lip,  passed  through  cheek,  fracturing  the  inferior  maxilla, 
and  injuring  the  internal  maxillary  artery,  and  made  its  exit  at  left  ear ; then  entered  the  shoulder,  fracturing  the  acromion 
jirocess  of  the  scapula.  He  was  admitted  to  the  Fairfax  Seminary  Hospital,  near  Alexandria,  Virginia,  on  June  7th,  1864. 
His  constitutional  condition  was  good.  Cold  water  dressings  were  applied.  Hsemorrhage  occurred,  and  on  June  18th  the  common 
carotid  artery,  just  above  omo-hyoid,  was  ligated  by  Acting  Assistant  Surgeon  J.  11.  York.  He  died  on  Juno  19,  1864,  in  con- 
sequence of  haimorrhage,  caused  by  sloughing  of  posterior  scapular  artery,  from  second  ball  lodging  upon  it.  The  case  is  reported 
by  Assistant  Surgeon  II.  Allen,  U.  S.  A. 

C.\SE. — Corporal  Henry  McDowell,  Co.  G,  60th  New  York  Volunteers,  aged  30  years,  was  wounded  at  the  battle  of 
Gettysburg,  July  2d,  1863,  by  a piece  of  shell,  carrying  away  the  inferior  maxilla.  He  was  on  the  same  day  admitted  to  the 
field  hospital.  Twelfth  Corps.  Secondary  haimorrhage  from  the  facial  artery  occurred  July  13th,  amounting  to  about  twenty 
ounces  of  blood.  Patient  died  July  16,  1863.  The  case  is  reported  by  Surgeon  H.  Ernest  Goodman,  U.  S.  V. 

Case. — Private  John  L.  Murray,  Co.  B,  42d  New  York  Volunteers,  aged  32  years,  was  wounded  in  the  engagement  at 
Bristow  Station,  Virginia,  October  14th,  1863,  by  a conoidal  ball,  which  entered  posteriorly  to  right  of  spinous  process  of  fifth 
cervical  vertebra,  jiassed  anteriorly  through  middle  third  of  inferior  maxillary,  pioducing  compound  fracture,  and  emerged 
opposite  the  canine  teeth  of  same  side ; the  injured  parts  were  badly  swollen  and  inflamed.  He  was  admitted  to  the  third  division 
hospital,  Alexandria,  Virginia,  on  October  17th,  1863.  On  October  25th,  chloroform  was  administered,  and  the  common  carotid 
artery,  right  side,  was  ligated,  and  a partial  resection  of  the  lower  jaw  performed  by  Surgeon  Edwin  Bentley,  U.  S.  V.  The 
ligatures  came  away  November  11th,  1863.  He  was  discharged  from  the  service  bn  February  13th,  1864.  The  case  is  reported 
by  the  operator.  His  name  does  not  appear  on  the  pension  list. 

Case. — Private  Samuel  Meinnis,  Co.  A,  11th  Illinois  Volunteers,  aged  27  years,  was  wounded  at  the  battle  of  Vicksburg, 
Mississippi,  May  22d,  1863,  by  a musket  ball,  which  entered  immediately  above  and  posterior  to  angle  of  left  jaw,  passed 
through  jiharynx  and  posterior  nares,  and  made  its  exit  at  angle  (right)  of  lower  jaw,  fracturing  the  bone.  He  was  admitted  to 
the  Jackson  Hospital,  Memphis,  Tennessee,  on  May  27th,  1863;  wound  suppurating,  profuse  haemorrhage  from  external  carotid 
and  branches.  On  May  31st,  the  common  carotid  artery  was  ligated  by  Surgeon  E.  M.  Powers,  7th  Missouri  Volunteers.  Great 
general  depression  of  system  ; pulse  feeble  and  frequent;  considerable  febrile  excitement  and  restlessness.  Stimulants,  nutritious 
diet,  and  opiates  were  administered.  No  unpleasant  symptoms  after  operation.  On  June  5th,  1863,  jiatient  was  doing  well. 
He  died  on  June  7th,  1863.  The  case  is  reported  hy  the  operator. 

Case. — Sergeant  Francis  Maas,  Co.  E,  6th  Kentucky  Volunteers,  aged  40  years,  was  wounded  at  the  battle  of  Resaca, 
Georgia,  May  15th,  1834,  by  a conoidal  musket  ball,  which  entered  the  mouth,  fracturing  the  inferior  maxilla,  and  emerged 
through  the  neck.  On  May  21st,  he  was  conveyed  to  the  field  hospital  at  Bridgeport,  Alabama.  Secondary  hannorrhage 
occurred,  on  the  following  day,  from  the  inferior  maxilla  or  some  of  its  ramifications,  amounting  to  eighteen  ounces,  which  was 
arrested  by  the  application  of  ice.  Simple  dressings  were  apjdied,  and  the  wound  liealed  kindly.  He  was  furloughed  July  9th. 
On  August  8th,  he  was  admitted  to  the  Crittenden  Hospital,  Louisville,  Kentucky,  and  is  charged  with  desertion  December  Jlst, 
1864.  He  is  a pensioner.  Assi.stant  Surgeon  H.  T;  Legler,  U.  S.  V.,  reports  the  case. 

Case. — Private  Patrick  McCormick,  Co.  A,  4tb  New  York  Vidimteer.s,  was  wounded  at  the  battle  of  Antietam,  Maryland, 
September  17tb,  1862,  by  a conoiilal  ball,  which  entered  the  face,  fracturing  the  npiier  jaw,  jiassed  backward  and  downward 

' In  the  first  issue  it  w-is  erroneously  stated  that  a second  ligation  was  practiced  in  this  case.  In  a letter  of  March  lUth,  1873,  Dr.  Whiting  makes  a 
handsouic  apology  fur  ascribing  the  consenucut  paralysis  to  the  operation  rather  than  to  the  injurj’. 


352 


WOUNDS  AND  INJURIES  OF  THE  FACE, 


[Chap.  II. 


through  tlio  neck,  wounding  the  carotid  artery.  He  was  conveyed  to  the  hospital  of  the  Third  Corps,  and,  on  September  22d, 
was  admitted  to  No.  5 Hosj)ital,  Frederick,  Maryland.  September  24th,  abscess  opened  over  the  thyroid  cartilage,  and  bone 
extracted.  The  opening  from  abscess  communicates  from  above  with  the  mouth,  a sinus  leading  downward  toward  sternum. 
He  died  September  29th,  from  secondary  hatmorrhage  from  the  carotid  artery.  Autopsy  : the  missile  entered  the  mouth  opposite 
symphysis  of  lower  jaw,  right  side,  in  juring  the  tongue  and  soft  parts,  comminuting  the  bone  up  to  its  ramus,  and  producing  a 
disloc.'ition  outward,  and  lodged  in  the  inferior  triangle  of  the  neck,  grazing  the  common  carotid,  one  inch  from  its  bifurcation. 
Secondary  haemorrhage  was  from  the  ulceration  of  the  artery.  The  jaw  was  divided  at  its  symphysis.  The  whole  inner  surface 
of  sterno-mastoid  was  dissected.  Surgeon  H.  S.  Hewitt,  U.  S.  V.,  reports  the  case. 

Case. — Private  A.  Mooney,  Co.  H,  1st  New  York  Artillery,  aged  34  years,  was  wounded  May  29th,  1862,  by  a musket 
ball.  The  missile  entered  the  left  cheek,  fractured  the  malar  bone,  and  passing  backward,  emerged  parallel  to  and  one  inch 
behind  the  mastoid  process  of  the  left  temporal  bone.  He  was,  on  June  3d,  1862,  admitted  to  the  hospital  at  Annapolis,  Maryland. 
.June  5th,  successive  secondary  hatmorrhages  from  the  infernal  maxillary  artery.  On  the  9th,  lost  from  six  to  eight  ounces  of 
blood,  which  was  arrested  by  the  application  of  ice  and  injections  of  the  solution  of  persulphate  of  iron.  On  the  16th,  he  had 
slight  htemorrhage.  Patier.t  died  comatose  June  27th,  1862.  The  case  is  reported  by  Surgeon  Thomas  A.  MeParlin,  U.  S.  A. 

Case. — Private  William  H.  McL , Co.  A,  108th  New  York  Volunteers,  aged  21  years,  was  wounded  at  the  battle 

of  Antietam,  September  17th,  1862,  by  a musket  ball,  which  fractured  the  ramus  of  the  inferior  maxilla,  left  side.  The  missile 
entered  below  the  mastoid  process  of  the  right  temporal  bone,  passed  upward  and  forward,  tr.aversing  the  parotid  gland,  and 
carried  away  the  condyle  and  a jiart  of  the  ascending  ramus  of  the  lower  maxilla,  and  lodged  in  the  zygomatic  fossa,  severing 
in  its  course  the  temporal  and  the  internal  maxillary  branches  of  the  carotid  artery.  He  was,  on  September  26th,  admitted  to 
Carver  Hospital,  Washington.  On  October  15th,  excessive  haemorrhage  occurred,  to  the  amount  of  thirty  ounces,  from  the 
temporal  and  the  branches  of  the  internal  maxillary  arteries,  which  was  controlled  by  compression.  Haemorrhage  recurred  on 
the  21st  and  22d.  Patient  died  October  24th,  1862.  The  pathological  specimen  is  No.  632,  Sect.  I,  A.  M.  M.  The  case  is 
reported  by  Surgeon  O.  A.  Judson,  U.  S.  V. 

Case. — Corporal  Charles  Morrow',  Co.  I,  4th  New  Jersey  Volunteers,  received,  at  the  battle  of  Fredericksburg,  Virginia, 
December  13th,  1862,  a gunshot  fracture  of  the  inferior  maxilla,  right  side.  He  was  conveyed  to  the  hosj)ital  of  the  1st  division. 
Sixth  Corps,  and,  on  December  19th,  was  sent  to  the  2d  division  hospital,  Alexandria,  Virginia.  Haemorrhage  from  the  facial 
artery,  which  occurred  at  various  times,  was  controlled  by  compression  and  lint  saturated  w'ith  persulphate  of  iron.  He  was 
discharged  from  the  service  on  February  23d,  1863.  He  is  a pensioner,  his  disability  being  rated  three-fourths  and  permanent. 
The  case  is  reported  by  H.  W.  Sawtelle,  M.  D. 

Ca.se. — 1st  Lieutenant  Thomas  E.  !Maley,  5th  United  States  Cavalry,  aged  29  years,  was  wounded  at  the  engagement  at 
Deep  Bottom,  Virginia,  July  28th,  1864.  An  explosive  ball  entered  the  face  beneath  the  right  zygoma,  and  passing  through, 
exjiloded  in  the  left  antrum  of  Highmore.  He  was  admitted  to  the  Ladies’  Home  Hospital,  New  York  City,  on  August  1st,  1864. 
Secondary  haemorrhages  occurred  on  August  18th,  22d,  23d,  and  24th.  He  was  prostrated  from  loss  of  blood.  Pulse  105  and 
feeble.  On  August  24th,  the  right  common  carotid  artery  was  ligated  by  Surgeon  Alexander  B.  Mott,  U.  S.  V.  August  30th, 
])atient  doing  well  under  generous  diet  and  tonics ; jmlse  84.  On  September  10th,  ligature  came  away.  No  recurrence  of 
haemorrhage.  He  was  granted  leave  of  absence  on  October  4th,  1864,  and  was  dropped  from  the  rolls  while  on  leave.  On  July 
28th,  1868,  Lieutenant  ISIaley  called  on  Assistant  Surgeon  George  A.  Otis,  U.  S.  A.,  in  reference  to  a ))lastic  operation.  He  is 
not  a pensioner.  The  case  is  reported  by  the  operator. 

Case. — Private  Joseph  D.  Norcross,  Co.  I,  9th  Maine  Volunteers,  aged  40  years,  w’as  wounded  at  the  battle  before 
Petersburg,  July  30th,  1864,  by  a conoidal  ball,  which  passed  through  the  superior  maxilla.  He  was,  on  August  2d,  admitted 
to  Fort  Monroe  Hospital.  Simple  dressings  were  applied  to  the  wound.  On  August  0th,  he  was  transferred  to  New  York, 
where  he  was  admitted  into  the  DeCamp  Hospital,  David’s  Island.  Secondary  haemon-hage  fi’om  the  jugular  vein  occurred 
August  14th,  amounting  to  forty  ounces  of  blood.  Stimuhants  and  tonics  were  administered.  Patient  died  August  15th,  1864. 
The  case  is  reported  by  Assistant  Surgeon  Warren  Webster,  U.  S.  A. 

Case. — Private  P.  O’Connor,  Co.  F,  61st  New  York  Volunteers,  received,  at  the  battle  of  Fair  Oaks,  June  1st,  1862,  a 
gunshot  wound  of  the  oesophagus  and  a fracture  of  the  ramus  of  the  lower  jaw,  on  the  left  side.  He  was,  on  June  8th, 
admitted  to  the  South  Street  Hospital,  Philadelphia.  The  wound  of  the  neck  had  already  healed.  Repeated  attempts  at  appo- 
sition of  fractured  portions  of  the  jaw  were  made  by  means  of  ]>asteboard  splints  and  Barton’s  bandages.  The  patient  was 
suft’ering  with  profuse  salivation,  which  was  attended  with  great  thirst  and  a constantly  increasing  difficulty  of  deglutition.  The 
dressings  interfered  with  his  efforts  to  quench  his  thirst,  and  were  removed  hy  him  at  the  first  opportunity  after  their  application. 
As  the  throat  symptoms  became  more  and  more  prominent,  all  treatment  of  the  fractured  jaw  was  abandoned.  Secondary 
haemorrhage  occurred  June  12th,  from  the  arteries  of  the  throat,  which  was  checked  by  a solution  of  persulphate  of  iron. 
Successive  haemorrhages.  Inability  to  swallow.  Milk  punch  freely  administered  per  rectum.  Patient  died  of  exhaustion  June 
15th,  1862.  Post  mortem  showed  that  the  ball  entered  on  the  right  side  of  the  neck,  at  the  posterior  border  of  the  sterno-cleido- 
mastoid  muscle,  and  passed  behind  the  larynx  and  laid  open  the  oesophagus,  then  turning  at  a right  angle,  penetrated  the  floor 
of  the  mouth,  and  passed  out  a little  to  the  left  of  the  mental  symphysis,  producing  a fracture  of  the  ramus  of  the  lower  jaw,  on 
the  left  side. 

Case. — Private  Albert  W.  Perry,  Co.  C,  1st  Vermont  Artillery,  aged  24  years,  was  wounded  at  the  battle  of  Cold 
Harbor,  June  1st,  1864,  by  a conoidal  ball,  which  fractured  the  facial  bones.  He  was  conveyed  to  the  hospital  of  the  2d  divisif)n. 
Sixth  Corps,  and  transferred  h}'  steamer  from  White  House  Landing  to  Netv  York,  where,  on  the  15th,  he  was  admitted  to 
DeCamp  Hospital,  David's  Island.  Simple  dressings  were  applied  to  the  wound.  Secondary  haiinorrhage  from  the  superior 
maxillary  artery  occurred  June  18th,  and  recurred  on  the  20th,  amounting  to  sixty-four  ounces  of  blood.  Patient  died  June 
21st,  1864.  The  case  is  rej)orted  by  Assistant  Surgeon  Warren  Webster,  U.  S.  A. 


Skct.  II.] 


OUNSITOT  FRACXrRES  OF  THE  FACIAL  RONES. 


353 


Case. — Corporal  John  II.  R , Co.  II,  19tli  Mniiu*  VoluntocVs,  aped  31  years,  was  wounded  at  tlie  haltle  of  Spottsyl- 

vania.  May  l“2th,  18(54,  by  a conoidal  ball,  wliieli  entered  the  nuiuth,  producing  a coniiniiiuted  fracture  of  the  alveolar  process  of 
the  superior  and  fracture  of  the  inferior  maxilla;  also  lacerating  deeply  the  right  border  of  the  tongue  to  the  extent  of  two  inches. 
He  was  on  May  2Lst  admitted  to  Finley  Hospital,  Washington.  Simjile  dressings  were  applied  to  the  wound.  Secondary 
hfflmorrhage  from  the  internal  carotid  artery  occurred  May  28th,  amounting  to  two  ])ints  of  blood.  Patient  died  May  2yth,  11564. 
The  specimen  is  No.  207,  Sect.  I,  A.  M.  M.  The  case  is  reported  by  Surgeon  G.  L.  Pancoast,  U.  S.  V. 

Case. — Corporal  Isaac  W.  Patterson,  Co.  E,  19th  !Maine  Volunteers,  aged  19  years,  was  wounded  at  the  battle  of  Si)ott- 
sylvania,  Virginia,  May  10th,  1864,  by  a conoidal  ball,  which  fractured  the  inferior  maxilla  and  wounded  the  facial  artery.  He 
was  conveyed  to  the  hospital  of  the  2d  division.  Second  Corps,  and  on  May  16th  he  was  admitted  to  the  Lincoln  Hosj)ital,  Wash- 
ington. Secondary  haemorrhage  occurred,  which  was  controlled  by  compression  and  persulphate  of  iron.  He  died  May  21st, 
1864.  Assistant  Surgeon  J.  Cooper  McKee,  U.  S.  A.,  reports  the  case. 

Case. — Private  Wdliain  Prater,  Co.  R,  48th  Virginia  Regiment,  aged  23  years,  was  wounded  February  6th,  1865,  by  a 
conoidal  ball,  which  struck  the  middle  of  the  right  cheek,  passed  through  the  right  ramus  of  the  inferior  maxilla,  and  ploughing 
through  the  tongue,  fractured  the  left  ramus  at  its  angle;  it  then  glanced,  and  emerged  from  under  the  left  mastoid  process.  He 
was  admitted  to  the  Chimborazo  Hosj)ital  No.  1,  Richmond,  Virginia.  On  February  13th,  secondary  hemorrhage  occurred  from 
the  lingual  artery,  at  the  root  of  the  tongue,  which  was  arrested  by  styj)tics. 

Case. — Sergeant  Philip  C.  Quick,  Co.  H,  141st  Pennsylvania  Volunteers,  aged  26  years,  was  wounded  at  the  battle  of 
Spottsylvania,  May  12th,  1864,  by  a conoidal  ball,  which  caused  a compound  fracture  of  the  inferior  maxilla,  right  side.  He  was 
on  ^3ay  ICth  admitted  to  Lincoln  Hospital,  Washington.  Secondary  htemorrhage  from  the  sublingual  and  the  superior  thyroid 
iirtery  of  the  left  side  occurred  May  18th,  and  recurred  on  the  19th,  amounting  to  about  sixty  ounces  of  blood.  In  consetjuence 
of  the  laceration  of  the  muscular  structure,  it  was  impossible  to  ligate  in  the  wound;  and  after  the  luemorrhage  occurred,  the 
patient  was  too  much  debilitated  to  admit  of  ligating  the  carotid  artery,  which  was  the  only  alternative.  As  he  opened  his 
mouth  with  great  difiiculty,  enemas  of  beef  tea  and  brandy  were  administered  every  three  or  four  hours.  Lint,  saturated  with  a 
solution  of  chloride  of  iron,  was  constantly  apjdied  to  the  wound.  He  died  May  19th,  1864.  The  case  is  reported  by  Assistant 
ISurgeon  J.  C.  McKee,  U.  S.  A. 

Case. — Private  Frastus  Ranger,  Co.  E,  32d  Maine  Volunteers,  aged  26  years,  was  wounded  at  the  battle  of  Petersburg, 
Virginia,  July  6th,  1864,  by  a conoidal  ball,  which  entered  one  and  a half  inches  below  the  angle  of  the  lower  jaw,  left  side,  passed 
obli(|uely  across  the  neck,  and  emerged  two  inches  to  the  right  of  the  symphysis,  comminuting  the  bone  in  its  course,  and  injuring 
the  thyroid  cartilage.  He  was  conveyed  to  the  hospital  of  the  2d  division.  Ninth  Corps,  where  several  fragments  of  bone  were 
removed,  and  on  the  16th  admitted  to  Mower  Hos])ital,  Philadelphia.  Simple  dressings  tvere  applied.  On  July  19th,  hmmorrhage 
occurred,  supposed  to  come  from  the  lungs.  On  J uly  21st,  profuse  htemorrhage  took  i)lace  from  the  mouth,  nose,  and  both  wounds, 
and  death  resulted  on  the  same  day.  Post-mortem  examination  revealed  the  inferior  thyroid  and  lingual  arteries  severed  by  the 
ball.  Surgeon  Joseph  Hopkinson,  U.  S.  V.,  reports  the  case. 

Case. — Private  William  Reeves,  Co.  C,  76th  New  York  Volunteers,  aged  22  years,  received,  at  the  battle  of  the  Wilder- 
ness, Virginia,  May  6th,  1864,  a com})ound  comminuted  fracture  of  inferior  maxilla  b^^  a conoidal  ball,  which  entered  the  left 
cheek  half  an  inch  anterior  to  the  angle  of  the  jaw,  and  emerged  at  a point  nearly  opposite.  He  was  conveyed  to  a field  hospital, 
where  a large  number  of  splinters  were  removed  through  the  mouth  and  aperture  of  exit.  He  was  admitted  to  the  Stanton 
Hospital,  Washington,  on  May  11th,  1864.  Aperture  of  entrance  small;  that  of  exit  about  three  inches  in  its  longest  diameter. 
On  May  12th,  secondary  haemorrhage  occurred.  He  lost  about  twenty-four  ounces  of  blood,  and  was  much  exhausted.  On  the 
same  day,  at  five  o’clock  r.  M.,  the  left  common  carotid  artery  was  ligated  by  Assistant  Surgeon  George  A.  IMursick,  U.  S.  V. 
No  anaesthetic  was  useil.  Patient  did  not  rally  after  the  operation.  He  died  on  May  13th,  1864,  at  four  o’clock  a.  m.,  from 
exhaustion.  The  autopsy  showed  the  haemorrhage  to  have  occurred  from  the  lingual  and  inferior  dental  arteries.  The  case  is 
reported  by  the  operator. 

Case. — Private  John  R , Co.  B,  63d  New  Y'ork  Volunteers,  aged  30  years,  was  wounded  at 

the  battle  of  the  Wilderness,  May  5th,  1864,  by  a conoidal  ball,  which  fractured  the  inferior  maxilla  ami 
divided  the  carotid  artery,  and  lodged  behind  the  tonsil.  He  was,  on  May  13th,  admitted  to  Finley  Hos- 
jiital,  Washington.  Successive  hsemorrhages  from  the  internal  wound  in  the  fauces  occurred  May  14th, 
amounting  to  one  pint  of  blood.  Cold  water  dressings  were  ap]died  to  the  wound.  On  May  31st,  frag- 
ments of  bone  were  removed,  and  the  comfiion  carotid  artery  was  ligated  below  the  right  omo  hyoid 
muscle  by  Surgeon  G.  L.  Pancoast,  U.  S.  V.  The  patient  died  June  1st,  1864,  from  secondary  luxunorrhage. 

S))ecimens  of  the  common  carotid  artery  and  inferior  maxilla  were  contributed  to  the  museum  by  the 
operator,  and  are  Nos.  2481  and  2482. 

C.vSE. — Private  Lemuel  Reccord,  Co.  A,  7th  Indiana  Volunteers,  agtsl  24  years,  was  wounded  at 
the  battle  of  the  Wilderness,  May  9th,  1864,  by  a conoidal  ball,  which  entered  the  nostril,  right  side,  and 
passed  out  at  the  neck,  fracturing  the  lower  jaw.  He  was  on  the  same  day  conveyed  to  the  hosjiital  of  the 
4th  division.  Fifth  Corps,  and  transferred  to  Alexandria  on  May  12th,  where  he  was  admitted  into  the  2d 
division  hosjjital  on  the  14th.  Simple  dressings  were  applied  to  the  wound.  Secondary  limmorrhage  from  the  transverse  facial 
artery  occurred  May  30th,  and  recurred  on  the  31st,  amounting  to  twelve  ounces  of  blood.  Styptics  were  ap]ilicd.  Patient  died 
.June  2d,  1864.  The  ca.se  is  rejiorted  by  Surgeon  F<lwin  Bentley,  II.  S.  V. 

Case. — Corporal  I'ohcrt  V.  Ricks,  Co.  F,  55th  North  Carolina  Regiment,  aged  25  years,  was  wounded  at  the  battle  of 
Spottsylvania,  May  10th,  1864,  by  a conoidal  ball,  which  fractured  the  suiyerior  anil  inferior  maxilla.  He  was  on  May  Pith 

45 


354 


WOUNDS  AND  INJURIES  OF  THE  PACE 


[Chap.  II. 


aduiittc-d  to  thu  2d  division  hospital,  Alexandria.  Secondary  liajinorrhage  from  a branch  of  tlio  carotid  artery  occurred  Slay  12th, 
amounting  to  fourteen  ounces  of  blood,  which  was  controlled  by  the  a])plication  of  ])ersnlj)hate  of  iron.  On  .June  1st.  ho  was 
transferred  to  Lincoln  Hospital,  Washington,  wdience  h(‘  was  sent  to  the  Old  Capitol  Prison,  as  a jn'isoner  of  war,  June  29th, 
1854.  The  case  is  reported  by  Surgeon  E.  Bentley,  U.  S.  V. 


Case. — Private  John  A.  Schott,  Co.  C,  98tli  Pennsylvania  Volunteers,  aged  24  years,  was  wounded  at  the  battle  of 
Fredericksburg,  May  Jd,  186.'?,  b}*  a eonoidal  ball,  which  entered  the  left  side  of  the  face,  about  one  inch  below  the  eye,  and 
passed  inward  and  backward,  entering  the  mouth,  fracturing  the  hard  palate  and  inferior  maxilla,  and  totally  destroying  sight 
of  left  eye;  then  jiassed  out  again  to  the  right  side  of  the  neck,  and  lodged  superficiallj'  about 
one  inch  and  one-half  below  the  right  ear.  He  was  on  May  7th  admitted  to  Campbell  Hospital, 
Washington,  and  transferred  to  Philadelphia,  where,  on  June  28th,  he  was  adnntted  into  the 
Tni'iiers’  Lane  Hospital.  Simj)le  dressings  and  tlax-seed  jioultices  were  applied  to  the  wound. 
On  June  JOth,  there  was  much  pain  in  the  right  superior  posterior  triangle  of  the  neck,  which 
was  very  much  inllamed,  and  discharging  freely  from  an  opening  in  that  region.  On  July  2d,  the 
ball,  with  adherent  ])iece  of  bone  about  one  inch  in  length,  supposed  to  be  a portion  of  the 
inferior  maxilla,  was  removed,  suppuration  and  ulceration  having  taken  place  around  it.  Slight 
hffiinorrhage  followed  the  removal  of  the  ball.  On  December  12th,  the  wound  had  entirely  healed, 
and  the  jiatient’s  health  was  good,  though  there  was  much  chronic  enlargement  of  the  right  side  of 
the  face.  He  was  transferred  to  the  2d  battalion.  Invalid  Corps,  November  4th,  1883.  Schott  is  a pensioner.  He  is  very  much 
disfigured.  His  disability  is  rated  total.  Pension  Examiner  Thomas  B.  Keed  reports  that  he  has  to  use  an  obturator  to  enable 
him  to  speak  distinctly.  A cast  of  the  head,  showing  deformity,  and  the  missile,  a eonoidal  ball  much  battered  and  increased 
longitudinally  by  compression,  with  a spicula  of  bone  lodged  in  it,  are  in  the  collection  of  the  Army  Medical  Museum,  and  are 
numbered  1554  and  4518,  Sect.  I.  The  c.ase  is  reported  by  Acting  Assistant  Surgeon  D.avid  Burpee,  who  contributed  the  ball 
represented  in  the  wood-cut  (FiG.  160),  and  the  cast  of  the  deformed  face  was  contributed  by  Acting  Assistant  Surgeons  C. 
Carter  and  C.  B.  King. 


Fig,  Ifil. — Ball,  with  impacted 
hone,  prohablj'  from  the  lower 
maxilla.  Spec.  4518,  Sect.  I,  A. 
M.  M. 


Case. — Corporiil  Asa  D.  Smith,  Co.  D,  IGth  Massachusetts  Volunteers,  was  admitted  into  hospital  at  the  Nav'al  Academy, 
Annapolis,  Maryland,  .Tune  4th,  1802,  with  a comj)ound  fracture  of  the  lower  jaw.  The  treatment  consisted  of  the  removal  of 
that  jiortion  of  the  jaw  lying  between  the  molars  of  the  opposite  sides.  Secondary  hasmorrhage,  which  was  arrested  by  the 
aj)plieation  of  ice,  occurred  July  12th.  He  recovered,  and  was  discharged  from  the  service  July  27th,  1862,  with  very  little  dis- 
figuration. The  case  was  reported  by  the  operator.  Acting  Assistant  Surgeon  B.  B.  Miles.  He  is  a pensioner.  On  September 
26th,  1866,  Pension  Examiner  George  S.  Jones  reports  that  the  bone  is  re-united,  but  the  pensioner  is  unable  to  masticate  solid 
f(K)d.  His  disability  is  rated  total  and  permanent. 

Ca.se. — Sergeant  John  Starkey,  Co.  F,  6th  New  Hampshire  Volunteers,  was  wounded  at  the  second  battle  of  Bull  Run, 
Virgini.a,  August  30th,  1862,  by  a eonoidal  ball,  which  entered  the  upper  lip  and  emerged  just  behind  the  ear,  right  side,  causing  .a 
compound  comminuted  fracture  of  the  superior  maxillary  and  malar  bones  of  tluat  side.  A portion  of  the  upper  jaw  was  removed 
on  the  field  by  Assistant  Surgeon  Benjamin  Howard,  U.  S.  A.  He  was  admitted  into  the  Unitarian  Church  Hospital,  at  Wash- 
ington, September  7th,  1862,  at  which  time  there  was  erysipelas  of  the  whole  right  side  of  the  face,  and  of  the  right  eye,  with 
severe  jiain.  Simple  dressings  were  applied  to  the  wounds,  and  as  he  could  not  use  any  solid  food,  beef-tea  and  chicken-broth, 
combined  with  a milk  diet,  was  ordered.  Hu  stated  that  sevfu’al  pieces  of  bone  had  been  removed  in  the  field  hospital.  On 
Seidember  15th,  the  wounds  were  unhealthy,  the  discharges  ichorous.  The  swelling  of  the  face  was  disappearing.  He  lost  the 
sight  of  the  right  eye  by  retinitis.  On  the  18th,  hminorrhage,  which  recurred  several  times,  took  place  from  the  wound  of  exit. 
The  amount  of  blood  lost  at  each  time  was  small,  owing  to  the  immediate  application  of  jiersulphate  of  iron  and  compress.  No 
lacerated  artery  could  bo  discovered  upon  examination.  He  was  very  weak  and  reduced  when  the  hsemorrhage  occurred.  He 
died  on  September  22d,  1832.  There  was  no  autopsy,  but  the  base  of  the  brain  was  believed  to  be  affected.  The  case  is  reported 
by  Acting  Assistant  Surgeon  A.  A.  Buck. 

C.VSE. — Corporal  Amos  G.  Schofield,  Co.  F,  1st  Minnesota  Volunteers,  was  wounded  at  the  battle  of  Bull  Run,  Virginia, 
July  21st,  1861,  by  a eonoidal  ball,  which  entered  two  inches  behind  the  left  mastoid  process,  and  escaped  at  the  mouth,  fractur- 
ing the  lower  maxilla,  and  carrying  away  a ]>ortion  of  the  i)rimitive  carotid  and  its  branches  from  the  left  side.  He  was 
admitted  to  the  3d  division  hospital,  Alexandria,  the  next  day;  an  aneurisinal  tumor  had  formed.  The  case  did  well,  except 
that  there  was  a hard  circumscribed  swelling  beneath  the  left  ear.  On  August  4th,  a hmmorrhage  occurred  from  the  wound  of 
entrance,  which  was  controlhnl  by  a graduated  compress,  but  which  was  gradually  succeeded  by  a swelling  which  extended 
from  the  mastoid  process  to  the  clavicle,  and  which  was  caused  by  the  escape  of  blood  into  the  tissues  of  the  neck.  Frequent 
haemorrhages  occurred  from  the  wound  in  the  mouth,  which  could  not  be  controlled  but  by  compression  on  the  loft  carotid. 
The  compression  on  the  veins  of  the  neck  induced  great  oedematous  swelling  of  the  face,  the  left  eye  was  closed,  the  tongue 
hung  from  the  open  mouth,  and  articulation  became  impossible.  The  haemorrhage  from  the  mouth  having  returned  about 
5 A.  M.,  on  August  11th,  compression  was  made  over  the  carotid,  when  the  patient  appeared  to  have  drawn  into  his  glottis  a 
clot  of  blood,  during  an  effort  at  inspiration.  Apncea  ensued,  followed  in  a few  moments  by  death,  his  strength  being  entirely 
exhausted  by  his  losses  of  blood  and  rest,  and  his  continued  suffering.  At  the  autopsy  the  left  skid  of  the  neck  was  found  dis- 
tended by  effused  blood.  The  internal  carotid  was  uninjured,  but  the  external  was  lost  in  the  tumor,  which  seemed  to  be  a true 
aneurism  undergoing  consolidation.  Behind  the  pharynx  was  found  a quantity  of  dark  fluid  blood.  In  the  right  ventricle  of 
the  larynx  was  found  a soft  clot,  which  was  the  immediate  cause  of  death,  since  it  acted  as  a valve  permitting  of  expiration, 
but  ju’eventing  inspiration.  A.ssistant  Surgeon  11.  Lawrence  Sheldon,  U.  S.  A.,  decided  against  an  operation,  as  he  could  not 
s.atisfy  his  mind  as  to  the  source  of  the  haemorrhage.  The  jjathological  specimens,  consisting  of  a part  of  the  lower  jaw  and  a 
portion  of  the  primitive  carotid  and  its  brancheo  exhibiting  a tumor,  were  contributed  to  the  Army  Medical  Museum,  with  a 
history  of  the  case,  by  Assistant  .Sur<;eon  William  'I’homson,  U.  S.  A.,  and  are  numbered  4923  and  4925  of  tiu'  Surgical  Section. 


Sect.  II.] 


GUNSHOT  FRAOTUEES  OF  THE  FACIAL  HONES. 


355 


Casio. — Private'  Saunie-l  Stieiitx'rgc'r,  1st  Unitod  States  Cavalry,  was  wouiide'd  at  tliu  battle  (if  Willianislnirg-,  Virginia, 
May  Ctli,  186:2,  by  a imiski^t  ball,  wbich  enitered  to  tbo  left  of  the  symphysis  of  lower  jaw,  fractured  tlu'  boue  and  carried  away 
several  teeth,  a part  of  the  tongue,  and  posterior  wall  of  pharynx.  lie  was  unable  to  swallow  nonrislnnent,  without  the  greatt'st 
distress  and  difficulty.  Swelling  of  injured  parts;  copious  boemorrbage.  lie  was  admitted  to  the  llygeia  Hospital,  Fort  Mon- 
' roe,  Virginia,  (jn  May  9tb,  1862.  On  May  13tb,  re'moval  of  ball  and  sevc'ral  teedli  from  absce.'s  aboi’e  clavicle.  May  Kith, 
coiiious  baemorrbage  from  wound.  Snlidiuric  ether  was  administered,  and  the  common  c.arotid  artery  was  ligated  by  Surgeon 
Heed  H.  Hontecou,  U.  S.  V.  Seven  days  after  ligation,  batmorrbages  from  wound  from  which  ball  was  e.xtracted;  an  unsuccess- 
ful attempt  was  mad^  to  find  the  bleeding  point.  He  died  on  May  23d,  1882,  from  exhaustion  from  bmmorrliage.  Antojisy 
indicated  that  the  ball  bad  fractured  the  transverse  jirocess  of  the  third  cervical  vertijbra.  The  vertebral  artery  had  worn 
against  the  spicula  thus  produced,  and  hence  the  second  hannorrhage.  The  ciise  is  reported  by  the  operator. 

C.VSE. — Private  George  W.  Scales,  Co.  B,  54th  Indiana  Volunteers,  was  wounded  at  the  battle  of  Vicksburg,  IMississipjii, 
December  29th,  1862.  The  missile  entered  the  mouth,  knocking  in  the  front  teeth  of  the  upper  and  low(>r  jaw,  and  lodged  in 
the  neck  below  and  behind  the  mastoid  process.  He  was  conveyed  to  the  hosjiital  of  the  3d  division.  Thirteenth  Corps,  where 
he  remained  until  .laniiary  8th,  1833,  when  he  was  t.aken  on  board  tbe  hospital  transjiort  City  (jf  Memphis.  On  January  9th, 
secondary  haemorrhage  occurred,  which  was  anvsted  by  the  .aiiplicatiou  of  jiersidjihate  (jf  iron.  On  January  13th,  he  was 
admitted  to  hospital  at  Paducah,  Kentuck3',  and  discharg(‘d  from  service  .Tidy  5th,  1863,  for  aneurism  of  the  left  e.xternal  carotid 
arterv.  The  case  is  reported  bv  Surgeon  H.  P.  Stearns,  U.  S.  V.  On  MaJ’  19th,  1838,  Pension  Examiner  W.  A.  Clapii  reports 
that  mastication  is  difficult,  as  well  as  deglutition,  from  injniy  to  tongue.  He  rates  his  disabilitj'  total  and  permanent. 

^ Ca.se. — Captain  Jacob  Schwartzlander,  Co.  D,  104th  Pennsjdvania  Volunteers,  aged  32  v'ears,  was  wounded  at  the  battle 
of  Fair  Oaks,  Virginia,  May  31st,  1832,  bj'  a conoidal  ball,  which  entered  the  inferior  maxilla,  right  side,  in  front  of  its  angle, 
jiassed  through  the  tongue  about  one  inch  behind  its  apex,  and  emerged  through  the  inferior  maxilla  of  left  side,  higher  up  .and 
somewhat  back  of  the  wound  of  entrance,  fracturing  it.  In  its  course,  it  shattered  tbe  jaw  at  point  of  entrance,  removed 
several  lower  and  one  upper  molar  tooth,  and  lacerated  the  tongue  so  that  the  anterior  part  protruded  from  the  mouth.  The  b.all 
evidentlj'  struck  with  its  side,  its  axis  parallel  to  the  cheek,  and  turned,  in  its  course,  so  as  to  make  its  exit  with  its  apex 
forward.  The  wounds,  wbich  lik'd  jirofuselj',  were  dressed  with  lint  and  adhesive  strips.  He  became  weak  from  lo.ss  of  blood, 
.and  was  convej'ed  to  Savage  Station,  where  the  wound  was  redressed.  There  was  .some  haemorrhage  during  the  night,  but  not 
much  pain,  .and  the  tongue  so  much  swolk'ii  as  to  protrude  from  the  mouth  .and  prevent  deglutition.  He  was  conveja'd  to  the 
hospital  transport  W.  Willidin,  for  transfer  to  Philadelphia.  On  June  1st,  several  spicula;  of  bone  and  some  teeth  were 
removed,  the  tongue  was  replaced  : o far  as  tumefaction  would  allow,  the  fracture  adjusted  and  pasteboard  splint  aiuL  bandage 
applied.  He  was  unable  to  take  nourishment  until  June  2d,  when  beef  tea  was  administered  by  a tube  through  the  nostrils. 
He  was  admitted  to  St.  Joseph’s  Hospittd  at  Philadelphia,  June  4tb,  at  which  time  he  could  not  articulate,  deglutition  was  still 
difficult,  the  wounds  were  suppurating  freelj’,  the  tongue  was  .sloughing,  the  discharge  being  veiy  fetid,  and  the  general  strength 
much  reduced.  Several  spiculse  of  bone  were  extracted,  and  the  lacerated  and  protruding  tongue  was  removed  hy  lig.ature, 
which  came  away  in  three  weeks.  lie  was  fed  for  eight  weeks  through  a tube,  the  mouth  and  fauces  were  syringed  with  watiu- 
every  two  hours,  and  external  apjilications  of  a solution  of  suljihate  of  copper  were  made.  About  August  24th,  he  was  able  to 
articulate  distinctlv'.  The  tongue  was  gradually  filling  up.  He  was  able  to  eat  eveiy  kind  of  food.  The  deformity  of  jaw  was 
disappearing,  and  there  was  givat  mobility.  He  was  returned  to  dut^'.  Not  a pensioner. 

C.wsE. — Private  Anthony  Surbe,  Co.  C,  Gtli  Iowa  Volunteers,  aged  22  j-ears,  was  wounded  at  the  battle  of  Dallas,  Georgi.a, 
May  2()th,  1834,  by  a conoidal  ball,  which  fractured  the  lowi'r  jaw,  .and  escaped  near  the  left  angle  of  the  mouth.  He  was 
admitted  to  the  hospital  of  the  4th  division.  Fifteenth  Corps,  thence  convej'ed  to  the  field  hospital,  Chattanooga,  Tennessi'c', 
where  he  was  admitted  on  June  4th.  Tonics,  stimulants  and  nourishing  diet  ordered.  Secondary  ba;morrhage  from  the  right 
external  carotid  artery  occurred  June  .5th;  loss  of  blood,  one  pint.  Iltemorrhage  recurred  on  tbe  7th,  the  loss  of  blood  amounting 
to  three  (piarts.  Patient  died  June  7th,  1834.  The  case  is  reported  by  Assistant  Surgeon  C.  C.  Bj’rne,  U.  S.  A. 

C.VSE. — Private  William  Wolf,  Co.  K,  7th  New  York  Heavy'  Artilleiy,  aged  30  years,  was  wounded  at  the  battle  of  Peter.s- 
burg,  April  7th,  1835,  ly  a conoidal  ball,  which  entered  the  lower  jaw,  near  the  right  angle,  ji.assing  directly'  through,  producing  a 
compound  comminuted  fracture  of  the  inferior  maxilla,  and  lacerating  almost  from  ear  to  e.ar.  He  was  on  April  15th  admitt(  (l 
to  1st  division  hospital.  Annapolis,  Maryland.  On  admission  the  patient  was  feeble  .and  anmmic,  having  from  time  to  time  lost 
considerable  blood;  the  wound  was  looking  badly  and  V’ery  offensive;  the  jaw  was  veiy  much  shattered,  many  of  the  fragments 
being  imbedded  in  the  clmek,  others  hanging  loosely  through  the  opening  below  the  chin ; every  tooth  was  carried  away,  and 
altogether  the  wound  was  frightful.  The  jiower  of  utterance  was  gom;,  and  it  was  with  difficulty'  he  could  swallow,  most  of  the 
food  passing  through  the  opening  below.  lie  improved  up  to  the  23d,  when  secondary'  hsemorrhage  from  the  sub-maxillary', 
lirobably  the  facial  artery,  occurred  April  23d,  and  recurred  on  the  27th,  amounting  to’tvventy-four  ounces  of  blood,  whicb  was 
controlled  by  pressure  upon  the  right  carotid  artery  and  the  ajjplication  of  tincture  of  muriate  of  iron.  After  the  hoemorrhage 
on  the  27th,  his  case  became  hopeless.  The  patient  died  April  30th,  1805.  The  case  is  reported  by  Surgeon  B.  A.  Vander- 
kieft,  U.  S.  V. 

Case. — Qu.artermaster  Sergeant  Amos  Whitney,  Co.  C,  .5th  New  York  Heavy  Artillery,  aged  39  years,  was  wounded  at 
Snicker's  Gap,  .July'  18th,  1834,  by  a conoidal  ball,  which  pi'oducc'd  a transverse  fi’actiire  of  the  lower  maxilla.  He  w!is,  on  .Inly 
22(1,  admitted  to  Sandy  Hook  Hosjiital,  Maryland,  and  transferred  on  the  27th  to  Frederick  City  Hospital,  wheri;  he  was 
admitted  the  same  d.ay'.  Simple  (lr(;ssings  were  aiijilied  to  the  wound.  Secondary  h.aunorrhage  from  the  facial  artery  occiiired 
July  31st,  amounting  to  sixty-four  ounces  of  blood.  Patient  died  .July  31st,  1834.  The  case  is  repoi-ted  by  Assistant  Surgeon 
H.  F.  Weir,  U.  S.  A. 

C.v.SE. — Lieut(‘nant  Thomas  We.stcott,  Co.  K,  8lh  New  York  Heavy  Arlilh'ry,  tiged  23  y'e.ars,  was  wounded  at  the  battle 
of  Cold  Harbor,  June  1st,  1834.  by  a conoidal  ball,  wbich  fractured  the  left  superior  maxilla.  'I'he  missile  entered  the  left  side 


356 


WOUNDS  AND  INJURIES  OF  THE  FACE. 


[Chap.  II. 


(if  the  nasal  cavity,  jiassed  througli  the  levater  muscle,  and  lodged  in  the  stenio-eleido-niastoid  muscle,  lie  was  conveyed  to  the 
hospital  of  the  2d  division,  Second  Corjis.  On  the  4th,  he  was  admitted  to  Si'ininary  Hospital,  Georgetown,  where  Acting 
Assistant  Surgeon  J.  M.  McCalla  administered  chloroform  and  extracted  the  ball  from  the  left  side  of  the  trapezius  muscle. 
Cold  water  dressings  and  flax-seed  poultices  were  applied  to  the  wound.  The  a]ipetite  was  jioor,  and  the  patient  .suffered  much 
from  loss  of  sleep.  On  tlio  2r)th,  he  was  transferred  to  Daltimorc,  and  admitted  into  the  Newton  University  Hospital.  Secondary 
hiemorrhage  from  the  internal  maxillary  artery  occurred  June  29th,  and  recurred  the  same  day  and  on  the  30th,  amounting  to 
fourteen  ounces  of  blood,  which  was  controlled  by  pressure.  On  September  24th,  he  was  transferred  to  Annajiolis,  where  he 
was  admitted  into  the  1st  divi.sion  hospital.  He  was  discharged  the  service  October  ICth,  18C4.  The  case  is' reported  by  Surgeon 
E.  JIcDonnell,  U.  S.  V.  He  is  a ]>ensioner;  his  disability  is  rated  total  and  probably  permanent. 

Ca.se. — Private  George  T.  A , Co.  E,  3d  North  Carolina  Infantry,  was  wounded  at  the  battle  of  Gettysburg,  July  3d, 

18G3,  bv  a colloidal  musket  ball,  which  fractured  the  right  lower  jaw.  He  also  received  a wound  of  the  neck.  He  was  taken 
prisoner  and  treated  in  field  hosiiital  until  July  10th,  1833,  when  he  was  admitted  to  the  Newton  University  Hospital,  Baltimore, 
Maryland,  where  fragments  of  bone  w'ere  removed  from  the  body  of  the  right  lower  jaw,  halfway  between  chin  and  angle,  and 
the  [larts  coaptated.  Barton’s  bandage  was  applied,  with  cold  water  dressings.  Mild  saline  cathartics  were  given,  and  nourish- 
ing licpiid  diet  ])rescribed.  He  imjiroved  rapidly,  and  on  July  Kith  was  transferred  to  the  Chester  Hospital,  Pennsylvania, 
whence  he  was  transferred,  on  September  17th,  to  City  Point,  Virginia,  for  exchange.  He  was  afterward  admitted  to  Hospital 
No.  1,  Kichmond,  Virginia,  and,  on  September  25th,  1833,  furloughed  for  forty  days.  The  pathological  specimen,  consisting  of 
three  fragments  of  bone  and  a molar  tooth,  was  contributed  to  the  Army  Medical  Museum  by  Surgeon  C.  \V.  Jones,  U.  S.  V., 
and  is  numbered  1391  of  the  Surgical  Section. 

Case. — Private  Henry  C.  , Co.  F,  30th  North  Carolina  Infantry,  received  a gunshot  wound  of  the  face  at  the 

battle  of  Antietam,  Septcanber  17th,  1832,  the  entire  lower  jaw'  being  shot  away  to  points  within  one  inch  and  a half  of  the 
angles.  He  was  admitted,  on  October  18th,  to  Hospital  No.  5,  Frederick,  where  death  resulted,  on  December  17th,  18G2,  from 
exhaustion  and  inanition.  The  pathologic.al  specimen  consists  of  the  inferior  maxilla.  An  irregular  plate  of  new  bone  measuring 
two  inches  in  length,  three-fourths  of  an  inch  in  width,  and  half  an  inch  in  thickness,  has  formed  anteriorly,  and  is  connected 
to  the  rami  on  either  side  by  ligamentous  bands.  It  was  contributed  to  the  Army  Medical  Museum  by  Surgeon  H.  S.  Hewit, 
U.  S.  V.,  and  is  numbered  1162  of  the  Surgical  Section. 

Case. — Private  John  Baker,  Co.  I,  9th  Pcnn.sylvania  Eeserves,  aged  19  years,  was  wounded  at  the  battle  of  Charles 
City  Cross  Koad.s,  Virginia,  June  30th,  1832,  by  a conoidal  ball,  which  entered  at  the  left  angle  of  the  mouth,  fractured  the 
npj)er  ja\’\^  cut  the  tongue  h.alf  in  two,  and  emerged  at  the  angle  of  the  right  lower  jaw,  fracturing  it  and  displacing  the  teeth. 
He  n^ceived  also  a bayonet  wound  in  the  lower  jiart  of  the  back,  which  penetrated  the  left  thigh.  He  was  admitted  into  the 
Satterlee  Hospital,  Philadelphia,  on  July  26th,  1832.  On  the  same  day.  Acting  Assistant  Surgeon  Edward  A.  Smith  removed 
several  ideces  of  loose  bone.  Cold  w'ater  dressings  were  a])plied,  and  the  jaw  was  kept  closed.  Fluid  diet  was  ordered.  As  the 
bone  became  loosened  it  was  removed  from  the  inside  until  almost  the  entire  right  side  of  the  inferior  maxilla  became  detached. 
Then  the  outer  wound  healed,  the  jaw  became  gradually  stiffened  until  February  3d,  1863,  at  which  time  he  was  able  to  chew 
food  of  some  consistence,  and  sutt'ered  but  little.  He  had  neuralgic  pains  at  times,  and  some  deterioration  of  the  facial  angle;  his 
health  was  good.  He  was  discharged  the  service  (jn  A])!'!!  14th,  1863.  The  case  is  reported  by  the  operator.  On  November 
17th,  1869,  I’ension  E.xaminer  .S.  Logan  reports  that  Baker’s  leg  is  jiaralyzed  and  atrophied,  resulting  from  the  bayonet  wound, 
and  that  his  disability  is  permanent. 

Case. — Second  Lieutenant  Nelson  Crockett,  Co.  A,  55th  Ohio  Volunteers,  aged  37  years,  was  wounded  at  the  second 
battle  of  Bidl  Run,  August  30th,  1832,  by  a conoidal  ball,  which  entered  the  left  side  of  the  inferior  maxilla,  two  inches  from  the 
angle,  fractuilng  it  at  this  point,  then  passed  across  beneath  the  tongue  and  emerged  on  the  right  side  from  the  inferior 
maxilla,  fracturing  this  also  at  a point  one  inch  and  a half  from  the  symphysis.  He  was  conveyed  to  Alexandria,  Virginia,  and 
admitted  into  the  3d  division  hospital  on  August  31st,  1862.  The  fractured  portions  of  the  bone  were  secured  at  the  two 
extremities  by  silver  wire,  and  Barton’s  apparatus  was  applied.  The  patient  was  discharged  the  service  on  April  4th,  1863, 
the  union  of  the  bone  being  imperfect.  The  case  is  rejiorted  by  Surgeon  Edwin  Bentley,  U.  S.  V.  On  April  5th,  1868, 
Pension  Examiner  H.  Frasse  reports  “the  fracture  is  imimited,  interfering  with  the  patient’s  speech,  and  disables  him  from 
masticating  solid  food.”  Hu  rates  his  disability  total  and  permanent. 

Case. — Private  Michael  Donhouser,  Co.  11,  10th  United  States  Inftmtry,  aged  25  years,  was  w'ounded  at  Gettysburg, 
Jidy3d,  1863,  by  a conoidal  musket  ball,  which  fractured  both  rami  of  the  inferior  maxilla  at  the  angles.  Several  teeth  were 
carried  aw'ay  and  the  tongue  injured.  The  haimorrhage  was  .sev'ere.  He  was  treated  in  field  hospital  until  Septdiiber  26th, 
1883,  when  he  was  transferred  to  St.  Joseph's  Hospital,  Central  Park,  New  York.  On  admission,  the  j.iw  was  imperfectly 
united  by  fibrinous  exudations  on  both  sides.  Aiticulation  was  destr(.)yed.  On  October  1st,  a small  s])iculum  of  bone  was 
removed,  internally,  from  the  left  side  of  the  jaw'.  By  November  19th,  the  wound  having  healed,  he  was  transferred  to  the 
post  hosjdtal  at  Fort  Columbus,  New  York  Harbor,  whence  he  was  discharged  on  December  16th,  1863,  on  account  of  complete 
aphonia  from  injury  to  the  tongue.  He  is  not  a j)ensioner. 

Case. — Lieutenant  William  E , 17th  United  States  Infantry,  was  wounded  at  the  battle  of  Getty.sburg,  July  2d,  1863, 

by  a conoidal  ball,  which  entered  the  left  side  of  the  face,  shattering  the  body  of  the  inferior  maxilla,  and  emerged  beneath  the 
ramus  of  right  side.  He  wa.s,  on  the  next  day,  admitted  to  the  Seminary  Hos])ital,  Gettysburg,  and  on  July  8th,  transferred  to 
Newton  University  Hospital,  Baltimore.  On  .admission,  he  w'as  much  enfeebhxl,  and  the  wound  was  in  very  bad  condition. 
Surgeon  C.  W.  Jones,  U.  S.  V.,  at  once  removed  the  fractured  portions  of  bone  and  two  molar  teeth  from  left  side  of  body  of 
the  inferior  maxilla,  syringed  the  wound,  chaned  the  mouth  with  tincture  of  myrrh,  applied  a dressing  of  lint  saturated  with  a 
solution  of  chlorinated  soda,  and  secured  the  jaw  by  Barton’s  bamhige.  Stimulants  and  nourishing  diet  were  given.  Under  this 
treatment  the  patient  rcacte(l  rajiidly.  and  continued  to  improve  st(*adily.  In  thirty-six  hours  he  could  converse  intelligibly; 


Sect.  II.] 


GUNSHOT  FRACTUHES  OF  THE  FACIAL  BONES. 


357 


subsequently  yeast  anil  charcoal  poultices  v.  ere  a])i)Ueil  to  the  wound,  which  left  it  clean,  with  healthy  granulations,  and  he  was 
granted  a leave  of  absence  on  July  14th,  1833.  On  January  23d,  18(14,  he  was  admitted  to  the  1st  division  hospital  at  Annapolis ; 
the  wounds  had  closed  with  but  slight  deformity  ; the  tongue  was  pai-tially  paralyzed.  He  was  returned  to  duty  on  February 
Cth,  18C4.  The  pathological  specimen,  consisting  of  tune  small  fragments  of  bone  and  two  molar  teeth,  was  contributed  to  the 
Army  Medical  Museum  by  the  operator,  and  is  numbered  1689  of  the  Surgical  Section.  A fang  of  one  of  the  teeth  is  broken 
off  and  remains  in  the  .socket,  which  forms  part  of  the  largest  fragment.  The  fragments  correspond  to  about  one  inch  of  the 
body  of  the  bone.  He  is  not  a pensioner. 

Case. — Private  Patrick  Gibney,  Co.  B,  31st  New  York  Volunteers,  aged  19  years,  received  a gunshot  wound  of  the  face  at 
Chancellorsville,  Virginia,  on  May  3d,  1863,  the  missile  entering  at  right  alse  nasi  and  emerging  near  the  right  angle  of  the  lower 
jaw,  which  it  fractured.  He  was  treated  in  field  ho.spital  until  May  9th,  when  he  was  admitted  to  Harewood  Hospital,  Wash- 
ington. Simple  dressings  were  applied  to  the  wound,  and  the  fractured  parts  kept  in  position.  He  recovered,  and  was 
discharged  on  May  25th,  1863,  his  tenii  of  service  having  exjiired.  He  is  not  a jjensioner. 

Case. — Private  Robert  Goldsnuth,  Co.  A,  107th  New  York  Vidunteers,  aged  23  years,  was  wounded  at  Antietam, 
September  17th,  1862,  by  a conoidal  ball,  which  entered  in  front  of  the  syinphj’sis  of  the  right  inferior  maxilla,  passed  obliijuely 
backward  beneath  the  tongue,  then  downward  and  backward,  and  lodged  in  the  scapula  just  above  its  spine,  fracturing  the 
maxilla  at  the  symphysis  and  the  angle.  The  ball  was  cut  out  on  the  field.  Considerable  limmorrhage  followed  immediately 
after  the  injury,  with  complete  paralysis  of  the  right  arm.  He  was  conveyed  to  Philadelphia,  and  admitted  into  the  Broad  and 
Cherry  Streets  Hospital  on  September  26th,  1862,  when  Ins  arm  was  still  paralysed,  the  tissues  around  the  jaw  swollen  and 
inttamed,  and  the  wounds  discharging  freely.  The  left  fragment,  at  the  symjihysis  was  displaced  backward  and  slightly  down- 
ward. The  patient’s  general  condition  was  good.  The  wounds  were  dressed  with  a flaxseed  poultice,  a Barton's  bandage  was 
applied  to  the  head,  and  extra  diet  was  ordered.  On  November  12th,  rapid  improvement  had  taken  ])lace,  the  paralysis  having 
almost  entirely  disappeared.  The  wound,  made  by  removing  the  ball,  had  entirely  closed;  the  wound  of  entrance  was  still 
discharging  slightly.  One  fragment  of  bone  W'as  removed  from  the  symphysis ; the  union  was  firm.  The  deformity  existing  at 
the  time  of  his  admission  into  the  hospital  still  existed  to  a slight  extent.  On  December  11th,  1862,  he  was  transferred  to  the 
Cuyler  Hospital  at  Germantown,  where  he  w’as  discharged  the  service  on  January  6th,  1863.  The  case  is  rejiorted  by  Surgeon 
John  Neill,  U.  S.  V.  The  patient  is  a pensioner,  his  disability  being  rated  one-half  and  permanent. 

Case. — Private  Robert  Jeffery,  Co.  F,  126th  New  York  Volunteers,  was  wounded  at  Gettysburg,  July  3d,  1863.  While 
lying  on  his  breast,  with  his  head  raised,  a ball  struck  him  on  the  front  of  the  nose,  on  a tine  with  the  internal  cauthus,  fracturing 
the  nasal  bones,  and,  passing  downward  through  the  left  antrum,  the  hard  jialate,  and  left  side  of  the  tongue,  opposite  the  last 
molar  tooth,  came  out  on  the  left  side  of  the  neck,  opposite  the  upper  border  of  the  thyroid  cartilage.  The  wound  bled  freely  for 
a short  time.  He  was  treated  in  fteld  hospital  until  July  13th,  when  he  was  admitted  to  the  Broad  and  Cherry  Streets  Hospital, 
Philadelphia.  Several  small  spicnlae  of  bone  had  been  removed.  The  patient’s  general  condition  was  good.  Simple  dressings 
were  applied,  the  mouth  was  frequently  w'.ashed  wdth  a solution  of  borax,  and  a fluid  diet  was  ordered.  Under  this  treatment 
he  improved  rapidly.  A few  days  after  admission,  several  small  fragments  of  the  nasal  bones  were  removed,  and  by  August  1st 
the  wound  of  entrance  had  entirely  closed,  occluding  the  left  nostril.  The  wound  through  the  hard  palate  had  diminished  in 
size,  leaving  a fistulous  opening  communicating  with  the  left  antrum;  that  of  the  tongue  had  cicatrized  and  was  adherent  to  the 
side  of  the  jaw’  by  false  adhesions,  and  traumatic  paralysis  was  so  well  marked  that  in  attempting  to  jirotrude  the  tongue  it  was 
strongly  drawn  to  the  left  side;  his  articulation  w'as  slightly  impaired.  A slight  discharge  still  continued  from  the  wound  of 
exit,  but  the  patient  had  made  a rapid  recovery,  with  slight  deformity,  considering  the  nature  of  the  injury.  He  was  dischargi'd 
from  serv'ice  on  January  19th,  1864,  and  pensioned.  Pension  Examiner  H.  A.  Potter  reports,  Ajuil  11th,  1864,  that  “ the  sense  of 
smell  and  taste  are  gone  and  the  voice  much  impaired.  He  has  difficulty  in  deglutition,  and  much  prostration  on  slight  exertion. 
It  seems  to  be  on  the  left  side.  The  pneumogastric  nerve  must  be  involved  in  some  way.  The  left  side  of  the  tongue  is 
paralysed.” 

Case. — Private  R.  R.  Kates,  Co.  H,  l*2th  New  Jersey  Volunteers,  aged  22  years,  was  wounded  at  Chancellorsville,  Jlay 
3d,  1833,  by  a musket  ball,  which  entered  the  mesial  line  of  the  upper  lij),  carried  away  almost  the  entire  superior  maxilla  of  that 
side,  and  emerged  about  two  inches  behind  the  left  ear.  He  was  taken  to  the  hosjiital  of  the  3d  division.  Second  Corps,  and,  on 
May  8th,  transferred  to  the  Douglas  Hospital,  Washington,  where  fragments  of  bone  were  extracted.  There  were  some  pieces 
of  bone  deeply  imbedded  in  the  neck,  and  small  fragments  were  daily  discharged  from  the  mouth.  On  June  8th,  a tooth  was 
extracted  from  the  neck  behind.  He  was  furloughed  on  June  26th,  at  which  time  the  posterior  wound  had  healed;  the  iqiper 
portions  of  the  bone  were  still  inflamed ; he  could  swallow  easily,  but  spoke  indistinctly.  He  was  returned  to  duty  on  September 
29th,  1863.  His  name  does  not  ajipear  upon  the  Pension  Roll. 

Case. — Private  .lames  Kelly,  Co.  I,  3Lst  New  York  Volunteers,  aged  26  years,  was  wounded  at  the  battle  of  Gaines’s 
Mill.  Virginia,  .Itine  27th,  1862,  by  a conoidal  musket  ball,  which  entered  near  the  middle  of  the  angle  of  the  left  lower  jaw, 
splintering  the  outer  wall  of  the  maxillary  bone,  jiassed  downward,  across  the  neck,  between  the  trachea  and  the  oesiqihagus, 
fractured  the  right  clavicle,  and  lodged  beneath  the  lower  edge  of  the  jiectoralis  major  muscle.  He  lay  on  the  battle-field  all 
night,  and  was  taken,  on  the  next  day,  to  Ravage  Station,  where  he  remained  a day  and  a night,  when,  feaiful  of  being  taken 
prisoner,  he  walked  to  Harii.son’s  Landing,  a distance  of  twenty  miles.  On  .July  1st,  he  was  sent  to  Fort  Monroe,  where  a 
liiece  of  dead  bone  w.as  removed  from  the  jaw.  On  .July  2d,  he  was  transferred  to  J’hiladelphia,  entering  Salterlee  Hospital  on 
the  7th.  When  admitted,  his  general  health  was  good.  An  ojjeidng  at  the  point  of  entrance  of  the  ball  being  explored  liy 
means  of  ti  probe,  loose  [lieces  of  dead  bone  were  I'eadily  felt.  The  inobe,  a very  large  ball-headed  one,  was  passed  down  along 
the  track  of  the  ball  to  the  furrow  marking  the  junction  of  the  trachea  and  lesophagus.  The  passage  between  these  had  healed 
up.  The  patient  stated  that,  for  .several  days  aftei-  the  reception  of  the  injury,  he  had  considerable  difficulty  in  swallowing. 
A large  swelling  existed  at  the  right  side  of  the  neck,  and,  on  July  9th,  fluctuation  being  perciqitible,  an  opening  was  made  at 


358 


W0UN])S  AND  INJUKIES  OF  THE  FACE. 


[Chap.  II, 


its  most  pniniiiieiit  iioint,  about  tlie  middle  of  tlie  neck.  On  July  lltli,  the  1)011  being  distinctly  felt  under  the  lower 

edge  of  the  })ectoralis  majoi'  muscle,  Acting  Assistant  Surgeon  John  H.  Packard  made  an  incision  and  removed  it  without 
difficulty.  The  swelling  at  the  side  of  the  neck  soon  diminished,  and  the  orifice  made  on  .Inly  9th  came  down  so  as  to  he  on  a 
level  with  the  claVicle,  large  portions  of  which  were  removed  from  time  to  time,  and  fragments  of  the  jaw  also  came  away 
through  the  wound  made  by  the  entrance  of  the  hall.  The  opening  by  which  the  hall  was  extracted  healed  up  very  readily. 
There  was  considerable  swelling  near  the  middle  of  the  right  clavicle,  owing  to  a deposit  of  new  hone.  A small  opening  existed 
at  the  orifice  of  entry,  and  a sinus  extended  down  toward  the  lower  edge  of  the  jaw,  hut  no  dead  hone  could  he  felt.  The 
patient  recovered,  and  was  discharged  from  service  on  FThruary  hth,  1863.  He  is  not  a pensioner. 

* Cask. — Private  F'rancis  H.  Kirker,  Co.  E,  100th  Pennsylvania  Volunteers,  aged  20  years,  was  wounded  at  Bull  Pun, 

August  29th,  1862,  by  a small  ride  hall,  which  entered  on  the  left  side  of  the  nose,  at  the  junction  of  the  nasal  hone  with  its 
cartilage,  and,  ])assing  obliquely  across  and  slightly  backward,  emerged  one  inch  above  the  angle  of  the  lower  jaw,  on  a vertical 
line  with  the  external  meatus,  tearing  away  a i)art  of  the  lobe  of  the  ear.  Fie  was  conveyed  to  Washington,  entering  George- 
town College  Hospital  on  September  Cth  ; on  FAbrnary  4th,  1863,  lie  was  transfen-ed  to  Broad  and  Cherry  Streets  Hospital.  He 
stated  that  the  wound  bled  freely  at  intervals  for  several  days,  and  that  several  small  jiieces  of  bone  had  been  removed.  On 
admission  the  wound  of  entrance  and  exit  had  healed.  There  was  partial  paralysis  of  the  muscles  of  the  right  cheek  and 
some  deafness  on  that  side  from  injury  to  the  nerves.  There  was  slight  ptosis  of  ujiper  lid  and  partial  loss  of  vision  in  the  right 
eye.  The  ophthalmoscope  revealed  a congested  state  of  the  retina.  He  was  discharged  from  service  on  March  19th,  1863,  and 
pensioned.  I’ension  Examiner  A.  II.  McClure  reports,  Ajiril  Cth,  1867,  that  there  is  necrosis  of  the  su])erior  maxilla,  and  that 
the  pensioner  is  unable  to  peiform  any  labor  without  causing  pain. 

Case. — Private  John  McNallcy,  Co.  H,  81st  Pennsylvania,  aged  23  years,  was  wounded  at  Fredericksburg,  Virginia, 
December  13th,  1862,  by  a round  musket  ball,  which  entered  on  the  left  side  of  the  nose,  on  a line  with  the  internal  canthus  of 
eye,  fractured  the  nasal  bone,  and,  passing  obliquely  across,  fractured  the  right  superior  maxillary  bone  and  j)enetrated  the  cheek 
opposite  the  second  molar  tooth,  in  its  course  giving  rise  to  a fistula  lachrymalis  on  the  right  side.  He  was  at  once  admitted  to 
the  ho.spital  of  the  1st  division.  Second  Corps,  .and,  on  December  20th,  sent  to  Cathariny  Street  Hospital,  I’hiladelphia,  whence 
he  was  transferred,  on  FAbruary  2d,  1863,  to  Broad  and  Cherry  Streets  Flosjjital.  When  admitted,  both  wounds  had  closed, 
with  little  depression  at  the  wound  of  entrance.  The  right  cheek  was  consider.ably  swollen.  The  hstula  had  almost  healed, 
and  closed  a few  days  after  admission.  The  patient  stated  that  the  wounds  bled  very  freelj',  at  intervals,  for  the  first  twelve 
hours,  and  that  several  small  })it'ces  of  bone  were  removed  on  admission  to  Catharine  Street  Hospital.  He  conqilained  of 
partial  loss  of  vision.  The  ball  of  the  eye  was  slightly  atrojihied,  and  its  jaipil  considerably  larger  than  the  other,  and 
irregular  and  .slow  in  action.  An  examination  with  the  ophthalmoscope  showed  the  vessels  of  the  retina  to  be  in  a congested 
condition.  He  was  discharged  from  service  on  iMarch  31st,  1863.  He  is  not  a pensioner. 

Case. — Private  AVilliam  Madison,  Co.  H,  118th  lAnnsylvania  Volunteers,  aged  46  years,  was  wounded  at  Blackffird’s 
FArd,  September  20th,  1862,  by  a conoidal  ball,  which  entered  just  in  front  of  the  coronoid  process,  on  the  left  side,  passed 
through  the  cheek  and  .soft  p.alate,  and  emerged  on  a line  with,  and  about  one-half  an  inch  below,  thelobeof  the  right  car,  tearing 
away  the  uvula  and  the  lateral  half  arches  and  fracturing  the  ramus  of  the  jaw  on  the  right  side  just  above  the  angle.  He  was 
conveyed  to  Philadelphia,  and  admitted  into  the  Broad  and  Cheriy  Streets  Hospital  on  Sej)tember  27th,  1862.  The  patient 
stated  tliat,  immediately  after  the  injury,  he  suffered  from  loss  of  blood,  and  before  le.aving  the  field  the  surgeon  removed  some 
tissue  from  his  mouth.  On  his  admission  into  the  liosj)ital,  the  right  cheek  was  swollen  and  inflamed,  and  both  wounds  were 
discharging  slightly.  The  uiiper  fragment  of  the  bone  was  disj)laced,  backward  and  inward ; the  parts  within  looked  very 
well.  The  right  side  was  dressed  with  a flaxseed  poultice ; the  left  side  with  a warm  water  dressing,  and  a Barton’s  bandage 
was  lightly  aj)plied.  Extra  diet  in  a liquid  form  was  ordered.  The  patient  comi)lained  of  a loss  of  sensation  in  the  right  half 
of  the  lower  rq),  owing  to  a division  of  the  inferior  dental  nerve  at  the  seat  of  the  fracture.  He  improved  rapidly,  and  on 
November  1st,  1862,  was  convalescent,  the  wound  of  entrance  having  closed,  the  wound  of  exit  discharging  slightly,  and  the, 
bony  union  firm.  He  was  transferred  to  the  Veteran  Reserve  Corps  on  x\pril  21st,  1863.  The  case  is  reported  by  Surgeon  John 
Neill,  U.  8.  V.  On  December  13th,  1865,  Pension  Examiner  E.  A.  Smith  reports  that  the  sense  of  taste  is  destroyed,  tongue 
jiaralysed  on  the  left  side,  and  hearing  in  right  ear  and  sense  of  smell  are  much  im])aircd.  He  rates  the  disability  three-fourths 
and  jn-ohably  })ermanent. 

Case. — Sergeant  Alfred  Malone,  Co.  K,  6th  West  Virginia  Cavalry,  aged  39  years,  was  wounded  at  Springfiehl, 
Virginia,  June  26th,  1864,  by  a pistol  ball,  wljich  entered  the  left  cheek  one  inch  and  a half  from  the  angle  of  the  mouth, 
on  a line  with  the  external  canthus  of  the  left  eye,  passed  horizontally  beneath  the  nares,  and  emerged  two  and  a half  inches 
from  the  right  angle  of  the  mouth,  on  a line  with  the  meatus  anditorius  externus,  fracturing  both  sides  of  the  superior  maxilla. 
One  molar  and  two  bicuspid  teeth  on  the  right  side  were  removed  by  the  patient  himself  at  the  time  of  the  injuiy.  He  was 
admitted,  on  the  next  day,  to  the  hospital  at  Cumberland,  Maryland.  When  admitted  the  incisors  and  canine  teeth,  attaclied  to 
a fragment  of  the  superior  maxilla,  were  lianging  loosely  between  his  lips;  the  left  bieusi)id  teeth  were  displaced,  and  the  root 
of  the  left  canine  tooth  was  cut  otf  and  remaining  loose  above  the  fracture.  A very  ofiensive  foetid  odor  accompanied  the 
discharge  from  the  wound.  Several  fragments  of  bone  had  come  away  by  snp])nration,  and  others  were  exposed,  but  so 
attached  to  the  muscular  tissue  ns  to  in-event  their  removal  without  danger  of  hasmorihage.  The  anterior  })alate  was  cut 
tln-ough  and  hung  pendulous  in  the  month.  The  bleeding  was  free  at  first,  but  was  conqdetely  arrested  by  cold  water  a]iplications. 
The  fractured  teeth  and  maxilla  were  placed  in  position  with  as  much  care  as  possible,  and  supported  by  a tin  splint  so  formed 
as  to  fit  over  the  upper  lip  and  beneath  the  superior  incisors,  and  held  in  position  by  a T bandage.  The  mouth  was  ch>ansed 
with  a weak  solution  of  chlorinated  soda,  and  resin  cerate  ajiplied  to  the  wounds  of  the  cheeks,  with  stimulants  and  nourishing 
diet  internally.  I’nder  this  treatment  the  i)atient  rallied,  and  on  July  1st,  the  bad  odor  had  ceased;  healthy  granulations  were 
forming  rapidly.  Several  fragments  of  bone  had  been  discharged.  On  July  22d,  the  patient's  health  was  good.  The  wound 


Sect.  II.] 


GUNSHOT  FKACTUHES  OF  THE  FACIAL  BONES. 


359 


through  th(^  superior  maxilla  had  .so  far  united  as  to  hold  up  the  fragment  of  bone  and  teeth  without  the  aid  of  the  sjdint.  He 
was  furloughed  on  July  22d,  18'o4.  While  at  home  an  abscess  ])ointed  through  the  right  cheek,  between  the  -wound  of  exit  ami 
the  angle  of  the  mouth,  which  discharged  pus  freely  and  several  spicuhu  of  bone,  among  them  a fragment  of  the  liard  ])alate, 
one-half  inch  long.  By  September  2'2d,  the  wound  of  the  left  cheek  had  entirely  liealed.  A small  discharge  still  continued  from 
the  wound  in  the  right  clieek.  The  upper  incisors  and  bicuspids  were  held  in  place  by  union  of  the  soft  parts,  but  were  not 
sufficiently  solid  to  uSt>  in  chewing.  He  was  transferred  to  the  hospital  at  Grafton,  on  September  25th,  and  returned  to  duty  on 
October  15th,  1804.  He  was  discharged  on  May  22d,  1866,  and  pensioned.  Pension  Examiner  E.  D.  Salford  reports,  Octola  r 
28th,  1868,  that  “the  hones  have  never  united,  and  he  has  no  ability  to  chew  food,  and  is  a great  suft'erer  from  facial  neuralgia 
in  consequence  of  the  injury.”  , 

Case. — Corporal  Jacob  M , Co.  G,  20th  Michigan  Volunteers,  aged  29  years,  was  wounded  at  the  battle  of  Cold 

Harbor,  Virginia,  June  3d,  18.64,  by  a conoidal  musket  ball,  which  fractured  the  right  lower  jaw.  He  was  taken  to  the  hosiiital 
of  the  3d  division.  Ninth  Corps,  and,  on  June  8th,  admitted  to  the  Emory  Hospital,  Washington.  On  June  10th,  Surgeon  N.  K. 
Moseley,  U.  S.  V.,  removed  several  fragments  of  bone  from  the  inferior  maxilla.  Simple  dre.ssings  were  applied,  and,  on  August 
Cth,  he  was  tramsfern'd  to  St.  Mary's  Hospital,  Detroit,  and,  on  October  14th,  to  Harper  Hospital,  where  death  resulted  on 
December  7th,  1864,  from  -wound,  complicated  with  Inemorrhage  of  the  lungs.  The  pathological  specimen,  consisting  of  seven 
pieces  of  bone,  to  which  a small  flattened  jiiece  of  the  missile  is  attached,  was  contributed  to  the  Army  Medical  Museum  by  the 
operator,  and  is  numbered  2507  of  the  Surgical  Section. 

Case. — Private  William  T.  Moore,  Co.  G,  15th  Massachusetts  Volunteer.s,  was  wounded  at  Gettysburg,  July  2d,  1863,  by 
a conoidal  ball,  which  entered  the  buccal  muscle  of  the  left  side  of  the  face,  passed  slightly  upward  and  emeiged  on  the  right 
side  of  the  face,  knocking  out  three  teeth  of  the  left  upper  jaw,  and  fracturing  the  right  tipper  jaw.  He  was  at  once  admitted 
to  the  hospital  of  the  2d  division.  Second  Corps;  thence  sent  to  Baltimore,  and,  on  July  10th,  1863,  admitted  into  the  Newton 
University  Hospital.  Immediately  after  admi.ssion,  a fragment  of  the  alveolar  process  of  the  right  sujierior  maxilla,  containing 
one  canine  and  one  bicuspid  tooth,  was  removed.  The  parts  were  then  coaptated.  Barton’s  bandage  applied  with  cold  water 
dre.ssings,  and  liquid  diet  given.  On  J uly  3l6t,  he  was  nearly  well,  and  his  general  condition  was  excellent.  He  was  trans- 
ferred to  the  Veteran  Keserve  Corps  on  October  20th,  1863.  The  pathological  .specimen  is  No.  1690,  Section  I,  A.  M.  M.,  and 
was  contributed,  with  the  history,  by  Surgeon  C.  W.  Jones,  U.  S.  V.  This  man  is  a pensioner;  his  disability  is  rated  one- half 
and  permanent. 

Case. — Private  Madison  B.  Moss,  Co.  I,  23d  Pennsylvania  Volunteers,  aged  31  years,  was  wounded  at  Fair  Oaks, 
Virginia,  May  31st,  1862,  by  a conoidal  ball,  which  entered  ])osteriorly,  just  below  the  right  condyle  of  the  lower  jaw,  and, 
passing  obli(juely  forward  and  across,  emerged  at  the  left  angle  of  the  mouth.  Most  of  the  ramus  of  the  right  side  was  carried 
away ; the  lip  was  lacerated,  and  a part  of  the  tongue  on  the  right  side,  with  several  teeth,  and  their  alveoli,  on  the  left  side  at 
the  point  of  exit  of  the  ball,  were  wanting.  The  patient  remained  on  the  field  two  daj's,  very  much  prostrated  from  the  loss  of 
blood.  He  was  afterward  removed  to  a j)rivate  house  ; thence  to  Norfolk,  Virginia,  where  he  remained  for  three  weeks,  when 
he  was  sent  to  New  York,  and  thence  to  Philadelphia,  .and  admitted  into  the  Broad  and  Cherry  Streets  Hospital  on  October  3d, 
1862.  The  patient  stated  that  the  only  dressing  applied  was  lint  wet  with  cold  water,  and  the  mouth  w-as  well  syringed  daily. 
His  diet  consisted  of  beef-tea  and  an’ow-root.  During  the  treatment,  several  pieces  of  bone  were  removed  from  the  wound.  On 
his  admission  into  this  hospital,  the  wound  of  the  right  cheek  had  .almost  cicatrized,  leaving  a deep  scar,  which  extended  from 
the  ear  to  the  angle  of  the  mouth.  The  wound  on  the  left  side  had  entirely  he.aled.  His  health  was  good,  but  he  is  unable  to 
take  solid  food.  The  deformity  of  the  soft  places  was  such  that  a benefit  would  ))rohably  result  from  a plastic  operation.  On 
J.anuary  14th,  1863,  the  patient  was  transferred  to  the  Mower  Hospital,  Philadelphia,  where  he  was  discharged  the  service  on 
January  19th,  1863.  The  case  is  reported  by  Surgeon  John  Neill,  U.  S.  V.  The  patient  is  a pensioner,  his  disability  being  rated 
total  and  permanent. 

Case. — Private  Michael  Murphy,  Co.  G,  69th  New  York  Volunteers,  aged  24  ye.ars,  was  wounded  at  the  Wilderness, 
Virginia,  May  5th,  1864,  by  a conoidal  ball,  which  caused  a lacerated  wound  of  the  face,  injured  the  palate,  and  comminuted  the 
upper  jaw.  He  was  taken  to  the  hospital  of  the  1st  division.  Second  Corps,  where  detached  pieces  of  bone  were  removod  by 
Surgeoii  Wm.  O’Meagher.  On  May  11th,  he  was  transferred  to  Judiciary  Square  Hosj)ital,  Washington,  whence  he  was  returned 
to  duty  on  July  12th,  1864.  He  is  not  a pensioner. 

Ca.se. — Private  Peter  Kafferty,  Co.  B,  69th  New  York  Volunteers,  was  wounded  at  the  battle  of  Malvern  Hill,  Virginia, 
July  1st,  1862,  by  a conoidal  ball,  which  entered  the  n{)j)er  lip  on  the  left  side,  at  the  angle  of  the  mouth,  passed  through  that 
side  of  the  tongue,  one-half  an  inch  from  the  tip,  thence  oblicpiely  across,  struck  the  right  lower  jaw  at  a point  one  inch  in 
advance  of  its  angle,  passed  downward  and  outward  and  emerged  through  the  cheek,  knocking  out  fouiteen  or  fifteen  teeth, 
fracturing  both  jaws  and  cutting  the  tongue  .almost  off  at  the  middle.  The  same  ball,  fracturing  the  clavicle  in  its  middle  third, 
lodged,  and  w.as  removed  by  the  patient.  He  received  also  a gunshot  fracture  of  the  bones  of  the  foot.  A jirofuse  Innnorrhage 
followed,  amounting  to  syncope,  and  the  patient  remained  insensible  for  twenty-four  hours.  Being  taken  prisoner,  he  was 
removed  to  a ho.sj)ital  on  the  field,  and  three  days  afterward  waswnt  to  Pichmond,  Virginia,  where  his  wounds  were  dressed 
with  cold  water,  but  he  received  poor  diet.  He  had  colli<|Uative  diarrha-a  for  two  wei'ks.  On  .Inly  2.5th,  1862,  he  was  paroled, 
and  conveyed  to  Philadelphia,  and,  on  July  29th,  was  admitt(!d  into  the.  Broad  and  Cheriy  Streets  Hospital  in  a Very  weak 
condition.  The  fragments  of  the  jaw  were  exj)osed  in  the  wound  for  some  distance;  the  soft  parts  were  sloughing,  and  rhe 
wound  of  the  foot  looked  badly;  that  over  the  fractured  clavicle  had  healed,  with  some  union  of  the  bone,  the  intier  fragment 
overlapping.  Lint,  saturated  with  a solution  of  chlorate  of  j)otash,  was  applied  to  the  wound  of  the  cheek,  and  a flaxseed 
potdtice  to  the  wound  of  the  foot.  Stimulants  tind  anodynes  and  liipiid  diet  wen-  giv(‘n.  Two  large  pit^ces  of  bone  were 
removed.  A few  days  after  admission,  the  patient  had  another  attack  of  diarrho-a,  which  continued  two  weeks,  causing  gn'at 
prostration.  Kecovering  from  this,  he  impi-oved  rai)!dly.  On  November  1st,  1862,  the  wound  of  the  cheek  had  neaily  healed. 


360 


WOUNDS  AND  INJUKIES  OF  TEE  FACE. 


[Chap.  II. 


leaving  a deep  scar.  No  callous  was  tlirown  out ; the  jaw  was  drawn  toward  the  right  side,  giving  rise  to  considerable  deformity, 
and  tile  ])atipnt  was  unal>le  to  take  solid  food.  A firm  iniion  of  tlie  clavicle  had  t.aken  })lace.  The  wound  of  the  foot  had  nearly 
healed.  The  patient  was  discharged  the  service  on  January  5th,  lyC3,  and  pensioned.  The  case  is  reported  hy  Acting  Assistant 
Surgeon  John  Neill. 

Case. — Piivate  Aaron  S , Co.  G,  1st  Maine  Heavy  Artillery,  received  a gunshot  fracture  of  the  inferior  maxilla,  in 

an  engagement  before  Peteivshurg,  Virginia,  .Tune  18th,  18G4.  He  was  at  once  taken  to  the  hospital  of  the  3d  division.  Second 
Corps,  where  Dr.  A.  Garcelon,  a volunteer  surgeon,  removed  five  fragments  of  the  inferior  maxilla,  with  a lateral  incisor,  canine 
and  bicuspid  teeth.  Death  resulted  ou  June  20th,  1804.  The  ])ath(dogical  sj)ecimen,  consisting  of  the  ))ortions  of  bone  removed, 
Was  contributed  to  the  Army  Medical  Museum  by  the  operator,  and  is  numbered  .522  of  the  Surgical  Section. 

Case. — Private  Samuel  W.  S , Co.  B,  1st  New  York  Dragoons,  aged  23  years,  was  wounded  at  Spottsylvania,  May 

8th,  1804,  by  a conoidal  ball,  which  entered  the  back  two  inches  below  and  a little  to  the  right  of  the  superior  angles  of  the 
right  scapula,  and  passing  upward  and  forward  through  the  neck  and  mouth,  fractured  the  inferior  maxilla.  He  received  also 
a gunshot  flesh  wound  of  the  left  thigh.  He  was  admitted  into  the  general  field  hosjdtal  of  the  Cavalry  Corps  at  Fredericksburg, 
Virginia,  on  May  13th,  1804;  thence  he  was  transferred  to  Alexandria,  Virginia;  and,  on  May  24th,  1804,  was  admitted  into 
the  2(1  division  hospital.  Ou  May  27th,  a copious  secondary  haemorrhage  occurred  from  the  mouth,  which  was  arrested  by  the 
persuljdiate  of  ii'on,  ])re.ssure,  cold  applications,  and  an  elevated  position.  Extra  diet  was  given.  The  patient  died  on  June 
4th,  1804.  At  the  autopsy,  it  was  found  that  the  body  of  the  inferior  maxilla  was  fractured  half  way  between  the  angle  and 
the  symphj’sis.  The  jugular  vein  just  above  the  middle  of  the  omo-hyoid  muscle  was  found  discolored,  shriveled,  closed,  and, 
apj)arently,  in  a sloughy  condition,  and  filled  with  coagulmu  for  two  inches  below  the  wound.  The  ha;morrhage  was  evidently 
from  this  vein.  The  .specimens  are  No.  2440,  Sect  I,  A.  M.  M.  (two  fragments,  being  the  right  half  of  the  inferior  maxilla),  and 
2441,  Sect.  I,  A.  !M.  IM.  (a  wet  ]U'eparation  of  a portion  of  the  light  internal  jugular  vein).  The  specimens  and  history  were 
contributed  by  Acting  Assistant  Surgeon  Jonathan  Cass. 

Ca.se. — Private  .John  W.  S , Co.  I,  82d  Pennsylvania  Volunteers,  aged  21  years,  was  ■wounded  at  the  battle  of  Cold 

Harbor,  Virginia,  June  3d,  1804,  by  a conoid.al  musket  ball,  which  entered  ,at  the  left  side  of  the  nose,  and,  emerging  opposite 
at  ramus  of  inferior  maxilla,  fractured  the  superior  maxilla  at  entrance  and  the  inferior  maxilla  between  condyle  and  ramus.  He 
was  conveyed  to  Washington,  and,  on  June  10th,  admitted  to  Emory  Hospital,  where,  on  the  next  day,  the  b.all  and  upper  portion 
of  the  jaw  were  removed,  and  simple  dressings  applied  to  the  wound.  On  June  21st,  he  was  transferred  to  Haddington  Ilosjiital, 
Philadeljdiia.  ErysipGas,  contiguous  to  the  wound,  supervened  on  July  0th,  but  disappeared  under  the  aj)plication  of  iodine 
with  stimulants  internally.  He  was  returned  to  duty  on  October  19th,  1804.  The  pathological  specimen,  consisting  of  one  inch 
and  a half  of  the  right  condyloid  extremity  of  the  inferior  maxilla,  including  the  articular  sniface,  was  contributed  to  the  Army 
Medical  Museum  by  Surgeon  N.  K.  Moseley,  U.  S.  V.,  and  is  numbered  504  of  the  Surgical  Section.  The  patient  is  not  a 
pensioner. 

Case. — Private  Johnson  S , Co.  D,  0th  Alabama  Infantry,  aged  18  years,  was  wounded  at  Gettysburg,  July  3d,  1803, 

hy  a musket  ball,  which,  entering  about  one  inch  from  the  chin  on  the  left  side,  produced  a compound  fracture  of  the  lower 
maxillary  hone,  and  lodged.  lie  was  admitted,  on  July  0th,  to  the  hos]iital  at  Frederick,  Maryland,  where  water  dressings 
W’ci’e  a])])lied  to  the  wound.  The  location  of  the  missile  could  not  be  det(*rmined.  The  patient’s  general  condition  was  good. 
On  July  10th,  sevei-.al  small  fi'agments  of  bone  weie  extracted.  The  patient,  app.arently,  did  well  until  Se])tember  1st,  the 
Wound  of  jaw  having  healed,  when  he  complained  of  pain  in  the  neck,  which  increased  in  severity.  An  abscess  formed  on  the 
left  side  of  the  neck,  discharging,  when  oj)ened,  about  four  ounces  of  fmtid  j)us.  On  September  18th,  it  was  found  that  air  passed 
through  the  o])ening  made  info  this  abscess.  The  ])atient  complained  of  a feeling  of  numbness  in  the  left  side  of  the  body, 
followed,  on  the  19th,  by  partial  paralysis,  which  extended  into  the  bladder.  His  ui’ine  was  drawn  (jft'  twice  a diiy.  Ou 
Seiitember  21st,  he  was  placed  upon  a water  bed.  The  ajiiiearance  of  the  hack  ji.art  of  the  neck  indicated  some  dis])lacement  of 
the  vertebra  ; jn-essure  uj)on  that  jiart  of  the  neck  produced  a gurgling  sound.  Complete  jniralysis  had  occurred  hy  September 
23d,  and  the  patient's  strength  was  rajiidly  failing.  Milk  punch  was  freely  given,  but  a consider.able  quantity  of  all  the  liquids 
taken  by  the  mouth  passed  out  through  the  fistulous  opening.  He  continued  to  sink,  and  died  on  September  28th,  1803.  At  the 
autopsy,  the  fractured  jaw  was  found  to  have  only  partially  united.  The  hall  had  lodged  in  the  fifth  cervical  vertebra,  producing 
extensive  comminution.  The  bone  was  very  much  necrosed,  and  the  soft  ])arts  greatly  disorg.anized.  The  su])puration 
extended  to  the  spinal  canal;  there  was  red  softening  of  the  spinal  cord.  The  fistulous  op(‘ning  extended  into  the  ]iharynx. 
The  pathological  specimen  is  a wet  preparation  of  the  iiderior  maxilla,  showing  a fracture  of  the  body  by  a mu.sket  ball,  one-half 
inch  to  the  left  of  the  symphysis,  partially  united  by  ligament.  The  fracture  runs  obli(juely  downward,  forward,  and  inward,  and 
one  inch  of  the  body  of  the  bone,  with  the  canine,  bicuspid,  and  first  molar  teeth,  had  been  comminuted  and  ])artia]ly  removed. 
Sevei'al  small  fragments  remain  in  situ.  It  was  contributed  to  the  Army  Medical  Museum,  with  a history  of  the  case,  by  Assistant 
Surgeon  R.  F.  Weir,  U.  S.  A.,  and  is  nund)ered  3979  of  the  Surgical  Section. 

Case. — Private  Samuel  T , Co.  E,  88th  Pennsylvania  Volunteers,  waswoimded  at  the  Alexandria  Prison,  July  2Cth, 

1804,  by  a musket  hall.  He  died  on  the  same  day.  At  the  autop.sjq  the  hall  was  found  to  have  entered  the  right  corner  of  the 
mouth  and  emerged  just  below  the  right  ear,  badly  fracturing  the  right  side  of  the  lower  jaw  in  several  places,  and  rujjuring 
the  iutei'ual  maxillary  artery.  The  hamiorrhage  from  the  internal  maxillary  artery  was  siqiposed  to  have  caused  his  death. 
The  specimen  is  No.  33.50,  Sect.  1,  A.  M.  M.,  showing  the  right  half  of  the  inferior  maxilla  fractured,  and  a small  portion  of  the 
ball  attached.  The  specimen  and  history  were  contributed  hy  Surgeon  Edwin  B(mtley,  U.  S.  V. 

Ca.se. — Corporal  F.  Augustus  W , Co.  K,  111th  New  York  Volunteers,  aged  22  years,  was  wounded  at  Gettysburg, 

Penusylvania,  July  2d,  1803,  by  a conoidal  hall,  which  fractured  the  right  side  of  the  inferior  maxiHa.  He  was  semt  to  the 
'regimental  hospital  of  the  111th  New  York  Volunteers,  and,  on  the  same  day,  transferred  to  the  general  field  hosjjital  at  Gettys- 


SlJCT.  II.] 


GUNSHOT  FRACTURES  OF  THE  FACIAL  BONES. 


361 


burg;  thence  lie  was  sent  to  Baltimore,  and  admitted  into  the  Jarvis  Hosiutal  on  July  15th,  18G3.  Owing  to  the  amount  of 
swelling  and  the  extreme  tenderness  of  the  mouth,  the  wound  was  not  examined.  The  patient  was  able  to  take  food  in  a li(|uid 
state  until  noon  on  July  2'2d,  18f)3,  when  he  was  found  gasping  for  bi’eath,  and  died  soon  after.  At  the  autopsy,  it  was  found 
that  the  hall  had  entered  about  one  inch  to  the  right  of  the  symjihysis,  shattered  the  inferior  maxilla,  passed  downward  inside 
of  the  hyoid  bone  and  lodged  in  the  thyroid  cartilage.  The  surrounding  tissues  were  congested  and  infiltrated  with  blood. 
The  ejiiglottis  was  much  enlarged,  and  the  larynx  filled  with  coagulated  blood.  This  man  never  had  much  h.x-morrhagi',  and 
no  large  artery  was  found  divided.  The  specimens  are  No.  1451  (a  wet  specimen  of  the  maxilla),  and  No.  1440  (a  wet, 
specimen  of  the  larynx  with  the  missile).  Sect.  I,  A.  M.  M.,  and  were  contributed,  with  the  history,  by  Acting  Assistant 
Surgeon  B.  B.  Miles. 

Case. — Private  R.  W , Co.  F,  95th  Pennsylvania  Volunteers,  aged  39  years,  was  wounded  at  Chancellorsville, 

Virginia,  May  3d,  1803,  by  a conoidal  ball,  which  entered  the  left  side  of  the  face  at  the  infra-orbital  foramen  of  the  superior 
maxilla,  and  emerged  between  the  ascending  branch  of  the  lower  jaw  and  the  traverse  process  of  the  atlas,  half  an  inch 
external  to  the  latter,  in  the  left  nuchal  region,  fracturing  the  malar  bone  below  its  infra-orbital  edge  and  perforating  the 
superior  maxilla.  He  also  received  a gunshot  fracture  of  the  surgical  neck  of  the  right  humerus.  Being  taken  to  Washington, 
he  entered  the  Douglas  Hospital  on  May  8th,  1863,  suffering  considerably  from  cough  and  im]ieded  deglutition.  On  May  11th, 
there  was  paralysis  of  the  facial  nerves  of  the  left  side,  the  nerves  presiding  over  deglutition,  and  the  brachial  nerves  of  the 
right  side.  The  point  of  the  tongue  pointed  toward  the  left  side,  on  being  stretched  out.  Several  pieces  of  bone  were  removed 
fi'om  the  superior  maxilla  and  its  sinus.  The  wound  of  the  face  was  plugged  with  charpie,  Desault’s  bandage  was  applied  to 
the  right  arm,  and  stimulating  diet  was  given.  On  May  19th,  the  fauces  were  red  and  inflamed.  On  Jlay  24th,  the  patient, 
while  drinking  a cuj)  of  tea,  became  suddenly  suffocated  and  exj)ired.  At  the  autopsy,  it  was  found  that  ulceration  of  the 
oeso])hagus  had  taken  place.  The  ball  had  barely  escaped  the  latei’al  process  of  the  atlas.  There  was  an  effusion  of  blood  into 
the  muscles  of  the  neck,  causing  compression,  doubtless,  on  important  nerves.  No  manifest  cause  for  his  sudden  death  was 
discovered.  The  pathological  specimen  is  No.  1239,  Sect.  I,  A.  M.  M.,  showing  the  left  superior  maxilla  and  a part  of  the 
malar  bone  fractured  by  a musket  ball,  which  carried  away  the  upper  part  of  the  body  and  the  oi’bital  process  and  the  zygo- 
matic process  of  the  malar  broken  off  at  its  root.  The  pathological  specimen  of  the  fractured  humerus  is  No.  1238,  Sect.  I, 

A.  M.  M.  The  specimens,  with  the  history,  were  contributed  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A. 

Case. — Private  Daniel  S.  Wilkinson,  Co.  K,  7th  Wisconsin  Volunteers,  aged  20  years,  was  wounded  at  the  second 
battle  of  Bull  Run,  Virginia,  August  30th,  1862,  by  a conoidal  ball,  which  entered  the  right  side  of  the  upper  lip,  just  below  the 
ala  of  the  nose,  and  emerged  just  behind  the  lower  jaw,  near  the  angle,  fracturing  the  upper  and  lower  jaw  and  carrying  away 
all  the  teeth  on  the  right  side.  He  was  admitted  into  the  regimental  hospital  of  the  7th  Wisconsin  Volunteers  the  same  day, 
and  afterwards  transferred  to  New  York  City,  and  admitted  into  the  Ladies’  Home  Hospital  on  September  13th,  1862.  Ordinary 
bandages  and  poultices  were  applied.  On  September  30th,  1882,  a piece  of  bone,  one-fourth  of  an  inch  in  length,  was  removed. 
Several  pieces  of  bone  hav’e  been  discharged  from  the  wound  from  time  to  time.  On  November  9th,  1862,  the  bone  had  com- 
pletely united ; when  the  mouth  was  closed  the  coaptation  between  the  teeth  was  not  entire.  On  January  14th,  1863,  the  wound 
had  entirely  healed,  the  patient’s  health  was  good,  and  he  was  returned  to  duty,  there  being  no  difficulty  with  the  jaw,  excepting 
the  overlapping  of  the  fragments,  and  consequent  shortening  of  the  body  of  tlie  jaw.  The  case  is  reported  by  Surgeon  Alexander 

B.  Mott,  U.  S.  V.  The  patient  is  a pensioner,  his  disability  being  rated  one-half  and  permanent. 

Case. — Sergeant  David  W.  Scott,  Co.  I,  140th  Pennsylvania  Volunteers,  was  wounded  at  Gettysburg,  July  3d,  1863,  by 
a conoidal  ball,  which  entered  below  the  angle  of  the  lower  jaw,  left  side,  passed  under  the  tongue,  and  shattered  the  jaw  on 
the  right  side.  He  was  treated  in  field  hospital  until  January  6th,  1864,  when  he  was  admitted  to  the  hospital  at  Pittsburg, 
Pennsylvania.  Simple  dressings  were  applied.  He  was  discharged  from  service  on  February  20th,  1864,  on  account  of  pseudo- 
arthrosis of  both  sides,  preventing  complete  mastication.  On  February  22d,  1868,  Pension  Examiner  D.  Stanton  reports  that 
there  is  a false  joint,  owing  to  non-union  of  the  bone.  The  patient  is  unable  to  masticate  solid  food.  His  disability  is  rated 
four-fifths  and  permanent. 

Case. — Private  Dennis  B , Co.  I,  22d  Massachusetts,  was  wounded  at  Fredericksburg,  Virginia,  Decend)er  13th, 

1862,  by  a ball,  which  entered  above  and  a little  forwtird  of  the  posterior  fold  of  the  left  axilla,  j)assed  inward,  uj)ward,  and 
forward,  and  emerged  just  above  the  convexity  of  the  left  clavicle,  which  it  shattered,  again  entered  an  inch  nearer  the  neck, 
])reserving  nearly  its  original  direction,  finally  emerging  through  the  right  cheek,  breaking  a few  small  |)icces  from  tlie  middle 
of  the  lower  edge  of  the  jaw.  He  was  conv(‘ycd  to  Washington,  and,  on  December  18th,  admitted  to  .Judiciary  S(|uare  Hospital. 
There  was  consider.able  offensive  di.scharge,  particidarly  from  the  first  wound  of  exit.  About  December  30th,  his  mind  hecame 
somewhat  affected,  and  there  was  great  and  increasing  tendency  to  sleep.  On  the  night  of  .January  12th,  1883,  he  was  attacked 
with  violent  pain  in  the  left  hypochondrium,  which  was  partly  relieved  by  the  application  of  sinaj)isms.  On  .January  13th,  two 
fragments  of  bone  were  removed  with  the  forceps  from  the  acromial  portions  of  the  clavicle  ti’om  which  they  had  become 
partially  detached.  On  January  14th,  he  went  to  sleep  after  eating  heartily;  his  breathing  was  shorter  than  usual.  Ui)on 
being  spoken  to  he  oj)eued  his  eyes,  but  closed  them  again  ; his  breathing  became  still  shorter,  and  with  longer  intervals,  for 
about  five  minutes,  when  he  died,  perfectly  <puet,  and  a))parently  without  pain.  At  the  autopsy,  the  head  of  the  humerus  was 
found  destroyed,  and  the  shaft  fractured  for  three  inches  below  it.  The  glenoid  cavity  and  neck  of  the  sca])ula  wiu'e  destroyed 
as  far  back  as  the  supra-scapular  notch ; a i)artial  fracture  extended  across  the  infra-spinous  fossa.  The  front  of  the  thyroid 
cartilage  had  been  cari-ied  away.  A notch  was  cut  out  of  the  under  surface"  of  the  infei'ior  maxilla,  right  side.  The  left 
lung  was  comj)ressed  by  an  abunilatit  pleuritic  effusion,  and  contained  a single  abscess.  The  parenchyma  of  the  left  Inng  was 
not  examined.  There  was  not  any  o])ening  into  tin;  pleura.  A drop  of  blood  taken  from  the  axillary  vein  exhibited  nearly  as 
many  white  as  red  corpuscles.  The  specimen,  consisting  of  the  left  clavicle,  sca])ula,  and  u])))er  thii'd  of  tlu!  humerus,  is 
numbered  695  of  the  .Surgical  Section  of  the  Anny  Medical  Museum,  and  was  contributed,  with  a historv  of  the  case,  by  Medical 

•K* 


362 


WOUNDS  AND  INJUKIES  OF  THE  FACE, 


[Chap.  II, 


Cadet  Burt  G.  WiMer,  U.  S.  A.  Tlie  bull  entered  tlie  posterior  aspect  of  the  .slioulder-joint,  and  emerged  at  the  centre  of  tlio 
clavicle,  causing  (‘Xtensive  connninuliou  of  the  glenoid  cavity  and  head  of  the  humerus.  The  clavicle  is  fractured  ohli(piely. 
A lissure  extends  transversely  through  the  body  of  the  sca})id’a  behw  the  spine.  The  acromion  and  coracoid  processes  ar<! 
detached.  The  shaft  of  the  humerus  exhibits  several  fissures.  The  fractured  extremities  of  the  clavicle  are  necrosed.  Thu 
specimen  shows  but  little  attempt  at  repair. 

Case. — Private  Alvah  Fassett,  Co.  B,  52d  Pennsylvania  V(dunteers,  aged  2G  years,  was  wounded  at  Fair  Oaks,  Virginia, 
May  31st,  1862,  by  a round  ball,  which  enteri-d  the  left  side  of  the  neck,  jiassed  through  the  pharynx,  and  emerged  through 
the  right  angle  of  the  jaw,  fracturing  the  inferior  maxilla  and  paralyzing  the  dental  nerve  of  the  right  side.  He  was  conveyed 
to  the  field  hosj)ital.  The  wounds  bled  freely ; bandages  and  adhesive  strips  were  applied.  The  j)atient  was  tramsferred  to  the 
White  House,  thence  by  steamer  to  Philadelphia,  where  he  was,  on  June  4th,  admitted  into  the  Saint  .Jose])h’s  Hospital.  On 
admission,  there  was  dilficulty  of  deglutition.  Simj)le  dressings  were  a]>plied  to  the  W'ound,  and  nourishing  diet  ordered. 
Several  sjncula!  of  bone  were  removed  on  July  5th,  and  afterwards  at  various  times.  The  motion  of  the  jaw  w'as  much 
restricted,  and  could  not  be  closed  within  one-fourth  of  an  inch,  nor  opened  more  than  one-half  of  an  inch.  Some  of  the  smaller 
branches  of  the  facial  nerve  were  injured.  He  was  discharged  the  service  on  August  12th,  1862.  The  case  is  reported  by 
Acting  Assist.ant  Surgeon  Willianf  P.  Moon.  This  man  is  a pensioner,  his  disability  being  rated  three-fourths  and  permanent. 

Case. — Sergeant  Franz  Wolbe,  Co.  E,  31st  New  York  Volunteers,  aged  31  years,  received,  at  the  battle  of  West  Point, 
IMay  7th,  1862,  a gunshot  wound.  The  missile  entered  the  centre  of  the  right  cheek,  carrying  aw.ay,  in  its  jiassagi',  the  superior 
maxilla  and  teeth,  two-thirds  of  the  hard  palate,  and  about  half  of  the  tongue,  and  emerged  near  the  angle  of  the  mouth,  on  the 
left  side,  lacerating  the  soft  parts  to  a considerable  extent.  He  was,  on  May  14th,  admitted  into  the  general  hospital,  Alexandria, 
Virginia.  The  wounds  were  healing  rapidly,  and  the  patient  doing  well.  He  was  discharged  the  service  on  August  11th,  1862. 
The  case  is  rej)orted  by  Surgeon  John  E.  Summers,  U.  S.  A.  Wolbe  is  a pensioner.  The  power  of  speech  is  partially  destroyed. 
His  disability  is  rated  total. 

Case. — Sergeant  Milo  A.  Dix,  Co.  C,  49th  Ohio  Volunteers,  aged  23  years,  was  wounded  at  Nashville,  Tennessee, 
December  15th,  1864,  by  a conoidal  ball,  which  entered  immediately  beneath  the  septum  of  the  nose,  fractured  both  sui)erior 
maxillary  bones  at  the  symphysis,  and  emerged  at  the  hack  of  the  neck  a little  to  the  right  of  the  median  line,  fracturing  the 
transverse  processes  of  the  cervical  vertebra;.  He  was  treated  in  regimental  hospital  until-December  17th,  whenhe  was  admitted 
to  hospital  No.  1,  Nashville,  and,  on  December  21st,  transferred  to  Crittenden  Hospital,  Louisville,  Kentucky.  Simple  dressings 
were  apidied  to  the  wounds.  Death  resulted  on  December  29th,  1864,  from  pyatmia.  At  the  autop.sy,  two  or  three  metastatic 
abscesses  were  found  in  th(‘  base  of  the  left  lung.  Portions  of  the  lower  lobe  of  the  left  lung  were  gangrenous,  and  there  was  a 
small  quantity  of  sero-purulent  matter  in  the  left  pleural  cavity. 

Ca.se. — Corporal  James  Green,  Co.  C,  1st  United  States  Colored  Troo))s,  aged  26  years,  received  a gunshot  compound 
fracture  of  the  lower  jaw  at  Fair  Oaks,  Virginia,  October  27th,  1864.  He  was  admitted,  on  October  29th,  1864,  to  Balfour 
Hospital,  Portsmouth,  Virginia.  Cold  water  was  injected  through  the  wound.  Death  residted  on  November  3d,  1864,  from 
exhaustion. 

Case. — Private  Joseph  D.  Parks,  Co.  A,  29th  Connecticut  Colored  Volunteers,  aged  30  years,  was  wounded  in  an 
engagement  before  Kichmond,  Virginia,  October27th,  1864,  by  a conoidal  ball,  which  entered  the  left  side  of  the  face,  midway 
between  the  angle  and  symphysis  of  the  inferior  maxillaiy,  jtassed  obliipiely  inward  and  outward,  abrading  the  tongue,  and 
emerged  af  the  aiigle  of  the  inferior  maxilla,  right  side,  extensively  fracturing  the  bone  to  within  the  capsule  of  left  articulation, 
besides  greatly  comminuting  the  body  of  the  jaw.  He  was  at  once  taken  to  the  hos|)ital  of  the  Tenth  Corps,  being  unable  to 
articulate  sufficiently  distinct  to  be  understood.  On  the  same  day,  he  was  placed  in  a jjartiall}’  reclining  position,  and  chloro- 
formed by  Surgeon  C.  M.  Ckark,  39tii  Illinois  Volunteers.  An  incision  was  then  made,  commencing  at  the  lobe  of  the  left  ear, 
carried  along  the  inferior  border  of  the  bone  to  the  chin,  and  the  soft  parts  dissected,  leaving  the  jieriosteum.  After  removing 
all  the  loose  fragments,  the  stumj)  of  the  left  ramus  was  grasped  with  the  bone  pliers  and  disarticulation  accomplished  with  a 
few  strokes  of  the  knife.  A similar  incision  was  then  made  on  the  right  side  to  connect  with  the  other,  severing  the  geniohyo- 
glossus  and  geniohyoid  muscles,  and  the  tongue  retracted  so  as  to  fill  the  pharynx.  The  tongue  was  then  drawn  forward  and 
retained  in  that  jiosition  by  means  of  a silk  cord  j)assed  through  it  and  •fastened  externally.  The  bone  was  then  dissected  the 
same  as  on  the  oi)posite  side,  and  removed  to  within  a short  di.stance  of  the  sigmoid  notch,  where  it  was  found  to  be  sound,  and 
was  severed  at  the  upi)er  third  of  ramus  by  a chain  saw  ; the  ^vound  was  brought  together  with  silk  sutures.  Cold  water 
dressings  and  compress,  with  paste-board  support,  were  apjilied,  and  nourishing  diet  administered  through  a tube.  The  operation 
occupied  one  and  a half  hours  time.  Very  little  blood  was  lost.  The  only  artery  ligated  was  the  facial ; the  others  were 
twisted.  The  patient  was  at  no  time  unconscious,  and  bore  the  operation  with  great  fortitude.  Death  resulted  on  November 
6th,  1864,  from  exhaustion.  The  case  is  reported  by  the  operator. 

Ca.se. — Private  Isaac  Smith,  Co.  H,  39th  Illinois  Volunteers,  aged  19  years,  was  wounded  at  Deep  Bottom,  Virginia, 
August  IGth,  1864,  by  a conoidal  ball,  which  caused  a comminuted  fracture  of  the  right  inferior  maxilla.  He  was  admitted  to 
the  hos]>ital  at  Fort  Monroe,  Virginia,  August  18th,  1864,  suffering  from  traumatic  irritation  and  insomnia.  On  August  2t)th, 
Acting  Assistant  Surgeon  S.  J.  Holley  anffisthetised  the  patient,  and  excised  the  right  ramus  anil  two-thirds  of  the  body  of  the 
lower  jaw.  The  hajmorrhage  was  slight ; one  ligature  was  ajiplied.  I’atient  reacted  jironijitly.  On  October  8th,  he  was 
transferred  to  Grant  Hos[)ital,  Willett's  Point,  New  York,  and  transferred  to  the  Veteran  Beserve  Corps  on  May  4th,  1865. 
Pension  Examiner  C.  IJ.  Parke  reports,  February  27th,  1869,  that  “a  small  fistulous  opening  remains,  from  necrosed  bone; 
serous  discharge.  Stooping  causes  dizziness.  He  is  subject  to  slight  indigestion,  caused  by  inability  to  masticate  his  food 
thoroughly.” 


Sect.  II.] 


GUNSHOT  FKACTURES  OF  THE  FACIAL  HONES. 


3G3 


Ca.se. — Private  Saninel  H , Co.  G,  SCrth  Now  York  Volnntoors,  aged  1!2  yoars,  was  woiiii(lc(l  at  Gottyslmrg,  I’omi- 

sylvania,  July  Jd,  18o3,  by  a fragment  of  shell, •which  lacerated  the  cheek  severely  and  fractured  the  left  inferior  maxilla,  the 
lower  portion  of  the  body  of  the  bone  being  severely  comminntetl.  The  alveoli  were  but  slightly  injured.  Ho  was  at  once 
taken  to  the  field  hospital,  where  Assistant  Surgeon  J.  Theodore  Calhoun,  U.  S.  A.,  administered  chloroform,  and  removed, 
piece  bv  piece,  the  left  half  of  the  body  of  the  inferior  maxilla,  between  tbe  central  incisors  anteriorly  and  the  last  two  molar.s 
behind,  following  the  line  of  fracture  which  involved  the  alveolar  arch  at  those  ])oints  only.  The  bone,  whicb  was  broken 
acro.ss  transversely,  was  rendered  quite  smooth  by  the  bone  forceps  at  or  near  the  angle  (jf  the  jaw.  A Hey’s  saw  was  used, 
the  soft  jiarts  being  held  out  of  the  way  by  a spatula.  Uuring  the  operation,  the  tongue  was  carefully  kept  in  situ,  by  a ligature 
ji.assed  through  its  lip  and  held  hy  an  assistant.  After  carefully  securing  all  the  bleeding  vessels,  and  removing  the  bui-nt  or 
destroyed  tissue,  the  excessively  ragged  wound  was  brought  together  in  accurate  ai'position  by  the  introduction  of  silver  i)ius 
with  a wire  figure-of-8  suture.  On  July  IGth,  ho  was  transferred  to  McKim’s  Mansion  Hospital,  Haltimore,  and  on  November 
2Ist,  188:5,  to  Patterson  Park  Hospital,  where  he  was  reported  a.s  convalescent.  In  a letter  to  this  office,^  dated  May  28th,  1886, 
the  operator  states  that  “the  cicatri.x  is  nearly  four  inches  long,  and  is  almost  hidden  by  his  beard.  His  appearance  is  quite 
good.  He  lives  mainly  upon  food  of  a semi-solid  consistence,  and  conqilains.  of  indigestion  to  some  extent."  The  pathological 
sj>ecimen,  consisting  of  the  excised  portion  of  boive,  was  forwarded  to  the  Army  Medical  Museum  by  the  operator,  and  is 
numbered  1532  of  the  Surgical  Section.  Not  a pensioner. 

Case. — Private  Daniel  Beckhorn,  Co.  E,  8th  New  York  Heavy  Artillery,  aged  18  3'ears,  was  wounded  at  Cold  IIarl)or, 
Virginia,  June  3d,  1864,  b_v  a conoidal  musket  ball,  which  entered  the  mouth,  fractured  the  lower  jaw,  and  emerging  at  its 
right  angle,  passed  through  the  right  shoulder,  injuring  the  head  of  the  humerus.  He  was  convej’ed  to  Washington,  and,  on 
June  8th,  admitted  to  the  Emorj'  Hospital.  Cold  water  dressings  were  applied,  and,  on  .lime  11th,  he  was  transferred  to 
Patterson  Park  Hospital,  B.altimore.  On  June  13th,  ten  fragments  of  bone  were  removed  from  the  jaw,  and,  on  Julv  1st,  three 
])ieces  more.  The  di’cssing  consisted  of  oakum,  wet  with  baker’s  yeast.  On  July  20th,  the  remaining  loose  jiiece  of  jaw, 
containing  four  teeth,  commenced  to  unite.  Fragments  of  hone  were,  at  various  times,  removed  from  the  wound  of  the  shoulder, 
which  progi-essed  favorabh',  and,  on  September  11th,  the  patient  could  move  the  shoulder  in  all  directions,  but  the  jiower  of 
abduction  was  somewhat  imp.aired.  On  September  12th,  he  was  furloughed;  on  October  23d,  admitted  to  the  lilower  Hospital, 
I’hiladelphia,  whence  he  was  returned  to  dut^v  on  April  15th,  1835.  The  pathologic.al  specimen,  consisting  of  six  fragments  of 
bone  from  the  inferior  maxilla,  was  contributed  to  the  Army  Medical  Museum,  by  Acting  Assistant  Surgeon  J.  W.  Faj',  and  is 
numbered  3467  of  the  Surgical  Section.  The  patient  is  not  a pensioner. 

Ca.se. — Private  John  Boon,  Co.  C,  8th  Ohio  Volunteer.s,  was  wounded  at  Chancellorsville,  Virgini.a,  Ma_v  3d,  1863,  \>y  a 
ball  from  a case-shot,  which  entered  one  inch  below  the  right  angle  of  the  mouth,  and  lodged  at  a point  one  inch  in  front  of  the 
angle  of  the  jaw.  He  was  treated  in  field  hosjntal  until  May  9th,  when  he  was  admitted  to  the  Carver  Hospital,  Washington. 
There  was  a hard  and  painful  swelling  over  the  lower  jaw,  near  its  angle.  There  was  no  wound  within  the  mouth.  Fracture 
of  the  jaw  could  be  detected.  An  .abscess  formed  below  the  jaw,  which  was  opened  on  Mu}'  18th,  and  again  on  the  20th, 
allowing  the  escape  of  considerable  jms.  On  Maj'  22d,  a bullet  was  discovered  within  the  wound,  which  was  removed  with 
forceps  by  Acting  Assistant  Surgeon  B.  F.  Craig.  Poultices  were  applied  over  the  jaw  and  wound,  and  on  ,Iune  2'.5d,  the 
jiatient  was  transferred  to  the  McClellan  Hospital,  Philadelphia,  thence  on  October  24th,  to  Camp  Dennison,  Ohio,  when-  he 
was  treated  for  syphilis  nntil  November  IGth,  1833,  when  he  was  returned  to  duty.  The  .specimen,  showing  a .spherical  leaden 
ball  somewhat  grooved  at  one  portion,  with  a long  fragment  of  bone  imbedded,  was  contributed  to  the  Army  Medical  IMuseum 
by  the  ojierator,  and  is  numbered  809  of  the  Surgical  Section.  He  is  not  a pensioner. 

Case. — Private  Albert  Bryant,  Co.  H,  19th  Indiana  Volunteers,  was  wounded  at  Antietam,  Maiwland,  Septefnber  17th, 
1862,  by  a conoidal  musket  ball,  which  entered  at  the  right  tingle  of  the  mouth,  cut  its  way  through  the  upper  surface  of  the 
tongue,  and  fractured  the  lower  jaw  at  its  angle.  He  was  treated  in  field  hosjiital  until  Sejitember  29th,  when  he  was  admitted 
to  the  1st  division  hospital,  Alexandria,  Virginia.  There  was  ])ersistent  swelling  and  inflammation,  with  incessant  suppuration 
inside  the  mouth  and  at  the  angle  of  the  jaw.  The  jaws  became  fixed,  three-fifths- of  an  inch  apart.  On  October  30th  a large 
])iece  of  loose  bone,  triangular  in  .shape  and  an  inch  in  altitude,  consisting  of  the  angle  of  the  jaw,  was  extracted  by  Surgeon 
.John  E.  Simimers,  U.  S.  A.,  and  the  presence  of  the  ball  detected.  On  November  4th,  the  jiatient  w.as  chloroformed,  and 
search  being  made  for  the  ball,  it  was  at  length  discovered  firmly  imbedded  outside  and  beyond  the  angle  of  the  jaw,  whence 
it  was  extracted  with  very  great  difficulty.  The  ]iatienl  recovered,  and  was  returned  to  duty  on  Noyember  18th,  1HG2.  The 
missile,  a conoidal  ball,  with  a longitudinal  h.alf,  obliipiely  and  roughh-  torn  off,  and  the  iqqiosite  side  of  the  cup  rolled  up 
outwardly-  uiion  itself,  was  contributed  to  the  Army  Medical  Museum  h^-  Acting  Assistant  .Surgeon  George  F.  French,  and  is 
numbered  29/G  of  the  Surgical  Section.  Biyant  is  not  a pensioner. 

C.VSE. — Priyate  Peter  Both,  Co.  E,  4th  United  .States  Artilleiy,  was  wounded  at  Frederick.slmrg,  Virginia,  December 
13th,  1832,  by  a musket  ball,  which  lodged  in  the  left  superior  maxilla,  after  haying  shattered  the  malar  bone.  He  was  admitted 
to  the  Cai-yer  Hospital,  Washington,  on  December  21st,  and  on  January  8th,  1833,  transferred  to  Patterson  Park  Hospital, 
Baltimore,  where,  on  January  11th,  Acting  Assistant  Surgeon  ’Theodore  Artaud  extracted  the  ball  and  fragmi-nts  of  bone. 
After  the  extraction  of  the  ball,  the  prohe  could  communicate  freely- with  the  antrum  of  Highmore.  'The  wound  he.ilcd  with 
some  depression.  'The  patient  was  returned  to  duf^y  iu  June,  18G3.  'The  j.athological  siiecimen,  a yery  greatly  battered  leaden 
bullet,  was  contributed  to  the  Army  Medical  Museum  by  the  operator,  and  is  numbered  4.554  of  the  Surgical  Section.  Both 
is  not  a pensioner. 

Ca.se. — Priyate  Daniel  C.  Ulfelman,  Co.  B,  198th  Pennsylyania  Volunteers,  aged  19  years,  was  wounded  at  South  Side 
Bailroad,  Virginia,  April  l.st,  1835,  ly  a conoidal  ball,  which  entered  one  ijuarter  of  an  inch  to  the  left  of  the  s^'mphv'sis,  and 
fracturing  the  jaw  badly,  emerged  under  the  chin,  reentering  the  neck  just  beside  the  trachea,  and  lodged,  as  was  supl.osed,  in 
the  ceryical  vertebra;.  He  was  at  once  admitted  to  the  held  hospital  of  the  1st  division,  I’iflh  Corps,  where  the  teeth  and  some 


364 


WOUNDS  AND  INJUItlES  OF  THE  FACE 


[Chap.  II. 


pieces  of  bone  were  removed.  On  A))ril  4tb,  1805,  lie  wns  sent  to  tlie  depot  field  lio.spital  of  tlie  Fiftli  Corps,  tlience  tran.sferred 
to  Wasliington,  and,  on  April  7tli,  admitted  into  the  Finley  Hospital.  On  April  14tb,  .two  pieces  from  the  symidiysis  of  the 
inferior  maxilla  were  removed  by  Surgeon  G.  L.  I’ancoast,  U.  «S.  V.  Splints  and  simple  dressings  were  tipplied.  Special  diet 
■was  given.  On  May  19tli,  be  was  transferred  to  the  Mower  Hospital  at  Pbiladeljihia,  where  he  was  mustered  out  of  service  on 
June  5th,  1805,  in  accordance  with  general  order  from  the  War  Department,  dated  May'  3d,  1805.  The  specimen  is  No.  4288, 
Sect.  I,  A.  M.  M.  (two  small  fragments  from  the  symphysis  of  the  inferior  maxilla,  one  inch  long  by  one-fourth  of  an  inch 
wide),  and  was  contributed,  with  the  history,  by  the  oyierator.  Uffelman  is  not  a pensioner. 

Case. — Private  .Tohn  Schultz,  Co.  H,  7th  Wisconsin  Volunteers,  aged  28  years,  was  wounded  at  Gettysburg,  Pennsyl- 
vania, July  1st,  1803,  by'  a conoidal  ball,  which  entered  at  the  right  superior  maxilla,  passed  backward  and  downward,  and 
lodged  under  the  integuments  behnv  the  mastoid  process  of  the  te\nporal  bone.  He  was  admitted,  on  the  next  day,  to  tbe 
Seminary'  Hospital  at  Gettysburg,  where  the  ball  was  removed,  and,  on  July  12th,  he  was  transferred  to  Turner’s  Lane  Hos])ital, 
Philadelidiia,  whence  he  was  transferred  to  the  Veteran  Reserve  Corps  on  November  4th,  1863.  The  missile,  showing  the  apex 
flattened  njxm  the  body,  and  tbe  base  laterally  compressed,  was  contributed  to  the  Army'  Medical  Museum  by  Acting  Assistant  Sur- 
geon David  Burjiee,  and  is  numbered  4533  of  the  Surgical  Section.  Schultz  is  not  a pensioner. 

Case. — Corporal  James  P.  Stewart,  Imlependent  Battery  E,  Pennsylvania  Artillery,  aged  25  years,  was  wounded  at 
Brown’s  Ferry’,  Tennessee,  October  28th,  1803,  by'  a musket  ball,  which  entered  the  right  cheek  just  altove  the  angle  of  the 
lower  jaw,  pas.sed  horizontally  through  and  emerged  from  the  centre  of  the  left  cheek,  fracturing  the  inferior  maxilla  upon  the 
right  side,  ojiening  the  maxillary’  antrum,  fracturing  the  palatine  arch  and  the  body'  of  the  superior  maxilla  on’  the  right  side, 
lacerating  the  .soft  palate  and  nearly  severing  the  tongue.  He  was  admitted,  on  the  next  day,  to  hospital  No.  2,  Chattanooga, 
Tennessee.  Deglutition  and  s|)eech  W’ere  entirely  suspended.  Simple  dressings  w'ere  ai)plied  to  the  wound,  and  beef  soup  and 
milk  given  twice  a day  by  means  of  a stomach  tube  passed  into  tbe  pharvnx.  Under  this  treatment  the  patient  commenced  to 
improve,  and  by  November  16th,  the  external  wounds  had  nearly  healed ; he  was  able  to  speak  indistinctly  and  swallow  a little. 
No  further  information  can  be  obtained  until  April  11th,  1864,  when  he  was  admitted  to  the  hospital  at  I’ittsburg,  Pennsylvaniii, 
whence  he  was  discharged  from  service  on  May  3d,  1864.  The  powers  of  deglutition,  mastication,  and  articulation  are  seriously 
injured.  He  is  a pensioner. 

Case. — Private  Henry  A.  Preston,  4th  Rhode  Island  Battery',  was  wounded  at  Antietam,  Maryland,  September  17th, 
1862,  by  a rou7id  ball,  which  entered  at  the  roots  of  the  molar  teeth  of  right  side,  upper  jaw,  and  passed  out  at  the  angle  of  the 
left  inferior  maxilla,  comminuting  the  bone  to  tbe  extent  of  two  inches.  He  was  convey’ed  to  Baltimore,  and,  on  September  21st, 
admitted  to  the  Newton  University  Hospital.  On  September  23d,  Surgeon  C.  W.  Join's,  U.  S.  V.,  removed  the  fragments  of 
bone  by  dilating  the  opening  made  by'  the  exit  of  the  ball.  The  w'ounds  bealed  rapidly  w’ith  but  slight  deformity,  and  the  jiatient 
was  returned  to  duty  on  November  13th,  1862.  The  pathological  specimen,  consisting  of  two  fragments  and  the  crowns  of  two 
molar  teeth  from  the  left  side  of  the  inferior  maxilla,  was  contributed  to  the  Army  Medical  J.Iuseum  by  the  operator,  and  is 
numbered  463  of  the  Surgical  Section.  He  is  not  a pensioner. 

Ca.se. — Corporal  H.  H.  Pryor,  Co.  H,  11th  Pennsylvania  Volunteers,  aged  29  years,  was  wounded  at  Antietam,  Septem- 
ber 17th,  1862,  by  a conoidal  ball,  which  entered  the  left  side  of  the  nose,  just  above  the  low'er  edge  of  the  nasal  bone,  jiassed 
obli(juely’  across  tbrough  the  antrum  on  the  right  side,  and  emerged  just  below  the  malar  process,  causing  difficulty  of  respiration 
and  partial  loss  of  sight  of  right  eye.  Free  hsemorrhage  follow'ed  for  about  twenty  minutes  after  he  received  the  injury,  when 
it  ceased,  and  did  not  return.  He  was  admitted  into  the  Broad  and  Cherry'  Streets  Hos])ital,  Philadel])hia,  on  December  11th, 
1862.  He  stated  that  one  or  two  small  pieces  of  bone  w’ere  discharged  from  the  w’ound  of  entrance;  that  the  only'  treatment  he 
received  was  the  application  of  a simple  dressing  to  the  w’ound,  and  that  at  no  time  did  the  wound  give  him  much  trouble.  On 
his  admission  into  this  hospital  the  wounds  had  entirely  healed  w ith  very  slight  deformity.  He  was  discharged  the  service 
January  9th,  1863.  The  case  is  reported  by  Surgeon  John  Neill,  U.  S.  V.  Pry’or  is  a pensioner. 

Ca.se. — Sergeant  Cy’i'us  C.  Holmes,  Co.  G,  18th  Massachusetts  Volunteers,  w’as  wounded  at  Bull  Run,  Virginia,  August 
29th,  1862,  by  a conoidal  ball,  which  entered  at  the  symphysis  of  the  lower  jaw  on  the  median  line,  passed  downward  and 
backward,  and  emerged  about  two  inches  from  the  jilace  of  entrance,  knocking  out  tw’o  of  the  canine  teeth,  two  bicuspids,  and 
the  hrst  molar  of  the  right  lower  jaw’.  He  was  conveyed  to  Alexandria,  Virginia,  and  admitted  into  the  3d  division  hosjiital  on 
Se])tember  1st,  1862.  Loose  fragments  of  the  jaw’  w’ere  removed.  He  w as  discharged  the  service  on  October  27th,  1862,  with 
rigidity  and  loss  of  power  of  the  muscles  of  the  jaw',  caries  of  the  boue,  and  listulous  ulceration  of  the  glands.  The  case  is  rejiorted 
by’  Surgeon  Edwin  Bentley,  U.  S.  V.  Hidmes  is  a pensioner. 

Case. — Corporal  Asa  W.  Taylor,  Co.  D,  83d  New  York,  aged  32  years,  was  wounded  at  Antietam,  September  17th, 
1862,  by  a musket  ball,  w'hich  entered  at  the  posterior  edge  of  the  right  sterno-cleido  mastoid  muscle,  just  below  tbe  occiput, 
and  emerged  just  below'  tbe  left  nostril,  fracturing  the  lower  jaw  a little  anterior  to  the  ramus  of  the  right  side,  destroying 
several  teeth,  jiassing  through  the  hard  palate,  and  knocking  out  tw’o  of  the  front  teeth.  He  w'as  sent  to  Frederick,  Mary’hmd, 
and,  on  Sejitember  24th,  1862,  admitted  into  Hospital  No.  1,  and,  on  Sejitember  27th,  w'as  sent  to  the  Si.xteenth  and  Filbert 
Streets  Hospital  at  Philadeljihia.  On  his  admission,  the  wounds  were  sujijuirating  moderately’.  There  w’as  no  fever,  or  consti- 
tutional irritation.  The  voice,  at  first  lost,  w’as  partially'  regained.  A bandage  was  apjilied  to  the  fractured  jaw,  and  cerate 
dressings  to  the  W'ounds;  soft  and  li(iuid  diet  was  ordered.  He  was  discharged  the  service  on  December  30th,  1862,  doing  well 
in  all  respects.  'I'he  case  is  rejiorted  by  Acting  Assistant  Surgeon  A.  D.  Hall.  Taylor  is  not  a pensioner. 

Case. — Private  Samuel  Yoder,  Co.  D,  3d  Pennsylvania  Reserves,  aged  21  years,  was  wounded  at.  Bull  Run,  Virginia, 
August  29tb,  1862,  by  a conoidal  ball,  which  entered  the  right  cheek,  at  the  anterior  edge  of  the  masseter  muscle  and  emerged 


Skct.  II.] 


GUNSHOT  FRACTUHKS  OF  TIIK  FACIAL  HQNES. 


365 


at  tlie  chin,  close  to  the  syuipliysis,  carrying  away  two  inches  of  the  body  of  the  right  inferior  inaxilla,  and  extensively  hican'ating 
the  soft  parts  in  the  floor  of  the  mouth.  He  w.as  sent  to  Alexandria,  Virginia,  and  admitted  into  the  3d  division  hospital  on 
Sei)tember  1st,  18G2.  Fragments  of  hone  were  removed  from  time  to  time.  Slight  infl.ammatory  action  ensued.  He  was 
discharged  the  service  on  Uecemher  1st,  1862,  with  i)artial  anchylosis  of  the  jaw.  The  case  is  reported  hy  Surgeon  Edwin 
Bentley,  U.  S.  V.  Yoder  is  a pensioner,  his  disability  being  rated  total  and  i)erm.ment. 

Case. — Private  G.  W.  Gibson,  Co.  C,  4th  Vennont  Volunteers,  was  wounded  during  the  seven  days’ battles  in  June,  1862, 
hv  a colloidal  hall,  which  entered  the  middle  third  of  the  inferior  maxilla,  left  side,  passed  downward  and  backward,  and  made 
its  exit  at  a ])oint  over  the  spine  of  the  left  scainda.  He  was  admitted  into  the  McKim’s  Mansion  llosjiital,  Baltimore,  July 
2.')th,  1862.  Flight  small  fragments  of  the  inferior  maxilla  were  removed  from  beneath  the  upjier  third  of  the  sterno-cleiilo- 
mastoid  muscle.  On  September  19th,  1862,  the  patient  was  transferred  to  the  West's  Buildings  Hospital,  Baltimore,  where  he 
Avas  discharged  the  .service  on  October  9th,  1862,  for  phthisis.  The  specimen  is  No.  413,  Sect.  II,  A.  M.  M.,  and  Avas  contributed, 
Avith  the  history,  by  Surgeon  L.  Quick,  U.  S.  V.  He  is  a pensioner  ; his  disability  is  rated  one-half. 

Case. — Private  Ellis  ITllom,  Co.  H,  110th  Ohio  Volunteers,  aged  31  years,  Avas  Avounded  at  Monocacy,  Maryland,  July 
9th,  1864,  by  a conoidal  musket  ball,  Avhich  entered  one  inch  before  the  prominence  of  the  left  malar  hone,  j)assed  directly 
through,  and  escaped  one  inch  heloAV  the  ear,  fracturing  the  superior  maxillary  hone.  Fie  Avas  treated  in  field  hospital  until 
August  16th,  Avhen  he  Avas  sent  to  the  Chester  Hospital,  Pennsylvania.  On  admission,  his  general  health  aauis  poor,  and  he 
suft’ered  severely  from  pain  in  the  head.  Both  Avounds  Avere  discharging  healthy  pus  ; pus  Avas  also  discharged  from  the  external 
auditory  meatus.  The  hearing  of  the  left  ear  Avas  entirely  gone.  There  Avas  jiaralysis  of  the  right  arm  immediatidy  after  the 
inJiUT,  Avhich  still  continued.  Several  pieces  of  hone  Avere  removed,  and  stimulants  and  nutritious  diet  administered.  By 
August  26th,  the  discharge  from  the  Avound,  pain  in  the  head,  and  {)aralysis  of  the  arm  had  dimini.shed,  and  he  had  some  janver 
over  the  hand  and  fingers.  He  Avas  transferred,  on  8e])tcml)er  23d,  to  Turner’s  Lane  Hospital ; on  October  1st,  to  F’ilbert  Street 
Hospital,  and,  on  Jilarch  6th,  1865,  Avas  returned  to  Turner’s  Lane  Hospital,  Avhere  galvanism  Avas  apjilied  daily.  On  !May  9th, 
1865,  he  Avas  discharged  from  service.  He  is  a pensioner.  The  sight  of  the  left  eye  is  entirely  gone,  from  paralysis  of  the 
nerves.  His  disability  is  rated  total  and  permanent. 

Case. — Captain  .John  Algoe,  Co.  A,  10th  Micliigan  Volunteers,  aged  31  years,  Avas  AVOunded  at  .Jonesboro’,  Georgia, 
September  1st,  1834,  by  a conoidal  ball,  Avhich  passed  through  the  loAver  edge  of  the  r.amus  of  the  inferior  maxilla,  comminuting 
the  bone  and  tearing  the  parts  extensively.  The  tongue  lay  upon  the  sternum.  He  Avas  taken  to  the  hos])ital  of  the  2d  division, 
F''ourteenth  Corp.s,  Avhere  Surgeon  EdAvard  BatAvell,  14th  Michigan  Volunteers,  removed  the  fractured  ])ortions  of  hone,  saAved 
off  the  ends  of  the  angles,  and  brought  the  edges  of  the  AVOund  together  hy  interruirted  sutures.  At  the  end  of  three  Aveeks  all 
had  united,  except  at  the  loAver  extremity  of  the  right  angle,  Avhere  the  loss  of  substance  had  formed  a fistulous  opening.  The 
surrounding  tissues  Avere  loosened,  .an  incision  about  one  inch  and  a half  long  Avas  made  through  the  opening,  .and  the  edges  th.al 
had  been  pared  brought  together  and  retained  in  position  Avith  pins  and  tAvisted  suture.  At  the  end  of  six  Aveeks,  the  AVounds 
Avere  perfectly  healed,  and  his  general  health  Avas  not  at  all  impaired.  A fibrous  tissue  appe.ared  to  take  the  place  of  the  bone, 
and  afforded  considerable  resistance  to  the  upper  teeth  in  m.astication  ; but  the  tongue  seemed  to  be  the  chief  agent  made  use  of 
by  nature  to  compensate  for  the  loss  of  the  loAver  JaAV.  On  October  25th,  1864,  he  Avas  sent  to  the  Officers’  Hospital,  Lookout 
Mountain,  Tennessee,  and  discharged  from  service  on  March  8th,  1865.  He  is  a pensioner,  his  disability  being  rated  total  and 
permanent. 

Case. — Private  .John  IT.  Spear,  Co.  H,  29th  Massachusetts  Volunteers,  aged  32  years,  Avas  Avounded  before  Petei'sburg, 
Virginia,  .July  29th,  1864,  hy  a conoidal  b.all,  Avhich  perforated  and  broke  the  nasal  process  of  the  upper  j.aAV  on  the  left  side, 
passed  obli(piely  doAA'iiAvard,  and  emerged  near  the  right  angle  of  the  mouth,  fracturing,  in  its  course,  the  superior  maxilla  and 
hard  pal.ate,  and  base  of  the  loAver  JaAV.  He  Avas  t.aken  to  the  hospital  of  the  1st  division.  Ninth  Corp.s,  Avhere  the  front  of  the 
superior  maxilla  and  a portion  of  the  hard  palate  Avere  excised,  and  simple  dressings  apjdied  to  the  AVound.  On  August  1st,  Jie 
Avas  admitted  to  IlareAvood  Hosi)ital,  Washington,  Avhence,  on  October  22d,  1834,  he  Avas  transferred  to  the  Veteran  Reserve 
Corps.  In  February,  183.5,  he  Avas  furnished  Avith  an  artificial  juAV,  at  Avhich  time  the  Avound  had  healed.  He  is  a pensioner. 
The  fissure  through  the  roof  of  the  mouth  causes  great  inconvenience  in  deglutition  ; fluids  are  throAvn  through  the  nose.  His 
disability  is  rated  total  and  permanent. 

Case. — Corporal  Alfred  W.  Smith,  Co.  D,  9th  Maine  Volunteer.s,  .aged  29  years,  Avas  Avounded  at  F''.air  Oaks,  Vii’ginia, 
October  27th,  1864,  bj' a conoidal  ball,  Avhich  fractured  the  inferior  maxilla.  He  Avas  taken  to  the  hospital  of  the  Tenth  Cori)s, 
Avhere  the  fractured  ])ortion  of  the  bone  Avas  removed  and  simjile  dressings  apj)lied.  On  October  31st,  he  Avas  sent  to  the  hosjiital 
at  F’ort  Jlonror,  Avhence  he  Avas  furloughed  on  December  26th,  1864.  He  Avas  discharged  from  service  on  October  29tli,  1865. 
He  is  not  a pensioner. 

Case. — Sergeant  Elias  Gabriel,  Co.  B,  24th  loAva  Volunteer.s,  aged  24  ye.ars,  Avas  Avounded  at  Cedar  Creek,  Virginia, 
October  19th,  1864,  by  a conoidal  ball,  Avliich  entered  the  right  side  of  the  face,  close  to  the  ala  of  the  nose,  ])assed  outAvard.  and 
emerged  on  a line.Avith,  and  one  inch  behind,  tin*  lobe  of  the  left  ear.  He  Avas  taken  to  tlu!  hospital  of  the  Nimdeenth  Coius, 
Avhere  simi)le  dressings  AA'ere  .applied  to  the  AVound.  On  October  25th,lie  Avas  transferred  to  the  hosi)ital  at  York,  Pennsylvaiua. 
There  AA’as  a discharge  of  serous  fluid  from  the  left  ear.  the  he.aring  of  Avhich  Avas  entirely  d(!stroyed.  He  Avas  unable  to  close 
the  left  earn,  but  there  AV.as  some  motion  in  the  lids.  The  Avound  of  exit  had  nearly  clo.sed.  By  November  2d,  both  nostrils  Avere 
discharging,  and  there  Avas  paralysis  of  the  mu.scles  of  tin;  left  cheek.  He  Avas  transferred  to  I)aveni>ort,  Iowa,  on  Decemher 
15th,  1864,  and  discharged  from  service  on  January  .5th,  18,35.  On  October  29th,  I8(i9,  Pension  Examiner  W.  Wakefield 
reports  that  the  injured  hones  are  in  a diseased  conditioTi,  and  exfoliating,  causing  pain,  discharge  from  the  nose,  deafness  of  the 
right  ear,  and  p.aralysisof  the  right  side  of  the  face. 


366 


WOUNDS  AND  INJURIES  OE  THE  FACE 


[Chap.  II, 


Case. — I’rivatu  William  JIcDaiiiels,  Co.  F,  5th  United  States  Colored  Troops,  aged  22  years,  was  wounded  at  Deep 
Bottom,  Virginia,  September  29th,  18'J4,  by  a musket  ball,  which  entered  anterior  to  and  below  the  right  malar  bone,  and 
ranging  backward,  downward,  and  obli(piely  to  the  left  side  of  the  face,  emerged  over  the  left  angls  of  the  inferior  maxilla. 
He  was  treated  in  field  hosj)ital  until  October  Gth,  18G4,  when  he  was  admitted  to  the  Balfour  IIosj)ital,  I'ortsmouth,  Virginia. 
On  Octobei’  15th,  a fragment  of  bone  was  removed.  Simple  dressings  were  applied  to  the  wound,  and  stimulants  given  internally. 
He  improved  slowly  and  steadily,  and,  on  June  27th,  1805,  was  transferred  to  Fort  Monroe,  whence  he  was  mustered  out  of 
service  on  October  14th,  1865.  He  is  a pensioner.  The  wound  healed,  leaving  (juite  a large  opening  into  the  nares  between  the 
roof  of  the  mouth  and  the  soft"  palate.  There  is  partial  anchylosis  of  the  lower  jaw.  His  disability  is  rated  onedialf  and 
permanent. 

Ca.se. — Corporal  Thomas  H.  Matthews,  Co.  I,  198th  Pennsylvania  Volunteers,  aged  26  years,  was  wounded  before 
Petersburg,  Virginia,  March  29th,  1865,  by  a conoidal  ball,  which  entered  below  the  left  car,  and  emerged  below  the  left  eye, 
fracturing,  in  its  course,  the  condyle  and  coronoid  ))rocess  of  the  inferior  maxilla  and  zygomatic  process  of  temporal  and  malar 
bones.  He  was  at  once  taken  to  the  hospital  of  the  1st  division.  Fifth  Corps,  and  on  Ajuil  2d,  sent  to  Harewood  Hosjiital, 
Washington.  When  admitted,  the  left  side  of  the  head  and  face  was  very  much  inflamed,  with  slight  ery.sipelas  in  right  eye 
and  face;  he  suffered  also  from  the  effects  of  the  shock  of  the  injury  and  transportation  from  Petersburg.  On  Aj)ril  14th,  the 
zygomatic  j)rocess  of  the  temporal  and  fragments  of  the  malar  bone  were  removed.  Bj'  May  19th,  the  patient  had  fully 
recovered,  with  the  e.xception  of  a slight  anchylosis.  He  was  discharged  from  service  on  May  29th,  1865.  He  is  a pensioner. 
Pension  Examiner  H.  S.  Woodruff  rejiorts  that  he  is  almost  totally  blind  in  the  left  eye,  and  deaf  in  the  left  ear.  He  is  affected 
with  fainting  fits,  on  stooping.  His  disability  is  rated  total  and  permanent. 

Case. — Private  Joshua  Simmons,  Co.  G,  74th  Ohio  Volunteers,  aged  32  years,  was  wounded  at  Jonesboro’,  Georgia, 
September  1st,  1834,  by  a round  ball,  which  fr.actured  the  infei'ior  maxilla,  right  side.  He  was  sent  to  the  hospital  of  the  1st 
division.  Fourteenth  Corps,  where  simple  dressings  were  ap])lied  to  the  wound.  On  October  27th,  he  was  transferred  to 
Hospital  No.  2,  Nashville,  Tennessee,  whence  he  was  discharged  from  service  on  February  16th,  1863,  on  account  of  anchylosis 
of  the  jaw.  He  is  a pensioner. 

Case. — Private  William  Higginson,  Co.  B,  131st  New  York  Volunteers,  aged  35  years,  was  wounded  at  Winchestej’, 
Virginia,  by  a musket  ball,  which  caused  a compound  comminuted  fracture  of  the  left  inferior  maxilla,  and  lodged  in  the  spinous 
])rocess  of  the  left  scapula.  He  was  taken  to  the  field  hosjiital  of  the  Nineteenth  Corps,  where  the  ball  was  removed,  and 
8im])le  dressings  ai)plied  to  the  wound.  On  October  12tli,  he  was  transferred  to  the  hosjiital  at  Frederick,  Maryland.  Fragments' 
of  bone  were  removed  on  Novendier  4th.  He  was  furloughed  on  March  13th,  1865,  and,  on  Ajiril  5th,  was  admitted  to  Grant 
Ilo.sjiital,  Willett’s  Point,  New  York.  On  June  2d,  he  was  transferred  to  De  Caniji  Hosjiital,  whence  he  was  discharged  from 
service  on  June  16th,  1865,  on  account  of  loss  of  half  of  lower  jaw.  He  is  a jiensiouer.  Pension  Examiner  G.  S.  Gale  rejiorts 
that  the  remaining  jwrtiiin  of  the  lower  jaw  does  not  match  the  ujijier,  and  mastication  is  quite  imperfect. 

Case. — Private  Henry  Morgan,  Co.  D,  77th  New  York  Volunteers,  aged  24  years,  was  wounded  before  Petersburg, 
Virginia,  Ajiril  2d,  1865,  by  a conoidal  ball,  which  entered  at  the  left  sujierior  maxillary  bone,  facial  surface,  jjassed  inward  and 
downward  into  the  mouth,  destroying  all  the  ujiper  teeth  on  the  left  side.  He  was  admitted,  on  the  same  day,  to  the  hosjiital  of 
the  2d  divi.sion,  Sixth  Corjis ; simjile  dressings  were  ajijilied  to  the  wound.  On  Ajiril  12th,  he  was  transferred  to  Harewood 
Hosjiital,  Washington.  When  admitted,  the  right  side  of  the  head  and  face  were  very  much  iuHamed,  ('lysijielas  closing  both 
eyes,  which  disajijieared  under  ajijirojiriate  treatment,  and,  on  May  1st,  the  jiatient  was  doing  well.  He  was  discharged  from 
service  on  June  8th,  1835.  He  is  a jiensioner. 

Case. — Private  Ferdinand  Lauersdorf,  Co.  D,  6tli  AVisconsin  Volunteers,  aged  28  years,  was  wounded  in  an  engagement 
on  the  South  Side  Railroad,  near  I’etershurg,  A^irginia,  March  31st,  1865,  by  a fragment  of  shell,  which  struck  the  body  of  the 
lo\7erjaw,  and  tore  away  the  entire  anterior  jiortion  of  the  bone.  He  was 'conveyed  to  the  hosjiital  of  the  3d  division  of  the 
Fifth  Corjis,  and,  on  Ajiril  Gth,  sent  to  Camjiliell  Hosjiital,  AVashington,  whence  he  was  discharged  from  service  on  July  14th, 
1865,  on  which  date  a jihotograjih  was  taken  at  the  Army  Medical  Museum.  The  fractured  extremities  of  the  jaw  had  united, 
and  the  wound  had  neaily  healed.  The  movements  of  the  jaw  were  very  limited,  but  deglutition  was  but  slightly  interfered 
with.  He  is  a jiensioner. 

Ca.se. — Private  John  Keil,  Co.  K,  102d  Pennsylvania  A''olunteers,  aged  25  years,  was  wounded  at  the  AA'ilderness, 
Virginia,  May  5th,  1864,  by  a conoidal  ball,  which  entered  at  the  inner  canthus  of  the  left  eye,  passed  through  under  the  nose, 
and  lodged  in  the  right  antrum  of  Highmore,  jienetrating  the  right  sujierior  maxilla,  and  knocking  out  the  second  molar  tooth 
on  the  right  side.  He  was  conveyed  to  AAhishington,  and  admitted  into  the  Stanton  Hosjiital  on  May  11th,  1864.  On  May  23d, 
the  wound  of  entrance  had  nearly  healed;  there  w'as  a jiurulent  discharge  from  the  right  nostril,  and  a fissure  in  the  anterior 
pai-t  of  the  supei'ior  maxilla,  the  length  of  which  could  not  be  satisfactorily  ascertained.  A jirobe  was  readily  passed  into  the 
antrum.  Assistant  Surgeon  George  A.  Mursick,  U.  S.  V.,  made  an  incision  from  the  angle  of  the  mouth  to  the  lower  edge  of 
the  malar  bone,  turned  uji  the  fiaji  of  the  cheek,  ajiplied  a large  trejihine  over  the  antrum,  removed  a button  of  bone,  and 
extracted  the  ball,  which  rvas  found  lying  loose  in  the  antrum.  The  jiatient’s  constitutional  condition  was  good.  On  May  24th, 
he  had  some  fever  and  swelling  of  the  cheek.  On  May  2.3th,  the  swelling  of  the  firce  had  increased  and  was  erysipelatous  in 
ch.aracter.  f)n  May  27th,  the  swelling  having  nearly  subsided,  the  sutures  were  removed.  The  lower  half  of  the  incision  had 
united  by  first  intention  ; the  remainder  was  sujijiurating ; the  discharge  from  the  nostril  had  diminished,  and  the  jiatient  was 
doing  well.  On  August  1st,  the  wound  had  not  healed  ; there  was  an  ojiening  over  where  the  bone  was  trejihined.  Some 
small  jiieces  of  bone  were  discharged,  both  from  the  wound  of  ojieration  and  the  nostril.  The  jiatient  was  able  to  chew  his 
food  well.  On  Sejitember  3d.  1864,  his  term  of  enlistment  having  exjiired,  he  was  discharged  the  service.  The  wound  of 


Motl  H J-urg.  Hitsl . of  tlie  War  of  tlie  Kebellion,  Part  I.  Vol.II.  Op  j)aOe  007 


I'l.  A.S|)ie<jfl,  I Srr  [miv.- 402.1  2 I’t.  A .Silshec  ,i  s<-,.  paw  OOT. 

PLATE  VIII.  SHOT  WOUNDS  OF  THE  FACE  AND  NECK. 


Sect.  II.] 


GUNSHOT  FUACTURES  OF  THE  FACIAL  RONES. 


367 


operation  liaJ  not  entirely  lioalod ; a small  sinus  was  leading  to  the  antrmn,  the  orifice  of  which  was  surrounded  hy  pouting 
granulations,  and  a small  piece  of  necrosed  hone  coidd  he  felt  at  the  bottom.  The  cicatrix  w'as  rather  large,  hut  there  was  no 
other  deformity.  The  specimen  Ls  No.  3374,  Sect.  II,  A.  M.  M.,  showing  the  disk  of  bone  removed  from  the  superior  maxilla, 
with  the  battered  and  flattened  ball.  The  specimen  and  history  were  contributed  by  the  operator.  On  ISIarch  8th,  1835, 
Pension  Examiner  G.  S.  McCook  reports  that  the  jaw  is  e.xfoliating,  and  rates  the  patient’s  disability  three-fourths  and  permanent. 

Case. — Private  Hugh  F.  Creighton,  Co.  A,  1st  New  Jersey  Volunteers,  aged  45  years,  was  wounded  at  Spottsylvania, 
Virginia,  May  10th,  1834,  by  a canister,  which  carried  away  all  his  upper  teeth  and  fractured  the  lower  jaw.  Hu  was  conveyed 
to  Alexandria,  Virginia,  and  admitted  into  the  3d  division  hospital  on  ISIay  13th,  1834,  and  thence,  on  June  7th,  transferred  to 
the  !Mower  Hospital  at  Philadelphia.  Simple  dressings  Avero  applied  to  the  avouikI.  He  Avas  discharged  on  J une  2'Jth,  1835. 
The  s])ecimen.  No.  2702,  Sect.  II,  A.  M.  M.,  consists  of  seven  fragments  of  bone  fi-om  the  inferior  maxilla,  including  the  coronoid 
process  and  the  greater  part  of  the  ramus.  It  Avas  contributed  by  Assistant  Surgeon  J.  T.  Calhoun,  U.  S.  A.  Creighton  is  a 
pensioner,  his  disability  being  rated  total  and  permanent. 

Case. — Private  George  Messenger,  Co.  K,  114th  Pennsylv'ania  Volunteers,  aged  34  years,  Avas  Avounded  at  Chancellors- 
A’illo,  May  3d,  1863,  by  a conoidal  ball,  Avhich  entered  the  right  side  of  the  loAver  jaAV,  oj)posite  the  canine  tooth,  passed  around, 
and  emerged  opposite  the  left  canine,  fracturing  the  alveolar  process.  He  Avas  taken  to  the  hospital  of  the  1st  division.  Third 
Corps,  and,  on  May  9th,  sent  to  HareAvood  Hospital,  Washington.  On  May  10th,  Surgeon  Thomas  Antisell,  U.  S.  V.,  brought 
the  edges  of  the  Avound  together  by  hare-lip  suture.  He  Avas  aftei-Avard  transferred  to  the  24th  Rc'giment  Veteran  Reserve 
Corps.  On  October  19th,  1834,  he  Avas  admitted  to  Ricord  Hospital,  Wasliington,  Avith  a vieAV  of  being  operated  uj)on  to 
relieve  the  deformity  Avhich  still  existed,  but  his  system  Avas  too  Ioav  to  Avarrant  it.  The  Avound  had  entirely  healed.  The  angle 
of  the  mouth  at  right  side  .Avas  draAvn  doAvn,  and  there  Avas  also  great  loss  of  substance.  He  Avas  returned  to  duty  on  May 
27  th,  1835. 

Ca.se. — Private  Albert  Silsbee,  Co.  D,  83th  Noav  York  Volunteers,  aged  18  years,  Avas  Avounded  at  Beverly  Ford, 
Virginia,  June  9th,  1833.  While  lying  on  his  left  side,  his  head  being  toAvard  the  enemy,  the  missile,  probably  a buckshot, 
entered  just  antcriorily  to  the  tragus  of  the  ear,  making  a AVOund  having  an  incised  appearance,  and  lodged  someAvhere  near  the 
ramus  of  the  jaAV.  He  Avas  admitted,  on  the  next  day,  to  Lincoln  Hospital,  Washington,  Avhere  Avater  dressings  Avere  applied. 
The  ball  could  not  be  discovered.  There  Avas  no  avouiuI  of  the  mouth  or  fauces,  but  considerable  SAvelling  of  the  right  check, 
Avith  lividity  about  the  right  eye;  both  eyes  Avere  slightly  injected  and  felt  sore.  The  patient  had  no  bad  symptoms  after 
admission,  and,  as  he  Avas  not  suffering  inconvenience  from  the  ball,  operative  interference  Avas  thought  unjustifiable.  He  Avas 
tran.sfeiTcd,  on  June  IGth,  to  West’s  Buildings  Hospital,  Baltimore,  Avhence  he  Avas  returned  to  duty  on  June  27th,  1833.  He 
is  not  a pensioner.  The  history  of  this  case  Avas  reported  from  Lincoln  Hosjjital  by  Medical  Catlet  J.  N.  Hyde,  U.  S.  A.,  from 
West’s  Buildings  Hospital  by  Surgeon  T.  II.  Bache,  U.  S.  A.  The  concealment  of  the  ball  under  the  petrous  bone,  perhaps,  or 
in  the  pterygoid  fossa,  or  behind  the  ramns  of  the  loAver  jaAV,  Avas  (esteemed  A’ery  I'emarkable,  and  the  aspect  of  the  entrance 
Avound  Avas  unusual.  Surgeon  J.  H.  Brinton,  U.  S.  V.,  therefore,  had  a careful  draAving  made,  in  color,  of  the  AVOund,  by 
Hospital  StCAvard  Stanch.  This  is  accurately  copied  in  the  right-hand  or  upper  figure  of  the  chromo-lithograph.  It  is  unlikely, 
but  not  impossible,  that  the  missile  fell  out  before  the  patient's  admission  to  hospital. 

Of  tlie  cases  above  enumerated,  fifty-seven  were  fatal.  But  it  will  be  observed  that 
the  abstracts  are  compiled  from  the  gravest  of  the  reported  gunshot  wounds  of  the  face, 
and  afibrd  no  indication  of  the  average  mortality  after  such  injuries.  Forty-nine  of  the 
men  mentioned  in  the  abstracts  are  pensioned.  It  will  be  noticed  that  secondary  hsemor- 
rhage  supervened  in  seventy-six  cases,  and  that  the  common  carotid  was  ligated  in  no  less 
than  thirteen  cases,  five  of  which  had  a favorable  issue.  In  thirty-six  of  the  cases,  there 
was  removal  or  secondary  exfoliation  or  extended  necrosis  of  bone.  The  diversity  in  tlie 
nature  of  the  injuries  forbids  a rigorous  classification  ; but  it  would  appear  that  of  the  whole 
number,  impartially  selected,  seven  were  fractures  of  both  the  upper  and  lower  jaws.  The 
upper  maxilla  was  principally  involved  in  twenty-two  cases  ; the  lower  in  eighty  cases  ; 
the  buccal  cavity  and  tongue  in  three  cases.  In  twenty-seven  cases  the  destruction  of  the 
nasal,  lachrymal,  turbinate,  or  malar  bones  is  particularly  noted. 


3G8 


PLASTIC  OPKHATICXS. 


[CiiAr.  II, 


Section  TIL 


PLASTIC  OPERATIONS. 


Special  reports  were  made  of  the  following  cases  of  hlepharoplastic,  rliinoplastic,  and 
clieiloplastic  operations  of  sta]jhylorapliy  and  of  complex  operations  for  vicious  cicatrices 
or  losses  of  tissue  in  various  portions  of  the  soft  parts  of  the  face.  » 

Case. — Private  Garrett  Rozel],  ICth  New  A'ork  Battery,  aged  30  years,  was  wounded  in  tlie  engagement  at  Chapin’s 
Farm,  Virginia,  Septemher  20tli,  1804,  by  a j)iece  of  shell,  which  tore  away  the  eyebrow,  eyelid,  and  part  of  the  temporal  and 
malar  bones,  left  side,  completely  extirpating  the  left  eye,  and  opening  a wound  into  the  nasal  bone  one-fourth  by  oue-eighth  of 
au  inch  in  extent,  leaving  the  loose  a])j)endages  turned  inward  .and  Ininging  over  the  cheek  as  low  as  the  middle  of  the  nose. 
He  was  sent  to  the  hosjiital  at  Fort  Monroe,  Virginia,  which  he  entered  on  October  2d.  He  was  furloughed  on  December  20th. 
On  February  27th,  18G5,  he  was  admitted  to  the  hospital  at  Ehnir.a,  New  York.  The  wound  had  healed,  but  a fistula  existed  in 
the  nose.  On  March  31st,  ISC.b,  a [ilastic  operation  was  performed  by  Acting  Assistant  Surgeon  A.  Merrill,  while  the  patient  was 
under  the  inflnence  of  ether.  The  lid  and  brow  w’ere  di.ssected  aw’ay  from  the  unnatural  adhesions,  their  old  positions  as  far  as 
possible  resumed,  the  cicatrized  surfaces  again  made  raw  by  a removal  of  the  skin,  and  seven  sutures  taken  and  adhesive  straps 
used  to  retain  the  lid  in  its  place.  Erysipelas  ensued.  The  parts  healed,  and  on  July  21st,  18C5,  Eozell  was  discharged  fi'om 
the  service  and  pensioned.  Examiner  John  G.  Orton,  M.  D.,  reports,  July  27th,  1867,  th.at  the  face  is  so  badly  disfigured  that 
he  will  ever  be  an  object  of  pity,  and  unable  to  gain  a living,  except  in  seclusion  from  society. 

Case. — Sergeant  Alexander  Miller,  Co.  A,  2d  Ohio  Volunteers.  Shell  wound  of  face.  Fracture  of  zygoma  and  inferior 
maxilla,  destruction  of  eye  and  Laceration  of  soft  parts  of  face  and  of  arm  from  shoulder  to  elbow.  Hoover’s  Gap,  Tennessee, 
June  27th,  1863..  Plastic  operation  to  repair  the  loss  of  right  angle  of  mouth.  Returned  to  duty  December  22d,  1863. 
Discharged  and  pensioned. 

Ca.se. — Pi’ivate  John  Oaks,  Co.  F,  118th  Pennsylvania  Volunteers,  aged  47  years.  Fragment  of  shell  struck  the  superior 
extremity  of  nasal  bone,  lacerated  inner  canthus  of  right  eye,  and  destroyed  the  lachrymal  duct.  Fredericksburg,  Virginia, 
December  13th,  1862.  Transferred  to  Veteran  Reserve  Corps.  In  February,  1864,  the  cornea  was  dull  and  diy,  owing  to  want 
of  proj)er  secretion.  Paralysis  of  facial  nei've,  drawing  the  mouth  upward  and  to  the  side.  Ectropion  of  lower  lid.  Plastic 
operation  peiformed  February  25th,  1864.  Extirpation  of  right  eye  on  August  8th,  1864.  Discharged  April  13,  1865.  Not  a 
pensioner. 

Case. — Corporal  Andros  Guille,  Co.  K,  97th  Ohio,  aged  32  years,  was  wounded  on  November  25th,  1863,  at  the  battle 
of  Missionary  Ridge,  by  a fragment  of  a shell,  which  carried  away  the  entire  nose  to  the  turbinated  bones  and  upper  lip,  with 
the  anterior  portion  of  alveolar  ])rocess  of  sujierior  maxilla  from  the  right  to  the  last  two  molars  on  left.  He  also  received 
fracture  of  metacai'pal  bone,  and  contusion  of  right  shoulder  from  fragments  of  the  same  shell.  He  was  admitted  to  No.  8 
Hospital,  Nashville,  on  January  28th,  1864.  His  constitutional  condition  good.  Fissure  of  face  triangular  in  shape,  from  apex 
to  where  lij)  should  be,  two  and  a half  inches  in  length ; at  base,  from  one  side  of  pressure  to  the  other,  about  three-fourths  of 
an  inch.  Nasal  bones  came  away,  leaving  their  septum  between  exterior  and  posterior  foramen.  Suppuration  nearly  ceased. 
On  February  4th,  1864,  Surgeon  William  C.  Otterson,  U.  S.  V.,  performed  a plastic  operation ; an  H Hap  from  right  cheek  was 
turn(‘d  upon  itself  and  fastened  to  the  opposite  surface  with  two  pins  and  one  silver  suture,  and  a band  of  adhesive  plaster  from 
cheek  to  cheek,  as  a support.  No  ansesthetic  was  used.  Six  daj's  after  operation,  stitches  were  removed.  Eight  days  after, 
erysipelas  appeared,  which  swelled  the  face  and  parts  involved  in  operation  so  as  to  burst  the  adhesions  of  the  new  lip.  After 
rending  suture,  erysipelas  subsided  in  a few  days.  He  was  discharged  on  April  23d,  1864.  The  case  is  reported  by  the 
operator.  Guille  is  a pensioner  ; his  disability  is  rated  total  and  permanent. 

Case. — Private  Frank  Hart,  Co.  E,  4th  New  York  Volunteers,  aged  22  years,  was  wounded  at  Antietam,  Maryland, 
September  17th,  1862,  by  a fragment  of  shell,  which  caused  a comminuted  fracture  of  the  inferior  maxilla,  detaching  portiqn.s 
of  the  bone,  and  carrying  away  the  integuments  covering  the  chin,  with  one-half  the  lower  lij).  He  was  treated  in  field  hospital 
until  October  3d,  when  he  was  sent  to  the  hospital  at  Chester,  Pennsylvania.  On  admission,  the  patient  pi-esented  a horribly 
disfigured  appearance,  the  whole  mass  of  flesh  on  the  chin  being  carried  away,  with  part  of  the  bones  and  two  of  the  incisor 
te(‘th.  The  cavity  was  filled  with  lint,  and  the  opposite  sides  drawn  together  as  much  as  possible  by  adhesive  strips;  still,  at 


Sect.  III.] 


PLASTIC  OPERATIONS. 


369 


first,  there  was  at  least  one  inch  between  the  edges.  B3’  December  20th,  the  fragments  of  bone  had  all  been  detached.  The 
wound  had  so  well  filled  with  granulations  that  it  was  hut  one  inch  in  perpendicular  length  and  one-half  inch  in  breadth.  An 
operation  for  the  relief  of  the  deformity  was  performed,  an  incision  being  made  jierpendicularly  through  the  old  cicatrix,  down 
to  the  inferior  edge  of  the  bone,  and  the  edges  of  the  incision  and  part  not  filled  with  granulations  pared  so  as  to  make  a 
V-shaped  space,  with  the  base  at  the  superior  part.  The  old  cicatrix  was  then  detached  from  the  hone,  in  order  to  permit  the 
fi’ee  edges  of  the  wound  to  approach  each  other,  and  the  parts  being  approximated,  three  hare-lip  pins  were  introduced  and 
fastened  in  the  ordinarj'  way.  The  parts  were  kept  moist  with  a solution  of  acetate  of  lead  iind  laudanum.  The  sutures  were 
removed  on  the  fourth  da.y,  when  union,  by  the  first  intention,  was  found  to  have  taken  place  to  the  extent  of  three-(piarters  of  an 
inch  at  the  upper  part  where  the  edges  were  free  and  the  parts  vital ; hut  through  the  old  cicatrix  the  union  was  less  perfect,  there 
remaining  about  one-half  an  inch  ununited ; this,  however,  soon  closed  hv  granulations,  and  hj-  December  dlst  only  a small  opening, 
about  the  size  of  a pea,  remained,  through  which  the  saliva  dribbled.  He  was  discharged  from  service  on  February  24th,  18(53, 
eutirelj'  recovered. 

Case. — First  Lieutenant  J.  W.  ]Meeks,  jr.,  38th  New  York  Volunteers,  aged  31  years,  was  wounded  at  the  battle  of 
Chancellorsville,  Virginia,  Maj'  3d,  1833,  by  a conoidal  ball,  which  entered  just  behind  and  above  the  left  external  auditoiy  meatus, 
passed  forward,  inward,  and  downward  through  the  left  orbit,  fracturing  the  orbital  process  of  the  malar  bone,  and  emerged  from 
the  inferior  extremity  of  the  nose,  fracturing,  in  its  course,  the  left  nasal  bone.  He  was  taken  to  the  field  hospital,  where  simple 
dressings  were  applied.  Several  spiculae  of  bone  were  discharged  from  the  wound  of  exit.  The  sense  of  hearing  of  the  left  ear 
w.as  entirely  lost  from  the  first.  The  patient  was  transferred  to  his  home  from  the  field  hospital,  and  discharged  from  service  on 
June  2d,  1833,  and  pensioned.  The  wound  did  well,  and  healed  in  about  eight  months,  the  cicatrix  producing  ectropion  of  the 
lower  lid,  for  which  an  operation  was  performed  in  1867,  with  a good  result,  though  in  November,  18(58,  there  was  veiy  slight 
eversion,  resulting  from  loss  of  bone.  The  sense  of  hearing  was  still  entirely  lost,  and  Mr.  Meeks  stated  that  he  occasionally 
detected  a slight  discharge  from  the  ear. 

Case. — Private  George  C.  Huntington,  Co.  H,  14'2d  New  York  Volunteei's,  aged  18  j’cars,  was  wounded  near  Richmond, 
Virginia,  October  27th,  18G4,  by  a conoidal  ball,  which- caused  a wound  of  the  right  cheek.  He  was  taken  to  the  Flying  Hos])ital 
of  the  Tenth  Corps,  where  Surgeon  David  McFalls  of  the  same  regiment  performed  an  operation.  Simi)le  dressings  were  a])j)lied, 
and  he  was  transferred  to  Balfour  Hospital,  Portsmouth,  whence  he  was  discharged  from  service  on  IMay  27th,  1865. 

Case. — Jlajor  Ephraim  Dawes,  53d  Ohio  Volunteers,  aged  25  years,  was  wounded  at  Dallas,  Georgia,  on  May  25th,  1864, 
by  a conoidal  ball,  which  struck  the  lower  jaw  on  the  left  side,  one  inch  and  a half  from  the  chin,  passed  through  the  mouth, 
and  emerged  through  the  right  side,  comminuting  the  bone,  destroying  the  lower  lip,  and  wounding  the  under  part  of  the  tongue. 
He  was  taken  to  the  field  hospital  of  the  Fifteenth  Corps,  where  loose  fragments  of  the  alveolar  processes,  chin,  and  jaw,  were 
removed.  On  June  3d,  he  was  admitted  to  the  Officers’  Hospital,  Nashville,  and  on  September  10th,  to  the  Grant  Hospital, 
Cincinnati.  The  patient’s  general  health  was  good.  On  September  22d,  Professor  G.  C.  Blackman  chloroformed  the  jiatient, 
and  performed  an  operation  for  restoration  of  the  lower  lip.  Hare-lip  and  interrupted  sutures,  with  transverse  adhesive  straps, 
were  used,  and  water  di-essings  applied.  The  patient  was  discharged  on  October  25th,  1864,  at  which  time  the  lower  lii)  was 
entirely  restored ; but  the  fracture  remained  ununited.  On  September  16th,  1867,  Pension  Examiner  G.  O.  Hildreth  reported  the 
patient  to  be  able  to  masticate  readily  by  means  of  artificial  teeth;  hut  that  the  injury  affected  his  general  health.  Ho  rated  his 
di.sability'  one-half.  The  patient,  being  dissatisfied  with  this  rating,  appealed,  and,  upon  another  examination,  his  disability  was 
rated  as  total. 

Case. — Elbert  Ernest,  saddler,  Co.  C,  9th  Iowa  Cavalry,  aged  31  years,  being  admitted  for  small  pox  into  the  Small-pox 
Hospital  at  St.  Louis,  was  treated  there  until  July  2d,  1864,  when  he  was  admitted  into  the  Marine  Hospital  in  very  feeble 
health,  and  with  a perforation  of  the  right  cheek,  the  orifice  being  about  three-fourths  of  an  inch  in  circumference.  On  July  9th, 
1864,  Surgeon  A.  Hammer,  U.  S.  V.,  performed  a plastic  operation.  Wire  sutures  were  used,  and  simple  dressings  ajiplied.  The 
patient  was  discharged  on  August  12th,  1864,  for  “central  opacity  of  both  cornea,  arising  from  varioloid,  not  much  improved.” 
The  case  is  reported  by  the  operator.  Ou  January  16th,  1868,  Pension  Examiner  W.  F.  Peck  reports  that  the  patient’s  vision 
is  totally  extinct. 

Ca.se. — Private  John  H.  Felch,  Co.  L,  2d  Massachusetts  Cavalry,  aged  24  _years,  was  wounded  at  the  battle  of  Fisher’s 
Hill,  Virginia,  September  22d,  1864,  by  a conoidal  ball,  which  carried  awaj'  the  greater  portion  of  the  lower  lip,  half  of  the 
lower  jaw,  and  the  front  incisors.  He  was  treated  in  the  National  Hospital,  Baltimore,  and,  on  October  20th,  1864,  was  sent  to 
the  Harvey'  Hospital,  Madison,  Wisconsin.  The  remaining  portion  of  the  lower  lip  had  fii-mly  adhered  to  the  jaw,  anteriorly, 
and  as  far  laterally  on  each  side  as  the  canine  teeth.  A fold  of  mucous  membrane  projected  at  each  corner  of  the  mouth.  An 
abscess  had  recently  opened  under  the  right  body  of  the  jaw,  which  had  healed.  The  j>rovisional  callus  thrown  out  had  been 
partly  absorbed,  and  the  inflammatory  deposits  about  the  jaw  nearly  removed.  All  the  contraction  of  the  soft  jiarts  that  could 
ensue  had  taken  jdace,  and  the  saliva  continually  flowed  from  the  mouth,  obliging  him  to  wear  a pad  and  bandage  over 
it.  On  January  23d,  186.5,  Surgeon  H.  Culbertson,  U.  S.  V.,  performed  the  following  operation : The  flaps  having  been  marked 
out,  a curvilinear  incision  was  made  from  angle  to  angle  of  the  mouth,  the  convexity  downwards,  leaving  a portion  of  the 
remnants  of  the  lower  lip  one-foui-th  of  an  inch  wide,  adherent  to  the  jaw,  which  was  turned  down  so  as  to  prevent  the  new  lip 
from  contracting  adhesions  to  the  jaw  in  fi’ont.  Quadrilateral  flaps  were  then  raised  from  below  the  jaw,  and  the  mucous 
membrane  detached  and  stretched  to  the  margin  of  the  new  lip,  which  extended  towards  the  middle  line  of  the  lip,  about  one 
inch  fi'om  either  angle.  The  two  flaps  were  approximated  in  the  middle  line  by  four  pins  and  figure-8  ligatures.  Triangular 
spaces  at  base  of  jaw  were  dressed  with  dry  lint.  As  the  angles  of  the  mouth  were  too  rounded,  a small  V-shaped  portion 
was  taken  out  of  each,  and  the  edges  of  each  approximated  by  a needle  and  thread.  There  was  no  stress  on  the  flai)s,  and  no 
vessels  divided  that  rccpiired  taking  up.  Immediately  after  the  o])eration,  three-fourths  of  a grain  of  morphia  was  given,  and 


370 


AVOUNDS  AND  INJUEIES  OF  THE  FACE 


[Chap.  II, 


tho  patient  enjoined  not  to  move  liis  face  or  lip.  On  January  24tb,  tlie  flaps  having  taken  well,  he  was  ordered  to  lay  on  his 
side,  that  the  discharges  might  readily  flow  off  from  the  mouth,  and  the  attendants  were  instructed  to  remove  gently  and 
frequently  the  mpisture  from  and  about  the  flaps.  He  was  allowed  chicken  broth,  and  cold  water  and  lint  dressings  were 
aiiplied.  This  man  was  discharged  on  May  13th,  1865,  and  pensioned,  his  disability  being  rated  total  and  permanent.  The 
case  is  reported  by  the  oj)erator. 

Cask. — Corporal  Henry  Gibbs,  Co.  K,  67th  Ohio  Volunteers,  was  wounded  at  the  battle  of  Winchester,  Virginia,  March 
23d,  1862,  by  a musket  ball,  which  entered  at  one  angle  of  the  jaw,  passed  under  the  tongue,  and  emerged  at  the  other, 
fracturing  the  lower  jaw  at  both  angles  and  in  its  body.  He  was  conveyed  to  the  Union  Hospital  at  AVinchester,  Virginia,  and, 
on  March  27th,  Surgeon  S.  FA  Forbes,  67th  Ohio  Volunteers,  made  an  incision  from  thb  angle  of  the  mouth  on  the  right  side  to 
the  orifice  of  exit,  and  removed  the  whole  of  the  lower  jaw.  A plastic  operation  was  then  performed,  pins  put  in,  and  in  four 
weeks  the  patient  had  entirely  recovered  without  any  a])parent  external  deformity.  He  was  admitted  to  the  hospital  at  Camp 
Chase,  Ohio,  July  2d,  1862,  and  discharged  from  service  on  July  4th,  1862.  He  is  not  on  the  Pension  List. 

Case. — Private  Peter  Jordan,  Co.  E,  2d  Connecticut  Heavy  Artillery,  was  wounded  at  Cold  Harbor,  Virginia,  by  a 
fragment  of  shell,  which  carried  away  the  lower  incisor  teeth,  with  a large  portion  of  the  anterior  part  of  the  lower  jaw,  and 
destroyed  the  whole  under  lip.  He  also  received  a severe  wound  of  the  left  hand.  He  was  treated  in  the  hospitals  at  Black- 
well’s Island,  New  York,  and  New  Haven,  Connecticut,  and,  on  October  16th,  he  was  admitted  into  the  Eeadville  Hospital, 
Massachusetts.  On  November  28th,  1864,  Acting  Assistant  Surgeon  Francis  C.  Ropes  dissected  up  the  soft  parts  from  the  jaw, 
and  retained  them  as  high  as  possible  with  bandages.  Dressings  of  chloride  of  soda  were  applied.  There  was  a slight  sloughy 
appearance  for  a few  days.  Healthy  granulations  set  in,  and  the  wound  healed,  with  some  improvement  in  appearance  and 
comfort  of  patient.  He  was  discharged  on  January  16th,  1865.  The  case  is  reported  by  the  operator.  On  January  24th,  1870, 
Pension  Examiner  J.  AY.  Toward  reports  that  the  saliva  constantly  dribbles  from  the  patient’s  mouth.  The  mouth  presents  a 
shocking  deformity,  which,  in  a great  measure,  excludes  him  from  society.  He  has  had  three  operations  performed  on  his  lip. 

Case. — I’rivate  Donald  Gray,  Co.  E,  38th  New  York  A’^olunteers,  aged  38  years,  was  wounded  at  F’redericksburg, 
Virginia,  December  13th,  1862,  by  a round  mmsket  ball,  which  entered  just  under  the  right  eye,  fractured  the  upper  maxilla, 
not  materially  separating  the  fi  agments,  and  lodged.  On  admission  to  the  Satterlee  Hospital,  Philadelphia,  December  23d, 
1862,  the  cheek  was  greatly  swollen.  On  January  3d,  1883,  the  swelling  having  considerably  subsided,  the  ball  was  removed 
from  behind  the  masseter  muscle  by  an  incision.  Numerous  fragments  of  bone  were  found  firmly  imbedded  in  the  ball,  and  an 
abscess,  Avhich  had  formed  in  its  place  of  lodgemeiit,  discharged  freely,  and  was  kept  open  by  the  introduction  of  a tent.  On 
the  22d,  the  wound  had  entirely  healed.  Gray  had  been  wounded  once,  in  lhe  Crimea,  in  the  head,  and  four  times  during  the 
late  war.  One  of  these  wounds  had  disfigured  his  nose.  The  right  side  was  slit,  at  the  junction  of  the  ala  and  septum,  for 
about  Inalf  an  inch,  and  on  the  loft,  a /^-shaped  portion  was  lost  at  the  same  place.  On  February  11th,  1863,  Acting  Assistant 
Surgeon  AV.  AA^.  Keen,  jr.,  operated  on  the  right  side,  simply  paring  the  edges,  and  approximating  by  five  sutures.  On  the  left 
side,  the  mucous  membrane  and  fascia  of  the  ala  and  septum  were  everted,  their  edges  pared  and  approximated  by  sutures.  A 
plug  was  also  placed  in  this'  side  to  prevent  inversion,  and  cold  water  dressings  were  apjilied.  The  edges  united  perfectly, 
except  a portion  of  the  elevated  flaps,  which,  after  a second  opening,  March  1st,  1833,  united  firmly,  and  completely  filled  up 
the  gap.  This  man  was  discharged  on  March  14th,  1833,  on  account  of  inability  to  eat  any  hard  food.  He  applied  for  a pension, 
but  his  claim  was  rejected,  there  being  no  disability. 

Case. — Citizen  Henry  Kennedy,  aged  19  years,  was  admitted  to  the  General  Hospital  at  Little  Rock,  Arkansas,  on 
August  23d,  1864,  with  loss  of  the  inferior  lip  from  mercurial  gangrene,  the  superior  margin  of  the  cicatrix  being  firmly 
adherent  to  the  periosteum  covering  the  inferior  maxilla.  His  constitutional  condition  was  very  good.  On  August  24th,  Surgeon 
FI  A.  Clark,  U.  S.  V.,  performed  a rhinoplastic  operation  by  dissecting  the  cicatrix  and  paring  the  edges,  and  drawing  up  the 
tissues  of  the  skin  and  retaining  them  in  conjunction  with  the  remaining  portions  of  the  lower  lip.  Simple  dressings  were 
applied.  The  patient  was  retnrned  to  duty  on  September  29th,  1864.  The  case  is  reported  by  the  operator. 

Case. — Lieutenant  Adam  Miller,  2d  Massachusetts  A’'olunteers,  aged  23  years,  was  wounded  on  August  9th,  1832,  at  the 
battle  of  Cedar  Mountain,  by  an  elongated  musket  ball,  which  entered  below  the  right  orbit,  and  traversing  the  nasal  fossa“, 
'emerged  thi'ough  the  left  orbit,  destroying  the  globe  of  the  left  eye,  and  lacerating  the  left  lower  eyelid.  Fie  was  made  a 
■prisoner,  and  taken  to  an  hospital  at  Charlottesville,  Virginia,  where  his  wound  ultimately  cicatrized,  with  great  deformity. 
Having  been  exchanged,  he  entered  the  New  York  Eye  Infirmary,  and,  on  April  10th,  1863,  ether  having  been  administered,  a 
plastic  operation  was  peiformed,  by  Dr.  Henry  15.  Sands,  for  the  restoration  of  the  eyelid.  The  operation  was  eminently 
successful,  and,  on  April  22d,  1863,  the  parts  were  sufficiently  healed  to  permit  the  insertion  of  an  ai’tificial  eye.  Although  the 
lachrymal  sac  and  puncta  were  destroyed,  little  inconvenience  was  experienced  from  stillicidium.  Lieutenant  Miller  was, 
sidjsequently,  transferred  to  the  7th  Regiment  A'^eteran  Reserve  Corps.  A photograph  was  taken  in  April,  1866,  and  is  numbered 
135  of  the  Surgical  Series.  He  is  a pensioner;  his  disability  is  rated  one-half. 

Case. — Private  JT.  M.  Wyatt,  Page's  battery,  1st  Virginia  Artillery,  aged  46  years,  was  wounded  on  September  13th, 
1883,  by  a fragment  of  shell.  Fie  was  admitted  into  the  No.  1 hospital,  Richmond,  Virginia,  September  17th,  1833.  The  lower 
jaw,  from  the  first  molar  tooth  of  the-right  side,  nearly  to  the  angle  of  the  jaw  on  the  left  side,  the  soft  tissues  forming  a portion 
of  the  cheeks,  the  whole  lower  lip  and  the  original  covering  of  the  chin  were  carried  away.  His  tippeai’ance  was  frightful  and 
most  pitiable.  Sloughing  had  commenced.  In  a few  days,  however,  the  sloughing  ceased;  and,  although  suppuration  was 
profuse  and  very  offensive,  the  granulating  process  became  fully  established.  On  November  10th,  he  was  well  enough  to  go 
home  on  a furlough.  He  retnrned  to  the  hospital  early  in  January.  Cicatrization  had  occurred.  Irregular  and  lumpy 
cicatrices  extended  into  the  cheeks  from  the  corners  of  the  upper  lip,  which  had  been  involved  in  the  wound,  down  to  the  throat ; 
and  the  tongue  aj)pearing  in  the  chasm  representing  his  mouth,  adhered  to  the  transverse  edge  of  the  cicatrix  two  inches  below 
the  border  of  the  uj)per  lip.  It  was  determined  to  make  a new  lower  lip,  if  possible,  by  dissecting  the  tissues  of  the  throat  and 


Sect.  III.] 


PLASTIC  OPEKATIONS. 


371 


cheeks,  sliding  them  to  a level  with  the  hordei-  ot  the  upper  lip,  and  securing  them  in  position  by  sutures.  The  operation  was 
performed  on  January  lOlh,  1834,  without  chloroform,  as  it  was  desirable  that  the  patient  should  not  incur  the  danger  of  blood 
passing  into  the  air  pas.sages.  An  incision,  three  inches  long,  was  made  downward  in  the  centre  of  the  tissues  of  the  throat, 
terminating  about  the  middle  of  the  thyroid  cartilage.  From  the  termination  of  this  incision  another  was  carried,  first  on  the 
right  side  and  then  on  the  left,  upward  and  backward,  toward  either  angle  of  the  jaws,  each  to  the  extent  of  three  inches,  and 
the  two  tl.aps  were  marked  out.  These  flaps  were  then  dissected  one-fourth  of  an  inch  in  thickness,  from  the  subjacent  ti.ssues, 
so  that,  when  the  dissection  was  completed,  the  two  fl.aps,  each  being  seized  at  the  central  incision,  could  be  raised  and  brought 
up  so  as  to  ju’esent  an  opposing  margin  or  surface  to  tlu'  upper  lip.  As  was  anticipated,  the  flaj)8  now  required  to  be  incised  to 
prevent  the  edges,  by  which  they  were  to  be  united,  from  overlapiiing;  accordingly,  about  a (piarter  of  an  inch  in  width  >vas 
removed  from  each  flap  along  the  edges.  Being  again  brought  up  to  the  border  of  the  iqiper  lip,  the  flaps  were  united  in  a 
central  line  by  interrupted  sutures  of  silver  wire.  Two  incisions  were  then  made  from  either  angle  of  the  new  mouth  upward ; 
the  lum])y  and  unsightly  cicatrices  were  cut  out,  and  the  wounds  united  by  silver  wire.  Adhesive  strijis  and  a bandage 
completed  the  operation.  Direction  was  given  as  to  diet  and  drink,  and  an  anodyne  was  administered.  On  the  fourth  day 
perfect  union  occurred,  and,  with  the  exception  of  the  suture  at  the  upper  end  of  the  central  lino,  which  idcerated  thi-ough,  all 
was  doing  well.  The  sutures  produced  no  irrit.ation,  and  were  not  removed  until  the  tenth  day,  when  the  j)arts  were  ])erfcctly 
consolidated.  The  wound  below  suppuratwl  and  granulated  kindly.  On  March  1st,  the  patient  loft  the  hospital  for  his  homo 
greatly  improved  in  appearance  and  in  his  power  of  articulation.  The  case  is  reported  by  the  operator.  Surgeon  C.  B.  Gibson, 
P.  A.  C.  S.,  and  illustrated  in  the  Confederate  States  Medical  and  Surgical  Journal  for  July,  1834,  p.  104. 


Case. — Private  John  S- 


-,  Co.  B,  1st  New  York  Mounted 
Rifles,  aged  29  years,  received,  on  Jnly  12th,  1863,  at  Indiantown,  North 
Carolina,  a gunshot  fracture  of  the  lower  jaw,  by  a conoidal  ball,  which 
carried  away  the  right  anterior  portion  as  far  back  as  the  second  bicuspid 
tooth,  and,  on  the  left  side,  as  far  back  as  the  second  molar.  He  was 
treated  in  the  regimental  hospital  until  August  29th,  1863,  when  he  was 
admitted  to  the  Balfour  Hospital,  Portsmonth,'<nid,  on  November  2d,  1863, 
sent  to  the  St.  Joseph’s  Hospital,  New  York.  His  constitutional  condition 
was  good.  Wound  cicatrized  in  mesial  line,  approximating  the  two 
fractured  ends  of  the  jaw.  Patient 
entirely  destitute  of  a chin;  he  could 
not  articulate  distinctly;  constant 
dribbling  of  saliva  from  month.  On 
December  26th,  1863,  etlier  was  ad- 
ministered, and  Assistant  Surgeon  J. 

W.  S.  Gouley,  U.  S.  A.,  performed 
an  operation  for  reconstruction  of  the 
lower  lip  and  chin.  The  incisions 
united  by  first  intention,  except  at  a 
point  corresponding  to  the  tip  of  the 
chin,  where  suppuration  was  estab- 
lished in  twenty-four  hours.  Local 
applications  of  lead  and  opium  were 
used.  Nourishment  and  stimulants 
were  given  by  the  rectum,  each  enema 
containing  fifteen  drops  of  Magendie’s 
solution,  and  repeated  once  in  four  or 
five  hours.  On  the  second  day,  the 
patiently  as  able  to  take  nourishment  by  mouth  through  a funnel  with  a long  narrow  gutta  perch  a tube.  He  was  discharged 
on  September  1st,  1864.  The  case  is  reported  hy  the  operator.  On  April  1st,  1865,  Pension  Examiner  W.  M.  Chamberlain 
reports  that  the  patient  has  lost  his  speech  and  power  of  mastication,  and  rates  his  dis.abilities  as  total  and  i)erraanent.  A 
cast  of  the  head  and  face,  taken  just  previous  to  the  operation,  is  copied  in  the  wood-cut  (Fig.  162),  and  a cast  of  the  lower 
part  of  the  face,  taken  eight  months  after  the  operation,  is  represented  by  Fig.  163. 


I'm.  IfiS. — Cicatrix  after  a gunshot  wound  of  the  cliin. 
From  a wax  cast.  Spec.  :(49,  .Sect.  I,  A.  M.  M. 


Fig.  163. — Result  of  a chciloplastic 
operation.  From  a plaster  cast.  Spec. 
560,  .Sect.  I,  A.  M.  M. 


Case.  Private  Andrew  Nelson,  Co.  G,  140th  New  York  Heavy  Artillery,  aged  27  years,  was  wounded  at  Spottsylvaniii, 
Viiginia,  May  19th,  1861,  hy  a conoidal  ball,  which  passed  through  the  lower  maxilla  at  the  symphysis,  and  emerged  from  the 
neck  on  the  l(;ft  side,  thence  passed  through  the  shoulder-joint,  fracturing  the  clavicle  and  acromion  process.  Two  inches  of  the 
jaw  at  the  symphysis  was  carried  away.  He  was  admitted  to  the  Emory  Hospital,  Washington,  May  22d,  and  to  the  Hadding- 
ton Hospital,  Philadelphia,  on  June  1st,  1864.  He  was  very  much  debilitated.  Food,  in  liquid  form,  was  taken  with  difficulty, 
and  there  was  extensive  laceration  and  disjdacement  of  the  p.arts.  Some  spiculae  of  bone  were  removed  from  the  left  scapulo- 
clavicular articulation,  the  gap  in  the  chin  was  appro.ximated  hy  adhesive  plaster;-  bandage  and  charpie  were  apjdied  to  absorb 
profuse  saliva,  and  cold-water  dressings  were  applied.  Power  of  intelligible  speech  was  lost.  June  20th,  api)etite  good ; jaw 
used  in  attempting  mastication.  June  30th,  speech  could  bo  understood;  ate  toasted  bread  soaked.  July  10th,  abscess  over 
hyoid  region  lanced;  no  bone  detected.  .July  15th,  divided  the  integument  from  gums;  ])ared  the  (ulges,  and  brought  the  parts 
togethci  by  two  suture.s  over  needles.  .July  18th,  pin  suture  having  torn  out,  {)ared  edges  on  board,  and  again  applied  two 
sutures.  July  20th,  hoi)e  of  bringing  edges  together  abandoned,  but  orifice  is  filling  up;  salivary  discharge  far  less.  August 
8th,  mohars  have  apimoximated  tolerably;  ])atient  eats  and  talks  well;  abscesses  have  formed  under  the  chin,  and  discharged. 


372 


WOUNDS  AND  INJURIES  OF  THE  FACE, 


[CiiAr.  II, 


spiculic.  Tlic  patient  WAS  (lischargeil  on  August  27tli,  1864.  Operator,  Dr.  Nordman,  Acting  Assistant  Surgeon.  On  November 
l‘2th,  1867,  Pension  Examiner  S.  Phelps  reports  the  wound  in  the  lower  lip  to  be  united  by  a cicatrix,  so  that  the  saliva 
constantly  escapes.  Articulation  is  im|)erfect,  and  mastication  impossible.  He  rates  bis  disability  as  total  and  permanent. 


Case. — Private  Archibald  P- 


-,  Co.  C,  16th  Wisconsin,  aged  19  years,  was  wounded  at  Atlanta,  Georgia,  July  21st, 


1864,  by  a conoidal  ball,  which  entered  at  the  lower  border  of  the  left  malar  bone,  and,  fracturing  it,  passed  transversely  to  the 
right,  dividing  the  soft  parts  in  its  course,  separated  the  lower  lid  of  the  left  eye  at  the  inner  angle,  fractured  the  nasal  process 
on  the  left  side,  divided  the  alar  cartilages  close  to  their  attachment  to  the  bony  margin  of  the  nose,  and  passed  out  at  the  right 
alar  cartilage.  On  October  19th,  1864,  he  was  admitted  to  the  Harvey  Hospital,  Madison,  Wisconsin.  The  lower  eye-lid  was 
drawn  downward  and  outward,  exposing  the  mucous  membrane  of  the  lid.  The  nose  was  drawn  upward,  and  to  the  left,  the 
septum  being  bound  down  by  adhesions  to  the  bony  margin.  There  were  dense  cicatrices  across  the  cheek,  and  an  opening 
large  enough  to  admit  the  point  of  a jjrobe,  communicated  with  the  nas.al  cavity.  On  December.  12th,  1864,  Surgeon  H. 
Culbertson,  U.  S.  V.,  plugged  the  nostrils  and  made  one  incision  .along  the  inner  mai-gin  of  the  injured  eye,  carried  downward 
one-fourth  of  au  inch  below  the  lower  in.argin  of  orbit,  and  outward  and  upward  three-quarters  of  an  inch  from  external 
orbital  anMe.  The  .attachment  of  the  lid,  and  the  parts  included  by  the  incision  were  divided.  Another  incision  commenced 
over  the  left  malar  bone,  extending  through  the  lower  edge  of  the  transverse  cicatrix.  The  right  alar  c.artil.age  and  the 
tr.ansverse  cicatrix  were  removed.  The  left  cheek  was  raised  and  carried  upward.  Another  incision  was  made  from 

beginning  of  first,  downward  along  the  base  of  the  left  side  of  the  nose ; the 
cicatrices  and  inner  .angle  of  the  eye  were  dissected  out,  and  the  parts  placed 
in  position.  A flap  from  the  right  cheek  was  raised  to  fill  up  the  gap  extending 
tr.ansversely  .across  the  nose.  On  December  20th,  flaps  not  having  adhered 
at  the  inner  corner  of  the  left  eye,  and  the  lower  eyelid  having  receded  at 
the  inner  angle,  the  edges  were  pared,  the  eyelid  was  placed  in  position, 
and  a flap  taken  from  the  forehead  to  fill  up  the  gap.  On  January  14th, 
1865,  another  operation  was  performed,  the  object  being  the  division  of  the 
pedicles,  and  the  replacement  of  them,  so  fai-  as  possible,  in  their  original 
beds:  1st,  the  pedicle  a was  divided  in  the  line  c,  and  the  upper  and  inner 
surfaces  thinned  with  the  scissors,  and  a bed  made  for  it  at  c,  and  two 
sutures  jiassed  at  its  upper  extremity.  The  pedicle  was  then  straightened 
by  incisions,  so  as  to  remove  all  incurvation,  and  cut  from  its  base  a 
triangular  shape,  point  upwards,  and  a Imd  made  in  the  new  growth  of  the 
forehead,  in  which  the  ilap  would  neatly  lay,  and  the  iiap  secured  with 
four  sutures  and  plasters.  2d.  The  pedicle  h,  on  right  side  of  nose,  was 
divided  vertic.ally  and  turned  down,  made  angular,  and  a bed  made  for  it, 
as  seen  at  h,  secured  by  two  sutures  and  plasters.  Patient  was  put  in  bed, 
.and  his  hands  tied  down  to  his  side;  perfect  I’est  enjoined  in  a recumbent 
position.  Rice  water  w.as  given.  No  water  applied  as  a dressing.  He 
was  discharged  on  May  31st,  1865.  The  case  is  reported  hy  the  o])erator. 
This  man  is  a pensioner.  Examining  Surgeon  A.  W.  Dunton  reports  that 
the  sight  of  the  left  eye  is  lost  and  there  is  a constant  discharge  from  near 
the  nose,  and  rates  his  disability  as  total  and  permanent. 


Fig.  1G4. — Plastic  operation  for  clofunnity  from  gunshot. 
(From  a drawing  by  the  operator.) 


Case. — Private  William  Semmons,  Co.  F,  14th  New  York  Heavy  Artillery,  aged  20  years,  was  wounded  at  Petersburg, 
March  25th,  1865,  by  a fragment  of  shell,  which  entered  the  right  cheek,  fractured  the  zygomatic  process  of  the  malar  bone, 
comminuted  the  ramus  and  body  of  the  inferior  maxilla,  lacer.ated  and  opened  the  ducts  of  the  parotid  and  maxillary  glands, 
and  removed  all  the  integuments  of  the  cheek,  leaving  the  right  angle  of  the  mouth  hanging  loose.  He  was  taken  to  the  field 
hospital  of  the  Ninth  Corps,  where  about  two  inches  of  the  alveoli  of  the  superior  maxilla  was  excised  and  the  wound  stitched. 
On  April  1st,  he  was  transferred  to  Armory  Square  Hospital,  Washington.  Owing  to  his  inability  to  swallow,  liquid  food  and 
stimulants  were  introduced  by  the  stomach  pump.  On  September  21st,  he  was  transferred  to  De  Camp  Hospital,  New  York 
Harbor,  and  discharged  from  service  on  October  21st,  1835.  On  October  26th,  he  was  admitted  to  the  New  York  Hospital. 
The  wounded  parts  had  been  completely  cicatrized  for  more  than  two  months.  The  face  was  extensively  disfigured.  The  chin, 
owing  to  the  absence  of  the  lower  jaw,  had  retr.acted  and  lost  its  prominence.  On  the  right  side  of  the  face  a cicatrix  extended 
from  the  middle  of  the  zygoma  to  the  angle  of  the  mouth,  at  which  latter  point  it  was  deeply  depressed  and  closely  adherent  to 
the  .alveolar  margin  of  the  upper  jaw,  from  which  the  teeth  had  been  carried  .away.  This  adhesion  h.ad  drawn  up  the  upper 
lip  and  lengthened  it  considerably  toward  the  right  side.  The  lower  lip  having  been  detached  by  a laceration  vertically  at  the 
right  angle  of  the  mouth,  and  also  horizontally  by  another  laceration  ciossing  the  upper  part  of  the  chin,  nearly  an  inch  below 
its  vermilion  border,  had  dropped  below  its  proper  level  and  become  adherent,  leaving  a st'paration  between  the  two  li|is  at  the 
right  angle  of  the  mouth  of  a finger’s  breadth,  which  exposed  the  end  of  the  tongue  to  view,  and  permitted  a constant  escape  of 
saliva.  Irregular  cicatrical  lines  crossed  each  other  below  the  hift  angle  of  the  mouth,  one  of  which  passed  across  the  left  cheek 
nearly  to  its  middle.  All  that  remained  of  the  lower  jaw  was  the  upper  half  of  the  ramus  on  the  right  side,  and  the  entire 
ramus,  with  the  .angle  supporting  two  mol.ar  teeth,  on  the  left  side.  From  the  point  where  the  right  angle  of  the  mouth  adhered 
to  the  upper  jaw,  a free,  callous,  thick  border  of  skin  stretched  across  the  cavity  of  the  mouth  and  terminated  at  the  left  angle 
of  the  jaw,  to  which  it  firmly  adhered.  This  was,  evidently,  the  lacerated  edge  from  which  the  lower  lip  had  been  torn  by  the 
original  injury  and  had  lamiainod  separated.  It  performed  the  important  office  of  a substitute  for  the  lower  jaw,  afibrding 
support  to  the  tongue,  the  attachments  of  which  were  felt  connecting  with  its  posterior  surface.  The  last  iqiper  molar  tooth  on 
'the  right  side  remained  (’a  ska.  All  the  u|)per  teeth  between  it  and  the  left  canine  were  gone,  those  beyond  the  canine  on  the 


Sect.  III.] 


PLASTIC  OPERATIONS. 


373 


loft  side  remaining.  Upon  introdneing  tlio  finger  into  the  mouth,  it  was  iiumd  tliat  the  body  of  the  tongue  was  hound  on  the 
right  side  to  the  adjacent  jiarts  hy  adliesion,  and  its  movement  of  protiusiou  therehy  limited.  Mastication  being  iiupiactieahle, 
the  patient  was  restricted  to  the  use  of  soft  solids  and  licpiids.  Deglutition  was  unimpaired.  His  articulation  was  very 
defective,  owing  to  the  confinement  of  the  tongue  by  the  adhesions.  In  consecpience  of  this  defect,  the  patient  was  averse  to 
using  his  voice,  and  preferred  making  himself  understood  by  signs  and  the  use  of  a pencil  and  paper.  His  health  was  good, 
his  complexion  floritl,  and  his  general  appearance  robust.  On  November  7th,  Dr.  Gurdon  Ruck  performed  the  following 
reparative  autoplastic  operation  : The  lower  lip  was  detached  by  a horizontal  incision  extending  along  the  cicatricial  line 
crossing  the  chin,  to  a point  below  the  left  angle  of  the  mouth.  The  entire  thickness  of  the  lip,  with  its  lining  mucous 
membrane,  was  divided.  Its  vermilion  border,  which  had  shrunken  into  a fan-like  shape  by  cicatrization,  could  now  be 
straightened  out  and  applied  to  the  upper  lip  throughout  its  entire  length.  To  form  a new  angle  for  the  , mouth,  a jwint  was 
chosen  at  the  margin  of  the  uj)per  lip,  equidistant  from  the  median  line  with  the  left  angle,  and  at  this  point  the  border  was 
pared  away  obliquely.  A corresponding  point  was  chosen  on  the  lower  li(>  and  pared  in  the  same  manner.  The  two  fresh  cut 
surfaces  were  brought  into  accurate  apposition  and  secured  by  sutures.  The  adherent  right  extremity  of  the  upper  lip  was 
dissected  up  from  the  alveolar  border  of  the  jaw,  and  from  this  point  an  incision  was  carried  outward  and  iqiward,  along  the 
ui)per  margin  of  the  cicatrix  crossing  tlie  cheek  as  high  as  the  zygoma.  The  skin  and  subjacent  tissue  were  detached  fixa^ly 
toward  the  orbit  and  temple.  Another  incision  was  then  commenced  below  the  left  angle  of  the  mouth,  at  a point  where  the 
incision  detaching  the  under  lip  terminated,  and  carried  to  the  right,  across  the  chin,  at  a finger’s  breadth  below  the  free  callous 
border  above  described  as  constituting  a substitute  for  the  lost  jaw.  This  incision  was  continued  on  obliquely  uj)ward  and 
outward,  over  the  cheek  below,  and  close  to  the  cicatrix  as  far  as  the  zygoma.  A third  incision,  beginning  at  the  starting  point 
of  the  preceding  one,  below  the  left  angle  of  the  mouth,  was  carried  perpendicularly  downw.ard  a distance  of  two  inches  upon 
the  neck.  In  its  course  a cyst,  of  the  size  of  a dollar,  was  encountered,  filled  with  a brownish,  transparent,  viscid  fluid,  such  as 
is  met  with  in  r.anula,  and  was  dissected  out  entire.  The  angle  included  between  these  two  incisions,  as  well  as  the  integument 
below,  crossing  the  right  cheek,  were  extensively  detached  from  the  parts  beneath.  An  upper  and  lower  flap,  including  the 
entire  right  cheek  and  nearly  the  whole  chin,  were  thus  formed.  They  were  separated  by  the  cicatrix  crossing  the  cheek,  which 
had  been  left  in  situ.  After  paring  oft' the  surfaces  of  the  cicatrix,  the  edges  of  the  flaps  were  brought  together  so  as  to  cover  it 
u|),  and  secured  by  sutures.  At  the  right  angle  of  the  mouth,  reconstructed  in  the  manner  already  described,  the  flaps  above 
and  below  were  matched  to  the  lips  and  also  secured  by  sutures.  Sutures  were  introduced  in  close  proximity  throughout  the 
entire  extent  of  the  flaps,  so  as  to  maintain  their  edges  in  accurate  adjustment.  Four  of  the  sutiu’es  w'ere  twisted  and  were 
imserted,  one  at  the  right  angle  of  the  mouth,  two  upon  the  right  cheek  at  ])oints  where  they  would  afford  the  best  support  to 
the  flaps,  and  one  arthe  angle  of  the  Haps,  below  the  under  lip.  The  newly  constructed  mouth  was  of  medium  dimensions,  the 
lips  maintaining  themselves  in  contact  and  retaining  the  salivary  secretion.  The  adjustment  of  the  different  parts  to  each  other 
was  effected  without  any  strain  upon  the  sutures  at  anj'  one  point.  No  adhesive  plaster  was  used.  Liquid  nourishment  was 
directed  to  be  given  through  a tube,  and  water  dressings  to  bo  applied  to  the  face.  The  case  ])rogressed  favorably,  and  by 
November  10th,  adhesions  had  taken  place  throughout  almost  the  entire  extent  of  the  flaps,  and  all  the  pin  sutures,  with  mo.st  of 
the  thre.ad  sutures,  were  removed.  A free  discharge  of  pus  was  taking  place  at  the  lower  e.xtremity  of  the  incision  under  the 
chin,  where  the  cyst  was  removed.  Strips  of  adliesivo  plaster  were  applied  at  jioints  where  their  su])port  seemed  needed.  A 
suj)erficial  slough  of  the  size  of  a copper  cent  had  formed  over  the  zygoma,  which  could  not,  however,  mar  the  residt  of  tlu; 
o])eration.  The  suppuration  below  the  chin  gradually  diminished,  and  ceased  entirely  in  a few  days,  every  part  of  the  wound 
healing  completely.  On  December  12th,  18G5,  the  patient  left  the  hospital  to  return  to  his  home.  The  ability  to  maintain  the 
lips  in  contact,  and  thus  retain  the  saliva,  constituted  an  immense  amelioration  of  his  condition.  His  inn)roved  appearance,  and 
some  improvement  of  articulation,  were  also  results  highly  gratifying  to  the  patient. 

Case. — Sergeant  Robert  Beck,  Co.  G,  27th  Iowa,  aged  2.5  years,  received,  at  the  battle  of  Pleasant  Hill,  Louisiana, 
April  9th,  18.)4,  a gunshot  wound  ; the  missile  entered  the  left  temple  on  a level,  and  one  inoli  jwsterior  to  outer  eminence  of  the 
left  eye,  and  pas.sed  out  one-half  of  an  inch  below  the  right  eye,  destroying  in  its  course  the  left  eye,  the  lachrymal  sac,  duct  of 
right  eye,  and  the  bone.s,  and  produced  ectropion  of  the  right  eye.  He  was  admitted  to  the  IMariue  Hospital,  St.  Louis,  on  Ajtril 
7th,  1835.  On  April  27th,  Surgeon  J.  H.  Grove,  U.  S.  V.,  performed  a ])lastic  operation  for  deformity  of  right  eye.  Sinn)le 
dressings  were  applied.  The  result  was  j)erfect.  He  was  discharged  on  May  13tb,  1805.  The  case  is  repoi  tcd  by  the  oj)erator. 
In  March.  1871,  Pension  Examiner  J.  W.  Smith  reports  that  necrosed  bone  has  been  discharged,  during  the  past  year,  from 
wound  of  exit;  the  left  nostril  is  closed,  except  by  forced  ins|)iration.  Ho  rates  his  disability  as  total  and  permanent. 

Ca.se.— Private  W.  H.  Blanchard,  Co.  H,  7th  Michigan  Volunteers,  aged  23  years,  was  wounded  at  the  battle  of  Antictam, 
Maryland,  September  17th,  1862,  by  conoidal  ball,  which  entered  a little  below  the  zygomatic  process  of  the  sujierior  maxillary 
bone  of  the  left  side,  passed  through,  carrying  away  the  symphysis  and  palatin(>  processes,  and  emerged  a little  above  the  right 
angle  of  the  upper  lip.  He  was  ti;eated  iu  field  hospital  until  September  23d,  when  he  was  admitted  to  hosjiital  at  Frederick, 
Maryland,  where  several  small  pieces  of  bone  were  removed.  The  wounds  healed  by  January  1st,  1833.  On  January  3d,  the 
patient  was  chloroformed,  and  the  adhesions  in  line  of  fissure  and  cicatri.x  were  set  free  by  incisions,  and  the  cut  surfaces  on 
either  side  of  the  cicatrix  brought  together  by  sutures  after  an  incision  on  the  right  side  of  the  nose  for  mor(“  conqdete  adjust- 
ment. The  result  was  very  satisfactory,  and  by  January  30th,  the  parts  had  united  with  very  little  deformity.  llc!  was 
discharged  from  service  January  12th,  183'3,  and  from  hosj)ital  on  Feliruary  2(>tli.  The  records  of  the  Pension  Office  state  that 
in  July,  186.5,  Blanchard  was  a pensioner;  that  he  was  restricted  to  soft  diet,  and  was  badly  di.sfigured.  His  disability  was 
rated  total  and  pennanent. 

Ca.se. — Private  Rowland  W , Co.  E,  4th  New  York  Heavy  Artillery,  aged  46  ye.ars,  was  wounded  at  Ream’s  Station, 

Virginia,  August  25th,  1864,  by  a fragment  of  shell,  which  destroyed  and  completely  carried  aw.ay  the  inferior  maxillary  bone 
and  soft  parf.s,  commencing  two  inches  anterior  to  the  angle  on  the  right  side,  ciirrying  away  the  chin  and  all  the  soft  ])arts  down 
the  neck,  on  a level  with  the  hyoid  bone,  destroying  the  floor  of  the  mouth  conqiletely,  allowing  the  tongue  to  i)rotrude 
and  hang  (lown  on  the  neck  ; deglutition  and  ai-ticulation  were  im|)ossible.  Three  of  the  right  lower  incisor  teeth,  with  the 


374 


WOUNDS  AND  INJURIES  OF  THE  FACE 


[Chap.  II, 


corresponding  nlreoli  loosely  connected  with  the  tissue,  remained,  and  were  allowed  to  stay  in  that  position  until  the  healing 
])rocess  to(dc  place*,  as  they  gave  a partial  siii>i)ort  to  the  tongue  and  siihinaxillary  gland,  which  was  not  injured.  The  wound 
extended  acro.ss  to  the  left  side,  carrying  away  all  the  teeth  and  jaw  bone,  except  those  previously  mentioned,  to  a point  as  high 
up  as  the  angle  of  the  inferior  maxillary  on  the  left  side.  He  was  admitted  to  Lincoln  Hospital,  Washington,  August  28th,  1864. 
His  general  health  was  bad  from  .scurvy.  The  patient  did  well,  and  improved  rapidly.  On  December  9th,  he  was  furloughed 
for  thirty  days,  and,  at  the  exjiiration  of  his  furlough,  he  was  readmitted  to  hospital  in  good  condition.  On  January  20th,  1865, 
an  operation  was  perbmned  to  construct  a floor  for  the  mouth — no  anaesthetic  was  used.  Pi-eliminary  to  the  operation,  twp 
molar  teeth  were  extracted  from  the  right-hand  fi'agment  of  the  lower  jaw.  An  incision  was  made  two  and  a half  inches  in 
length  down  the  median  line  of  the  neck,  terminating  one  inch  above  the  thyroid  cartilage.  Two  lateral  incisions,  one  upon 
e.ach  side,  of  equal  length,  right-angled  to  the  vertical  incision,  these  incisions  corresponding  to  the  bas(!  of  the  jaw.  These  flaps 
were  then  carefully  dissected  up,  brought  together  .at  the  middle  incision,  and  secured  by  three  hare-lii)  needles,  the  parts  being 
su])i)orted  by  adhesive  straps.  Frequent  application  of  dry  lint  was  made  to  ])rotect  the  parts  from  the  injurious  effects  of  the 
saliva,  wliicli  was  being  constantly  secreted.  The  healing  ])roceedcd  rapidly,  the  parts  uniting  by  first  intention.  Power  of 
articulation  and  degnstation  was  much  imjiroved.  Tlie  needles  were  removed  on  the  third  day.  On  April  22d,  1865,  the  jjarts 
being  in  a favorable  condition,  ether  was  administered,  and  a second  operation  was  performed.  Two  incisions,  one  on  the  right 
and  one  on  the  left,  j)arallel  to  the  inferior  border  of  the  inferior  maxillary  bone,  each  three  inches  in  length,  severed  both  the 
facial  arteries,  which  were  secured  by  ligatures.  The  upper  flaps  were  carefidly  dissected  up,  .as  far  back  as  the  angle  of  the 
jaw  upon  each  side.  The  anterior  edges  of  these  flaps  were  freely  incised,  as  well  as  the  superior  edge  of  the  parts  remaining 
after  the  first  o])eration.  The  Haps  were  then  brought  into  apposition  and  ret.ained  by  four  hare-lip  needles,  two  in  the  upper 
flap  forming  the  lip,  .and  one  upon  each  side,  uniting  the  lower  edge  of  the  flap  to  the  freshened  edge  of  the  p.arts  after  the  first 
operation.  Dry  lint  dressings  were  applied,  and  the  patient  was  fed  through  a gum  catheter.  The  hare-lip  pins  were  removed 
from  th(^  longitudinal  incision  on  the  third  day,  the  others  being  removed  on  the  fourth  day,  at  which  time  the  remaining  pins, 
together  with  all  the  sutures,  were  removed,  the  parts  being  supported  throughout  the  remainder  of  the  treatment  by  strtips  of 
adhesive  plaster.  On  the  morning  of  the  27th  of  A])ril,  secondary  hfemorrhage  occurred  from-the  left  facial  artery,  which  was 
readily  controlled  by  digital  compression.  Owing  to  the  constant  secretion  of  saliva  from  the  sublingu.al  gland,  which  was 
carefully  ])reserved  during  the  operation,  a slough  was  produced  at  the  junction  of  the  inferior  angle  of  tin;  flaps.  This  was 
checked  by  the  application  of  a weak  solution  of  nitric  acid.  On  June  23d,  tin*  patient  was  discharged  at  his  own  request.  A 
fistulous  orifice,  one-fourth  of  an  inch  in  diameter,  only  remaining,  in  consequence  of  the  constant  secretion  of  saliva  from  the 
soblingu.'d  gland,  which  prevented  the  parts  from  closing  by  granulation.  He  is  able  to  articulate  quite  plainly,  which  he  h.as 
hitherto  been  unable  to  do  since  the  date  of  his  injury.  Until  the  completion  of  this  operatioiuthe  patient  was  compelled  to  assume 
a recumbent  position  to  receive  his  nonrislnnent,  or  even  a swallow  of  ^vater.  He  can  now  take  his  food  and  drink  without  any 
<lifiiculty,  in  an  erect  postuie.  By  the  use  of  a rubber  button,  properly  adjusted  to  the  fistulous  orifice,  the  secretion  of  saliva 

was  prevented  from  making 
its  exit  externally.  The  ap- 
pearance of  the  patient,  both 
before  and  after  operation, 
is  shown  by  photographs 
Nos.  1G7,  168,  169,  170  and 
183,  Surgical  Series,  A.  M. 

M.  The  photographs  were 
printed  from  negatives  jjre- 
pared  at  Lincoln  Hospital, 
under  the  direction  of  Sur- 
geon J.  Cooper  ItIcKee,  U. 

S.  A.,  who  w.as  the  oper.ator 
in  this  case.  On  November 
8th,  1839,  Ward  forwarded 
a letter  to  the  Surgeon 
General  in  leference  to  a 
l)ension.  He  wrote  th.at  ho 
was  obliged  to  live  on  milk 
diet.  The  letter,  with  pho- 
tographs iuul  a history  of 
b.is  case,  was  forwarded  to 
the  Pension  Office.  He  is 
a i)ensioner. 


Fio.  1G5. — Gunshot  laceration  of  chin.  (From  photograph 
186,  S.  .8.  A.  M.  M.) 


Fig.  166. — Successful  chciloplastic  operation  for 
gunshot  injurj*.  (From  photograph  170,  S.  S.  A.  M.  M.) 


Cask. — Private  Elbert  Hewitt,  Co.  C,  6th  Vermont  Volunteers,  aged  22  years,  was  wounded  at  Winchester,  Virginia, 
September  19th,  1864,  by  a fragment  of  shell,  whieh,  coming  from  the  left,  struck  his  month,  carrying  away  the  upper  and  lower 
front  teeth,  lacerating  the  under  lip  near  the  right  angle  of  the  mouth,  and  laying  open  the  right  cheek  from  the  mouth  to  near 
the  angle  of  the  jaw.  The  nose  and  upper  lip  were  also  split  vertically.  The  lower  jaw  was-also  fractured  at  the  symphysis. 
He  was  tre.ated  in  the  field  hospital  until  September  27tb,  when  he  w.as  admitted  to  the  hospital  at  Frederick,  M.aryland,  where 
simple  dressings  were  apjdied  to  the  wound.  On  November  19th,  he  w.as  transferred  to  St.  Joseph’s  Hospital,  New  York,  whence 
he  was  furloughed  qn  December  23th,  1834,  and  re.admitted  to  hospital  on  January  25th,  1865.  The  injured  ptirts  had  all 
picatrized.  The  mouth  had  contracted.  The  right  half  of  the  under  tip  was  drawn  in  and  adhered  closely  to  the  jaw  from  the 


SlXT.  III.] 


PLASTIC  OPERATIONS. 


375 


nlvoolar  niargin  ta  tlio  chin.  When  the  month  was  shut,  a dcci)  notch,  ca]i.ahlc  of  lodging:  tlic  forcfin£];('r,  occnjiu'd  the  ria;ht  half 
of  the  lower  li|),  and  allowed  the  saliva’ to  escape  constantly.  The  ni)i)er  lip  was  shortened  transveisely  hy  linear  cicatrix.  The 
right  angle  of  the  mouth  puckered,  from  which  a curved  linear  cicatrix  extended  towar<l  the  angle  of  the  jaw.  The  two  halves 
of  the  lower  jaw  were  approximated  in  consequence  of  the  loss  of  bone  at  the  seat  of  fracture.  On  February  2Sth,  1865,  ether 
having  been  administered.  Dr.  Gurdon  Buck  performed  the  following  operation  : The  adhesions  between  the  under  lip  and  jaw 
were  divided  throughout  their  whole  extent.  A vertical  incision  was  then  carried  through  the  middle  of  the  lip  to  a point  below 
the  chin,  within  one  finger’s  breadth  of  the  os  hyoides ; another  incision,  commencing  at  the  right  angle  of  the  mouth,  was  carried 
downward  in  a converging  line  to  join  the  first  at  its  termination.  The  included  triangular  patch,  consisting  chielly  of  cicatricial 
tissue  was  removed.  The  remaining  left  half  of  the  lip  was  dissected  up  from  the  jaw  laterally  to  a point  beyond  the  angle  of 
the  mouth,  and  inferiorly  to  a line  below  the  edge  of  the  maxilla.  Thus  detached,  it  could  be  glided  toward  the  right  side.  To 
supply  the  deficiency  thus  created  by  the  removal  of  the  right  half  of  the  lip,  an  incision  was  made  transversely  through  the 
entire  thickness  of  the  right  cheek  from  the  angle  of  the  mouth  to  within  a finger’s  hreadth  of  the  edge  of  the  masseter  muscle. 
From  the  latter  point,  a second  incision  was  carried  downward  and  a little  forward  over  the  edge  of  the  jaw,  to  a juiint  on  the 
same  level  as  the  lower  angle  of  the  space  to  be  filled  up.  The  quadrilateral  Hap  thus  formed  was  dissected  u[)  from  tin;  jaw 
and  upper  part  of  the  neck,  and,  being  brought  forward,  was  adjusted  to  the  left  half  of  the  lip  by  a twisted  suture  inserted  netir 
the  vermilion  border,  and  by  several  interrupted  thread  sutures  below.  In  its  new  situation,  the  mucous  membrane,  lining  the 
upper  half  of  the  flap  to  the  depth  of  an  inch,  confronted  the  denuded  surface  of  the  jaw,  from  which,  in  the  earlier  steps  of  the 
operation,  the  adherent  cicatrix  had  been  removed.  To  form  a new  labial  border  for  the  transjiosed  fla)),  a prism-shajied  strij) 
of  tissue  was  excised  from  between  the  skin  and  mucous  membrane  above  the  nj)per  edge  of  the  flap,  and  the  mucous  membraiui 
lapped  over  it  and  secured  to  the  skin  by  fine  stitches  inserted  close  to  each  other.  In  order  to  extend  the  mouth  toward  the 
right  side  it  was  necessary  to  prepare  the  fresh  cut  edge  of  the  cheek  above,  on  a line  with  the  upper  lip,  in  the  same  manner  as 
just  described,  and  to  the  extent  of  five-eighths  of  an  inch  beyond  the  limit  of  the  lip.  At  the  point  where  the  new  angle  of  the 
mouth  was  to  be  established,  the  edges  of  the  divided  cheek  above  and  below  were  accurately  confronted  throughout  their  entire 
thickness,  and  secured  by  a single  twisted  suture;  interrupted  sutures  were  employed  to  secure  the  remainder  of  these  edges. 
The  reconstruction  of  the  lip  being  thus  accomplished  there  still  remained,  to  complete  the  operation,  a space  to  be  covered,  from 
which  the  cheek  flap  had  been  transposed  to  supply  the  lip.  This  was  done  by  prolonging  the  horizontal  incision  of  the  cheek 
toward  the  ear  an  inch  and  a half  through  the  skin  only,  dissecting  up  the  included  angle,  and  gliding  it  forward  to  fill  the 
vacant  space,  which  it  did  without  stretching.  Interrupted  sutures,  closely  inserted,  were  employed  to  secure  it  in  its  new 
location.  But  few  vessels  required  to  be  ligated.  Special  care  was  taken  in  the  new  adjustment  of  the  parts,  that  there  should 
be  no  strain  on  the  sutures,  and,  in  order  to  render  the  adjustment  as  (perfect  as  possible,  the  sutures  were  everywhere  inserted 
in  close  proximity,  with  the  intention  of  removing  the  alternate  ones  at  the  exi>ir;\tion  of  twenty-four  hours.  The  loss  of  blood, 
though  considerable,  did  not  produce  extreme  depression  of  the  pulse.  The  operation  occu])ied  about  three  hours,  frecpient 
interruptions  being  necessary  to  keep  up  the  effects  of  the  ethei-.  No  adhesive  straps  were  employed.  Tepid  water  dressings 
were  directed.  During  the  three  days  succeeding  the  operation,  the  swelling  of  the  parts,  though  considerable,  was  not  excessive, 
and  febrile  reaction  was  moderate.  After  that  the  swelling  began  gradually  to  diminish.  At  the  expiration  of  the  first  twenty- 
four  hours,  the  alternate  sutures  were  removed,  and  every  day  following  additional  ones  were  got  rid  of  at  points  where  they 
could  be  safely  dispensed  with.  On  the  sixth  day,  all  the  sutures  had  been  removed,  and  union  by  adhesion  bad  taken  place 
throughout  every  part  of  this  extensive  wound.  The  only  point  where  su|)puration  occurred  was  at  the  lower  angle  of  th(( 
wound  under  the  chin,  which,  however,  was  not  of  long  duration.  Before  the  expiration  of  the  second  week,  the  ])atient  had 
left  his  bed  and  was  about  the  ward.  He  regarded  his  condition  as  very  materially  improved.  The  saliva  no  longer  passed 
uncontrolled  from  his  mouth.  Articulation  and  mastication  were  very  much  ameliorated.  Both  lips,  for  want  of  the  su])i)ort  of 
the  front  teeth,  fell  in,  and  the  symmetry  of  the  mouth  itself  was  considerahly  disturbed,  three-fifths  of  its  length  being  situated 
to  the  right  of  the  median  plane  and  two-fifths  to  the  left.  On  April  16th,  he  was  transferred  to  the  Governor  Smith  Hospital, 
Brattleboro’,  Vermont,  and  discharged  from  service  on  July  ‘Joth,  1805.  On  December  12th,  1805,  he  was  induced  to  ent(!r  the 
N(!W  York  Hospital,  with  a view  of  having  an  operation  jierformed  for  the  improvement  of  the  mouth;  preliminary  to  which, 
Mr.  J.  A.  Bishop,  of  New  York,  ingeniously  adapted  a plate  of  vulcanite  to  both  jaws  that  would  supply  the  deficient  front  teeth 
and  aftbi’d  support  to  the  lips.  On  January  9th,  1800,  the  second  operation  was  performed  by  Dr.  Gurdon  Buck,  the  object 
being  to  extend  the  mouth  about  five-eighths  of  an  inch  on  the  left  side,  so  as  to  restore  its  symmetry  to  a good  degree.  The 
angle  of  the  mouth  was  circumscribed  by  an  incision  along  the  vermilion  border,  involving  about  five-eighths  of  an  inch  of  the 
upper  and  lower  lip.  A double-edged  knife  was  then  inserted  flatwise  at  the  angle  between  the  lining  membrane  and  the  cheek, 
and  the  lining  membrane  detached  in  the  direction  in  which  the  enlargement  was  to  be  made.  The  cheek  alone  was  then 
divided  with  strong  scissors,  in  a line  with  the  commissure  of  the  mouth,  to  the  extent  of  three-fourths  of  an  inch,  and  a narrow 
angular  strip  pared  off  from  the  fresh  cut  edges  above  and  below.  The  subjacent  mucous  membrane  was  next  divided  to  the 
same  extent,  and  the  newly  formed  angles  of  the  cheek  and  lining  membrane  secured  together  by  a twisted  pin  suture.  The 
remaining  edges  of  the  mucous  membrane  were  pared  and  adjusted  to  the  corresponding  edges  of  the  cheek,  and  were  both 
secured  together  by  fine  interrupted  sutures  inserted  close  to  each  other.  Everything  went  on  favorably  after  the  operation,  and 
the  result  was  highly  satisfactory  to  the  patient  as  well  as  to  the  surgeon.  He  is  a pensioner.  A cast,  representing  the  condition 
of  the  injured  parts  previous  to  the  first  operation,  is  numbered  265  of  the  Surgical  Section  of  the  Army  Medical  Museum. 
Another,  showing  the  patient’s  appearance  two  months  after  the  operation,^  is  numbered  485.  A third  cast,  taken  January  8th, 
1803,  prior  to  the  second  reparative  operation,  represents  substantially  the  same  condition.  These  casts  were  contributed  by 
the  operator.  A photogi-aph  of  the  case  is  numbered  282  of  the  Photogi-aph  Series  of  the  Army  Medical  Museum. 

Case. — Private  Carleton  B , Co.  B,  Purnell’s  Maryland  Legion,  aged  20  years,  was  admitted  into  the  hospital  at 

Frederick,  August  4th,  1802,  in  a prostrated  condition.  He  had  a bed-sore  over  the  sacrum;  his  body  was  bathed  in  sweat  and 
covered  with  sudamina.  His  tongue  was  dry  and  his  teeth  covered  with  sordes.  It  was  reported  that  he  had  been  sick  in  camp 
since  June  5th,  and  that  he  had  recently  taken  as  treatment  for  pneumonia,  two  scruples  of  calomel,  onescruplt!  of  mercury  with 


376 


WOUNDS  AND  INJURIES  OF  THE  FACE, 


[Chai-.  II, 


Fig.  Appearance  of  patient  -with  loss  of  ii])per  maxilla 
and  soft  tissues,  from  sloughing,  prior  to  operation.  .Soe  casts 
and  jdiotograplis,  A.  BI.  M.,  No.  4Go5,  Sect.  I. 


chalk,  and  sixty-live  grains  of  blue  pill.  Stimulants  and  nutritious  diet 
were  administered.  On  August  Gth,  a jagged  ulcer  was  discovennl  on 
the  right  edge  of  the  tongue.  On  the  lOlh.  a slough  ajipeared  on  the  gum 
at  the  root  of  the  right  upper  bicuspid  tooth.  The  ulci'r  rapidly  extended 
to  the  cheek  and  the  roof  of  the  mouth  ; by  the  21st,  it  had  nearly  reached 
the  orbit,  the  entire  upper  maxilla  being  exposed.  From  this  date,  the 
parts  gradually  assumed  a healthy  action,  and,  by  the  27th,  ulceration 
had  entirely  ceased.  It  was  then  close  to  the  eye,  and  had  removed  the 
right  ala  of  the  nose  and  the  right  half  of  the  upper  lip  from  the  angle 
of  the  mouth,  beyond  the  median  line,  on  the  left  side.  On  October  1st, 
the  entire  right  superior  maxill.a,  the  vertical  plate  of  the  palate  bone, 
and  a narrow  strip  of  the  left  maxilla,  being  quite  separated  from  the 
healthy  bone,  were  removed  (Fig.  171).  The  great  loss  of  substance  on 
the  right  side  of  the  face  caused  frightful  deformity.  The  right  eye  \vas 
destroyed  and  sunken ; the  right  half  of  the  upper  lip,  the  right  ala  of  the 
nose,  and  the  adjacent  portion  of  the  cheek,  besides  the  right  superior 
maxillary  bone,  were  gone,  leaving  an  exten- 
sive opening  directly  into  the  cavity  of  the 
mouth  and  right  nasal  fossa.  The  margin  of 
the  opening,  which  was  everywhere  cicatrized, 
was  constituted  below  and  outwardly  by  the 
border  of  the  lower  lip,  which  was  stretched 
obliquely  upward  and  outward,  and  termi- 
nated at  the  malar  bone,  where  the  superior 
maxilla  had  separated  from  it  and  where  it 
was  closely  adherent.  From  this  point,  which 

corresponded  nearly  to  the  middle  of  the 
, , , . , , , , Fig.  1()8. — Cap  for  holding 

cheek,  tlie  margin  extended  upward  and  uproof-piece  (Fig.  169.  From 


Fig.  169.— Artificial  roof  of  mouth,  with  teeth. 
(From  a photograph  furnished  by  ilr.  Gunning.) 


inward,  in  a curved  direction,  to  the  side  of  the  nose,  approaching  within  a finger’s  breadth  of  the  a.  P^iotograph  from  Mr.  Gun- 
inner  canthus,  and  continuing  thence  downward  along  the  ridge  of  the  nose,  a little  to  the  right 

of  the  median  line,  and  terminating  at  its  tip.  The  columna  nasi  being  destroyed,  the  left  ala,  and  the  rounded  margin  of  the 
left  half  of  the  lip,  which  terminated  nearly  exactly  at  the  median  line,  constituted  the  limit  of  the  opening  on  this  side.  About 

three-fourths  of  an  inch  of  the  vermilion  border  of  the  lower  lip,  at  its  right  extremity, 
appeared  to  have  belonged  to  the  upper  lip,  and  to  have  assumed  its  present  position, 
in  a continuous  line  with  the 
lower  lip,  in  consequence  of 
the  adhesions  which  had 
taken  place  in  the  cicatriz- 
ing process.  The  integu- 
ment and  subjacent  tissues 
were  supple  throughout  the 
margin,  up  to  the  line  of 
their  adhesion.  The  walls  of  the 
cavity  exposed  to  view  by  this 
opening,  presented  the  following  : 
inward,  toward  the  median  line,  was 
the  septum  nasi,  deflected  somewhat 
toward  the  left  side,  incomplete 
anteriorly  and  inferiorly,  where  its 
cartilaginous  portion  had  been  de- 
stroyed, and  where  the  anterior 
portion  of  the  inferior  turbinated 
boiK!,  with  the  passage  to  the  nasal 
duct  of  the  left  side,  is  seen.  Upward, 
the  scrolled  inferior  edge  of  the  middle 
turbinated  bone  presented  itself.  The 
outer  wall  was  a smooth,  uniform  surface, 
which  was  lost  below  in  the  general 
cavity  of  the  mouth;  the  floor  of  the 
cavity  was  occupied  by  the  tongue.  The 
jiosterior  portion  of  the  bony  palate,  con- 
stituted by  the  palatine  process  of  the 
palate  hone,  presented  its  free  anterior 
edge  cicatrized  and  stretching  horizon- 
tally across  the  middle  of  the  cavity 


Fig.  170. — Nose-iiiece  devised  by  Mr. 
T.  It.  Guuiiiiig.  (From  a photograph.) 


Fl(i.  171. — Inferior  maxilla  ex- 
fiiliated  utter  disease.  Xpec.  Go7, 
Sect.  1,  A.  M.  M. 


Fig.  179. — Appearance  of  Burgan  after  the  fifth  and  final 
operation.  (After  photographs  and  i)laster  casts  presented  by 
Dr.  Buck.) 


Sect.  III.] 


PLASTIC  OPERATIONS. 


377 


posteriorly.  The  line  of  separation  between  the  two  superior  maxillary  bones  having  taken  place  a little  to  the  left  of  tlie 
median  suture,  the  left  middle  incisor  tooth  had  been  carried  away.  The  lining  membrane  of  the  cavity  presented  everywhere 
a remarkably  healtby  appearance.  The  palatine  process  of  the  palate  bone,  with  the  velum,  having  escaped,  deglutition  was 
jierformed  without  disturbance ; his  speech,  howeVer,  was  very  indistinct,  and  resembled  that  of  an  individual  with  a bad 
cleft  palate.  A pulfy  condition  was  observed  below  the  inner  half  of  the  lower  lid  of  the  right  eye,  connected,  probably, 
with  chronic  irritation  of  the  lachrymal  sac ; the  puncta,  though  open,  and  admitting  a fine  probe,  did  not  allow  it  to 
pass  on  into  the  sac.  On  December  22d,  Burgan  was  discharged  from  service  to  go  to  New  York  City,  entering  the 
City  Hospital  on  December  31st,  where  a plan  was  devised  for  the  restoration  of  the  jiarts  destroyed.  Before  commencing 
the  operation,  dental  fixtures,  partly  temporary,  were  ingeniously  constructed  by  Mr.  Thomas  B.  Gunning,  of  New  York, 
and  fitted  to  the  cavity  f)f  the  tnouth  to  afford  solid  support  to  the  soft  parts  that  were  transferred  for  the  reconstruction 
of  the  mouth,  and  the  closure  of  the  cheek  and  nostril.  Fixtures,  in  three  parts,  were  made  of  vulcanite,  two  principal 
and  one  supjdementary.  The  upper  ])iece  filled  out  the  right  half  of  the  nose ; the  lower  piece  formed  an  artificial  palate ; 
the  third  part  connected  with  the  ludate  piece  by  bent  spiral  wire;  the  patient  wore  them  two  weeks  prior  to  the  first 
o))eration.  On  March  2Gth,  ether  having  been  administered,  the  first  operation  was  performed,  which  consisted,  first,  in 
liberating  and  shaping  the  left  half  of  the  upper  lip ; second,  in  suppljdng  material  for  the  right  half  of  the  lip ; third,  in 
bringing  forward  the  middle  and  lower  portions  of  the  right  cheek,  and  adapting  them  to  the  newly  transposed  neighboring 
half  of  the  mouth.  Nothing  further  was  attempted  at  this  operation.  It  occujiied  at  least  two  hours  and  a half;  much  of  the 
time,  however,  was  employed  in  the  rcadministration  of  the  ether  to  keep  the  patient  quiet.  No  adhesive  plasters  were  applied, 
the  sutures  being  exclusiv(dy  relied  on.  Warm  water  dressings  were  directed  to  the  pai  ts.  On  Ajtril  23d,  the  parts  involved 
in  tbe  first  operation  being  free  from  swelling  and  having  regained  their  suppleness,  a second  operation  was  ])erformed,  the 
object  of  which  was  to  improve  the  mouth  by  extending  it  toward  the  right  side  and  converting  the  circular  turn  into  an  angle, 
which  was  accomplished  while  the  patient  was  under  the  infiuence  of  ether.  On  June  18th,  a third  operation  w’as  perlbrmed  to 
close  the  remaining  opening  in  the  cheek  and  cover  the  side  of  the  nose  with  a llap  from  the  forehead,  which  was  also  accom- 
plished while  the  patient  was  under  the  influence  of  ether.  On  August  8th,  an  operation  was  performed  to  remove  the  deformity 
at  the  root  of  the  uo.se,  resulting  from  the  jn-evious  operation,  and,  on  October  27th,  another,  to  remove  a furrow  and  notch  in 
the  nose.  In  .June,  18o4,  Burgan  enjoyed  good  health,  and  had,  for  several  months,  been  able  to  discharge  efficiently  the  duties 
of  an  assistant  nurse  in  a large  ward  of  the  New  York  no.spital.  The  hypertrophied  condition  of  the  nasal  ])atch  still  persisted, 
and  might  be  regarded  as  a permanent  condition  ; quite  the  reverse  of  what  was  anticipated,  it  had  the  advantage  of  maintaining 
the  side  of  the  nose  in  a plump  form.  When  the  patch  was  piicked  the  sensation  was  no  longer  referred  to  the  forehead  as 
at  first,  but  to  the  jiarts  irritated.  The  cicatricial  bands  on  the  inside  of  the  mouth  had  been  kept  from  contracting  by  the 
persevering  eftbrts  of  the  patient,  who  had  faithfully  executed  the  directions  given  him  on  the  subject,  which  were  to  introduce 
one  or  two  fingers  into  the  mouth  and  stretch  the  bands  to  their  utmost  endurance,  and  rejieat  the  jirocess  several  times  daily. 
The  only  dental  fixture  worn  by  the  patient  .at  that  time  was  the  principal  jiiece,  which  covered  the  roof  of  the  mouth  and 
sujijilied  the  lost  teeth  of  the  right  ujijier  maxilla  (FiG.  1G9).  It  was  worn  constantly  with  entire  comflu’t,  and  was  removed  and 
replaced  at  jile.asure.  When  the  moutli  was  open  to  its  fullest  extent,  the  forefinger  could  be  introduced  edgewise  between  the 
front  teeth.  Mastication  of  all  descrijitions  of  food  was  performed  with  facility.  The  sjieech,  which,  without  the  dental  fixture, 
was  hardly  intelligible,  scarcely  betrayed  any  defect  when  it  Avas  worn.  An  artificial  eye  was  adapted  to  the  right  orbital 
socket,  and  was  worn  by  the  patient  a jjart  of  the  time.  A colored  plaster  cast  of  his  face  was  prepared  previous  to  the  patient’s 
discharge,  and,  with  the  pathologic.al  specimen,  consisting  of  the  greater  portion  of  the  right  superior  m.axilla,  showing  necrosis, 
was  contributed  to  the  Army  Medical  Museum  by  Assistant  Surgeon  R.  F.  Weir,  U.  S.  A.,  and  is  numbered  557  of  the  Surgical 

Section.  A detailed  history  of  the 
case  by  the  ojierator.  Dr.  Gurdon 
Buck,  will  be  found  in  an  illustrated 
jiajier  in  the  Transtvetions  of  the 
New  York  State  Medical  Society, 
for  18G4,  jiage  173.  Burgan  tvas  a 
j)ensioner  in  December,  1871.* 


Case. — Private  John  W- 


I’lG.  173. — Defiirmity  after  gunshot  wounds  of  the 
face.  (From  a pliotograph.) 


Co.  C,  140th  New  York  Volunteers, 
aged  24  years,  was  wounded  at  the 
Wilderness,  May  5th,  1864,  by  a 
colloidal  ball,  which  entered  the. 
right  side  of  the  face,  midway  be- 
tween the  eye  and  the  ujiper  lij), 
passed  dotvinvard  and  outward, 
emerging  on  the  left  side  of  the  face, 
immediately  below  the  malar  bom*, 
producing  a comjiound  fracture  of 
the  superior  maxilla,  tind  destroy- 
ing the  four  front  teeth,  eye-tooth, 
and  three  large  teeth  on  the  left 
side,  with  their  alveolar  jirocesses, 
and  p.art  of  the  ji.alate  process.  He 
received  also  a wound  in  the  leg. 


Flo.  174. — Result  of  a plastic  operation  in  the 
ease  fiiruml  in  No.  ]73. 


*^Tlie  case  is  fig-nrcd  in  Prof.  Oito'h  paper,  '’^Me.tUode.n  dvr  plasfuchen  chirurfjiv,"  in  VON  PlTHA  uiul  P.lLMiOTII,  Cliirurf/iv,  Hd.  I II,  2 II<*ft,  S.  142. 

48 


378 


WOUNDS  AND  INJUEIP]S  OF  THK  FACK, 


[ClIAl*.  II, 


On  Fcbniai'V  24tli,  IKif),  lii*  was  adinittcil  to  Carver  llosjjital,  Wasliingtoii.  The  woiiinl  was  eiilirely  liealed  when  adnnttecl, 
hnt  tin!  cieatrix  ]H()dnced  great  deforniity  of  the  npjier  lip,  interfering  with  jiroper  iirtieidation.  On  Marelj  Stl],  Surgeon 
O.  A.  Jndson,  U.  S.  A.,  decided  to  operate,  and  liaving  etlierized  the  patient,  made  an  incision  from  wound  of  entrance  down- 
ward through  the  n])per  lip  and  a large  portion  of  the  cicatrix.  The  adhesions  that  were  found  heneath  were  dissected  up, 
and  the  ]iarts  hiought  in  apposition  hy  pin  sutures.  Simple  dressings  were  apjdied  to  the  wound.  The  case  progressed 
favorahly,  and,  hy  March  22d,  the  wound  had  nearly  healed  hy  first  intention.  The  lip  presented  a much  better  appearance, 
the  articulation  was  greatly  improved,  and  the  patient  could  readily  partake  of  solid  food.  On  April  8th,  he  was  transferred  to 
Mower  Hospital,  riiiladelphia,  whence  he  was  discharged  from  service  on  .June  24th,  18C5.  On  January  3d,  186G,  Pension 
Examiner  11.  T.  IMontgoinefy  reports  “a  large  opening  from  month  to  nose;  great  permanent  deformity  of  face;  voice  and 
mastication  impaired.”  He  rates  his  disability  three-fourths,  partly  hy  reason  of  the  wound  of  the  foot. 

Ca.sk. — Private  Edgar  M.  Chaney,  Co.  A,  32d  AVisconsin  Volunteers,  aged  29  years,  was  wounded  in  an  engagement  on 
the  Comhahee  Diver,  South  Carolina,  February  3d,  1865,  hy  a conoidal  hall,  which  entered  over  the  right  malar  hone,  and, 
]iassing  obliquely  down  to  the  left,  tore  up  the  attachment  of  the  tarsal  cartilage  near  the  inner  canthus,  destroyed  the  substance 
of  the  lower  eyelid,  passed  through  the  nose,  separated  a part  of  the  right  alar  cartilage  and  septum  nasi,  and  emerged  nearly 
ujion  the  bridge  of  the  nose,  half  an  inch  from  its  point.  He  was  conveyed  to  Beaufort,  and,  on  February  Clh,  adnutted  to 
ilivisiou  No.  1 hospital.  On  February  24th,  he  was  transferred  to  Grant  Hospital,  New  York  Harbor,  and,  on  April  17th,  to 
H arvey  Ho.spital,  Madison,  Wisconsin.  When  admitted  his  constitutional  condition  was  good.  The  right  alar  cartilage  was 
(h-awn  up  belotv,  so  as  to  stand  !it  the  hiidge  half  an  inch  higher  than  the  septum  nasi,  while  attachment  at  its  base  was  natural ; 
the  left  alar  c.artilage  was  somewhat  drawn  up  at  the  apex  of  the  nose  ; the  right  lower  eyelid,  drawn  down  and  outwiird,  was 
attached  to  the  right  malar  hone  and  everted,  with  a large  fold  of  its  mucous  memhi'aue  presenting;  and  the  tar.sal  cartilage  h.ad 
united  hy  cellular  tissue  at  its  middle  third.  Rest  and  occasional  laxatives  having  improved  the  ]>atieut's  condition.  Surgeon  H. 
Culbertson,  U.  S.  V.,  decided  on  performing  a plastic  oper.atiou.  On  May  2d,  183.5,  chloroform  was  administered,  and  the 

nostrils  plugged.  An  incision  was  commenced  at  the  bridge  of  the  nose,  and 
carried  to  a level  with  the  cheek  through  the  right  aliir  cartilage  and  mucous 
membrane  of  the  nose,  and  which  extended  to  the  point.  The  cartilage  being 
then  depressed  to  its  natural  level,  another  incision  was  extended  through  the 
skin  and  cicatrices,  and  the  edges  of  the  wound  at  the  tip  of  the  nose  were 
freshened.  A flap,  with  much  cellular  tissue,  was  next  raised,  gently  twisted 
upon  itself,  and  secured  in  a bed  made  hy  depressing  the  separated  alar 
cartilage,  as  seen  at  a.  The  points  of  alar  cartilage  were  adjusted  and  secured 
by  one  suture  ; and  the  edges  of  the  gap  made  by  the  removal  of  the  flap 
were  approximated  hy  sutures.  An  incision,  parallel  with  the  lower  border 
of  the  orbit,  was  then  made,  and  the  cicatrix  removed,  and  the  remaining 
portion  of  the  lower  eyelid  brought  up  to  its  natural  position.  A flap  was 
afterwards  raised  as  deeply  as  superficial  fascia — but  broader  than  shown  in 
the  figure — reverted,  jJaced  in  situ,  as  seen  at  h,  and  secured  by  sutures.  The 
edges  of  the  wound  at  c were  api)roximated  ami  secured  by  sutures,  and 
additional  support  was  furnished  hy  adhesive  strips.  After  the  operation, 
the  patient’s  hands  were  secured  to  the  sides  of  his  bed,  a grain  of  morphine 
was  given,  lint  moistened  with  sweet-oil  was  apidied  over  the  pedicles  and 
margins  of  the  flaps,  aud  a slop  diet  was  ordered.  The  flap  beneath  the  eye 
united  by  first  intention,  and  also  a part  of  the  flap  of  the  nose ; the  other 
parts  of  the  latter  flaj)s  healed  by  granulation,  and  w'ere  ke|)t  in  situ,  by  fine 
jjins.  The  pedicles  were  divided  on  the  21st  day,  and  thrown  back  into  their 
original  beds — i.  e.,  tlie  part  of  flaps  not  required.  This  man  was  mustered 
out  of  service  on  June  8th,  1865.  The  lower  eyelid  was  nearly  natural  in 
appearance  ; the  nose  was  slightly  depressed  on  the  bridge,  and  the  beds  from 
which  the  flajis  were  taken  had  nearly  healed.  The  patient  tippeared  as  indicated  by  the  wood-cut,  on  which  the  lines  of  the 
incision  are  .also  traced. 

Case. — Private  A.  Gilbert,  Co.  B,  126th  Ohio  Volunteer.s,  aged  24  years,  was  wounded  at  the  Wilderness,  May  12th, 
18, k1,  by  a conoidal  l)all,  which  entered  the  left  side  of  the  face  .at  a point  corresponding  to  the  body  of  the  malar  bone,  passed 
inward  tind  forward,  and  emergcal  at  symphysis  of  superior  maxilla.  He  was  treated  in  field  hospital  until  May  16th,  when  he 
w:is  .sent  to  Lincoln  Hospital,  Washington,  where  simple  dressings  were  ai)plied.  The  wound  healed  rapidly,  leaving  an 
opening  through  the  iqiper  lip.  On  May  28th,  he  w.as  transferred  to  Mower  Hosjiital,  Philadeljdiia.  On  October  5th,  Dr. 
Morton  clo.sed  the  opening  in  the  upper  lip  by  t.aking  a flap  of  tissue  from  the  left  side  of  the  face  and  making  union  as  for  hare- 
lip. Water  dressings  were  .applied.  Gilbert  was  discharged  from  service  May  27th,  1865. 

Ca.sk. — I’rivate  llllliani  M.  Cool-,  Co.  K,  3d  Georgia  Regiment,  received,  at  Chancellorsville,  May  3d,  1863,  a wound  in 
the  face  by  a fragment  of  shell,  which  extensively  mutilated  the  ui)per  lip  and  nostrils.  He  was  admitted  to  Hospit.al  No.  1, 
Richmond,  Virginia,  where  a plastic  operation  was  performed  about  six  weeks  after  the  injury.  He  was  furloughed  on  August 
18th,  1863,  for  sixty  days,  and  afterward  returned  .to  duty  in  his  regiment. 

Cask. — Private  Robert  Spornitz,  Co.  B,  5th  Minnesota  Volunteers,  was  discharged  from  service  at  Fort  Ridgely,  Minne- 
sot.a,  on  October  24th,  1862,  on  account  of  a gunshot  wound  through  the  upper  jaw,  with  loss  of  all  the  upper  teeth,  received  in 
a fight  with  Indians.  The  operation  of  staphylorraphy  was  successfully  performed. 


Fig.  17.'). — Incisions  in  a plastic  ojieration  on  the  lower 
eye-lid  and  nose.  (From  a drawing  by  the  operator.) 


Skct.  III.] 


PLASTIC  OPERATIONS. 


379 


Plastic  Operations.— In  the  foregoing  tliirty  examples  of  plastic  operations,  the 
regions  in  which  attempts  at  reparation  were  made  were,  in  the  eyelids,  in  six  cases ; the 
nose,  in  five;  the  cheek,  in  three;  the  lips,  or  palate,  or  other  parts  about  the  mouth,  in ^ 
twelve  ; and  the  chin,  in  four  cases.  On  page  331,  another  instance  of  blepharoplasty  is 
cited,  and  on  page  348  an  unsuccessful  case  of  staphylorraphy.  Of  the  thirty-two  cases, 
twenty-nine  were  for  deformities  following  gunshot  injuries.  In  the  majority  of  the  cases 
a certain  measure  of  relief  was  afforded.  Dr.  Buck’s  operation  (p.  374)  must  be  reckoned 
among  the  chief  triumphs  of  modern  plastic  surgery.  The  history  of  Corporal  Henry 
Gibbs  (}L  370),  communicated  by  Surgeon  S.  F.  Forbes,  67th  Ohio  Volunteers,  subse- 
quently pension  examining  surgeon  at  Toledo,  Ohio,  is  extraordinary.  The  removal  of  the 
entire  lower  jaw  “without  any  apparent  external  deformity”  after  four  weeks,  is  a result 
rarely  achieved,  and  it  is  to  be  regretted  that  the  patient  is  not  registered  on  the  pension 
list,  and  that  casts  and  photographs  were  not  forwarded  with  the  history.  There  were 
other  cases  in  which  plastic  operations  on  the  face  were  contemplated  or  unsuccessfully 
attempted,  some  of  which  are  illustrated  by  photographs  in  the  Army  Medical  Museum,* 
where  the  distressing  deformities  produced  from  excessive  loss  of  tissue  about  the  soft 
parts  of  the  face,  prompted  surgeons  to  yield  to  the  solicitations  of  patients,  and  to 
intervene  with  but  slight  anticipation  or  hope  of  success.  There  were  other  examples  of 
gunshot  wounds  involving  the  ethmoid,  or  the  nasal  or  other  small  bones  of  the  nasal 
region,  or  the  upper  portions  of  the  superior  maxilla,  in  which  ugly  fissures  were  left, 
which  could  not  be  closed  because  of  the  protracted  suppuration  and  frequent  exfoliation 
of  minute  portions  of  bone.  Many  such  patients  have  presented  themselves  at  the 
Museum.  A remarkable  instance  is  recorded  on  p.  329  [ante),  the  case  of  Sergeant  Prince.f 
In  this,  and  in  several  similar  cases,  where  the  patients  were  examined  at  periods  from 
three  to  seven  years  after  the  reception  of  their  injuries,  it  was  found  that  the  incon- 
venience likely  to  be  caused  by  an  autoplastic  operation  would  scarcely  compensate  for  the 
possible  modification  of  external  deformity.  In  cases  in  which  the  patient  had  long 
respired  through  the  cloaca  leading  to  the  nasal  passages,  it  was  found  that  the  anterior 
nares  had  so  contracted,  from  disease,  that  a closure  of  the  traumatic  orifice  was  imprac- 
ticable, or  else  that  injuries  of  bone  involving  the  lachrymal  sac  or  its  canal  indicated 
that  any  operative  interference  would  be  almost  hopeless.  A study  of  the  sufficiently 
detailed  histories  of  cases  on  the  Pension  Polls,  and  personal  examinations  of  many 
patients  and  pensioners  mutilated  by  gunshot  wounds  of  the  face,  convince  me  that  the 
occasions  on  which  autoplastic  operations  are  likely  to  be  employed  advantageously  are 
few  in  number.  How  and  then,  by  removing  disorganized  parts,  and  paring  and  approx- 
imating the  sound  tissues  by  twisted  sutures,  favorable  results  may  be  attained.  But,  as 
a general  rule;  the  deformities  following  gunshot  wounds  of  the  face  and  suggesting  some 
plastic  procedure  are  either  accompanied  by  such  extensive  loss  of  tissue  or  chronic  disease 
of  the  osseous  structures,  as  to  forbid  any  hopeful  undertaking  in  the  way  of  reparative 
surgery.  Thus  the  records  of  gunshot  injuries  of  the  face  in  the  late  war,  nearly  ten 
thousand  in  number,  furnish  only  the  few  examples  above  enumerated.  Dr.  Chisolm 
{op.  cit.),  the  author  of  the  principal  systematic  treatise  on  military  surgery  in  the  Confed- 
erate service,  does  not  refer  to  the  subject,  and  from  the  accessible  sources  of  information 

* Photographs  of  Surgical  Cases  and  Specimens.  I’repared  by  15vt.  lA.  Col.  G.  A.  OTIS;  by  direction  of  the  Surg-eoii  General,  Washington, 
18(J5-1S7().  Vol.  I,  p.  ild;  Vol.  II,  pp.  2!),  30;  Vol.  Ill,  p.  3.");  Vol.  IV,  p.  36. 

t See  Photographs  of  Surgical  Cases,  etc.,  op.  cit.  Vol.  VII,  p.  12. 


380 


WOUNDS  AND  INJUKIES  OF  THE  FACE. 


[Chap.  II, 


regarding  the  surgery  in  the  Confederate  army  only  two , cases  are  to  he  gleaned. 

( Wyatt,  p.  370  ; Cook,  p.  378.) 

Surgeon  David  Prince,  U.  S.  V.,  writing,  in  1868,  an  ingenious  “brief  exposition 
of  Plastic  Surgery,”  does  not  advert  to  its  applications  in  military  surgery,  and  as  he  has 
evidently  carefully  studied  the  subject,  it  may  he  assumed  that  these  applications  are  few. 
Among  the  photographs  filed  in  the  Museum  are  several  in  which  unavailing  attempts 
have  been  made  to  close  apertures  in  the  cheek,  caused  by  the  perforation  of  musket  balls. 
Probably  the  incisions  were  made  through  the  inodular  cicatrical  tissue  bordering  the 
apertures,  and  had  it  been  practicable  to  extend  the  operations  by  “gliding,”  more 
successful  results  might  have  been  attained.  From  the  pensioners  at  the  Soldiers’  Home 
and  the  National  Asylums  for  Disabled  Volunteers,  no  instances  of  loss  of  tissue  from 
gunshot  wounds  have  been  reported  where  autoplastic  operations  could  be  undertaken 
with  reasonable  anticipations  of  success.* * 

A single  example  is  reported  of  an  attempt  at  otoplasty,  or  rather  otorrhaphy,  in  the 
case  of  a teamster  whose  ear  was  bitten  off’  in  a fight.  The  auricle  was  completely 
detached  and  was  covered  with  dirt.  It  was  immediately  washed  in  warm  spirits  and 
water  and  accurately  stitcheel  on  by  interrupteel  metallic  sutures,  and  covered  lightly  by 
carded  raw  cotton  and  bandaged.  But,  at  the  end  of  three  days,  there  was  no  attempt 
at  union,  and  the  detached  pinna  showed  no  sign  of  vitality. 

There  were  a few  instances  of  salivary  fistulse  following  gunshot  wounds.  Abstracts 
have  been  cited  of  the  histories  of  the  cases  of  Colonel  Guiney  (p.  330),  and  of  Private 
Hart  (p.  368).  The  complication  was  uncommon,  however,  the  laceration  produced  by 
the  projectile  usually  sufficing  to  obliterate  the  salivary  ducts.  In  the  few  cases  that 
occurred,-  the  ordinary  measures  of  treatment,  by  occlusion,  cauterization,  and  frequent 
dilatation  of  the  excretory  orifice  of  the  canal  of  Steno,  were  employed  with  success. 

Whatever  was  communicated  in  regard  to  the  methods  of  operating  in  the  autoplastic 
])rocedures  has  been  specified  in  the  abstracts  of  individual  cases.  The  precepts  of  Jobert 
appear  to  have  been  commonly  followed,  though  Dr.  Buck’s  extraordinary  operations 
abounded  in  original  expedients.  [Since  the  first  issue  of  this  volume  this  eminent  sur- 


* U is  .unnecessary  to  enlarge  <;n  the  literature  of  the  subject,  unless  to  indicate  to  medical  otiicers  the  principal  works  accessible  in  the  Librarj"  of 
ithc  Kurgeun  General's  Office,  among  others  the  7^7’inceps  edition  in  vellum  (1597)  of  Taliacotius,  the  "Venice  edition  of  Tagliacozzi,  and  several  more 
.modem  reprints  or  translations,  of  this  famous  llolognese  surgeon's  writings  and  plates,  and  DilTeubach’s  earlier  essays : 

Taliacotius,  De  curtoruvi  chirurgia  per  insitionem,  Veuet.,  1597;  PlEiiUS  (of  Antwerj’),  Lihri  chirurgici,  Tract  XII,  1G12;  Paulus  Aegineta, 
Tab.  VI,  Cap.  2G;  I'AlililClus  IllLUANUS,  Observat.  chirurg.^  Cent.  HI,  Obs.  :U ; SciiENiaus,  De  Narihus,  Obse^^^  8 ; AMBROSE  Pare,  translated  by  Tn. 
.JOIINSOX,  p.  526;  PALLOriUS,  De  decoratione.  Cap.  2;  SCHOlTI,  Italia  illustrata,  HilO;  Benedictus,  De  prax.  »icd.,  Lib.  IV,  Cap.  39;  GourmelenL’S, 
Chirurgia,  Lib.  I;  LEONARDO  FIORAV./VNTI,  llscgretti  de  Chirurgia ; BLEGNY,  Zodiacus  medico-gallicus,  Genevm,  1680;  Celbus,  De  re  mcdica.,  Lib. 
VII,  Cap.  IX;  Fabricius  (ab  Aquape..dcnte),  Op.  C/tri*.,  Cap.  Gl;  Blandix,  De  Vautoplastie,  Paris,  1836;  BLSUNAN,  Observations  on  the 

Restoration  of  the  Nose,  London,  1833;  Ammon  UND  Baumgarten,  Die  Plastische  Chirurgie,  Berlin,  1842;  Fritze,  Die  Plastische  Chirurgie,  Berlin, 
1845  (with  48  engravings);  JOBERT,  Traile  de  chirurgie  plastique,  Paris,  1849;  ZEIS,  Ilandbuch  der  2>lcistischen  Chirurgie,  Berlin,  1838;  MICHON, 
Menioirc  ci  observations  sur  quelqves  cas  d' autoplastic  de  la  face,  Paris,  1847;  Sl^DiLLOT,  De  V application  de  la  methode  anaplastique,  etc.,  Strasbourg, 
1845.;  Serre,  Traiti  sur  I'art  de  restaurer  les  diJformiUs  de  la  face,  Montpellier,  1842 ; Nasemann,  Questiones  de  rhinoplastice,  Halis,  1849 ; DROOP,  Dc 

*usu  iabii  sujyerioris  in  rhinoplastice,  Halis,  1844;  Labat,  De  la  rhinoplastie,  Paris,  1840;  Dieffenbach,  Die  Oqyerative  Chirurgie,  Leipzig,  1845; 
iCAiaMJE,  Account  of  two  successf  ul  Ox)eraiions,  etc.,  London,  1815 ; GarengeoT,  Traiti  dcs  operatioiis  de  chirurgie,  Paris,  1748 ; Weiseman,  De  coaliin 
parlium  a reliquo  cor  pore  pr  or s ns  disjunctiarum,  Lipsia?,  1824 ; BUNGER,  Gelungencr  Fall  einer  Nasenbilduvg,  in  v.  GraeiTS  und  V.  'VValTHER’s  Journal. 
Jld.  IV,  p.  5G9;  Laruey,  Clinique  Chirurgicale,  Paris,  1829,  T.  H,  p.  12;  SiMS,  Silver  sutures  in  Surgery,  New  York,  1858;  SkeY,  Operative  Surgery, 
ijd  cd.,  p.  521;  IIOLME.S,  A System  of  Surgery,  Vol.  V,  p.  558:  C.  F.  v.  Graefe,  lihinojylastik ; FlllCKE,  in  v.  Graefe  und  V.  Waltiieu’S  Journal,  Bd. 
tl2,  p.  45G;  FriEDUERG,  Chirurgische  KliniJc,  Jena,  1855;  Malgaigne,  Mid.  operat.,  1843,  p.  421 ; Erichsex,  Science  ami  Art  of  Surgery,  p.  G70; 
Albucasis,  Chirurgia,  Lib.  H,  Cap.  13  et  14;  ThevexiX,  Oeuvres,  Chap.  99,  ICO,  Paris,  1G59;  PLAINER,  InsUtutioncs  chirurg.,  Lips.,  1745,  Par.  580; 
'TT'IXTOR,  Ueber  Chciloidastilc,  Bd.  XXI,  Ileft  5 u.  6,  p.  49G;  CramptoX,  Essay  om  entropium,  London,  1815;  DELI’ECII,  Chirurgie  clinique,  Tom.  H,  p. 
587;  Caurox  DU  VlLLARD,  Jiestauratio7is  des  2)anpiires,  in  Gazette  dcs  hopitaux,  163G;  Sa^:S0N,  Journal  universelle  et  hebdomadaire,  No.  1G2,  u.  1G4, 
Nov.  1833;  BUST,  Ilandbuch  der  Chirurgie,  Bd.  IV,  p.  575;  Ciiopart,  Anaplastie  des  levres,  des  Jones  ft  des  paupidres,  Paris,  1841,  p.  CO;  Velpeau, 
Lanc.fran^,  gaz.  d'Hdpit.,  13,  Aout,  1840 ; MaisoXABE,  Clinique  sur  Ics  dijj'ormitis  dans  Vespece  humaine,  Paris,  1834,  Tom.  II,  ju  ICO ; BECK,  Ilandbuch 
der  Augenheilkunde,  Heidelberg,  1823;  DeSMARRKS,  Annales  d' Oculist,  Oct.  1843;  and  also  the  works  of  Syme,  Lakciier,  FOLLIX,  PARTRIDGE, 
NtLATOX,  Earle,  Coote,  SliE,  I\Iuller,  Teele,  Paxcoast,  Prince,  B.  Brown,  J.  M.  Warren,  Ollier,  Laxgenbrck,  Buchanan,  Cooper, 
Gensoul,  Ciielius,  Dzondy,  J.veger  (Vienna),  Baum,  Lisfuanc,  Dupuytrex,  Koux,  Lallemand.  Mouleau,  Tiiomain,  Hutchinson,  Davies, 
SvMic,  T’vRRicL,  Liston,  Hoefft,  Pirogoff,  Dvbeck,  and  Clot-Bev. 


Sect.  III.! 


CONCLUDING  OBSERVATIONS. 


381 


geon  has  contributed  to  the  Museum  a number  of  casts  and  photographs  illustrating  the  re- 
markable operations  that  he  has  accomplished  for  the  repair  of  deformities  from  shot  inju- 
ries of  the  face,  with  references  to  the  instructive  descriptions  that  he  has  published  in  the 
journals,  of  the  steps  of  these  difficult  and  ingenious  surgical  achievements.  In  the  Third 
Surgical  Volume  will  be  found,  in  Plate  XXXVIII,  a representation  of  an  interesting 
example  of  blepharoplasty  after  shot  injury.] 

Concluding  Observations  on  Wounds  and  Injuries  of  the  Face. — In  the  pre- 
ceding pages  abstracts  of  individual  cases  of  the  different  groups  of  this  category  have  been 
detailed  almost  without  commentary.  It  remains  to  examine  numerically  and  more  compre- 
hensively the  regional  distribution  of  the  various  injuries,  and  to  add  such  remarks  upon 
the  several  subdivisions  as  are  suggested  by  the  reports. 

In  Tables  XII  and  XIII,  statements  of  the  results  of  gunshot  fractures  and  flesh 
wounds  of  the  face  are  presented.  Table  XIV  contains  a summary  of  operations  after 
wounds  of  the  face,  and  table  XV  gives  a recapitulation  of  the  aggregate  results  of  injuries 
of  the  face  from  whatever  cause, — incised,  or  punctured,  or  lacerated,  or  contused,  or  gun- 
shot,— with  or  without  fracture,  that  appeared  on  the  returns  during  the  War  : 

Table  XII. 


Table  of  Three  Thousand  Three  Hundred  and  Twelve  Cases  of  Gunshot  Fractures  of  the 

Bones  of  the  Face. 


REGION. 

Cases. 

Died. 

Discharged. 

Dufy. 

Unknown. 

Inferior  maxilla 

1,  G07 

121 

779 

550 

157 

Superior  maxilla 

555 

42 

247 

228 

38 

Both  ma.xilla; 

1.57 

13 

8G 

46 

12 

Maxilla ; not  stated 

2G0 

33 

96 

80 

51 

Malar.  - 

218 

14 

95 

89 

20 

Nasal - 

93 

26 

53 

14 

• 

Palate 

17 

7 

7 

3 

Several  bones  implicated 

405 

117 

152 

101 

35 

Aggregates 

3,312 

340 

1, 488 

1, 154 

330 

It  appears  fiom  Table  XII  that  of  the  two  thousand  nine  hundred  and  eighty-two 
cases  in  which  the  results  were  ascertained,  11.4  per  cent,  died,  49.9  per  cent,  were 
discharged,  and  38.7  per  cent,  went  to  duty.  It  has  not  been  practicable  to  learn  how 
many  of  the  one  thousand  four  hundred  and  eighty-eight  discharged  men  were  pensioned ; 
but  we  can  judge  fairly  of  the  proportion  by  analyzing  the  one  hundred  and  thirty-eight 
abstracts  in  Section  II,  of  this  Chapter,  and  find  from  the  record  of  the  eighty-one  patients 
who  recovered,  that  forty-nine,  or  60.5  per  cent.,  'were  pensioned.  Hence  we  are  forced 
to  the  conclusion  that  gunshot  fractures  of  the  bones  of  the  face  are,  when  we  consider 
large  averages,  graver  than  writers  on  military  surgery  have,  heretofore,  admitted  ; for 


382 


AVOUNDS  AND  INJURIES  OF  THE  FACE. 


[Chap.  II. 


beside  the  considerable  rate  of  mortality  in  these  three  thousand  cases,  a large  proportion 
of  those  who  recovered  were  disabled,  and  invalided.  The  lodgment  of  balls  in  the 
maxillary  sinuses,  in  the  ethmoidal  and  sphenoidal  cells,  and  the  consequent  protracted 
suppuration,  necrosis,  and  exfoliation,  evulsion  of  teeth  with  inability  to  masticate,  and 
frequently  with  the  persistent  discharge  of  foul  pus,  and  unwholesome  broken-down  tissues 
into  the  throat ; secondary  hiemorrhages  from  vessels  not  readily  secured,  and  secondary 
inflammations  extending  to  the  brain  ; these  are  among  the  causes  which  bring  the  mor- 
tality rate  of  wounds  of  the  face  to  within  nearly  a fifth  of  that  of  wounds  of  the  head. 

Table  XIII. 


Table  of  Four  Thousand  Nine  Hundred  and  Fourteen  Cases  of  Gunshot  Wounds  of  the 

Face,  without  known  Fracture. 


INJUKIES. 

Cases. 

Died. 

Duty. 

V.  11.  C. 

Exchanged. 

Discharged. 

Deserted. 

Furloughed. 

Unknown. 

Flesh  Wounds  of  the  Face.. . 

4,914 

58  , 

2,147 

15G 

93 

780 

187 

343 

1, 150 

Of  the  above  4,914  cases,  seventeen  were  complicated  with  erysipelas,  three  with 
gangrene,  seven  with  pyaemia,  and  nine  with  secondary  haemorrhage.  In  two  cases  there 
was  neuralgia  ;■  in  two,  necrosis  ; in  four,  paralysis  ; and  in  one,  concussion.  In  five  cases, 
the  hearing  was  impaired,  and  one  resulted  in  aphonia.  The  missile  is  reported  to  have 
lodged,  and  without  record  of  its  being  removed,  in  twenty-two  cases ; and  the  fact  that 
it  was  extracted  is  recorded  in  sixteen  cases. 

Of  the  fifty-eight  fatal  cases,  five  died  of  erysipelas,  two  of  gangrene,  six  of  pyaemia, 
seven  of  secondary  haemorrhage,  seven  of  pneumonia,  eight  of  chronic  diarrhoea,  four  of 
t}q)hoid  fever,  three  of  small-pox,  and  one  each  of  congestive  fever,  enteric  fever,  irrita- 
tive fever,  diphtheria,  ascites,  and  spasm  of  the  glottis,  and  ten  from  causes  not  stated. 

Table  XIV. 


Nature  and  Results  of  Nine  Thousand  Eight  Hundred  and  Fifteen  Injuries  of  the  Face 

from  all  Causes. 


INJURIES. 

Cases. 

Duty. 

Discharged. 

Died. 

Unknown. 

Sabre  and  Bayonet  wounds 

64 

40 

15 

2 

7 

Fractures  of  the  bones  of  the  face  from  various  causes 

64 

37 

17 

3 

7 

Injuries  of  the  face  from  miscellaneous  causes 

271 

167 

83 

3 

18 

Gunshot  flesh  wounds  of  the  face 

4,  911 

2,  396 

1,  310 

58 

1, 150 

Gunshot  wounds  of  the  orbital  region 

1, 190 

379 

679 

. 64 

68 

Gunshot  fractures  of  the  bones  of  the  face 

3,  312 

1, 1.54 

1,488 

340 

330 

Aggregates 

9,815 

4,173 

3,  C92 

470 

1, 580 

In  the  eight  thousand  two  hundred  and  thirty-five  cases  in  whicli  the  i-esults  were 
determined,  the  mortality  rate  was  5.7.  But  it  was  probable  that  this  I’atio  would  be 
much  diminished  if  the  termination  of  the  remaining  one  thousand  live  hundred  and 


Skct.  III.] 


RESULTS  OF  OPERATIONS. 


383 


eighty  cases  could  be  traced.  In  the  British  army  in  the  Crimea,'"  fractures  of  the  face 
numbered  one  hundred  and  seven,  and  flesh  wounds  four  hundred  and  twenty-six,  a total 
of  five  hundred  and  thirty-three,  or  7.4  of  the  entire  number  of  wounds,  and  the  mortality 
rate  was  but  2.6.  But,  in  the  British  return,  the  proportion  of  wounds  penetrating  or 
perforating  the  bony  structures  was  but  20.1  per  cent,  of  the  face  injuries,  whereas  in 
Table  XIV,  the  proportion  of  fractures  is  33.5.  In  reporting  on  the  casualties  of  the 
French  Crimean  Army,  M.  Chenuf  records  one  thousand  four  hundred  and  fourteen 
injuries  of  the  face  from  all  causes,  with  a mortalit)^  of  one  hundred  and  eighty-four,  or 
13  per  cent.  In  his  statistics  of  the  Italian  war  of  1859,  the  same  author  J tabulates 
nine  hundred  and  fifty-five  cases  of  face  injuries,  with  one  hundred  and  fourteen  deaths, 
a mortality  rate  of  11.9. 

The  next  table  exhibits  the  number  of  operations  performed  after,  wounds  of  the  face  : 

Table  XV. 


Table  of  Six  TTundred  and  Seventy-one  Ofteraiions  after  Wounds  of  the  Faee. 


OPERATIONS. 

Cases. 

Hied. 

Discharged. 

Duty. 

Unknown. 

Excision  of  jtortions  of  the  inferior  maxilla 

81 

8 

58 

9 

6 

Excision  of  portions  of  the  superior  maxilla 

13 

3 

8 

2 

Excision  maxilla,  not  specified 

3 

3 

Excision,  malar 

7 

2 

4 

1 

Excision,  several  bones 

7 

1 

4 

1 

1 

Removal  of  bone 

268 

16 

136 

98 

18 

Extraction  of  ball 

192 

9 

92 

65 

26 

Ligation  of  common  ctirotid 

53 

38 

11 

3 

1 

Ligation  of  external  carotid 

6 

2 

2 

1 

1 

Ligation  of  common  and  external  carotid 

2 

1 

1 

Ligation  of  facial 

5 

1 

1 

o 

1 

Ligation  of  lingual 

1 

1 

Ligation  of  internal  jugular  vein 

1 

1 

Ligation  of  branch  of  superior  thyroid 

1 

1 

Plastic  operations 

32 

27 

4 

1 

Aggi-cgatcs 

672 

81 

349 

186 

56 

Having  furnished  the  statistical  evidence,  verified  as  carefully  as  has  been  practicable, 
we  can  now  consider  the  conclusions  to  be  derived  therefrom  relative  to  flesh  wounds  and 
fractures  and  operations  in  this  region. 


* Medical  and  Surgical  Ilistory  of  the  British  army,  which  served  in  the  Crimea,  during  the  war  against  Russia,  in  the  years  1854,  1855,  1856. 
London,  1858.  Vol.  II,  p.  304. 

t Rapport  an  Cnnseil  de  Santi  des  Armies  sur  les  Risultats  du  Service  Midico-Chirurgical  aux  Amhulances  dc  Crimie  et  aux  Ildpitaux  Militaircs 
Francis  en  T nrquie  pemlant  la  Campagne  d' Orient  cn  18.54,  18.5.5,  18.56.  I*!ir  .1.  C.  C'HEMJ,  I).  M.,  IMedecin  Princip.il,  liibliothecaire  do  i LcoIc  Lniiorialo 
de  Sledecinc  Jlilitairo,  (llTicicr  de  la  L6gion  d'llonneur,  etc.  Paris:  Victor  .Masson  et  Fils,  1805.  (Juarto,  p.  14,5. 

; Statistiqne  Meiico-Chirurgicale  de  la  Campagne  d'Rali’e  en  1850  e!  18J0.  Par  le  Ur.  J.  C.  ClIE.NU,  M6decin  Principal  d'Armdc  cu  rotraite,  etc., 
etc.  Paris;  1869,  T.  II,  447. 


384 


WOUNDS  AND  INJUEIES  OF  THE  FACE. 


[Chap.  II, 


Wounds  of  the  Ear. — The  abstracts  of  face  injuries  selected  comprise  few  of  the 
ear.  The  wounds  of  the  auricle  were  either  infrequent  or  else  regarded  as  of  insufficient 
importance  to  be  particularized.  In  the  few  cases  in  which  any  details  were  given,  where 
the  yellow  cartilage  and  ligaments  of  the  pinna  were  torn  by  musket  halls  or  divided  by 
sword-cuts,  the  parts  were  plastered  together,  sutures  being  used  sometimes,  and  the 
dressing  was  completed  by  lint  compresses,  with  cerate  or  warm  fomentations,  and  a roller 
bandage.  The  results  were  generally  unfavorable,  the  injured  tissues,  in  a few  days, 
sloughing  away.  Nearly  all  of  the  reported  injuries  of  the  middle  and  internal  ear  have 
been  considered  in  connection  with  the  head  injuries.  One  of  the  most  interesting  is  that 
recorded  on  p.  175  [ante),  of  Major  Simms,  who,  at  the  Wilderness,  was  struck  by  a 
conoidal  ball,  which  buried  itself  in  the  petrous  bone.  Seven  years  subsequently,  the 
Pension  Board,  in  New  York,  furnished  the  following  additional  particulars  in  the  case : 

“ Examining  Board,  New  York,  March  22d,  1871.  Report  ball  entered  petrous  portion  of  left  temporal  bone.  There  is 
now  an  opening  one-half  inch  in  diameter,  two  and  one-half  inches  in  depth,  forward  and  inward,  and  connecting  with  the  ear. 
The  tympanum  has  been  destroj'ed.  The  symptoms  of  cerebro-spinal  lesion  are  complete.  Paralysis  and  partial  atrophy  of 
muscles  supplied  by  the  left  facial  nerve.  Complete  deafness  in  the  left  ear,  partial  blindness  in  the  left  eye,  and  anaesthesia  of 
the  integument  of  the  left  side  of  the  head  and  face.  There  is  also  partial  paralysis  of  the  right  arm  and  leg,  but  no  implication 
of  sensation  in  those  parts;  certain  muscles  in  the  right  leg  have  become  shortened,  producing  deformity  of  the  right  foot.  The 
ophthalmoscope  reveals  degeneration  of  the  left  optic  disc.  These  .symptoms  are  due  to  a circumscx’ibed  inflammation  of  the  base 
of  the  brain,  results  of  the  above-described  wound.  The  disability  will  steadily  progress,  and,  in  time,  destroy  his  life. 
Disability  total,  second  grade  ($20  per  month).  Pemianent,  and  will  increase ; he  has  been  in  his  present  condition  since 
January,  1866. 

In  February,  1872,  I examined  this  officer,  who  then  had  partial  right  hemiplegia, 
with  facial  paralysis  on  the  left  side.  There  was  a deep  cavity  communicating  with  the 
left  petrous  bone,  the  orifice  closed  by  a rubber  obturator,  devised  by  one  of  the  ingenious 
aurists  of  Philadelphia  or  New  York.  Puriform  discharge  and  exfoliation  of  the  can- 
cellous structure  of  the  temporal  persisted,  and  the  diagnosis  and  prognosis  of  the 
examining  board  was  reluctantly  vffiified. 

Baron  Larrey^  and  Dr.  Hennen,®  have  sanctioned  the  belief  that  the  auricle  may  be 
nearly  torn  off,  and  yet  be  made  to  re-unite.  Dr.  Nathan  E.  Smith  holds  the  same 
opinion,^  and  describes  the  proper  mode  of  promoting  adhesion  by  using  sutures  of  the 
integument  on  either  side,  sparing  the  cartilage,  a precept  disregarded  by  Leschevin^  and 
Verduc,®  but  inculcated  by  the  ancients.  Pard  and  Hildanus  and  other  authors  of  the 
time  when  sabre-cuts  of  the  external  ear  were  common,  and  ablation  of  the  ear  as  a 
punishment  not  infrequent,  recite  instances  of  adhesion  of  the  auricle  after  its  complete 
detachment,  and  give  minute  instructions  as  to  dressing  such  wounds.  Such  instances  are 
not  recorded  in  the  returns  we  are  considering.  The  rule  to  cleanse,  replace,  and  keep  in 
apposition  by  sutures  and  adhesive  plasters  all  lacerated  portions  of  the  ears,  nose  or 
integuments  of  the  face  is  as  absolute  in  military  as  in  civil  surgery,  and,  as  Mr.  Coote 
observes,* *’  some  unpromising  cases  terminate  with  comparatively  slight  deformity.  After 
all,  the  loss  of  the  external  ear  in  man,  however  unsightly,  impairs  the  hearing  but  little. 
Seven  instances  are  found  in  the  records  where  the  auricle  was  carried  away  by  large 
projectiles, — either  cannon  shot,  or  shell-fragments,  or  grape,  and  two  cases  where  great 

■ D.  J.  Laubev,  Clin.  Cliir.,  ed.  cit.  T.  V,  p.  61,  and  Mim.  de  Ghir.  Mil.  1817,  T.  IV,  p.  239. 

* JOHN  HENNEN.  Op.  cit.  3d  cd.,  p.  353. 

^ .See  his  Supplement  to  a Translation  of  Saissy's  Work  on  Diseases  of  the  External  Ear.  Baltimore,  1839,  p.  206. 

■*  Leschevin,  Mem.  pour  les  Prix  de  VAcad.  de  Chir.  Paris,  1819.  T.  IV,  p.  85. 

® VekduC.  Ahrcge  de  la  Chir.  de  Guy  de  Chauliac.  Paris,  1740. 

® Holmes.  Syst.  of  Surg.  2dcd.  Vol.  II.  p.  420. 


Sect.  III.] 


REVIEW,  WOUNDS  OF  THE  ORBITAL  REGION. 


385 


mutilation  of  the  external  ear  was  produced  by  musket  balls.  Of  these  nine  patients,  six 
were  returned  to  duty,  with  the  sense  of  hearing  believed  to  be  as  acute  as  ever,  and  as 
the  three  who  were  discharged  cannot  be  traced  on  the  pension  rolls,  it  is  probable  that 
their  disabilities  were  not  serious.'^  ,This  series  of  observations  should  set  at  rest  the 
question — if  it  remain  a question  in  the  mind  of  any  experienced  military  surgeon  or 
officer  of  ordnance— of  the  “windage”  of  balls.  Rupture  of  the  membrane  of  the 
tympanum  from  propinquity  to  artillery  fire  was  frequent.  The  precautions  enjoined  by 
the  gunners  in  the  navy,  in  serving  heavy  ordnance,  were  not  always  observed  in  tlie 
army.  The  proportion  of  cases  of  deafness  among  the  officers  of  the  artillery  arm,  as 
well  as  among  the  cannoniers,  has  been,  since  the  war,  a frequent  subject  of  remark. 

Wounds  of  the  Orbital  Region. — Many  examples  of  injuries  of  the  superciliary 
region  and  of  the  frontal  sinuses  have  been  cited  in  the  chapter  on  wounds  of  the  head,  and 
on  page  325,  and  succeeding  pages,  are  grouped  thirty-nine  cases  of  wounds  of  the  malar 
and  infraorbital  regions,  involving  both  eyes.  These  are  followed  by  a long  series  in 
which  a single  eye  or  its  orbit  was  implicated.  The  sad  series  of  destruction  of  both  eyes 
by  small  projectiles  gave  a mortality-rate  of  27.8,  only.  In  addition  to  the  two  instances 
of  recovery,  after  balls  had  passed  from  side  to  side  behind  the  orbital  foramina,  dividing, 
no  doubt,  the  optic  nerves,  was  that  of  a general  officer,  wounded  at  Gettysburg,  whose 
case  was  not  reported  in  detail.  There  was  less  of  suppuration  and  necrosis  in  these  three 
than  in  much  less  formidable  cases,  and  the  cicatrices  remained  firm  and  sound,  with  no 
consecutive  disease  of  the  surrounding  tissues,  although  so  many  of  importance  were 
implicated.  The  returns  furnish  many  abstracts  that  might  greatly  interest  students  of 
ophthalmology  could  they  be  reported  with  minuteness  ; but  the  duties  of  the  reporters 
forbade  them  to  give  those  precise  details  which  give  value  to  such  observations.  Of 
gunshot  wounds  of  a single  eye,  there  were  twenty-six,  in  which  it  was  requisite  to  extract 
balls  or  fragments  of  bone,  and  it  was  found  well  to  interfere  unhesitatingly  when  the 
lodgment  of  foreign  bodies  in  the  orbit  was  suspected.  Extirpation  of  the  globe  was 
called  for  in  two  instances.  A loss  of  the  senses  of  smelling  or  hearing  was  observed  in 
six  of  the  cases  of  recovery  selected  for  publication.  There  was  a special  hospital  for  the 
treatment  of  wounds  and  diseases  of  the  eye  established  during  the  war,  under  the  charge 

* Consult  fiirther  on  the  effect  on  hearing  of  loss  of  the  auricle,  ‘NVErFEii,  Ueher  das  schiucre  Gehor^  Leipzig,  1794,  p.  19;  J.  F.  ISIeckel, 
Ilandbtich  der  Pathologischen  Anatomic,  IL  I,  p.  400,  Leipzig,  1812;  Fhitelli,  Orteschi  Giorn.  di  Med,  T.  Ill,  p.  60;  Obeuteuffeu  in  Stark's  Neues 
Archiv.  B.  II,  p.  638,  and  Jlr.  Darwin,  Descent  of  Man,  Vol.  I,  p.  12;  Itard,  Traite  de$  Maladies  de  V Oreille  et  de  V Audition,  Paris,  1842,  says  that 
“everj'thing  combines  to  show  that  the  auricle  is  absolutely  useless  in  man;  t^jat  the  hearing  is  not  altered  when  it  is  removed,  I have  had  occasion  to 
assure  myself  most  positively.”  Valsalva  {De  aure  Humana  tractatus,  Bologne,  1703)  and  Haller  {Disp^dationes  anatomiaie)  and  Leschevin  {Prix 
dc  V Acad.,  T.  IV,  p.  87)  express  an  opposite  opinion ; but  adduce  no  evidence  in  support  of  their  assertions.  WiLDE,  On  Aural  Surgery  {Am.  ed.,  1855,  p. 
104) ; Kramer,  Handhuch  der  OhrenheilJcunde,  Berlin,  1867 ; I’lLCHER,  Treatise  on  the  Ear  {Am.  ed.,  Phila.,  1843,  p.  41),  say  nothing  to  controvert  Itanl's 
doctrine.  TOYNBEE  {Diseases  of  the  Ear,  London,  1868,  p.  12)  remarks  that  in  the  recorded  cases  of  diminished  hearing  from  wounds  of  the  auricle 
alone,  no  accurate  acoustic  tests  were  employed,  and  he  gives  a carefully  obser\’ed  case  of  a sailor,  whose  external  car  was  bitten  off  without  any  impair- 
ment of  hearing.  Consult  further  on  this  subject:  WRIGHT,  Varieties  of  Deafness,  London,  1829,  p.  8;  Erhard,  On  Examination  of  the  Ear  with 
lieference  to  Soldiers  and  Medico  Legal  Questions,  translated  from  Wien.  Wochenschrift,  1864,  pp.  730,  761,  and  Brauchhare  Jlorohre,  Berl.  Klin. 
Wochensehrift ; THOMSON,  A.,  Edinburgh  Jour,  of  Med.  Sci.,  1847;  MOOS,  Ueher  das  Subjective  ITdren  wirklicher  musikalischer  Tone,  Virchow's 
Archiv.,  XXXIX,  2,  p.  280;  Agnew,  C.  U.,  Sinus  through  Mastoid  from  Old  Otitis  Media,  Transactions  of  the  American  Otological  Society,  Boston, 
1870;  LUCJE,  Ueher  eine  Neue-Methode  zur  Untersuchung  des  Geh'ororgans  zu  Physiologischen  and  Diagnostichen  Zweeken,  in  Arch.fiir  Ohrenheilkunde. 
Ill,  2,  No.  3,  p.  186;  IlOOSA,  D.  B.,  in  Trans.  Am.  Otol.  Society,  Boston,  1870,  and  Am.  Jour.  Med.  Sci.,  April,  1871  ; Pagenstecher,  On  Trephining 
the  Mastoid  Process  and  Petroxis  Bone,  Arch.f.  Klin.  Chir.,  IV,  S-  523,  1864;  COLLES,  W.,  Dublin  Quart.  Jour,  of  Med.,  No.  99,  p.  32;  Follin,  Gaz. 
des  Hop.,  1864,  p.  4;  Eustachius,  B.,  Tab.  Anatomicx  Cur.  Lancisii,  Amsterdam,  1722;  CURTIS,  Present  State  of  Aural  Surgery,  etc.,  2d  ed.  London, 
1841;  Harvey,  The  Ear  in  Health  and  Disease,  with  Practical  Remarks  on  the  Prevention  and  Treatment  of  Deafness,  London,  1865;  Turnhull, 
Clinical  Manual  of  Diseases  of  the  Ear,  Phila.,  1872;  A.  B^:uard,  Diet,  dc  Med.  ou  Rep.  Gin.  des  Sci.  Mid.  2“®  cd.  Paris,  1840,  T.  XXII.  p.  3.50; 
Cassebohm,  Dissertationes  de  aure  interna,  Franefort,  1730;  C..VSSEUIUS,  De  vocis  auditiisqne  organis  historia  anaiomica,  Fcrraria,  1600-01; 
COTUNNIUS,  De  aquxductibus  auris  humanx  internx,  Neapol.,  1760 ; TrOltsch,  Diseases  of  the  Ear,  their  Diagnosis  and  Treatment,  New  York,  1 964 ; 
GRUBjiu,  Lehrbuch  der  Ohrenheilkunde,  Wien,  1870 ; Fano,  Ti'aiU  ilimentaire  de  Chirurgie,  Paris,  1869,  T.  I,  p.  737,  devotes  a large  sub-chapter 
to  wounds  of  the  membrane  of  the  drum;  Neill,  A Report  upon  Deafness,  Liverpool,  1840. 

49 


WOUNDS  AND  INJURIES  OF  THE  FACE. 


[CiiAr.  II, 


38() 

of  Surgeon  Joseph  H.  Hildrctli,  U.  S.  V.,  and  special  wards  were  assigned  for  this  purpose 
in  several  of  the  larger  general  hospitals.* *  An  hospital  steward,  long  on  duty  in  this 
office,  wlio  lost  an  eye  at  Gettysburg, has  observed,  with  natural  interest,  the  remote 
eflects  of  the  destruction  of  the  globe  of  the  eye  by  musket  or  pistol  balls,  in  the  numer- 
ous pensioners  who  visit  the  Army  Medical  Museum.  In  all  who  wore  glass  eyes,  there 
was  a shrinkage  of  the  soft  tissues  of  the  orbit,  which  called  for  the  replacement  of  the 
artificial  eye  by  a larger  disk.  In  about  half  of  the  cases,  the  enamel  substitute  followed 
the  movements  of  the  globe  of  the  remaining  eye.  It  was  found  unwise  to  wear  the 
artificial  eye  more  than  eight  of  the  twenty-four  hours  of  the  day,  and  the  uninjured  eye 
had  to  be  treated  tenderly,  becoming  irritated  readily  from  slight  causes.  There  was  a case 
of  a punctured  wound  of  the  eye,  which  came  under  my  observation,  November,  1861, 
that  of  Corporal  Levi  Brizzee,  Co.  0,  27th  Massachusetts  Volunteers.  Entering  a small 
“ wedge  tent,”  from  the  bright  light  outside,  he  walked  upon  a stack  of  muskets,  and  the 
point  of  a bayonet  entered  the  lower  part  of  the  right  cornea,  producing  a laceration  of  the 
iris,  with  protrusion.  He  was  brought  immediately  to  the  regimental  hospital,  a few  yards 
distant.  The  anterior  chamber  was  filled  with  blood,  and  the  condition  of  the  interior  of 
the  eye  could,  therefore,  not  be  discerned.  With  a probe,  I raised  the  corneal  flap,  and 
replaced  the  prolapsed  iris,  dressing  as  after  an  operation  for  extraction  of  cataract, — 
borrowing  an  hair  pillow,  to  elevate  the  head,  from  the  neighboring  general  hospital. 
Without  other  treatment  than  a severely  restricted  diet  this  man  recovered,  and  his 
vision  was  unimpaired.  On  the  third  day,  I removed  the  occlusive  dressing,  and  found 
the  anterior  chamber  free  from  blood,  and  the  cicatrization  of  the  iris  progressing  favorably. 
In  three  weeks  the  patient  returned  to  duty  with  less  opacity  of  the  cornea  than  is  usually 
seen  after  cataract  operations.  Subsequently,  I frequently  met  him  on  the  field,  and  was 
astonished  at  the  absence  of  even  the  loss  of  the  power  of  accommodation  in  the  injured 
eye.  He  told  me  that  he  always  aimed  with  that  eye.  There  was  slight  distortion  of  the 
pupil,  and  a leucomatous  streak  at  the  outer  margin  of  the  cornea;  but  I could  not  discover 
any  impairment  of  vision.  I endeavored  to  trace  the  history  of  this  remarkable  injury;  but 
the  man  was  made  prisoner  in  the  action  Drury’s  Bluff,  May  16th,  1864,  and,  escaping 
from  the  military  prison  at  Macon,  Georgia,  rejoined  his  regiment  in  North  Carolina,  and  I 
did  not  see  him  again.  He  died  of  pernicious  intermittent  fever,  at  his  home  in  Massachu- 
setts, wliile  on  i'urlough,  April  15th,  1865.  In  searching  the  records,  I have  not  found 
examples  of  wounds  of  the  lachrymal  glands  distinct  from  general  destruction  of  the 
contents  of  the  orbit.  Those  reported  by  Bavaton^  and  Larrey®  appear  to  remain  the  only 
recorded  instances. 

Wounds  of  the  Nose.— The  few  cases  reported  in  detail  of  wounds  of  the  nasal 
region  were  those  in  which  some  attempt  at  reparation  or  restoration  had  been  made.  On 
page  322  several  cases  of  sabre  cuts  of  the  nose  are  enumerated,  and  illustrations  of 
gunshot. wounds  of  the  nq^e  are  given  on  page  358.  In  incised  and  lacerated  wounds  of 

* The  ophthalmoscope  was  not  used  in  the  field  hospitals  of  the  Union  or  Southern  armies,  so  far  as  ca.i  be  leanied.  But  in  the  recent  Prussian- 
French  War,  we  learn  from' Dr.  L.  VASLlx's  G lides  siir  les  Plains  par  Armes  a Feu,  Paris,  1872,  p.  203,  ct  se.q.,  that  Dr.  Galogowski  was  able  to  determine 
the  existence  of  subchoroidean  elTusions  and  of  lacerations  of  the  choroid  by  contrecoup.  Tliese  refinements,  like  that  of  detecting-  a cheiTy-stono  in  the 
cesopliagus  by  percussion,  are  not  of  practical  utility. 

t Being  shot  through  the  di'sccnding  colon  and  left  popliteal  space  as  well,  and  having,  alter  eight  years,  a fistula  in  the  lumbar  region  and  false 
anchylosis  of  the  knee. 

* Op.  cit.,  p.  17.5.  Clin.  C/iir.,  T.  3,  31)6.  I’eniarkable  examples  of  foreign  bodies  lodged  for  many  years  in  the  orbit,  are  recorded  hy  Dr. 
Gai.kzOWsxi,  Traite  dc  Maladies  des  Feax,  Paris,  1872,  i».  81.0,  and  by  1\I.  DEMAKQUAV,  McnK  sur  les  (^orjis  etrav/j.  arretes  dans  VOrbile.  l/Union  M^d. 
1851),  pp.  82.  123. 


Sect.  III.] 


REVIEW,  WOUNDS  OF  THE  CHEEK. 


387 


the  cartilaginous  portion  of  tlie  nose  the  parts  were  secured  in  position  by  adhesive  strips, 
and  by  placing  in  the  nostrils  bits  of  gum  catheter  plugged  about  with  sponge  or  lint,  to 
preserve,  as  much  as  practicable,  the  proper  configuration  of  the  organ,  and  to  avert  the 
contraction  of  the  nasal  passages  and  depression  of  the  nose,  which  give,  in  some  instances, 
such  an  unpleasant  resemblance  to  the  results  of  tertiary  syphilis.^'  In  these  lamentable 
cases,  surgery  has  little  aid  to  aflford.  As  has  been  seen  in  Section  III  [ante  p.  368),  some- 
thing may  be  sometimes  accomplished  by  plastic  procedures.  Again,  the  deformity  may 
be  masked  by  an  artificial  nose  of  wax  or  gutta  percha.f  When  the  nasal  and  spongy 
bones  were  destroyed  the  condition  of  the  sufferers  was  yet  more  cruel.  In  all  of  the  cases 
that  I have  examined  or  enquired  into,  there  was  no  cessation  in  gradual  exfoliation  and 
foetid  discharge  into  the  nares,  even  after  six  or  eight  3mars.  The  patients  thus  suffered 
ill-health  because  of  the  local  lesions,  and  mental  distress  from  feeling  that  their  injuries 
rendered  them  repulsive.  Such  Cases  appeal  to  our  warmest  commiseration. 

Wounds  of  the  Cheek. — Examples  of  punctured  wounds  by  the  bayonet,  and  of 
incised  wounds  by  the  sabre  have  been  cited  on  page  323.  The  latter  presented  a frightful 
appearance  sometimes  ; but  usually  healed  readily  under  the  judicious  use  of  adhesive 
strips  and  sutures,  with  support  from  bandages.  The  cheeks  were  often  badly  torn  by  gun- 
shot projectiles,  and  ugly  cicatrices  were  left ; but  in  the  majority  of  cases  the  missiles  pene- 
trated or  perforated  the  buccal  cavity,  often  implicating  the  teeth  or  jaws.  Of  wounds  in- 
volving the  soft  parts  only,  the  most  interesting  were  those  in  which  the  division  of  the 
parotid  duct  resulted  in  salivary  fistula.  Dr.  John  Thomson  [Report  after  Waterloo),  met 
several  cases  of  this  sort, -and  regarded  them  as  very  difficult  to  cure,  and  generally  incur- 
able ; but  I had  one  case  under  my  immediate  care,  of  an  incised  wound  of  the  anterior 
part  of  the  right  duct  of  Steno,  in  which  the  fistula  closed  in  about  eight  weeks.  The 
treatment  consisted  in  introducing  a probe  daily  into  the  orifice  of  the  duct,  opposite  the 
second  molar,  and  occasionally  cauterizing  the  external  wound  and  applying  constantly  an 
occlusive  dressing  with  collodion.  In  this  instance,  the  continuity  of  the  duct  was  pre- 
served, and,  after  recovery,  the  saliva  might  be  seen  to  trickle  from  the  buccal  orifice  of  the 
duct.  Other  successful  cases  are  reported,  two  of  which  are  noted  on  page  380.  Some 
valuable  observations  on  this  subject  are  to  be  found  in  the  Memoirs  of  the  French  Acad- 
emy of  Surgery.J  Many  instances  are  reported  where  wounds  of  the  portio  dura  ol'  the 
seventh  pair,  or  branches  of  the  fifth  pair,  caused  various  paralyses  or  nervous  twitchings, 
or  tics  in  the  muscles  of  the  face.  Several  examples  will  be  found  in  the  preceding  })ages, 
and  others  are  detailed  at  length  in  the  dissertation  already  alluded  to,  on  gunshot  wounds 
and  injuries  of  the  nerves,  by  Drs.  Mitchell,  Morehouse,  and  Keen.  These  careful  observa- 
tions, made  at  the  military  hospital  at  Christian  Street,  Philadelphia,  illustrate  the  utility 
of  electric  currents  in  the  treatment  of  such  cases,  besides  affording  interesting  physiologi- 
cal and  clinical  studies. 


* There  have  been  not  a few  instances  nf  discharged  soldiers  who  liave  reliuquislied  humble  positions  under  Government,  and  of  otfteers  who  have 
gone  into  retirement  on  account  of  tlieir  sensitiveness  regarding  disfigurements  after  wounds  cf  the  nose,  that  were  ascribed  by  the  ignorant  an<l  unchari- 
table to  combats  under  the  inspiration,  not  of  Mars,  but  of  Venus. 

tOn  wounds  of  the  nose  consult  IIaUDKXS,  Clin,  de.s  Plains  d'Armns  d Paris,  1830,  p.  173;  I).  .1.  Mim.  On.  Oiir.  Mil , Paris,  18.7, 

T.  IV,  pp.  21  and  211;  Gaukngeot.  TraiU  0.' Op.,  T.  III.  p.  55.  rioiiAVKNTi,  MOLi.iNKM.i,  IJitiUENTtACii,  I,ouvrr.  IIautiiIclkmv,  (’akliz/j, 

IIlegxv,  Lev.ser,  and  IIOFFACEEK,  liavc  reported  instances  < f adhesion  after  entire  detachment  « f the  cartilaginous  part  of  the  nose;  GaUVIN,  'fhc.'.c  Oc 
Paris,  Xo.  1855,  p.  35:  Jami.n’,  Path.  Chir.,  T.  1,  p.  (177;  Df.nOXVILLKRS  et  GOShKLIX.  Conp.  On.  Chir.  J'ral..  '\  . III.  j).  ^3. 

J Meinoires  de  VAcaddniie  RojaU  dn  Chirurpie,  Paris,  d*®,  17.77,  T\  III,  ji.  d3J,  rl  snq.;  I)i  I’llK.M.x,  Mokand,  uihI  I.otTS,  in  ihcir  several  disserta- 
tions relate  many  personal  observations  resi)ecting  wounds  <)f  the  salivary  canals,  and  cite  from  V Wii^  i Hook  10,  c.'t.  2b).  P.VlUOCIPS  OF  >\c^lfArFM)KN'llC 
(Dn  Vain.  pirticuL),  ML’.n’.NICX.S  (Prar.  (Jhiranj.,  Lib.  2,  c.  lb),  UooMiL’is,  PlCVUrUK,  Vaxdkiiwikl  ( Ohn.  rar.,  'P.  2 , .MOlt(;Ar.\T  < Advrrs.  Anatom. 
VI),  IvF.3XIF.ll  Die  Gu  \AF  and  VK’l’MIHVr.-X'.  and  many  otliers  important  facts  respecting  tins  form  of  injury.  See  also  I.KC.OPFsr.  1.  v.  p.  382. 


388 


WOUNDS  AND  INJURIES  OF  THE  FACE. 


[Chap.  II, 


It  is  well  known  ■ that  Larrey^  recommended,  in  accordance  with  the  precepts  of 
Desault,^  to  unite  all  gunshot  wounds  of  the  soft  parts  of  the  face  by  sutures,  having  first 
pared  or  “refreshed”  the  contused  borders.  Surgeon  J.  J.  Chisolm,^  P.  A.  C.  S.,  sought 
to  generalize  this  method,  and  a circular  letter  was  issued  by  the  Confederate  Surgeon  Gen- 
eral, calling  for  reports  on  the  subject.  Surgeon  Middleton  Michel,  P.  A.  C.  S.,  published^ 
a paper  on  the  subject,  with  cases  designed  to  prove  the  efficacy  of  the  method.  I will 
here  only  say  briefly,  that  the  evidence  adduced  was  inconclusive,  and  that  I fully  agree 
with  M.  Legouest,®  that  Larrey’s  advice  should  not  be  followed  in  gunshot  wounds  of  the 
face,  since  the  slighter  cases,  and  even  those  in  which  the  cheeks  are  perforated,  or  the  lips 
divided,  generally  healed  readily,  while  the  extended  lacerations  were  commonly  followed 
by  swelling  and  elimination  of  the  mortified  parts  ; and  by  regulating  such  wounds  by  the 
knife,  there  was  great  liability  of  sacrificing  more  tissue  than  nature  would  have  done. 

Wounds  of  the  Upper  Jaw. — The  returns  of  these  injuries  presented  a larger  pro- 
portionate fatality  than  the  observations  of  European  surgeons  would  have  led  us  to  an- 
ticipate. Our  reports  indicated  that  the  patients  who  escaped  the  immediate  dangers  of 
hsemorrhage,  either  primary  or  consecutive,  had  often  to  undergo  such  complications  as 
erysipelas  and  pysemia ; while  copious  and  protracted  suppurations  and  the  accidents  per- 
taining to  the  ingestion  of  decomposed  secretions  into  the  digestive  organs  were  other  perils 
to  be  encountered.  Dr.  Chisolm  [op.  cit.  p.  502)  in  the  last  edition  of  his  manual  for  the 
use  of  the  Confederate  surgeons,  published  in  the  third  year  of  the  war,  shares  the  opinions 
of  Dr.  Stromeyer  [op.  cit.  p.  36)  and  of  Matthew  [loc.  cit.  p.  305),  and  regards  the  accidents 
which  follow,  even  very  severe  injuries  of  the  facial  bones,  as  comparatively  slight.  But 
the  facts  embodied  in  Table  XIV  compel  one  to  dissent  from  this  conclusion  and  to  adopt 
rather  the  opinion  of  Guthrie  [op.  cit.  p.  524)  that  such  wounds  are  often  followed  by  “ much 
suffering  and  by  permanent  inconvenience.”  In  consulting  the  returns  of  the  Pension 
Office,  and  in  communicating  with  medical  officers  of  extended  experience,  few  examples 
of  fair  healing  of  gunshot  wounds  of  the  spongy  bones  forming  the  walls  of  the  nasal  cavi- 
ties have  been  noted,  though  many  pensioners  with  such  injuries  have  now  been  upon  the 
rolls  or  under  observation  for  six  or  eight  years  since  the  recejition  of  their  injuries, — and 
to  indicate  how  long  such  wounds  may  remain  unhealed,  I will  here  cite  the  case  of  a pen- 
sioner of  the  war  of  1812,  for  which  I am  indebted  to  Dr.  A.  L.  Lowell,  of  the  Pension 
Bureau : 

Case — Private  Noali  Austin,  of  Captain  Brown’s  Co.,  New  York  State  Militia  {Pension  Claim  No.  1700),  was  enlisted 
August  oOtli,  1812,  and  was  wounded  at  Queenstown  on  October  13th,  1812,  and  died  on  September  12th,  1870;  the  following 
are  copies  of  the  various  surgical  certificates  in  the  case;  1st:  “ Gunshot  wound  received  at  the  battle  of  Queenstown.  A 
canister  shot  entered  the  face  one  and  a half  inches  to  the  left  of  the  nose,  and  still  remains  lodged  in  the  bones  of  the  face. 
There  is  an  opening  in  the  hard  palate  three-fourths  of  an  inch  in  diameter,  and  there  is  a discharge  through  both  wounds,  but 
principally  through  the  nose.  His  speech  is  affected  and  his  general  health  is  impaired.  The  disability  is  total.”  2d  : “A 
canister  shot  entered  the  face  between  the  nose  and  the  left  cheek.  The  ball  now  remains  in  the  cavity  of  the  cheek,  and  still 
remains  lodged  in  superior  maxillary  bones,  from  which  constantly  issues  a foetid  discharge,  and  it  totally  disqualifies  him  for 
manual  labor.”  2Cl,  filed  October  9t/i,  1831 : “External  wound  a little  above  alae  of  nose,  left  side,  on  a line  falling  from  inner 
canthus  of  left  eye.  The  shot  entered  obliquely  and  probably  lodged  under  the  left  malar  bone.  From  a fistulous  opening,  there 
is  a constant  discharge.  The  presence  of  the  ball  produces  irritation  and  afiects  the  health,  so  as  to  disqualify  from  manual 
labor.”  4th,  filed  Septemher  Zd,  1839 : “ Gunshot  wound  of  the  head  ; ball  still  remains  lodged  in  the  head,  causing  constant 


‘ Clin.  Chir.,  T.  II,  p.  3. 

Dicsault,  aSuvres  Chirurg.,  3d  cd.,  Paris,  1813,  T.  II. 
3 ClUSOLM,  op.  cit. 

* liichmond  Med.  Jour.,  18GG,  Vol.  I,  p.  448. 

5 Op.  cit.  p.  385. 


Sect.  III.] 


EEVIEW,  WOUNDS  OF  THE  UPPER  JAW. 


389 


discharge  from  the  nostrils.  The  shot  has  changed  position  since  1833.  Disability  increased.”  5th,  fikd  March  2Gih,  1850 ; 
“ Canister  shot  in  left  cheek;  constant  pain  and  intense  headache  when  stooping,  and  totally  unfitting  him  for  manual  labor.” 
6th,  filed  September  12th,  1870:  “The  pensioner  died  from  the  effects  of  a gunshot  wound  of  the  head  and  face.  For  many 
years  said  wound  kept  up  a constant  discharge,  and  when  he  died  the  discharge  had  greatly  increased,  and  just  before  he  died, 
the  ball  passed  into  his  mouth  and  was  taken  out  by  him,  after  it  had  destroyed  the  bony  structures  where  it  had  been  lodged. 
The  immediate  cause  of  death  was  pyaemia.” 

Balls  lodged  in  ttie  facial  bones  are,  however,  sometimes  eliminated  by  the  efforts  of 
nature,  as  in  the  case  of  Private  Williams,  5th  Vermont,  noted  on  page  342.  The  missile, 
a musket  ball  of  ragged  shape,  had  lain  upon  the  left  palatine  bone  from  May  6th,  1864, 
until  May  22d,  1868,  when,  according  to  the  Manchester  Journal,  the  patient,  being 
aroused  from  his  sleep  by  a sense  of  suffocation,  with  great  pain  extracted  the  projectile 
with  his  fingers  through  the  soft  palate.  Yet  the  removal  of  the  foreign  body  did  not 
effect  a cure,  and  the  pensioner  is  still  on  the  rolls. 

To  the  many  illustrations  already  adduced,  may  be  added  that  of  General  Alexander 
Asboth,  who  was  shot  September,  .1864,  by  a musket  ball,  at  Marianna,  Florida,  the 
missile  passing  through  the  left  antrum  of  Highmore,  and  lodging  upon  the  palatine  bone. 
The  external  wound  healed  ; but  there  was  profused  suppuration  and  interminable  exfoliation 
through  the  posterior  nares,  and  the  general,  already  enfeebled  by  the  effects  of  a gunshot 
fracture  of  the  humerus,  received  at  Pea  Pidge,  of  a flesh-wound  of  the ‘thigh,  and  several 
sabre  wounds  of  the  face,  was  steadily  losing  strength.  After  he  had  been  a year  or  more 
under  treatment,  he  visited  Washington.  There  was  a profuse  purulent  discharge  into 
the  fauces,  and  frequent  exfoliations.  The  ball  was  readily  detected  by  passing  the  left 
index  finger  above  the  arch  of  the  soft  palate.  Though  he  had  resolved  to  submit  to  an 
extraction  of  the  missile,  his  duties  in  connection  with  the  mission  to  the  Argentine 
Republic,  with  which  he  had  been  charged,  were  so  urgent  that  he  sailed  without  under- 
going the  operation.  Suppuration  and  exfoliation  continued,  and  the  general  died  at 
Buenos  Ayres,  three  years  afterwards,  from  the  effects  of  this  wound.  These  instances, 
with  the  figures  presented  in  the  tables,  may  suffice  to  controvert  the  assertions  of  those 
military  surgeons  who  regard  gunshot  wounds  of  the  maxillary  sinuses  as  comparatively 
trifling. 

The  more  detailed  abstracts  reported  indicate  that  in  the  treatment  of  wounds  of  the 
upper  jaw,  the  practice  of  experienced  surgeons,  employed  in  the  war,  generally  conformed 
to  those  simple  lessons  taught  by  the  later  preceding’  European  campaigns,  and  confirmed 
by  what  we  can  learn  of  the  surgical  results  of  the  wars  of  1866  and  1870.  Dr.  Chis- 
olm [1.  c.,  p.  304)  informs  us  of  the  usual  course  pursued  by  the  Confederate  medical 
officers  : 

“ Unless  the  fragments  are  either  completely  detached  or  but  slightly  adflerent,  they 
should  not  be  taken  away,  but  should  be  replaced  with  care — as,  in  time,  consolidation  may 
take  place,  and  very  little  permanent  deformity  will  be  left.  Should  some  of  these  frag- 
ments die,  they  will  be  found  loose,  often  as  early  as  the  sixth  or  eighth  day,  and  should 
be  removed.  The  cold-water  dressings,  with  an  occasional  dose  of  salts  to  relieve  the 
excessive  swelling,  is  the  only  medication  required.  The  wound  in  the  face,  after  a careful 
adjustment  of  the  movable  fragments,  should  be  -closed  with  adhesive  plaster,  and,  with 
the  use  of  cold-water  dressings  for  a few  days,  the  case  is  left  pretty  much  to  nature.” 

To  cleanse  the  wound,  to  remove  detached  fragments  of  bone^  to  replace  and  adjust 
undetached  fragments,  to  suppress  hsemorrhago ; then  to  bring  tlie  soft  parts  as  nearly  in 
apposition  as  j)racticable,  connecting  them  with  adhesive  straps,  and  dressing  lightly  with 


390 


WOUNDS  AND  INJURIES  OF  THE  B'ACE, 


[ClIAI>.  II, 


compresses  clipped  in  cold  lotions,  and  supported  by  a bandage — such  was  the  simple 
routine  commonly  observed  by  the  Union  surgeons,  and  with  fair  results  usually,  thougli 
much  deformity  was  left  in  many  cases,  and  tlie  proportion  of  fatal  results  was  not  incon- 
siderable. ]\[r.  Blenkins  (/.  c.  p.  822)  confirms  the  observation  of  Guthrie  that,  where  the 
lachrymal  bones  or  sac  are  wounded,  the  tears  usually  continue  through  life  to  overflow  ; — 
and  Dr.  AVilliamson  [oj).  cit.  p.  65)  describing  the  invalided  men  from  the  Indian  mutiny, 
speaks  of  the  serious  nature  of  gunshot  wounds  of  the  face  and  of  the  fediousness  of  their 
cure, — of  the  caries  and  necrosis  and  “profuse  and  very  foetid  suppurative  discharge”^  that 
followed  such  injuries.  Matthew,  in  his  Crimean  surgical  report,  expresses  the  belief  that 
extensive  necrosis  rarely  takes  place  in  wounds  of  the  facial  bones  ; but  it  must  be  borne 
in  mind  that  he  had  not  the  opportunity  of  following  the  ulterior  histories  of  the  cases  he 
reports.  In  the  footnote'  is  appended  his  view  regarding  the  treatment  of  detached  bone 
fragments  and  teeth.  j\Ir.  klatthow  cites  a case  of  grave  secondary  bleeidng,  in  whicli 
the  ap|)lication  of  perchloride  of  iron  proved  successful ; and  Dr.  Chisolm  observes,  in  this 
connection,  that  “the  iron  styptic  will  control  the  most  annoying  haemorrhage.”  The 
persulphate  of  iron  in  powder,  and  the  perchloride  in  solution,  were  largely  employed  by 
the  surgeons  of  the  Union  Army  in  haemorrhages,  both  secondary  and  primary.  These 
salts  were  placed  in  every  hospital  knapsack  and  in  every  hospital.  Little  evidence  is 
adduced  of  their  utility,  though  the  suffering  they  caused  to  the  patients  is  jiainfully 
conspicuous.  In  wounds  of  the  upper  jaws  especially,  they  increased  the  inflammatory 
phenomena,  and,  moreover,  converted  the  tissues  into  a blackened  mass,  in  which  the 
relations  of  parts  could  not  be  distinguished,  and  bleeding  vessels  could  be  properly  secured 
l)y  ligature  only  with  the  greatest  difiiculty.  Such  is  my  intense  aversion  to  the  employ- 
ment of  these  sty})tics  that  I am  not,  on  this  point,  an  impartial  judge,  and  will  prefer  to 
cite  a very  competent  authority.  Dr.  Garretson 

“ Monsel’s  solutions,  so  warmly  lauded  for  their  styjkic  qualities,  have  exhibited  to 
me  more  ill  results  than  I have  ever  met  with  from  any  dozen  other  articles.  If  used  at 
all,  I tliink  the  bleeding  points  sbould  be  alone  touched ; but  of  one  thing  any  one  using 
them  may  bo  assured  : if  the  application  does  not  control  the  heemorrhage  instantly  and 
permanently,  he  will  have  increased  his  trouble  manifold.” 

Wounds  of  the  Lower  Jaw. — Guthrie  remarks  {1.  c.  p.  525)  that  these  injuries 
“ are  perliaps  more  common,  and  are  certainly  more  troublesome  than  those  of  the  upper.” 
The  records  we  are  considering  indicate  that  the  frequency  of  gunshot  fractures  of  the 
lower  maxilla  is  thrice  that  of  similar  injuries  of  the  upper  jaw-bones.  Dupuytren 
declares  {1.  c.  T.  VI,  p.  258)  that  the  gunshot  injuries  of  the  lower  jaw  are  far  the  most 
dangerous.  The  records  show  that  in  an  aggregate  of  more  tlian  two  thousand  cases  (see 
Tadle  Xll,  }).  381)  the  ratio  of  mortality  was  nearly  equal  in  the  two  classes  of  injuries  : 
8.1  per  cent,  for  the  ujiper,  and  8.3  for  the  lower  maxilla.'* 

^ 8ee  rreiiaratiou  2955  of  the  Netley  Museum. 

2 •‘T'here  is.  indeed,  no  great  object  beyond,  perliaps,  the  present  comfort  of  tlie  patient  to  be  attained  in  removing  either  fragments  of  bone  or 
loosened  teeth  in  the  great  majority  of  instances.  If  they  die,  tliey  become  loose,  and  are  readily  lifted  away  without  trouble  to  the  surgeon,  and  but  little 
jiain  to  the  patient.  This  observation  is  specially  applicable  to  fractures  of  the  lower  jaw.  Surgeons  in  this  [the  Urimean]  war  liave  seen  so  many  eases 
of  badly-fractured  instances  of  this  hind  unite,  and  that  with  a very  small  amount  cf  deformity,  that  men  of  experience  arc  now  excessively  charj’  of 
removing  any  portion  of  this  bone,  unless  it  has  become  dead,  (T  the  fnigment  is  so  situated  as  to  interfere  considerably  with  the  adjustment  of  the 
rtmiainder,  or  the  bone  so  nuudi  comminuted  as  to  give  no  probable  hojie  of  its  becoming  consolidati'd,  or  so  sliari'ly  angular  as  to  threaten  further  injury 
to  the  soft  jiarts,  or  to  intcrferi'  materially  with  their  adjustment.”  Op.  cit.,  Vol.  II.  p,  305. 

^ ( i AKKL'LSON,  .Iamls  10.  A ITvatise  on  lh(i  Diseases  and  Surgery  of  tin*  Mouth,  Jaws,  and  Associate  Parts.  Phihnleljfliia,  1869,  p.  474. 

Dupuytren  fell  into  amflher  error  by  reasoning  deductively,  and  teaching  that  on  account  of  the  great  density  and  hardness  (;f  the  inferior  maxilla, 
the  resistance  opposed  by  it,  a .shock  to  the  cerebrum  was  often  produced  by  the  impact  of  balls,  a species  of  cmitrecoup,  causing  cerebral  commotion.  Ilis 
disciiilcs,  II.  LaiTC}'  and  l.egouest.  “find  this  an  hard  doctrine."  There  is  nothing  in  the  records  we  are  examining  to  sanction  it. 


Sect.  III.] 


KEVIEW,  WOUNDS  OF  THE  LOWEK  JAW. 


391 


111  the  Confederate  armies,  some  form  of  inter-dental  splint  was  often  employed  in 
gunshot  fractures  of  the  lower  jaw.  An  apparatus  devised  and  successfully  used  in  many 
unpromising  cases  hy  Dr.  J.  B.  Bean,  a dentist  of  Atlanta,  Georgia,  is  praised  liighly  hy 
many  of  the  Southern  surgeons,^  and  forty  or  more  examples  of  its  useful  apjilication 
have  been  published.  According  to  Dr.  Chisolm  [1.  c.  p.  305)  the  usual  method  of  treat- 
ing gunshot  fractures  of  the  lower  jaw  was  that  described  in  the  footnote.^ 

As  ]\Ialgaigne  has  remarked,  in  treating  of  fractures  of  the  lower  jaw,  the  '^fixation 
des  denis  ” dates  from  the  time  of  Hippocrates ; but  every  writer  on  minor  surgery  has  his 
pet  fixture.  The  evidence  of  the  utility  of  Dr.  Bean’s  apparatus,  in  cases  in  which  its 
application  was  supervised  by  himself,  is  conclusive.  Surgeon  Philip  S.  AAales,  U.  S.  N., 
some  years  ago  contrived  an  apparatus,  which,  he  tells  iis,^  was  used  successfully  in  twelve 
cases  of  fractured  lower  jaw.  As  figured  in  his  work,  it  is  very  trig  and  sailor-like,  well 
fitted  to  fulfill  the  indications  for  maintaining  fractures  of  the  lower  maxilla;  but  perha])S, 
like  so  many  others,  too  complicated  to  meet  the  exigencies  of  field  practice.  In  the 
Union  armies,  softened  binders’  board,  secured  by  a four-tailed  bandage,  was  the  ordinary 
dressing.  If  there  was  much  comminution,  loose  fragments  were  removed,  and  occasion- 
ally excisions  were  perfornied  of  portions  of  body  or  of  the  rami.  In  the  base  hospitals, 
complex  apparatus  of  leather,  gutta  percha,  papier  mache,  were  employed,  according  to 
the  prevailing  fashion  oi  the  section  of  country  in  which  the  hospital  was  situated."* *  The 
experiment  of  wiring  the  fractured  extremities  of  the  maxilla,  as  proposed  and  practiced 
by  Baudens,  was  occa,sionally  employed ; but  Dr.  Bentley  and  otliers  report  unfavorably  of 
this  method,  and  several  examples  of  ununited  fracture  are  recorded,  in  which  it  had  been 
adopted,  with  the  additional  dressing  of  Barton’s  bandage.  Wiring  together  the  contigu- 
ous teeth  was  frequently  yet  not  advantageously  practiced.  A pad  of  oakum  under  the 
cross-pieces  of  pasteboard  was  found  convenient.  Frequent  detergent  collutories,  liquid 
food,  and  an  antiphlogistic  regimen  were  regarded  as  essential  in  the  treatment.  A solitary 
instance  of  fracture  of  the  lower  maxilla  by  a bayonet,  is  related  on  page  323.  The 
fractures  from  falls  and  blows  were  . not  infrequent.  In  the  Army  Medical  Museum, 
specimens  of  thirty-two  gunshot  fractures  of  the  lower  jaw  may  be  found,  exhibiting  many 
varieties  of  union,  partial  reparation,  caries,  and  necrosis.^  A single  additional  illustration 

* Covey,  Itichmmid  Med  and  fSurr/.  Jour.,  Viil.  I,  p.  81 ; BOLTON,  p.  ;!18. 

* “The  surgeon  accoinjianj-ing  tlie  transiuirts  usually  sends  injuries  of  the  face  to  the  field  infirmary  untouehod,  or  should  the  lower  jaw  he  hroken, 
applies  a folded  handkerchief  or  hand  under  it  to  support  it.  This  fracture  is  jiernianently  jiut  up  at  the  field  infirmary  in  a pasteboard  splint,  well  padded 
with  carded  cotton,  and  secured  hy  folded  cloth  or  double-tailed  bandage.  One  band  passes  over  the  vertex,  supporting  the  jaws,  while  the  other  passes 
from  the  front  of  the  chin  behind  the  head,  and  then  around  the  forehead,  where  it  is  secured  hy  pins,  iiefore  the  dressings  are  apjdied  (he  wounds  should 
have  been  examined  carefully  with  the  finger,  and  all  [lerfectly  detached  spicula Of  bone  should  have  been  removed.  From  (he  exi'cssive  vascularity  cf 
all  the  ti.ssucs  of  this  region  the  hones  do  not  necrose  as  extensively  as  in  other  portions  of  the  body,  and  portions  of  bone  which  are  attached  to  the  soft 
parts  very  often  consolidate.  The  surge.,:i  must  be  prcjiarcd  to  meet  much  swelling  and  profuse  salivation.  All  gunshot  injuries  to  the  bones  of  (In^  face 
being  compound,  suppuration  is  soon  estaldished,  and  the  secretion  of  jnis  is  coiiious.  AVhen  the  hall  has  i)erforul<'d  th<^  buccal  cavity,  causing  inllamma- 
tion  and  salivation,  it  will  ad<l  much  to  the  comfort  of  the  patient  if  his  mouth  he  swabbed  out  daily  with  a piece  ( 1 suit  rag  or  siicngc  attached  to  a th'n 
piece  of  wood.  From  the  difficulty  in  swallowing,  fluid  nourishment  must  be  ]irescribed.  Tin?  consf.mt  thirst  of  thc.se  wounded  will  be  relieved  by  small 
doses  of  mor]ihine,  or  by  acidulated  drinks,  made  either  with  diluted  nitric  acid  or  vinegar.  Injuries  ab.iiit  the  face  arc  verv  liable  to  ervsi])clatou.s  attacks, 
which,  however  are  readily  controlled  by  the  free  use  of  the  muriated  tincture  of  iron, — thirty  drops  every  three  hours  often  checking  tin?  )?ri'gress  of  the 
disease  by  the  end  of  the  first  d;iy  (?f  treatment." 

’AVales.  Practical  Treatise  on  Surgical  Apparatus,  Appliances,  and  Elementary  Operations.  I'hiladelphia,  18(17.  j).  US'!. 

■*  It  would  be  supcrfluou.s  to  enumerate  the  diir(?rent  splints,  bandages,  anil  complicated  dental,  interdental  and  stibmental  ci  ntrivances  that  were 
occasionally  employed  at  the  general  hospitals  in  the  treatment  of  fractures  of  the  lower  jaw.  Barton's  and  (libson's  methods  (;f  liarnhiging  were 
freipiently  employed  (E.  WAIttlE.V,  op.  cit.  p.  tilM).  A few  examples  are  noted  of  the  .application  i f the  aiiparatus  of  Dr.  (larrctson  (Iric.  cil.  p.  .7!8),  of 
3Ir.  Nasmyth,  and  of  Dr.  dunning;  still  fewer  of  the  cork  .sidint  of  Boyer,  and  Matter's  silver  clasp.  Startin's  wire  sidint,  f.onsdalc's  clamii,  and  Ham- 
ilton's api?aratus  were  employed,  each  in  a single  case,  with  .satisfactory  result.s.  There  arc  indications  in  the  reports  that  (he  medical  officers  were  not 
ignorant  of  the  methods  of  dressing  devised  by  Hutcidck,  .‘^'alicct,  .lou.ssct,  Bush,  Ilartig  and  Ilouselot,  iCIiige  ami  Jlalgaignc,  hut  they  fi  nnil  the  simples 
dressings  the  best  for  lii-ld  scr\'ii?e. 

.See'  Photograph  tKd,  .Surgical  .Series,  for  Dr.  Hewit's  remarkable  specimen  of  repartition  of  the  bi  dy  i f the  infcrii.i-  maxilla  iiftcr  ti  gunsln  t mjnr\- 
nearly  destroying  the  lower  jaw.  reported  on  page  a-K!.  ft  was  imiiracticahlc  to  get  a wood-cut  of  this  interesting  preparation  in  sensen  for  the  |.|c.;.s. 

Excellent  illustrations  of  united  simple  fractures  of  the  body  and  the  rami  of  the  lower  Jaw  are  aiforded  by  specimens  .'ihiti,  .M-IU,  .IM?; and  specimens 

5151  and  51*18  c.\hibit  the  effeets  of  caries  and  necrosis  following  injury*. 


392 


WOUNDS  AND  INJUEIES  OF  THE  FACE. 


[CUAP.  11, 


may  be  cited,  as  it  relates  to  the  next  subject  to  be  considered.  Eecurring  secondary 
haemorrhage,  probably  from  the  lingual  artery,  was  unsuccessfully  treated  by  ligating  the 
common  carotid. 


Fig.  17G. — Gunshot  fracture  of  the  body  of  the  lower  jaw. 
Spec.  3542,  A.  M.  M. 


Case. — Private  G.  T , Co.  C,  82(1  Pennsylvania  Volunteers, 

aged  22  years,  tvas  wounded  at  Spottsylvania,  May  10th,  1864,  by  a 
bullet,  which  entered  the  left  side  of  the  face,  one  inch  anterior  to  the 
angle  of  the  inferior  maxilla,  and  comminuting  its  body,  passed 
through  the  tongue  inferiorly,  and  escaped  two  inches  posterior  to  the 
symphysis  of  the  right  side.  He  was  sent  to  Washington,  and  admitted 
to  Douglas  Hospital  on  the  25th.  The  tongue  was  so  swollen  as  to 
project  from  the  mouth,  and  render  articulation  and  deglutition  almost 
impossible.  The  patient  was  nourished  with  milk  and  beef-essence, 
which  were  injected  into  the  oesophagus.  Secondary  hmmorrhage,  to 
the  extent  of  twelve  ounces,  occuired  on  June  2d,  requiring  the  liga- 
tion of  the  left  primitive  carotid.  The  internal  jugular  vein  was  also 
tied,  having  been  nicked  during  the  operation.  On  the  3d,  a slight 
return  of  hcemorrhage  to  the  extent  of  two  ounces  to(>k  place,  and 
death  soon  followed  from  exhaustion.  The  fractured  maxilla  is  shown 
in  the  adjoining  cut.  It  was  contributed  to  the  Army  Medical  Museum 
by  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  and  is  No.  3542  of  the 
Surgical  Section. 


Wounds  of  the  Buccal  Cavity. — In  the  abstracts  selected  to  illustrate  the  face 
wounds,  many  instances  of  lesions  of  the  buccal  cavity  may  be  noted.  Most  of  the  gun- 
shot injuries  of  the  jaws  were  of  this  class.  Wounds  complicated  by  lesions  of  the  tongue, 
epiglottis,  soft-palate,  or  glands  of  the  mouth,  or  by  the  evulsion  of  several  teeth  were 
serious  and  very  painful.  Percy  (1.  c.  p.  116)  cites  from  Bartholin,  Mangetus,  and  Pard 
examples  of  balls  lodged  from  three  to  six  years  in  the  tongue.  I have  not  observed 
any  such  instances  in  the  records.  The  reader  will  not  overlook  the  case  of  Jeffery 
(p.  357),  where  the  wounded  tongue  contracted  adhesions  with  the  jaw, — or  the  cases  of 
Lynn  (p.  350),  Schwartzlander  (p.  355),  and  Stewart  (p.  364), — all  presenting  remarkable 
complications  of  gunshot  wounds  of  the  tongue.  In  many  of  the  wounds  involving  the 
alveolar  processes  and  palatine  arch,  the  aid  of  skilful  dentists  was  sought  advantageously. 

Hemorrhage  in  Wounds  of  the  Face. — We  can  here  consider  the  means  adopted 
to  suppress  haemorrhage  after  wounds  of  the  face,  and  more  particularly  after  gunshot 
fractures  of  the  facial  bones.  Unless  some  large  arterial  trunk  was  implicated,  primary 
bleeding,  that  could  not  be  controlled  by  judicious  compression  and  cold  applications,  was 
rarely  observed ; but  the  secondary  haemorrhages  following  gunshot  wounds  of  the  facial 
bones  were  frequent  and  very  dangerous.  The  abuse  of  styptics  in  this  class  of  cases  has 
been  already  adverted  to.  The  profuse  distribution  of  powders  of  persulphate  and  solu- 
tions of  perchloride  of  iron  in  the  field-case,  paniers,  knapsacks,  and  dispensaries  appeared 
to  invite  ignorant  orderlies  or  stewards  to  stuff  every  bleeding  wound  with  lint  or  charpie 
saturated  with  undiluted  solutions  of  these  corrosive  salts.  The  rule  that  the  use  of 
styptics, — other  than  cold,  compression  and  position, — should  be  restricted  within  the  nar- 
rowest limits,  is  nowhere  more  strictly  applicable  than  in  wounds  of  the  face. 

Detailed  abstracts  have  been  given  of  the  cases  of  Amos  (p.  332),  Martin  (p.  339), 
Baine  (p.  346),  Beamenderfer,  Copeland,  and  Cox  (p.  347),  Heiser  (p.  349),  Kilburn  (p. 
350),  Merchant,  Mcllroy,  Murray,  and  Meinnis  (p.  351),  Maley  (p.  352),  Beeves  and  John 

B (p.  353),  Stienberger  (p.  355),  and  G.  T (p.  392).  And  here  may  be  introduced 

particulars  regarding  three  other  ligations  of  the  common  carotid,  which  are  illustrated  by 
pivparalions  in  the  Army  Medical  Museum. 


SlCCT.  111.] 


EEVIEW,  IIJiMOEEIlAGES  AND  LIGATIONS. 


393 


Case.— Sergeant  Lyman  A.E- , Co.  D,  8th  New  York  Heavy  Artillery,  aged  21  years,  was  wounded 

at  EeanTs  Station,  August  2iith,  1804,  by  a musket  ball,  which  entered  over  the  right  mastoid  process,  injured 
the  external  ear,  and  lodged  under  the  skin,  a little  in  front  of  the  auditory  foramen.  In  the  difficult  retreat 
from  Beam’s  Station,  he  was  conveyed  to  the  Base  Hospital  at  City  Point,  and  thence  was  sent  to  Washington 
and  admitted  to  the  Lincoln  Hospital,  on  August  28th.  The  ball  had  not  been  extracted,  and  no  symptoms 
attracted  special  attention  until  September  7th,  when  Acting  Assistant  Surgeon  A.  M.  Sherman,  in  charge  of 
the  case,  observed  that  the  right  parotid  gland  was  so  greatly  iutlamed  that  the  patient  with  difficulty  sepa- 
rated his  teeth  more  than  one-fourth  of  an  inch.  In  the  course  of  the  day,  he  had  an  alarming  hsemorrhage, 
supj)osed  to  proceed  from  the  posterior  auricular.  This  was  stopped  by  compression  with  lint  steeped  with 
solution  of  persulphate  of  iron.  On  September  8th,  there  was  no  recurrence  of  bleeding ; on  the  forenoon  of 
the  9th,  he  had  an  alaiming  haemorrhage,  which  was  temporarily  arrested,  with  difficulty,  by  compression 
with  lint  and  styptics,  until  the  patient  could  be  removed  to  the  operating  room,  when  the  right  primitive 
carotid  Avas  ligated  by  Acting  Assistant  Surgeon  W.  W.  Valk,  the  patient  being  etherized.  The  ligature 
Avas  placed  a short  distance  beloAV  the  bifurcation,  and  coagula  Avere  removed,  and  the  ball,  already 
mentioned,  Avas  extracted  from  near  the  angle  of  the  jaAV.  On  the  10th,  the  patient  was  quiet,  Avith  a frequent 
pulse ; on  the  11th,  bleeding  recurred,  and  again  on  the  12th,  but  ceased  spontaneously.  There  Avas  diarrhma 
and  vomiting.  On  the  14th  and  15th,  the  symptoms  Avere  regarded  by  Dr.  Sherman  as  favorable.  On  the 
18th  there  was  several  recurrences  of  htemorrhage ; on  the  19th,  there  was  much  sAvelling  of  the  face  and 
neck,  Avhen  the  ligature  Avas  removed.  The  patient  died  from  haemorrhage  on  the  folloAving  day.  The 
folloAving  is  an  abstract  of  the  notes  made  at  the  autopsy,  by  Acting  Assistant  Surgeon  H.  M.  Dean  : “Height, 
five  feet  seven  inches.  * * * * The  submaxillary  gland  Avas  in  a suppurating  condition ; * * the 

jugular  vein  Avas  perfectly  normal ; there  Avas  an  abscess  extending  above  and  beloAv  the  point  of  the  artery 
ligated  about  three-fourths  of  an  inch  ; the  ligature  had  come  away,  and  the  tAvo  extremities  of  the  artery,  at 
the  point  of  ligation,  Avere  covered  Avith  pus.”  The  Avound  already  adverted  to,  behind  the  right  ear,  Avas 
connected  Avith  an  abscess,  Avhich  extended  doAvn  to  the  angle  of  the  inferior  maxilla,  and  contained  a dark- 
colored  fcEtid  pus.  The  artery  from  Avhich  the  hemorrhage  came  Avas  not  detected.  The  case  is  reported  by 
Drs.  Sherman  and  Dean,  and  Assistant  Surgeon  McKee,  in  his  quarterly  report,  gives  no  further  remarks  on 
the  case  by  Dr.  Valk.  The  pathological  specimen,  figured  in  the  Avood-cut,  shoAvs  one-third  of  the  calibre  of 
the  vessel  undivided.  In  the  Avood-cut  (Fig.  177),  the  ligature  on  the  internal  carotid  AA'as 
apparently,  as  Dr.  Woodhull  has  remarked,  an  experiment  upon  the  cadaver. 

Case. — Private  P.  O’C- 


Fig.  177.-Innom- 
inata,  pertiun  of 
subclavian  and 
three  carotids, 
showing  division 
by  ulceration  on 
the  tentli  day  af- 
ter ligation  of  the 
common  carotid. 
Spec.  3252,  Sect.  I, 
A.  M.  M. 


j Co.  18lh  XJ,  S.  Infantry,  was  wounded  at  Chiclvamauga,  September 
20th,  1863,  by  a conoidal  ball,  Avhich'entered  beloAV  the  left  zygomatic  arch,  passed  through  to  the  right  side, 
and  made  its  exit  beloAV  the  angle  of  the  inferior  maxilla.  Secondary  hemorrhage  occurred  from  the  Avound 
of  exit  and  from  the  mouth  on  October  2d,  but  it  Avas  temporarily  checked  by  compresses.  October  4th  Sur- 
geon Peter  H.  Cleary,  U.  S.  V.,  ligated  the  external  carotid.  The  patient  improved  rapidly 
and  appeared  perfectly  safe,  Avhen,  on  October  12th,  haemorrhage  recurred ; but  Avas  again 
checked  by  compression.  The  Avounds  Avere  nearly  healed,  but  the  patient  Avas  greatly 
enfeebled  from  repeated  loss  of  blood.  On  October  23d,  a profuse  haemorrhage  set  in  from 
the  Avound  of  exit.  Surgeon  I.  Moses,  U.  S.  V.,  then  ligated  the  right  common  carotid,  about 
one  and  a half  inches  above  its  origin.  The  patient  sank  rapidly,  and  died  on  October  25th, 

1863.  The  preparation,  forAvarded  to  the  Museum  by  Dr.  Moses,  U.  S.  V.,  is  represented  in 
the  Avood-cut  (FiG.  178).  It  shows  a ligature  of  the  common  trunk,  and,  at  the  bifurcation, 
a large  coagulum  is  imperfectly  indicated.  Above  are  the  origins  of  the  occipital  and  facial 
arteries,  and,  at  the  extremity,  the  rugose  ulcerated  section  of  the  external  carotid. 

Case. — Corporal  G.  P — 


Fig.  178.— Lig- 
ation  of  right  car- 
otid. Spec.  2133, 
8ect.  I,  A.  M.  M. 


-,  Co.  H,  91st  Pennsylvania  Volunteers,  aged  28  years, 
was  admitted  to  Emory  Hospital,  Washington,  October  3l8t,  1864,  for  a gunshot  wound  of 
the  face,  received  near  South  Side  Eailroad,  Virginia,  October  27th.  A ball  had  entered  the 
chin  at  the  left  side,  passed  inAvard  and  lodged  beneath  the  angle  of  the  inferior  maxilla, 
Avhence  it  Avas  extracted  through  the  mouth.  The  AVOund  Avas  dressed  Avith  cold  Avater,  and 
a compress  Avas  applied  to  the  jaAV.  On  November  4th,  secondary  haemorrhage  occurred, 
Avhich  Avas  arrested  by  plugging  the  Avound  Avith  sponges.  The  common  carotid  artery  Avas 
tied  in  the  continuity,  just  above  the  omo-hyoid,  by  Surgeon  N.  E.  Moseley,  U.  S.  V.,  for  recur- 
ring hemorrhage  on  the  6th,  and  the  patient  died  from  exhaustion  on  the  evening  of  Novem- 
ber 16th,  1864.  The  post-mortem  examination  revealed  a firm  clot  in  the  artery.  A Avet 
ju-eparation,  shoAving  the  extent  of  this  formation,  Avas  contributed  to  the  Army  liledical 
Museum  by  Acting  Assistant  Surgeon  W.  H.  Coombs,  and  is  rejiresented  in  the  adjoining 
Avood-cut  (Fig.  179). 


In  Table  XV,  fifty-five  cases  of  ligation  of  the  conimon  carotid  after  gunshot  wounds 
of  the  face  are  accounted  for,  including  two  instances  in  which  the  external  carotid  was 
also  tied.  Twenty  cases  have  been  recited,  with  such  particulars  as  \W'rc  communicated. 
The  remaining  tliirty-five  must  he  consolidated  in  a tahuhir  statement. 

50 


394 


WOUNDS  AND  INJURIES  OF  THE  FACE. 


[ClIAP.  II, 


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REMARKS. 

Operator,  Surgeon  W.  S.  Love,  P.  A.  C.  S. 

Operator,  Surgeon  D.  W.  Bliss,!'.  S.  V.  The 

facial  artery  was  tied  on  May  12,  18fi4. 

Operator,  Surgeon  Z.  E.  Bliss.  U.  S.  V.  Disa- 

bility three-fourths  and  permanent,  Januar\', 
1870. 

Disability  seven-eighths  and  permanent,  April, 

1S()7. 

Operator,  Ass’t  Surgeon  K.  F.  AVeir,  IJ.  S.  A. 

Operator,  Assistant  Surgeon  Philip  Adolidius, 

U.  S.  A. 

Operator,  Assistant  Surgeon  Francis  C.  Greene, 

3Uth  ]\Iassaehusctts  Volunteers.  Disability 

one-half  and  permanent,  March,  1804. 

Operator,  Acting  Ass’t  Surgeon  N.  A.  Bobbins. 

Operator,  Ass’t  Surgeon  R.  F.  Weir,  U-  S.  A. 

Operator,  Acting  Ass’t  Surgeon  J.  II.  Packard. 

RESULT. 

Death. 

Nov.  2,1864 

Sept.  1, 1864 

Get.  22,1864 

July  6, 1864 

c 

o 

Ui 

^11  11  j 1 I 1 , 

i S'  § s'  .1  s s'  5 

Ilf  II  ill  Si 

J « i ; ; 

U.  ^ 
02 

^ 3 

«g 

1 II  I i 1 ; 1 I i 

i'g  s'  is  : S'  s' 

1 It  f if  ill  1 

1 ill  'i  III 
fi  iS  3 ^'.P 

E-.T  1.“  . D,"  E> 

1 1 

Date  of 

a 

J 

< 

5 

2 

i 

1 i 1 1 II  i 1 1 I 

55  : s'  : 7':i  : S'  2 

f i 1 I ffi  : I 1 1 

1 ill  I 1 

Sb'3  i "' 

k.  S ?<  2 : k, 

S 53  big  ; = 

Date  of 

Wound. 

ill  ii  III  I 

f7  ^ CO  co"  ^*‘  tP  o ^ ci 

III  It  III  1 

11  1 1 

S*"  ^ 

t 3 & 1 

O >-5  CO  '-S 

LIGATION. 

Common  carotid,  j ust  below 
bifurcation. 

Right  common  carotid 

Right  common  carotid... 

Comnn  m earotid.j  ust  above 
omo-hyoid. 

Right  common  carotid. . .-. 

1 

Common  carotid 

Right  Common  carotid 

Common  carotid 

Right  common  carotid  . . . .' 

Common  carotid ! 

1 

Left  comtnon  carotid,  at 
lower  triangle. 

Right  common  candid,  un- 
der omo-hyoid. 

1 

Common  carotid ^ 

Right  common  carotid, near 
bifurcation. 

INJURY. 

G.  S.  F.  of  lower  jaw 

G.  S.  W.  of  lower  jaw 

G.  S.  F.  of  lower  jaw,  with 
wound  of  sublingual  ar- 
tery. 

G.  S.  F.  of  lower  jaw 

Conoidal  musket  ball  frac- 
turing right  upper  max- 
illa. 

G.  S.  W.  of  mouth 

G.  S.  F.  of  inferior  maxilla. 

G.  S.  F.  of  upperandlower 
jaw ; sight  <)f  one  eye 
destroyed. 

G.  S.  F.  of  inferior  maxilla. 

G.  S.  W.  of  face 

'■  i 4 ° 

bi  1 ? 

i 1 t s 

=S  =•  3 

“ If  b| 

CO  CO 

NASIE  AND  MIL.  DES. 

Beard,  J.  J.,  Lieut.  19th  Va. 
Cavalry.  * 

Fuglcson,  C.,  Serg't,  4th  Ohio. 

Higgins,  Pat'k,  Private,  5Gth 
Kew  York. 

Klingcnberg.  C..  Private,  7th 
New  York  Artillery. 

Reed,  James,  12th  Mass 

R , J.  R.  r.,  JOtli  Mass.. 

Sandy.  N.  B.,  I’rivate,  Jd  M'est 
Virginia. 

Siggins,  T.,  Lieut.,  4L)tli  Mass 

1 

Salmon.  G.  A.,  Private.  27tli  1 
Pennsylvania. 

^Vaits,  ir.  ir..  Private,  Gi.i 
.Simth  Carolina  Cavahy. 

Ashley,  J.  J.,  Citizen 

Bachvs.  J.  ir..  Private,  12th 
Georgia. 

Clark.  J.,  Private  57th  Penn- 
sylvania. 

Cronin.  i\I.,  Private,  95th  New 
York.  . 

NO. 

r-i  c*  cc  -r  1-  00  Cl  o f-H  c?  r*' 

8kct.  III.] 


KEVIEW,  HAEMORRHAGES  AND  LIGATIONS. 


395 


396 


WOUNDS  AND  INJUEIES  OF  THE  FACE. 


[Chap.  H, 


The  results  of  ligation  of  the  common  carotid  for  gunshot  injuries  of  the  face  were 
ascertained  in  fifty-four  of  the  fifty-five  cases  reported.  There  were 
fifteen  recoveries  and  thirty-nine  deaths  (or  72.2  per  cent.)  This 
mortality  rate  is  larger,  of  course,  than  shown  by  the  tabular  state- 
ments of  Dr.  George  Norris  and  others,  for  ligations  of  the  carotid  for 
all  causes ; but  not  excessive  for  a series  of  ligations  of  the  carotid  for 
injury.  In  thirty-seven  cases  the  affected  side  was  noted. 

The  right  carotid  was  tied  in  twenty,  and  the  left  in  six- 
teen cases.  In  Case  30,  reported  by  Dr.  Cheever,  the 
ligature  being  applied  on  the  fourteenth  day  after  the 
injury,  the  patient  had  recurrent  hsemorrhages ; but  sur- 
vived until -the  twenty-fourth  day  (Fig.  180).  In  the 

case  of  R.  J.  P (p.  349),  death  occurred  on  the  eighth 

day  after  the  reception  of  the  wound.  The  specimen  is 


FIG.  180.— Clot 
in  left  primary 
carotid.  -Spec.  508, 
Sect.  I,  A.  M.  M. 


represented  in  the  wood-cut.  Fig.  181. 


Fig.  181. — Partial  division  of 
the  extonial  carotid,  near  the 
origin  of  the  internal  maxillary. 
Spec.  2222,  Sect.  I,  A.  M.  M. 


Of  the  fifty-five  ligations  of  the  common  carotid  for  gunshot  face  injuries,  two  were 
wounds  of  the  soft  parts  only.  The  others  involved  fractures  limited  mainly  to  the  mastoid 
or  malar  regions  in  nine  instances,  to  the  upper  maxillary  in  twenty  cases,  to  the  lower 
maxilla  in  twenty-two  cases,  and  extending  to  both  jaws  in  three  cases.  The  period 
intervening  between  the  date  of  injury  and  the  date  of  operation  is  known  in  forty-nine 
of  the  fifty-five  cases  cited,  giving  an  average  of  eighteen  days.  The  period  between  the 
date  of  operation  and  the  date  of  death  is  recorded  in  thirty-eight  of  the  thirty-nine  fatal 
cases,  averaging  six  days.  The  common  carotid  was  re-ligated  in  four  cases.  In  one 
instance  (case  of  Fugleson,  p.  394)  the  patient  recovered ; in  the  other  three,  the  men  died 
on  the  same,  the  first  and  second  day,  respectively. 

There  were  six  cases  reported  of  ligations  of  the  external  carotid,  in  addition  to  the 
two  already  mentioned  in  conjunction  with  ligations  of  tlie  common  trunk.  Four  of  the 
six  may  be  regarded  as  successful,  in  the  sense  of  recovery  from  the  operation  : 


Bryant,  W.,  Private,  17th  Indiana  Volunteera.  Gunshot  wound  of  inferior  maxilla,  June  25th,  1863.  Hiemorrhage 
occurred  July  5th,  1863.  Ligation  of  external  carotid,  July  5th,  1863.  Hiemorrhage  recurred,  and  artery  je-ligated,  July  8th, 

1863.  Recovered  August  30th,  1863.  In  October,  1867,  his  disability  was  rated  total  and  permanent. 

Diss,  C.,  Private,  13th  Ohio  Volunteers.  Gunshot  fracture  of  right  zygoma  and  malar  bone;  loss  of  eye,  September  14th, 
1862.  -Hiemorrhage  from  right  external  carotid  occurred  September  22d,  1862.  Artery  ligated  September  22d,  1862.  Recov- 
ered November  19th,  1862.  September  4th,  1865,  Pension  Examiner  Th.  A.  Reamy  stated  that  the  right  eye  is  sympathetically 
affected,  and  that  the  patient’s  general  system  is  failing  rapidly.  Pensioner  died  September  22d,  1865. 

Godfrey,  A.,  Private,  14th  New  York  Heavy  Artillery.  Gunshot  wound  of  the  jaw,  June  18th,  1864.  Hiemorrhage 
occurred  from  the  external  carotid,  June  27th.  Artery  ligated  June  27th,  1864,  by  Surgeon  G.  L.  Pancoast,  U.  S.  V.  Patient 
died  June  30th,  1864. 

Henderson,  G.,  Sergeant,  7th  Wisconsin  Volunteers.  Gunshot  fracture  of  superior  maxilla,  September  14th,  1862, 
Hiemorrhage  occurred  from  right  external  carotid,  September  15th,  1862.  Artery  ligated  September  15th.  Recovered  October 
15th,  1862.  In  June,  1863,  his  disability  was  rated  two- thirds  and  temporary. 

Nelson,  G.  W.,  Private,  12th  Georgia  Regiment.  Gunshot  fracture  of  zygoma,  June  6th,  1864.  Hffimorrhage  occun-ed 
from  left  external  carotid,  June  6th  and  7th.  Artery  ligated  June  7th.  Hannorrhage  recurred  June  19th.  Died  June  19th, 

1864. 

Thompson,  L.  C.,  Private,  1st  Texas  Regiment.  Gunshot  fracture  of  right  inferior  maxilla,  December  14th,  1864, 
Ilannorrhage  occurred  from  right  external  carotid,  December  14th,  1884.  Artery  ligated  December  14th,  1864,  by  Surgeon  J. 
C.  .Jones,  4th  Texas.  Recovered  January  14th,  1865.  ' 


Skct.  III.]  EEVIEW,  II^MOERIIAGES  AND  LIGATIONS.  397 

A sifigle  instance  is  noted  of  ligation  of  the  internal  jugular  for  a wound  made  in 
extracting  a ball  lodged  behind  the  great  vessels : 

Case. — Private  William  McDonald,  Co.  F,  Slst  New  York  Volunteers,  was  wounded  at  New  Berne,  March  14th,  18G2, 
by  a musket  ball,  which  entered  the  lower  jaw,  one  and  a half  inches  to  the  left  of  the  symphysis,  passed  downward  into  the  left 
side  of  the  neck  and  lodged  at  the  apex  of  the  superior  carotid  triangle,  between  the  jugular  vein  and  the  carotid  artery.  The 
haemorrhage  was  severe.  He  was  treated  at  the  New  Berne  Hospital  till  April  14th,  and  thence  transferred  to  New  York,  and 
sent  to  Bellevue  Hospital.  On  May  8th,  he  was  transferred  to  Ladies’  Home  Hospital.  Loose  pieces  of  bone  were  removed  on 
June  15th,  and,  at  subsequent  periods,  other  fragments,  in  all  amounting  to  sixteen.  The  wound  finally  healed,  about  Septem- 
ber 15th.  At  that  date,  he  sufiered  from  numbness  of  left  shoulder  and  partial  paralysis  of  corresponding  arm;  he  was  unable 
to  perform  arduous  duty,  but  was  placed  on  light  duty  at  the  hospital.  On  January  5th,  1863,  the  bullet  was  removed  by 
Surgeon  Alexander  B.  Mott,  U.  S.  V.  In  cutting  down,  over  the  ball,  it  was  found  that  the  relative  anatomy  of  the  part  was 
deranged.  The  bullet  was  lying  behind  the  deep  jugular  vein  and  carotid  artery,  and  pressed  the  vein  forward  to  such  an 
extent  that  the  vessel  was  collapsed  and  little  or  no  blood  could  pass  through  it.  The  sui-rounding  tissues  also  closely  invested 
the  missile.  Although  the  incision  was  made  through  the  sterno-cleido-mastoid  muscle  to  the  outside  of  the  deep  jugular  vein, 
owing  to  the  above  facts  it  was  accidentally  wounded.  The  htemorrhage,  however,  was  inconsiderable,  being  controlled  by 
pressure,  the  danger  of  cutting  the  vein,  and  the  probability  of  the  accident  having  been  duly  announced  by  the  operator 
previous  to  the  operation.  The  ball  ^vas  extracted  with  some  difficulty,  and  a double  ligature  passed  around  the  vein  so  as  to 
secure  it  above  and  below ; the  wound  was  drawn  together  by  interrupted  sutures  and  adhesive  straps.  The  ball  was  flattened 
on  the  posterior  aspect  and  was  very  jagged  where  it  was  in  contact  with  the  carotid  artery.  The  wound  healed  kindly,  the 
ligatures  coming  away  on  the  ninth  day  after  the  operation.  The  patient  was  finally  discharged  from  service  on  April  13th, 
1883.  Pension  Examining  Surgeon  G.  S.  Gale  reports,  September  30th,  1868,  that  exfoliation  is  still  progressing;  difficulty  of 
deglutition ; left  arm  paralytic  from  probable  injury  of  the  cervical  nerves. 

No  instances  of  ligations  of  the  internal  carotid  for  gunshot  injuries  of  the  head  or 
face  were  reported.  The  examples  of  tying  the  facial,  lingual,  superior  thyroid,  and  other 
minor  branches  were  but  few,  and  the  particulars  reported  but  scanty.*  The  following 
citations  will  indicate  what  can  be  gleaned  from  the  reports: 

Everson,  P.,  Private,  1st  Minnesota  Volunteers.  Gunshot  wound  through  base  of  tongue,  with  fracture  of  jaw,  July 
2d,  1863.  Hasmorrhage  occurred  July  14th,  and  both  lingual  arteries  were  tied  in  the  wound  en  masse  the  same  day.  The 
patient  recovered.  In  September,  1865,  his  general  health  was  seriously  impaired;  he  was  unable  to  eat  other  than  liquid  food. 
Disability  total. 

Atwood,  G.,  Private,  142d  New  York  Volunteers.  Gunshot  injury  of  inferior  maxilla  and  fracture  of  left  fibula, 
October  27th,  1864.  Hcemorrhage  occurred  from  a branch,  of  the  superior  thyroid,  November  7th,  1864.  Thyroid  ligated 
November  7th,  1864.  Recovered  April  19th,  1865.  In  June,  1866,  his  disability  was  rated  one-half  anil  permanent. 

Case. — Private  Benjamin  Foote,  Co.  I,  4th  United  States  Colored  Troops,  aged  22  years,  received,  at  Petersburg,  June 
15th,  1864,  a gunshot  wound  through  the  upper  maxillary.  He  was  conveyed  to  Portsmouth,  and,  on  June  20th,  admitted  to 
the  Balfour  Hospital.  There  was,  apparently,  little  laceration  or  comminution,  but  the  patient  was  much  debilitated  from 
profuse  hajmorrhage.  On  June  23d,  Acting  Assistant  Surgeon  C.  C.  Ella  ligated  the  right  facial  arteiy  just  below  the  com- 
mencement of  the  ascending  palatine,  but  the  case  terminated  fatally  on  the  same  day  at  ten  in  the  evening. 

Case. — Private  William  Gaines,  Co.  C,  5th  United  States  Colored  Troops,  aged  20  years,  received,  at  Petersburg,  June 
18th,  1864,  a gunshot  wound  of  the  face.  The  ball  entered  the  left  cheek,  fractured  the  inferior  maxilla,  right  side,  and  emerged 
from  the  right  cheek,  cutting- the  right  facial  artery.  He  was  conveyed  to  the  Balfour  Hospital,  Portsmouth,  on  June  20th. 
Considerable  laceration  and  comminution  existed,  especially  on  the  right  side.  Secondary  hicmorrhage  occurred  on  June  25th, 
and,  on  the  following  day.  Acting  Assistant  Surgeon  C.  C.  Ella,  ligated  the  right  facial  artery,  near  the  inferior  margin  of  the 
inferior  maxillary.  The  patient  improved  steadily,  and  was  transferred  on  July  19th,  1864. 

Bessel,  A.  J.,  Sergeant,  14th  Michigan  Volunteers.  Gunshot  fracture  of  inferior  maxilla,  light  side,  July  5th,  1864. 
Haemorrhage  occuiTed  and  facial  artery  ligated.  Discharged  January  4th,  1865. 

McCray,  J.,  Private,  145th  Pennsylvania  Volunteers.  Gunshot  wound  of  lower  jaw.  May  12th,  1864.  Hannorrhage 
occurred  June  4th,  1864.  Facial  artery  ligated  in  wound,  June  4th,  1884.  Recovered  July  1st,  1864. 

Woodward,  C.  L.,  Private,  2d  Vermont  Volunteers.  Gunshot  fracture  of  right  lower  jaw.  May  3d,  1863.  Ligation  of 
left  facial  artery  in  wound.  Recovered  February  19th,  1864. 


* Consult,  on  ligations,  Dr.  Gurdon  Buck  {N.  Y.  Med.  Times^  Nov.,  1855).  See  tbe  important  papers  of  Dr.  Geougk  NOUlilS  (Am.  Jour.  Med.  Sci., 
1847,  Vol.  XIV,  p.  13)  and  the  first  in  the  Medico-Chirurgical  Transactions  (by  Mr.  ASTLEY  Coopkk,  and  read  Jan.  2yth,  180C) ; ]\I.  1*.  BkOca,  Dcs 
anevrysmes^  Paris,  18.35,  p.  503;  Dr.  James  U.  Wood  (iV.  Y.  Jour.  Med.,  July,  18.57) ; N.  CiiKVKliS,  Lond.  Med.  Gaz.,  N.  S.,  Vol.  I,  p.  1140 ; HoiCNRU, 
W.  L.,  Ayner.  Jour.  Med.  Sci.,  1832,  Vol.  X,  p.  403;  BltOWN,  J.  B.,  Surgeon  U.  S.  A.,  Am.  Jour.  Med.  Sci.,  N.  S.,  Vol.  XXVIII,  p.  415;  Isaacs,  C.  K., 
N.  Y.  Jour,  of  Med..  \6\.  X.V.,  ii.  S.,  p.  151;  see  also  Blackman,  Western  Lancet,  Vol.  XVl;  TvviTCHELL,  A'cw  JCng.  Jour.  Med.  and  Surg.,  October, 
1842;  MUSSEV  and  COGSWELL,  same  Journal,  Vol.  XI,  p.  359,  and  Vol.  XIU,  p,  357,  1824;  Wauuen,  J.  C.,  JSoston  Med.  and  Surg.  Jour.,  Vol.  I,  p.  42, 
1828,  and  LEWIS,  same  Journal,  Vol.  II,  p.  371,  1829. 


398 


WOUNDS  AND  INJURIES  OF  THE  FACE. 


[Chap.  II, 


Leaving  the  ligations,  which  will  be  reverted  to  in  connection  with  operations  for 
injuries  of  the  neck,  it  may  he  noted  that  hut  few  of  the  cases  reported  as  excisions 
appear  to  have  heen  extensive  operations;  hut  rather  the  removal  of  portions  of  hone 
that  were  partially  detached  or  had  perished  from  necrosis  and  required  slight  operative 
interference  for  their  extraction.  Yet  there  were  important  exceiDtions  to  this  general 
statement,  as  in  the  cases  of  Downey  (p.  348)  and  Spear  (p.  365),  where  formal  excisions 
were  practiced  of  portions  of  the  upper  maxillaries,  and  those  of  Beamenderfer  (p.  347), 
Murray  (p.  351),  Smith  (p.  362),  and  Algoe  (p.  365),  in  which  considerable  parts  of  the 
lower  maxilla  were  excised.  Most  of  these  were  intermediary  opera- 
tions; hut  several  were  performed  at  the  field  hospitals.  In  two  or 
three  instances  staphyloraphy  was  early  performed,  and  quite  success- 
fully in  a case  noted  on  p.  378.  Commonly,  wounds  of  the  palatine 
region  were  too  extensive  to  admit  of  an  ojieration  of  such  nicety. 

Of  trephining  the  antrum  to  extract  halls,  a very  few  cases  were 
reported,  and  one  only  (Keil,  p.  366)  in  any  detail. 

An  example  of  a hall  splitting  on  the  symphysis  of  the  lower 
maxilla,  after  wounding  the  right  common  carotid,  is  illustrated  hy  Fig. 
Fic.  ]82.— conoidai  ball,  ig2.  All  iiistance  of  the  extraction  from  the  orhit  of  two  pieces  of  wire 

Split  on  impact  with  lower  -L 

i,“a.' m!  is  described  and  figured  in  the  following  case : 


Case. — I’rivate  Simon  Flory,  Co.  F,  1st  Peiinsj'lvania  Artillery,  aged  22  years,  was 
admitted  to  Tumor’s  Lane  Hospital,  Pbiladelpliia,  on  July  lltli,  for  a wound  of  the  eye,  received 
at  Gettysburg,  July  2d,  1863.  A piece  of  iron  wire,  possibly  from  a case-sbot,  bad  entered  tbe 
upper  and  inner  part  of  tbe  right  oi-bit,  and  lodged.  It  was  at  once  removed  by  tbe  regimental 
surgeon,  being  bi’oken  in  two  pieces.  By  December  12tb,  tbe  wound  bad  bealed,  but  tbe  sight  of 
the  eye  was  destroyed.  The  above  particulars,  with  the  specimen,  which  is  rejiresented  in  tbe 
adjoining  cut  (Fig.  183)  were  contributed  by  Assistant  Surgeon  C.  H.  Alden,  U.  S.  A.  Tbe  man 
is  a pensioner,  and  bis  disability  was  rated  one-lialf  in  December,  1865,  tbe  eye  being  amaurotic. 

Examining  Surgeon  J.  J.  Crawferd,  of  Williamsport,  Lycoming  County,  Pennsylvania,  under  date 
of  September  lltb,  1866,  states:  “Tbe  projectile,  a piece  of  canister  wire  tbe  shape  of  a half 
circle,  entered  one  point  above  tbe  right  eyeball,  tbe  other  at  tbe  inner  cantbus  of  tbe  same  eye. 

Tbe  supra-orbital  nerve  was  wounded  by  the  upper  point,  and  tbe  violent  concussion  of  tbe  brain  Fic..l83. — Iron  wire  removed 

injured  tbe  optic  nerve.  Tlie  eye  is  amaurotic.”  Tbe  foreign  body  was  removed  by  Surgeon  M.  aTi'  aF 
F.  Price,  1st  Pennsylvania  Artillery. 

Ill  the  shocking  cases  in  which  the  greater  portion  of  the  lower  maxilla  was  carried 
away  hy  large  projectiles,  or  where  considerahle  parts  of  both  jaws  were  destroyed,  the 
mortality  was  far  less  than  might  have  heen  anticipated.  In  many  of  these  instances, 
ingenious  prothetic  apparatus  was  ada]ited,  and  the  mutilated  men  were  enabled  to  retain 
liquid  food,  and  to  avoid  the  dribbling  of  saliva,  as  well  as  to  mask  their  deformities. 
No  examples  were  reported  of  halls  remaining  lodged  for  a long  time  in  the  tongue,  such 
as  Larrey  records. 

The  most  important  complication  of  wounds  of  the  face,  viz:  hsemorrhage,  will  he 
reverted  to  in  connection  with  wounds  of  the  neck.* 

* C’onsiilt  Holmes,  op.  cit..  VdL  II,  p.  183;  DoniilCLIN,  Dc  Ifniendis  Vulnerum  Oris^  Halae ; WisEMAN,  Several  Chiruryical  2'rcatise.s,  London, 
1G76,  p.  301;  RlliES,  Diet,  dcs  Sci.  Mid.,  Paris,  1818,  T.  29,  p.  375;  Oaiiuetsox,  A Treatise  on  the  Diseases  and  Surgery  of  the  Mouthy  Jaws,  and, 
Associated  Parts,  Phila.,  1809;  JoL’DATX,  A Treatise  on  the.  Diseases  and  Surgical  Operations  of  the  Mouth  and  ]*oxts  Adjacent,  Phila.,  1851;  Mal- 
GAIGNlC,  Traitc  dcs  Fractures  ct  des  Luxations,  Paris,  1874,  T.  I,  p.  378 ; Journ.  Gen.  de  Medicitie,  T.  LXIII,  p.  4,  and  T.  LXVI,  p.  80  ; Rccua  Medicate, 
1824,  T.'lV,  p.  405;  Diet,  dc  Medicine,  Paris,  1832-1845,  T.  XIX  : HOUZELOT,  These  Inaug.,  I’aris,  1827;  NeUCOUT.  Ohs.  de  Fract.  dc  la  Mathoirc  hf.; 
Journ.  dc  Chir.,  1844,  j).  359:  DESAULT,  Journ.  dc  Chir.,  'Ik  1,  j).  8;  Lecat,  Remarques  siir  une,  Especc  Part,  de  Fract.  dc  la  Machoire  Inf.,  Stqqjle- 
merit  uux  In.d.  Chir.  d'  IlEISTEU,  p.  154  ; ROSSI,  Med.  Operat.,  T.  I,  p.  78;  VIDAL,  Traiti  dc  l*ath.  Ext.,  Paris,  1801,  'V.  Ill,  p.  502;  FLAJAN'J,  Colledone 
di  os.w.ri'aziom,  etc.,  Roma.  1802,  T.  Ill,  j).  100;  Annates  dc  la  Chirurgic,  T.  VIII,  p.  472;  MiCIIAELIS,  licschrcihung,  etc..  Journal  der  Chirurgic 
VON  (illALEE  nnd  Waltiie:!,  1823;  BlAlAUD,  Gaz.  dcs  Ilopitaux,  19  Aodt,  1841;  BUSH,  Lrmdoii  Med.  and  Phys.  Journal,  Nov.,  1822,  p.  401  ; Wales, 
A Practical  Treatise  on  Surgical  Apparatus,  Appliances,  and  Elementary  Operations,  Phila.,  1807;  PKIiCV,  1.  c.  p.  IKi;  BoYEU,  1.  c. ; DelalajX, 
Bulletin  de  I Acad,  d,-  Med.,  Paris,  April  Ifith,  1872. 


CHAPTER  III. 


WOUNDS  AND  INJURIES  OP  THE  NECK. 


The  wounds  and  injuries,  of  the  neck  reported,  and  here  to  be  considered,  numbered 
about  five  thousand.  The  results  are  tabulated  at  the  conclusion  of  the  chapter.  So 
many  injuries  of  the  neck  were  comjDlicated,  either  by  lesions  of  the  face,  or  of  the  chest, 
or  of  the  cervical  vertebrae,  or  of  the  great  vessels  of  the  neck,  that  the  conclusions  must 
be  regarded  as  approximative  only,  a large  number  of  cases  being  elsewhere  classified. 
Many  ligations  of  the  carotids  are  included.  The  injuries  of  the  spine  are  separately 
considered  in  the  fourth  chapter.  This  chapter  will  include  sections  on  miscellaneous 
injuries,  on  gunshot  wounds,  and  on  operations. 


Section  I. 

INCISED  AND  PUNCTUEED  WOUNDS,  AND  MISCELLANEOUS  INJUEIES. 


Forty-six  cases  of  this  nature  appear  on  the  returns,  comprising  a few  sabre  and 
bayonet  wounds,  suicidal  attempts  with  razors,  stabs  from  knives,  and  contusions  from 
various  causes.  The  cases  of  sabre  and  bayonet  wounds  will  be  specified,  and  the 
remaining  cases  tabulated.  There  was  one  instance  of  an  unimportant  injury  from  a 
fragment  of  a torpedo. 

Sabre  Wounds. — There  were  five  cases  that  came  under  treatment,  as  follows: 

I.irrr.K,  ,J.  II.,  I’l-ivate,  Co.  B,  IStli  I’emifiylvania  Cavalry,  agvd  24  years.  Elesh  wouiul  of  left  side  of  iieclv ; salire. 
Satterlee  Hosi'ital,  Bliila(leli)liia.  Duty,  January  2:5<1,  18:14. 

I’aytox,  William,  Puvato,  Co.  K,  fc’lli  West  Virginia  Cavalry,  aged  22  years.  Sabre  wound  of  left  side  of  iiedv. 
Bunker  Hill,  Virginia,  Sejiteiiiber  3d,  18t)4.  Division  No.  1 Hospital,  Annapolis,  October  9tb.  Deserted,  Noveinlier  29tl],  18:14. 

McIntO-SII,  Daa  id,  Sergeant,  Co.  E,  Gtb  Ohio  Cavalry.  Sabre  wound  of  back  of  neck.  Cavalry  raid  in  Virginia,  May 
9tb  to  l.utl),  18G4. 

Mooxicy,  Daxiicl  T.,  Private,  Co.  H,  2d  New  .Jersey  Cavalry.  Sabre  wound  of  ligbt  side  of  neck.  Ninvark  Hcspifal, 
Newark,  New  Jer.sey,  I'ebruary  22d,  1834.  Disebarged  April  8tli,  18o5,  for  unreducible  dislocation  of  right  shoulder. 

.Jacobs  Thoma.s,  Piivate,  Co.  I,  1st  Potomac  Home  Brigade.  Sabre  wound  of  neck;  slight.  Monocacy  Junction, 
Marylan;!,  July  Dth,  18, i4.  Hospital  at  Frederick,  Jidy  13th,  1804.  Transferred  to  Baltimore,  and  returned  to  duty  on  August 
•2d,  1834. 

3'./J 


400 


WOUNDS  AND  INJURIES  OF  THE  NECK. 


[Chap.  Ill, 


Bayonet  Wounds. — Three  slight  cases  and  one  that  was  fatal  were  reported.  In 
the  latter,  the  great  vessels  of  the  neck  were  perforated  : 

Hassetf,  B.  J.,  Bugler,  Co.  F,  121st  New  York  Volunteers,  aged  19  years.  Bayonet  wound  of  right  side  of  neck  ; slight. 
Wilderness,  May  5th,  1854.  Washington,  Baltimore,  and  Annapolis  hospitals.  Returned  to  duty  on  August  IGth,  1864. 

!Mooke,  James,  Corporal,  Co.  D,  38th  Ohio  Volunteers,  aged  24  years.  Bayonet  wound  of  neck.  Jonesboro’,  Georgia, 
September  1st,  1804.  Nashville,  Cincinnati.  Mustered  out  on  June  21st,  1865. 

Dustin,  Elbridge,  Private,  Co.  B,  9th  New  Hampshire.  Bayonet  wound  of  neck.  Jackson,  Mississippi,  July  13th, 
1863.  Surprised  on  picket  and  brought  into  hospital  dead.* 

Littxe,  John  N.,  Sergeant,  Co.  I,  2d  West  Virginia  Volunteers.  Bayonet  wound  of  neck,  posterior  to  pharynx,  April 
18th,  1865.  Discharged  on  June  21st,  1865. 


Table  XVI. 


Jxesults  of  Forty-six  Cases  of  Injuries  of  the  Neele  from  Miscellaneous  Causes. 


CHARACTER  OF  INJURY. 

Cases. 

Duty. 

Disciiauged. 

Dnsn. 

UNKNOWN. 

5 

2 

2 

1 

4 

1 

2 

1 

9 

6 

3 

2 

1 

1 

Incised  Wounds  (not  sabre) 

27 

16 

4 

5 

2 

Aggregates 

47 

26 

8 

6 

7 

The  more  important  incised  wounds  of  the  neck  were  self-inflicted,  in  awkward 
attempts  at  suicide ; the  knife  being  applied  too  high  up,  missed  the  great  vessels.  A 
remarkable  illustration  may  be  cited: 

Case. — Private  J.  L.  McC , Co.  C,  23d  Massachusetts  Volunteers,  entered  Academy  Hospital,  New  Berne,  April 

9th,  1862.  He  had  cut  his  throat  at  the  level  of  the  crico-thyroid  cartilage,  the  incision  severing  the  larynx  and  oesophagus,  and 
extending  to  the  inner  borders  of  the  sterno-mastoid.  He  fiercely  resisted  any  attempt  to  dress  his  wound  or  to  introduce  a 
stomach  tube.  The  bleeding  was  comparatively  unimportant.  The  most  remarkable  feature  of  the  case  was  the  sufferer’s 
intense  thirst.  From  a pail  of  water,  placed  above  the  level  of  his  head,  he  could  suck  through  a rubber  tube,  by  bending  forward 
and  closing  the  wound,  a little  water  that  was  apparently  swallowed  ; — then,  using  the  tube  as  a syphon,  he  would  let  the  water 
pass  through  the  pharyn.x  and  escape  through  the  wound.  He  required  eight  pailfuls,  or  twenty  gallons  of  water  daily.  Unavail- 
ing attempts  were  made  to  anaesthetize  him  in  order  to  admininister  nourishment.  He  died  exhausted  on  April  15th,  1862. 

Case. — H.  W , jailor,  was  hanged  at  Washington,  November  10th,  1865.  He  was  about  40  years  of  age,  and 

weighed  about  160  pounds.  The  rope  was  half  an  inch  in  diameter;  the  knot  was  placed  under  the  left  ear ; the  fall  was  five 
feet.  The  body  was  suspended  for  fifteen  minutes  and  then  removed  to  the  hospital.  No  rigor,  no  relaxation  of  sphincters,  no 
. seminal  ejaculation.  Face  pallid;  eyes  not  congested,  pupils  dilated;  mouth  open,  but  tongue  not  protruding.  Cicatrices  on 
left  shoulder,  forearm,  and  legs,  of  old  ulcers,  probably  scorbutic.  A deep  sulcus,  with  tumefaction  of  the  adjacent  soft  parts. 
Laceration  of  the  inner  fibres  of  the  trapezius  and  of  the  belly  of  the  sterno-mastoid  was  observed  on  removing  the  skin.  The 

hyoid  bone  had  received  six  injuries — separation  of  the  greater  and  lesser  processes  on 
both  sides  from  the  body  of  the  bone  and  true  ft-acture  of  the  outer  third  of  the  greater 
process  on  either  side.  There  was  no  lesion  of  the  brain.  The  atlas  and  axis  had  not 
been  luxated,  and  the  spinal  cord  had  escaped  compression.  In  the  thorax,  old  jileuritic 
adhesions ; aortic  insufficiency,  with  calcareous  deposits ; in  the  abdomen,  nothing 
abnoi'mal.  On  the  right  forearm  were  cicatrices  and  two  small  indolent  ulcei’s,  involving 
the  integuments  only.  The  bones  of  the  forearm  had  not  been  fractured  or  resected. 
Drs.  W.  Thomson  and  H.  Allen,  from  whose  official  report  the  foregoing  notes  are  taken, 
remark  the  extreme  rarity  of  fractures  of  the  hyoid.  Death  resulted  from  apnoea  alone. 
The  specimens  forwarded  with  the  report  are  Nos.  298  to  302,  inclusive,  in  the  Surgical 
Section.  The  preparation  of  the  hyoid  is  represented  in  the  wood-cut  (Fig.  184). 


* See  Reports  of  Surgeon  W.  A.  Webster,  9tli  New  H.nmpshire  Vols.,  and  of  Natt  Head,  Adjutant  General  of  N.  H. 


Sect.  II.] 


GUNSHOT  WOUNDS  OF  THE  NECK. 


401 


Section  II. 


GUNSHOT  WOUNDS. 


Gunshot  wounds  of  the  neck  may  be  subdivided  into  tliose  of  tlie  anterior,  lateral,  or 
posterior  cervical  region.  The  injuries  of  the  anterior  region  may  bo  grouped  in  two  lesser 
divisions — as  they  are  inflicted  above  or  below  the  hyoid  bone.  Among  them,  wounds 
of  the  larynx,  hyoid  bone,  trachea,  pharynx,  and  oesophagus  are  presented  for  consideration. 
In  the  lateral  region,  lesions  of  the  great  vessels,  of  the  pneumogastric  and  sympathetic 
nerves,  and  of  the  chain  of  lymphatic  glands  are  encountered.  The  posterior  sub-region, 
occupied  by  strong  muscles,  with  comparatively  unimportant  nerves,  vessels,  and  lymphatics, 
is  of  less  interest,  in  a surgical  point  of  view,  than  the  others.  A few  abstracts  of  the 
gunshot  flesh  wounds  may  be  noted : 

Case. — Lieutenant  John  O’Connor,  Co.  A,  7th  Missouri  Volunteers,  received  a gunshot  wound  of  the  neck,  at  Vicksburg, 
Mississippi,  May  22d,  1863.  The  missile  entered  the  posterior  superior  process  of  the  scapula,  passed  upward  and  emerged  one 
inch  below  the  angle  of  the  right  jaw.  He  was  treated  in  the  field  hospital  until  June  22d,  when  he  entered  the  City  Hospital, 
St.  Louis,  Missouri.  On  July  24th,  he  was  transferred  to  Jefierson  Barracks,  and  finally  mustered  out  at  the  exjjiration  of  his 
term  of  service  on  June  14th,  1864.  He  is  not  a pensioner. 

Case. — Private  Allen  Gregg,  Co.  A,  73d  Indiana  Volunteers,  was  wounded  at  Day's  Gap,  Alabama,  April  30th,  1863,  a 
buckshot  entering  at  the  back  of  the  right  ear  and  emerging  from  the  posterior  aspect  of  the  nock.  On  May  27th,  ho  was  admitted 
to  the  1st  division  hospital,  Annapolis,  Maryland.  The  wounds  healed,  and  he  was  returned  to  duty  on  March  1st,  1864.  He  is 
not  a pensioner. 

Case. — ^Private  John  Knuller,  Co.  E,  1st  Michigan  Cavalry,  aged  38  years,  received  a gunshot  wound  of  the  neck  at  Cold 
Harbor,  Virginia,  June  3d,  1864,  a conoidal  ball  entering  the  left  side,  just  below  the  occipital  ]irotuberauce,  and  emei’ging  above 
the  seventh  cervical  vertebra.  He  was  taken  to  the  hospital  of  the  1st  division.  Cavalry  Corps,  where  simple  dressings  were 
applied  to  the  wound.  On  June  7th,  he  was  sent  to  Ilarewood  Hospital ; on  June  18th,  to  Summit  House  Ilospit.al,  Philadelphia, 
and,  on  August  18th,  to  the  Satterlee  Hospital.  By  October  25th,  the  wound  of  exit  had  entirely  healed,  but  reopened  on  Decem- 
ber 25th,  discharging  freely.  On  .July  18th,  1835,  lie  was  transferred  to  Harper  Hospital,  Detroit,  Michigan,  and  discharged  from 
service  on  October  2d,  1865.  He  is  not  a pensioner. 

Case. — Private  Franklin  Smith,  Co.  B,  28th  United  States  Colored  Troops,  of  an  athletic  constitution,  was  wounded  in 
the  left  side  of  the  neck  at  Camp  Fremont,  Indiana,  April  24th,  1834,  a pistol  ball  striking  near  the  angle  of  the  maxilla,  posterior 
to  the  carotid  artery.  He  was  taken  to  the  regimental  hospital,  where  simple  dressings  were  ajiplied  to  the  wound.  It  was  said 
that  immediately  after  the  reception  of  the  injury,  the  ball  was  distinctly  felt  one  inch  and  a half  below  the  point  of  abrasion,  the 
surface  of  which  might  be  said  to  be  hermetically  closed.  He  was  not  confined  to  the  hospital,  apparently  sufl'eriug  but  little  from 
his  wound.  He  is  not  a pensioner. 

Case. — Private  J.  J.  Gibson,  17th  South  Carolina  Regiment,  aged  21  years,  received  a gunshot  wound  of  the  throat,  near 
Petersburg,  Virginia,  August  6th,  1864,  the  missile  entering  below  the  external  meatus  of  the  left  side,  and  emerging  in  the 
inferior  triangle  on  the  right  side  of  the  neck.  He  was  taken  to  the  Confederate  Hospital,  Petersburg,  and  furloughed  on  August 
27th,  1864. 

The  next  case  was  regarded  by  Surgeon  J.  II.  Brinton,  U.  S.  V.,  as  an  excellent  illus- 
tration of  the  incised  appearance  occasionally  presented  by  the  entrance  wounds  of  conoidal 
balls,  and  a water-colored  drawing  (No.  II,  Surgical  Series)  was  made,  by  Dr.  Briuton’s 
direction,  by  Hospital  Steward  E.  Stauch.  This  is  carefully  copied  in  the  left-hand  figure 
of  the  chromo-lithograph  facing  page  367. 

51 


402 


WOUNDS  AND  INJIIEIES  OF  THE  NECK. 


[Chap.  Ill, 


Case. — Private  Anthony  Speigle,  Co.  K,  5th  United  States  Cavalry,  was  wounded  at  Beverly  Ford,  Virginia,  June  9th, 
18G3,  by  a hall,  which  entered  the  hack  of  the  neck  and  passed  out  on  the  right  side  some  two  inches  above  the  clavicle.  He 
was  sent  to  Washington  ; .admitted  to  Lincoln  Ilosjiital  on  the  10th;  transferred  to  Philadelphia  on  the  22d,  and  admitted  to  the 
McClellan  Hospital  on  the  2od.  By  this  time  a cicatri.x;  had  formed.  He  \vas  returned  to  duty  cured  on  August  23d,  18G3. 
Speigle  is  not  a pensioner. 

Case. — Private  J.  H.  McKittrick,  Co.  F,  66th  Ohio  Volunteers,  aged  20  years,  received  a gunshot  wound  of  the  neck  at 
Cedar  Mountain,  Virginia,  August  9th,  1862.  The  missile  entered  just  behind  and  at  the  base  of  the  lobe  of  the  left  ear,  passed 
forward  beneath  the  integument,  and  emerged  at  about  the  middle  of  the  chest.  He  was  admitted,  op  the  13th,  to  the  3d  division 
hospit.al,  Alexandria,  Virginia,  where  cold  water  dressings  were  applied  to  the  wound.  He  was  transferred  on  August  30th,  1862, 
at  which  time  he  was  doing  well.  He  is  not  a pensioner. 

Case. — Corporal  Uriah  F.  Snediker,  Co.  H,  2d  Connecticut  Heavy  Artillery,  aged  23  years,  received  a gunshot  wound  of 
the  neck,  by  a conoidal  ball,  at  Cold  Harbor,  Virginia,  June  1st,  1864.  He  was  taken  to  the  hospital  of  the  1st  division.  Sixth 
Corps,  and  cold  water  dressings  were  applied  to  the  wound.  On  June  6th,  he  was  sent  to  the  Soldier’s  Eest  Hospital,  Alexandria; 
on  June  16th,  to  Mower  Hospital,  Philadelphia,  and,  on  July  13th,  to  Knight  Hospital,  New  Haven,  Connecticut,  whence  he  was 
discharged  the  service  on  June  7th,  1865.  He  is  not  a pensioner. 

Case. — Private  Joseph  S.  Hambright,  Co.  F,  17th  South  Carolina,  aged  19  years,  was  wounded  at  Burkesville,  Virginia, 
April  9th,  1865,  by  a conoidal  ball,  which  entered  in  front  of  the  lobe  of  the  left  ear  and  emerged  one  and  a half  inches  below  the 
occipital  protuberance.  He  was  taken  prisoner,  and,  on  the  11th,  admitted  to  the  hospital  of  the  Tenth  Corps,  near  Humphrey’s 
Stiition.  On  April  19th,  he  was  sent  to  Lincoln  Hospital,  Washington,  whence  he  was  released  on  June  9th,  1865. 

Case. — Private  A.  J.  Bowen,  Co.  E,  48th  Georgia,  aged  27  years,  was  wounded  at  Gettysburg,  Pennsylvania,  July  2d, 
1863,  by  a conoidal  ball,  which  entered  about  the  centre  of  the  inner  border  of  the  trapezius  muscle,  right  side,  passed  beneath 
th.at  muscle,  and  emerged  from  the  back  between  the  inferior  angle  of  the  scapula  and  the  spine.  Another  ball  entered  the  right 
side  of  the  back  over  the  tenth  rib,  passed  horizontally  across  and  emerged  about  one  and  a half  inches  from  the  spine.  He  also 
received  a wound  of  the  scalp  on  the  back  and  left  side  of  the  head,  about  three  inches  in  length  and  one  and  a half  inches  in 
width,  which  was  apparently  caused  by  a fragment  of  shell.  He  was  taken  prisoner  and  conveyed  to  the  Seminary  Hospital, 
Gettysburg.  Cold  water  dressings  were  applied  to  the  wound,  and  tonics  and  stimulants  given,  with  a Dover’s  powder  at  night. 
By  July  15th,  the  wounds  in  the  neck  and  back  were  suppurating  freely;  the  discharges  were  healthy.  His  appetite  was  gone, 
and  he  was  very  much  disheartened  and  reduced.  On  the  18th,  there  was  considerable  inflammation  around  the  wounds  in  the 
back,  and,  on  the  19th,  erysipelatous  inflammation  set  in,  extending  fi’om  the  umbilicus  around  the  body  up  to  the  neck.  The 
face  was  also  inflamed,  the  eyes  being  completely  closed,  and  the  skin  was  in  a frightful  mdematous  condition.  The  wounds  looked 
healthy,  with  the  exception  of  the  neck.  There  was  considerable  hasmorrhage  during  the  night.  Pulse  faint.  A local  application 
of  tincture  of  iodine  was  made,  and  beef  tea  given.  On  the  20th,  the  inflammation  on  the  body  had  subsided;  the  face  and  eyes 
were  still  oedematous.  He  continued  to  improve,  and,  on  July  27th,  was  sent  to  the  hospital  at  Camp  Letterman,  whence  he  was 
transferred  to  the  Provost  Marshal  on  September  16th,  1863,  for  exchange. 

The  two  following  cases  are  illustrated , by  a plate  copied  from  the  water-colored 
drawing,  made  by  Dr.  Brinton’s  direction,  to  illustrate  the  appearances  of  entrance  and 
exit  gunshot  wounds.  The  first  figure  illustrates  how  a ball  may  almost  harmlessly 
traverse  a region  containing  organs  of  vital  importance;  and  the  second  illustrates  the 
resiliency  of  the  great  vessels  of  the  neck.  It  was  the  opinion  of  several  surgeons,  who 
saw  the  case,  that  the  ball  had  passed  through  the  sheath  of  the  carotid,  and  probably 
between  the  carotid  and  jugular  vein: 

Case. — Private  George  W.  Brown,  Co.  I,  4th  Vermont  Volunteers,  was  wounded  at  Fredericksburg,  on  May  3d,  1863, 
by  a conoidal  musket  ball  fired  at  a distance  of  thirty  yards.  The  missile  having  entered  the  neck  posteriorly  on  the  right  side, 
passed  into  the  mouth,  knocking  out  three  of  the  lower  teeth,  and  escaped.  Being  sent  to  Washington,  the  patient  was  admitted 
to  the  Judiciary  Square  Hospital  on  the  8th;  the  wound  was  dressed  simply.  On  the  9th,  he  was  transferred  to  De  Camp 
Hospital,  New  York  Harbor,  and,  on  July  16th,  to  General  Hospital  at  Brattleboro’,  Vermont.  He  was  returned  to  duty  on 
November  Gth,  1863. 

Case. — Private  Joseph  Keepers,  Co.  G,  17th  Pennsylvania  Cavalry,  was  wounded  in  the  neck  at  Beverly  Ford,  Virginia, 
June  9th,  1863.  He  was  mounted  at  the  time,  and  distant  from  the  enemy  about  one  hundred  and  fifty  yards.  The  missile,  a 
conoidal  ball,  entered  the  right  side  of  the  neck,  just  below  the  chin,  at  the  anterior  border  of  the  sterno-mastoid  muscle,  and, 
passing  backwards  about  three  inches,  emerged.  There  was  excessive  haemorrhage,  and  the  shock  was  great.  The  patient 
being  sent  to  Washington  was  admitted  to  Lincoln  Hospital  on  the  10th;  ice  was  applied  to  the  wound;  low  diet  ordered.  On 
June  11th,  the  wound  was  very  painful ; treatment  continued.  June  16th,  steadily  improving,  very  little  discharge  from  wound, 
water  dressing,  half  diet;  June  19th,  free  discharge,  full  diet.  On  June  22d,  he  was  transferred  to  Philadelphia,  and  admitted 
to  the  McClellan  Hospital.  His  condition  at  that  time  was  good,  and  the  wound  is  reported  to  have  healed  without  any 
changes  or  symptoms  worthy  of  notice.  On  April  15th,  1834,  the  patient  is  reported  to  be  unable  to  turn  his  head  freely  from 
side  to  side,  in  consequence  of  the  sterno-cleido-mastoid  muscle  having  lost  its  function.  He  was  transferred  to  duty  in  the 
Veteran  Reserve  Corps,  May  3d,  1864.  Examining  Surgeon  J.  L.  Suesserott,  of  Chambersburg,  Pennsylvania,  reported  March 
9th,  1867,  that  * * * “his  right  arm  is  weak  and  somewhat  atrophied.”  His  disability  is  rated  at  the  Pension  Office  as 

one-half  and  not  permanent. 


Mi  ll  H Sur'X  Hist . of  llu‘ \\';ir  ol’ the  R(>l)t'llii)n,  I'iirt  l.Vol  II  Op.jinoc  -l-Oi; 


U.  ff.C.MMiiown.tSoi-paso  Pt  . ,1 . K<‘ei>i'rs  ,(  See  pa-ie  1-02. 

PLATE  IX.  WOUNDS  OF  THE  NECK  BY  CONOIDAL  MUSKET  BALLS. 


Skct.  II.] 


BALLS  LODGED,  EXTEACTED,  OR  DISCHARGED. 


403 


There  were  others  pensioned  on  account  of  wounds  of  the  neck,  regarding  whom  it 
was  difficult  to  decide,  (“ither  from  the  hospital  or  pension  reports,  whether  they  were 
slightly  or  seriously  injured  : 

Case. — Private  John  Valentine,  Co.  K,  88th  Pennsylvania  Volunteers,  aged  19  years,  was  wounded  at  Cold  Harbor, 
May  30th,  1864,  hy  a conoidal  hall,  which  entered  the  right  side  of  the  neck,  near  the  inner  border  of  the  trapezius  muscle, 
passed  obliquely  downward,  and  to  the  left,  and  emerged  near  the  axillary  border  of  the  lower  angle  of  the  scapula.  He  was, 
on  June  4th,  admitted  to  Mount  Pleasant  Hospital,  Washington,  and,  on  June  9th,  transferred  to  Philadelphia,  where  he  was 
admitted  to  the  South  Street  Hospital  on  June  13th.  Simple  dressings  were  applied  to  the  wound,  also  compress  Wet  with  lead 
water,  and  tincture  of  iodine  was  painted  over  the  track  of  the  ball.  Milk  punch  was  freely  administered.  The  wound 
discharged  pus  fi'eely,  and  the  patient  was  very  weak.  On  July  21st,  the  wounds  were  healed.  He  was  returned  to  duty  on 
September  8th,  1864.  On  May  14th,  1866,  Pension  Examiner  J.  Cummiskey  reports  that  the  patient  has  a gi’eat  deal  of  pain  in 
the  back  of  the  neck,  and  feebleness  of  the  left  arm,  which  has  existed  since  the  reception  of  the  wound. 

Case. — Private  B.  F.  Hawkins,  Co.  D,  7th  Ohio  Volunteers,  received  a gunshot  wound  of  the  neck  at  Port  Republic, 
Virginia,  June  9th,  1862.  The  missile  entered  above  the  middle  of  the  spine  of  the  scapula  on  the  right  side,  and  emerged  at 
the  middle  of  the  stemo-cleido  mastoid  muscle,  anterior  border.  He  was  admitted  to  Cliffburne  llospit.al,  W'ashington,  Juno 
15th,  1862,  and  returned  to  duty  on  August  5th.  On  August  12th,  he  was  admitted  to  the  3d  division  hospital,  Alexandria,  and 
again  returned  to  duty  on  March  2d,  1863.  Pension  Examiner  A.  O’Brien  reports,  September  6th,  1866,  that  the  muscles  which 
elevate  the  arm  were  cut  across. 

Many  fatal  cases  were  reported  so  indefinitely,  that  it  was  possible  only  to  conjecture 
the  probable  cause  of  death,  the  extent  and  nature  of  the  wounds,  and  character  of  the 
succeeding  symptoms  being  referred  to  with  extreme  brevity,  if  at  all.  The  following 
may  serve  as  illustrations  of  this  class : 

Case. — Private  Thomas  Mcllvaine,  Co.  E,  llOth  Pennsylvania  Volunteers,  was  wounded  at  Winchester,  March  23d,  1862, 
by  a musket  ball,  which  entered  one  inch  below  and  behind  the  mastoid  process,  and  emerged  over  the  spinous  process  of  the 
third  cervical  vertebra.  On  April  2d,  he  was  admitted  into  Saint  Joseph’s  Hospital,  New  York,  with  slight  fever.  Simple 
dressings  were  applied  to  the  wound.  Sulphate  of  quinine,  refrigerant  drinks,  tonics,  and  milk  punch  were  administered,  and 
nourishing  diet  ordered.  Profuse  epistaxis  occurred  on  April  7th,  and  recurred  on  the  8th,  when  gastritis,  followed  hy  hmma- 
temesis  set  in.  On  April  12th,  the  patient  was  unable  to  articulate ; difficult  deglutition  and  involuntary  evacuations  ensued ; he 
sank  gradually,  and  died  on  April  13th,  1862. 

Case. — Corporal  Warren  Eutan,  Co.  I,  1st  New  Jersey  Cavalry,  aged  20  years,  received  a gunshot  wound  of  the  neck 
by  a conoidal  ball,  at  Salem  Church,  Virginia, May  28th,  1864.  He  was  taken  to  the  hospital  of  the  2d  division.  Cavalry  Corps; 
on  Jime  4th,  sent  to  Mount  Pleasant  Hospital,  Washington;  on  June  10th,  to  DeCamp  Hospital,  New  York;  on  June  14th,  to 
Grant  Hospital,  New  York ; and  finally,  on  October  20th,  1864,  to  Ward  Hospital,  Newark,  N.  J.  He  died  while  at  home  on 
furlough,  March  21st,  1865. 

Case. — Private  George  W.  Buffum,  Co.  D,  5th  Wisconsin  Volunteers,  aged  39  years,  received,  at  Harper’s  Farm, 
Virginia,  April  6th,  1865,  a gunshot  wound  of  the  shoulder  and  neck,  by  a conoidal  ball.  He  was  taken  to  the  hospital  of  the 
3d  division.  Ninth  Corps,  and  on  April  15th,  sent  to  the  hospital  at  Annapolis,  Maryland.  When  admitted  he  was  much 
exhausted,  and  partially  delirious.  He  suffered  extreme  pain  in  the  injured  parts.  His  ap])etite  was  poor,  and  he  was  able  to 
retain  but  a small  quantity  of  solid  food.  Dry  oakum  was  applied  to  the  wound,  and  tonics  and  stimulants  administered.  Death 
resulted  on  April  28th,  1865. 

Balls  lodged,  extracted,  or  discharged. — In  one  hundred  and  thirty-six  cases  of 
gunshot  wounds  of  the  neck,  the  missile  lodged.  From  these  numerous  examples  of 
lodgment  of  small  projectiles  in  the  neck,  the  following  abstracts  are  selected.  In  most 
cases  of  this  class  (in  eighty-seven,  to  speak  .more  precisely),  the  missiles  were  extracted  ; in 
others,  they  were  probably  encysted,  causing  no  immediate  inconvenience ; less  frequently, 
they  gravitated  through  the  soft  parts,  toward  the  nearest  cavity  or  exterior  surface,  and 
were  eliminated  spontaneously : 

Case. — Private  John  R.  Fletcher,  Co.  A,  10th  Illinois  Cavalry,  received  a gunshot  wound  of  the  neck  at  Bayou  Teche, 
Arkansas,  September  10th,  1863,  the  ball  lodging  in  the  complexus  muscles  of  the  left  side.  He  was  admitted,  on  the  next  day, 
to  the  hospital  at  Little  Rock,  where  the  ball  was  removed,  and  he  was  returned  to  duty  on  October  23d,  1863.  He  is  not  a 
pensioner. 

Case. — Private  Ludovico  Bowles,  Co.  D,  24th  Michigan  Volunteers,  was  wounded  at  Chancellorsville,  Virginia,  May  3d, 
1863,  by  a conoidal  ball,  which  entered  the  left  side  of  the  neck  just  below  the  submaxillary  gland,  traversed  the  base  of  the 
tongue,  and  lodged  upon  the  right  side  just  below  the  base  of  the  jaw.  He  was  taken  to  the  regimental  hosj)ital ; tlie  ball  could 


404 


WOUNDS  AND  INJURIES  OF  THE  NECK. 


[Chap.  Ill, 


be  felt  in  se.at  of  loilgnieiit.  The  p.aticnt  was  so  refractory  that  it  could  not  bo  cut  to  in  the  mouth,  wlioro  the  incision  would 
havo  been  slight.  I’ai-tial  aucesthesia  was  induced  with  difficulty.  The  ball  was  pressed  by  the  finger,  below  the  right  sub- 
inaxillaiy  gland,  the  forceps  had  been  i)assed  to  the  ball  by  way  of  entrance,  but  extraction  was  imjrracticable.  On  June  14th, 
he  was  sent  to  Mount  Pleasant  Hospital,  Washington,  and,  on  June  ICth,  to  IVest’s  Buildings  Hospital,  Baltimore,  whence  he 
was  returned  to  duty  on  July  3d,  1863.  He  is  not  a pensioner. 

Case. — Private  Isaac  D.  Davis,  Co.  I,  156th  New  York,  was  wounded  at  Fort  Bisland,  Louisiana,  April  9th,  1863,  by  a 
fragment  of  shell,  which  struck  the  posterior  surface  of  the  neck.  The  missile  was  cut  out.  In  August,  1837,  Davis  reenlisted 
in  the  Veter.an  Reserve  Corps.  There  was  not  any  bad  result;  the  movements  were  normal.  He  was  also  injured  by  a fall  at 
Alexandria,  Louisiana,  causing  a fracture  of  the  left  elbow-joint.  The  movement  of  the  joint  was  very  fair.  It  was  suspected 
there  was  a rupture  of  the  circular  ligament,  for  which  he  was  treated  by  flexion  at  right  angle.  His  health  was  good.  He  was 
discharged  from  service  on  April  7th,  1839.  His  claim  for  pension  is  pending. 

Ca.se. — Corporal  Albion  L.  Jackson,  Co,  I,  13th  Massachusetts  Volunteers,  was  wounded  at  Gettysburg,  Pennsylvania, 
July  1st,  1863,  by  a conoidal  ball,  which  entered  near  the  malar  process  of  the  left  superior  maxillary  bone  and  lodged  beneath 
the  angle  of  the  left.  He  was  admitted  on  the  same  day  to  the  regimental  hospital.  For  three  weeks  afterward  a hard 
substance  could  be  felt  beneath  the  angle  of  the  jaw,  when  it  disappeared,  and  the  left  side  of  the  pharynx,  corresponding, 
began  to  be  swollen.  He  returned  to  his  regiment  suft'eriiig  no  inconvenience  from  his  wound,  which  had  healed,  nor  from  the 
swollen  pharynx,  except  a slight  pain  on  deglutition,  which  would  be  increased  on  taking  cold,  when  also  bloody  matter  would 
be  expectorated.  On  the  morning  of  October  28th,  1333,  he  was  awakened  by  something  in  his  throat,  which,  with  a little 
effort,  was  spit  out  and  proved  to  be  a conoidal  lead  bullet,  so  flattened  at  its  base  as  to  form,  on  one  side  of  it,  nearly  parallel 
lips,  which  held  between  them  some  apparently  fibrous  and  earthy  substance.  At  the  time  the  bullet  was  discharged,  there  was 
but  slight  expectoration,  and  the  swelling  and  soreness  of  the  pharynx  soon  disappeared.  He  is  not  a pensioner. 

Case. — Private  William  Herbert,  Co.  H,  159th  New  York  Volunteers,  aged  22  years,  was  wounded  at  Cedar  Creek, 
October  19th,  1834,  by  a conoidal  ball,  which  entered  at  the  left  side  of  the  sixth  cervical  vertebra,  and  lodged  just  above  the 
middle  of  the  left  clavicle.  He  was  conveyed  to  the  hospital  of  the  2d  division.  Nineteenth  Corps,  and  transferred  to  Baltimore, 
where  he  was  admitted  into  the  Jarvis  Hospital  on  October  27th.  Simple  dressings  were  applied  to  the  wound.  The  missile 
w.as  extracted  on  November  7th.  On  December  11th,  he  was  admitted  to  Mower  Hospital,  Philadelphia,  whence  he  was 
discharged  the  service  on  June  7th,  1835.  On  October  25th,  Pension  Examiner  Charles  Rowland,  stated  that  Herbert  had  pain 
in  the  left  breast,  with  severe  cough,  and  general  debility,  resulting  from  the  wound. 

In  the  following  case,  an  inch  and  a quarter  grape-shot,  from  a battery  about  three 
hundred  yards  distant,  was  deflected  on  striking  the  hyoid  bone,  and  buried  itself  in  the 
muscles  over  the  right  shoulder-blade,  whence  I cut  it  out.  He  died  on  the  fourth  day 
from  oedema  of  the  glottis  ; 

Case. — Private  Fi’ederick  Soule,  Co.  F,  27th  Massachusetts  Volunteers,  was  wounded  at  New  Berne,  March  14th,  1862, 
by  a large  grape  shot.  The  missile  entered  near  the  right  b.orn  of  the  hyoid  bone,  passed  obliquely  across  the  neck,  and  lodged 
in  the  subscapular  fossa,  from  which  it  was  removed  by  an  incision.  Very  little  irritative  fever  supervened.  Water  dressings 
were  applied  to  the  wound,  and  morphine  administered.  On  the  night  of  March  18th,  1832,  the  patient  was  unexpectedly  seized 
with  a choking  fit,  and  died  suddenly  half  an  hour  thereafter.* 

Case. — Private  George  R.  Boorman,  Co.  H,  18th  United  States  Infantry,  was  wounded  at  Chickamauga,  Georgia, 
September  20th,  1863,  by  a conoidal  ball,  which  entered  the  left  side  of  the  neck,  a little  above  the  level  of  the  thyroid  cartilage, 
passed  through  the  sterno-mastoid,  and,  ranging  forward  and  downward,  lodged.  He  was  admitted  on  the  next  day  to  the 
hospital  at  Chattanooga,  Tennessee.  There  was  considerable  swelling  of  the  left  side  of  the  neck,  and  most  oppressive 
dyspnoea.  On  September  24th,  a solid  foreign  substance,  which  was  decided  to  be  the  ball,  was  detected  lying  at  the  sternal 
extremity  of  the  left  clavicle,  at  which  point  there  existed  the  greatest  degree  of  swelling.  The  wound  of  entrance  was  care- 
fully enlarged,  and  the  bidl  removed  by  forceps  after  it  had  been  raised  by  external  manipulation.  During  the  operation  a 
consider.able  amount  of  pus  was  evacuated.  His  breathing  was  but  little  improved,  even  for  a short  time,  and  death  resulted  on 
the  morning  of  September  25th,  1833,  from  ajjnoea.  At  the  autopsy,  eight  hours  after  death,  the  fact  was  revealed  that  the  sheath 
of  the  common  carotid  artery,  together  with  the  trachea,  served  for  a part  of  the  wall  of  the  abscess ; no  part  of  the  air 
passages  had  been  penetrated  by  the  ball  or  pus.  The  bronchial  glands  were  very  much  enlarged,  and  all  the  tissues  covering  the 
anterior  part  of  the  neck  wore  so  much  congested  and  swollen  as  to  preclude  the  possibility  of  jierforming  tracheotomy.  The 
left  side  of  the  thyroid  cartilage  bore  evidence  of  having  been  struck  by  the  ball.  Beneath  the  cartilage  proper  and  its  mucous 
lining  wa-s  a thin  layer  of  coagulated  blood.  Within  the  larynx  were  all  the  evidences  of  general  laryngitis ; muco-purulent 
matter,  with  congestion,  producing  nearly  entire  occlusion  of  the  air  passages.  The  conoidal  extremity  of  the  ball  was  bruised 
on  one  side  and  grooved  as  if  from  striking  some  solid  body.  ^ 

Case. — Corporal  Janies' A.  llayes,  Co.  A,  6th  Alabama  Regiment,  aged  18  year.s,  was  wounded  at  South  Mountain, 
September  14th,  1832,  by  a conoidal  ball,  which  entered  above  the  clavicle,  and  lodged  between  the  scapula  and  the  spinal  column, 
right  side.  He  was,  on  September  24th,  admitted  to  National  Hospital,  Baltimore.  Simple  dressings  were  applied  to  the  wound ; 
tonics  and  stimulants  were  administered.  An  abscess  had  formed  around  the  ball,  and  a (piantity  of  pus  flowed  through  the 
incision  made  to  remove  the  ball.  The  patient  had  one  attack  of  erysipilas.  On  November  29th,  he  was  sent  to  the  South  to 
be  exchauged,  cured. 

* See  Kepvt  of  the  Wounded  ut  the,  Iluttle  of  Neu’  Jh'.rne,  Amcrioan  ]Mcili<'al  Tiiuos,  J uly  .'5,  18fi2. 


Sect.  II.] 


FOREIGN  BODIES  EXTRACTEp. 


405 


Case. — Private  Joniel  Leonard.  Co.  I,  38th  Indiana  Volunteers,  aj'od  21  yeans,  received,  at  Perryville,  October  8th, 
1882,  a gunshot  wound  of  the  back  of  the  neck  ; also  a gunshot  fracture  of  the  os  calcis;  the  ball  lodged.  He  was,  on  October 
26th,  admitted  to  Hospital  No.  1,  Louisville.  On  admission,  the  wound  of  the  heel  presented  an  indolent,  flabby  appearance.' 
Linseed  poultices  were  applied  to  the  wound,  belladonna  plaster  to  the  back,  and  tonics,  stimulants,  and  opiates  were  adminis- 
tered. On  November  2d,  tetanus  aj)pearod,  trismus,  with  quick  contraction  of  the  extensor  muscles,  occurring  in  spasms ; the 
bowels  were  costive,  and  the  patient  sweating.  On  November  4th,  he  had  convulsions  every  fifteen  or  twenty  nnnutes  ; profuse 
sweating  and  costiveness.  On  November  5th,  the  convulsions  were  less  fi’equent  and  severe ; still  costive,  and  sweating  profusely. 
On  November  8th.  the  patient  had  convulsions  every  thirty  minutes,  and  from  that  time  the  convulsions  grew  less  frequent.  On 
the  25th,  he  was  able  to  sit  up  in  a chair;  the  use  of  the  muscles  of  the  jaw  were  natural,  and  the  wounds  had  healed.  He  was 
discharged  the  service  on  January  12th,  1833.  The  case  is  reported  by  Acting  Assistant  Surgeon  A.  W.  Kayes.  Leonard  is  not 
a pensioner. 

Foreign  Bodies  Extracted. — It  was  not  uncommon  for  bits  of  clothing,  buttons,  wire, 
and  other  fragments  of  the  soldier’s  outfit  to  be  buried  in'  the  wound  : 

Case. — Privuite  Garret  Lukens,  Co.  E,  88th  Peunsylvaiua  Volunteers,  aged  40  years,  was  wounded  at  Gettysburg,  July 
1st,  1863,  by  a conoidal  ball,  which  entered  just  below  the  middle  of  the  steruo-cleido-mastoid  muscle,  and  emerged  over  the 
sixth  cervical  vertebra.  Ho  was,  on  July  7th,  admitted  to  Satterlee  Hospital,  Philadelphia.  Flaxseed  poultices  were  applied 
to  the  wound;  tonics,  stimulants,  and  cod-liver  oil  were  administei'ed,  and  full  diet  ordered.  On  August  25th,  a piece  of  blouse 
was  taken  from  the  posterior  part  of  the  wound.  The  patient  had  severe  night  sweats,  and  a tendency  to  anmmia.  On  October 
20th,  he  had  slight  tonsilitis,  and  stiffness  of  the  neck.  He  was  returned  to  duty  March  24th,  1864.  The  case  is  reported  by 
Acting  Assistant  Surgeon  W.  J.  Grier.  Lukens  is  not  a pensioner. 

Case.^ — Sergeant  J.  E.  Gemniel,  8th  New  York  Battery,  was  wounded  at  Fair  Oaks,  May  31st,  1862,  by  a musket  ball, 
which  entered  over  the  left  border  of  the  trapezius  muscle,  opposite  to  the  sixth  cervical  vei’tebra,  passed  upwai'd  and  inward, 
and  lodged  in  the  superior  carotid  triangle,  immediately  external  to  the  trachea.  On  the  reception  of  the  injiuw  the  ))atient  fell 
from  his  horse,  receiving  a contusion  of  the  left  arm.  He  was,  on  .Juno  4th,  admitted  to  Douglas  Hospital,  Washington.  Simple 
dressings  were  applied  to  the  wound.  On  June  6th,  the  patient  had  considerable  difficulty  of  deglutition.  An  abscess  had 
formed,  which  was  opened,  and  the  ball,  with  a piece  of  cloth  one  inch  in  length,  was  extracted,  and  difficulty  of  deglutition 
disappeared.  June  20th,  there  was  neuralgic  pain  in  the  arm,  and  impairment  of  its  use.  He  was  discharged  the  service 
July  11th,  1862.  The  case  is  reported  by  Assistant  Surgeon  William  Thomson,  U.  S.  A.  Gemmel  is  a pensioner.  The 
Examining  Surgeon  repoifs  that  the  ball  must  have  severed  some  part  of  the  cervical  plexus  of  nerves,  as  there  is  complete 
paralysis  of  arm  and  hand.  The  arm  is  much  smaller  than  it  should  be,  and  cannot  be  used  except  for  very  light  work. 

Torticollis. — Many  examples  of  wry-neck  will  be  found  among  the  abstracts  of  cases, 
in  which  some  other  complication  was  a more  prominent  feature.  It  is  the  opinion  of  Dr. 
Stromeyer*  that  when  the  muscles  only  are  injured,  in  gunshot  wounds  of  the  neck, 
torticollis  will  not  be  permanent,  and  there  is  no  higher  authority  on  this  particular  suliject. 
Yet  the  reports  of  the  pension  examining  surgeons  indicate  that  distortion  of  the  neck  from 
wounds  of  the  sterno-mastoid  is  often  very  persistent. 

Case. — Private  Andrew  Burknett,  Co.  E,  25th  Kentucky  Volunteers,  aged  31  years,  received  a gunshot  wound  of  the 
neck  and  side  at  New  Hope  Church,  Georgia,  May  27th,  1864.  He  was  taken  prisoner,  and  afterward  paroled  and  admitted  to  the 
hospital  at  Camp  Chase,  Ohio.  On  February  23d,  1865,  he  was  transferred  to  the  Tripler  Hospital  at  Columbus,  Ohio.  On 
admission,  the  patient  was  in  a debilitated  condition  consequent  upon  his  long  imprisonment,  and  sufi'ering  from  a severe  hernia. 
Partial  torticollis  supervened.  He  was  discharged  from  service  on  AprW  10th,  1865.  He  is  not  a pensioner. 

Case. — Private  Baltzer  Weild,  Co.  K,  9th  Pennsylvania  Volunteers,  received,  at  the  battle  of  Bull  Run,  August  30th, 
1862,  a gunshot  wound  of  the  neck,  on  the  right  and  posterior  portion.  The  missilt!  passed  under  the  trapezius  muscle  and 
emerged  at  the  opposite  side.  lie  was,  on  the  following  day,  admitted  to  the  Mansion  House  Hosj)ital,  Alexandria,  Virginia. 
He  was  returned  to  duty  on  November  18th,  1832.  Examining  Surgeon  G.  McCook  reported  that  the  patient’s  head  was  bent 
and  could  not  be  moved. 

Case. — Private  Christopher  Kallehan,  Co.  I,  95th  Illinois,  was  admitted,  from  the  field,  to  McPherson  Hospital,  Vicksburg, 
June  15th,  1863,  having  been  wounded  the  same  day  by  a conoidal  ball,  which  entered  the  left  cheek,  ])ussed  downwtird  and 
backward,  struck  the  front  of  the  atla.s,  and  passing  forward  into  the  pharynx,  was  thrown  out  of  the  mouth.  Simi)lu  dressings 
were  applied  to  the  wound.  The  patient  was  discharged  the  service  on  October  2d,  1863.  There  was  jxu-manent  wry  neck, 
and  almost  perfect  deafness.  His  disability  is  rated  at  one-half.  Pension  Examiner  11.  A.  Buck  rei)orts,  February  6th,  1864, 
that  the  pensioner  suffers  from  contraction  of  the  left  eyelid,  deformity  of  the  jaw  and  face,  and  deafness. 

Case. — Private  Charles  L.  Clarke,  Co.  I,  27th  Massachusetts  Yolunteers,  aged  19  years,  was  wounded  at  Roanoke 
Island,  February  8th,  1832,  by  a musket  ball,  which  entered  one  inch  bidow  the  lower  jaw,  .and  ))assed  through  the  neck,  just 
behind  the  windpipe,  emerging  at  the  s.ame  jtoint  on  the  opitosite  side,  wounding  the  larynx  and  oesopliiigus  in  its  transit.  H(i 
was  conveyed  to  the  Craven  Street  Hospital,  New  Berne.  The  patient  had  severe  hsemorrluige,  which  was  controlled  by  pressure. 
He  was  transferred  to  Boston  in  April,  1862.  He  recov^ered,  his  head  drawn  to  one  side,  and  was  discluirged  the  service  on 
August  18th,  1862.  He  is  not  a pensioner. 

* ilaximm  der  Kriegsheilkunst,  S.  423. 


406 


WOUNDS  AND  INJUKIES  OF  THE  NECK. 


[Chap.  Ill, 


Wounds  of  the  Larynx  and  Trachea. — No  instances  were  reported  of  fracture 
or  laceration  of  the  larynx  or  trachea  from  blows  or  falls,  as  are  described  by  authors  ; 
but  about  two  per  cent.  (2.2)  of  the  gunshot  wounds  of  the  neck  that  came  under  treat- 
ment belonged  to  this  category.  In  a few,  the  larynx  and  trachea  were  both  involved  ; 
in  others,  the  air  passages,  together  with  the  pharynx  or  oesophagus,  were  implicated,  as  in 
the  case  described  under  the  head  of  torticollis  (Clarke,  supra).  Dr.  Derby  first  cared 
for  this  man,  arresting  the  profuse  venous  haemorrhage  by  pressure  and  pledgets  of  lint. 
There  could  be  no  question  that  both  trachea  and  oesophagus  were  wounded,  for  both 
liquids  and  air  passed  out  of  both  wounds  of  entrance  and  exit.  The  patient  remained 
under  my  care  for  several  weeks  subsequently.  He  could  take  fluid  nourishment  without 
the  use  of  a stomach  tube,  and  only  on  a few  occasions,  when  he  was  sitting  upright,  was 
there  any  inconvenience  from  his  soup  or  drink  passing  into  the  air-passages.  The  wound 
of  the  oesophagus  was  probably  small.  It  has  been  impossible  to  ascertain  the  sequel  of 
the  case. 

The  returns  corroborate  the  opinion  of  Mr.  Blenkins  (op.  cit.  p.  824)  regarding  the 
comparative  frequency  of  gunshot  wounds  of  the  larynx,  exposed  as  it  is  by  its  superficial 
position,  size,  and  prominence.  Aphonia,  exfoliation  of  cartilage,  and  persistent  fistulse 
were  among  the  consequences  of  these  wounds.  The  trachea  was  less  frequently  injured 
by  small  projectiles  than  the  larynx.  Gunshot  wounds  of  the  organ  are  oftener  observed 
in  the  posterior  membraneous  portion,  undefended  by  cartilaginous  rings,  than  elsewhere. 
Professor  S.  D.  Gross  remarks  (op.  cit.  Vol.  II,  p.  384)  that  there  is  reason  to  believe  that 
“ this  tube  possesses  the  faculty  of  deflecting  bullets.”  That  missiles  are  diverted  from 
their  course  on  impact  with  the  trachea,  there  is  ample  evidence.  Abstracts  of  a few 
cases  may  be  cited  : 

Case. — Corporal  J.  TV.  Terry,  Co.  B,  14th  Virgini.a,  was  wounded  at  Spottsylvania,  May  10th,  18G4,  by  a conoidal  ball, 
which  entered  the  left  side  of  the  neck,  passed  through  the  trachea,  and  emerged  parallel  to  the  opposite  point  of  entrance,  and 
again  entered  the  right  shoulder  anteriorly.  On  IMay.  11th,  he  was  admitted  to  the  Receiving  and  Wayside  Hospital,  Richmond, 
the  air  from  his  lungs  passing  through  the  wounds  of  entrance  and  exit.  On  May  ICth,  the  wound  of  entrance  had  closed ; hut, 
he  breathed  still  through  the  wound  of  exit.  On  the  18th,  the  wounds  were  suppurating  freely ; the  patient  was  able  to  swallow 
with  comparative  ease,  the  bowels  were  regular,  appetite  good,  tongue  clean  ; and  there  was  no  pain,  except  in  breathing.  On 
the  20th,  he  was  evidently  improving;  sat  up  in  bod  and  said  he  was  feeling  very  well.  About  ten  o’clock,  some  intermeddling 
woman  going  through  the  hospital,  thinking  that  she  would  benefit  the  patient  by  renewing  the  dressing,  and,  without  consulting 
the  Surgeon  in  charge  of  the  ward,  removed  the  dressing  and  plugged  the  wound  with  cotton,  saturated  with  turpentine.  The 
patient,  not  being  able  to  speak,  was  compelled  to  submit  to  this  cruel  treatment,  which  caused  his  death  on  May  20th,  1864, 
before  the  woman  who  did  the  mischief  left  his  bedside.  The  case  is  reported  by  Surgeon  W.  F.  Richardson,  P.  A.  C.  S. 

Ca.se. — Private  Patrick  Riley,  Co.  D,  1st  New  York  Volunteers,  .aged  21  years,  was  wounded  at  Chancellorsville,  M.ay 
1st,  1863,  by  a musket  ball,  which  entered  on  the  left  side  of  the  neck,  passed  behind  the  trachea,  near  the  cricoid  cartil.age,  and 
in  front  of  the  oesophagus,  laying  open  both  tubes.  He  was,  on  May  12th,  admitted  to  Stanton  Hospital,  Washington. 
Enemat.a,  stimulants,  and  opiates  were  administered,  .and  beef  tea  injected  by  an  oesophageal  tube.  Air  and  nourishment  passed 
through  the  wound.  The  patient  h.ad  a severe  cough,  and  was  restless  and  constip.atcid.  May  24th,  vomiting  occurred;  28th, 
emaciated  from  inanition  ; capilLary  circulation  diminished;  skin  cool  and  moist;  pulse  slow  and  feeble,  and  the  mind  w.andering. 
The  patient  died  on  May  29th,  1863.  The  case  is  reported  by  Assistant  Surgeon  P.  C.  Davis,  U.  S.  A. 

Case. — Private  John  Homer,  Co.  B,  18th  Pennsylvania  Volunteers,  aged  18  years,  was  admitted  to  Douglas  Hospital, 
W.ashington,  June  4th,  1862,  having  been  wounded  by  a missile  which  entered  immediately  below  the  zygomatic  .arch,  passed 
downward  through  the  parotid  gland  into  the  pharynx,  and  emerged  through  the  integuments  on  a level  with  and  one  inch 
external  to  the  thyroid  cartilage  on  the  opposite  side.  June  5th,  patient  being  unable  to  swallow,  and  fluids  taken  into  the 
mouth  passing  out  at  the  lower  orifice,  he  was  nourished  by  fluids  introduced  into  the  stomach  through  a tube;  pus  and  s.aliva 
discharged  from  wound.  June  7th,  no  grave  constitutional  symptoms;  patient  still  nourished  by  means  of  the  stomach  tube. 
June  8th,  dyspnoea  came  on  about  four  in  the  afternoon,  and  he  died  seven  hours  subsequently  from  apnoea. 

Case. — Captain  Ferdinand  Mueller,  Co.  B,  9th  Ohio  Volunteers,  was  wounded  at  Chickamauga,  Georgia,  September  20th, 
1883,  by  a conoidal  ball,  which  entered  the  base  of  the  neck  on  the  right  side,  passed  transversely  and  obliquely  upward,  and 
emerged  beneath  and  mitlway  between  angle  and  chin  of  inferior  maxilla,  involving  the  trachea,  thyroid,  and  cricoid  cartilages. 


Sect.  II.  J 


WOUNDS  OF  THE  LARYNX  AND  TRACHEA. 


407 


and  external  jugular  vein.  He  also  received  a wound  oftlie  slioulder-Joint.  He  was  admitted,  on  the  next  day,  to  the  hospital 
at  Chattanooga,  Tennessee.  There  was  considerable  swelling  at  first.  Ho  did  well  up  to  the  25th,  when  secondary  hacmori-hage 
occurred.  There  was  not  much  loss  of  blood.  On  the  2Gth  it  recurred,  and  the  patient  expired  before  surgical  assistance  arrived. 

Aphonia. — In  the  following  cases,  however,  chronic  cough,  or  complete  loss  of  voice 
followed  gunshot  injuries  of  the  larynx  or  trachea.  Dr.  Chisolm'^  tells  us  of  similar 
cases  observed  in  the  Southern  armies,  some  requiring  the  use  of  a tracheal  tube  to 
prevent  apnoea : 

Case. — Sergeant  Adolphus  Mepsen,  Co.  F,  103d  New  York  Volunteers,  was  wounded  at  Suffolk,  May  3d,  1803,  by  a 
musket  ball,  which  entered  the  neck  two  and  a quarter  inches  to  the  left  of  the  median  line,  and  two  inches  above  the  clavicle, 
passed  through  the  trachea,  and  emerged  one  and  a quarter  inches  to  the  right  of  the  median  line.  He  was  conveyed  to  the 
hospital  of  the  3d  division.  Ninth  Corps.  The  patient  spit  up  blood  freely  immediately  after  the  in  jury,  and  lost  the  power  of 
speech  partially.  Air  made  its  escape  by  the  wounds.  Slight  external  hannorrhage,  and  the  spitting  of  blood  continued  only 
for  a short  time.  He  was  transferred  to  the  Chesapeake  Hospital,  where  he  was  admitted  on  May  4th.  Fourteen  days  after  the 
reception  of  the  injury  the  power  to  articulate  began  to  return,  and,  on  June  7th,  the  wounds  had  healed.  He  was  transferred 
to  the  Veteran  Reserve  Corj)s.  The  case  is  reported  by  Surgeon  T.  H.  Squire,  89th  New  York  Volunteers.  This  soldier  is 
not  a pensioner.  . 

Case. — Private  Joseph  Pearson,  Co.  F,  64th  Illinois  Volunteers,  aged  18  years,  received,  at  Atlanta,  Georgia,  July  22d, 

1864,  a gunshot  wound  of  the  neck.  A conoidal  bullet  entered  the  integuments  over  and  anterior  to  the  larynx  and  injured  the 
windpipe.  He  was  admitted  to  the  Marine  Hospital,  Chicago,  September  3d,  1864.  On  the  16th,  he  was  transferred  to  Camj) 
Douglas,  Illinois.  His  case  is  diagnosed  as  “ aphonia  from  gunshot  wound.”  Simple  dressings.  Pension  Examiner  John  F, 
Daggett,  reports,  October  30,  1867,  that  the  pensioner's  voice  is  impaired. 

Case. — Private  James  K.  Deerner,  Co.  G,  102  Pennsylvania  Volunteers,  aged  34  years,  was  wounded  at  Cedar  Creek, 
October  19th,  1864,  by  a conoidal  ball,  which  entered  the  left  side  of  the  neck  and  passed  through  the  trachea.  He  was  taken 
to  the  field  hospital,  where  simple  dressings  were  applied.  On  October  22d,  he  was  admitted  to  the  Satterlee  Hospital,  Phila- 
delphia. By  November  1st,  the  wound  had  almost  healed.  Aphonia  supervened.  Ho  was  dischai'ged  from  service  on  May  15th, 

1865.  He  is  not  a pensioner. 

Case. — Private  August  Beck,  Co.  D,  54th  New  York  Volunteers,  aged  42  years,  was  wounded  at  Gettysburg,  July  2d, 
1833,  by  a musket  ball,  which  passed  laterally  through  the  thyroid  cartilage,  destroying  the  upper  half  and  two-thirds  of  the 
anterior  part,  thereby  inj uring  the  chordae  vocales.  He  was,  on  July  9th,  admitted  to  Satterlee  Hospital,  Philadelphia.  Resj)i- 
ration  was  carried  on  largely  through  the  apertures  made  by  the  ball,  and  when  he  attempted  to  speak,  the  air  passed  through 
with  a hissing  or  sibilant  sound.  His  voice  was  gone,  but  he  could  whisper  with  a strong  expiratory  effort ; the  sound,  however, 
never  became  hoarse.  The  edges  of  the  wound  were  approximated  with  silver  sutures  and  adhesive  plaster,  with  head  Hexed  on 
the  chest.  Cold  water  dressings  were  applied.  On  September  1st,  the  wound  had  entirely  healed,  but  the  patient  had  lost  his 
voice.  He  was  transferred  to  the  Veteran  Reserve  Corps  on  September  26th,  1863.  The  case  is  reported  by  Acting  Assistant 
Surgeon  W.  \V.  Keen,  jr.  He  is  not  a pensioner. 

Case. — Colonel  Morgan  H.  Chrysler,  2d  New  York  Cavalry,  aged  48  years,  was  wounded  at  Atchafalaya,  Alabama, 
August  28th,  1834,  by  a minie  ball,  which  entered  at  the  interclavicular  notch  of  the  sternum,  just  at  the  point  of  the  right 
clavicle,  injured  the  trachea  and  the  origin  of  the  sterno-cleido-mastoid  muscle,  passed  to  the  right  and  emerged  at  the  superior 
point  of  the  shoulder.  He  was  sent  home,  where  he  was  treated  for  about  two  months  and  a half,  when  he  returned  to  duty. 
Mustered  out  of  service  on  November  8th,  1865.  A certificate  from  the  Pension  Examining  Board  states  that  " the  right  arm  can 
scarcely  be  extended  above  the  horizontal  plane  of  the  shoulder  joint.  The  cicatrix  of  entrance  extends  across  the  clavicular 
origin  of  the  sterno-mastoid  muscle.  Pressure  upon  it  causes  cough  and  spasmodic  contraction  of  the  laryngeal  and  pharyngeal 
muscles,  which  is  visible  upon  the  surface.  Similar  spasm  is  caused  by  loud  speaking  or  by  swallowing  fragments  of  food  of 
sufficient  size  to  press  upon  the  trachea  in  passing  through  the  ocsojihagus.  He  has  attacks,  usually  nocturnal,  of  extreme 
dyspnoea,  with  a sensation  of  complete  constriction  of  the  lower  part  of  the  trachea.  These  are  very  transient  but  often 
repeated — sometimes  without  assignable  cause,  but  oftener  after  fatigue  or  exposure.  This  hyper  aesthetic  condition  of  the  inferior 
laryngeal  nerve  seems  to  depend  upon  deep  cicatricial  contraction  rather  than  upon  a neuritis,  as  in  the  latter  case,  the  length 
of  time  which  has  elapsed  since  the  reception  of  the  wound,  nearly  eight  years,  should  have  led  to  an  implication  of  the  nerve 
centres,  of  which  there  is  no  evidence.  The  disability  is  regarded  as  total  and  permanent,  and  depends  both  upon  the  impaired 
use  of  the  right  arm  and  upon  the  affection  of  the  throat.” 

Case. — Corporal  Lester  Shaw,  Co.  G,  35th  Ohio  Volunteers,  aged  34  years,  was  wounded  at  Chickamauga,  Georgia, 
Sejjtember  19th,  1863,  by  a conoidal  ball,  which  entered  the  right  shoulder,  just  behind  the  acromion,  passed  inward,  injured  the 
cavity  of  the  shoulder-joint,  fi-actured  the  clavicle  badly  in  its  external  and  middle  thirds,  produced  a comminuted  fracture  of  the 
first  rib,  passed  obliquely  upward  under  the  skin,  penetrating  the  neck  between  the  trachea  tind  the  oesophagus,  and  emerged 
just  in  front  of  the  left  carotid  artery,  on  a level  with  the  j)omum  Adami.  The  oesophagus  was  slightly  wounded,  and  the 
trachea  partly  severed  and  badly  contused.  He  was  taken  to  the  hospital  of  the  3d  division.  Fourteenth  Cori)s,  where  water 
dressings  were  applied,  and  liquid  diet  given.  Severe  inflammation  ensued,  followed  by  ulceration  over  tlie  middle  of  the  first 


* “Several  instanecs  have  oecurred  in  the  Ccnfedcrato  campaigns,  where  the  trachea  has  been  pcrfur.ated  by  a sliot,  cr  the  larynx  carried  away. 
Such  coutractien  of  the  air  passage  and  dilHculty  of  breathing  follows  upon  this  accident,  as  to  force  the  patient  to  wear,  ]>ennanently,  a tracheal  tube, 
to  pnitect  him  from  attacks  threatening  suITucation.  In  such  cases  the  voice  is  reduced  to  a whisper.”  CnisoLSi,  ojo  cit.  j).  3t)'J. 


408 


WOUNDS  AND  INJURIES  OF  THE  NECK 


[CllAl>.  Ill, 


rib  and  beneath  tlie  clavicle.  On  September  25th,  the  patient  was  sent  to  hospital  No.  IG,  Nashville,  and,  on  October  3d,  to 
hospital  No.  1.  Pus  was  discharged  for  several  months,  during  which  time  several  spiculm  of  bone  came  away.  On  May  12th, 
1864,  he  was  transferred  to  the  Corps  d’Affique  Hospital,  New  Albany,  Indiana,  and,  on  June  29th,  to  the  Hospital  at  Camp 
Dennison,  Ohio,  whence  he  was  discharged  on  September  20th,  1864,  for  expiration  of  term  of  service.  Pension  Examiner  E. 
Mendenhall  I’eports  that  he  examined  Shaw  while  home  on  furlough  in  February,  1864.  The  external  wounds  were  healed. 
4'he  ulceration  between  the  clavicle  discharged  large  quantities  of  pus,  with  an  occasional  spicula  of  bone.  The  whole  shoulder 
was  very  sore,  tender,  and  immovable,  and  the  arm  and  hand  were  swollen  and  numb.  The  neck  was  tender  on  both  sides,  and 
he  could  scarcely  speak  above  a whisper.  After  a long  and  tedious  process,  the  wounds  all  healed.  Dr.  Mendenhall  I'e-exam- 
ined  this  patient  in  April,  1866.  He  sufl'ered  from  hoarseness  and  dyspnoea,  which  increased  on  exertion,  and  was,  no  doubt, 
produced  by  narrowing  of  the  trachea  at  the  place  of  injury.  The  arm  and  shoulder  were  partially  paralyzed  ; but  the  general 
health  apjteared  to  be  good. 

Wounds  of  the  Pharynx  and  OEsophagus. — The  gunshot  wounds  of  these  regions, 
tliat  came  under  treatment  in  the  hospitals,  were  .less  numerous  than  those  of  the  more 
exposed  portion  of  the  anterior  region  of  the  neck.  Complicated  hy  lesions  of  the  great 
vessels  or  nerves,  in  many  instances,  such  instances  often  proved  fatal  on  the  field.  I cite 
a few  cases  in  which  the  wound  seems  to  have  been  mainly  confined  to  these  canals.  A 
review  of  the  reports  confirms,  fully,  the  opinion  of  the  accurate,  reliable,  and  learned 
Hennen,*  that  we  can  only  derive  satisfactory  explanations  of  the  symptoms  in  wounds 
of  .the  neck,  or  rational  views  as  to  treatment,  by  considering  the  region  as  a “ complete 
and  sympathizing  whole.”  Yet,  for  convenience’  sake,  where  so  large  a number  of 
abstracts  of  cases  are  to  be  compared,  it  is  well  to  employ  subdivisions  : 

Case. — Private  i?.  Wiseman,  Co.  C,  6tli  North  Carolina  Regiment,  aged  23  years,  was  wounded  at  Winchester,  September 
19th,  1864,  by  a conoidal  ball,  which  passed  through  the  oesophagus.  He  was  conveyed  to  the  depot  field  hospital,  W^inchester. 
Simple  dressings  were  applied  to  the  wound.  The  patient  suffocated  from  iuternal  haemorrhage,  and  died  on  September  21st,  1864. 

Case.— Private  Lewis  0.  Ritch,  Co.  C,  106th  Pennsylvania  Volunteers,  aged  20  years,  was  accidentally  wounded  at 
Fairfax  Court-house,  September  20th,  1862,  by  a round  musket  ball  and  two  buckshot.  The  ball  entered  below  the  thyroid 
cartil.age,  passing  through  the  trachea,  and  lodged  in  the  pharynx,  from  which  it  was  subsequently  extracted.  One  buckshot 
fractured  the  right  side  of  the  lower  jaw,  and  destroyed  five  teeth,  and  another  entered  the  left  side  of  the  neck,  a few  inches 
above  the  clavicle,  and  lodged,  and  is  still  in  the  neck.  He  was,  on  October  6th,  admitted  to  Armory  Square  Hospital,  Wash- 
ington. Cold  water  dressings,  lotions  of  lead  and  opium,  and  warm  fomentations  were  applied  to  the  wounds,  and  tonics  and 
stimulants  administered.  There  was  much  inflammation  about  the  throat,  and  food  could  be  swallowed  only  with  difficulty  ; air 
passed  through  the  wound  in  respiration.  On  October  10th,  the  wound  discharged  slightly,  but  healthy ; on  the  15th 
discharged  freely ; patient  exhausted,  labor!  ng  under  anorexia.  On  October  23d,  inflammation,  erysipelatous  in  character,  was 
increasing,  and,  on  the  26th,  extended  over  the  entire  head  and  face.  November  2d,  the  patient  was  improving,  and,  on  the 
6th,  the  wounds  were  healing.  He  was  discharged  the  service  on  December  15th,  1862.  Tiie  case  is  reported  by  Surgeon  D.  W. 
Bliss,  U.  S.  V.  Pension  Examiner  11.  E.  Goodman  reports,  September  1st,  1869,  that  there  is  a large  depression  over  the  cervical 
bone,  loss  of  voice,  difficulty  of  breathing,  with  constant  cough.  The  lungs  and  heart  are  normal ; the  digestion  is  bad,  and 
constant  care  is  necessary  to  prevent  inflammation. 

Case. — Private  Jonathan  Colgrove,  Co.  F,  57th  Pennsylvania  Volunteers,  aged  19  years,  was  admitted  to  McKim’s 
Mansion  Hospital,  Baltimore,  on  July  5th,  1863,  for  a gunshot  wound  of  the  neck,  received  at  Gettysburg,  July  2d,  1863.  Tfie 
missile  having  entered  the  right  side  near  the  submaxillary  triangle,  emerged  on  the  opposite  side,  near  the  median  line,  perfo- 
1 ating  the  cricoid  cartilage,  and  wounding  the  oesophagus.  Cold-water  dressings  were  applied  to  the  wound,  and  a full  diet 
allowed.  For  some  days  after  the  reception  of  the  injury,  both  air  and  liquids  escaped  from  the  wound.  On  August  15th,  there 
was  partial  .aphonia.  This  man  was  returned  to  duty  on  August  24th,  1863.  He  is  not  a pensioner. 

Paralysis. — Many  examples  of  paralyses,  partial  or  total,  resulting  from  gunshot 
wounds  of  the  cervical  nerves,  or  of  those  ascending  to  the  face  or  descending  to  unite  in 
the  brachial  plexus,  are  found  in  the  reports.  A few  abstracts  may  be  cited : 

Case. — Private  John  P.  Crole,  Co.  F,  27th  Michigan  Volunteers,  was  wounded  at  Poplar  Grove  Church,  Virginia, 
September  30th,  1864,  by  a minie  ball,  which  entered  two  inches  above  the  sternal  extremity  of  the  left  clavicle,  emerging  at 
the  superior  angle  of  the  left  scapula.  He  was  treated  in  the  hospitals  of  the  Ninth  Corps  until  October  5th,  when  he  was 
admitted  to  Mount  Pleas.ant  Hospital,  Washington,  and  discharged  on  March  20th,  1865.  There  was  partial  loss  of  motion  of 
left  arm.  He  is  not  a pensioner. 

* The  close  and  intimate  connection  of  the  great  vessels  and  nerves,  and  of  the  canals  leading  to  the  thorax  and  abdomen,  are.  such  that  separate 
views  of  their  affections,  however  they  may  carry  the  appearance  of  minute  accuracy  along  with  them,  arc  more  the  objects  of  speculative  calculation  in 
the  closet  than  the  results  of  actual  experience,  and  cun  seldom  be  of  any  j)ractical  utility  in  the  held  or  hospital.  Op.  cit.  b'd  ed.,  p.  3G1. 


Sect.  II.] 


PAKALYSIS  IN  GUNSHOT  WOUNDS  OF  THE  CERVICAL  REGION. 


409 


Case. — Private  Joseph  Hoilinger,  Co.  G,  Ctli  Maryland  Volunteers,  aged  22  years,  was  wounded  at  Wineliester,  Virgini.a, 
September  lOtli,  18G4,  by  a conoidal  ball,  which  entered  about  one-half  an  inch  above  and  slightly  to  the  right  of  the  median 
line  of  the  thyroid  cartilage,  and  emerged  from  the  top  of  the  left  shoulder,  three  inches  above  the  sj)ine  of  the  scapula  and  four 
inches  to  the  left  of  the  spine.  He  was  taken  to  the  hospital  of  the  3d  division.  Sixth  Corps,  and,  on  September  27th,  sent  to  the 
hospital  at  Frederick,  Maryland.  Simple  dressings  were  applied.  On  November  18th,  he  was  transferred  to  the  Mower  Hospital, 
Philadelphia,  and  on  January  2Gth,  18G5,  to  Turner’s  Lanfe  Hospital.  While  at  Mower  Hospital,  electricity  had  been  applied, 
which  caused  great  pain.  On  admission  to  Turner’s  Lane  Hospital,  his  general  health  was  good;  there  was  ]iartial  paralysis  of 
the  arm,  with  slight  atrophy;  galvanism  was  applied  daily  to  the  arm.  On  May  24th,  he  was  transferred  to  IMcClellan  Hospital. 
Friction  was  applied,  and  the  arm  rubbed  with  liniment.  He  was  discharged  from  service  on  June  10th,  18G5,  at  which  time 
he  had  recovered  from  paralysis.  He  is  not  a pensioner. 

Case. — Private  William  Hunter,  Co.  F,  5th  Maryland  Volunteers,  received,  at  the  battle  of  Antietam,  Maryland,  September 
17th,  18G2,  a gunshot  wound  of  the  neck,  the  missile  entering  about  an  inch  and  a half  below  the  right  ear  and  emerging  a little 
above  the  seventh  cervical  vertebr-a.  He  was  taken  to  the  hospital  of  the  3d  division.  Second  Corps.  On  January  14th,  18G3, 
he  was  admitted  to  Carver  Hospital  and  discharged  from  service  on  IMarcli  30th,  18G3.  Pension  Examiner  H.  W.  Owings 
reports,  January  24th,  18G7,  that  the  right  arm  is  almost  completely  paralyzed. 

Case. — Private  T.  D.  Pomeroy,  Co.  E,  68th  Ohio  Volunteers,  received  a gunshot  wound  of  the  neck  at  Champion  Hills, 
Mississippi,  May  16th,  1863,  the  ball  entering  below  the  right  jaw  and  lodging  near  the  vertebra  of  the  neck.  He  was  treated 
in  field  hospit.al  until  June  24th,  1863,  when  he  was  conveyed  to  Memphis,  Tennessee.  On  July  Cth,  he  was  admitted  to  the 
City  Hospital,  St.  Louis,  aiid  transferred  to  Jefferson  Barracks,  Missouri,  July  24th,  1863,  at  which  time  there  was  partial 
paralysis  of  the  whole  system.  He  was  discharged  from  service  on  August  14th,  1863.  Pension  Examiner  Wulliam  Ramsey 
reports,  September  29th,  1863,  that  the  spinal  marrow  has  been  injured  to  such  an  extent  as  to  produce  paralysis  of  the  upper 
extremities,  more  especially  the  right  arm.  His  speech  was  also  affected. 

Case. — Private  Sylvester  Dcarstyne,  Co.  F,  44th  New  York  Volunteers,  received  a gunshot  wound  of  the  neck  at  Bull 
Run,  Virginia,  August  30th,  1832.  The  missile  entered  at  the  centre  of  the  right  sterno-cleido-mastoid  muscle  and  lodged.  He 
was  admitted,  on  the  next  day,  to  Fairfax  Street  Hospital,  Alexandria.  On  September  16th,  he  was  furloughed  for  thirty  days, 
and  reporting,  at  the  expiration  of  his  leave,  to  Ira  Harris  Hospital,  Albany,  New  York,  was  discharged  from  service  on 
November  lOth,  1862,  at  which  time  there  was  paralysis  of  the  right  arm.  He  is  not  a pensioner. 

Case. — William  Benson,  a seaman  attached  to  the  steamer  Commodore  Perry,  was  admitted  into  the  Post  Hospital  at 
Plymouth,  North  Carolina,  Msiy  1st,  1863,  with  a gunshot  wound  of  the  neck.  The  missile  having  entered  immediately  above 
the  clavicle  at  the  junction  of  its  external  and  middle  thirds,  passed  backward  and  emerged  near  the  spine  of  the  scapula,  at  the 
superior  angle  of  the  bone,  injuring,  in  its  passage,  the  branches  of  the  brachial  plexus  distributed  ovei'  the  arm  and  shoulder. 
Simple  dressings  were  applied.  Paralysis  of  the  muscles  of  the  arm  and  shoulder  resulted.  He  was  discharged  from  service 
on  November  3d,  1863.  He  is  a pensioner. 

Case. — Private  John  Hartman,  Co.  E,  15th  New  York  Heavy  Artillery,  aged  24  years,  was  wounded  on  the  South  Side 
Railroad,  Virginia,  April  Isl,  1865,  by  a conoidal  ball,  which  entered  just  beneath  the  angle  of  the  left  inferior  maxilla,  passed 
downward  and  backward,  and  emerged  over  the  spinous  ])rocess  of  the  third  cervical  vertebra.  He  was  treated  in  field  hospital 
until  April  5th,  when  he  was  sent  to  Lincoln  Hospital,  Washington.  On  May  23d,  he  was  sent  to  Summit  Plouse  Hospital, 
Philadelphia,  whence  he  was  discharged  from  service  on  June  15th,  1865.  Pension  Examiner  W.  M.  Chamberlain  reports.  May 
2d,  1869,  that  the  brachial  plexus  was  probably  injured,  as  the  arm  is  semi-paralyzed  and  feeble. 

Case. — Private  G.  Bowen,  Co.  D,  51st  North  Carolina,  aged  31  years,  was  wounded  ne.ar  Richmond,  Virginia,  Miiy  10th, 
1864,  by  a conoidal  ball,  which  entered  at  the  top  of  the  sternum  and  emerged  at  the  internal  superior  portion  of  the  left  sc.apula, 
passing  through  the  neck.  He  was  admitted,  on  the  same  day,  to  the  Chimborazo  Hospital,  Richmond.  An  abscess  formed 
near  the  wound  of  entrance  about  one  week  after  admission,  which  was  opened.  Cold  applications  were  aj)plied.  There  was 
paralysis  of  the  left  arm  and  leg.  On  May  22d,  small  abscesses  appeared  in  the  leg  of  wounded  side.  Death  resulted  on  June 
25th,  1864.  'The  autopsy  revealed  both  wounds  healed  ; the  track  of  the  wound  was  found  occupied  by  clotted  blood. 

Case. — Private  Patrick  Norton,  Co.  D,  70th  New  York  Volunteers,  was  wounded  at  Bull  Run,  Virginia,  August  28,  1862, 
by  a pistol  ball,  which  entered  near  the  right  primitive  carotid  artery,  and  emerged  near  the  inferior  border  of  the  scajtula  on  the 
left  side.  He  was  admitted,  on  the  next  day,  to  the  Presbyterian  Church  Hospital,  Georgetown,  D.  C.  The  patient  was  somewhat 
exhausted  when  admitted,  but  rallied  under  the  use  of  stimulants.  Respiration  was  easy.  Cold  water  dressings  were  a])plied 
and  anodynes  given.  During  the  night  the  patient  was  extremely  restless,  continually  calling  for  w.ater,  and  wishing  to  have  his 
position  changed.  The  pulse  was  full  and  bounding.  There  was  paralysis  of  the  upper  and  lower  extremities,  consequent  upon 
the  severing  of  some  of  the  nerves  involved  in  the  wound.  There  was  also  paralysis  of  the  sphincters  of  the  bladder  and  rectum, 
the  fseces  and  urine  being  voided  involuntarily.  Great  irritability  of  the  stomach  was  a constant  symptom,  it  being  impossible 
for  the  patient  to  retain  food  or  medicine  for  more  than  fifteen  minutes.  Involuntary  emissions  of  semen  occurred  nearly  every 
two  hours.  The  patient  finally  became  so  noisy  and  troublesome  that  it  was  necessary  to  have  him  isolated.  He  continued  iu 
this  condition  until  September  16th,  when  he  began  to  sink,  and  died  on  September  20th,  1862. 

Case. — Private  Henry  Graff,  Co.  I,  7th  Massachusetts  Volunteers,  aged  30  years,  received,  at  Fredericksburg,  May  2d, 
1863,  a gunshot  wound  of  the  neck,  left  side,  just  above  the  clavicle.  He  was  conveyed  to  the  hospital  of  the  3d  division.  Sixth 
Corps,  and  transferred  to  Washington,  where  he  was  admitted  into  the  Lincoln  Hospital  on  June  15th.  On  the  16th,  he  was 
transferred  to  the  Camden  Street  Hospital,  Baltimore,  where  he  w.as  admitted  on  the  same  day.  On  .Inly  2d,  he  was  trtmsferred 
to  Hammond  Hospital,  Point  Lookout,  whence  ho  was  returned  to  duty  on  June  14th,  1864.  On  September  3d,  1864,  Examining 
Surgeon  George  Stevens  Jones  stated  that  a fistulous  ojiening  existed,  and  that  his  left  arm  was  nearly  powerless  and  useless. 

52 


410 


WOUNDS  AND  INJUEIUS  OF  THE  NECK. 


[CiiAr.  III^ 


Case.— rrivate  F.  B.  Smith,  Co.  B,  17th  Michigan  Volunteers,  aged  27  years,  received,  on  May  Gth,  1HG4,  a gunshot 
wound  of  the  upper  third  of  the  neck,  posteriorly.  lie  was,  on  May  2r.th,  admitted  to  Campbell  Hospital,  Washington.  The 
patient  had  total  paralysis  of  the  right  hand,  and  partial  of  the  left.  He  died  on  June  2d,  18G4. 

Case. — Private  James  Carson,  Co.  G,  95th  Pennsylvania  Volunteers,  aged  19  years,  received,  at  Spottsylvania,  on  May 
12th,  18G4,  a gunshot  wound  of  the  neck.  The  missile,  a conoidal  ball,  entered  one  and  a half  inches  to  the  right  of  the  seventh 
cervical  vertebra,  passed  diagonally  through  and  emerged  just  below  the  inferior  maxilla,  one  inch  from  its  angle,  carrying  away 
a small  spicula  of  bone,  involving  the  nerves  and  destroying,  to  some  extent,  the  deep  muscles  of  the  side  of  the  neck.  The 
patient  fell  paralyzed  on  the  reception  of  the  wound,  and  was  unable  to  move  his  limbs  for  half  an  hour,  but  he  gradually 
regained  the  use  of  the  lower  extremities  and  the  left  arm,  on  the  following  day.  He  was,  on  May  25th,  admitted  to  Harewood 
Hospital,  Washington,  and,  on  the  31st,  transferred  to  Philadelphia,  where  he  was  admitted  into  the  Convalescent  Hospital. 
Simple  dressings  were  applied  to  the  wound.  On  June  22d,  he  was  transferred  to  the  Turner’s  Lane  Hospital,  where,  on 
Sei)tember  5th,  a small  piece  of  necrosed  bone  was  removed.  He  was  discharged  the  service  on  December  9th,  1864,  and 
pensioned. 

Case. — Private  William  H.  Curtis,  Co.  A,  78th  Illinois  Volunteers,  aged  28  years,  was  wounded  at  the  battle  of  Jones- 
boro’, September  1st,  1864,  by  a conoidal  ball,  which  entered  the  left  side  of  the  neck,  one  inch  anterior  to  the  sterno-cleido- 
mastoid  muscle,  at  a point  midway  between  the  sternum  and  the  inferior  maxilla,  and  lodged  about  the  centre  of  the  scapula  on 
the  anterior  side.  He  was,  on  November  26th,  admitted  to  Brown  Hospital,  Louisville,  Kentucky,  and  thence  transferred  to 
Jlound  City  Hospital,  Illinois,  December  1st.  Simple  dressings  were  applied  to  the  wound.  The  wounds  had  healed  December 
13th ; there  was  partial  paralysis  of  the  arm  and  hand,  and  all  the  muscles  of  the  shoulder  were  partially  atrophied.  The 
patient  was  unable  to  raise  his  hand  to  his  face,  and  had  some  constant  pain  in  his  shoulder.  He  was  discharged  the  service 
March  11th,  1865.  The  case  is  reported  by  Surgeou  Horace  Wardner,  U.  S.  V.  Curtis  is  a pensioner;  his  hand  is  completely 
disabled  and  stiff.  His  disability  is  total  and  permanent. 

Case. — Corporal  Ralph  White,  Co.  E,  9th  Pennsylvania  Reserves,  received  at  the  battle  of  Drainsville,  December  20th, 
1861,  a gunshot  wound  of  the  neck.  A ball  entered  a few  inches  to  the  right  of  the  fourth  cervical  vertebra  and  lodged.  The 
wound  healed  and  he  performed  duty  until  the  middle  of  January,  1863 , when  he  commenced  to  suffer  from  severe  pain.  He 
was  discharged  from  service  March  9th,  1863,  and  pensioned.  Pension  Examiner  G.  McCook  reports  that  there  is  partial 
paralysis  of  the  right  shoulder,  caused  by  ball  pressing  on  the  nerves.  Disability  one-third. 

Case. — Private  David  Campbell,  Co.  F,  29th  Pennsylvania,  aged  31  years,  was  wounded  at  Gettysburg,  June  3d,  1863, 
by  a conoidal  ball,  which  entered  the  left  side  of  the  neck ; passed  directly  downward  through  the  edge  of  the  trapezius 
muscle  into  the  cavity  of  the  thorax,  where  it  lodged.  He  was  admitted,  on  October  25th,  to  Satterlee  Hospital,  Philadelphia. 
Simple  dressings  were  applied  to  the  wound;  the  ball  was  unsuccessfully  searched  for.  The  transverse  process  of  the  fifth 
cervical  vertebra,  being  found  necrosed,  was  removed.  The  wound  granulated  finely,  and  by  November  22d,  had  almost 
healed.  He  was  transferred  to  the  Veteran  Reserve  Corps,  December  31st,  1863.  Pension  Examiner  Thomas  H.  Hope 
reports,  July  16,  1869,  that  the  pensioner  complains  of  frequent  shooting  pains  through  the  chest  and  along  the  left  arm  to  the 
elbow,  the  use  of  which  is  impaired.  On  the  same  day  that  he  received  the  above  injury  he  was  ridden  over  by  the  enemy’s 
cavalry,  receiving  extensive  wounds  of  the  thigh,  which  ulcerated.  The  limb  is  much  enlarged.  See  page  459. 

Case. — Private  Frederick  Gening,  Co.  H,  100th  New  York  Volunteers,  was  admitted  to  Ira  Harris  Hospital,  Albany, 
New  Yoi’k,  October  4th,  1862,  with  seven  gunshot  wounds,  supposed  to  have  been  received  at  the  battle  of  Fair  Oaks,  Virginia, 
May  31st,  1862.  One  missile  entered  midway  between  the  two  scapulas  over  the  seventh  cervical  vertebra,  disappearing  and 
wounding  or  pressing  upon  the  right  axillary  plexus  of  nerves.  During  the  treatment  of  the  case  one  ball  was  extracted.  Ho 
was  discharged  from  service  November  10th,  1862.  There  was  total  paralysis  of  the  right  arm.  Horatio  N.  Loomis,  Pension 
Examiner,  reports.  May  27th,  1864,  that  the  right  arm  was  almost  useless,  and  that  he  suffered  pain  in  right  side  and  chest. 

Case. — Captain  John  Foster,  Co.  D,  111th  Illinois  Volunteers,  aged  35  years,  was  wounded  at  Fort  McAllister,  December 
13th,  1864,  by  a conoidal  ball,  which  entered  at  the  middle  of  the  upper  third  of  the  left  humerus,  ranged  upward  and  inward, 
passed  through  the  deltoid  muscle  anterior  to  the  bone,  through  the  axilla,  beneath  the  clavicle  at  its  middle,  and  thence  through 
the  neck,  emerging  at  the  posterior  edge  of  the  sterno-cleido-mastoid  muscle  of  the  right  side,  wo\inding,  in  its  track,  the  brachial 
plexus  and  destroying  sensation  in  the  ulnar  side  of  the  arm.  He  was  admitted,  on  December  26th,  to  the  Officers’  Hospital, 
Be.aufort,  South  Carolina,  whence  he  was  discharged  from  service  on  December  30th,  1864.  Pension  Examiner  \V.  H.  Castle 
reports  that  the  pensioner  suffers  from  constant  dyspnoea  and  partial  loss  of  voice. 

Case. — Private  Charles  C.  Ewer,  Co.  D,  44th  Massachusetts  Volunteers,  aged  23  years,  was  wounded  while  in  the  act 
of  firing,  at  Whitehall,  North  Carolina,  December  16th,  1862,  by  a round  musket  ball,  which  entered  at  the  inferior  border  of 
the  thyroid  cartilage,  just  to  the  right  of  the  median  line,  passed  backward  and  outward,  and  emerged  over  the  right  scapula 
about  an  inch  from  its  superior  angle  posteriorly  and  near  its  spine.  On  the  reception  of  the  injury  the  arm  fell,  and  he  suffered 
great  pain  for  about  one  month,  during  which  time  the  arm,  forearm,  and  hand  were  very  sensitive,  the  slightest  contact  causing 
intense  pain.  The  power  of  speech  was  lost  entirely  for  six  w-eeks.  The  limb  was  carried  at  right  angles,  and  sulphate  of 
morphia  exhibited  hypodermically  to  relieve  the  pain.  He  was  admitted  to  the  hospital  at  New  Berne,  North  Carolina,  December 
21st  1862.  The  wounds  of  entrance  and  exit  healed  by  February  5th,  1863,  and  never  broke  out  again.  At  this  date  he  was 
transferred  to  his  home  in  Boston,  Massachusetts,  where  he  was  treated  by  Dr.  Gay.  The  pain  abated  gradually,  and  in  six 
months  he  was  able  to  bear  some  friction  with  the  palm  of  the  hand  on  .the  surface  of  the  limb.  Passive  motion  of  the  arm, 
which  had  become  somewhat  fixed,  was  continued  daily,  with  friction,  for  about  a year,  when  he  was  able  to  cany  a light  cane. 
He  was  dischai-ged  from  the  service  on  May  Gth,  1863.  H.  W.  Sawtelle,  M.  D.,  reports,  under  date  of  November  26th,  1870, 
“the  limb  is  now  normal  in  size,  but  the  fingers  are  quite  sensitive  in  cold  and  damp  weather.  He  states  that  after  much 
exertion,  and  promiting  and  supinating  the  limb,  a sharj)  pain  is  experienced  in  the  thumb  and  index  finger.”  Mr.  Ewer  is  a 
clerk  in  the  Treasury  De])artment.  He  is  a pensioner. 


Sect.  II.] 


HiEMOREHAGE. 


411 


Case. — Private  J.  II.  McCullough,  Co.  F,  59tli  Alabama  Regiment,  aged  27  years,  was  wounded  near  Ridimond,  Virginia, 
Itlay  16th,  1864,  by  a conoidal  ball,  wbicb  passed  transversely  through  the  neck  from  the  right  side,  one  and  a half  inches  below 
the  thyroid  cartilage,  perforating  the  trachea.  He  suffered  from  aphonia  until  June  5th,  1864,  when  he  was  furloughed,  at  which 
time  both  orifices  were  entirely  healed. 

Case. — Corporal  Eohert  T.  Arnold,  Co.  A,  4th  Georgia  Regiment,  was  wounded  on  May  8th,  1864,  hy  a conoidal  b.all 
which  entered  about  the  middle  of  the  sterno-cleido-mastoid  muscle,  left  side,  and  emerged  at  the  middle  of  the  right  clavicle, 
wounding  the  larynx  in  its  course.  He  was  conveyed  to  the  Confederate  hospital  at  Farmville,  Virginia.  The  treatment  in  the 
case  has  not  been  recorded.  The  injury  resulted  in  aphonia.  He  was  furloughed  on  J uly  18th,  1864,  for  sixty  days.  On 
February  2oth,  1865,  he  was  admitted  into  the  Jackson  Hospital,  at  Richmond,  Virginia,  whence  he  was  returned  to  duty  on 
February  28th,  1865. 

Case. — Private  William  L.  Switzer,  Co.  F,  5th  Iowa  Volunteers,  aged  25  years,  was  wounded  at  luka,  September  19th, 
1862,  by  a musket  ball,  which  struck  the  larynx  near  its  centre,  just  below  the  left  portion  of  the  lower  jaw,  passed  through  it 
and  emerged  at  the  edge  of  the  sterno-cleido-mastoid  muscle,  about  three  inches  below  the  angle  of  the  jaw;  another  ball  struck 
near  the  acromium  process  of  the  right  shoulder  in  front,  psssed  under  the  upper  portion  of  the  humerus,  and  out  about  four 
inches  below  the  head  of  the  bone,  near  the  external  edge  of  the  deltoid  muscle.  He  was,  on  October  19th,  admitted  to  Keokuk 
Hospital,  Iowa.  On  March  31st,  1863,  he  could  not  speak  aloud,  and  probably  never  would ; he  was  pale  and  sickly  looking, 
and  had  the  appearance  of  a person  whose  general  health  was  broken  down.  He  was  discharged  the  service  on  December  20th, 
1862.  The  case  is  reported  by  Examining  Surgeon  Oramel  Martin. 

Case. — Corporal  Valentine  Stork,  Co.  L,  5th  Pennsylvania  Cavalry,  received,  at  Williamsburg,  September  9th,  1862,  a 
gunshot  wound.  The  missile  entered  the  right  side  of  the  neck,  passed  under  the  sterno-mastoid  muscle,  through  the  tracliea, 
and  emerged  at  the  left  side  above  the  sternum.  He  was,  on  September  10th,  admitted  to  Nelson  Hospital,  Yorktown,  Virginia. 
He  was  discharged  the  service  on  November  30th,  1862.  Examining  Surgeon  G.  McCook,  by  whom  the  case  was  reported, 
states  that  Stork’s  voice  was  almost  suppressed,  and  his  breathing  impaired. 

Case. — Private  Joseph  Phillips,  Co.  F,  7th  West  Virginia  Volunteers,  aged  30  years,  received  a gunshot  wound  of  the 
neck  at  Autietam,  Maryland,  September  17th,  1862,  the  missile  entering  on  the  left  side  under  the  sterno-mastoid  muscle, 
opposite  pomum  Adami,  and  emerging  at  the  superior  angle  of  the  scapula.  He  was  treated  in  field  hospital  until  the  27th, 
when  he  was  admitted  into  Satterlee  Hospital,  Philadelphia.  He  was  discharged  from  service  on  November  28th,  1862,  at 
which  time  the  wound  had  healed;  there  was  loss  of  vision  and  entire  paralysis  of  the  left  arm.  The  Pension  Examining  Board 
at  Wheeling,  West  Virginia,  reports.  May  8th,  1870,  that  there  is  atrophy  of  the  left  arm,  with  partial  loss  of  motion. 

Case. — Private  John  A.  White,  Co.  A,  31st  Missouri,  received  a gunshot  wound  of  the  neck,  right  side,  at  Vicksburg, 
Mississippi,  December  29th,  1862.  He  was  admitted  to  hospital  at  Benton  Barracks,  St.  Louis,  June  29th,  1863,  and  was 
discharged  the  service  on  October  22d,  1863,  for  total  deafness.  His  disability  is  rated  one-half. 

Case. — Private  George  Fealce,  of  Sturdevant’s  Battery,  was  struck  by  a ball,  which  passed  through  the  concha  of  the 
right  ear  and  emerged  near  the  first  cervical  vertebra.  He  was  admitted  to  Farmville  (Confederate)  Hospital.  There  ensued 
entire  loss  of  hearing  on  the  injured  side,  and  the  patient  suffered  from  neuralgic  pains. 

Haemorrhage. — Of  cases  in  which  primary  or  secondary  htemorrhage  was  the  princi- 
pal feature,  the  following  may  be  cited; 

Case. — Major  Richard  Banning,  80th  Ohio  Volunteers,  received,  at  Corinth,  October  3d,  1862,  a gunshot  wound.  The 
missile  passed  through  the  neck  just  in  front  of  the  carotid  artery.  He  died  on  the  field,  from  hsemorrhage,  on  October  3d, 

1862.  The  case  is  reported  by  Surgeon  E.  P.  Buell,  80th  Ohio  Volunteers. 

Case. — Private  Edward  B.  Taylor,  Co.  I,  6th  Connecticut  Volunteers,  was  wounded  at  Fort  Wagner,  South  Carolina, 
July  18th,  1863,  by  a fragment  of  shell,  which  struck  at  the  base  of  the  neck,  tearing  open  the  branches  of  the*  thyroid  axis 
and  the  jugular  vein.  He  was  admitted,  on  the  next  day,  to  Hospital  No.  8,  Beaufort,  where  styptics  and  compresses  were 
applied.  Itwas  decided  that  to  operate  upon  him  would  hasten  his  death  on  account  of  haemorrhage.  He  died  on  July  27  th,  1863. 

Case. — Colonel  John  J.  Mudd,  2d  Illinois  Cavalry,  received  a gunshot  wound  of  the  neck,  in  June,  1863,  by  being  fired 
at  fi’om  an  ambush,  near  Vicksburg,  Mississippi.  The  missile,  a buckshot,  entered  near  the  inferior  orbital  foramen,  passed 
downward  and  backward  behind  the  angle  of  the  lower  jaw,  wounding  the  ]iarotid  gland,  and  lodged  deeply  in  the  neck, 
probably  under  the  sterno-cleido-mastoid  muscle.  Simple  dressings  were  applied.  The  wound  produced  great  swelling  in  the 
fauces  and  difficulty  of  deglutition,  with  some  hajmorrhage  from  the  mouth.  He  was  furloughed,  and  having  returned  to  duty 
was  subsequently  killed  in  action  on  the  steamer  City  Bell,  on  May  3d,  1864. 

Case. — Sergeant  Eugene  Wilcox,  Co.  E,  10th  Connecticut  Volunteers,  aged  30  years,  was  wounded  at  Whitehall,  North 
Carolina;  December  16th,  1862,  by  a conoidal  ball,  which  entered  just  above  the  right  clavicle,  and,  traversing  the  neck,  ]>assed 
out  immediately  below  the  spinous  ])rocess  of  the  seventh  cervical  vertebra.  He  was  treated  in  the  field  hospital  until  December 
21st,  when  he  was  admitted  into  Stanley  Hospital,  New  Berne,  North  Carolina.  Simple  dressings  were  applied,  and  tonhrs, 
stimulants,  and  nutritious,  fluids  administered.  On  December  24th,  there  was  external  hmmorrhage  to  a considerable  extent, 
which  recun-ed  on  the  28th.  It  was  decided  that  operative  interference  could  afford  no  relief.  Death  resulted  in  a few  houi's 
after  the  recurrence  of  the  hsemoiThage,  on  December  28th,  1862.  The  autopsy  revealed  a wound  of  one  of  the  imjautant 
branches  of  the  thyroid  axis  and  of  the  external  jugular  vein,  with  sloughing  of  the  neighboring  integument. 

Case. — Sergeant  J.  W.  J.  Junls,  Co.  D,  28th  Jlississippi  Cavalry,  was  wounded  at  Fr;mklin,  Tennessee,  April  10th, 

1863,  by  a conoidal  ball,  which  entered  oj)posite  the  thyroid  cartilage,  at  the  inner  border  of  the  sterno-mastoid  muscle,  and 
emerged  about  an  inch  and  a half  to  the  left  of  the  lower  cervical  vertebra.  He  was  taken  prisoner,  and  admitted  to  the  hospital 


412 


WOUNDS  AND  INJURIES  OF  THE  NECK. 


[ClIAl’.  Ill, 


at  Eraiikliii  on  tlio  smno  day.  lie  lost,  in  tlio  coiirso  of  tliree  liours,  pcrliaps  two  (jnarts  of  blood,  after  wldc-li  the  lia>niorrliage 
erased.  On  tlie  second  day,  be  was  taken  with  severe  chills,  which  recurred  at  the  rate  of  two  or  three  a day,  followed  by  high 
febrile  reaction.  Death  resulted  on  Ajiril  ICtli,  1803.  The  autopsy  showed  that  the  jugular  vein  had  been  completely  severed. 
The  surrounding  tissues  were  extensively  infiltrated  with  pus  and  blood,  and  the  divided  extremities  of  the  vein  contained  a 
large  amount  of  jhis. 

Case. — Captain  Jarvis  N.Lake,  Co.  B,  93d  Ohio  Volunteers,  aged  31  years,  was  wounded  at  Missionary  Ridge,  November 
23d,  1803,  by  a musket  ball,  which  entered  the  right  side  of  the  neck,  on  a level  with  the  pomum  Adami,  passed  between  the 
juguhir  veiti  tind  carotid  artery  in  a directioti  downward  and  backward,  and  emerged  one  inch  and  a half  below  and  one  inch 
to  the  right  of  the  last  cervical  vertebra.  He  remained  senseless  for  hours,  and  was  supposed  to  be  dead;  signs  of  life  appearing, 
he  was  conveyed  to  the  field  hospital,  where  he  recovered  from  the  severe  nervous  shock  which  he  had  sustained.  Severe 
hsemorrhage  occurred.  On  December  18th,  he  was  admitted  into  the  field  hospital,  Bridgeport,  Alabama.  Cold  water  dressings 
were  api)lied  to  the  wound,  and  restoratives  administered.  He  was  transferred  to  Nashville  on  December  22d.  Pension  Exam- 
iner E.  Mendenhall  states,  on  January  4th,  18G4,  that  “ the  patient’s  wounds  are  healed,  but  the  side  of  the  neck,  the  entir^j 
shoulder,  and  arm  of  the  right  side  are  very  sore,  swollen,  and  paralyzed.”  On  a subsequent  examination,  the  soreness  and 
swelling  were  gone,  and  the  jiatient  could  use  his  forearm  and  hand  ; some  of  the  muscles  of  the  shoulder  were  atrophied.  His 
general  health  was  good. 

Case. — Private  Joseph  Step,  Co.  I,  40th  Georgia  Regiment,  aged  29  years,  received.  May  20th,  1864,  a gunshot  wound. 
The  missile  entered  just  below  the  angle  of  the  right  inferior  maxilla,  passed  through  the  neck,  and  emerged  at  a corresponding 
point  on  the  left  side;  the  same  ball  also  fractured  the  left  humerusT  He  was  admitted  to  Institute  Hospital,  Atlanta,  where 
amj)utation  at  the  upper  third  of  the  left  arm  was  performed.  The  patient  was  weak  from  loss  of  blood;  there  was  considerable 
constitutional  disturbance.  Secondary  haemori  hage  occurred  from  the  wounds  of  the  neck  on  June  7th.  The  patient  died  on 
June  8th,  1864. 

Case. — Private  Big  Jim,  Co.  M,  6th  Kansas  Cavalry,  received,  in  a brawl  on  July  4th,  1864,  a gunshot  wound  of  the 
neck,  bj'  a conoidal  ball,  which  entered  above  the  outer  third  of  the  right  clavicle,  and  emerged  above  the  middle  third  of  the 
left  clavicle.  He  was,  on  July  4th,  admitted  to  Fort  Smith  Hospital,  Arkansas.  Simple  dressings  were  applied  to  the  wound. 
Secondary  hasmorrhage  from  the  common  carotid  artery  occurred  on  July  11th,  which  was  temporarily  controlled  by  the  appli- 
cation of  the  solution  of  persulphate  of  iron.  The  patient  died  on  July  12th,  1864.  The  autopsy  revealed  an  aperture  in  the 
carotid,  about  two  lines  in  diameter’,  and  about  three-fourths  of  an  inch  above  its  origin. 

Case. — Corporal  Jacob  Brandt,  Co.  D,  142d  Pennsylvania  Volunteers,  aged  31  years,  was  wounded  at  the  Wilderness, 
May  6th,  1864,  by  a fragment  of  shell,  which  entered  at  the  right  side  of  the  face,  on  a level  with  the  lower  margin  of  the 
inferior  maxilla,  and  one  inch  in  front  of  the  condyle,  passed  backward  and  downward,  and  emerged  between  the  scapulte  over 
the  spinal  column.  He  was,  on  May  11th,  admitted  to  Armory  Square  Hospital,  Washington.  Stimulants  were  administered, 
and  generous  diet  ordered.  The  patient  had  frequent  chills,  and  all  the  symptoms  of  jiyaunia,  and  was  very  much  exhausted. 
Secondary  hccmori  hage,  which  was  slight,  occurred  on  June  3d,  from  an  ulceration  of  the  external  jugular  vein.  He  died  on 
June  3d,  1864.  The  case  is  rej)orted  by  Surgeon  D.  W.  Bliss,  U.  S.  V. 

Case. — Private  Alonzo  Hoyt,  Co.  I,  14th  Michigan  Volunteers,  was  admitted  from  the  field  into  hospital  No.  1,  Nashville, 
on  January  4th,  1863,  for  a gunshot  wound  of  the  neck,  received  at  the  battle  of  Murfreesboro’,  on  the  3d.  The  missile  had 
j)assed  through  the  neck,  dividing  the  intervertebral  muscles  and  laying  open  the  spinal  cord.  He  did  not  seem  to  suffer  much, 
but  on  the  night  of  January  14th,  secondary  hmmorrhage  supervened,  and,  before  any  assistance  could  be  rendered,  he  lost  so 
much  blood  that  he  died  on  the  evening  of  January  15th.  At  the  post-mortem,  it  was  found  that  sloughing  of  the  common 
carotid  artery  had  taken  place.  No  paralysis  occurred,  or  anything  to  mark  the  extent  of  the  injury.  He  conversed  fi’eely  up 
to  the  moment  of  his  death.  The  case  is  reported  by  Surgeon  Edward  Batwell,  14th  Michigan  Volunteers. 

Few  writers  on  military  surgery  have  failed  to  remark  on  the  curious  manner  in  which 
missiles  elude  the  great  vessels  of  the  neck,  though  passing,  apparently,  in  their  immediate 
track.  The  examples  of  this  description  reported  were  numerous.  Dr.  Williamson,*  64th 
British  Regiment,  suggests  an  exiilanation  of  this  phenomenon. 

Erysipelas  after  Neck-wounds. — The  liability  of  gunshot  injuries,  especially  of  this 
region,  to  be  complicated  by  erysipelatous  action  is  often  noticed  in  the  reports.  One  or 
two  cases  of  recovery  are  appended.  Without  other  complications,  this  was  rarely  fatal. 
Indeed,  in  healthy  subjects  traumatic  erysipelas  is  not  commonly  a very  serious  affair. 
Tonics,  and  especially  iron  in  the  form  of  tincture  of  the  sesquichloride,  were  usually 
employed : 

Case. — Private  diaries  Guttery,  Co.  D,  140tb  Peimsylvaniq  Volunteers,  aged  18  years,  received,  at  Spottsylvania,  May 
12tli,  1864,  a gunshot  wound  of  the  upper  and  posterior  part  of  the  neck.  He  was,  on  May  15th,  admitted  to  Lincoln  Hosjiital, 
Washington,  and,  on  the  18th,  transferred  to  I’ennsylvauia,  where  he  was  admitted  into  the  York  Hospital,  May  21st.  Simjile 
dressings  were  ajiplied  to  the  wounds.  Erysijielas  set  in,  which  covered  the  entire  face  and  scalp.  On  June  13tb,  he  was  trans- 
ferred to  the  I’ittsburgh  Ho.sjiital,  whence  he  was  returned  to  duty  on  September  22d,  1864. 

*“It  is  remarkable  that  the  largo  ailcrics  and  veins  in  the  neck  should  escape  injury  so  frequently  in  gunshot  wounds.  This  may,  in  some 
measure,  be  accounted  for  by  the  structures  in  tliis  retfioii  being  so  loose  and  movable  that  they  yield  and  recede  before  any  projectile."  WlLLL\JlSON. 
Op.  cit.  p.  72. 


Sect,  II.] 


SLOUGHING  AND  GANGRENE,  AND  PY.^MIA. 


413 


Case. — Private  .lolm  II.  Betts,  Co.  II,  120tli  New  York  Volunteers,  was  wounded  at  Gettjsbur",  July  2d,  18G3,  by  a 
musket  ball,  which  entered  at  a point  over  the  scalenus  niedius  of  the  left  side,  one  inch  above  the  clavicle,  passed  through  the 
neck,  and  emerged  at  a corresponding  point  on  the  right  side.  He  was,  on  July  5th,  admitted  to  Satterlee  Hospital,  I’hiladclphia. 
On  admission,  the  parts  were  erysipelatous,  and  the  iiatient  had  some  difficulty  of  swallowing.  He  stated  that  after  the  inception 
of  the  injury,  he  spat  blood  for  several  days.  Flaxseed  poultices  were  applied  to  the  wound,  and  perfect  rest  was  ordered.  The 
wounds  discharged  pus  freelj',  but  the  matter  burrowed  into  the  supra-sternal  fossa,  which  being  emptied,  soon  granulated,  and 
the  wounds  healed  readily,  with  some  inclination  of  the  head  forward  fi’om  a rigidity  of  the  anterior  muscles  of  the  neck.  He 
was  returned  to  duty  on  September  23d,  18G3.  The  case  is  reported  by  Acting  Assistant  Surgeon  T.  G.  Morton.  The  name  of 
this  patient  does  not  appear  on  the  Pension  List. 

Another  case  [Hayes,  6th  Alabama)  is  detailed  on  page  404. 

. Sloughing  and  Gangrene. — Wounds  of  the  neck  were  seldom  affected  with  sloughing. 
Perhaps  the  looseness  of  the  textures  was  a safeguard  against  this  complication.  At  all 
events,  the  few  instances  observed  were  in  the  region  of  the  denser  tissues.  One  or  two 
abstracts  may  be  cited : 

Gase. — Private  John  McCafferty,  Co.  I,  114th  Pennsylvania  Volunteers,  .aged  23  years,  received  a gunshot  flesh  wound 
of  the  right  side  of  the  neck  by  a conoidal  ball,  at  Gettysburg,  July  2d,  1863.  He  was  taken  to  the  hospital  of  the  1st 
division.  Third  Corps,  and  on  July  7th,  sent  to  Mower  Hospitiil,  Philadelphia.  When  admitted  the  wound  was  unhealthy  .and 
painful,  with  a tendency  to  slough.  Cold-water  dressings  were  applied  to  the 
wound,  with  stimulants  internally.  By  July  13th,  the  slough  extended  over  a 
surface  four  inches  in  length  by  three  inches  in  width.  The  patient  was  very 
weak,  and  the  pain  continued.  On  the  same  day  a portion  of  the  slough  was 
removed  with  the  scalpel,  .and  a solution  of  creasote  applied.  By  July  21st,  the 
appearance  of  the  wound  was  much  improved  and  granulating.  The  slough  was 
all  cleaned  off.  The  patient  continued  to  improve,  and  was  returned  to  duty 
October  224,  1863,  at  which  time  the  wound  had  entirely  healed.  He  is  not  a 
pensioner. 

Case. — Private  Frank  Eastman,  Co.  D,  6th  New  Hampshire  Volunteers, 
aged  18  years,  was  wounded  before  Petersburg,  Virginia,  April  2d,  1865,  by  a fi’ag- 
ment  of  shell,  which  entered  near  the  spinous  process  of  the  seventh  cervical 
vertebra  and  emerged  in  front  of  the  ear  on  the  right  side.  He  was  treated  in  field 
liospital,  and,  on  the  4th,  transferred,  per  steamer  Cosmopolitan,  to  Washington, 
entering  Harewood  Hospital  on  the  5th.  The  wounds  of  entrance  and  exit  were 
greatly  lacerated,  and  in  a sloughing  condition.  After  the  eschars  separated,  he 
steadily  improved,  from  the  first,  without  any  apparent  constitutional  disturbance, 
the  wound  discharging  he.althy  pus  and  granulating  finely.  On  May  15th,  he  was 
transferred  to  Webster  Hospital,  Manchester,  New  Hampshire,  whence  he  was 
discharged  from  service  on  July  24th,  1865.  Pension  Examiner  C.  H.  Boynton 
reports,  November  13th,  1865,  that  the  patient  suffers  from  deafness  in  the  right 
ear,  and  pain  and  dizziness.  Thei-e  was  a daily  discharge  of  matter  from  the  mouth, 
coming  through  the  right  Eustachian  tube.  He  was  unable  to  Labor.  The  appear- 
ance of  the  wounds,  on  admission,  are  imperfectly  represented  in  the  wood-cut  (Fig. 

145),  a reduced  copy  of  aii  excellent  photograph. 

PycBmia. — Purulent  infection  occurred  as  an  occasional  sequel  of  wounds  of  the  neck, 
but  was  not  a frequent  complication.  Of  the  few  cases  reported  in  detail,  the  notes  of  the 
autopsies  are,  unhappily,  incomplete.  The  following  memoranda  are  placed  on  record: 

Case. — Private  John  Gilman,  Co.  G,  12th  New  Hampshire  Volunteers,  aged  31  years,  was  wounded  .at  Ch.ancellorsville, 
May  3d,  1863,  by  a musket  b.all,  which  grazed  the  r.amus  of  the  inferior  maxilla,  near  the  angle  of  the  left  side,  and  entered  the 
neck  above  the  sterno-clavicular  articulation  of  the  right  side,  and  passed  to  some  point  not  ascertained.  He  was,  on  May  9th, 
admitted  to  Harewood  Hospital,  Washington.  Cold  water  dressings  were  applied  to  the  wound;  stimulants  were  administered, 
and  generous  diet  ordered.  On  May  14th,  the  patient  h.ad  some  cough,  expectoration  of  a yellowish  tenacious  sputa,  and  crepitus 
in  the  apex  of  the  right  lung.  On  the  15th,  he  had  chills  and  fever;  on  the  23d,  restless;  pulse  fre(juent ; slight  venous  hfcmorrhage. 
The  patient  died  on  May  23d,  1833.  The  post  mortem  examinatioiVrevealed  an  abscess  like  an  egg,  in  the  spleey-,  which  was 
eight  inches,  by  four  inches  wide.  Black  gangrenous  congestion  in  several  patches  in  the  lower  lobe  of  the  right  and  left  lungs. 
The  case  is  reported  by  Acting  Assistant  Surgeon  Hirshfield. 

Ca.se. — Sergeant  .John  Parker,  Co.  G,  39th  New  York  Volunteers,  aged  30  years,  received,  .at  Beam's  Station,  August 
25th,  1864,  a gunshot  wolmd  of  the  neck.  The  missile,  a conoidal  ball,  (uitercal  over  the  sterno-cleido-masloid  niusch?,  on  a line 
with  the  inferior  edge  of  the  thyroid  cartilage  and  lodged,  fracturing  the  fir.st  rib.  He  w.as  conveyed  to  the  hospital  of  th(^  1st 


Fig.  185. — Sloughing  shell-wound  of  neck. 
Vkot.  of  Surg.  Cascs^  A.  M.  JM.,  Vol.  I,  p.  21. 


414 


WOUNDS  AND  INJUEIES  OF  THE  NECK. 


[Chap.  Ill, 


divisfioii,  Second  Corps,  and  transferred  to  Wasliington,  where  he  was  admitted  into  the  Lincoln  Hospital  on  August  28th.  The 
ball  was  removed  from  near  the  first  rib;  stimulants  were  administered,  and  nutritious  diet  ordered.  On  August  30th,  there  was 
a constant  discharge  of  sanguineous  liquor  from  the  wound,  which  was  arrested  by  compression  and  bandages.  The  patient  was 
pate  and  ana;mic;  on  September  2d,  had  chills;  sallow  look;  the  surface  of  the  body  covered  with  a profuse  perspiration. 
Pymmia  supervened,  and  the  patient  died  on  September  13th,  18G4.  The  autopsy  revealed  fifty  ounces  of  fluid  in  the  left 
thoracic  cavity;  a large  abscess  in  the  left  lung,  and  a small  one  in  the  right.  The  case  is  reported  by  Acting  Assistant  Surgeon 
W.  E.  Roberts. 

Case. — Musician  Samuel  Potter,  Co.  K,  43d  United  States  Colored  Troops,  aged  17  years,  received,  on  July  30th,  1864,  an 
accidental  gunshot  wound  of  the  neck,  by  a pistol  ball.  He  was,  on  July  31st,  admitted  to  Summit  House  Hospital,  Philadelphia. 
Simple  dressings  were  applied  to  the  wound;  tonics  and  stimulants  administered,  and  generous  diet  ordered.  On  August  10th, 
pyaemia  supervened.  The  patient  died  on  August  13th,  1864. 

The  following  table  is  a consolidation,  from  all  the  reports  received,  of  gunshot  wounds 
of  the  neck.  The  mortality  is  15  per  centum.  But  it  must  be  understood  that  the  figures 
were  taken  from  the  casualty  lists  and  regimental  field  reports,  as  well  as  from  the  returns 
of  the  field,  and  base,  or  general  hospitals.  And  thus  the  excessive  ratio  of  mortality  is 
explained,  klany  cases  are  included  of  grave  injuries  that  never  came  under  treatment: 

Table  XVII. 


Table  of  Four  Thousand  Eight  Hundred  and  Ninety-Jive  Cases  of  Gunshot  Wounds  of  the 
Neek  without  ICnown  Injury  to  the  Cervical  Vertebrae. 


CHARACTER  OP  WOUND. 

Cases. 

Died. 

Discharged. 

Duty. 

Unknown. 

Gunshot  Wounds  of  the  Neck 

4789 

570 

1056 

2394- 

769 

Gunshot  Wounds  of  the  Neck,  injuring  Trachea 

41 

21 

11 

8 

1 

Gunshot  Wounds  of  the  Neck,  injuring  Larynx 

30 

10 

8 

2 

10 

Gunshot  Wounds  of  the  Neck,  injuring  Pharynx 

13 

7 

2 

3 

1 

Gunshot  Wounds  of  the  Neck,  injuring  (Esophagus 

10 

6 

2 

2 

Gunshot  Wounds  of  the  Neck,  injuring  Trachea  and  Larynx 

4 

1 

3 

Gunshot  Wounds  of  the  Neck,  injuring  Trachea  and  Pharynx 

2 

2 

Gunshot  Wounds  of  the  Neck,  injuring  Trachea  and  (Esophagus 

2 

2 

Gunshot  Wounds  of  the  Neck,  injuring  Larynx  and  Oesophagus 

1 

1 

Gunshot  Wounds  of  the  Neck,  iniurinn:  Pharynx  and  (Esophagus 

1 

1 

Gunshot  Wounds  of  the  Neck,  injuring  Pharynx  and  Larynx 

2 

2 

Aggregates 

4895 

618 

1083 

2413 

781 

SlXT.  III.] 


OPEEATIONS  ON  THE  AIR  PASSAGES. 


415 


Section  III. 


OPERATIONS  ON  THE  NECK. 


The  following  table  presents  a numerical  exhibit  of  the  principal  cases  in  which 
operative  interference  was  resorted  to  on  account  of  injury  or  disease  in ‘the  cervical 
region ; 

Table  XVIII. 


Table  of  One  Hundred  and  Thirty-eight  Operations  for  Gunshot  Wounds  and  Surgical 

Diseases  of  the  Nech. 


CHARACTER. 

Cases. 

Died. 

Discharged. 

Duty. 

Unknown. 

29 

22 

2 

4 

1 

14 

8 

4 

2 

6 

5 

1 

2 

2 

87 

12 

36 

29 

10 

Affjrreiiates 

138 

47 

45 

35 

11 

Operations  on  the  Air-passages. — Of  the  twenty  cases  of  bronchotomy  reported, 
six  -were  operated  on  because  of  gunshot  wounds,  and  two  of  these  had  a successful  issue. 
The  abstracts  are  appended, — to  be  followed  by  those  of  the  operations  performed  for 
disease : 

Case. — Captain  John  S , 53d  Pennsylvania  Volunteers,  aged  24  years,  was  admitted  to  Jarvis  Hospital,  Baltimore, 

July  5th,  1863,  having  been  wounded  at  Gettysburg  on  July  2d.  He  states  that  he  received  a wound  of  the  neck,  which  bled  so 
profusely  that  he  had  to  be  carried  to  the  rear,  where  simple  dressings  were  applied.  The  hminorrhage  continued  for  some 
hours,  and  finally  stopped  of  its  own  accord.  At  nine  o’clock  A.  M.,  on  the  day  of  admission,  he  was  found  bright,  breathing 
easy,  pulse  96,  and  able  to  converse  without  difficulty.  There  was  excessive  swelling  .about  the  neck  ; the  wound  had  closed, 
and  no  emphysema  existed.  The  patient  reported  that  for  two  diiys  air  had  esc.aped  from  the  wound  at  each  expiration,  but 
now  it  had  entirely  ceased.  The  wound  (supposed  to  h.ave  been  made  by  a buckshot)  is  loc.ated  over  the  centre  of  the  left  j)late 
of  the  thyroid  cartilage,  is  about  one-fourth  of  an  inch  in  length,  and  its  course  is  directly  backward.  Where  the  shot  lodged 
could  not  be  ascertained,  but  it  must  have  passed  through  the  larynx.  The  patient’s  symptoms  after  admission  scjon  became 
alarming.  He  fell  asleep  in  a sitting  posture,  and  dyspnoea  was  most  marked.  At  twelve  o’clock  M.  his  pulse  had  increased  to 
116;  breathing  was  more  labored;  the  chest  and  face  were  covered  with  a cold  perspiration,  and  his  expression  was  extremely 
.anxious — symptoms  indicating  a critical  condition  and  demanding  active  steps  to  be  taken.  The  swelling  and  aalema  around 
the  seat  of  injury,  both  internally  and  externally,  were  rapidly  on  the  increase ; emphysema  had  set  in,  and  extended  down  the 
chest,  especially  on  the  left  side,  as  far  as  the  false  ribs.  A consultation  of  surgeons  was  held,  and  it  was  decided  to  pei'foi-m 
tr.acheotomy.  The  instruments  wdected  for  the  operation  not  being  .at  hand,  they  were  kindly  furnished  by  a distinguished 
surgeon  of  Baltimore.  A straight  incision,  commencing  over  the  cricoid  cartil.age,  was  made  and  carried  downward  in  the 
direction  of  the  median  line  for  about  one  and  a half  inches  through  the  integuments.  The  thyroid  gland  being  exposed  was 
found  greatly  distended  and  infiltr.ated  with  air,  fibrin,  and  bloody  8<!rum,  .as  indeed  were  .all  the  tissues.  Carefully  dissecting 


416 


WOUNDS  AND  INJURIES  OF  THE  NECK. 


[CiiAr.  Ill, 


tlie  parts  on  a grooved  director,  the  lower  edge  of  the  cricoid  cartilage  and  the  upper  ring  of  the  trachea  were  finally  reached. 
A grooved  tenacuhun  was  hoohed  through  the  trachea  just  below  the  cricoid  cartilage,  and  held  firm  by  the  hands  of  an  assistant, 
with  the  handle  resting  on  the  patient's  chin.  A narrow,  sharp-pointed  knife,  guided  bj-  the  groove  of  the  tenaculuiu,  was  then 
inserted  to  perforate  the  trachea,  which,  owing  to  its  unusual  and  great  thickness,  caused  considerable  iinpediinent  to  the  first 
attempt.  The  length  of  the  blade  passed  out  of  sight  without  nccomj)lishing  the  object,  and  the  patient  uttered  a complaint  of 
too  much  pressure.  The  tenacuhun  was  still  steadily  held  while  further  dissections  and  slight  enlargement  of  the  bottom  of  the 
incision  was  made.  The  second  attemiit  proved  less  difficult,  and  was  inunediately  followed  by  the  escape  of  bubbles  of  air. 
The  fresh  wound  was  thoroughly  cleansed,  and  through  the  opening  a blunt-pointed  narrow  knife  was  passed  and  carried  down- 
ward and  forward  until  at  least  three  rings  of  the  trachea  had  been  divided.  Very  little  blood  escaped  into  tin;  trachea,  and  one 
or  two  exj)losive  efforts  cleared  it  of  these  small  clots  and  a quantity  of  tough  mucus,  and  the  patient  breathed  easily  through 
the  new  opening.  The  operation  was  completed  by  introducing  a largo-sized  Desault’s  tube,  which  was  properly  retained  in 
position  in  the  usual  manner.  No  ligatures  were  required,  and  the  amount  of  blood  lost  was  insignificant.  The  relief  experienced 
by  the  patieiit  was  instantaneous,  and  a change  for  the  better  in  all  his  alarming  symptoms  was  immediately  noticed.  His  pulse 
fell  to  9G,  and  he  was  soon  enjoying  a pleasant  sleep.  July  Gth.  The  patient’s  condition  is  much  improved,  the  swelling  is 
subsiding,  and  the  wounds  look  healthy.  The  treatment  consists  in  keeping  the  patient  quiet,  giving  him  flaxseed  tea  to  drink, 
and  fluid  nourishment.  July  9th.  The  patient  continues  to  improve,  and  as  the  swelling  of  the  neck  has  entirely  disappeared, 
the  tube  was  removed  and  left  out.  lie  was  watched  closely,  and  on  the  following  day  he  commenced  breathing  freely  through 
the  natural  passages.  July  18th.  The  wounds  have  almost  healed,  the  patient  walks  about,  and  his  voice  is  as  strong  as  ever. 
Being  anxious  to  return  to  his  home,  he  was-discharged  cured.  The  operation  performed  in  this  case  is  the  one  I'ecommended  by 
M.  ChasSiaignac.  The  steps  of  the  operation  were  not  familiar  to  me,  and  I am  indebted  to  Dr.  Christoj)her  Johnson,  of  Balti- 
more, for  its  ado])tion.  I consider  it  preferable  to  any  I have  witnessed,  and  should  judge  it  was  particularly  applicable  in 
children,  where  it  is  all  important  to  retain  the  larynx  and  trachea  under  jierfect  control  during  their  struggles.  The  operation 
was  conjointly  performed  by  Dr.  Johnson  and  myself,  and  I have  been  truly  pleased  \vith  the  result.  [The  case  is  reported  by 
the  operator.  Assistant  Surgeon  Do  Witt  C.  Peters,  U.  S.  A.  On  April  7th,  18G4,  Pension  Examiner  H.  P.  Moody  stated  that 
the  wound  had  seriously  affected  the  air  passages  and  might  lead  to  confirmed  tuberculosis.  There  appears  to  be  no  later  record 
of  this  patient  at  the  Pension  Office.  ] 

Case. — Private  John  H.  Murphy,  Co.  D,  30th  Illinois  Volunteers,  was  wounded  at  Black  River  Bridge,  May  3d,  18G3, 
by  a musket  ball,  which  entered  the  superior  portion  of  tin;  larynx,  passed  downward,  backward,  and  outward  through  the 
supcu'ior  angle  of  the  left  scapula,  injuring  the  sheath  of  the  carotid  artery.  On  May  4th,  he  was  admitted  to  Mary  Anno 
Hospital,  Mississippi,  almost  moribund;  had  dyspnoea,  and  great  difficulty  of  deglutition.  Cold  water  dressings  were  applied 
to  the  wound.  On  Ma}'  Gth,  Acting  Assistant  Surgeon  C.  B.  Miller  performed  the  operation  of  laryngo-trachcotomy.  The 
j)atient  died  on  May  Gth,  1833.  The  post-mortem  examination  revealed  great  extravasation  of  blood  iqn^n  the  pueumogastric 
nerve,  which  was  j)urple,  and  within  the  sheath  of  the  carotid  artery.  The  case  is  reported  by  the  operator. 

Case. — Private  Lysander  Martin,  independent  company,  Andrew’s  Massachusetts  Sharpshooters,  aged  28  years,  was 
wounded  at  Fredericksburg,  June  lOtli,  18G3,  by  a conoidal  ball,  which  entered  the  neck  three-fourths  of  an  inch  under  the  left 
ear,  passed  through  the  root  of  the  tongue,  and  emerged  through  the  middle  of  the  right  cheek.  On  June  14th,  he  was  admitted 
to  Hammond  Hospital,  Maryland,  suffering  much  from  pharyngitis,  difficulty  of  deglutition,  and  very  distressing  dyspnoea.  Cold 
water  dressings  were  applied  to  the  wound,  and  li(pud  diet  administered  by  means  of  the  stomach  pump.  On  June  19th,  Acting 
Assistant  Surgeon  T.  Liebold  performed  tracheotomy,  and  a large  quantity  of  sanguino-purulent  matter  escaped  from  the  trachea. 
The  immediate  relief  in  breathing  was  great,  but  it  became  soon  evident  that  he  could  not  survive.  The  patient  died  on  June 
19th,  18G3.  The  post-mortem  examination  revealed  the  pharynk  considerably  lacerated,  epiglottis  swollen,  and  the  trachea  and 
bronchia  lined  with  a thick  false  membrane.  The  bases  of  the  lungs,  gorged  with  blood,  presented  an  appearance  as  in  red 
hejratization,  and  had  a few  small  abscesses  in  them.  The  case  is  reported  by  the  operator. 

Case. — Private  John  Durham,  Co.  K,  21st  New  York  Cavalry,  was  admitted  to  the  field  hospital  .at  Sandy  Hook,  Mary- 
land, on  July  27th,  1834,  having  receiveal,  two  days  previously,  at  the  battle  of  Winchester,  Virginia,  a gunshot  wound,  fracturing 
the  neck  and  perforating  the  trachea.  The  soft  parts  were  lacerated,  and  there  was  extreme  difficulty  in  breathing ; constitutional 
cemdition  fair.  On  the  day  of  his  admission  to  hospital,  tracheotomy  was  peiformed  by  Assistant  Surgeon  J.  S.  Taylor,  23d 
Illinois  Infantry.  Subsequent  treatment  was  restorative.  The  patient  died  on  July  30th. 

Case. — Private  P.  C.  Young,  Co.  I,  3d  Massachusetts  Cavalry,  aged  34  years,  wtts  admitted  to  hospital  at  Eeadville, 
Massachusetts,  January  2d,  18G5,  having  received,  at  Cedar  Creek,  Virginia,  October  19th,  18G4,  a gunshot  wound  of  the  neck, 
causing  aj)honia  and  dysjmoea.  A_  laryngoscopic  examination  showed  great  swelling  of  the  superior  op'ening  of  the  glottis,  the 
apparent  cause  of  marked  dysitiima.  Difficulty  of  breathing  gradually  increased  to  such  an  extent,  notwithstanding  frequent 
aj)i>lications  of  nitrate  of  silver  to  the  glottis,  as  to  render  an  operation  imperative.  On  January  Cth,  the  patient  was  etherized 
and  tracheotomy  performed  by  Acting  Assistant  Surgeon  S.  W.  Langmaid.  The  operation  was  simply  a longitudinal  incision,  as 
low  down  in  the  trachea  as  possible,  and  the  insertion  of  a silver  tube.  Beyond  the  great  congestion  of  the  blood-vessels  of  that 
part  of  the  trachea  involved  in  the  operation  no  local  lesions  were  observed  (the  original  wound  having  healed),  and  the  patient’s 
general  condition  was  good,  with  the  exception  of  almost  complete  apnoca  from  difficult  respiration.  The  operation  was  followed 
by  instant  relief  of  the  dyspnoea,  and  rapid  recovery  of  health  and  strength.  The  wound  healed  kindly  under  the  application  of 
t(q)id  water  dressings.  On  March  26th,  the  original  tube  was  removed  and  a double  fenestrated  canula  substituted.  A laryngoscopic 
examination  showed  great  swelling  and  depression  of  the  epiglottis,  effectually  preventing  observation  of  the  parts  below.  Direct 
apj)lication  of  glycerine  and  tannin  solution  by  aid  of  the  laryngoscope  resulted  in  restoring  the  ejnglottis  to  its  normal  size  and 
position  by  March  3Gth,  and  the  j)atient  was  able  to  articulate  distinctly  a few  words.  He  still  wore  the  tube.  On  July  Gth, 
18G.3,  this  man  was  transferred  to  Dale  Hospital.  His  naimi  is  not  on  the  Pension  List. 


Sect.  III.] 


OPERATIONS  ON  THE  AIR-PASSAGES. 


417 


Case. — Private  TV.  J.  Hindles,  Co.  H,  6th  North  Carolina  Regiment,  aged  30  years,  received  a gunshot  wound  at  Win- 
chester, Virginia,  September  19th,  1834,  the  ball  entering  at  the  left  shoulder,  near  the  spine,  and  emerging  at  the  symphysis 
of  the  lower  jaw.  He  was  admitted  on  the  same  day  to  the  depot  field  hospital.  On  October  1st,  ho  had  become  anaemic  from 
repeated  limmorrhage.  The  entire  neck  in  front  was  distended  from  diffused  clot.  Surgeon  A.  Atkinson,  P.  A.  C.  S.,  performed 
tracheotomy  on  occurrence  of  asphy.xia  from  pressure  of  clot  on  larynx  while  attempting  its  removal.  He  gradually  sank  from 
loss  of  blood  and  suffocation,  impending  from  diffused  clot  pressing  on  trachea,  and  died  on  the  same  day  from  asphyxia  and 
hmmorrhage.  At  the  autopsy,  a diffused  clot  was  found  throughout  the  front  and  side  of  the  neck,  pressing  upon  the  trachea  and 
following  in  the  track  of  the  wound.  The  transverse  processes  of  the  third  and  fourth  cervical  vertebrm  were  found  fractured, 
and  the  vertebral  artery  severed. 

Bronchotomy  for  Disease. — Six  cases  of  laryngotomy  or  laryngo-tracheotomy,  and 
eight  of  tracheotomy  for  non-traumatic  causes  were  reported.  Of  the  fourteen  cases,  one 
of  laryngotomy  and  four  of  tracheotomy  were  successful. 

In  six  of  these  cases,  the  operation  was  performed  on  account  of  cedenia  of  the  glottis  : 

Case. — Private  Samuel  Frosh,  Co.  F,  1st  Regiment  Potomac  Home  Brigade,  aged  21  years,  was  admitted  to  Hospital 
No.  1,  Frederick,  Maryland,  March  24th,  1834,  with  pleuro-pneumonia  of  the  left  side,  from  which  he  made  a very  favorable 
recovery,  and  was  able  to  go  out,  about  April  7th.  On  April  10th,  he  complained  of  a sore  throat  and  very  great  difficulty  in 
swallowing,  occasionally  strangling  on  attempting  it.  There  was  tenderness  on  pressure  of  the  larynx  and  trachea.  Nothing 
but  a very  slight  redness  could  be  seen  in  the  throat.  A gargle  was  ordered,  with  hop  fomentations.  On  the  12th,  his  coun- 
tenance was  anxious,  inspiration  and  respiration  obstructed  but  not  laborious.  On  feeling  the  epiglottis  it  was  found  to  be 
cushiony.  It  was  of  a yellowish  red  color,  and  shone  much  as  if  serum  were  beneath  the  mucous  membrane.  The  sides  of  the 
fauces  were  not  much  reddened.  (Edema  of  the  glottis  was  diagnosed.  The  treatment  consisted  of  incisions,  which  were 
thoroughly  made,  and  the  application,  externally,  of  tincture  of  iodine,  with  inhalation  of  vapor  from  warm  water.  The 
incisions  gave  him  great  relief.  At  three  o’clock  A.  M.,  on  the  13th,  he  had  an  alarming  attack  of  dyspnoea.  The  incisions 
were  continued,  and  the  epiglottis  and  arytmuo-epiglottidean  folds  scarified.  At  two  o’clock  P.  M.,  it  was  decided  to  operatt?. 
Assistant  Surgeon  R.  F.  Weir,  TJ.  S.  A.,  cut,  with  the  scalpel,  down  upon  and  then  through  the  crico-thyroid  membrane  and 
cricoid  cartilage  and  one  or  two  rings  of  the  trachea ; a double  trachea  tube  was  inserted,  and  a warm  moist  sponge  and  folded 
mosquito  netting  placed  over  it.  Two  teaspoonfuls  of  blood,  mostly  venous,  were  lost.  The  result  was  immediate  relief,  to  a 
remarkable  degree,  of  his  respiration  and  suffering.  On  May  3d,  ho  was  returned  to  duty  ; the  tube  was  no  longer  worn ; the 
granulating  surface  at  the  site  of  the  incision  was  very  nearly  healed;  otherwise,  he  was  perfectly  well.  He  visited  the  hospital 
on  June  9th,  1834,  having  returned  from  a re-enlistment  furlough.  His  voice  was  still  rough  and  hoarse.  In  attempting  to 
shout,  he  emitted  a squeaking,  high-pitched  noise. 

The  other  five  operations  of  this  series  resulted  fatally  : 

Case. — Private  John  L , 1st  United  States  Volunteers,  aged  23  years,  was  admitted  to  Douglas  Hospital,  Washington, 

April  7th,  1835,  sufiering  from  an  attack  of  typhoid-pneumonia.  He  was  apparently  doing  well  until  the  20th,  when  he 
complained  of  sore  throat.  On  examination,  the  posterior  wall  of  the  phai-ynx  was  found  to  be  a little  reddened,  and  covered 
with  an  abundance  of  tenacious  mucus.  At  about  2.30  p.  M.,  on  the  25th,  he  was  suddenly  seized  with  great  dyspncea ; 
respiration  stertorous,  countenance  livid,  and  lips  blue.  There  was  complete  orthopnooa,  with  great  restlessness  and  jactitation, 
and  entire  inability  to  speak  above  a faint  lisping  whisper.  These  symptoms  continued  to  increase  in  severity  in  spite  of  the 
administration  of  an  emetic.  A consultation  was  held,  and  it  was  decided  that  the  symptoms  were  those  of  oedema  of  the 
glottis,  and  that  unless  relief  were  promptly  afforded  the  patient  would  die  of  suffocation.  Laryngotomy  was  thereupon 
performed  by  Assistant  Surgeon  William  F.  Norris,  U.  S.  A.,  by  plunging  a narrow  straight  bistoury  into  the  larynx,  just 
above  the  cricoid  cartilage.  The  relief  was  almost  instantaneous,  and  there  was  but  little  hemorrhage.  For  want  of  a trachea 
tube  the  lips  of  the  wound  were  kept  apart  by  bent  copper  wires,  which  were  carried  backward  and  fastened  by  a piece  of  tape 
behind  the  neck.  During  the  night  the  patient  took  sherry  wine  and  beef  tea  through  an  elastic  bougie,  swallowing  small 
quantities  at  a time.  The  following  afternoon  a trachea  tube  was  introduced  into  the  larynx,  which  rendered  the  patient  much 
more  comfortable,  although  it  was  frequently  necessary  to  remove  and  cleanse  the  inner  tube,  which  became,  from  time  to  time, 
plugged  by  the  thick  and  tenacious  mucus  which  was  constantly  expectorated.  On  April  28th,  there  was  a feeling  of  oppression 
in  the  chest ; all  the  symptoms  of  bronchitis  became  more  marked,  and  on  the  following  day  he  was  attacked  with  pleurisy  in 
the  right  side.  May  1st,  well-marked  pneumonia  of  the  right  side  ; respiration  rapid  ; sputa  rusty  and  frothy.  Death  resulted 
from  pneumonia  on  May  4th.  A careful  dissection  was  made,  and  the  lungs,  laryn.x,  and  heart  removed  together.  The 
larynx  was  pale.  The  epiglottis,  with  the  edges  and  upper  portion  of  the  glottis,  was  swollen  and  oedematous,  almost  entirely 
closing  the  passage.  There  was  a small  irregular  opening  near  the  vocal  .cord  of  the  left  side,  through  which  an  abscess  had 
evidently  discharged.  It  had  previously  burrowed  down  to  some  extent  in  the  cellular  tissue,  outside  of  the  larynx,  aud  had 
evidently  been  the  cause  of  the  sudden  and  urgent  dyspnoea.  There  was  well-marked  hepatization  of  the  lower  lobe  of  the 
right  lung.  There  was  one  pint  of  sero-purulent  effusion,  and  numerous  recent  adhesions  between  the  parietal  and  viscera 
pleura.  The  pathological  specimen  is  No.  2513,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Assistant 
Surgeon  William  F.  Norris,  U.  S.  A. 

Case. — Private  William  11.  Schlosser,  Co.  F,  140th  Indiana  Volunteers,  aged  43  years,  was  admitted  to  Douglas  Hospital, 
Washington,  February  3d,  1835,  with  slight  bronchitis,  which  improved  up  to  February  Pith,  when  he  was  attacked  with  sore 
throat  and  inflammation  of  the  glands  of  the  neck.  The  symptoms  were  not  severe  until  the  17th,  when  great  dyspnoea  suddeidy 
set  in.  The  oedematous  epiglottis,  which  was  seen  and  felt,  was  immediately  scarified,  with  some  relief,  which,  however,  was 
only  temporary,  and  in  the  afternoon  the  operation  of  laryngotomy  was  decided  upon,  which  was  performed  by  Assistant 

53 


418 


WOUNDS  AND  INJURIES  OF  THE  NECK, 


[Chap.  Ill, 


Surgeon  William  F.  Norris,  U.  S.  A.  The  patient  died  at  the  close  of  the  operation  from  apnoea.  At  the  necropsy  the  chink 
of  the  glottis  was  found  almost  closed  by  oedema  of  the  tissues  surrounding  it.  The  epiglottis  was  also  oedeniatous.  The 
bronchial  tubes  were  much  injected  down  to  their  minute  subdivisions.  There  was  a small  patch  of  pneumonic  consolidation  in 
the  lower  part  of  the  left  lung.  The  other  organs  were  healthy. 

Case. — Private  William  Carpenter,  Co.  B,  1st  Wisconsin  Heavy  Artillery,  aged  20  yeai’s,  was  admitted  to  Harvey  Hospital, 
Madison,  Wisconsin,  October  10th,  18G4,  with  an  abscess  near  the  larynx.  On  December  25th,  Surgeon  H.  Culbertson,  U.  S.  V., 
performed  tracheotomy  for  suflbeation  from  oedema  of  the  glottis.  The  patient  had  nearly  ceased  to  breathe  when  the  trachea 
was  reached,  and  it  was  necessary  to  enter  the  trachea  before  the  bleeding  had  stopped.  Blood  llowed  into  the  trachea,  and 
respiration  and  action  of  the  heart  ceased.  A catheter  was  introduced,  and  artificial  respiration  established.  A ligature  was 
passed  beneath  the  isthmus  of  the  thyroid  gland  on  each  side  to  prevent  further  htemorrhage,  and  a tube  introduced.  He  died 
on  December  2uth,  18G4,  from  syncope,  induced  by  old  heart  clots.  At  the  necropsy,  an  old  abscess  was  found  upon  the  right 
side  of  the  larynx,  which  had  destroyed  the  substance  of  tlve  right  thyroid  cartilage,  and  lay  beneath  the  mucous  membrane 
and  the  cellular  investment  of  the  larynx,  and  extended  down  the  trachea  two  inches  from  the  cricoid  cartilage.  The  rima 
glottidis  was  neat  ly  closed,  and  would  only  admit  a knitting-needle.  The  mucous  membrane  of  the  trachea  was  in  a state  of 
inflammation,  and,  opposite  the  abscess,  thickened  and  indurated  in  bronchi  and  bronchioli.  The  lungs  were  healthy.  Heart 
generally  hypertrophied.  The  walls  were  attenuated,  and  in  the  right  ventricle  an  old  fibrinous  deposit  obstructed  the  circulation 
at  the  mouth  of  the  pulmonary  artery.  The  latter  vessel  was  empty.  The  left  ventricle  was  distended  with  dark  grumous  blood. 
The  walls  of  the  right  ventricle  and  auricle  presented  fatty  degeneration. 

Case. — Private  James  Simonds,  Co.  A,  3d  New  Hampshire  Volunteers,  aged  39  years,  was  admitted  to  the  National 
Hospital,  Baltimore,  February  2d,  1865,  with  pneumonia  in  its  first  stage,  extending  over  nearly  the  entire  surface  of  the  left 
lung.  The  respiratory  murmur  was  finely  crepitant  on  admission.  Crepitation  became  more  crude  on  the  evening  of  February 
6th.  Symptoms  of  laryngeal  inflammation  set  in,  succeeded  by  those  of  oedema  of  the  glottis,  which  continued  until  the  7th, 
when  the  patient  was  apparently  dying.  Respiration  was  excessively  labored  and  ineffective.  A blue  color  pervaded  the 
surface.  The  pupils  were  dilated  and  the  extremities  cold.  The  operation  of  laryngotomy  was  performed  by  straight  incision 
between  the  thyroid  and  cricoid  cartilages.  As  soon  as  the  operation  was  performed,  all  breathing  by  the  glottis  ceased  except 
a little  valvular  cough.  The  opening  was  maintained  at  first  by  one,  and  afterwards  by  two  gutta-percha  tubes.  Warmth 
returned  to  the  extremities,  and  a faint  color  appeared  in  the  face.  Death  resulted  in  twelve  hours  after  the  operation  from 
pneumonic  prostration. 

Some  operators  would  have  reckoned  the  next  case  as  a success,  the  patient  liaving 
survived  for  sixteen  days,  and  died  of  pneumonitis  twelve  days  after  the  aperture  in  the 
larynx  had  been  closed  : 

Case. — Private  J.  J.  Bryant,  Co.  E,  1st  Texas  Cavalry,  aged  51  years,  was  admitted  to  the  Marine  Hospital,  New  Orleans, 
January  5th,  1865,  suffering  from  oedema  of  the  glottis.  The  patient  became  weak  and  emaciated.  On  the  25th,  the  larynx 
and  adjoining  parts  were  greatlj’  swollen.  Acting  Assistant  Surgeon  R.  W.  W.  Carroll  performed  laryngotomy.  Immediate 
relief  was  afforded  by  the  operation.  The  oedema  gradually  subsided,  and  on  the  fourth  day  the  tube  was  removed  and  the 
aperture  closed,  but  inflammation  of  the  lungs  supervening,  death  resulted  on  February  10th,  1865. 

There  were  three  operations  for  diphtheria,  a successful  instance  of  laryngotomy,  and 
two  of  tracheotomy  that  terminated  unfavorably  : 

Case. — Private  S.  G.  Inlay,  Co.  K,  180th  Ohio  Volunteers,  aged  30  years,  was  admitted  to  the  3d  division  hospital,  Alexan- 
dria, Virginia,  February  21st,  1865,  with  diphtheria.  On  March  5th,  he  was  nearly  asphyxiated.  Assistant  Surgeon  W.  G.  Elliott,  U. 
S.  V.,  performed  laryngotomy.  Simple  dressings  were  applied.  He  recovered,  and  was  discharged  from  service  J une  14th,  1865. 

Case. — Sergeant  James  W.  Sutherland,  Co.  D,  1st  Maine  Volunteers,  aged  24  years,  received  a gunshot  wound  of  the  right 
thigh,  at  Cedar  Creek,  Virginia,  October  19th,  1864,  which  fractured  the  femur  just  below  the  trochanter  major.  He  was  treated 
in  the  field,  and,  on  October  24th,  sent  to  Jarvis  Hospital,  Baltimore.  The  fracture  was  an  exceedingly'  obstinate  one,  owing  to 
the  exterior  injury  caused  by  the  ball.  He  became  greatly  emaciated  and  broken  down,  but  after  several  months  the  fracture 
united  by  the  use  of  Smith’s  anterior  splint,  a large  amount  of  j)rovisional  callus  being  deposited.  From  this  time  he  did  well, 
and  improved  rapidly  under  the  use  of  tonics,  stimidants,  and  good  diet ; but  there  were  several  sinuses  which  communicated 
externally,  and  were  still  dischai-ging  a considerable  amount  of  pus.  On  the  morning  of  May  24th,  1865,  he  complained  of 
some  soreness  of  the  throat,  but  symptoms  of  diphthei’ia  Avere  not  specially  marked,  there  being  no  traces  of  membrane  whatever. 
About  10  o’clock  P.  M.,  the  same  day,  the  nurse  Avas  awakened  by  the  groans  and  efforts  of  the  patient  to  breathe.  When 
medical  attendance,  Avhich  Avas  close  at  hand,  reached  him,  he  Avas  breathing  stertorously ; his  tonsils  Avere  so  much  SAVollen  as 
to  nearly  close  the  glottis  and  fauces,  and  the  posterior  nares  Avere  covered  Avith  diphtheritic  membrane.  Measures  Avere  at  once 
resorted  to  for  his  relief,  but  Avithout  efl'ect.  About  12  o’clock  P.  M.,  an  operation  Avas  deemed  necessary,  and  tracheotomy  Avas 
performed  by  Acting  Assistant  Surgeon  F.  P.  Foster,  Avhich  seemed  to  give  relief  for  a time;  but  he  soon  relapsed  and 
gradually  greAV  Avorse,  until  death,  Avhich  occurred  about  4 o’clock  A.  Ji.,  May  25th,  1865.  At  the  neci’opsy  the  tonsils  Avere 
found  greatly  enlarged,  and  the  larynx  and  posterior  nares  covered  Avith  diphtheritic  membrane,  Avhich  extended  a considerable 
distance  doAvn  the  trachea. 

Case. — Private  Clement  Dennison,  Co.  E,  32d  Maine  Volunteers,  aged  17  years,  Avas  admitted  to  the  hospital  at  Fort 
Wood,  Ncav  York  Ilarboi’,  October  29th,  1864,  suffering  from  inflammation  of  the  tonsils,  Avith  diphtheria.  The  constitutional 
condition  of  the  patient  Avas  bad.  On  November  1st,  Acting  Assistant  Surgeon  Frederick  D.  Sturges  performed  tracheotomy, 
Avith  but  little  loss  of  blood.  The  neck  being  short  and  much  swollen,  the  operation  Avas  quite  difficult.  Death  resulted, 
November  2d,  1864,  from  exhaustion. 


Sect.  III.l 


OPERATIONS  ON  THE  AIR-PASSAGES. 


419 


There  were  two  successful  operations  for  simple  laryngitis  : 

Case. — Private  Martin  Bowen,  Co.  K,  149th  Pennsylvania  Volunteers,  aged  .31  yeai-s,  was  admitted  to  Lincoln  Hospital, 
Washington,  October  24th,  18C3,  with  pneumonia  of  the  lower  lobe  of  both  lungs.  On  November  24th,  asphyxia  set  in.  Ether 
was  administered,  and  Acting  Assistant  Surgeon  W.  E.  Peck  performed  tracheotomy.  One  small  vessel  was  ligated.  About 
half  an  ounce  of  blood  was  lost.  Tonics,  stimulants,  and  nutritious  diet  were  given.  He  gradually  improved,  and  recovered, 
with  the  exception  that  he  still  had  to  wear  the  tube.  He  was  transferred,  on  August  12th,  to  the  hospit.al  at  Whitehall, 
Pennsylvania,  and  discharged  from  service  June  26th,  1865. 

Case. — Private  Alfred  Newcomer,  Co.  H,  7th  Michigan  Volunteers,  was  admitted  to  Bellevue  Hospital,  New  York  City, 
suffering  from  laryngitis,  contracted,  by  exposure,  while  convalescent  from  typho-malarial  fever.  Tracheotomy  was  performed. 
A few  houi's  after  the  operation  the  pulse  was  160,  small  and  very  weak ; great  irritation  of  the  larynx,  causing  almost  constant 
coughing.  Stimulants  and  small  quantities  of  beef  tea  were  given.  He  soon  commenced  to  improve,  and  in  two  weeks  was 
able  to  sit  up,  and  in  four  was  walking  about.  He  could  breathe  (juite  free  through  the  tube,  but  it  was  found  that  it  could  not 
be  removed.  Discharged  from  service  about  the  middle  of  October,  1862.  Examiuei'  J.  A.  Brown  reported,  March  9th,  1865, 
that  respiration  is  entirely  performed  through  the  cannula.  Disability  three-fourths  and  increasing. 

There  were  three  cases  in  which  the  operation  was  practiced  for  threatened  asphyxia 
from  tonsillitis  or  abscess  of  the  tonsil.  One  resulted  successfully  : 

Case. — Private  Tajdor  Misinger,  Co.  H,  130th  Indiana  Volunteers,  aged  17  years,  was  admitted  to  Hospital  No.  1,  Nashville, 
Tennessee,  April  3d,  1864,  suffering  from  tonsillitis.  On  May  1st,  1864,  spasm  of  the  glottis  set  in.  The  patient  became 
asphyxiated.  Assistant  Sui’geon  Robert  McNeilly,  19th  Ohio  Volunteers,  performed  the  operation  of  tr.icheotomy,  dividing  the 
second  and  third  rings,  and  inserting  a tube.  Respiration  was  established  in  thirty  seconds  after  the  operation.  The  tube 
remained  twelve  hours.  On  June  25th,  1864,  the  wound  had  healed  entirely,  and  the  patient  was  returned  to  duty. 

Case. — Private  Elias  E.  Terry,  Co.  M,  2d  New  Jersey  Cavalry,  was  accidentally  wounded  at  Memphis,  Tennessee,  April 
2d,  1864,  by  a carbine  ball,  which  fractured  the  second  toe  of  the  right  foot.  He  was  admitted  on  the  same  day  to  Adams  Hospital, 
Memphis,  where  chloroform  was  administered,  and  the  toe  amputated  by  lateral  flap  method.  Soon  after  the  operation  he  was 
attacked  with  chills,  which  yielded  to  quinine.  On  April  17th,  measles  supervened,  followed  by  intense  tonsillitis  and  extreme 
dyspnoea.  On  April  21st,  Surgeon  J.  G.  Keenon,  U.  S.  V.,  performed  lai'yngotomy.  He  died  seven  hours  after  the  operation 
from  asphyxia.  The  necropsy  showed  exteirsive  inflammation  of  the  larynx,  bi'onchi,  and  trachea.  The  lungs  were  much  engoi’ged. 

Case. — Private  Nelson  Young,  2d  Battery,  1st  Maine  ^Mounted  Artillery,  aged  23  years,  received  a slight  gunshot  wound, 
at  Antietam,  Maryland,  September  17th,  1862.  On  October  16th,  he  was  admitted  to  the  hospital  at  Frederick,  complaining 
of  a sore  throat.  On  the  29th  there  was  slight  swelling  of  the  right  tonsil,  which  became  extended.  Inflammation  set  in  on 
the  next  day.  Astringents  were  ordered.  During  the  night  of  the  30th  a large  abscess  burst,  and  he  spat  up  pus.  At  9.30  P.  M., 
October  31st,  Acting  Assistant  Surgeon  Redferu  Davies  was  suddenly  called  to  attend  him,  and  found  his  pulse  feeble  and  too 
rapid  to  be  counted.  Respiration  was  excessively  labored  and  quick,  and  had  been  so  for  one-half  hour.  The  veins  of  the 
head  and  neck  were  turgid.  On  pulling  out  the  tongue  by  the  artery  forceps  respiration  was  relieved.  The  tongue  was  black, 
partly  from  the  tincture  of  muriate  of  iron,  and  his  lips  were  dark.  As  the  symptoms  grew  more  urgent,  the  skin  and  the 
crico-thyroid  ligament  were  divided  at  one  incision.  The  haemorrhage  was  slight,  and  the  respiration  immediately  relieved.  A 
little  froth  issued  from  the  opening;  he  also  breathed  by  the  opening.  The  pulse  immediately  fell  to  about  ninety-six,  and  the 
lips  became  almost  natural.  Finding  that  he  respired  easily  through  both  mouth  and  opening,  no  tube  was  used.  At  11  P.  M. 
Dr.  Davies  was  again  summoned.  The  symptoms  had  reappeared.  A triangular  portion  of  the  crico-thyroid  cartilage  was 
removed.  No  hasmorrhage  followed.  Respiration  gradually  declined,  and  at  11.30  P.  M.  he  died.  At  the  autopsy,  twelve 
hours  after  death,  the  tonsils  were  found  to  be  ulcerated,  the  right  one  especially,  which  was  deeply  ulcerated  and  still 
contained  some  pus.  The  uvula  was  thickened  by  effusion  of  lymph,  and  ulcerated  on  the  right  side.  The  epiglottis  was 
erect,  hard,  and  thickened  by  effusion  of  lymph  underneath  the  mucous  membrane.  The  arytaeno-epiglottidean  folds  were 
much  thickened,  especially  on  the  right  side,  which  was  considerably  above  the  level  of  the  left.  The  opening  of  the  sacculus 
laryngis  was  entirely  closed  by  the  effusion  above.  Several  small  patches  of  false  membrane  by  deposit  of  lymph  were  found 
above  the  vocal  cords,  especially  on  the  left  side ; none  below.  The  mucous  membrane  of  the  trachea  and  bronchia  was  deeply 
congested,  but  without  ulceration,  effusion,  or  deposit. 

Excision  of  Tonsils  for  Disease. — Only  two  instances  of  this  operation  are  recorded : 

Case. — Private  John  K.  Orlup,  Co.  D,  1st  Illinois  Light  Artillery,  aged  20  years,  was  admitted  to  Desmarres  Hospital, 
Chicago,  Illinois,  October  llth,  1864.  The  right  tonsil  was  considerably  enlarged,  and  greatly  obstructed  the  isthmus  of  the 
fauces.  By  May  12th,  1865,  the  tonsil  had  become  hypertrophied  and  dense.  Surgeon  J.  S.  Hildreth,  U.  S.  V.,  excised  the  right 
tonsil.  His  breathing  became  easier  and  general  health  greatly  improved.  He  was  discharged  from  service  May  25th,  1865. 

Case. — Private  Milton  Scott,  24th  Ohio  Battery,  aged  21  years,  was  admitted  to  Desmarres  Hospital,  Chicago,  Illinf)is, 
October  28th,  1834,  suffering  from  double  otorrhcea.  The  tonsils  became  largely  hypertrophied,  closing  at  least  three-fourths 
of  the  isthmus  of  the  fauces.  On  January  28th,  1865,  Surgeon  J.  S.  Hildreth,  U.  S.  V.,  excised  both  tonsils.  Little  itiflam- 
mation  followed.  The  wound  healed  rapidly.  He  was  discharged  from  service  June  26th,  1865.  His  hearing  and  general 
health  were  considerably  improved. 

Ligations. — Twenty-nine  cases  of  ligations  for  gunshot  wounds  of  the  neck  were 
reported.  A few  will  be  cited  in  detail.  The  first  six  are  of  the  primary  carotid ; 

Case. — Corporal  eJ.  W.  Bohinson,  Co.  C,  27th  Georgia  Regiment,  aged  21  years,  was  wounded  .June  19th,  1864.  A 
musket  ball  entered  the  muscles  of  the  neck,  just  external  to  the  spine,  on  the  left  side,  passed  downward,  wounded  the  internal 


420 


WOUNDS  AND  INJURIES  OF  THE  NECK. 


[Chap.  Ill, 


carotid  artery,  and  probably  some  branch  of  the  occipital.  He  was  conveyed  to  the  Washington  Street  Hospital,  Petersburg, 
Virginia,  where  the  left  common  carotid  artery  was  ligated  in  the  superior  triangle.  On  July  2d,  the  hmmorrhage  recurred. 
.July  3d,  the  ligature  came  away ; the  artery  was  re-ligated  below  the  omo-hyoid,  but  the  haemorrhage  still  continued,  though  in 
diminished  quantity,  until  July  5th,  when  death  occurred. 

Case. — Lieutenant  William  Fisher,  Co.  A,  09th  Pennsylvania  Volunteers,  was  wounded  at  Petersburg,  Virginia,  October 
7th,  1864,  by  a conoidal  ball,  which  entered  two  inches  behind  the  angle  of  the  left  inferior  maxilla,  and  lodged  beneath  the 
integument,  near  one  of  the  cervical  vertebrae,  severing  the  facial  and  carotid  arteries.  He  was  conveyed  to  the  hospital  of  the 
3d  division.  Second  Corps.  He  was  much  exhausted  from  loss  of  blood.  Beef  essence  and  brandy  were  administered.  On 
October  9th,  Surgeon  William  B.  Reynolds,  2d  U.  S.  Sharpshooters,  ligated  the  left  common  carotid  artery  below  the  omo-hyoid 
muscle.  Death  resulted  in  twenty-six  lK)urs  after  the  operation. 

Case. — Lieutenant  Charles  Debolt,  Co.  D,  82d  Ohio  Volunteers,  received  a gunshot  wound  of  the  neck  .at  Bull  Pasture 
Mountain,  Virginia,  May  8th,  1882.  The  missile  entered  the  triangular  space  formed  by  the  sterno-cleido-mastoid  muscle  and 
the  larynx,  and  passed  backward  and  downward  along  the  spine.  Surgeon  J.  Y.  Cantwell,  82d  Ohio  Volunteers,  who  reports 
the  case,  says  : “There  was  but  little  haemorrhage  at  the  time  the  wound  was  received,  and  considering  the  locality  and  extent 
of  the  injury,  he  seemed  to  be  doing  rem.arkably  well  up  to  the  15th  d.ay.  On  the  night  following  that  day  he  had  an  attack 
of  secondary  haemorrhage  that  very  nearly  proved  fatal  before  I could  reach  his  bed.  I found  him  in  a state  of  syncope  and 
pulseless  at  the  wrist.  The  orifice  was  immediately  filled  with  lint,  saturated  with  a solution  of  persulphate  of  iron,  the  common 
carotid  artery  being  compressed  at  the  same  time.  This  completely  arrested  the  bleeding.  After  watching  him  until  daylight, 
at  which  time  his  pulse  and  consciousness  had  returned,  I carefully  cut  down  and  exposed  the  common  carotid  artery,  when  I 
ascertained  that  the  haemorrhage  was  caused  by  a slough  in  the  coats  of  the  external  carotid,  so  near  the  bifurcation  that  it 
could  not  be  ligated ; hence  the  ligature  was  applied  upon  the  common  carotid.”  The  case  progressed  well  to  all  appearances  for  six 
weeks,  but  suddenly  terminated  fatally.  At  the  necropsy,  a collection  of  matter  was  discovered  in  the  locality  of  the  right  kidney. 

Case. — Private  Hollis  Hutchins,  Co.  I,  25th  Ohio,  aged  25  years,  was  wounded  at  Pocotaligo,  South  Carolina,  December 
9th,  1864,  by  a conoidal  ball,  which  entered  the  chin,  fractured  the  inferior  maxillary  bone,  and  emerged  at  the  back  of  the 
neck.  He  was  transferred,  on  December  11th,  per  steamer  Cosmopolitan,  to  Beaufort,  South  Carolina,  entering  the  1st  division 
hospital  on  the  15th.  On  the  18th,  a violent  hiemorrhage  occurred  from  the  mouth,  which  was  supposed  to  proceed  from  the 
lingual  artery,  and  left  him  very  much  exhausted  and  almost  pulseless.  Acting  Assistant  Surgeon  S.  Hendrickson  ligated  the 
common  carotid  artery  just  above  the  omo-hyoid.  The  patient  rallied  after  the  operation,  and  continued  to  gain  strength  until 
December  27th,  when  haemorrhage  occurred  from  the  trunk  of  the  carotid  and  the  internal  jugular  vein.  He  died  on  the  same 
day.  The  necropsy  showed  an  organized  clot  below  the  ligature;  above  the  ligation  no  clot  had  formed,  and  the  coat  of  the 
internal  jugular  vein  had  sloughed  away. 

Here  we  have  another  of  the  numerous  examples  of  recurrent  hsemorrhage  from  the 
distal  end  of  the  divided  or  ligated  artery.  There  was  an  occlusive 
coagulum  on  the  cardial  side  of  the  ligature, — none  on  the  cranial 
side.  In  treating  of  haemorrhage  from  wounds  of  the  extremities, 
there  will  be  ample  opportunity  of  demonstrating  the  soundness 
of  the  views  of  Guthrie  on  hsemorrhage,  and  of  furnishing  exam- 
ples of  the  happy  results  following  the  teachings  of  that  great 
surgeon  regarding  the  management  of  bleeding  arteries : 

Case.— Private  Daniel  Shockey,  Co.  I,  101st  Indiana  Volunteers,  aged  22  years,  was 
wounded  at  Chickamauga,  Georgia,  September  20th,  1863,  by  a round  musket  ball,  which 
entered  the  face  about  an  inch  from  the  corner  of  the  mouth,  passed  downward  and  back- 
ward across  the  upper  part  of  the  neck,  badly  fractured  the  lower  jaw  in  its  passage,  and 
was  extracted  near  the  transverse  process  of  the  third  cervical  vertebra.  He  was  taken 
prisoner  .and  treated  in  a Confederate  hospital.  On  September  25th,  hemorrhage  occurred 
to  the  amount  of  a quart,  recurring  on  the  30th.  Three  other  hemorrhages,  of  October  6th, 
9th,  and  10th,  respectively,  so  reduced  the  strength  of  the  patient  that  the  common  carotid 
was  ligated.  The  ligature  separated  October  29th.  He  was  paroled  in  April,  1864,  and 
sent  to  Baltimore,  entering  Jarvis  Hospital  on  the  18th.  He  recovered,  and  was  transferred 
to  Camp  Parole,  Annapolis,  May  11th,  1864,  and  mustered  out  June  24th,  1865,  as  coi’poral. 

Case.— Private  G.  W.  B , Co.  G,  42d  Virginia,  aged  25  years,  was  .admitted  to 

hospital  at  Frederick,  Miiryland,  for  a gunshot  wound  of  the  neck  and  face  received  at 
Gettysburg,  July  3d,  1863.  There  was  secondary  haemorrh.age  to  the  extent  of  twelve 
ounces,  on  July  9th,  from  the  external  carotid  artery.  The  common  carotid  was  ligated 
three-quarters  of  an  inch  below  the  bifurcation,  on  July  10th.  IIcEmorrhage  did  not  recur. 
The  patient  died  July  13th,  1863.  A wet  preparation  of  the  ligated  artery  was  contributed 
to  the  Army  Medical  Museum,  with  the  history,  by  Assistant  Surgeon  E.  F.  IVeir,  U.  S.  A., 
and  is  No.  *3969  of  the  Surgical  Section.  It  is  represented  in  the  adjoining  wood-cut. 


Fig.  186. — Gunshot  wound  of  external 
carotid.  Spec.  3969,  Sect.  I,  A.  Jl.  M. 


Tabular  Statement  of  Fifteen  Ligations  of  the  Common  Carotid  Artery  for  Gunshot  Injuries  of  the  Neele. 


Sect.  III.] 


LIGATIONS 


421 


422 


WOUNDS  AND  INJURIES  OF  THE  NECK. 


[Chap.  Ill, 


lAgation  of  Subclavian. — But  a single  instance  of  deligation  of  the  subclavian  for 
gunshot  wound  of  the  neck  is  recorded.  It  was  an  unsuccessful  case,  in  which  a single 
ligature  was  placed,  outside  of  the  scalenus,  on  the  left  side,  for  secondary  bleeding  ; 

GitAVES,  H.,  Private,  5th  Pennsylvania  Cavalry.  Gunshot  wound  of  external  edge  of  sterno-cleido-mastoid  muscle,  left 
side,  about  two  inches  above  clavicle.  Ball  lodged.  Wounded  October  Cth,  1864.  Ilsemorrhage  occurred  December  14tb,  1864. 
Left  subclavian  artery  ligated  in  third  portion  by  Assistant  Surgeon  W.  E.  Day,  117tb  New  York  Volunteers,  December  16th. 
Died  December  18th,  1864. 

A number  of  examples  of  ligations  of  minor  trunks  were  also  reported.  When  both 
ends  were  tied  recovery  ensued,  and  the  other  cases  resulted  unfortunately  : 

Duttox,  a.  H.,  Colonel,  21st  Connecticut  Volunteers.  Gunshot  tvound  of  right  side  of  neck.  Ball  fractured  the  lower 
maxilla  and  passed  through  the  larynx,  May  29th,  1864.  Ilmmorrhages  occurred  May  31st  and  June  2d.  Facial  artery  ligated 
at  entrance  of  wound,  June  2d.  Died  June  4th,  1864. 

Bakrick,  T.,  Corporal,  44th  New  York  Volunteers.  Gunshot  wound  left  side  of  neck,  July2d,  1863  ; ball  lodged.  Ball 
extracted.  Haemorrhage  occurred  July  2l6t.  Suprascapular  artery  and  two  or  three  branches  ligated  on  the  same  day. 
Recovered  August  15th,  1863. 

Adzer,  L.  C.,  Private,  Co.  K,  9th  Louisiana  Regiment,  aged  20  years,  was  wounded  at  Monocacy  Junction,  July  9th,  1864, 
by  a oonoidal  ball,  which  penetrated  the  neck,  severing  the  occipital  artery.  He  was  admitted  on  the  same  day  to  the  hospital  at 
Frederick,  Maryland.  On  July  19th,  secondary  hmmorrhage  to  the  amount  of  sixteen  ounces  occurred,  and  on  the  next  day 
Surgeon  C.  H.  Todd,  C.  S.  A.,  ligated  the  occipital  artery  in  the  wound;  both  ends  were  secured.  He  recovered,  and  was 
transfen-ed  to  West’s  Buildings  Hospital,  Baltimore,  August  5th.  Transferred  to  Fort  McHenry  for  exchange,  November  19th, 
1864. 

Holeiday,  D.,  Sergeant,  26th  Pennsylvania  Volunteers.  Flesh  wound  of  left  side  of  neck,  July  2d,  1863.  Hremorrhage 
occurred  July  25th,  and  recurred  on  the  same  day.  Branch  of  occipital  artery  ligated  in  wound,  July  25th  ; both  ends  tied. 
Recovered  May  3d,  1864. 

Potter,  J.  H.,  Private,  15th  Massachusetts  Volunteers.  Gunshot  wound  of  left  posterior  triangle  of  neck,  June  18th, 
1864.  Hasmorrhage,  July  13th,  1864.  One  end  of  superficial  cervical  artery  ligated,  in  wound,  on  the  same  day.  Recovered 
September  23d,  1864. 

A successful  instance  was  reported  of  ligation  of  the  internal  jugular  vein,  a subject 
that  has  been  exhaustively  discussed  since  the  conclusion  of  the  war,  by  Dr.  Samuel  W. 
Gross,'*’  late  Staff-surgeon  of  Volunteers  : 

Case. — Private  William  Seymour,  Co.  G,  57th  New  York  Volunteers,  aged  19  years,  was  wounded  at  the  Wilderness, 
May  5lh,  1864,  by  a conoidal  ball,  which  entered  just  below  the  lobulus  of  the  left  ear,  and  passing  obliquely  downward  and 
forward,  emerged  one  inch  above  the  sterno-clavicular  articulation  of  the  light  side,  external  to  the  stei-no-mastoid  muscle ; the 
missile  then  struck  the  subclavian  region  at  the  external  end  of  the  middle  third  of  the  clavicle,  and  glanced  off’  along  the  arm 
without  touching  it.  He  fell  unconscious  on  the  reception  of  the  injury ; fifteen  minutes  after  which,  he  walked  to  the  rear 
assisted  by  a comrade.  He  had  considerable  haemorrhage,  which  ceased  spontaneously.  He  was  admitted  to  the  hospital  of  the 
3d  division.  First  Corps.  Cold  water  dressings  were  applied  to  the  wounds,  and  beef  tea  administered,  ivhich  partly  escaped 
through  the  wound  of  exit,  giving  evidence  of  injury  of  the  pharynx.  He  was  transferred  to  hospital  via  Frederickslmrg  and 
Belle  Plain  ; the  mode  of  conveyance  being  an  army  wagon,  the  jolting  of  which  caused  a slight  ha;morrhage,  which  he 
expectorated  per  orem  ; he  also  stated  having  expectorated  a piece  of  meat  one  inch  in  length.  He  was,  on  May  11th,  admitted 
to  Douglas  Hospital,  Washington."  Cold  water  dressings  were  applied  to  the  wounds,  and  the  patient  was  fed  through  gum- 
elastic  bougies,  and  injections  anum  of  beef  tea  for  four  days,  at  the  end  of  which  he  was  able  to  swallow  milk  with  ease. 
He  gradually  improved  until  May  19th,  when  he  had  a secondary  haemorrhage  from  the  mouth,  amounting  to  seven  ounces  of 
blood.  On  May  20th,  he  bled  one  ounce;  26th,  four  ounces;  and  on  the  27th,  a venous  haemorrhage  occairred,  which  was 
arrested  by  compression.  On  the  29th,  haemorrhage  recurred,  amounting  to  two  ounces  of  blood ; and  again  on  the  30th,  to  the 
amount  of  four  ounces;  after  which  it  was  thought  advisable  to  ligate  the  carotid  artery.  Assistant  Surgeon  William  Thomson, 
U.  S.  A.,  made  an  incision  for  the  artery,  which  was  searched  for  a long  while,  but  found  to  be  obliterated.  From  that 
time  no  haemorrhage  ocem-red,  and  the  patient  rapidly  recovered.  On  June  10th,  the  wound  of  entrance  was  entirely  closed, 
and  that  of  exit  granulating  finely.  He  had  lost  the  power  of  the  right  arm,  and  for  a long  time  had  complete  aphonia.  The 
wound  had  an  excrescence  not  unlike  cauliflower,  which  was  daily  decreasing  in  size.  He  was  transferred  to  Turner’s  Lane 
Hospital,  Philadelphi.a,  on  September  11th.  On  his  admission,  the  wounds  had  closed;  sensation  and  motion  feeble  throughout 
the  right  arm;  neck  had  only  one-foui-th  range  of  movement ; the  sense  of  touch  was  lost  from  the  chin  to  the  external  angle  of 
the  right  eye,  and  lessened  on  upper  neck;  analgesia  was  more  or  less  complete  in  these  ])arts;  loss  of  gustation  of  the  right 
side  of  the  tongue,  pain  and  sense  of  temperature  limited  by  median  line.  Very  far  back  there  seemed  to  be  considerable  sensa- 
tion, motion  seemed  good  on  the  right  side,  and  the  left  side  was  paralyzed  as  to  motion  entirely.  Deglutition  was  imperfect; 
the  voice  nearly  perfect ; appetite  and  digestion  good.  On  October  10th,  the  face  had  recovered  sensation  ; taste  not  perfect ; 


GKOBS,  (S.  W.)  On  Wounds  of  the  Internal  Jugular  Vein,  in  Amcr.  Jour,  of  Med.  Sci.,  1867,  Vol.  LIIl,  pp.  17,  305. 


Sect,  III.] 


H^IORRIIAGE  AND  LIGATIONS. 


423 


tact  and  pain  still  absent.  On  the  20tli,  there  was  seme  feeling  in  the  tongue,  but  no  motion  on  the  left  side.  He  was  returned 
to  duty  on  December  9th,  1804.  On  May  2d,  1866,  Examining  Surgeon  E.  Winslow  reports  that  Seymour’s  wounds  had  healed 
externally ; but  the  trachea  was  constantly  dischai-giiig  jius  by  coughing,  and  was  hoai’se,  and  his  light  arm  weak. 

Tlie  successful  case,  in  which  ligatures  were  placed  above  and  below  a puncture  of  the 
internal  jugular,  made  by  the  operator  in  extracting  a ball  [ante  p.  397),  and  the  two 
fatal  cases  of  gunshot  wounds  of  the  jugular  treated  by  cold  applications,  compression, 
and  position  (pp.  411,  412),  will  not  have  escaped  the  reader’s  attention. 

I fully  agree  with  Dr.  Gross,  that  this  subject  has  received  less  attention  from  surgeons 
than  it  merits,  and  should  enlarge  upon  it  here,  were  it  not  preferable,  in  order  to  avoid 
repetitions,  to  defer  its  consideration  to  a separate  chapter  on  Hceinorrhages. 

Grouping  the  ligations  of  the  large  vessels  of  the  neck,*  performed  on  account  of 
gunshot  wounds  of  the  face  or  of  the  neck,  we  have  a total  of  seventy-six  ligations  of 
the  common  carotid,  with  a mortality  of  78.6  per  cent.  The  exhibit  is  yet  more  deplorable 
than  that  of  the  preliminary  report  in  Circular  6,  S.  G.  0.  1865,  which  gave,  for  forty-nine 
cases,  a fatality  of  75  per  cent.  It  will  furnish  M,  Ldon  Lefort  {Gaz.  Hehdom.  de  Med.  et 
de  Chir.,  Paris,  1867)  an  additional  argument  against  the  performance  of  this  operation  for 
traumatic  causes,  unless  the  injury  involve  the  main  trunk  itself,  and  a ligature  can  be 
placed  above  and  below  the  point  of  injury.  Nowhere  else,  not  even  in  wounds  of  the 
fore-arm  or  legs  in  which  the  brachial  or  femoral  may  have  been  tied,  does  the  operation  of 
Anel  appear  to  greater  disadvantage.  Tying  the  common  trunk  for  injuries  of  the  smaller 
vessels  of  the  head  or  neck  is  an  operation  based  on  a fallacious  interpretation  of  the  ana- 
tomical and  physiological  relations  of  the  region.  Nothing  that  is  not  corroborative  of 
Guthrie’s  admirable  suggestions  is  found  in  the  preceding  cases.  If  the  indolent  or  timid 
surgeon,  who,  to  control  bleeding  from  minor  branches  of  the  carotid,  prefers  to  stuff  the 
wound  with  styptics,  or  to  perform  the  easy  operation  of  tying  the  common  trunk,  rather 
than  to  seek  in  the  difficult  anatomy  of  the  maxillary  and  thyroid  regions,  to  place  double 
ligatures  at  the  bleeding  point,  he  may  temporize,  or  may  associate  his  name  with  the 
necrology  of  ligations  ; but  if  his  patient  recover,  it  will  generally  be  found  to  be  under 
circumstances  in  which  the  surgeon’s  operative  intervention  was  uncalled  for.*}* 

The  subject  of  gunshot  wounds  of  the  nerves  of  the  neck,  briefly  illustrated  on  p.  408, 
et  seq.,  by  a series  of  concise  abstracts,  has  been  thoroughly  and  ably  discussed  by  Acting 

* See  Ssnxif,  (St.),  Ligature  of  tJie  External  and  Internal  Carotids^  for  Uaimorrhages  of  the  Face  and  N<xl:^  and  into  the  Mouth  and  Fauces^  in 
New  York  Med.  Jour..,  1874,  Vok  XIX,  p.  40,  and  PILZ  (C.),  De  arieriiz  carotldis  utrimquc  ligatura^  BeroUni,  1865. 

t On  pa^e  397  {ante)  have  been  cited  a few  works  on  ligations.  Consult  further;  JONES,  J.  F.  D.,  A Ti'eaiise  the  Process  employed  by  Nature 
in  suppressing  the  Haemorrhage  from  Divided  and  Punctured  Arteries  and  on  the  Use  of  the  Ligature.,  London,  1810;  PiLZ,  C.,  Zur  Ligatur  der 
Arteria  Carotis  Communis  nehst  einer  Statistik  dicser  Operation,  in  Archiv  fur  Klinische  Chirurgie,  von  Dr.  B.  VON  LANGENBECK,  Berlin,  1868, 
IX  Bund,  S.  I. ; Manec,  On  the  Ligature  of  Arteries,  Halifax,  1832,  and  TratU  th4orique  et  pratique  de  la  Ligature  dcs  Arttres,  Paris,  1834;  Year 
Book  of  Medicine  and  Surgery,  London,  1862,  pp.  80,  240  ; KEITH,  Successful  Ligation  of  the  Internal  Carotid,  Monthly  Jour,  of  Med,  Sci.,  Edinburgh, 
May,  1851,  p.  435,  probably  an  unique  case;  BOUCHAed,  Dc  la  Pathogenic  des  hemorrhagies,  Paris,  1869  ; CliASSAGNT,  Nouveauxmoyens  hemostatiques, 
Paris,  18(i8 ; Mott,  A.  B.,  Ilamorrhage  from  Wounds,  and  the  best  means  of  arresting,  New  York,  1863;  SaxsON,  Des  himorrhagies  traumxdiqucs, 
Paris,  1836;  Velbeah,  liecherches  sur  la  cessation  sponta'tiec  dcs  hemorrhagics  traumatiques  primitives,  Paris,  1830;  IjISTER,  Observations  on  Liga^ 
lures  of  Arteries  on  the  antiseptic  System,  Edinburgh,  1869.  I believe  that  Hennen’s  statement,  that  he  was  “not  acquainted  with  any  monograph  upon 
wounds  of  the  neck,”  might  be  reiterated  at  the  present  day,  unless  the  article  of  Mr.  Arthur  E.  Durham,  in  Holmes’s  System,  Vol.  II,  p.  436,  be  regarded 
as  an  exception.  Consult  Pae6,  par  MalgaigNE,  Paris,  1840,  T.  II,  p.  81 ; Rust,  J.  N.,  Einige  Bcohachtungen  ii,  d.  Wunden  der  Luft-und  Spciscrohre, 
etc.,  Wein,  1814  ; Allan  Burns,  Surg,  Anat.  of  the  Head  ami  Neck,  1811, 1st  ed.,  1824,  2d  ed. ; SiMONNEAU,  Essai  sur  Us  solutions  de  continuiti  du 
pharynx  et  dc  Voesopkage,  1808,  Th^se  de  Paris,  No.  150;  G.  BOULIN,  Dissertation  sur  les  plaies  dc  Veesophage,  1828,  Thlse  de  Paris,  No,  146;  SABATIER, 
Dcs plaies  du  cou^  in  Med,  Opir,  1833,  T.  II,  p.  70;  JOBERT,  Plaies  d'armes  a feu,  1833,  p.  155,  Laucier,  Dictionnairc  en  trenie  {Blessurcs  du  cou), 
1835,  T.  IX,  p.  1G2;  LarreY,  Sur  les  Plaies  de  Vmsophage,  in  Clin,  Chirurg.,  1829,  T.  II,  p.  154  ; DUPUYTliEN,  BUssures  du  cou  in  Lef^ons  oral,  de  cl, 
c7arwr^r.,  2'”«  6d.,  T.  VI,  p.  271,  18.39;  LegoUEST,  op,  ctf.  p.  406,  1863 ; FORESTUS,  P.,  Ohservaiionum  et  Curationum  Medicinalium  ac  Chirurgicarum 
Opera  Omnia,  Francofurti,  1634,  1,  p.  423;  Tricen,  Obsercationum  Medico- Chirurgicarum  Fasciculus,  Lngduni,  1743;  GUAtt  NI,  Essai  sur  V G^sopha^ 
gotomie,  Mem,  dcVAcad.  de  Chir.,  Paris,  1819,  T.  Ill,  p.  343;  Verdier,  Sur  une  Plaic  de  la  (lorge,  avec  dcs  Remarques  intercssanU  sur  cc  sujet. 
Ibid.,  p.  153;  Larrey,  Mem.  de  Chir.  Mil.,  Paris,  1817,  T.  IV,  p.  249;  Gross,  op.  cit.,  Phil.,  1866,  p.  382;  Gibr,  Diseases  of  the  Throat  and  Windpipe, 
as  rejlected  by  the  Laryngoscope,  Yoodon,  \ WISEMAN,  Several  Chirurgical  Treatises,  London,  1676,  p.  363;  Dieffenbacii,  ,J.  F.,  Die  Operative 
Chirurgie,  B.  II,  R.  321,  Leipzig,  18-18;  BELL  J*i  A Manualof  the  Operationsof  Surgery,  Loudon,  1866,  p.  17R;  HUNT,  WM.,  in  Athct.  Jour,  of  Mai, 
Sci.,  April,  1866,  j).  378. 


424 


WOUNDS  AND  INJURIES  OF  THE  NECK, 


[Chap.  Ill, 


Assistant  Surgeons  S.  Weir  Mitchell,  George  E..  Moorehouse,  anti  William  W.  Keen,  \vho 
were  assigned  to  tlie  wards  in  the  United  States  Army  Hospital,  Christian  Street,  Pliila- 
delphia,  with  a view  to  this  special  enquiry.  How  well  they  acquitted  themselves  of  their 
task  is  shown  by  their  publications.*  It  is  better  to  refer  the  reader  to  those  careful 
studies  than  to  attempt  an  elaboration  of  the  disconnected  clinical  notes  recorded  in  this 
Ofiice.  Two  cases,  however,  specially  communicated,  of  relief  of  paralysis  by  the  removal 
of  balls,  must  not  be  omitted  : 

Case. — Sergeant  F.  C , Co.  F,  GOtli  Alabama  Regiment,  aged  24  years,  was  wounded  at  Petersburg,  March  31st, 

1865,  by  a conoidal  ball,  which  entered  the  face  one  inch  and  a half  above  the  left  angle  of  the  mouth,  knocked  out  two  bicuspides 
and  half  of  the  first  molar  of  the  upper  jaw;  chipped  the  second  molar  of  tlie  lower  jaw',  transfixed  the  tongue,  which  it  split 
about  two  inches  to  the  apex,  and  lodged  in  the  supra-hyoid  space.  Profuse  haemorrhage  occurred  at  tlie  time  of  the  injury,  and 
continued  more  or  less  for  several  days.  The  wound  was  probed  in  search  of  the  ball,  but  it  could  not  be  reached;  the  vessels 
were,  however,  secured,  and  the  haemorrhage  arrested.  The  tongue  became  very  much  swollen,  in  which  condition  it  remained 
for  about  a week,  during  which  period  no  solid  food  was  taken.  On  April  7th,  the  patient  was  admitted  into  the  Confederate 
hospital  at  Danville,  where  another  unsuccessful  search  was  made  for  the  ball.  He  was  furloughed  on  April  11th,  and  sent  to 
Montgomery,  Alabama.  The  wound  healed  rapidly,  .and  he  was  not  disturbed  until  the  middle  of  July,  when,  after  much 
uneasiness  during  deglutition,  his  tongue  bec.ame  p.aralyzed  and  continued  so  until  about  August  10th,  when  power  and  motion 
returned  to  the  organ.  On  September  20th,  violent  pain  set  in,  and  continued  until  October  1st,  during  which  time  an  abscess 
formed  on  the  anterior  surface  of  the  right  side  of  the  neck,  on  a level  with  the  cornua  of  the  hyoid  bone ; this  was  opened, 
discharging  pus  very  freely.  His  condition  w'as  relieved  until  the  middle  of  December,  when  the  pain  in  the  neck  returned. 
Upon  examination,  it  was  discovered  that  the  depressor  muscles  of  the  neck  were  in  a partially  paralyzed  condition.  The  pain 
continued  until  February  1st,  when  it  ceased,  but  soon  return(;d  with  increased  violence.  On  Febru.ary  14th,  the  patient  reported 
to  Dr.  R.  Fraser  Michel,  at  Montgomery,  -who  detected  a foreign  body  in  tbe  lower  jiart  of  the  neck,  near  tbe  trachea,  which 
proved  to  be  the  b.all.  This  was  removed  through  an  incision  along  tbe  anterior  margin  of  the  sterno-mastoid  at  a point  where 
the  omo-hyoid  crosses  the  cervical  region.  The  base  of  the  ball  rested  beneath  the  deep-seated  cervical  fascia,  where  its  layers 
unite  upon  the  anterior  border  of  the  sterno-mastoid  to  be  prolonged  onwards  to  the  tniddle  line  of  the  neck.  After  the  removal 
of  the  ball,  a considerable  qnantity  of  pus  was  discharged.  The  wound  healed  in  a few  days,  and  the  patient  was  entirely 
relieved.  The  ball  was  very  ragged,  twelve  points  of  extreme  asperity  being  detected  upon  its  external  surface.  Three  fossm, 
evidently  depressions  made  by  the  three  teeth  from  the  upper  jaw,  were  discernible,  and,  near  the  base,  quite  an  excavation,  in 
which  was  lodged  the  chipped  portion  of  the  middle  molar  of  the  lower  jaw,  so  imbedded  that  it  could  not  be  removed  without 
injuring  the  specimen.  The  point  of  interest  in  the  case  is  a pass.age  of  a ball  through  the  entire  length  of  the  neck,  amid 
important  blood-vessels  and  nerves,  without  mtiterial  injury  to  the  part.  First,  pressing  upon  the  hypo-glossal  nerve  and 
producing  paralysis  of  the  tongue;  and,  secondly,  touching  the  descendens  noni  and  producing  partial  paralysis  of  the  depressor 
muscles  of  the  larynx. 

Case. — Private  George  T.  Cottrell,  Co.  G,  Ist  United  States  Sharp-shooters,  aged  21  ye.ars,  was  wounded,  while  in  the 
.act  of  firing,  at  the  battle  of  Chancellorsville,  Virginia,  JMay  2d,  18G3,  by  a conoidal  ball  entering  about  one-half  an  inch  above 
left  clavicle,  and  about  an  inch  from  its  sternal  extremity,  and  passing  behind  the  tr.achea,  lodg(?d  just  under  the  right  clavicle 
where  the  subclavian  emerges.  He  was  conveyed  to  Washington,  D.  C.,  and  admitted  into  St.  Aloysius  Hospital,  May  7th,  1863. 
There  was  but  little  blood  lost.  A numb  pain  ensued,  which  lasted  six  months,  referred  p.articularly  to  the  elbow-joint  and 
fingers,  the  fingers  remaining  semi-flexed  three  months.  He  was  unable  to  speak  aloud  for  two  weeks,  and  nourishment  could 
only  be  taken  in  liquid  form.  The  limb  was  carried  at  right  angles,  and,  by  the  middle  of  July,  the  wound  had  perfectly  healed 
anil  never  re-opened.  At  this  date,  the  joint,  which  had  become  firmly  fixed  at  right  angles,  from  inaction,  was  straightened 
while  the  patient  was  under  the  influence  of  chloroform,  and  frequent  flexion  and  extension  subsequently  fully  restored  the  use 
of  tbe  joint.  He  was  returned  to  duty  in  2d  battalion.  Veteran  Reserve  Corps,  October  31st,  1863,  and  discharged  from  the 
service  on  September  14th,  1864.  The  hand  and  fingers  continued  to  be  very  sensitive  to  cold  and  heat,  and,  at  times,  were  very 
painful.  One  morning,  in  the  fall  of  1865,  he  found  that  the  power  of  supporting  the  head  was  lost  to  such  an  extent,  that  he 
was  unable  to  rise  from  his  bed ; and  clonic  muscular  contraction,  drawing  the  head  to  the  right  shoulder,  lasted  four  days,  but 
did  not  recur.  Late  in  December,  1869,  the  pain  at  the  point  of  lodgment  beg.an  to  increase;  and  on  January  31st,  1870,  Prof. 
N.  S.  Lincoln,  M.  D.,  having  pl.aced  tbe  patient  under  the  irffluence  of  chloroform,  cut  down  and  removed  the  ball,  wbich  was 
found  thrust  in  between  the  subclavian  and  a branch  of  the  brachial  plexus,  the  missile  resting  on  the  artery  just  where  it 
emerges  from  beneath  the  clavicle,  .and  the  nerve  drawn  tightly  across  the  b.all  in  front.  On  pushing  aside  this  nerve  from  the 
missile,  vigorous  contraction  of  the  limb  was  produced.  The  wound  closed  readily  by  gr.anulation.  The  limb  is  now  equal  to 
its  fellow  in  size  and  strength,  .and,  with  the  exeeption  of  a very  slight  sensitiveness  of  the  fingers  to  cold  and  heat,  which  is 
improving,  the  patient  is  entirely  relieved.  He  is  unwilling  to  present  the  ball  to  the  Museum.  Mr.  Cottrell  is  a clerk  in  the 
Treasury  Dep.artment.  In  May,  1872,  there  was  a dull  pain  from  the  shoulder,  .along  the  course  of  the  nerve  of  the  arm,  during 
cold  and  damp  weather.  Case  reported  by  Dr.  H.  \V.  Sawtelle  of  the  Treasury  Department. 

Other  cases  germane  to  this  subject  will  be  found  in  the  next  chapter. 


*Circular  No.  G,  Surgeon  Generals  Office,  March  10th,  1864,  On  Rcjlex  Paralysis.  See  also  Gunshot  Wounds  and  Other  Injuries  of  Nerves, 
12  mo.,  pp.  1G4,  Pliiladclphia,  1864 ; Mitcuell,  Injuries  of  Nerves  and  their  Consequences,  small  8 vo.  pp.  377,  Phila.,  Lippiucott  &.  Co.,  1872. 


CHAPTER  IV. 


WOUNDS  AND  INJUKIES  OF  THE  SPINE. 


Cases  belonging  to  this  category  are  commonly  discussed  by  systematic  writers 
immediately  after  lesions  involving  the  head  and  the  encephalon.  In  the  majority  of  cases, 
the  fractures  and  other  injuries  of  the  vertebral  column  are  complicated  by  injuries  of  the 
neck,  chest,  or  abdomen,  yet  it  seems  best  to  devote  to  them  a separate  chapter.  The  total 
number  of  cases  reported  is  about  six  hundred.  They  will  be  referred  to  under  three 
sections : 


Section  I. 

INCISED  WOUNDS,  CONTUSIONS,  AND  MISCELLANEOUS  INJURIES. 


Seventy-seven  cases  of  this  class  are  on  record. 

Incised  Wounds. — Only  two  incised  wounds  of  the  spine  are  recorded;  one  with  a 
fatal  termination,  the  other  resulting  in  recovery. 


CASE.-^Pi'ivate  William  P.  Cook,  Co.  D,  Gtli  Tennessee  Cavalry,  aged  25  years,  was  admitted  to  Overton  Hospital, 
Memphis,  Tennessee,  November  25th,  18G4,  with  an  incised  wound  of  the  spine  inflicted  on  November  10th,  18G4,  with  a knife. 
Simple  dressings  were  applied  to  the  wound.  He  was  returned  to  duty  on  December  15th,  18G4. 


Case. — Private  George  S , Co.  B,  15th  New  York  Engineers, was  admitted 

to  Armory  Square  Hospital,  Washington,  on  April  22d,  1863,  having  been  stabbed 
with  a knife  in  the  back,  at  Falmouth,  A^irginia,  on  the  20th.  He  was  completely- 
paraplegic ; the  urine  had  to  be  drawn  off  by  the  catheter,  and  nothing  but  croton 
oil,  in  three-drop  doses,  succeeded  in  producing  a passage  three  days  after  admission, 
two  d<ay8  affer  which,  involuntary  defecation  and  micturition  set  in.  Sphacelus  on 
all  the  projecting  parts  of  the  lower  part  of  the  body  soon  followed,  j)roceeding 
rapidly  until  it  nearly  reached  the  spine  of  the  sacrum.  On  May  10th,  chills  came 
on  and  recuiTed  daily;  death  ensued  on  May  26th  from  exhaustion.  The  fourth, 
fifth,  and  a portion  of  the  sixth  dorsal  vertebrse,  sawn  longitudinally  to  exhibit  the 
blade  of  the  knife,  which  aj)pear8  to  have  been  broken  off  at  the  time  of  injury  and 
rem.ains  fixed  in  the  specimen,  are  numbered  IIGO  of  the  Surgical  Section,  and 
were  contributed  to  the  Army  Medical  Museum  by  Assistant  Surgeon  C.  C.  Byrne, 
U.  S.  A.  See  adjoining  wood-cut  (Fig.  188). 

54 


Fig.  18?. — Fourth,  fifth,  and  a portion  of  the 
sixth  dorsal  vcftebrje,  sawn  asunder  to  exhibit  a 
dirk  which  traversed  the  spinal  canal.  Spec.  IIGO, 
Sect.  1,  A.  M.  M. 


4-^5 


426 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[Chap.  IV, 


Contusions  AND  Miscellaneous  Injuries. — Seventy-nine  cases  are  reported;  caused 
principally  by  falling  from  horses,  by  blows  from  muskets  or  other  blunt  weapons,  and 
by  falling  of  trees.  A few  |)roved  fatal  from  fracture  or  luxation  or  from  peritonitis,  and, 
in  one  instance,  from  the  complication  of  small-pox : 

Case. — Corporal  John  B , Co.  C,  lOth  New  York  Volunteers,  of  good  constitution  and  physical  condition,  while 

felling  trees  at  Hatcher’s  Run,  Virginia,  March  11th,  1835,.was  struck  across  the  dorsal  and  lumbar  vertebras  by  a falling  limb, 
which  had  been  severed  by  a shell.  Being  knocked  senseless,  he  remained  in  this  condition  for  an  hou^or  more,  until  awakened 
by  the  motion  of  the  ambulance  that  conveyed  him  to  regimental  headquarters.  On  returning  to  consciousness,  he  was  unable 
to  move  the  lower  portion  of  his  body.  Arriving  at  Patrick’s  Station,  he  was  cupped,  and  mustard  applied  to  the  calves  of  the 
legs  and  to  the  spinal  region.  He  complained  of  pain  in  the  lower  portion  of  the  body.  He  was  blistered,  and  the  blisters 
dressed  with  lint.  He  was  sent  to  City  Point,  and  finally,  to  Washington,  where  he  entered  Finley  Hospital  on  the  19th. 
When  admitted,  he  was  in  a semi-comatose  condition ; complete  paraplegia ; sensation  peifect.  There  was  some  febrile  action, 
and  very  severe  diarrhoea.  He  passed  his  urine  and  fteces  involuntarily;  appetite  very  good;  pulse  full  and  bounding; 
emaciation  slight.  The  temperature  of  the  right  leg  was  slightly  higher  than  that  of  the  left,  but  both  wei-e  very  cold;  skin 
moist.  The  blistered  parts  on  each  leg  were  suppurating  slightly.  The  parts  in  the  region  of  the  sacrum  were  in  a gangrenous 
condition.  Opiates  were  given  at  night  and  chlorides  used  to  cleanse  the  gangrenous  wounds  over  the  sacrum.  Under  the 
administration  of  astringents  the  diarrhoea  ceased  by  the  25th.  The  patient,  however,  continued  to  sink,  and  died  on  March 
29th,  18G5.  At  the  autopsy,  the  first  lumbar  vertebra  was  found  transversely  fractured  entirely  through  its  body  at  its  upper 
third,  with  each  pedicle  broken  and  the  left  transverse  and  spinous  processes  encroaching  upon  the  cord,  which  was  lacerated  at 
the  lumbar  and  dorsal  junction.  The  membranes  were  torn  entirely  across,  except  a few  fibres  anteriorly  and  posteriorly,  and 
were  congested  above  and  below  the  seat  of  injury.  Clots  of  diffused  blood  were  found  near  the  fracture.  The  lower  portion 
of  the  cord,  severely  lacerated,  was  drawn  up  into  a bundle  at  the  seat  of  injury,  entirely  deprived  of  the  membranes.  The 
pathological  specimens  are  Nos.  149  and  150,  Section  I,  A.  M.  M.,  and  were  contributed,  with  a history  of  the  case,  by  Acting 
Assistant  Surgeon  H.  Dusenbury. 

Case. — Private  Joshua  C , Co.  H,  4th  Ohio  Volunteers,  aged  23  years,  received  an  injury  of  the  spine,  December 

21st,  18G3,  from  a tree  falling  across  him,  in  camp.  On  January  27th,  1864,  he  was  admitted  to  the  3d  division  hospital,  Alex- 
andria, Virginia,  with  entire  paralysis  of  the  lower  extremities,  both  as  to  sensation  and  motion.  He  did  not  complain  of  any 
great  amount  of  pain.  His  appetite  was  good.  There  was  no  movement  of  the  bowels,  except  as  the  effect  of  a cathartic,  and 
his  urine  had  to  be  drawn  regularly,  otherwise  it  passed  involuntarily  from  him  upon  the  bladder  becoming  partly  full.  The 
muscles  of  the  thigh  and  legs  twitched  involuntarily.  Blisters  were  ordered  to  the  spine  in  the  neighborhood  of  the  second 
dorsal  vertebra,  which  was  dislocated.  February  10th:  Counter  irritation  has  been  thoroughly  tried  with  no  good  result. 
Bed-sores  formed  on  each  hip,  although  an  astringent  wash  had  been  used  and  pressure  prevented  as  far  as  possible,  and  it  was 
feared  that  the  vitality  of  the  pai'ts  was  so  low  as  to  prevent  their  healing.  Patient  sank  gradually ; his  appetite  became  poor ; 
bed-sores  worse,  and  the  discharge  from  them  very  abundant  and  offensive.  Death  resulted  on  April  28th,  1864.  At  the  autopsy, 
forty-eight  hours  after  death,  the  viscera  was  found  apparently  healthy  ; there  was  pressure  upon  the  cord  at  the  point  of  dislo- 
cation of  the  vertebral  column  and  effusion  within  the  membranes.  The  pathological  specimen  is  No.  2255,  Section  I,  A.  M.  M., 
and  shows  the  fifth,  sixth,  seventh,  eighth,  and  ninth  dorsal  vertebras,  completely  fractured  through  the  eighth  and  displaced 
forward.  The  bones  are  partially  retained  in  their  abnormal  relation  by  callus  deposited  in  the  neighborhood.  The  fracture 
passes  transversely  through  the  body  and  embraces  the  processes  also.  It  was  contributed,  with  a history  of  the  case,  by 
Surgeon  Edwin  Bentley,  U.  S.  V. 

Case. — Captain  Thorwald  J , Commissary  of  Subsistence,  U.  S.  V.,  was  injured  at  Larkinsville,  Alabama,  on  the 

evening  of  December  31st,  1833,  by  the  falling  upon  him  of  the  front  of  a building.  He  was  taken  out  in  a few  minutes.  Upon 
examination,  bruises  were  found  on  the  head  in  the  frontal  and  occipital  regions,  and  on  other  parts  of  the  body.  No  bones 
appeared  broken  or  displaced.  There  was  complete  paralysis  of  the  arms  and  legs,  and  extreme  sensitiveness  of  the  front  of 
the  neck  and  upper  part  of  the  thorax.  He  was  not,  at  any  time,  insensible.  Respiration  was  performed  only  by  the  diaphragm, 
causing,  throughout  the  case,  great  suffering  from  dyspncea.  The  symptoms  indicated  dislocation  or  fracture  of  the  cervical 
vertebra;  below  the  phrenic  nerve,  and  above  the  brachial  plexus.  No  displacement  of  the  spinous  processes  could  be  detected, 
and  the  patient  was  .able  to  raise  his  head  and  move  it  from  side  to  side.  The  treatment  adopted  was,  of  course,  only  palliative. 
The  bladder  was  emptied  by  means  of  tbe  catheter.  His  condition  continued  with  very  little  change,  except  greater  or  less 
difficulty  of  breathing,  until  death,  which  occurred  on  the  evening  of  January  3d,  1864,  about  seventy-six  hours  after  the 
accident,  from  asphyxia.  A partial  examination,  next  morning,  revealed  a fracture  of  the  fourth  cervical  vertebra.  The  left 
lamina  was  in  two  pieces  and  depressed  upon  the  spinal  cord.  The  pathological  specimen  is  No.  2080,  Section  I,  A.  M.  M.,  and 
was  contributed,  with  a history  of  the  case,  by  Surgeon  J.  S.  Prout,  26th  Missouri  Volunteers. 

Case. — Private  John  A.  T , Co.  I,  1st  New  York  Engineers,  aged  18  years,  while  bathing  at  Folly  Island,  South 

Carolina,  July  27th,  1864,  dived  from  the  beach  in  two  feet  of  water,  striking  upon  the  top  of  his  head  against  the  hard  sandy 
bottom.  There  was  immediate  loss  of  sensation  and  power  of  motion  below  the  shoulders  and  in  the  upper  extremities,  except 
over  and  in  the  flexor  muscles  of  the  forearms,  and,  apparently,  the  deltoid,  though  the  extension  of  the  arm  at  the  shoulder 
was  rather  feeble  and  indeterminate,  and  was  probably  performed  bj'  the  long  or  scapular  head  of  the  biceps.  Respiration  was 
diaphragmatic;  pulse  but  little  accelerated;  consciousness  complete.  There  was  some,  though  not  excessive  pain  in  the  lower 
cervical  region.  He  was  at  once  conveyed  to  the  hospital  for  detachments  and  civilians  at  Folly  Island,  and  laid  on  his  b.ack, 
on  a mattress.  An  anodyne  was  given  during  the  night.  Eighteen  hours  after  the  injury,  a fever  set  in,  followed  by  some 


Sect.  I.] 


CONTUSIONS  AND  MISCELLANEOUS  INJURIES. 


427 


delirium ; an  enema  was  given,  which  soon  procured  a copious  alvine  discharge.  From  the  fifty-fourth  to  the  sixtieth  hour,  a 
similar  fever  prevailed,  which  was  allayed  by  the  application  of  ice  to  the  head,  and  mustard  to  the  feet  and  thighs,  with  wet 
cups  along  the  spine.  After  the  first  operation,  there  was  some  incontinence  of  feces  and  of  fiatus,  but  not  of  urine,  the  sphincter 
of  the  bladder  retaining  its  power  to  the  last,  although  of  course  the  urine  was  drawn  off  by  the  catheter.  Asphyxia  did  not 
become  prominent  until  the  sixty-second  hour,  but  steadily  increased  until  death,  which  occurred  on  July  30th,  1864,  sixty-eight 
hours  after  the  reception  of  the  injury.  At  the  autopsy,  two  hours  after  death,  the  body  of  the  sixth  cervical  vertebra  was 
found  vertically  fractured,  the  posterior  edges  of  the  partially  separated  halves  pressing  upon  the  anterior  surface  of  the  cord, 
opposite  the  origins  of  the  seventh  and  eighth  cervical  nerves,  and  the  third  and  fourth  of  the  brachial  plexus.  The  ciairal  arch 
of  the  sixth  cervical  vertebra  was  also  broken  down,  and  there  was  dislocation  of  the  spinous  processes  of  the  fourth,  fifth,  and 
sixth  cervical  vertebrae  and  sufficient  fracture  of  their  arches  to  injure  the  cord,  including  most  of  the  roots  of  the  sixth  cervical, 
but  not  at  all  those  of  the  fifth  nerve.  At  these  points  of  direct  injury,  the  substance  of  the  cord  was  inflamed  and  disorganized 
into  a red  pulp.  The  inflammation  and  disorganization  had  also  extended  upward  along  the  gray  commissures  and  the  posterior 
horns  of  the  gray  substance  almost  to  the  medulla-oblongata.  The  origins  of  the  phrenic  nerve  having  been  untouched  by  the 
original  injury,  the  diaphragm  was  able  to  continue  its  function  of  abdominal  respiration,  until,  perhaps,  the  advancing  inflam- 
mation invaded  its  origins.  The  pathological  specimen  is  No.  3159,  Section  I,  A.  M.  JM.,  and  was  contributed,  with  a history  of 
the  case,  by  Assistant  Surgeon  Burt  G.  Wilder,  55th  Massachusetts  Volunteers. 

Aherx.  J.  a..  Sergeant,  Co.  E,  31st  Ohio  Volunteers,  aged  23  years.  Concussion  of  spine.  Atlanta,  August  29th,  1864. 
Treated  in  Hospital  No.  8,  Nashville,  Tennessee.  Returned  to  duty  on  January  24th,  1865. 

Alexander,  George  W.,  Captain,  Ist  Michigan  Cavalry.  Injury  of  spine  by  fall  from  horse.  Gettysburg,  July  3d, 
1863.  Discharged  from  service. 

Allex,  Asa,  Private,  Co.  D,  60th  New  York  Volunteers,  aged  25  years.  Contusion  of  spine  by  fall.  Treated  in 
Hospital  No.  14,  Nashville.  Liniments.  Transferred  to  Veteran  Reserve  Corps,  October  18th,  1864. 

Beax,  Josiaii,  Private,  Co.  I,  31st  Maine  Volunteers.  Injury  of  spine.  Spottsylvania,  Virginia,  May  12th,  1864. 
Treated  in  Lincoln  Hospital,  Washington.  Returned  to  duty  o!i  May  24th,  1865. 

Bexham,  Tho.^ias,  Private,  Co.  A,  150th  New  York  Volunteers,  aged  35  years.  Spinal  injury.  Treated  in  hospital  at 
Columbus,  Ohio.  Returned  to  duty  on  March  20th,  1865. 

Borex,  J.  H.,  Private,  Co.  D,  91st  Indiana  Volunteers.  Contusion  of  spine.  Treated  in  Hospital  No.  19,  Nashville. 
Mustered  out  on  June  26th,  1865. 

Bowex,  William  H.,  Private,  Co.  C,  32d  Iowa  Volunteers,  aged  38  years.  Contusion  of  spine,  lumbar  pm-tion,  by  fall 
from  horse.  Treated  in  Washington  Hospital,  Memphis.  Cupping  and  blistering.  Returned  to  duty  on  .July  23d,  1864. 

Bre  ese,  Johx,  Private,  Co.  H,  5th  Illinois  Cavalry,  aged  17  years.  Concussion  of  spine  by  being  thrown  from  his 
horse.  Treated  in  Adams  Hospital,  Memphis.  Died  on  March  15th,  1865,  from  chronic  peritonitis. 

Breese,  E.  F.,  Private,  Co.  B,  83d  Pennsylvania  Volunteers.  Injury  of  spine  by  fall  of  horse.  Anodynes  and  counter- 
irritants.  Discharged  from  service  on  February  23d,  1865. 

Bright,  Samuel,  Private,  Co.  H,  124th  Indiana  Volunteers,  aged  18  years.  Spinal  concussion  from  fall.  Treated  in 
Cumberland  Hospital  and  Hospital  No.  8,  Nashville.  Simple  dressings.  Returned  to  duty. 

Brooks,  W.  J.,  Sergeant,  Co.  E,  77th  Illinois  Volunteers,  aged  26  years.  Spinal  injury  by  fall  from  wagon.  Treated 
in  hospital  at  Quincy,  Illinois.  Died  on  January  8th,  1864,  from  small-pox. 

Bryaxt,  Charles  F.,  Corporal,  Co.  K,  33d  Massachusetts  Volunteers.  Injury  of  spine.  Treated  in  Mason  Hospital, 
Boston.  Simple  dressings.  Returned  to  duty  on  June  3d,  1864. 

Buck,  Bow.max  H.,  Sergeant,  Co.  F,  3d  New  Jersey  Volunteers,  aged  35  years.  Contusion  of  spine  from  limb  of  tree. 
Spottsylvania,  Virginia,  May  10th,  1864.  Treated  in  Baltimore  and  Wilmington  hospitals.  Rest.  Returned  to  duty  on  August 
2d,  1864. 

Buick,  Axtiioxy,  Bugler,  Co.  I,  12th  Kentucky  Cavalry,  aged  34  years.  Injury  of  spine  by  fall  from  a horse.  May. 
1862.  Treated  in  hospital  at  Louisville,  Kentucky.  Tonics  and  stimulants.  Returned  to  duty  on  August  10th,  1863. 

Burch,  Berxard,  Private,  Co.  I,  4th  Michigan  Cavalry,  aged  20  years.  Spinal  injury  by  fall  from  horse  at  Mammoth 
Cave,  October,  1832.  Treated  in  hospital  at  Quincy,  Illinois.  Counter-irritation.  Returned  to  duty  on  December  21st,  1833. 

Carpexter,  J AMES  W.,  Private,  Co.  E,  Ist  Massachusetts  Cavalry.  Injury  of  spine.  Treated  at  Mason  Hospital, 
Boston.  Simple  dressings.  Returned  to  duty  on  May  9th,  1864. 

Cathermax,  Lewis,  Private,  Co.  E,  7th  Pennsylvania  Cavalry,  aged  33  years.  Injury  of  spine  by  fall  from  horse. 
Treated  in  hospital  at  Louisville.  Cathartics.  Returned  to  duty  on  July  11th,  1863. 

Clarksox,  George  A.,  Private,  Co.  A,  5th  Michigan  Cavalry.  Contusion  of  spine  by  fall  from  horse.  Treated  in 
hospital  at  Point  Lookout,  Maryland,  and  Washington  and  Baltimore.  - Liniments  and  counter-irritants.  Returned  to  duty  on 
October  28th,  1863. 

Clift,  Amos,  1st  Lieutenant,  Co.  F,  1st  Connecticut  Cavalry.  Injury  of  spine  by  fall  from  horse.  Discharged  from 
service  on  August  2d,  1865. 

Cook,  J.  C.,  Private,  Co.  G,  8th  Indiana  Cavalry,  aged  37  years.  Concussion  of  spine.  Treated  in  Hospital  No  8, 
Nashville,  Tennessee.  Returned  to  duty,  September  24th,  1864. 


428  WOUNDS  AND  INJURIES  OF  THE  SPINE.  [Chap.  IV, 

Cooper,  Alrert,  Sergeant  Major,  1st  Jlicbigan  Artillery,  aged  35  years.  Injury  of  spine.  Treated  in  Hospital  No.  8, 
Nashville.  Returned  to  duty  on  August  8th,  1834. 

Corey,  Jo.SEPH  R.,  Private,  Co.  L,  1st  Rhode  Island  Cavalry,  aged  56  years.  Spinal  injury.  Treated  at  Satterlee 
Hospital,  Philadelphia.  Tonics.  Discharged  from  service  on  June  6th,  1863. 

Crupper,  John,  Private,  Co.  G,  64th  Ohio  Volunteers,  aged  19  years.  Contusion  over  spine,  by  limb  of  a tree.  West- 
ville,  December  IGth,  1864.  Treated  in  Hospital  No.  14,  Nashville.  Liniments.  Returned  to  duty  on  M.ay  17th,  1865. 

Dodd,  James  L.,  Private,  Co.  A,  34th  Illinois.  Contusion  of  spine.  Treated  in  Hospital  No.  8,  Nashville.  Dis- 
charged from  service  on  July  12th,*1865. 

Farnsworth,  H.  M.,  Private,  Co.  C,  2d  Massachusetts  Cavalry,  aged  42  years.  Injury  of  spine.  Treated  at  Turner’s 
Lane  Hospital,  Philadelphia.  Discharged  from  service  on  January  25th,  1835. 

Foley,  Hugh,  Private,  33th  Company,  2d  Battalion,  Veteran  Reserve  Corps.  Injury  of  spine  and  breast  by  fall  from 
bridge.  Treated  in  Harevvood  Hospital,  Washington.  Stimulants  and  tonics.  Discharged  from  service  on  December  9th,  1863. 

Freiise,  Louis,  Private,  Co.  B,  37th  Ohio  Volunteers,  aged  26  years.  Injury  to  spinal  column.  Treated  in  Crittenden 
Hospital,  Louisville.  Simple  dressings.  Returned  to  duty  on  August  1st,  1864. 

Fudge,  Philip  ]\I.,  Private.  Co.  A,  74th  Ohio  Volunteers,  aged  21  years.  Concussion  of  spine.  Treated  in  Hospital 
No.  8,  Nashville.  Discharged  from  service. 

Gay',  Robert,  Private,  Co.  I,  112th  Illinois  Volunteers,  aged  39  years.  Spinal  concussion  from  fall.  Treated  in 
Hospital  No.  8,  Nashville.  Returned  to  duty  on  January  26th,  1865. 

Glasshook,  George  N.,  Private,  Co.  D,  12th  United  States  Infantry,  aged  27  years.  Spinal  injury.  Treated  in  Hare- 
wood  Hospital,  Washington.  Returned  to  duty  on  June  21st,  1863. 

Greisinger,  Alexander,  Private,  Co.  K,  1st  Ohio  Artillery,  aged  29  years.  Contusion  of  spine.  Treated  in  Cumber- 
land Hospital,  Nashville,  Tennessee.  Rest  and  liniment.  Returned  to  duty. 

Haler,  "William  C.,  Private,  19th  Indiana  Battery,  aged  34  years.  Contusion  of  sjiine.  Treated  in  Hospital  No.  8, 
Nashville,  Tennessee.  Returned  to  duty  on  November  15th,  1864. 

Hersey’,  Josiah  E.,  Private,  Co.  D,  17th  Illinois  Volunteers.  Injury  of  spine.  Shiloh,  April  6th,  1862.  Treated  in 
hospital  at  Quincy,  Illinois.  Blisters.  Discharged  from  service  on  May  26th,  1864.' 

Herton,  Henry  R.,  Corporal,  Co.  B,  1st  Michigan  Sharp-shooters,  aged  31  years.  Injury  of  spine  by  falling  tree. 
Treated  in  Mount  Pleasant  Hospital,  Washington.  Returned  to  duty  on  July  2d,  1864. 

Hervey',  Williaji,  Private,  Co.  G,  98th  Illinois  Volunteers.  Injury  of  spine  and  chest.  Treated  in  Hospital  No.  9, 
Louisville,  Kentucky.  Liniments  and  cathartics.  Transferred  to  Veteran  Reserve  Corps  on  July  20tli,  1864. 

Hillabiddle,  Daniel  W.,  Musician,  Co.  G,  125th  Ohio  Volunteers,  aged  46  years.  Contusion  of  spine.  Treated  in 
Hospital  No.  8,  Nashville.  Discharged  from  service. 

Hiram,  Ben.jamin,  Private,  Co.  B,  78th  Ohio  Volunteers,  aged  40  years.  Contusion  over  spine.  Treated  in  Hospital 
No.  14,  Nashville.  Liniments.  Returned  to  duty. 

Hoy,  Joseph,  Private,  Co.  D,  98th  Illinois  Volunteers,  aged  31  years.  Contusion  over  spine.  Treated  in  Cumberland 
Hospital,  Nashville.  Simple  dressings.  Discharged  from  service  on  June  27th,  1865. 

Himlett,  George,  Lieutenant,  Co.  M,  2d  New  Jersey  Cavalry,  aged  23  years.  Concussion  of  spine,  March  30th,  1864. 
Treated  in  Officers’  Hospital,  Memphis,  Tennessee.  Returned  to  duty  on  April  18th,  1864. 

Hutsman,  Charles,  Corporal,  1st  Iowa  Battery,  aged  25  years.  Spinal  concussion  from  blow.  Treated  In  Adams 
Hospital,  Memphis.  Discharged  from  service. 

Ives,  Richard  E.,  Sergeant,  Co.  G,  7tli  Illinois  Cavalry,  aged  26  years.  Spinal  concussion.  Treated  in  Hospital  No. 
8,  Nashville.  Returned  to  duty  on  December  21st,  1864. 

Jackson,  Jaaies  F.,  Corporal,  Co.  D,  36th  Wisconsin  Volunteers.  Injury  to  spine.  Treated  in  Lincoln  Hospital, 
Washington.  Returned  to  duty  on  December  28th,  1864. 

ICennedy,  Jajies  T.,  Private,  Co.  C,  25th  New  York  Cavalry,  aged  36  years.  Spinal  injury  by  fall  from  horse  at 
Harper’s  Ferry,  August,  1864.  Treated  in  hospital  at  Philadelphia.  Returned  to  duty  on  February  25th,  1865. 

King,  Isaac  M.,  Private,  Co.  D,  3d  New  Jersey  Volunteers.  Spinal  injury  by  blow  from  a musket.  Chancellorsville, 
Virginia,  May  3d,  1863.  Treated  in  hospital  at  Philadelphia.  Blisters.  Discharged  from  service  on  February  2d,  1864. 

Leard,  Samuel  F.,  Corporal,  Co.  B,  129th  Indiana.  Injury  of  spine  by  fall.  Treated  in  hospital  at  Madison,  Indiana. 
Liniments.  Returned  to  duty  on  November  21st,  1864. 

Leonard,  Edward  L.,  Private,  Co.  D,  24th  Wisconsin  Volunteers.  Injury  of  spine  by  fall  from  butdc.  Milwaukee, 
Wisconsin,  September  1st,  1862.  Treated  in  hospital  at  Quincy,  Illinois.  Counter-irritation.  Discharged  from  service  on 
February  17th,  1864. 

Nowbit,  Lora,  Private,  Co.  I,  4th  Maine  Volunteers,  aged  29  years.  Injury  of  middle  of  spinal  column,  June  9th, 
1864.  Treated  in  Lincoln  Hospital,  Washington.  Deserted  on  December  5th,  1864. 


Sect.  L]  MISCELLANEOUS  INJUEIES.  429 

McClure,  Thomas,  Private,  Co.  H,  6th  Pennsylvania  Eeserves,  aged  30  years.  Injury  of  spine  by  fall.  Treated  at 
Satterlee  Hospital,  Philadelphia.  Liniments.  Returned  to  duty  on  January  11th,  1864. 

McMasters,  Thomas  S.,  Private,  5th  Wisconsin  Battery,  aged  28  years.  Concussion  of  spine.  Treated  in  Hospital 
No.  8,  Nashville.  Returned  to  duty  on  November  25th,  1864. 

McPherson,  C.  C.,  Assistant  Surgeon,  73d  Illinois  Volunteers,  aged  27  years.  Contusion  of  spine  from  railroad 
accident.  Treated  in  Hospital  No.  1,  Chattanooga,  and  Officers’  Hospital,  Nashville.  Simple  dressings.  Leave  of  absence  on 
November  27th,  1884. 

Martin,  Samuel,  Private,  Co.  C,  98th  Ohio  Volunteers,  aged  23  years.  Injury  of  spine  by  fall.  Treated  in  Hospital 
No.  8,  Nashville.  Returned  to  duty. 

May,  Erastus  J.,  Private,  Co.  C,  177th  Ohio  Volunteers,  aged  29  years.  Injury  of  spine  from  fall.  Treated  in  hospital 
at  Madison,  Indiana.  Liniments.  Deserted  on  April  6th,  1865. 

Mitchell,  Joseph,  Private,  Co.  D,  8th  Kansas  Volunteers,  aged  21  years.  Injury  of  spine  by  fall  from  bridge. 
Treated  in  hospital  at  Louisville,  Kentucky.  Tonics  and  stimulants.  Discharged  from  service  on  August  5th,  1863. 

Moren,  George  W.,  Corporal,  Co.  C,  10th  Indiana  Cavalry,  aged  43  years.  Concussion  of  spine  by  railroad  accident 
on  May  6th,  1864.  Treated  in  Hospital  No.  2,  Vicksburg.  Simple  dressings.  Discharged  from  service. 

Parish,  Mortimer,  Private,  Co.  K,  1st  Michigan  Engineers,  aged  24  years.  Contusion  of  spine  by  fall.  Treated  in 
Hospital  No.  14,  Nashville,  and  Crittenden  Hospital,  Louisville.  Discharged  from  service  on  May  9th,  1865. 

Parker,  William  W.,  Corporal,  176th  Co.,  2d  Battalion,  Veteran  Reserve  Corps.  Injury  of  spine.  Treated  in  klason 
Hospital,  Boston,  Massachusetts.  Simple  dressings.  Returned  to  duty  on  June  3d,  1864. 

Payne,  M.  C.,  Private,  Co.  A,  6th  Illinois  Cavalry,  aged  23  years.  Injury  to  spine  by  fall  of  horee.  Tre.ated  in  hospital 
at  Quincy,  Illinois.  Rest.  Discharged  from  service  on  November  24th,  1864. 

Rey,  George,  Lieutenant,  Co.  C,  100th  Illinois  Volunteers.  Contused  wound  of  the  spine  by  limb  of  a tree.  Stone’s 
River,  Tennessee,  December  30th,  1862.  Treated  in  Hospitals  No.  2,  Nashville,  and  No.  14,  Louisville.  Returned  to  duty  on 
January  18th,  1863. 

Richardson,  Thomas  C.,  Private,  Co.  D,  4th  Illinois  Cavalry,  aged  30  years.  Concussion  of  spine.  Grierson’s  Raid, 
December,  1864.  Treated  in  Hospital  No.  2,  Vicksburg.  Simple  dressings.  Returned  to  duty. 

Ryno,  Edward,  Private,  Co.  L,  4th  Michigan  Cavalry,  aged  22  years.  Injury  of  spine  by  fall  from  horse.  Treated  in 
Cumberland  Hospital,  Nashville.  Simple  dressings.  Discharged  from  service. 

Sabines,  James,  Sergeant,  Co.  K,  49th  Ohio  Volunteers.  Injury  of  spine  by  falling  from  a wagon.  Treated  in  general 
hospital  at  Madison,  Indiana,  by  counter-irritation.  Discharged  from  service  on  July  7th,  1864;  case  considered  hopeless. 

Saunders,  John  B.,  Private,  Co.  K,  143d  New  York  Volunteers,  aged  47  years.  Injury  of  spine  at  lumbar  region  by 
fall.  Treated  in  Satterlee,  Philadelphia.  Discharged  from  service.  , 

Shepherd,  William,  Private,  Co.  B,  Gth  New  Jersey  Volunteers,  aged  23  years.  Injury  of  spine  in  lumbar  region. 
Treated  in  Mount  Pleasant  Hospital,  Washington.  Returned  to  duty  on  July  9th,  1864. 

Shirley,  Milton  D.,  Sergeant,  Co.  E,  10th  New  Jersey  Volunteers,  aged  20  years,  received  an  injury  of  the  spine  by 
a blow  from  a gun  at  Cold  Harbor,  June  3d,  1834.  He  was  treated  in  Campbell  Hospital,  Washington.  Returned  to  duty  on 
August  24th,  1864. 

Shoemaker,  Frederick,  Private,  Co.  B,  37th  Ohio  Volunteers,  aged  28  years.  Contusion  of  spinal  column.  Treated 
•in  Crittenden  Hpspital,  Louisville.  Simple  dressings.  Returned  to  duty  on  August  1st,  1834. 

Slater,  Frank,  Private,  Co.  E,  6th  New  York  Artillery,  aged  21  years.  Contusion  of  right  side  and  spine  by  fall  of 
horse.  May  30th,  1834.  Treated  in  Mount  Pleasant  Hospital,  Washington.  Discharged  from  service  on  June  1st,  1865. 

Snelling,  H.  G.,  Private,  Co.  F,  9th  Massachusetts  Volunteers.  Injury  of  spine.  Treated  at  Fairfax  Seminary, 
Virginia,  and  South  Street  Hospital,  Philadelphia.  Simple  dressings.  Transfeired  to  Veteran  Reserve  Corps,  June  Gth,  1864. 

Snyder,  Columbus,  Private,  Co.  D,  7th  Ohio  Cavalry.  Injury  of  spine.  Treated  in  hospital  at  Camp  Dennison,  Ohio. 
Discharged  from  service  on  June  5th,  1833. 

Taylor,  Edward  IL,  Private,  Co.  A,  47th  Massachusetts  Volunteers,  aged  38  years.  Sprain  of  spinal  column  at  Cold 
Harbor  on  June  3d,  1864.  Treated  in  Lincoln  Hospital,  Washington.  Discharged  from  service  on  June  17th,  1865. 

Tilse,  William,  Private,  Co.  B,  37th  Ohio  Volunteers,  aged  23  years.  Contusion  of  sj)inal  column.  Treated  in  Crit- 
tenden Hospital,  Louisville.  Simple  dressings.  Returned  to  duty  on  October  4th,  1834. 

Travelstean,  D.  W.,  Private,  Co.  C.,  100th  Illinois  Volunteers,  aged  38  years.  Injury  of  spine  by  a barrel  falling  on 
him  at  Lumsville,  Kentucky,  October,  1862.  Treated  in  hospital  at  Quincy,  Illinois.  Counter-irritants,  shower  baths,  and  tonics. 
Discharged  from  service  on  February  17th,  1864. 

Wakiner,  James  A.,  Private,  Co.  D,  16th  Pennsylvania  Cavalry.  Injury  of  spine  by  fall  from  horse.  Treated  in 
hospital  at  Philadelphia.  Cold  applications.  Returned  to  duty. 

White,  W.  J.,  Private,  Co.  E,  43th  Illinois  Volunteer.'!.  Injury  of  spine  and  rheumatism,  by  falling  into  a ditch. 
Treated  in  hospital  at  Quincy,  Illinois.  Discharged  from  service  on  Juno  15th,  1835. 

WiilTEiiOUSE,  Ben.Iamin,  Private,  Co.  C,  1st  Ohio  Artillery,  aged  IG  years.  Contusion  of  spine  and  lumbar  region. 
Treated  in  Asylum  Hospital,  Kno.xville,  Tennessee.  Returned  to  duty  on  May  30tli,  1835. 

Wood,  Haver  D.,  Private,  Co.  F,  2d  New  York  Heavy  Artillery,  aged  25  years.  Contusion  of  spine,  June  12lh,  1864. 
Treated  in  Lincoln  Hospital,  Washington.  Deserted  on  July  7th,  1834. 


430 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


fClIAP.  IV, 


Section  II 


GUNSHOT  WOUNDS. 


Cases  of  gunshot  injury  of  the  vertebrae  were  commonly  fatal;  yet  a few  examples 
were  recorded  in  which  the  transverse  or  spinous  apophyses  only  were  injured,  in  which 
more  or  less  complete  recovery  ensued,  and  fewer  still  in  which  the  patients  survived  for 
a protracted  interval,  after  fractures  of  the  bodies  of  vertebrae.  The  following  abstracts 
are  not  grouped  very  accurately,  but  are  generally  placed  according  to  region  and  result: 

Shot  fractures  of  the  Vertebrae. — Examples  will  be  given  of  this  injury  in  each  of  the 
true  vertebrae. 

Fractures  of  the  Cervical  Vertehroe. — In  the  five  following  cases,  the  patients  recov- 
ered; but  with  stiff  necks  or  palsied  arms;  another  example  is  recorded  on  page  450. 

Case. — Private  John  Mason,  Co.  D,  17th  Vermont  Volunteers,  aged  43  years,  was  wounded  at  Spottsylvania,  Virginia, 
May  12th,  1864,  by  a conoidal  ball,  which  entered  behind  and  below  the  left  ear  and  emerged  at  the  base  of  the  neck  two  inches 
to  the  right  of  the  spine,  injuring  the  spinous  processes  of  the  vertebrae.  He  was  treated  in  field  hospital  until  May  23d,  when 
he  was  admitted  to  Mount  Pleasant  Hospital,  Washington.  On  May  27th,  he  was  transferred  to  the  hospital  at  Chester,  Penn- 
sylvania. There  was  partial  paralysis  of  the  left  arm.  On  June  18th,  he  was  transferred  to  the  Sloan  Hospital,  Montpelier, 
Vermont,  and,  on  September  11th,  to  Baxter  Hospital,  Burlington,  whence  he  was  transferred  to  the  Veteran  Reserve  Corps  on 
April  27th,  1865.  Pension  Examiner  II.  H.  Atwater  reports,  July,  1866,  that  the  left  arm  is  numb  and  weak,  and  that  the 
pensioner  sufiers  from  stiffness  and  pain  in  the  upper  part  of  the  spine. 

Case. — Lieutenant  T.  L.  Whitaker,  Co.  D,  24th  North  Carolina  Regiment,  aged  31  years,  was  wounded  near  Richmond, 
Virginia,  May  16th,  1864,  by  a round  ball,  which  entered  at  the  angle  of  the  inferior  maxilla,  fractured  the  transverse  processes 
of  the  fourth  and  fifth  cervical  vertebrae  and  lodged.  He  was  conveyed  to  Richmond  and  admitted  to  Chimborazo  Hospital. 
There  was  paralysis  of  the  left  arm  and  partial  paralysis  of  the  left  leg  and  right  arm.  Cold  applications  were  made.  He  was 
furloughed  on  June  7th,  1864,  having  partially  recovered  the  use  of  liis  right  arm  and  left  leg. 

Case. — Priv.ate  John  Monday,  Co.  E,  47th  Pennsylvania  Volunteers,  aged  19  years,  was  wounded  at  Pocotaligo,  South 
Carolina,  October  22d,  1862,  by  a bullet,  which  entered  the  left  side  of  the  neck  two  inches  from  the  spine,  passed  transversely  across 
the  neck  through  the  spinous  process  of  the  sixth  cervical  vertebra  and  emerged  at  a point  corresponding  to  point  of  entrance.  He 
was  conveyed  to  Beaufort  and  admitted,  on  October  24th,  to  Division  No.  1 Hospital.  The  patient  was  unable  to  bend  his  neck, 
but  moved  the  spine  as  a whole.  A poultice  and  rest  were  ordered  and  half  diet.  On  November  10th,  some  pieces  of  bone  having 
come  away,  and  suppuration  having  nearly  ceased,  the  poultices  were  discontinued  and  cerate  dressings  used.  He  was  dis- 
charged from  hospital  on  November  16th,  1862,  at  which  time  the  wounds  had  nearly  healed,  but  the  neck  remained  stiff. 

Case. — Private  Charles  G.  Cleland,  Co.  G,  7th  Wisconsin  Volunteers,  aged  20  years,  was  wounded  at  Gettysburg,  Penn- 
sylvania, July  2d,  1863,  by  a conoidal  b.all,  which  entered  the  right  upper  lip  at  the  second  incisor,  destroyed  all  the  teeth  save 
the  last  molar  on  the  same  side  of  the  upper  jaw,  passed  below  the  soft  palate  and  penetrated  the  posterior  phar3mx  and  the 
body  of  the  third  cervical  vertebra.  He  was  treated  in  field  hospital  until  July  10th,  when  he  was  sent  to  Satterlee  Hospital, 
and,  on  August  7th,  transferred  to  Christian  Street  Hospital,  Philadelphia.  Here  the  prescmce  of  the  ball  was  determined  by  a 
Nelaton  probe  and  extracted.  There  was  paralysis  in  all  four  limbs,  from  which,  however,  he  rapidly  recovered  and,  for  a time, 
did  duty  .as  hospital  attendant.  He  was  transferred  to  Turner’s  Lane  Hospital  on  March  14th,  1864.  Acting  Assistant  Surgeon 
W.  W.  Keen,  jr.,  on  duty  at  that  hospital,  states  that  “nearly  the  entire  body  of  the  third  cervical  vertebra  has  come  away, 
including  the  anterior  half  of  the  transverse  process  and  the  vertebral  foramen.  No  injury  to  the  vertebral  artery  has  been 
disclosed.  What  supports  his  head,  anteriorly,  I can’t  conceive.  On  May  3d,  1864,  he  was  transferred  to  Washington  to  be 
assigned  to  a company  in  the  Veteran  Reserve  Corps.  The  only  remnant  of  his  paralysis  is  some  of  sensation  over  a surface, 
say  three  by  four  inches,  at  the  back  of  right  neck.  Some  bone  still  occasionally  discharges.”  Examiner  Joseph  Gadd  reports, 
April  1st,  1871,  that  the  right  side  of  the  tongue  is  distorted,  leaving  his  speech  affected;  that  the  right  side  of  his  throat  is 
contracted,  and  that  the  right  shoulder  and  arm  are  diminished  in  size  and  partially  paralyzed.  Disability  three-fourths  and 
permanent. 


Sect.  II.] 


SHOT  FRACTURES  OF  THE  CERVICAL  VERTEBRA]:. 


431 


Case. — Private  Peter  C.  Miller,  Co.  K,  7tli  Wisconsin  Volunteers,  aged  3G  years,  was  wounded  at  the  Wilderness,  Virginia, 
May  5th,  1864,  by  a conoidal  ball,  which  passed  transversely  beneath  the  trapezius  muscle  and  emerged  at  its  anterior  margin, 
fracturing  the  spinous  process  of  the  seventh  cervical  vertebra.  He  was  taken  to  the  field  hospital  of  the  4th  division.  Fifth 
Corps,  where  pieces  of  bona  were  removed  and  simple  dressings  applied.  On  May  11th,  he  was  sent  to  Douglas  Hospital,  Wash- 
ington; on  May  18th,  to  Satterlee  Hospital,  Philadelphia,  and,  on  July  9th,  to  Harvey  Hospital,  Madison,  Wisconsin,  whence  he 
was  discharged  from  service  on  December  17th,  1864.  The  motion  of  the  cervical  region  was  imperfect  and  painful.  A further 
account  of  the  case  will  be  found  on  page  459. 

Fatal  Cases. — The  nine  following  abstracts  relate  to  fatal  shot  injuries  of  the  cervical 
vertebrae : 


Fig.  189. — Caries  of  the  last  two  cervical 
vertebra;  followiag  gunshot  injury.  Spec. 
1807,  Sect.  I,  A.  M.  AI. 


Case. — Private  George  A.  A , Co.  C,  20th  New  York  Volunteers,  aged  40  years,  was  wounded  at  Gettysburg,  July 

2d,  1863,  by  a conoidal  ball,  which  fractured  the  right  lower  jaw  and  the  sixth  and  seventh  cervical  vertebrae.  He  was  admitted 
into  the  Satterlee  Hospital,  Philadelphia,  on  July  9th,  1863.  On  July  14th,  1863,  pyaemia 
developed.  Quinine  and  iron,  in  large  doses,  were  administered;  stimulants  and  generous 
diet  w'ere  given.  The  patient  died  on  July  21st,  1863.  Tlie  necropsy  showed  the  right 
side  of  the  lower  jaw  to  be  fractured  and  comminuted  midway  between  the  symphysis  and 
angle,  and  the  parts  in  the  vicinity  somewhat  gangrenous.  The  connective  tissue  on  the 
right  of  the  pharynx  and  descending  behind  the  oesophagus  was  blackened  and  gangrenous. 

The  body  of  the  sixth  cervical  vertebra  was  broken  through,  and  a fragment  was  chipped 
from  the  seventh.  The  ball  was  not  found;  it  was  stated  that  the  patient  had  ejected  it 
from  his  mouth.  The  oesophagus,  the  trachea,  and  the  bronchial  mucous  membranes  were 
inflamed.  The  right  lung  was  in  a recent  pneumonic  condition,  and  filled  with  a multitude 
of  small  abscesses.  'The  pericardium  was  distended  with  serum,  but  the  heart  and  all 
the  other  organs  appeared  healthy.  It  was  stated  that  the  patient  had  difficulty  of 
breathing,  but  had  no  paralysis ; he  walked  about  until  a few  days  before  his  death,  and 
had  only  complained  of  a slight  uneasy  feeling  when  turning  his  neck,  the  fracture  of 
which  was  not  suspected  during  life.  The  specimens  are  No.  1881,  Sect.  I,  A.  M.  M.,  a 
wet  preparation  of  the  lower  jaw,  and  No.  1867,  Sect.  I,  A.  M.  M.,  the  last  four  cervical 
and  first  dorsal  vertebrm,  and  were  contributed,  with  the  history,  by  Acting  Assistant 
Surgeon  Joseph  Leidy. 

Case. — Corporal  Mark  D , Co.  D,  11th  United  States  Infantry,  was  wounded  at  sunrise,  August  31st,  1864,  while 

on  picket  duty  near  the  Weldon  Railroad,  Virginia.  He  was  soon  afterward  brought  to  the  field  hospital  of  the  Fifth  Corps, 
where,  on  examination,  it  was  found  that  a musket  ball  had  entered  the  right  side  of  the  neck,  at  the  posterior  border  of  the 
sterno-cleido-mastoid  muscle  near  its  middle,  and  passed  inward,  downward,  and  backward.  Some  swelling  and  discoloration 
existed  upon  the  left  side  of  the  neck,  at  and  above  the  clavicle,  but  the  ball  could  not  be  felt.  Paralysis  of  motion  was  complete 
in  the  extremities  and  sensation  was  lost  in  them  except  in  the  arms  near  the  shoulders,  where  it  still  existed  to  a slight  degree. 
Nearly  the  entire  trunk  was  without  sensation  and  its  only  motion  was  that  of  respiration,  wliich  was  performed  by  the  di.aphragm. 
The  bladder  was  paralyzed,  and  the  urine  drawn  off  with  a catheter.  The  bowels  were  not  under  the  control  of  the  will. 
Deglutition  and  respiration  were  slightly  obstructed  by  swelling  of  the  tissues  near  the  track  of  the  bullet.  The  patient  could 
whisper,  but  spoke  aloud  with  difficulty.  His  pulse  was  at  first  nearly  normal,  but  afterward  became  weak  and  frequent.  The 
lividity  of  the  countenance  indicated  a want  of  aer.ation  of  the  blood.  The  shock  from  the  receipt  of  the  wound  seemed  to  be 
slight  and  he  retained  his  intellectual  faculties  until  death,  which  took  place  at  eleven  o’clock  P.  M.,  September  1st.  At  the 
mortem,  examination,  the  ball  was  found  in  the  subscapular  muscle  in  contact  with  the  scapula  of  the  left  side.  It  had  taken  a 
direct  course  from  its  entrance,  and  jiassed  diagonally  through  the  bodies  of  the  fifth  and  sixth,  and  fractured  the  laminm  and 
transverse  processes  of  the  sixth  and  seventh  cervical  vertebra;,  slightly  lacerating  the  spinal  cord  and  forcing  it  to  one  side  of 
the  canal  and  compressing  it  seriously  in  its  passage.  The  pathological  specimen,  consisting  of  portions  of  the  last  four  cervical 
vertebra;,  was  contributed  to  the  Army  Medical  JIuseum  by  Assistant  Surgeon  Edward  Brooks,  U.  S.  A.,  and  is  numbered  4157 
of  the  Surgical  Section. 

Case. — Lieutenant  George  C , Co.  K,  20th  North  Carolina  Regiment,  aged  24  years,  was  wounded  at  Monocacy 

Junction,  Maryland,  July  9th,  1864,  by  a conoidal  ball,  which  entered  the  anterior  part  of  the  neck  immediately  to  the  left  of  the 
thyroid  cartilage,  passed  through  between  the  roots  of  the  seventh  and  eighth  cervical  nerves,  and  emerged  between  the  sjiinous 
processes  of  the  seventh  cervical  and  first  dorsal  vertebra;,  a little  to  the  left  of  the  neck.  He  was  taken  to  Frederick,  and 
admitted  on  the  next  day  to  the  1st  division  hospital.  Simple  dressings  wore  applied.  By  August  4th,  the  wounds  of  entrance 
and  exit  had  entirely  healed.  Large  bed-sores  had  formed  on  the  back,  arms,  and  legs.  There  was  entire  paralysis,  with 
involuntary  discharge  of  urine  and  fmces  and  a profuse  diarrhoea.  He  was  placed  upon  a water-bed  and  tonics  and  stimulants, 
in  connection  with  opiates  and  astringents,  given  internally,  but  the  diarrhoea  obstinately  persisted,  and  the  patient  sank  exhausted 
and  died  on  August  12th,  1864.  'The  autopsy  revealed  a slight  effusion  of  blood  between  the  membranes  and  cord  on  the  right 
side  and  external  to  the  membranes  on  the  anterior  part  of  the  spinal  cord.  There  was  no  direct  injury  to  the  cord.  The 
pathological  specimen,  consisting  of  a wet  preparation  of  the  bodies  and  transverse  processes  of  the- last  cervical  and  first  two 
dorsal  vertebra;,  with  the  corresponding  portion  of  the  cord,  were  contributed  to  the  Anny  Medical  Jluseum  by  Assistant  Burgeon 
R.  F.  Weir,  U.  S.  A.,  and  is  numbered  3976  of  the  Surgical  Section. 

Case. — Sergeant  J.  H.  R , Co.  H,  11th  Pennsylvania  Reserves,  was  wounded  at  Fredericksburg,  Virginia,  Decem- 

ber 13th,  1862.  The  ball  entered  near  the  inferior  angle  of  the  scapula,  fracturing  the  anterior  border,  neck,  and  coracoid 
process;  it  then  passed  through  the  left  clavicle,  causing  a fracture  of  the  outer  and  middle  thirds;  then  behind  the  scaleni 
muscles,  carrying  away  the  transverse  processes  of  the  third  and  fourth  cervical  vertebrae,  laying  bare  the  vertebral  artery, 


432 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[Chap.  IV, 


opening  the  sheath  of  the  carotid,  and  finally  lodged  behind  the  symphysis  of  the  inferior  maxilla.  He  was  conveyed  to  Wash- 
ington, and,  on  December  IGth,  admitted  to  Carver  Hospital.  Death  resulted  on  December  22d,  18G2.  The  autopsy  revealed 
great  infiltration  of  blood  in  the  cellular  tissues  of  the  neck  and  in  tlie  mediastinum.  The  pathological  specimens,  consisting  of 
the  fractured  clavicle  and  scapul.a,  with  the  third,  fourth,  and  fifth  cervical  vertebra;,  are  numbered  040,  G41,  and  901,  Surgical 
Section,  Army  Medical  Museum,  and  were  contributed,  with  a history  of  the  case,  by  Surgeon  O.  A.  Judson,  U.  S.  V. 

Case. — Private  W.  P , jr.,  Co.  F,  114th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Chaucellor.sville, 

Virginia,  May  3d,  18G3,  by  a conoidal  ball,  which  entered  about  an  inch  below  and  back  of  the  left  mastoid  process,  passed  inward 
and  upward,  and  lodged.  He  was  treated  in  the  field  hospital  for  several  days,  was  then  put  on  board  of  the  steamer  State  of 
Maine,  and  conveyed  to  the  1st  division  hospital,  Annapolis,  Maryland.  On  June  2d,  the  wound  was  enlarged  and  the  ball 
discovered,  supposed  to  be  sticking  about  the  mastoid  process,  and  an  unsuccessful  effort  made  to  extract  it.  On  June  3d,  the 
wound  was  still  further  enlarged,  and  a few  small  pieces  of  lead  removed  with  the  bullet-forceps,  the  ball  still  remaining  in  the 
head.  About  an  hour  after  the  operation,  the  patient  complained  of  a severe  chill,  from  which  he  soon  recovered  upon  the  admin- 
istration of  brandy.  June  5th,  pulse  IGO.  Nervous  twitching  of  the  upper  lip.  Urine  difficult  to  pass  and  highly  colored.  On 
the  morning  of  June  Gth,  he  vomited  a greenish  fluid;  an  enema  was  administered,  which  produced  a free  evacuation  of  the  bowels 
and  the  vomiting  ceased,  but  he  became  delirious  and  weak,  and  failed  rapidly  until  June  8th,  when  death  supervened.  At  the 
autopsy,  the  ball  was  found  lodged  against  the  occipital  and  atlas,  producing  a fracture  of  the  atlas  and  a fissure  of  the  left  portion 
of  the  occipital.  It  is  supposed  that  the  attempts  made  to  extract  the  ball  were  unsuccessful  on  account  of  the  contraction  of  the 
muscles  of  the  neck.  The  pathological  specimen  is  No.  1710,  Section  I,  A.  M.  !M.,  and  was  contributed,  with  the  history,  by 
Surgeon  B.  A.  Vanderkieft,  U.  S.  V. 

Case. — Private  Leverett  E , Co.  A,  8th  Connecticut  Volunteers,  aged  22  years,  of  small  stature  and  feeble  bui'd,  was 

wounded  at  Antietam,  Maryland,  September  17th,  18G2,  by  a musket  ball,  which  entered  the  open  mouth  about  the  middle  of  the 
left  anterior  pillar  of  the  fauces  and  emerged  at  the  back  of  the  neck  two  inches  from  the  spinous  process  of  the  second  cervical 
vertebra,  on  its  left  side.  He  was  treated  in  field  hospital  until  the  22d,  when  he  was  admitted  to  the  hospital  at  Frederick, 
Maryland.  He  stated  that,  upon  the  reception  of  the  injury,  he  lost  considerable  blood,  producing  faintness  for  several  hours. 
After  admission,  patient  did  well  until  October  31st,  when  arterial  htemorrhage  occurred  to  the  amount  of  a wine-glassful,  recurring 
slightly  two  days  after.  On  November  13th,  after  eating  breakfast,  his  mouth  was  observed  to  turn  inwiird;  all  facial  expression 
on  the  left  side  was  gone.  In  an  hour  muttering  delirium  occurred.  Death  resulted  on  November  14th,  1862.  The  autopsy 
revealed  that  the  internal  ai'tery  was  cut  by  the  ball,  and  closed  l)y  a strong  coagulum.  The  remainder  of  the  artery  had  disin- 
tegrated and  had  passed  aw.ay  in  the  discharge.  The  haemorrhage  was  from  small  openings  in  the  exter’nal  carotid.  The 
pathological  specimen  is  numbered  778,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Acting  Assistant 
Surgeon  Eedfern  Davies. 

Case. — Private  David  A.  C , Co.  D,  4th  New  York  Heavy  Artillery,  aged  27  years,  rvas  wounded  at  Petersburg, 

Virginia,  Mai'ch  31st,  1865,  by  a conoidal  .ball,  which  entered  on  the  left  side  of  the  neck  and  passed  through  the  vertebi-a;, 
producing  paralysis  of  the  lower  extreirrities  and  left  arm  and  hand.  He  was  taken  to  the  field  hospital  of  the  1st  division. 
Second  Corps,  where  simple  dressings  were  applied  to  the  wound,  and  he  was  sent,  after  several  days,  to  Harewood  Hospital, 
Washington.  On  admission,  the  condition  of  the  injured  parts  appeared  to  be  tolerably  good,  but  the  constitutional  state  of  the 
patient  was  very  low;  he  was  entirely  unable  to  move  his  limbs,  and,  at  times,  to  retain  his  urine  and  fatces.  He  remained  in  this 
condition,  notwithstanding  the  free  use  of  tonics,  stimulants,  and  a supporting  treatment  throughout,  and  gradually  saidc  and  died 
on  April  29th,  1865,  from  exhaustion.  The  pathological  specimen  is  No.  4346,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a 
history  of  the  case,  by  Surgeon  E.  B.  Bontecou,  U.  S.  V. 

Case. — Private  E.  IF.  V , Co.  K,  1st  Virginia  Cavalry,  received  a gunshot  wound  of  the  neck  at  Suffolk,  Virginia, 

April  13th,  1863.  He  was  conveyed  to  Harper’s  Ferry,  Virginia,  where  death  resulted  on  May  17th,  1863.  The  pathological 
specimen.  No.  1791,  Section  I,  A.  M.  M.,  consists  of  several  cervical  vertebra;,  showing  the  bodies  of  the  third  and  fourth  entirely 
carried  away  by  gunshot  and  subsequent  suppuration.  The  borders  of  the  cavity  are  necrosed,  and  the  membranes  have  ulcerated 
sufficiently  to  expose  a large  extent  of  the  cord.  The  specimen  illustrates  how  life  may  be  preserved  for  a long  time  after  exten- 
sive injury  to  the  spinal  cord.  It  was  contributed  by  Surgeon  B.  Beust,  U.  S.  V. 

Case. — Sergeant  George  E . Co.  A,  2d  Texas  Cavalry,  an  unusually  robust  andhealtby  man,  was,  on  June  4th,  1865, 

shot  twice  by  a comrade.  He  was  immediately  taken  to  the  hospital  at  Brownsville,  Texas.  One  ball  entered  one-fourth  of  an 
inch  below  the  frontal  sinus,  fractured  the  nasal  bones  and  the  internal  angular  jtrocesses  of  the  os  frontis,  and  passed tlownward 
and  backward,  but  could  not  be  found.  The  other  b.all  entered  about  half  an  inch  below  the  clavicle,  passed  to  the  opposite  side 
of  the  body,  and  lodged  about  half  an  inch  below  the  middle  of  the  posterior  border  of  the  left  scapula,  whence  it  was  removed 
immediately  after  admission  to  the  hospital.  His  sufferings  from  the  effects  of  the  second  ball  were  great  during  the  first  month 
and  a half.  He  was  kept  in  a semi-recumbent  posture,  as  the  prone  or  supine  condition  would  greatly  increase  the  jiain.  On 
August  23d,  he  was  removed  to  camp,  a distance  of  three-fourths  of  a mile.  The  wound  of  head  had  apparently  healed,  and 
the  wound  beneath  the  clavicle  suppurated  slightly ; the  pulse  was  feeble  and  rapid.  He  was  kept  under  the  influence  of 
morphia,  and  expressed  a constant  fear  lest  he  might  be  freed  from  the  power  of  the  narcotic,  and  left  exposed  to  the  violence  of 
pain  in  his  chest.  Ho  was  somewhat  emaciated,  but  his  appetite  was  good.  Simple  dressings  were  applied  to  the  wound  in  the 
clavicular  region.  On  September  5th,  he  was,  apparently,  fast  sinking.  Stimulants  were  given,  which  he  was  unable  to  bear. 
Even  wine  caused  inci-eased  circulation  and  greater  dyspnoea  from  coughing.  The  morphia  was  continued.  On  the  9th, 
diarrhoea  set  in,  which  was  checked  with  diarrhoea  mi.xture.  On  the  16th,  patient  was  nervous  and  anxious;  otherwise  he  was 
as  usual.  On  September  25th,  the  wound  of  chest  sloughed  more  freely,  and  the  pain  and  dyspnoea  had  become  intense. 
Morphia  and  balsam,  with  cough  mixtures,  were  given.  He  complained  a few  times  of  pain  in  the  head  and  neck.  On  Septem- 
ber 30th,  he  was  disconsolate,  and  requested  to  be  discharged  “that  he  might  go  home  to  die.”  He  was  able  to  walk  a few  yards 


Sect.  II.] 


FKACTURES  OF  THE  DORSAL  VERTEBRAi. 


433 


from  Lis  Led  and  return.  On  Oetolx"!-  lOtL,  lie  Lad  become  perceptibly  weaker,  and  died  on  October  20tL,  Laying  survived  Lis 
injuries  four  montlis  and  sixteen  days.  At  tlie  autopsy,  tlic  internal  organs  of  the  tlioracic  cavitj'  were  found  in  a normal 
condition,  witL  tlie  exception  of  tlio  riglii  lung.  wbieL  was  very  niiicL  disorganized.  TLe  ball  liad  broken  oil'  a splinter  of  tbe 
lower  border  of  tbe  clavicle,  at  a point  below  tbe  outer  attacLment  of  tbe  deltoid  muscle,  also  a small  iiortion  of  bone  from  the 
outer  border  of  tbe  first  rib,  and  passing  tbrougb  tbe  apex  of  tbe  right  lung  in  an  oblique  direction,  made  its  exit  between  tbe 
fourth  and  fifth  ribs,  both  of  which  were  fi'actured  near  tbe  spine.  Tbe  ball  in  tbe  bead  bad  fractured  the  ethmoid  bone,  and  bad 
extensively  comminuted  tbe  sphenoid  bone  in  its  passage  to  the  third  cervical  vertebra,  where,  impinging  upon  tbe  right  trans- 
verse process,  it  was  found  lodged  and  encysted  in  tbe  muscular  fibres  of  tbe  rectus  and  scaleni  muscles.  Tbe  substance  of  tbe 
brain  bad  not  been  injured  in  any  way.  Tbe  case  is  reported  by  Acting  Assistant  Sm-geon  A.  L.  Norris,  who  also  contributed 
tbe  specimen.  No.  3851,  Section  I,  A.  M.  M.,  a wet  preparation  of  tbe  third,  fourth,  and  fifth  cervical  vertebra;,  of  wbicb  the 
anterior  [)ortion  of  the  body  of  tbe  fourth,  on  tbe  left  side,  is  fractured  by  a bullet. 

Fractures  of  the  Dorsal  Vertebrae. — Shot  fractures  of  the  dorsal  vertebrae  were  gener- 
ally mortal,  unless  the  lesion  was  confined  to  tlie  apophyses.  Wounds  of  the  bodies  of 
the  vertebrae  were  usually  associated  with  penetrating  wounds  of  the  chest  or  abdomen. 

Partial  Recoveries . — Abstracts  of  a few  cases  of  recovery  after  injury  of  the  spinous, 
transverse,  and  articular  processes  are  appended  ; 

Case. — Private  William  Moran,  Co.  F,  22d  Kentucky  Volunteers,  aged  28  years,  was  wounded,  at  Cbam])ion  Hills, 
Mississipj)i,  May  16tb,  1863,  by  a ball  from  a canister-shot,  wbicb  entered  beneath  and  about  tbe  middle  of  tbe  spine  of  tbe 
scapula,  passed  tbrougb  tbe  infra-spinatus  muscle,  came  in  contact  with  tbe  spine,  wbicb  it  fractured,  and  entered  tbe  siqna- 
spinatus  muscle.  He  was  treated  in  tbe  field  until  June  4tb,  when  be  was  taken  on  board  tbe  hospital  steamer  R.  C.  Wood,  and 
conveyed  to  Memjjbis,  entering  Union  Hospital  on  tbe  8tb.  Tbe  wound  was  explored  in  search  of  tbe  ball,  but  it  could  not  be 
found ; fragments  of  comminuted  spine  were  extracted.  Large  fragments  still  remained,  attached  by  soft  tissues,  wbicb  were 
not  removed.  About  June  23tb,  gangrene  set  in.  Wound  about  two  inches  in  diameter ; edges  black  and  sloughy  ; large  .slough 
quite  deep  in  tbe  wound.  Nitric  acid  and  poultices  were  applied,  and  large  doses  of  inoipbine  given  to  quiet  tbe  nci'\’ous  system 
and  procure  sleej).  Under  this  treatment  tbe  condition  of  tbe  wound  improved,  and,  by  July  12tb,  was  granulating  linely. 
August  1st,  wound  filled  with  granulations  to  a level  with  tbe  skin,  and  became  much  smaller.  October  1st,  woimd  completely 
healed.  Patient  in  excellent  bealtb.  He  was  returned  to  duty  on  December  7tb,  1863. 

Case. — Lieutenant  James  Sample,  Co.  B,  118tb  Illinois  Volunteers,  aged  35  years,  was  wounded  at  Edward’s  Station, 
Mississippi,  July  1st,  1863,  by  a musket  ball,  wbicb  entered  near  tbe  nj)per  ])ortion  of  tbe  left  scapida,  passed  between  tbe 
first  and  second  dorsal  vertebra;,  shattering  tbe  processes  and  injming  tbe  sjiinal  column,  passed  tbrougb  tbe  upper  portion  of 
tbe  right  scapula,  entered  tbe  right  cavity  of  tbe  chest,  and  following  tbe  course  of  tbe  first  rib,  passed  tbrougb  tbe  right  shoulder 
joint  and  emerged  at  tbe  axilla.  He  was  discharged  from  service  at  New  Orleans  on  December  1st,  1863.  Pension  Examiner 
Charles  Hay  reports,  on  October  25tb,  1865,  that  a gradual  improvement  is  slowly  taking  place. 

If  the  diagnosis  was  indubitable,  the  next  is  a remarkable  instance  of  recovery: 

Case. — Corporal  W.  B.  Weldon,  Co.  A,  13th  Massachusetts  Volunteers,  aged  24  years,  was  wounded  at  Gettysburg, 
Pennsylvania,  July  2d,  1863,  by  a conoidal  ball,  wbicb  entered  tbe  left  side  between  tbe  eighth  and  ninth  ribs,  ])assed  through 
tbe  spine,  touching  the  spinal  cord,  and  emerged  between  tbe  fourth  and  fifth  ribs.  He  was  treated  in  tbe  field  hospital  until 
August  21st,  when  be  was  sent  to  tbe  hospital  at  Camp  Letternran.  Tbe  wounds  bad  nearly  healed.  Sejrtember  12tb,  pai'alysis 
of  tbe  right  leg.  Stimulants  were  given  and  tbe  limb  rubbed  with  liniments  fr  om  hip  to  ankle.  On  October  Ctb,  be  was  trans- 
fen-ed  to  Turner’s  Lane  Hospital,  Philadelphia,  and,  on  January  13tb,  1864,  to  Lovell  Hospital,  I’ortsmoutb  Grove,  Rhode 
Lsland,  whence  be  was  discharged  from  service  on  February  2d,  1864.  Acting  Assistant  Surgeon-II.  11.  Dutton  reported  tbe 
case.  Pension  Examining  Surgeon  Geo.  Stevens  Jones  reported,  April  28tb,  1864,  that  “the  ball  entered  at  tbe  bend  of  tbe 
tenth  rib,  passed  obliquely  upward  and  out  of  left  axilla,  where  it  entered  the  left  arm  in  its  upper  aspect,  and  was  extract(;d  at 
tbe  middle  of  tbe  ann.  In  consequence  of  tbe  injuries  to  tbe  back,  bo  has  some  pain,  besides  sufi'ering  from  other  inconvenience. 
Disability  one-half,  not  permanent.” 

Case. — Private  Luther  Weaver,  Co.  B,  126th  New  York  Volunteers,  aged  27  years,. was  wounded  at  Gettysburg,  Penn- 
sylvania, July  3J,  1863,  by  a conoidal  ball,  wbicb  entered  tbe  right  lumbar  region  on  a level  with  tbe  tenth  rib,  ])assed  across 
tbe  spine,  fracturing  tbe  spinous  and  transverse  processes  of  the  tenth  dorsal  vertebra,  and  lodged  in  tbe  muscles  on  tbe  left  side. 
He  was  treated  in  tbe  field  hospital  until  July  24tb,  when  be  was  sent  to  Camp  Letterman  Hospital.  On  admission,  bis  general 
health  was  feeble.  Cold-water  dressings  were  applied  to  the  wound  and  stimulants  administered.  Under  this  treatment,  the 
patient  Improved  very  much.  On  August  5tb,  several  spiculm  of  bone  were  l emoved.  He  was  transfeired  to  Mower  IIosi)ital, 
Philadelphia,  on  September  15tb,  and  returned  to  duty  on  November  25tb,  1863. 

Case. — Corporal  JV.  A.  Freeman,  Co.  B,  13th  North  Carolina  Regiment,  aged  24  years,  was  wounded  at  Williamsburg, 
Virginia,  May  5tb,  1862,  by  a musket  ball,  wbicb  entered  two  inches  below  tbe  spine  of  tbe  left  scapula,  passed  upwai  d and 
inward,  and  escaped  midway  between  the  s[)ine  of  tbe  right  scapula  and  tbe  right  clavicle.  He  was  admitted,  on  tbe  12tb,  to 
Clitfburne  Hospital,  Washington.  A counter  opening  bad  been  made  in  tbe  truck  of  tbe  ball  to  tbe  left  of  tbe  vertebral  column, 


434 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[Chap.  IV, 


aud  from  this  and  the  orifice  of  exit  tlie  discharge  of  pus  was  profuse.  Digital  examination  through  the  counter  opening  showed 
a shattering  of  the  spinous  jirocesses  of  two  of  the  dorsal  vertebra;,  and  the  existence  of  a large  abscess  over  the  muscles  to  the 
right  of  the  vertebrae.  A free  transverse  incision  was  made  over  the  spine,  the  splinters  of  bone  removed,  sharp  projecting 
points  snipped  oflt,  and  the  carious  portions  gouged  aw’ay.  The  cavity  left  was  stuffed  for  two  days  with  lint  soaked  in  laudanum 
and  subsequently  with  dry  lint.  The  wound  did  very  well.  By  July  3d,  the  wound  had  healed;  the  bullet  holes  were 
cicatrizing,  and  the  cavity  loft  by  the  operation  was  filling  up  with  granulations.  It  was  dressed  lightly  from  the  bottom  with 
dry  lint,  the  edges  of  the  wound  being  approximated  and  supported  by  adhesive  straps.  By  June  30th,  the  wounds  had  entirely 
healed.  On  July  11th,  1862,  he  was  transferred  to  Old  Capitol  Prison. 

..  Case. — Private  Frederick  Newman,  Co.  F,  81st  Now  York,  aged  18  years,  was  wounded  at  Drury’s  Bluff',  Virginia, 

May  IGth,  18G4,  by  a fragment  of  shell,  which  fractured  the  spinous  processes  of  the  dorsal  vertebrre.  He  was  treated  in  the 
field,  and,  on  May  19th,  sent  to  Hampton  Hospital,  Fort  Monroe.  Simple  dressings  were  applied  to  the  wound.  On  July  14th, 
he  was  transferred  to  McDougall  Hospital,  Fort  Schuyler,  New  York  Harbor,  and,  on  April  Gth,  1865,  to  the  hospital  at  Rochester, 
New  Y’ork,  whence  he  was  discharged  from  service  on  June  12th,  1865.  There  was  partial  paralysis  of  the  lower  extremities. 

• 

Case. — Private  Isaac  N.  Mitchell,  Co.  G,  8th  Pennsylvania  Reserves,  received  a gunshot  wound  directly  across  the  back, 
injuring  the  dorsal  muscles  and  spinous  processes,  .and  causing  concussion  of  the  rpine,  at  Gaines’s  Mill,  June  27th,  1862.  He 
was  treated  in  the  field  until  August  26th,  when  he  was  transferred  to  the  1st  division  hospital  at  Annapolis.  Returned  to  duty 
on  January  30th,  1863. 

Case. — Private  William  B.  Morse,  Co.  A,  40th  New  York  Volunteers,  aged  20  years,  was  admitted  to  Stanton  Hospit<al, 
Washington,  June  15th,  1863,  from  the  field  hospital  of  the  Army  of  the  Potomac,  at  Potomac  Creek.  He  said  that  he  had 
been  injured  in  the  battle  of  Chancellorsville,  May  3d,  1863,  by  the  explosion  of  a shell;  that  he  was  lying  on  the  ground  on 
his  right  side,  in  line  of  battle,  under  a heavy  .artillery  fire,  when  something  hit  him  violently  on  the  left  side  and  knocked  him 
senseless.  When  he  came  to,  his  mouth  was  filled  with  clotted  blood.  He  spat  blood  for  two  days,  with  a cough  which  had 
not  yet  entirely  left  him.  His  left  side  was  swelled  up,  and  was  tender  from  the  aionpit  all  the  way  down  to  the  hip.  He  could 
not  move  the  left  leg  at  all,  the  thigh  included,  .and  had  but  partial  use  of  the  right  one.  Sensation  .also  was  nearly  abolished  in 
the  left  lower  extremity.  The  motion  and  sensation  of  the  left  upper  extremity  were  considerably  impaired.  He  had  not  had 
any  difficulty  in  holding  or  voiding  liis  urine.  He  stated  that  the  left  side  appeared  to  be  badly  bruised,  but  the  skin  was  not 
broken.  When  admitted  to  hospital,  the  partial  p.ar.alysis  still  continued  and  was  most  marked  in  the  left  lower  extremity.  Ho 
had  dyspnma  and  cough,  but  no  expector.ation.  The  left  tliorax  was  much  shrunlven  and  tender  under  pressure.  The  left 
shoulder  had  fallen  down  a good  detil  below  the  level  of  its  fellow  on  the  opposite  side.  There  was  lateral  curvature  of  the 
spine,  and  his  posture  in  bed  bore  a strong  resemblance  to  that  produced  by  pleurosthotonos  of  the  left  side.  Nothing  abnormal 
was  detected  by  auscultation  and  percussion.  There  was  no  swelling  or  (‘cchymosis  of  the  injured  side,  or  evidence  that  the  ribs 
had  been  fractured.  He  complained  of  much  soreness  in  the  walls  of  the  left  thorax  and  left  side  generally,  and  the  motion  of 
the  left  arm  seemed  to  be  much  impaired  on  that  account.  His  intellect  was  clear,  and  he  presented  no  synijitoms  wh.atever 
diagnostic  of  a cerebral  lesion.  He  was  thin  and  rather  ))ale ; bowels  constipated.  He  was  manifestly  sufl'ering  from  the 
consequences  of  extensive  contusion  of  the  left  side  and  concussion  of  the  spinal  cord.  Dry  cups  were  ordered  to  bo  applied 
daily  over  the  spine  and  the  bowels  to  be  kept  open  with  laxatives.  He  was  allowed  full  diet.  The  dry  cupping  seemed  to 
benefit  him  very  much  and  the  paralysis  was  rajiidly  disappearing.  By  August  l'5th,  he  was  up  and  going  about  on  crutches. 
The  cups  were  discontinued,  and  acetate  of  strychnia  prescribed  in  small  doses.  This  i-emedy  was  discontinued  at  the  end  of  a 
month,  as  it  appeared  to  do  him  but  little,  if  any,  good.  During  the  fall  and  winter  he  continued  to  improve  slowly,  and,  by  the 
middle  of  March,  threw  his  crutches  aside,  preferring  to  walk  with  the  aid  of  a cane  only.  April  10th,  1864  : He  stands  erect  ; 
the  falling  down  of  the  left  shoulder,  the  shrinking  of  the  left  side,  and  the  posture  simulating  pleurosthotonos  have  entirely 
disappeared.  The  left  thigh  is  a trifle  smaller  and  more  flaccid  than  the  right  one.  At  times  he  has  a feeling  of  numbness  and 
tingling  in  the  left  arm,  but  none  in  the  right,  and  the  same  abnormal  sensations  in  the  left  thigh  and  leg,  but  not  in  the  right. 
He  presents  a enrious  limp  in  his  gait  in  walking.  His  body  sinks  very  low  on  placing  its  weight  on  the  left  limb,  from 
deficiency  in  the  power  of  the  extensor  muscles,  as  compared  with  that  of  the  flexor  muscles  of  the  limb,  to  support  the  body  at 
its  proper  height  in  walking,  and  thus  a strange  hobbling  is  produced  like  that  in  some  cases  of  rupture  of  the  ligamentum 
patellae.  He  was  discharged  from  service  on  April  18th,  1864. 

Fatal  Cases. — Of  fatal  cases  of  gunshot  injury  of  the  dorsal  vertebrae,  there  were 
numerous  illustrations,  with  great  variety  in  the  character  of  the  lesions,  as  the  processes, 
laminos,  bodies,  or  spinal  canal  might  be  involved.  Reasoning  only  from  the  cases  that 
came  under  treatment,  it  would  be  admitted  that  gunshot  fractures  of  the  dorsal  vertebrae 
had  hardly  a larger  fatality  than  amputations  of  the  thigh  ; but  the  many  examples  of 
immediate  death  on  the  field  would  then  be  overlooked.  It  will  be  remarked,  in  the 
abstracts  that  follow,  that  although  those  cases  complicated  by  wounds  of  the  great  cavities 
often  terminated  fatally  at  an  early  date  from  the  reception  of  the  injury,  those  in  which 
the  spinous  processes  and  laminae  were  alone  implicated  were  usually  lingering,  and  fatal 
from  secondary  causes. 


Sect.  II.] 


FRACTURES  OF  THE  DORSAL  VERTEBRA. 


435 


Illustrations  of  these  injuries  are  fully  afforded  by  the  specimens  in  the  Army  ]\Iedi- 
cal  Museum,  and  the  abstracts  of  histories  of  over  an  hundred  additional  cases.  Some  of 
the  more  remarkable  are  here  cited : 

Case. — Corporal  William  J.  F , Co.  B,  1st  Michigan  Volunteers,  was  wounded  at  Chancellorsville,  Virginia,  May 

3d,  1863,  by  a conoidal  ball,  which  fractured  the  second  dorsal  vertebra.  He  also  received  a wound  of  the  left  eye,  and  a scalp 
wound  of  the  left  side.  He  was  admitted,  on  the  same  day,  to  the  field  hospital  of  the  1st  division,  Fifth  Corps,  and  transferred, 
on  May  9th,  to  Armory  Square  Hospital,  Washington.  The  sight  of  the  left  eye  was  gone,  and  there  was  paralysis  of  the 
lower  extremities.  Death  occurred  on  May  13th,  1883.  At  the  necropsy,  tlieball  was  found  to  have  lodged  in  the  sj)inal  canal. 
The  right  rib  was  shattered  in  its  head.  The  right  lung  was  very  much  congested.  The  pathological  specimen  is  No.  1114, 
Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Assistant  Surgeon  C.  C.  Byrne,  U.  S.  A. 

Most  of  the  fractures  of  the  third  dorsal  vertebra  were  complicated  by  wounds  of  the 
thorax,  as  in  the  three  following  cases  : 

Case. — Private  William,  L.  B , Co.  I,  21st  Georgia,  aged  22  years,  received  a gunshot  penetrating  wound  of  the 

chest  at  Fort  Stevens,  District  of  Columbia,  July  12th,  1864.  He  was  admitted,  on  the  14th,  to  Lincoln  Hospital,  Washington. 
When  admitted,  he  was  suffering  intense  pain  in  the  chest ; retention  of  urine  and  faeces ; total  paralysis,  in  lower  extremities, 
of  both  motion  and  sensation;  breathing,  labored  and  painful;  pulse,  100.  Cold  water  dressings  were  applied,  and  opiates 
administered.  He  died  on  July  15th,  1864.  At  the  autopsy  a wound  was  found  directly  over  the  center  of  the  left  clavicle,  made, 
apj)arently,  by  a bullet,  but,  on  attempting  to  introduce  the  finger,  it  was  found  to  be  closed.  The  first  rib  was  fractured  at  its 
greatest  curvature,  but  was  not  entirely  broken  across.  There  was  one  hundred  and  eight  ounces  of  bloody  fiuid  in  the  thoracic 
cavity.  The  right  lung,  with  the  exception  of  a few  recent  adhesions  on  the  posterior  aspect  of  the  lower  lobe,  was  healthy. 
The  left  lung  had  a hole  through  it  about  one  inch  from  the  apex,  through  which  the  finger  could  be  introduced.  It  was  very 
much  compressed  by  the  fiuid.  The  ball  entered  at  the  attachment  of  the  rib  to  the  third  dorsal  vertebra,  the  left  transverse 
process  of  which  it  fractured,  and  was  found  lying  against  the  left  lamina  of  the  fourth  dorsal  vertebra,  which  it  had  fi’actured 
from  its  pedicle,  and  by  pushing  it  outward  and  backward  had  fractured  the  lamina  of  the  opposite  side  and  the  spinous  process. 
The  pathological  specimen  is  numbered  2843,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Acting 
Assistant  Surgeon  H.  M.  Dean. 

Case. — Private  Nathan  P , Co.  G,  124th  New  York  Volunteers,  aged  18  years,  was  wounded  at  Spottsylvania, 

Virginia,  May  10th,  1864,  by  a conoidal  ball,  which  caused  a penetrating  wound  of  the  chest.  He  also  received  a shell  woun<l 
over  the  renal  region.  He  was  taken  to  the  hospital  of  the  3d  division.  Second  Corps;  and,  on  May  10th,  transferred  to  Lincoln 
Hospital,  Washington,  where  he  died  on  May  17th,  1884.  At  the  autopsy,  the  ball  was  found  to  have  entered  two  and  one-fourth 
inches  posterior  to  the  right  acromion  process,  and  one  inch  below  the  spine  of  the  scapula,  causing  extensive  comminution  of 
the  spinous  and  transverse  processes  of  tlve  third,  fourth,  and  fifth  dorsal  vertebra}  of  the  right  side,  and  corresponding  ribs 
posterior  to  their  angles,  penetrated  both  lungs,  an<l  destroyed  that  portion  of  the  spinal  cord  lying  between  the  third  and  fourth 
vertebra}.  The  cord  was  also  diffluent  for  one-half  an  inch  above  the  third  dorsal  vertebra.  Above  and  below  these  points  it 
was  entirely  healthy.  The  fourth  rib  of  the  opposite  side  was  fractured  at  its  vertebral  attachment.  The  ball  was  found  in  the 
posterior  fold  of  the  axilla.  The  pathological  specimen  is  No.  2330,  Section  I,  A.  M.  M.,  and  was  contributed  by  Acting  Assistant 
Surgeon  A.  Ausell. 

Case. — Private  James  T.  L , Co.  G,  18th  Massachusetts  Volunteers,  aged  18  years,  received  a gunshot  penetrating 

wound  of  the  chest  at  Bull  Run,  Virginia,  August  30th,  1862.  He  was  treated  in  the  field  until  September  12th,  when  he  was 
sent  to  Master  Street  Hospilal,  Philadelphia.  Death  resulted  on  September  17th,  1862.  Necropsy : The  missile  had  entered 
over  the  head  of  the  right  humerus,  splitting  off  a fragment  of  it,  passed  through,  fractured  the  spinq  of  the  scapula,  coracoid, 
and  acromion  processes,  wounded  tire  lung,  driving  spiculae  of  bone  into  it,  thence  fractured  the  spine  of  the  second  and  the 
right  transverse  process  of  the  third  dorsal  vertebra  and  emerged  through  the  deltoid  muscle,  having  passed  through  the  left 
scapula  at  the  base  of  its  spine.  The  pathological  specimen  is  No.  843,  Section  I,  A.  M.  M.,  and  consists  of  the  second,  third, 
and  fourth  dorsal  vertebrae ; the  fragments  are  partly  agglutinated  by  new  deposit  and  the  spiculae  are  necrosed.  It  was 
contributed,  with  a history  of  the  case,  by  Surgeon  P.  B.  Goddard,  U.  S.  V. 

In  the  three  following  cases  of  gunshot  fracture  of  the  fourth  dorsal  vertebra,  the  usual 
symptoms  of  paralysis  and  functional  disturbances  of  the  alimentary  canal  and  urinary 
organs  were  observed  : 

Case. — Private  Frank  N.  H , Co.  G,  101st  Illinois  Volunteers,  aged  24  years,  a muscular  man,  in  excellent  health, 

was  wounded  on  board  the  ram  “Switzerland,”  at  Simmsport,  Louisiana,  June  3d,  1863,  by  a conoid.al  ball,  which,  passing 
through  an  oak  plank  two  inches  in  thickness,  entered  the  body  about  two  inches  above  the  inferior  angle  of  the  left  scaj)ula,  and 
passed  transversely  upward  and  a little  fonvard.  Complete  paralysis  of  the  lower  portion  of  the  body  immediately  ensued.  A 
small  quantity  of  air  escaped  from  the  wound  during  the  first  hour,  but  none  subsequently.  The  cxtenial  hsemorrhage  was 
slight,  and  but  about  four  ounces  of  blood  were  ejected  from  the  mouth.  The  respiration  was  but  little  .affected,  and  the  action 
of  the  heart  somewhat  increased.  The  introduction  of  a probe  was  quite  imi)ossible,  the  tendons  and  a])oneurotic  tissue  ])resent- 
ing  an  impassable  barrier.  The  patient  was  placed  in  bed  in  a sitting  posture,  supported  by  pillows,  and  seemed  to  be  (juite 
comfortable.  There  w.as  retention  of  urine  and  involuntary  ev.acuations  from  the  bowels  on  the  following  day,  iis  also  slight 


436 


WOUNDS  AND  INJURIP:>S  OF  THE  SPINE. 


[Chap.  IV, 


fever.  The  expectoration  of  blood  and  mucus  continued  about  twenty-four  hours,  becoming  gradually  less.  On  the  5tb,  the 
fever  had  somewhat  abated,  and  he  e.xpressed  himself  as  feeling  comfortable.  On  the  Glh,  he  was  transferred  in  an  ambulance, 
over  a very  rougb  corduroy  road,  to  the  hospital  steamer  Woodford.  A few  hours  after  his  transfer,  he  became  delirious,  and 
died  on  the  morning  of  .Tune  7th,  1863.  Al  the  autopsy,  the  ball  was  found  to  have  passed  upward  through  the  transverse 
process  of  the  fourth,  and  lodged  in  the  canal  opposite  the  third  dorsal  vertebra.  The  pathological  specimen  is  No.  1630,  Section 
I,  A.  Itl.  JI.,  and  was  contributed,  with  a history  of  the  case,  by  Surgeon  James  Roberts,  Mississippi  Marine  Brigade. 

Case. — Private  Alexander  L , Richardson’s  Partizan  Cavalry,  aged  18  years,  was  wounded  at  Warrenton  Junction, 

Virginia,  May  2d,  1863,  by  a small  conical  ball,  which  entered  at  the  lower  third  of  the  scapula  at  its  inner  edge,  passed  obliquely 
downward  and  to  the  left,  and  lodged  in  the  thorax.  He  was  admitted,  on  the  next  daj',  to  the  Mansion  House  Hospital, 
Alexandria.  On  admission,  he  was  found  to  have  paraplegia  and  complete  loss  of  sensation  of  all  parts  of  the  body  below  the 
fourtji  dorsal  vertebra.  Stimulants  and  tonics,  with  nourishing  and  sustaining  diet,  were  given.  On  May  Pith,  pneumonia  of 
the  left  lung  set  in,  which  rapidly  passed  into  the  third  stage.  His  tongue  was  clean  and  aj)petite  tolerably  good,  but  bis  pulse 
was  frequent  and  feeble.  An  expectorant  was  given,  with  an  anodyne  at  bedtime.  By  May  20th,  a cavity  had  formed  in  the 
lower  portion  of  the  left  lung  containing  fluid.  His  appetite  and  strength  were  diminishing.  On  the  22d,  several  gangrenous 
spots  appeared  on  the  lower  extremities.  His  urine  and  faeces  passed  continuously  and  involuntarily,  the  urine  displaying  the 
turbid  appearance  and  strong  ammoniacal  odor  so  characteristic  of  lesions  of  the  sjtinal  cord.  He  continued  to  grow  worse  and 
died  on  May  27th,  1863.  At  the  autops}’,  the  lower  and  part  of  the  upper  lobe  of  the  left  lung  were  found  entirely  destroyed 
and  converted  into  sanious  fluid,  of  which  there  were  found  three  pints  in  the  cavity  of  the  pleura.  The  ball  was  found  to  have 
passed  oblicpiely  downward  and  fortvard,  and  lodged  in  the  body  of  the  fourth  rib,  fracturing,  in  its  course,  the  spine  of  the 
fourth  dorsal  vert(;bra.  The  spinal  cord  at  this  point  was  found  softened  and  disintegrated.  The  pathological  specimen  is  No. 
1600,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Surgeon  Robert  Reyburn,  U.  S.  V. 

Case. — I’rivate  Oliver  A.  N , Co.  B,  13th  New  York  Cavalry,  aged  21  years,  was  wounded  at  Aldie,  Virginia, 

July  0th,  1884,  by  a couoidal  ball,  which  entered  the  right  side  below  the  nipple  and  lodged.  He  was  treated  in  the  field,  and, 
on  July  13th,  sent  to  the  3d  division  hospital,  Alexandria.  On  July  17th,  gangrene  appeared  in  the  wound.  Creasote  wms 
applied.  Stimulants,  anodynes,  and  tonics  were  administered,  and  nutritious  diet  given.  Death  occurred  on  July  23d,  1864. 
The  autopsy  revealed  a fracture  of  the  fifth  rib,  ulceration  of  the  lower  and  middle  lobes  of  the  i-ight  lung,  and  the  ball  imbedded 
in  the  fourth  dorsal  vertebra.  The  pathological  specimen  is  No.  3333,  Section  I,  A.  M.  M.,  and  w'as  contributed  by  Surgeon 
Edwin  Bentley,  U.  S.  V. 

Among  the  specimens  of  gunshot  wounds  of  the  fifth  dorsal  are  found  examples  of 
balls  lodged  in  the  body,  penetrating  the  pleural  cavity,  perforating  the  lung,  carrying 
foreign  bodies  before  them  into  the  substance  of  the  lung,  and  causing  effusions  into  the 
pleural  cavity.  Tlie  fifth  observation  will  be  remarked,  because  of  the  long,  interval 
between  the  reception  of  the  injury  and  the  fatal  issue,  when  the  bullet  had  traversed  the 
spinal  canal : 

Ca.se. — First  Lieutenant  F.  F , of  Mosby’s  command,  was  admitted  into  the  field  hospital  at  Sandy  Hook,  Maryland, 

September  5th,  1864,  with  a gunshot  fracture  of  the  upper  third  of  the  right  arm.  There  was  no  wound  of  exit.  He  died  on 
September  20th,  1864,  from  i)neumonia  and  secondary  haemorrhage.  At  the  autopsy,  the  track  of  the  ball  was  sbown  to  have 
been  in  the  long  axis  of  the  ami  and  down  the  chest.  The  pathological  specimen  is  No.  3515,  Section  I,  A.  M.  M.,  and  shows 
portions  of  the  dorsal  vertebrie,  with  a pistol  ball  firmly  imbedded  in  the  body  of  the  fifth,  nearly  the  whole  of  which  is  shattered. 
The  specimen  is  interesting  from  the  fact  of  the  injury  not  having  been  suspected  during  life.  It  was  contributed  by  Acting 
Assistant  Surgeon  J.  Younglove. 

Case. — Private  Lewis  N , Co.  G,  5th  AVisconsiii,  aged  20  years,  was  woundecl  in  the  left  chest  and  left  leg  at  Peters- 

burg, Virginia,  April  Cth,  1865.  He  was  taken  to  the  hospital  of  the  1st  division.  Sixth  Corps.  On  April  16th,  he  was 
transferred  to  the  1st  division  hospital,  Annapolis ; on  May  10th,  to  the  2d  division  hospital;  on  May  23d,  to  Jarvis  Hospital, 
Baltimore,  and,  on  July  24th,  to  Hicks’  Hospital.  When  admitted,  the  wound  discharged  large  quantities  of  foetid  pus,  evidently 
from  the  cavity  of  the  chest.  Tonics  and  stimulants  were  administered,  with  extra  diet.  The  wound  closed  up,  the  ball 
remaining.  Patient  gradually  failed.  Emaciation  was  extreme,  he  being  reduced  almost  to  a skeleton.  Death  resulted  on 
September  30th,  1865.  At  the  autopsy,  a conoidal  ball  was  found  to  have  entered  at  the  middle  of  the  posterior  fold  of  the 
axilla,  and  passed  inward  and  downward,  and  slightly  backward,  lodging  between  the  laminse  of  the  fourth  and  fifth  dorsal 
vertebrffi,  the  apex  of  the  ball  entering  the  spinal  canal,  but  not  ])ressing  ujioii  or  interfering  with  the  theca.  The  ))leural  sac 
had  been  opened  between  the  angles  and  heads  of  the  fourth  and  fifth  ilbs,  left  side.  Outside  of  this  point  of  opening,  the  callus 
had  formed  an  arch  between  the  angles,  so  that  the  finger  ()assed  over  a smooth  surface  in  approaching  from  the  outside  the  pohit 
of  ojiening  of  the  pleura.  The  pathological  specimen  is  No.  3171,  Section  I,  A.  M.  M.,  and  was  contributed  by  Surgeon  Thomas 
Sim,  U.  S.  V. 

Case. — Private  George  H.  C , Co.  H,  64th  New  York  Volunteers,  aged  17  years,  was  wounded  at  Petersburg, 

Virginia,  Mai'ch  25th,  1885,  by  a conoidal  ball,  which  entered  midway  between  the  centre  of  the  left  clavicle  and  the  sterno- 
cleido-mastoitl  muscle,  passed  inward  and  backward,  grazing  the  posterior  portion  of  the  upper  lobe  of  the  left  lung,  passed 
through  the  bodies  of  the  third,  fourth,  and  fifth  dorsal  vertebrm,  and  was  found  lying  loosely  on  the  sixth  rib,  right  side.  He 
was  treated  in  the  field  hospital,  and,  on  the  30th,  was  sent  to  Lincoln  Hospital,  Washington.  Tonics  and  stimulants  were 


Skct.  II.] 


FRACTURES  OF  THE  DORSAL  VERTEBRiE. 


437 


administered.  Deatli  occurred  on  April  Gtli,  1865.  The  necropsy  revealed  the  course  of  the  ball.  The  upper  lobe  of  the  left 
lung  and  the  lower  lobe  of  the  right  were  found  to  he  very  much  congested.  There  was  some  elfusion  on  the  right  side.  The 
pathological  specimen  is  No.  4082,  Section  I,  A.  M.  Jil.,  and  was  contributed,  with  the  history  of  tlie  case,  by  Acting  Assistant 
Surgeon  J.  P.  Arthur. 

— Private  Jacob  N , Co.  F,  1st  Maryland  Volunteers,  aged  26  j'ears,  was  wounded  at  Hatcher’s  Run, 

Virginia,  February  0th,  1835,  by  a conoidal  ball,  which  entered  the  right  side  of  the  thorax,  just  beneath  the  spine  of  the 
scapula,  and  lodged.  He  was  at  once  taken  to  the  hospital  of  the  2d  division.  Fifth  Corps,  where  simple  dressings  were  applied 
to  the  wound.  On  the  11th,  he  was  transferred  to  the  National  Hospital,  Baltimore.  An  exploration  of  the  wound  by  probing 
only  revealed  an  opening  through  the  scapula,  below  which,  examination  was  deemed  injudicious  on  account  of  the  j^roximity 
of  the  lung  posteriorly.  A few  days  after  admission,  tumefaction  Ix'gan  near  the  spinal  column  in  the  cellular  tissue  covering 
it.  This  tumefaction  increased  until  huctuation  became  manifest.  An  incision  of  an  inch  in  length  was  made  at  the  point 
where  the  w^all  was  thinnest,  and  about  twelve  fluid  ounces  of  pus  discharged.  This  discharge  conti  nued  and  was  very  profuse 
for  about  five  days,  w’hen  htemorrhages  supervened  from  the  posterior  opening.  These  occurred  daily,  and  the  patient  gradually 
sank  fi'om  exhaustion,  and  died  on  March  1st,  1865.  At  the  autopsy,  eight  hours  after  death,  the  ball  was  found  to  have  entered 
the  scapula  near  the  origin  of  the  siiinous  ])rocess,  passed  forward,  inward,  and  to  the  left,  at  an  angle  of  60°,  struck  between 
the  angles  of  the  fifth  and  sixth  ribs,  bearing  more  In-avily  upon  the  fifth  ; was  reflected  upward,  forwai'd,  and  to  the  left,  break- 
ing the  spinous  process  of  the  fifth  dorsal  vertebra,  and  lodging  under  the  rhomboid  muscle,  beneath  the  deep  fascia  of  tlie  left 
side.  A large  piece  of  blue  cloth,  carried  into  the  wound,  lodged  on  the  right  side  of  the  spinous  process.  A sac,  filled  with 
black  matter,  in  great  part  clotted  blood,  averaging  in  breadth,  from  two  inches  in  the  cervical  region  to  three  inches  in  the 
scapular  and  four  inches  in  the  doreal  and  fourteen  inches  in  length,  extending  from  the  fifth  cervical  to  the  first  lumbar  vertebra, 
was  observed.  On  the  left  side,  confined  by  the  deep  fascia,  was  an  abscess,  extending  from  the  last  cervical  vertebra  to  the 
sixth  doi-sal,  about  one  inch  in  length.  Having  cut  through  the  lamina  of  the  spinal  cord,  the  spinous  processes  were  removed. 
The  large  veins,  near  the  lamina  that  was  broken  by  the  ball,  were  found.  The  torn  extremities  of  a vein  were  found,  white 
and  old  looking,  near  the  point  of  injury.  The  spinal  cord  ^vas  thouglit  to  be  somewhat  thickened,  and  of  an  abnormal  dark 
color.  The  p.athological  specimen  is  numbered  1080,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by 
AV.  G.  Smull,  Acting  Assistant  Surgeon. 

Case. — Private  Henry  F.  W , Co.  II,  0th  Michig<an  Cavalry,  aged  48  ye.ars,  was  wounded  in  a skirmish  near 

Winchester,  Virginia,  November  18th,  1804,  hy  a mini6  ball,  which  entered  at  a point  on  the  left  side  of  the  fifth  dorsal  vertebra, 
p('rforated  the  bone,  injured  the  spinal  cord,  and  made  its  exit  on  the  right  side  of  the  chest,  between  the  third  and  fourth  ribs, 
without  involving  the  lung.  lie  was  treated  in  field  hospital  at  Winchester,  and  transferred  to  the  hospital  at  Frederick, 
December  23d,  1864.  When  admitted,  his  general  health  was  gi’eatly  impaired.  Pulse  very  feeble,  appetite  poor,  tongue  pale, 
teelh  covererl  with  sordes,  skin  cold  and  clammy,  and  body  considerably  emaciated.  The  muscles  of  the  thigh  were  atrophied. 
He  had  involuntary  discharges  of  feces  and  urine,  and  there  was  a frightful  sloughing  bed-sore  over  the  sacrum  and  one  on 
each  hip.  Paraplegia  was  complete  ; respiration  oppressive.  He  had  some  cough,  with  a muco-purulent  expectoration.  U))ou 
auscultation,  a bronchial  respiration  was  noticed  in  the  lower  lobe  of  the  right  lung  and  in  the  upper  h;be  of  the  left  lung;  moist 
rales,  likewise  dullness  over  same  upon  percussion.  Tonics,  stimulants,  and  generous  diet  were  administered,  and  counter- 
irritation ap])lied  externally.  The  bed-sores  were  ordered  to  be  thoroughly  syringed  twice  a day.  After  each  dressing  a poultice 
of  yeast  and  charcoal  was  applied.  The  jjatient’s  general  condition  deteriorated.  On  January  3d,  he  became  delirious  ; pulse, 
threadlike  and  almost  imperceptible.  He  died  on  the  same  day.  At  the  necropsy,  upon  removing  the  lungs,  the  lower  lobe  of 
the  light  was  found  to  be  completely  hepatized,  and  the  upper  lobe  of  the  left  filled  with  tubercles,  many  of  which  were  broken 
down,  fonning  little  abscesses.  The  fifth  doi’s.al  vertebra  was  removed  and  examined,  and  found  to  contain  the  track  of  the  ball 
communicating  with  the  medullary  cavity.  The  transverse  and  spinous  processes  of  this  vertebra  were  broken  off  from  its 
body,  and  the  lower  portion  of  the  spinous  process  of  the  fourth  vetebra,  as  well  as  the  upper  posterior  portion  of  the  body  of 
the  sixth.  The  ball  passed  directly  through  the  spinal  cord.  The  pathological  specimen  is  No.  38.50,  Section  I,  A.  M.  M.,  and 
was  contributed,  wdth  a history  of  the  case,  by  Acting  Assistant  Surgeon  J.  C.  Shimer. 

Histories  and  specimens  of  two  examples  of  gunshot  fracture  of  the  sixth  dorsal 
vertebra  were  contributed  : 

Case. — Sergeant  James  F.  U , Co.  B,  60th  Georgia  Regiment,  aged  24  years,  was  wounded  at  Petersburg,  Virginia, 

March  25th,  1865,  by  a conoidal  ball,  which  entered  at  the  sixth  dorsal  vertebra,  ploughed  its  way  upward  along  the  sj)inous 
processes,  and  imbedded  itself  in  the  third  dorsal  vertebra.  He  was  treated  in  the  field,  and,  on  the  30th,  sent  to  Lincoln  Hospital, 
Washington.  W^hen  admitted,  there  was  complete  paraplegia.  Both  faeces  and  urine  passed  involuntarily.  Tonics  and  stimu- 
lants were  administered.  The  patient  did  not  suffer  much  pain,  but  gradually  grew  weaker,  .and  died  on  April  4th,  1865.  The 
pathological  specimen  is  numbered  4083,  Section  I,  A.  !M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Acting  Assistant 
Surgeon  .1.  P.  Aithur. 

Case. — Corporal  Thomas  S , Co.  C,  20.5th  Pennsylvania  Volunteers,  was  received  into  the  3d  division  hospital, 

Alexandria,  April  8th,  1865,  having  died  on  board  the  hospital  steamer  State  of  Maine,  on  the  5th.  He  had  been  wounded, 
probably  before  Petersburg,  about  April  1st.  A necropsy  was  mtide;  a conoidal  ball  Imd  fractured  the  posterior  ytortion  of  the 
right  scapula  for  two  inches,  passed  upward  and  fractured  the  sixth  rih  externally  to  its  tuherclc,  passed  through  the  arches  of 
the  fifth  and  sixth  dorsal  vertebra,  and  lodged  in  the  cervical  portion  of  the  left  trayiezius.  The  lower  border  of  the  right 
transverse  proc(w.s  of  the  sixth,  the  .spinous  ])rocesses  of  both,  and  a portion  of  the  left  transverse  process  of  the  fifth  had  been 
carried  away,  and  incipient  caries  existed  in  the  body  of  the  sixth.  The  pathological  specimen  is  numbered  3230,  Section  I,  A. 
M.  M.,  and  was  contributed  by  Surgeon  Edwin  Bentley,  U.  S.  V. 


438 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[Chap.  IV, 


Among  the  gunshot  wounds  of  the  vertebral  column,  reported  in  detail,  were  several 
in  wliich  the  seventh  dorsal  was  chiefly  involved : 

Case. — Corporal  George  W.  M , Co.  B,  53cl  Pennsylvania  Volunteers,  aged  19 

years,  was  admitted  into  Harewood  Hospital,  Washington,  June  7th,  1864,  having  been 
wounded  at  Cold  Harbor  on  the  3d.  A conoidal  musket  ball  had  entered  near  the  inferior 
angle  of  the  left  scapula,  and  passing  downward,  inward,  and  forward,  through  the  left 
lung,  lodged  in  the  vertebral  canal  after  fracturing  the  transverse  process  of  the  seventh  dor- 
sal vertebra.  The  patient  sufl'ered  from  retention  of  urine  and  paraplegia;  pneumonia  also 
^complicated  the  case.  Owing  to  the  extreme  prostration,  no  active  antiphlogistic  measures 
were  employed.  The  patient  was  kept  in  bed  ; fed  on  beef-tea,  and  quinine  with  whiskey,  milk 
punch,  etc.  Stimulating  frictions  were  frequently  applied  to  the  legs  and  hips,  and  the  clu'st 
was  enveloped  in  an  oil-skin  jacket.  He  died  on  June  19th,  18G4.  At  the  autopsy  the  ball 
was  found  imbedded  in  the  substance  of  the  seventh  dorsal  vertebra,  encroaching  upon  the 
Fig.  190.— Gunshot  fracture  cf  medulla  spinalis.  The  lungs  at  their  bases  were  hepatized,  and  near  the  apices  were  filled  with 
tebra°''^^L*303o'sect  m"  *'•  tlark,  frothy  fluid.  The  pathological  specimen,  represented  in  the  adjoining  wood-cut,  was 

contributed  to  the  Army  Medical  Museum,  with  the  particulars  of  the  case,  by  Surgeon  E.  B. 
Bontecou,  U.  S.  V. 

Case. — Captain  Thomas  H , Co.  A,  C7th  Indiana  Volunteers,  was  wounded  at  Carrion  Crow,  Louisiana,  NovemhiT 

3d,  1863,  by  a pistol  ball,  which  entered  about  four  inches  to  the  right  of  the  fourth  dorsal  vertebra.  He  was  treated  in  the 
field  hosjiital  until  November  9th,  when  he  was  transferred  to  St.  James  Hospital,  New  Orleans.  Upon  admission,  there  was 
partial  paralysis  of  the  left  thigh  and  extremity.  After  the  most  careful  examination  the  course  of  the  ball  could  not  be  detected, 
and  the  tract  of  the  spinal  column,  both  above  and  below  the  wound  being  equally  sensitive,  no  correct  diagnosis  as  to  location 
could  be  made,  save  that,  from  the  symptoms,  lesion  of  the  cord  had  taken  place.  The  paralysis,  in  the  first  week,  invaded  the 
right  leg  as  well  as  the  bladder  and  rectum,  the  only  noticeable  instance  of  excito-motory  action  being  the  peculiarity  that 
tickling  the  glans-penis  produced  a partial  evacuation  of  the  bladder.  This  feature  continued  to  the  end  of  the  case.  Beloiv 
the  wound,  the  paralysis,  for  three  weeks  preceding  death,  was  entire,  of  both  the  sensory  and  motory  functions.  The  super- 
vention of  acute  pneumonia  proved  the  immediate  cause  of  death,  which  occurred  on  December  19th,  1863.  The  post-mortem 
examination  showed  the  ball  to  have  passed  downward  and  inward,  slightly  wounding  the  costal  pleura  and  fracturing  the  right 
transverse  process  of  the  seventh  dorsal  vertebra,  in  the  body  of  which  it  had  lodged,  producing  a slight  exfoliation  from  the 
inner  wall  of  the  canal,  thus  causing  compression  and  inflammation  of  the  cord  ; pus  was  found  in  the  theca.  The  right  lung  was 
far  advanced  in  suppuration.  The  pathological  specimen  is  No.  2999,  and  was  contributed,  with  a history  of  the  case,  by  Assist- 
ant Surgeon  S.  H.  Orton,  U.  S.  A. 

Case. — Private  Andrew  C , Co.  C,  32d  New  York  Volunteers,  was  admitted  to  Judiciary  Square  Hospital,  Wash- 

ington, May  14th,  1862,  with  a gunshot  fracture  of  the  transverse  processes  of  the  seventh  and  eighth  and  the  spinous  process 
of  the  eighth  dorsal  vertebrae;  the  sheath  of  the  spinal  cord  was  injured.  When  admitted,  there  was  paraplegia,  and  hyper- 
aesthesia  of  the  crural  nerves.  He  died  on  May  30th,  1862,  from  pyaemia.  The  pathological  specimen  is  No.  796,  Section  I, 
A.  M.  hi.,  and  was  contributed,-  with  a history  of  the  case,  by  Assistant  Surgeon  C.  C.  Byrne,  U.  S.  A. 

The  Museum  contains  four  specimens  illustrating  gunshot  fractures  of  the  eighth 
dorsal  vertebra. 

Case. — Private  Thomas  C , Co.  G,  8th  Illinois  Cavalry,  aged  30  years,  was  wounded  at  Upperville,  Virginia, 

June  21st,  1863,  by  a musket  ball,  which  entered  the  right  side  of  the  thorax,  between  the  sixth  and  seventh  ribs,  two  and  a half 
inches  below  the  nipple  and  two  inches  from  the  sternum,  remaining  in  the  body.  He  was  taken  to  the  Cavalry  Corps  Hospital, 
Army  of  the  Potomac,  and,  on  June  24th,  transferred  to  Lincoln  Hospital,  Washington.  The  wound  of  entrance  soon  healed. 
An  examination  revealed  the  presence  of  fluid  in  small  quantity  in  the  left  pleural  cavity,  with  compression  of  the  lower  lobe  of  the 
lung.  He  did  not  complain  of  pain  in  the  side,  which  varied  very  slightly  in  circumference  to  that  of  the  right.  The  scapula  of 
that  side  was  almost  motionless  on  respiration.  Cough  moderate;  sputa  none.  He  was  troubled  with  a persistent  diarrhoea, 
which  assumed  almost  the  same  characteristic  as  the  ordinary  chronic  diarrhoea,  being  accompanied  with  extreme  emaciation, 
abdominal  pain,  scantiness  of  the  secretions,  and  capricious  appetite.  In  the  latter  part  of  November,  the  patient  commenced  to 
sink.  A severe  cough  came  on.  Expectoration  became  profuse  and  sputa  very  offensive.  Orthopnoea  marked.  His  mind, 
however,  was  clear.  The  diarrhoea  increased  in  violence.  About  December  1st,  the  person  of  the  patient  became  very  ofi'ensive. 
Delirium  set  in.  Death  supervened  on  December  9th,  1863.  The  autopsy  showed  the  posterior  jiortion  of  the  right  lung  much 
compressed ; the  third  lobe  was  carnified  and  the  posterior  portion  of  the  lung  covered  with  a thick  layer  of  roughened  lymph  ; 
between  this  and  the  pleura  costalis  was  found  one  quart  and  two  ounces  of  dark  ami  offensive  pus.  The  liver  was  covered  on 
the  peritoneal  surface  by  thick  adhesive  bands.  The  kidneys  were  greatly  congested.  There  was  no  ulceration  of  the  intestines. 
The  ball  was  found  firmly  wedged  in  between  the  head  of  the  eighth  dorsal  vertebra  of  the  right  side  and  the  corresponding  rib. 
The  pathological  specimen  is  numbered  1954,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a historv  of  the  case,  by  Assistant 
Surgeon  H.  Allen,  U.  S.  A. 

Case. — Private  Andrew  McConnell,  Co.  E,  30th  Wisconsin  Volunteers,  was  wounded  at  Camp  Smith,  Wisconsin,  June 
20th,  18()3,  by  the  accidental  discharge  of  a gun,  the  wad  from  which  entered  just  to  the  left  of  the  spinous  process  of  the  eighth 
dorsal  vertebra  and  lodged  on  the  body  of  the  vertebra,  lacerating  the  parts  very  much,  and  producing  severe  concussion.  He 
w.as  taken  to  the  regimental  hospital,  where  the  w.ad  was  extracted,  and  cold-water  di’essings  applied  to  the  wound.  Entire 
paralysis  of  body  below  seat  of  injury.  Death  resulted  on  July  29th,  1863,  from  general  exhaustion  and  debility- 


Sect.  II.] 


FRACTURES  OF  THE  DORSAL  VERTEBRA. 


439 


Case. — Private  William  II.  C , Co.  II,  14th  New  York  Artillery,  aged  20  years,  was  wounded  at  Spottsylvania, 

Virginia,  May  18th,  18G4,  by  a couoidal  ball,  which  entered  at  the  spine  of  the  right  scai)ula,  passed  inward,  fractured  the  fifth 
rib,  the  inferior  part  of  the  eighth  dorsal  vertebra,  the  lamina  of  the  process,  and  supeiior  articular  process  of  the  ninth  dorsal 
vertebra,  and  lodged  in  the  spinal  canal.  He  was  treated  until  May  2Gth,  when  he  was  sent  to  Douglas  Hospital,  Washington. 
When  admitted,  there  was  complete  paraplegia  and  paralysis  of  both  bladder  and  rectum.  An  abscess  formed  between  the  lung 
and  thoracic  parietes,  which  contained  about  six  ounces  of  pus.  He  died  on  May  27th,  1864.  The  pathological  specimen  is  No. 
3530,  Section  I,  A.  M.  M.,  and  was  contributed  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A. 


Case. — Private  Alexander  McLain,  Co.  E,  7th  Michigan  Cavalry,  was  shot  in  the  back,  at  Fairfax  Station,  Virginia, 
May  11th,  18G3,  by  a rebel  guerilla.  He  was  admitted,  on  the  14th,  to  the  regimental  hospital  of  the  2d  Pennsylvania  Reserves. 
There  was  complete  paralysis  of  the  body  from  the  shoulders  to  the  feet;  great  dyspnoea  and  a 
continued  desire  to  expectorate  without  being  able ; paralysis  of  bladder,  with  complete  retention 
of  urine.  Constipation  for  the  first  four  days,  afterward  involuntary  stools.  Skin  dark-yellow, 
and,  for  several  days,  unusually  hot  to  the  touch.  Death  resulted  on  May  22d,  eight  days  after 
the  reception  of  the  injury.  Necropsy : The  missile,  a conoidal  pistol  ball,  entered  the  back, 
fracturing,  or  rather  crushing  the  spinous  process  of  the  eighth  dorsal  vertebra,  passed  into  the 
spinal  canal,  and  up  through  the  medulla  spinalis  as  far  as  the  first  cervical  vertebra,  where  it 
was  found  almost  entire  but  very  much  out  of  shape.  Two  small  pieces  had  separated  in  its 
striking  the  spinous  process;  and  were  found  imbedded  in  the  transverse  process.  The  lungs  were 
congested  and  full  of  very  dark  blood.  The  bladder  contained  about  four  ounces  of  thick  mucus- 
like substance. 

There  is  also  a specimen  illustrating  the  results  of  spinal  menin- 
gitis, from  a gunshot  injury  of  one  of  the  dorsal  vertehrm.  It  is  hardly 
practicable  to  determine  which  bone  was  injured  : 

Case. — Private  Thomas  B , Co.  F,  122d  Ohio  Volunteers,  aged  37  years,  received  a 

gunshot  wound  of  the  back,  at  the  Wilderness,  May  Cth,  1864 ; the  ball  entered  over  the  trans- 
verse process  of  the  dorsal  vertebra  and  lodged  in  the  bone.  He  was  sent  to  Washington,  and 
admitted,  on  the  next  day,  to  Mount  Pleasant  Hospital.  On  Jlay  15th,  lie  was  transferred  to 
Jarvis  Hospital,  Baltimore,  where  he  died  on  July  20th,  1864,  from  spinal  meningitis.  At  the 
necropsy,  the  ball  was  found  to  have  struck  the  body  and^  fractured  the  transverse  process  of  the 
dorsal  vertebra.  The  bone  was  necrosed.  The  membranes  of  the  spine,  for  two  inches  above  and 
below  the  injury,  showed  unequivocal  marks  of  intense  inllamination  and  ulceration.  The  path- 
ological specimen  was  contributed,  with  a history  of  the  case,  by  Acting  Assistant  Surgeon  B.  B. 

Miles,  Curator  of  Jarvis  Hospital.  It  consists  of  a portion  of  the  spinal  cord,  partially  disorgan- 
ized, as  represented  in  the  adjoining  wood-cut  (Fig.  191). 


Fig.  191. — Segment 
cord  ulcerated  after 
Spec.  3190,  Sect.  I,  A. 


of  spinal 
injury. 
M.  M. 


Instances  of  fractures  of  the  spine  by  pistol  and  musket  balls,  involving  the  ninth 
dorsal  mainly,  are  illustrated  in  the  Museum  by  four  specimens.  In  two  of  these  the  missile 
was  lodged  in  the  spinal  canal : 


Case.— Private  Frederick  L , Co.  H,  8th  New  York  Volunteers,  aged  26  years, 

having  been  wounded  at  Cold  Harbor,  Virginia,  June  3d,  1864,  was  sent  to  Washington,  and 
admitted  to  Carver  Hospital  on  the  11th.  A missile  had  entered  the  right  side  of  his  back, 
and  penetrated  the  vertebral  canal,  shattering  the  transverse  and  articular  processes  of  the 
eighth  and  ninth  dorsal  vertebrae.  The  patient  stated  that  immediately  upon  the  reception  of 
this  injury  he  lost  all  sensation  and  power  of  motion  below  the  wound.  On  admission,  he 
was  in  a very  feeble  state;  there  was  psychical  depression,  with  slow  pulse,  labored  respira- 
tion, cool,  clammy,  and  cyanosed  skin,  and  involuntary  passages  of  the  excretions.  In  this 
forlorn  condition,  he  lingered  until  June  27th,  when  symptoms  of  extreme  gastric  irritability 
supervened,  and  every  form  of  nourishment  was  promptly  rejected  by  the  stomach.  He  died 
on  July  2d,  1864.  At  the  autopsy,  a conoidal  musket  ball  was  found  imbedded  m the  verte- 
bral canal.  The  cord  appeared  to  have  been  completely  severed  at  tbe  seat  of  injury,  and 
was  disorganized  above  and  below.  A section  of  the  injured  vertebras,  having  the  ball  in  the 
canal,  was  forwarded  to  the  Army  Medical  Museum,  with  the  above  account,  by  Surgeon 
O.  A.  Jud.son,  U.  S.  V.  It  is  represented  in  the  accompanying  wood-cut  (Fig.  192). 


Fig.  192. — Conoidal  musket  Ii.aU 
lodged  in  the  spinal  canal,  between 
llie  eighth  and  ninth  vertebrae.  Spec. 
2939,  Sect.  I,  A.  M.  M. 


Case. — Adam  AV , a political  prisoner,  aged  33  years,  was  admitted  to  Hospital  No,  1,  Nashville,  Tennessee, 

March  3d,  1864,  with  a pistol-shot  wound  in  the  right  side  of  the  abdomen,  received  on  February  10th,  1864,  the  ball  lodging  in 
the  body  of  the  ninth  dorsal  vertebra.  He  died  on  May  18th,  1864,  from  pneumonia.  The  pathological  specimen  is  No.  2204, 
Section  I,  A.  M.  il.,  and  was  contributed,  with  a history  of  the  case,  by  Acting  A.ssistant  Surgeon  G.  1’;  Ilachenberg. 


440 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[ClIAP.  IV, 


Cask. — Private  Silas  B , Co.  E,  4th  Vei-nioiit  Volunteers,  aged  j'cars,  was  womide<l  at  the  Wilderness.  Virginia, 

May  Cth,  1.SG4,  by  a bullet,  which  entered  at  the  po.stericr  margin  of  the  left  sca])nla.  He  was  t.aken  to  the  field  hosi)ital  of  the 
Sixth  Corps,  where  he  remained  until  the  I3th,  when  he  was  transferred  to  Douglas  Hospital,  Washington.  Trar.matic  pleuro- 
Itneiimonia  soon  appeared;  the  right  jdeural  cavity  became  full  of  serum  and  paracentesis  was  about  to  be  perfonned,  when  the 
S(!rnm  found  a free  escape  from  the  tvound  of  entrance.  The  discharge  of  serum  was  profuse ; the  vital  powers  gradually 
became  enfeebled,  and  he  sank  and  died  from  exhaustion  on  May  21st,  18G4.  Necropsy : The  ball  was  found  to  have  jjassetd 
downward  and  toward  the  right  side,  comminuting,  in  its  course,  the  spinous  processes  of  the  lower  dorsal  vertebrat  and  the 
seventh,  eighth,  ninth,  and  tenth  ribs,  and  lodged  beneath  the  skin  over  the  twelfth  rib  on  the  right  side.  The  right  thoracic 
cavity  was  partially  tilled  with  dark-colored  ofIVnsive  serum  ; the  lung  was  covered  posteriorly  with  a large  layer  (;f  lymiih. 
There  was  no  consolidation  of  the  hing,  but  it  was  stained,  of  a dirty  greenish  color  externally,  and  was  softened  within.  The 
pleura  was  lacerated  by  fragments  of  bone,  and  several  spicnlaa  were  removed  from  the  thoracic  cavity.  The  pathological 
specimen  i.s  No.  3524,  Section  I,  A.  M.  51.,  and  consists  of  the  sixth,  seventh,  eighth,  ninth,  and  tenth  dorsal  vertebra*.  The 
right  transverse  processes  of  the  seventh  and  eighth  are  carried  away,  and  a fr.agment  of  the  ninth  is  chipped  off'.  A portion  of 
tile  fragments  of  theTractured  ribs  are  with  the  specimen.  It  was  contributed,  with  a history  of  the  case,  by  Assistant  Surgeon 
W.  Thomson,  U.  S.  A. 

Case. — Private  Charles  S , Co.  E,  87th  Pennsylvania  Volunteens,  aged  20  years,  was  wounded  on  .Inly  9th,  1834.  at 

5I(  nocacy,  il.aryland,  and  was  admitted.to  hospital  at  Frederick,  on  the  10th.  A musket  ball  having  entered  at  the  inferior 
border  of  the  left  sca})ula,  passed  inward  and  backward,  and  struck  the  spine,  causing  com|)lete  para- 
plegia. The  urine,  having  been  retained  since  the  i-eception  of  the  wound,  was  drawn  off  ivilh  a 
catheter.  The  wound  of  entry  was  dressed  simply.  The  patient  was  allowed  a generous  diet,  with 
one  bottle  of  ale  a d.ay.  He  complained  of  no  pain.  The  case  jirogi’essed  as  follows — .July  1.5th: 
Wound  suppurating  very  little;  slight  excoriation  over  sacrum;  jiatient  placed  on  a water-bed;  was 
catheterized  for  two  days  only  ; since  then  the  urine  dribbles  away  involuntarily ; ))enis  kept  in  the 
mouth  of  a urinal;  appetite  good.  August  1st:  Patient  becoming  soniewh.at  emaciated;  appetite 
failing;  sloughing  of  lower  extremities ; urine  and  fffices  still  jiassed  involuntailly.  In  addition  to 
other  treatment,  ordered  a pint  of  sherry  daily.  September  1st : Gradual  failing  occurred  during 
last  month  ; sloughing  extending;  supportive  measures  still  kept  up.  October  1st : Patient  rapidly 
failing;  treatment  continued.  October  13th  : Died  from  exhaustion.  Autopsy  twelve  hours  subse- 
quently : Body  much  emaciated ; rigor  mortis  VivW  markeil;  left  lung  much  compressed,  and  cavity 
filled  with  sero-purulent  fluid;  right  lung  partiallj*  hepatized ; abdominal  viscera  healthy.  The 
posterior  aspect  of  the  entire  dorsal  vertebra  seemed  perfectly  sound.  Knowing,  however,  that  the 
ball  had  injured  the  cord,  a portion  of  the  column,  including  the  fourth,  fifth,  si.xth,  seventh,  and 

eighth  vertebrae,  was  removed.  A section  was  then  made  through  the  fifth  vertebra,  which  jjassed 

through  the  upper  portion  of  the  ball,  which  was  found  lying  in  the  spinal  canal.  The  ball  had 
passed  through  the  intervertebral  notch  between  the  ninth  and  tenth  vertebrae,  producing  only  a 
very  slight  fracture,  and,  turning  dowmward,  had  lodged  at  that  point.  The  upper  end  of  the  spinal 
cord  was  much  softened.  The  pathological  specimen,  figured  in  the  adjoining  wood-cut,  was 
contributed  to  the  Army  iledical  5Iuseum,  with  the  histoiy,  by  Acting  A’ssistant  Surgeon  W.  S. 
Adams. 

The  specimens  of  gunshot  fractures  of  the  tenth  dorsal  preserved  are  from  cases  in 
which  the  cavities  of  the  chest  or  .abdomen  were  implicated; 

Case. — Private  .Tohn  Blumm,  Co.  C,  1st  Battalion  California  5Iountaineers,  was  wounded  in  a fight  with  the  Indians,  at 
Redwood  Creek,  California,  July  13th,  1803,  by  a round  ball,  which  entered  about  two  inches  to  the  left  of  the  spine,  striking 

the  tenth  rib,  running  along  it  to  the  spine,  cutting  the  articular  processes,  passing  between  and  through,  crushing  the  spinal 

marrow,  and  cutting  the  transverse  processes  on  the  right  side,  fractured  the  ninth  and  tenth  ribs,  and  lodged  against  the  spine, 
between  it  and  the  pleura.  He  lay  on  the  ground  twenty-four  hours  before  receiving  medical  attention.  He  was  then  conveyed 
to  Fort  Humboldt,  California,  where  he  arrived  on  the  IGth.  There  was  paralysis  of  the  rectum,  bladder,  and  lower  extremities. 
Stimulants  were  administered.  Death  resulted  on  July  31st,  1863.  The  necropsy  revealed  the  track  of  the  ball.  The  missile 
was  found  cut  in  two. 

Case. — Private  James  S , Co.  B,  1st  District  of  Columbia  Cavalry,  robust  and  well-developed,  received  a gunshot 

wound  of  the  liver  and  spine,  in  a bar-room  fracas  in  Washington,  on  October  18th,  1863.  He  was  admitted,  at  two  o’clock, 
A.  M.,  October  19th,  to  Douglas  Hospital.  When  admitted,  the  surface  was  cold  and  p.ale;  ])ulse  small  and  feeble;  counten.anee 
anxious ; great  depression  of  the  vital  powers  and  pain  at  the  seat  of  injury.  This  state  of  collapse,  together  with  dyspna-a, 
and  a peculiar  rattling  of  the  throat,  as  also  a dulness  of  the  abdomen,  on  percussion,  indicated  that  internal  hasmoriliage 
I'xisted.  The  lungs  were  not  implicated.  The  wound  was  a small  hole,  circular  in  form,  depressed,  of  a livid  color,  and 
incapable  of  admitting  the  little  finger.  It  was  situated  on  the  right  hypochondrium,  just  below  the  cartilage  of  the  tenth  rib, 
one-fourth  of  an  inch  externally  to  the  mammillary  line.  The  wound  was  continually  discharging  a small  quantity  of  venous 
blood  and  bloody  serum.  The  patient  was  perfectly  conscious.  He  complained  incessantly  of  great  coldness  and  pain  near  tl’.e 
wound.  Upon  removing  his  clothing  it  was  found  that  alvine  discharges  passed  involuntarily  from  him.  Stimulants  were  given 
freely,  and  water  dressings  applied  to  the  wound,  with  mustard  poidtices  to  the  calves  of  the  legs  to  reston*  the  circulation  of 
blood  to  the  superficial  skin.  An  anodyne  was  given.  At  lune  and  a half  o’clock  A.  M.,  he  had  somewhat  revived.  The  ])ale- 
ness  was  not  so  well  marked,  and  his  strength  had  rallied  from  the  nervous  shock.  Death  resulted  at  a ((uarter  past  eleven 


Fig.  193. — Conoidal  musket 
ball  ludged  in  the  vertebral  ea- 
nal  Spec.  3984,  Sect.  I,  A.  M.  M. 


SliCT.  II.  ] 


FRACTURES  OF  THE  DORSAL  VERTEBRA5. 


441 


o'clock  P.  M.,  October  19tli,  1863.  Necropsy:  The  boll  bad  entered  the  anterior  superior  aspect  of  the  i igbt  lobe  of  the  liver, 
and,  after  traversiug  it  inward,  downward,  and  backwaid,  emerged  at  the  inferior  posterior  aspect,  external  to  the  vena-cava, 
penetrated  the  body  of  the  eleventh  dorsal  vertebra  anterioily  on  the  right  side,  passed  obliquely  upward  and  backward  through 
the  body  of  the  tenth,  completely  shattering  it  jmsteiioily  and  breaking ’oif  the  right  pedicle,  passed  upward  and  to  the  left,  and 
emerged  through  the  left,  lamina  of  the  ninth  vertebra,  resting  against  the  corresponding  lib.  There  was  a considerable  quantity 
of  extravasated  blood  in  the  abdominal  cavity.  The  lungs  were  congested,  but  otherwise  healthy.  The  other  organs  were 
apparently  intact.  The  pathological  specimen,  consisting  of  the  last  six  dorsal  vertebra),  is  No.  2238,  Section  I,  A.  JM.  M.,  and 
was  contiibuted,  with  a history  of  the  case,  by  Acting  Assistant  Surgeon  Carlos  Carvallo. 

Of  gunshot  fracture  of  the  eleventh  vertebra,  the  Museum  possesses  also  a specimen 
in  which  the  spinous  process  was  carried  away,  and  the  right  transverse  process  partially 
fractured;  {/Sjjec.  2737,  Sect.  I,  A.  M.  M.)  A special  report  was  made  of  another  gunshot 
fracture  of  this  bone  ; 

Case. — Private  Joseph  Bass,  Co.  C,  43d  North  Carolina  Regiment,  was  wounded  at  Winchester,  Virginia,  September 
19th,  1864,  by  a conoidal  ball,  which  fractui-ed  the  eleventh  dorsal  vertebra.  He  was  at  once  taken  to  the  field  hospital,  where 
simple  dressings  were  applied.  I’aralysis  of  the  lower  extremities  supervened,  and  death  occurred  on  October  3d,  1864. 

Of  the  specimens  of  gunshot  injuries  of  the  last  dorsal  vertebra,  in  the  Museum 
collection,  two  are  from  patients  who  suffered  from  wounds  of  the  thoracic  or  abdominal 
cavities  as  well,  and  one  which  is  interesting  as  having  been  inflicted  by  a torpedo  ; 

Case. — Private  W.  A , Co.  F,  114th  Colored  Troops,  aged  about  25  years, 

large  and  robust,  was  shot  at  Brownsville,  Texas,  on  the  morning  of  January  28th, 

1866,  and  was  admitted  to  the  post  hospital.  He  died  in  thhty-eighl  hours.  At  the 
post  mortem,  it  was  found  that  the  ball  had  entered  two  inches  below  and  outside  of  the 
right  nipple,  gouged  out  its  calibre  from  the  upper  border  of  the  eighth  rib,  passed 
through  tlie  lower  lobe  of  the  right  lung,  the  diaphragm,  the  right  lobe  of  the  liver, 
and  lodged  in  the  body'  of  the  last  dorsal  vertebra.  The  pathological  specimen,  shown 
in  the  accompanying  wood-cut,  was  contributed  to  the  Army  Medical  Museum,  with 
the  history,  by  Assistant  Surgeon  Ira  Perry,  9th  U.  S.  Colored  Troops. 

Case. — Private  James  M , 2d  New  York  Cavalry,  aged  35  years,  was  admitted  to  the  2d  division  ho.sjiital, 

Alexandria,  Virginia,  October  2'^th,  1864,  from  the  Orange  and  Alexandria  Railroad  depot,  with  a pistol  shot  wound  of  the  left 
side  of  the  sjiine,  fracturing  the  twelfth  dorsal  vertebra,  said  to  have  been  received  in  action.  When  adndtted,  he  was  much 
depressed;  pulse  about  130;  tongue  very  thick  and  heavily  coated;  a great  deal  of  pain  over  the  abdomen  and  right  side.  His 
bowels  had  not  moved  for  three  days.  There  was  incontinence  of  urine.  All  below  a direct  line  from  wound  to  jiubis  was 
paraplegic.  About  thretf  pints  of  very  thick  and  dark-colored  urine  were  drawn  oft"  with  a catheter.  Stimulants,  tonics,  and  a 
cathartic  were  given,  with  an  anodyne  at  night.  Under  this  treatment,  he  began  to  improve,  and  did  well  until  November  loth, 
when  a bad  cough  set  in.  On  the  18th,  in  a fit  of  violent  coughing,  ha)moj)tysis  occurred  to  the  amount  of  a quart.  Death 
occurred  in  one-half  hour  afterward.  At  the  necropsy,  upon  opening  the  spinal  column  posteriorly  from  the  second  dorsal 
vertebra  to  the  sacrum,  the  muscular  tissue  in  the  lumbar  region  was  found  to  be  very  dark  and  softened.  No  abscesses  or 
infiltrated  pus  could  be  detected  in  it.  Upon  removing  the  spinal  cord  the  dura  mater  was  found  congested  and  firmly  adherent 
to  the  vertebra).  The  substance  of  the  coni  looked  very  red.  The  ball  had  passed  between  the  arches  of  the  twelfth  dorsal  and 
the  first  lumbar  vertebra),  then  through  the  body  of  the  twelfth  dorsal  on  the  right  side,  outside  of  the  spinal  meninges.  Its 
further  track  could  not  be  traced.  In  making  this  examination,  the  cavity  of  the  right  pleura  was  opened  and  from  it  escaped 
about  three  pints  of  dark  bloody  fluid,  which  emitted  a very  offensive  odor.  The  pathological  specimens  are  numbered  3449  and 
3500,  Section  I,  A.  M.  M.,  and  were  contributed,  with  a history  of  the  case,  by  Surgeon  Edwin  Bentley,  U.  S.  V. 

Case. — William  P , a sailmaker’s  mate  of  the  United  States  steamer  Sciota,  received  an  injury  of  the  spine  by  the 

explosion  of  a torpedo,  on  April  14th,  1865.  He  was  taken  on  board  the  United  States  steamer  Tallahatchie  and  sent  to  hosj)ital 
at  Pensacola,  Florida,  where  death  resulted  on  May  5th,  1865.  At  the  necropsy,  the  spinous  process  of  the  twelfth  dorsal 
vertebra  wtis  found  vertically  fractured  near  its  extremity,  and  the  body  of  the  vertebra  transversely  fractured,  with  comminution 
in  its  superior  fourth.  The  fractured  edges  were  necrosed.  The  pathological  specimen  is  No.  2447,  Section  I,  A.  M.  M.,  and 
w:i8  contributed  by  Surgeon  P.  J.  Ilorwitz,  Chief  of  the  Bureau  of  Medicine  and  Surgery,  U.  S.  Navy. 

Gunshot  Injuries  of  the  Lurnhar  Yertebrez. — There  were  more  than  seventy  recoveries 
after  gunshot  fractures  of  the  apophyses  of  the  lumbar  spine.  The  following  are  examples 
that  fairly  illustrate  this  series.  The  complete  recoveries  were  less  numerous  than  the 
cases  of  those  who  survived  but  remained  paralytic  or  troubled  with  fistulous  openings, 
exfoliations,  and  abscesses  : 

Cask. — Private  James  McDonald,  Co.  C,  8th  New  Jersey  Volunteers,  aged  32  j-ears,  was  wounded  at  Ilnfcher’s  Pun, 
Virginia,  April  2d,  1805,  hy  a conoidal  ball,  which  entered  the  right  side,  above  the  ci'cst  of  the  ilium,  and  lodged  in  llie  irans- 
oU 


FlO.  194. — Pistol  ball,  calibre  .37,  lodged  in 
the  last  dorsal  vertebra.  *S^ec.  31 80,  Sect.  1, 
A.  M.  M. 


442 


WOimDS  AND  INJURIES  OF  THE  SPINE. 


[Chap.  IV, 


voi-se  process  of  the  first  lumbar  vertebra.  He  was  taken  to  the  field  hospital  of  the  Second  Corps,  and,  on  April  btb,  sent  to 
Douglas  Hospital,  Washington.  Secondary  hsemon’liage  occurred  on  the  12th,  which  was  controlled  by  compression.  On  the 
14th,  the  ball  was  extracted.  This  man  was  discharged  from  service  on  September  11th,  1865.  On  October  20th,  he  was  readmitted 
to  Douglas  Hospital  by  order  of  the  medical  director.  Necrosis  of  the  transverse  process  of  the  first  lumbar  vertebra  was 
diagnosed.  He  was  transferred  to  Harewood  Hospital  on  November  2d,  and  finally  discharged  fi’om  hospital  on  November  9tb, 
1865.  He  is  not  a pensioner. 

Case. — Sergeant  James  D.  Hogan,  Co.  C,  1st  New  York  Volunteers,  was  wounded  at  Manassas,  Virginia,  August  30th, 
18G2,  by  a conoidal  ball,  which  entered  two  and  one-half  inches  to  the  right  of,  and  on  a level  with,  the  second  lumbar  vertebra, 
and  lodged.  He  also  leeeived  a gunshot  wound  of  the  right  thigh.  He  was  treated  in  the  field,  and,  on  September  3d,  sent  to 
Vi'olfe  Street  Hospital,  Alexandria.  No  search  was  made  for  the  ball  as  the  patient  assured  the  attending  surgeon  that  it  had  been 
removed  on  the  field.  The  wound  seemed  to  heal,  though  very  slowly  until  November  17tb,  when  a small  tent-like  protrusion 
of  exuberant  granulations  appeared,  such  as  are  usually  seen  at  the  orifice  of  a sinus  leading  to  dead  bone.  The  patient  was 
unable  to  stand  erect  or  lie  on  his  back.  Tbe  surrounding  parts,  being  considerably  inflamed  and  the  partially  cicatrized  wound 
reopening,  a careful  search  was  made  for  foreign  matter.  The  ball  was  found  about  three  inches  from  the  point  of  entrance  and 
removed  by  Acting  Assistant  Surgeon  S.  E.  Eurier.  The  track  of  the  missile  was  carefully  explored  and  found  to  extend  four 
inches  in  a direction  forward  and  a little  inward,  where  the  point  of  the  probe  came  in  contact  with  spiculm  of  bone.  There  was 
considei'able  tenderness  over  the  whole  of  the  lumbar  vertebras,  but  no  paralysis  or  other  symptoms  indicative  of  injury  to  the 
spinal  cord.  This  man  was  discharged  from  service  on  December  29th,  1862,  at  which  time  ho  was  improving  rapidly,  although 
he  was  still  unable  to  stand  erect.  The  specimen  is  No.  4486,  Section  I,  A.  M.  M.,  and  consists  of  an  elongated  smooth-bore 
musket  ball,  much  roughened  on  one  side.  The  incrustation  on  the  missile  exhibits,  under  the  microscope,  spongy  bone.  It  was 
contributed  by  the  operator.  Pension  Examiners  Craig  and  Porter,  of  Albany,  report  that  this  pensioneFs  disability  may  be 
rated  as  “one-half  and  permanent.”  Ho  had  “much  pain  and  weakness  of  the  back  ” in  July,  1871. 

Case. — Private  Timothy  Flaherty,  Co.  A,  1st  Maryland  Cavalry,  aged  43  years,  was  wounded  at  Fredericksburg, 
Virginia,  December  11th,  1862,  by  a conoidal  ball,  which  entered  the  lumbar  muscles  a little  to  the  right  of  the  spine,  passed 
forward,  somewhat  downward,  and  slightlj^  inward,  exposing  a portion  of  the  body  and  transverse  jirocess  of  the  second  lumbar 
V'ertebra.  He  was  admitted,  on  the  next  day,  to  Stanton  Hospital,  Washington.  There  was  complete  paralysis  of  the  lower 
extremities,  both  as  to  sensation  and  motion  ; the  urinary  bladder  was  also  paralyzed.  His  general  condition  was  favorable,  and 
appetite  excellent.  Simple  dressings  were  applied  to  the  wound,  and  nourishing  diet  administered.  Catheterization  was  resorted 
to,  twice  daily.  Duiing  the  month  of  January,  1863,  he  began  to  recover  the  jiower  of  using  his  limbs  in  bed  to  some  extent. 
In  February,  the  bladder  had  recovered  its  tone  so  that  it  was  only  necessary  to  use  the  catheter  occasionally.  During  this 
month,  the  paraplegia  continued  to  diminish  slowly.  The  bullet  came  aw'ay  in  the  dressings,  having  gravitated  down  from  its 
(dace  of  lodgment,  as  the  patient  lay  in  bed.  In  M.arcb,  electricity  was  applied,  and  diuretics,  tonics,  and  purgatives  .‘idminis- 
tered.  By  April  6th,  the  patient  was  able  to  sit  up,  and  stand  with  a little  assistance.  He  had  difficulty  in  the  retention  of  his 
urine  upon  assuming  the  erect  posture,  which  was  probably  occasioned  by  the  prolonged  use  of  the  catheter.  The  urine  was 
also  scanty.  On  August  15th,  he  was  furloughed.  The  wound  bad  healed  and  he  was  able  to  walk  with  the  aid  of  a crutch. 
April  4th:  walks  pretty  well  with  the  aid  of  a cane.  The  wound  reopens  at  intervals,  and  after  discharging  awhile,  closes  again. 
On  May  4th,  the  patient  was  transferred  to  Haddington  Hosjntal,  Philadelphia,  and,  on  July  14th,  to  Turner’s  Lane  Hospital, 
whence  he  was  returned  to  duty  on  September  26th,  1864.  Pension  Examiner  H.  W.  Owings,  of  Baltimore,  reports,  April  8th, 
1867,  that  the  patient  was  much  debilitated,  with  an  abscess  discharghig  through  a sinus  in  the  right  buttock,  and  that  he  could 
not  stand  without  assistance. 

Case. — Sergeant  Joseph  F.  Lake,  Co.  A,  17th  Maine  Volunteers,  aged  23  yeai’s,  was  wounded  at  Mine  Run,  Virginia, 
November  27th,  1863,  by  a conoidal  ball,  which  entered  the  left  side  about  two  inches  above  the  crest  of  the  ilium,  passed  trans- 
versely through  the  muscles  of  the  back,  in  its  course  striking  the  spinal  column,  and  emerged  very  nearly  opposite  the  point  of 
entrance.  He  was  taken  to  the  field  hospital  of  the  1st  division.  Third  Corps,  and,  on  December  5th,  transferred  to  the  3d 
division  hospital,  Alexandria.  Simple  dressings  were  applied  to  tho  wound.  Complete  paralysis  of  the  lower  extremities  and 
bladder  existed  for  five  months  after  the  reception  of  the  injury.  He  was  discharged  from  service  on  April  1.5th,  1864.  Pension 
Examiner  Horatio  N.  Small  reports,  March  29th,  1867,  “partial  j)aralysis  of  the  lower  extremities;  complete  of  the  bladder; 
has  to  use  a catheter  whenever  he  passes  urine.  The  integuments  over  the  sacrum  have  sloughed  away.  A large  sinus,  connect- 
ing with  this,  opens  in  the  right  side  of  the  perineum.  He  has  a large  ulcer  on  his  right  foot.  I opened  a largo  abscess  in  the 
back,  which  discharged  a considerable  amount  of  unhealthy  pus.  His  general  health  is  very  pool’ ; in  fact  he  is  a broken-down 
man.  He  can  walk  a little  with  two  canes,  but  is  incapacitated  for  performing  any  manual  labor,  and  permanently  so.  Much 
of  the  time  he  requires  the  constant  aid  and  attention  of  another  person.” 

Case. — Pi-ivate  Edgar  T.  Harris,  Co.  A,  1st  West  Virginia  Infantry,  aged  19  years,  while  scuffiing  with  a comr.ade,  at 
Webster,  West  Virginia,  March  15th,  1864,  was  wounded  by  the  accidental  discharge  of  his  own  pistol,  the  ball  entering  the 
I’ight  lumbar  region,  passing  in  .an  upward  direction  through  the  cylindrical  portion  of  the  third  lumbar  vertebra,  injuring  tbe 
spine  to  such  an  extent  as  to  cause  partial  paralysis  of  the  lower’  extremities.  He  was  taken  to  the  regimental  hospital,  where 
cold-water  dressings  were  applied  to  the  wound.  The  symptoms  were  unfavorable  at  first,  but  in  a few  days  sensibility  began 
to  return  to  the  lower  extremities,  and  he  was  soon  able  to  inform  the  attendants  when  he  wished  to  pass  fmces  or  void  urine. 
On  lila.y  8th,  he  was  transferred  to  the  post  hospital  at  Wheeling,  whence  he  was  returned  to  duty  on  May  9th,  1865.  Acting 
Assistant  Surgeon  J.  Kirker  reported,  April  28th,  1865,  that  he  had  carefully  examined  this  man,  and  found  him  sirfl'ering  from 
complete  paral.vsis  of  the  lower  extremities,  and  that,  in  his  belief,  Harris  would  be  permanently  disabled.  The  pension  claim 
was  rejected  on  the  ground  that  the  wound  was  not  received  in  the  lino  of  duty,  but  was  afterwards  allowed  by  a Joint  Resolu- 
tion of  the  Senate  and  House  of  Reiu’csentatives. 


443 


Skct.  II.]  FEACTURES  OF  THE  LUMBAR  VERTEBRA^:. 

Of  fatal  cases  of  gunshot  injuries  of  the  lumbar  vertebrce,  the  Museum  affords  many 
illustrations.  These  examples  were,  of  course,  often  complicated  by  wounds  of  the 
abdominal  cavity  ; 

CASE.-Quartermaster  Sergeant  Mon-is  L , Troop  G,  18th  New  York  Cavalry,  aged  36  years,  stout,  well  developed, 

and  of  apparent  good  health,  was  shot  (according  to  his  own  statement)  on  Apr!  14th,  1864,  at  Campti,  Louisiana,  iii  an  engage- 
ment with  rebels.  Being  sent  to  New  Orleans,  he  was  admitted  to  University  Hospital  on  the  10th.  One  inch  to  the  right  ot  t lo 
spinal  column  and  about  two  inches  below  the  edge  of  the  last  rib,  a largo  gun- 
shot wound  was  detected;  careful  probing  indicated  that  the  ball  took  a lateral 
and  slightly  downward  course,  penetrating  the  second  lumbar  vertebra.  The 
patient  was  slightly  delirious;  pulse  130,  small,  quick,  weak,  and  thready;  face 
and  prolabia  pale  and  livid ; eyes  somewhat  injected ; tongue  covered  with  a 
whitish  fur  ; abdominal  walls  contracted,  rigid,  and  tender  on  pressure  ; feces 
and  water  passed  involuntarily.  He  was  with  some  difficulty  aroused  from  his 
stupor,  and  when  asked  how  he  felt  and  if  he  was  in  pain,  would  smilingly  and 
good  naturedly  answer  he  was  all  right,  felt  no  pain,  and  was  anxious  to  rejoin 
his  friends.  It  was  directed  that  the  patient  be  kept  quiet,  and  take  evei-j'  third 
hour,  one  grain  and  a half  of  calomel,  with  three-fourths  of  a grain  of  pulverized 
opium,  also  a tablespoonful  of  “ neutral  mixture  ” every  two  liours,  and  be  allowed 
a light  diet.  On  April  12th,  the  patient  was  less  delirious  and  complained  of  no 
pain  ; pulse,  110 ; but  still  weaker  tlian  on  the  two  preceding  days  ; the  calomel 
and  opium  powders  were  omitted  ; “ neutral  mixture  ” was  continued,  with  wine- 
whey  and  beef-tea  ad  libitum.  Death  ocem-red  on  the  afternoon  of  April  18th. 

At  the  necropsy,  twelve  hours  subsequently,  a round  iron  ball,  about  an  inch  in 
diameter,  was  found  imbedded  in  the  cellular  tissue  investing  the  psoas  magnus 
muscle  of  the  left  side.  The  missile,  after  penetrating  the  spinous  process  of  the 
lirst  lumbar  vertebra,  lacerated  the  spinal  cord  and  emerged  at  the  superior  left 
lati^ral  surface  of  this  last-named  vertebra.  Purulent  infiltration  was  found  in 
the  psoa  muscles,  their  investments,  and  the  peritoneal  cavity.  The  lower  lobes  of  both  lungs  were  highly  engorged,  a condition 
probably  only  a mortem  result.  Two  small  circumscribed  metastatic  abscesses  were  detected  in  the  right  lobe  of  the  liver. 
All  other  organs  were  in  a healthy  condition.  The  principal  interesting  feature  in  this  case  was  the  absence  of  paralysis  in  the 
lower  extremities.  The  specimen  was  contributed  to  the  Army  Medical  Museum  by  Surgeon  Samuel  Kneeland,  U.  S.  V.  It  is 
shown  in  the  adjoining  cut  (Fig.  195.) 

In  the  following  case  the  patient  survived  the  injury  for  twenty-three  days,  though 
completely  paraplegic  : 

Case. — Private  J-iuther  W.  C , Co.  G,  2d  United  States  Sharp-shooters,  aged  24  years,  received  a gunshot  wound 

of  the  lumbar  region,  with  injury  to  the  spine,  at  North  Anna,  Virginia,  May  23d,  1864.  He  was  treated  in  the  field  hospital 
until  the  29th,  when  he  was  sent  to  F’inley  Hospital,  Washington,  where  he  died  on  June  ICth,  1864.  Necropsy  : The  last 
dorsal  and  first  lumbar  vertebrae  were  found  injured,  the  spinous  processes  being  driven  in,  crushing  the  spinal  cord.  The 
pathological  specimen  is  No.  2579,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Surgeon  G.  L. 
Pancoast,  U.  S.  V. 

The  next  is  also  a case  of  paraplegia  : 

Case. — Private  William  S.  L , Co.  K,  32d  Iowa  Volunteers,  aged  32  years,  was  wounded  on  the  skirmish  line 

near  Nashville,  Tennessee,  December  10th,  1864,  by  a conoidal  ball,  which  entered  the  back  on  the  left  side,  about  three  inches 
below  the  inferior  angle  of  the  scapula,  fiaatured  the  eleventh  and  twelfth  ribs,  passed  directly  across  the  back,  between  the 
last  dorsal  and  the  first  lumbar  vertebrtE,  both  of  which  it  fractured,  as  also  the  eleventh  and  twelfth  ribs  on  the  right  side,  and 
lodged  under  the  skin  at  a point  almost  corresponding  to  that  of  its  entrance  on  the  opposite  side.  The  lower  extremities  were 
instantly  paralyzed.  He  was  at  once  conveyed  to  the  Cumberland  Hospital,  Nashville,  where  the  ball  was  extracted  without 
any  difficulty.  There  was  no  limmonhage  of  any  importance.  The  patient  was  suffering  considerably  from  the  shock,  but  did 
not  complain  of  paiti,  except  in  the  right  lung.  Shortly  after  admission,  the  urine  was  drawn  off  by  the  catheter.  He  rested 
tolerably  well  during  the  night.  December  11th  ; Urine  drawn  oft' several  times  during  the  day  ; had  an  involuntary  evacuation 
of  the  bowels ; some  pain  in  the  right  lung  fi-om  pleurn-pneumonia,  which  had  set  in.  Anodyne  fomentations  were  applied  to 
the  lung,  and  an  expectorant  and  anodyne  given  at  bedtime.  On  the  13th,  the  pneumonia  was  much  better ; the  urine  had  to 
be  drawn  off  three  or  four  times  during  the  day.  The  evacuations  from  the  bowels  were  involuntary  and  unconscious,  and 
great  care  had  to  be  exercised  to  keep  his  bed  clean.  He  felt  tolerably  well  and  suffered  but  little  pain.  There  was  no  sense  of 
feeling  below  the  point  of  injury.  The  patient  gradually  lost  his  strength,  although  his  mind  remained  clear  up  to  the  hour  of 
his  death,  which  did  not  occur  until  January  4th,  1865,  twenty-five  days  .after  the  reception  of  the  injury.  About  ten  or  twelve 
days  before  his  death,  the  tissues  over  the  right  trochanter  and  for  a short  distance  down  the  thigh,  begtin  to  slough  away. 
The  sloughing  continued  until  the  trochanter  was  exposed.  It  also  commenced  over  the  sacrum  and  left  trochanter.  Although 
the  tissues  were  in  this  condition,  he  did  not  sull'er  the  least  pain.  At  the  autopsy,  ten  hours  after  death,  the  lobe  of  the 


Fig.  195. — Lumbar  vertebra?,  with  a cast-iron  stiot 
lodged  in  the  canal.  Sjpec.  3739,  Sect.  1,  A.  M.  M. 


444 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[Chap.  iV, 


riijlit  lung  was  found  Iiopatized,  and  tliu  postoricr  part  congested  ; there  were  also  some  pleuritic  adhesions.  It  was  found  that 
tlu‘  hall  liad  |)assed  directly  through  the  spinal  cord,  cutting  it  off.  The  pathological  specimens  are  numbered  717  and  4710, 
Section  I,  A.  M.  M.,  and  were  contributed,  with  a history  of  the  case,  by  Assistant  Surgeon  S.  C.  Ayres,  U.  S.  V. 


Tlie  following  case  lias  been  already  cited  in  Circular  6,  S.  G.  0.,  1865  (p.  28)  : 

Case. — Coi’poral  John  E , Co.  M,  14th  New  York  Heavy  Artillery,  being  wounded 

in  front  of  Petersburg,  on  July  20, 1864,  wassent  to  Washington,  and  admitted  to  Douglas  Hospital 
on  August  2d,  with  peritonitis  and  complete  paraplegia.  He  died  on  the  same  day.  The  autopsy 
revealed  the  passage  of  the  bullet  into  the  abdominal  cavity  througli  the  spinal  canal,  and  lacera- 
tion of  tlie  liver.  The  pathological  specimen  was  contributed  to  the  Army  Medical  Museum 
by  Assistant  Surgeon  W.  Thomson,  U.  S.  A.  It  is  figured  in  the  adjoining  wood-cut  (LTg.  196). 

Case. — Private  .James  B , Co.  G,  1st  Maine  Cavalry,  aged  19  years,  was  wounded 

at  Petersburg,  Virginia,  April  1st,  1863,  by  a conoidal  ball,  which  entered  one  inch  to  the  left  of 
the  eleventh  dorsal  vertebra,  and  lodged.  He  was  treated  in  field  hospital  until  April  4th, 
when  he  was  sent  to  Armory  Square  Hospital,  Washington.  There  was  complete  paraplegia, 
and  the  patient  suffered  from  incessant  vomiting.  A catheter  was  introduced  to  evacuate  the 
bladder.  Death  occurred  on  April  Idth,  1865,  from  nervous  prostration.  At  the  necrojtsy,  the 
ball  was  found  to  have  destroyed  the  spinous  process  of  tlie  twelfth  dorsal,  and  a.  pai-t  of  the  right  pedicle  of  the  first  lumbar 

vertebrae,  and  lodged  in  the  spinal  canal.  A specimen,  illusti’aling  this  injury,  is  No.  4093,  Section  I,  A.  M.  M.,  and  was 

contributed  by  Acting  Assistant  Surgeon  G.  H.  Bowen. 

Case. — Corjioral  George  Bowers,  Co.  D,  251d  Pennsylvania  Cavalry,  aged  19  years,  received  a gunshot  wound  of  the 
back  at  Winchester,  Virginia,  July  24th,  1864.  He  was  treated  in  the  field,  and.  on  July  27th,  sent  to  hospital  at  Sandy  Hook, 
Maryland,  whence  he  was  transferred,  on  the  30th,  to  Jarvis  Hospital,  Baltimore.  He  died,  on  August  3th,  1864,  of  spinal 
meningitis.  At  the  necropsy,  the  entii’e  body  was  covered  with  the  spots  characteristic  of  purpura.  The  missile  was  found  to 
have  entered  one  inch  to  the  right  of  the  spinous  process  of  the  twelfth  dorsal  vertebra,  jiassed  through  the  transverse  jirocess, 
and  embedded  itself  in  the  spinal  canal.  Pieces  of  clothing  were  found  lying  upon  the  cord,  which  was  in  a gangrenous  condi- 
tion. There  was  no  paralysis  during  the  progress  of  the  case,  except  that  of  the  bladder.  All  the  internal  organs  were 
congested,  especially  the  lungs,  liver,  spleen,  and  kidneys.  There  was  slight  effusion  in  the  pleura  of  a strong  urinous  odor. 
Effusion  in  pericardium  ; heart  very  large.  The  endocardium  was  of  a bright  yellow  color.  Liver  and  spleen  very  large.  Gall 
bladder  empty.  Kidneys  large  and  fatty,  the  calices  of  each  filled  with  clotted  blood.  The  pathological  .specimen  is  No.  3185, 
Section  I,  A..  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Acting  Assistant  Surgeon  B.  B.  Miles. 


— Two  lumbar  vertebne 
frauturud  vertically.  Spec.  35H3, 
I,  A.  11.  M. 


selected 


From  the  fatal  gunshot  fractures  of  the  second  lumbar  vertebra,  the  following  are 


Case. — Private  Joseph  R- 


-,  Co.  I,  86th  New  York  Volunteers,  stout,  muscular,  and  aged  19  years,  was  admitted  to 


Emory  Hospital,  Washington,  August  25th,  1862,  for  a gunshot  wound  of  the  back,  received  on  the  night  of  the22d.  Notwith- 
standing great  pain  and  restlessness,  he  gave  an  interesting  account  of  the  manner  in  which  he  was  wounded,  even  laughing  and 
jesting  at  times.  He  stated  that,  not  thinking  himself  hurt,  at  the  time  of  receiving  the  wound,  he  walked  some  distance  to  a 
tree  where  he  sat  and  watched  the  enemy  until  near  morning,  when  he  walked  into  camp,  and,  on  examination,  “found  a hole  in 
his  blouse  and  then  a hole  in  his  back.”  Being  night  when  he  was  admitted,  an  anodyne  was  prescribed,  and  cold  applications 
were  applied  to  the  wound.  August  26th  : passed  a restless  night,  and  morning  found  him  wearied  and  anxious,  veiy  restless, 
with  an  occasional  tetanic  spasm,  though  not  severe.  He  was  now  chloroformed,  tlie  wound  was  enlarged,  and  an  unsuccessful 
search  was  made  for  the  ball.  The  patient  being  removed  to  more  comfortable  quarters,  an  assistant  ami  a nurse  were  left  with 

him  with  directions  to  keep  him  partially  etherized  until  more  experienced  surgical  assistance 
could  be  secured.  The  services  of  Surgeon  E.  H.  Coolidge  were  shortly  obtained,  and,  after  a 
trial  of  more  than  one  hour,  he  succeeded  in  renKwing  the  ball,  which  was  found  firml}'  impacted 
in  the  canal  and  between  the  spinous  processes  of  the  first  and  second  lumbar  vertebrte.  After 
carefully  removing  all  spiculte  of  bone,  the  wound  was  drawn  together  by  adhesive  straps, 
and  cold-water  dressings  were  applied.  The  administration  of  an  enema  of  assafoetidat  and 
turpentine  left  the  patient  in  a profound  sleep,  disturbed  occasionally,  however,  by  slight 
spasms  of  short  duration.  August  27th  : bowels  acted  twice  at  night ; micturition  free  and  no 
symptoms  of  paralysis.  There  was  marked  increase  in  the  severity  of  the  tetanic  symptoms. 
The  enema  was  repeated,  but  had  little  or  no  effect  in  quieting  the  nervous  symptoms.  Chlo- 
roform was  now  brought  to  his  relief  and  its  use  continued  until  ten  o’clock  A.  M.,  when  he 
died.  At  the  autopsy,  the  ball  was  found  to  have  destroyed  entirely  the  spinous  process  of 
the  second  lumbar  vertebra,  and  to  have  buried  itself,  apex  foremost,  completely  in  the  verte- 
bral canal,  bruising  and  pressing  upon  the  cord.  The  case  is  one  of  interest  from  the  fact  that 
Fig.  197.— First  three  lumbar  no  symptoms  of  paralysis  followed  such  an  injury  to  the  spinal  cord  as  was  here  received, 

peSfedGL’^ranal'^aid^  ancl  the  ball  was  not  turned  in  its  course  by  the  sharp  edge  of  the  spinous  process.  The  path- 

impacted  between  the  arches  of  the  oloffical  specimen,  fiffuml  in  the  adioining  wood-cut,  was  contributed  to  the  Army  Medical 
first  and  second.  Spec.  611,  Sect.  ,,  ® . , , , . i * • * • z . d o t>  -n 

I,  A.  M M Museum,  with  the  above  account,  by  Acting  Assistant  burgeon  b.  K.  bkillern. 


Sect.  II.] 


FRACTURES  OF  THE  LUMBAR  VERTEBRAS. 


445 


Case. — Private  ^Yilliam  B , Co.  B,  5.'ith  ^Massaclinsetts,  was  shot  while  attempting  to  assault  the  provost  guard,  at 

Folly  Island,  South  Carolina,  November  11th,  18G4,  at  four  and  a half  o'cloc’k  r.  M. ; a conoidal  ball  entered  the  left  side  of  the 
abdomen,  midway  between  the  crest  of  the  ilium  and  twelfth  costal  cartilage,  and  lodged.  The  missile  was  fired  at  a distance 
of  nine  yards.  There  was  instant  and  great  pain  in  belly  and  small  of  back,  with  excessive  shock.  Consciousness  unimpaired. 
Little  external  hsemorrhage.  Copious  vomiting  of  all  the  contents  of  the  stomach,  unmixed  with  blood,  within  one  hour.  Three 
grains  of  opium  were  given,  with  some  relief  from  pain,  but  no  sleep  was  induced.  The  extremities  were  very  cold  and  could 
not  be  warmed.  He  died  fi’om  collapse,  .six  hours  after  the  reception  of  the  injury.  Necropsy:  Small  intestine  severed  at  two 
points,  allowing  the  escape  of  contents.  Descending  colon  bruised,  but  not  niptured,  near  external  wound.  There  was  about 
three  iiints  of  blood  in  the  cavity  of  the  abdomen,  but  no  very  large  vessel  wounded.  The  body  of  the  second  lumbar  vertebra 
was  perforated  transveisely,  laj’ing  bare,  but  not  injuring,  the  cauda  equina.  The  ball  was  found,  its  base  partially  flattened, 
near  a dejmessed  fracture  of  the  inner  table  of  the  ilium,  near  its  crest.  The  pathological  specimen  is  No.  3458,  Section  I,  A.  M. 
M.,  and  was  contributed,  with  a history  of  the  case,  by  Assistant  Surgeon  Burt  G.  Wilder,  55th  Massachusetts  Volunteers. 

Case. — Private  John  McD , Co.  K,  7th  Michigan  Cavalry,  while  in  a state  of  intoxication,  on  July  1st,  1863,  was 

wounded  by  a ball  from  a Colt’s  revolver  (navy  size),  fired  by  the  guai’d  at  the  camp  of  the  1st  Rhode  Island  Cavalry.  The 
pistol  W’as  discharged  at  a distance  of  ten  feet,  the  missile  entering  the  left  side,  four  inches  below  and  a little  to  the  light  of  the 
nipple.  He  dropped  instantly,  and  upon  attempting  to  remove  him  to  a tent,  it  was  discovered  that  he  was  wholly  unable  to 
move  the  lower  limbs,  and  that  below'  the  anterior  superior  spinous  processes  of  the  ilium  there  was  no  sensation  whatever, 
except  a very  slight  sense  of  feeling  when  hard  pressure  was  made  ujion  the  genitals.  The  shock  and  jirostration  were  very 
great,  and  followed  the  injury  immediately,  while  the  system  did  not  respond  to  the  stimulants  exhibited.  It  w'as  found  impossible 
to  probe  the  wound  to  any  extent,  and  one  hour  after  the  infliction  of  the  injury,  the  patient  was  removed  to  Columbian  Hospital, 
Washington.  Up  to  this  time  no  blood  had  issued  from  the  mouth,  nor  was  there  any  emjihysema.  Half  an  hour,  after  ad- 
mission, the  patient  commenced  to  vomit  blood  very  freely.  Although  thirst  was  intense,  he  ejected  the  drinks  given  him  almost 
as  soon  as  swallowed.  The  vomiting  of  blood  continued  until  four  o’clock  P.  M.,  tive  hours  after  the  injury,  when  it  ceased 
altogether,  although  water  was  thrown  up  as  before.  The  vomiting  was  spasmodic,  and  unaccompanied  by  ))ain.  About  this 
time  some  reaction  took  place,  and  the  patient  W'as  comparatively  comfortable  until  a quarter  before  eight  o’clock  I>.  JI.,  wlu'u 
lie  became  slighfly  convulsed,  and  expired  in  a few  minutes.  There  were  several  respirations  observed  after  the  action  of  the 
heart  had  ceased  entirely.  He  was  perfectly  conscious  to  the  last  moment.  Necropsy  : Ball  passed  inward  and  downward, 
going  between  the  seventh  and  eighth  ribs,  through  the  diaphragm  near  its  attachment  upon  the  left  side,  thence  through  a fold 
of  a dependent  portion  of  the  great  curvature  of  the  stomach,  through  the  mesentery,  and  entirely  through  the  body  of  the  second 
lumbar  vertebra,  lodging  in  the  deep  muscles  of  the  back.  The  spinal  cord  was  divided.  Both  the  thoracic  and  abdominal 
cavities  were  filled  with  bloody  serum,  while  at  the  bottom  of  each  were  coagula  of  considerable  size.  With  the  exception  of  a 
few  old  pleuritic  adhesions,  the  body  was  ^perfectly  healthy.  The  pathological  sjiecimen  is  No.  1331,  Section  I,  A.  M.  M.,  and 
was  contributed,  with  a history  of  the  case,  by  Acting  Assistant  Surgeon  A.  H.  Crosby. 

Case. — Private  Theodore  B.  H , Co.  F,  7th  Maryland  Volunteers,  received  a penetrating  gunshot  wound  of  the 

chest  and  abdomen  at  Petersburg,  Virginia,  June  19th,  1864.  He  was  taken  to  the  field  hospital  of  the  Fifth  Corps,  where 
simple  dressings  were  applied.  On  Jvdy  4th,  he  was  transferred  to  the  3d  division  hospital,  Alexandria.  The  ball  had  pene- 
trated the  lower  lobe  of  the  left  lung,  the  symptoms  being  great  ju-ostration,  difficulty  of  breathing,  anxiety  of  countenance,  slight 
haemorrhage,  and  bloody  expectoration.  The  patient  was  placed  on  his  wounded  side  to  favor  discharge  of  blood  and  ])us.  No 
foreign  matter  was  discovered.  'The  haemorrhage  was  controlled  by  rest  and  antiphlogistic  treatment.  Stimulants  were 
carefully  given.  July  Cth  ; Hectic  fever  set  in.  Opiates,  tonfes,  stimulants,  and  beef  essence.  He  sank  rapidly,  and  died  on 
July  9th,  1834.  Necropsy:  Ball  entered  between  the  ninth  and  tenth  ribs,  separated  the  former  from  its  cartilage,  passed 
through  the  lower  lobe  of  the  left  lung,  entered  the  abdomen,  passed  through  the  intestines  without  injury,  and  lodged  in  tlie 
second  lumbar  vertebra.  The  pathological  specimen  is  No.  3349,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of 
the  case,  by  Surgeon  Edwin  Bentley,  U.  S.  V. 

Ca.se. — Corporal  ,1.  L.  W , Co.  A,  2d  Connecticut  Heavy  Artillery,  aged  38  years,  received  a gunshot  jienetrating 

wound  of  the  abdomen  at  Cedar  Creek,  Virginia,  October  I9th,  1864.  He  was  treated  in  the  field  until  October  25th,  when  he 
was  sent  to  Patterson  Park  Hospital,  Baltimore.  The  missile  had  entered  about  the  ninth  rib,  on  the  left  side,  and  i)assed 
out  about  the  rib,  on  the  right  side.  When  admitted,  the  patient  was  sufi'ering  from  constitutional  debility,  but  did  not 
exhibit  much  distress  otherwise.  Simjde  dressings  were  applied  to  the  W'ound  and  an  anodyne  administered.  Death  resulted 
on  October  28th,  1864.  Necropsy : The  ball  fractured  the  ninth  rib  on  the  left  side,  passed  down  through  the  diaphragm,  per- 
forated the  spleen,  then  took  a transverse  direction  through  the  body  of  the  vertebrae,  thence  through  the  right  lobe  of  the  liver 
and  out  between  the  seventh  and  eighth  ribs.  The  left  side  of  the  thorax  was  filled  with  blood  and  the  left  lung  conqdetely 
collapsed.  The  immediate  cause  of  death  was  internal  haemorrhage  from  the  splenic  circulation  and  the  wounds  of  the  inter- 
costal arteries,  induced  by  mechanical  violence.  The  pathological  specimen,  showing  two  lumbar  vertebra;,  the  lower  of  which 
is  deeply  grooved  on  its  anterior  face,  is  No.  3471,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by 
Acting  Assistant  Surgeon  A.  Walsh  Emory. 

Of  musket-ball  fractures  of  the  third  lumbar,  the  Museum  possesses  eight  specimens. 
The  memoranda  communicated  with  them  are  appended,  with  wood-cuts  of  two  of  the 
specimens: 

Case. — Private  Thomas  D , Co.  F,  1st  Michigan  Sharp-^tooters,  aged  19  years,  received  a gunshot  wouml  of  the 

lumbar  region,  at  Petersburg,  .Tune  24th,  1864.  He  was  admitted,  on  the  same  day,  to  the  field  hospital  of  the  3d  division. 
Ninth  Coqts,  and,  on  July  1st,  sent  to  Stanton  Hospital,  Washington.  Stimulants  were  freely  administered,  with  subcutaneous 


446 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[CnAP.  IV, 


injections  of  sulphate  of  morphia.  Tetanus,  in  tlie  form  of  opisthotonos  and  trismus,  appeared  on  .he  4th.  Death  resulted  on 
July  5th,  1864.  At  the  necrop.sy,  a conoidal  ball  was  found  to  have  entered  on  the  left  side,  over  the  posterior  part  of  the  crest 
of  the  ilium,  passed  upward  and  inward,  and  lodged  in  the  left  side  of  the  body  of  the  third 
lumbar  vertebra.  The  anterior  crural  nerve  was  injured,  as  was  also  the  lower  end  of  the  left 
kidney.  There  was  limited  peritonitis,  and  a small  collection  of  pus,  say  a drachm,  about 
where  the  hall  impinged  against  the  peritoneum,  at  lower  end  of  kidney.  The  intestines  were 
not  injured.  The  pathological  specimen  is  No.  2702,  Section  I,  A.  M.  M.,  and  was  contributed, 
with  a history  of  the  case,  by  Assistant  Surgeon  George  A.  Mursick,  U.  S.  V. 

The  adjoining  cut  represents  the  lumbar  vertebrae,  with  the  third  fractured  by  a conoidal 
hall,  which  is  attached.  The  missile  appears  to  have  passed  from  the  left  directly  through  the 
intervertebral  notch  between  the  third  and  fouith  vertebrae,  chipping  the  superior  ai-ticular  pro- 
cess of  the  fifth  and  the  adjacent  portion  of  the  spinous  process  of  the  fourth,  fractuj-ing  the  left 
transverse  process  of  the  fourth,  aud  emerging  through  the  body  of  that  vertebra  on  the  right  side. 
Life  continued  long  enough  for  incipient  caries  to  present  itself.  The  specimen  was  contributed 
to  the  Army  Medical  Museum  by  Surgeon  John  A.  Lidell,  U.  S.  V.,  without  an  history.  A 
comparison  of  the  specimen  with  the  registers  and  case-hooks  of  Carver  Hospital,  and  with  Dr. 
Lidell’s  excellent  paper  On  Injuries  of  the  Spine  (Amer.  Jour,  of  Med.  Sci.,  October,  1864,  Vol. 
XLVIII),  does  not  permit  a reference  of  this  specimen  to  any  of  the  histories  recorded  there. 
It  corresponds  closely  to  several  of  the  recorded  cases,  and  more  than  one  history  has  been 
attached  to  it;  but  some  vital  discrepancy  between  the  history  and  specimen  has  been  subse- 
(piently  detected.  The  history  of  the  case  that  compares  most  closely  with  the  specimen 
Fig.  l£e.— i.imibar  vertebra',  the  represents  the  patient  as  alive  a fortnight  after  the  preparation  was  on  the  shelves  of  the  Museum  ; 

third  fractured  hj’  a imisket  hall,  and,  in  other  abstracts,  where  dates  agree,  there  is  discordance  as  to  position  and  extent  of 
which  is  attached.  .Spec.  2533,  Sect.  , ,,,,  . • i c o.  * u •*  i t iq.i  ioo.. 

1,  A.  M.  M.  lesions.  Ihe  specimen  was  received  from  Istanton  Hospital,  June  18th,  1864. 


Case. — Private  John  J , Co.  K,  14th  Connecticut  Volunteers,  was  wounded  at  Antietam,  September  17ih,  1862,  a 

ball  entering  the  right  side  three  inches  above  the  crest  of  the  ilium.  He  lay  upon  the  field  until  the.  20th,  when  he  was  sent 
to  Hospital  No.  1,  Frederick.  When  admitted,  he  could  walk,  but  paralysis  soon  supervened.  Retention  of  urine  lasted  for 
two  days,  after  which  there  was  no  difficulty.  There  was  no  derangement  of  the  alimentary  canal.  The  pulse  was  small  and 
weak ; the  fiice  flushed,  and  the  patient  sufiered  greatly  from  bed-sores.  On  October  6th,  he  suffered  great  pain  in  the  legs, 
which  were  without  feeling,  but  warm.  On  the  10th,  profuse  sweats  occuiTcd ; he  sank  rapidly,  and  died  on  October  11th, 
1862.  At  the  necropsy,  a conoidal  ball  was  found  to  have  passed  through  the  spine  and  spinal  cord  at  the  third  lumb.ir  vertebra, 
and  lodged  at  the  intervertebral  notch  on  the  left  side.  A specimen,  consisting  of  the  second,  third,  and  fourth  lumbar  vertebras, 
having  a battered  ball  attached,  is  No.  757,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Assistant 
Surgeon  G.  L.  I’orter,  U.  S.  A. 

Case. — Private  T.  J.  It , Co.  K,  7th  South  Carolina  Regiment,  received  a gunshot  wound  of  the  lumbar  region, 

about  tln-ee  inches  to  the  right  of  the  spinal  column,  at  Antietam,  Maryland,  September  17th,  1862.  He  was  treated  in  the  field 
until  the  27th,  when  ho  was  sent  to  Hospital  No.  1,  Frederick.  Patient  became  much  exhausted,  and  died  from  colliquative  fever 
on  December  7th,  1832.  The  entrance  made  by  the  bullet  had  taken  on  a gangrenous  character  some  days  previous  to  death. 
At  the  necrop.sy,  on  opening  the  walls  of  the  abdomen  and  removing  the  intestines,  a blackened  and  sloughing  condition  of  the 
parts  was  observable  in  front  of  the  spinal  column,  corresponding  to  the  second  lumbar  vertebra,  and,  on  the  left  side,  an  abscess 
existed  in  which  the  ball  was  found.  The  abscess  was  iininediately  in  contact  with  the  left  kidney,  but  the  latter  was  quite 
uiiatiected.  Dissecting  back  the  abdominal  vessels  and  structures  adherent  to  the  vertebral  column,  an  opening  was  found 
passing  through  the  body  of  the  third  lumbar  vertebra  anterior  to  the  transverse  process,  behind  the  aorta  and  in  front  of  the 
cord,  and  communicating  with  the  external  opening  and  the  sack  on  the  left  side  of  the  column  in  which  the  ball  was  found. 
The  spinal  cord  being  uninjiired  explained  the  absence  of  all  paralysis  during  life.  The  pathological  specimen  is  No.  742,  Section 
I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Assistant  Surgeon  James  Phillips,  U.  S.  A. 

Case. — Bugler  William  B , Co.  I,  1st  United  States  Cavalry,  received  a gunshot  penetrating  wound  of  the 

abdomen,  near  Brandy  Station,  Virginia,  August  1st,  1863.  He  was  admitted,  on  the  same  day,  to  the  hospital  of  the  Cavalry 
Corps,  Army  of  the  Potomac,  and,  on  the  next  day,  was  sent  to  Washington.  He  elied  in  an  ambulance,  while  being  ponveyed 
to  Douglas  Hospital.  At  the  necropsy,  a small  bullet,  as  though  from  a carbine,  was  found  to  have  entered  on  the  right  side, 
fractured  the  u]i])er  edge  of  the  eleventh  rib,  a little  internal  to  the  axillary  line,  perforated  the  liver  on  the  anterior  and  inferior 
surface  of  the  right  lobe,  laterally,  cut  through  the  spleen,  tore  away  its  low’er  portion,  cut  into  the  left  kidney,  into  which  it 
impacted  particles  of  bone,  perforated  the  right  kidney  through  the  superior  anterior  edge,  fractured  the  third  lumbar  vertebra, 
and  emerged  between  the  tenth  and  eleventh  ribs  on  the  left  side,  external  to  the  axillary  line.  The  omentum  major  protruded 
six  inches  in  length  from  the  wound  of  exit.  The  right  thoracic  cavity  was  filled  with  blood.  The  apparent  cause  of  death  was 
haemorrhage  from  the  liver.  The  pathological  specimen  of  the  fractured  vertebra  is  No.  1647,  Section  I,  A.  M.  M.  The  speci- 
mens of  the  liver  and  fractured  rib  are  numbered  1646  and  3291,  respectively.  They  were  contributed,  with  a history  of  the 
case,  by  Assistant  Surgeon  William  Thomson,  U.  S.  A. 

Case. — Sergeant  Sylvester  R , Co.  B,  14th  Indiana  Volunteei's,  was  wounded  at  Antietam,  Maryland,  September 

17th,  1862,  by  a conoidal  ball,  which  entered  the  left  lumbar  region,  half-way  from  the  twelfth  rib  to  the  crest  of  the  ilium,  and 
lodged.  He  was  taken  to  the  field  hospital  of  the  3d  division,  Second  Corps,  where  he  remained  until  the  29th,  when  he  was 
sent  to  Hospital  No.  1,  Frederick.  On  October  14th,  the  hall  was  e.xtracted  by  Acting  Assistant  Surgeon  Redfern  Davies. 
Cold-water  dressings  were  applied.  Obstinate  diarrhoea.  No  faeces  passed  from  the  wound.  Paralysis  of  the  sphincters  of  the 


Sect.  II.] 


FRACTURES  OF  THE  LUMBAR  VERTEBRAE. 


447 


bladder  occurred  about  October  20tb,  and  continued  until  the  23d,  when  death  occurred.  Necropsy  : The  ball  did  not  penetrate 
either  the  abdominal  or  peritoneal  cavities.  It  fractured  the  left  transverse  process  and  pedicle  of  the  third  lumbar.  The 
pathological  specimen  is  No.  80C,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Acting  Assistant 
Surgeon  W.  W.  Keen,  jr. 

Case.— Private  Elias  H , Co.  E,  149th  Pennsylvania  Volunteers,  aged  40  years, 

was  wounded  on  May  6th,  1864,  and,  on  the  18th,  was  admitted  to  Douglas  Hospital,  Wash- 
ington, in  a paraplegic  condition,  and  died  a few  hours  after.  A conoidal  musket  ball  had 
entered  over  the  lower  ribs  of  the  left  side,  and,  passing  deeply  in  the  muscles  of  the 
abdomen,  lodged  between  the  arches  of  the  second  and  third  lumbar  vertebra  and  partially 
in  the  spinal  canal,  injuring  the  cord.  The  bladder  was  distended.  The  pathological 
specimen  was  contributed  to  the  Army  Medical  Museum  by  Assistant  Surgeon  W.  Thomson, 

U.  S.  A.  It  is  represented  in  the  adjoining  wood-cut  (Fig.  199.) 

Qase. — Sergeant  W.  W.  C , Co.  II,  26th  Massachusetts  Volunteers,  was 

wounded  at  Opequan  Creek,  near  Winchester,  Virginia,  September  19th,  1864,  by  a conoidal 
ball,  which  penetrated  the  lumbar  region  through  the  erector  spinae  muscle,  right  side,  a few 
iucties  above  the  posterior  crest  of  the  ilium,  and  lodged.  The  left  ankle  and  lower  third 
of  the  left  femur  were  shattered  at  the  same  time.  On  the  next  day.  Surgeon  James  G. 

Bradt,  2Gth  JIassachusetts  Volunteers,  administered  an  ana?sthetic  and  amputated  the  left 
thigh  at  its  upper  third  by  antero-postorior  flap  operation.  The  patient  reacted  promptly 
and  did  tolerably  well,  but  remained  very  weak.  Stimulants  and  nutritious  diet  were  administered.  On  September  26th, 
he  was  sent  to  Sheridan  Depot  field  hospital,  Winchester.  By  October  31st,  he  had  gradually  become  anajmic,  but  suffered 
no  pain.  There  was  partial  paralysis  of  the  right  leg ; no  relaxation  of  the  sphincters ; appetite  moderate ; mental  manifesta- 
tions all  intact;  stump  healing  and  in  good  condition.  Death  resulted  on  November  3d,  1834,  from  asthenia  and  amemia,  the 
ultimate  occurrence  of  central  nervous  depression.  The  necropsy  revealed  adhesions  of  both  lungs.  The  heart,  liver,  spleen, 
kidneys,  and  intestines  were  sound  and  normal.  The  ball  was  found  lodged  in  the  intervertebral  articulation  of  the  third  and 
fourth  lumbar  vertebra.  Very  little  pus  was  found  in  the  track  of  the  ball.  The  pathological  specimen  is  No.  3796,  Section  I, 
A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  hy  Acting  Assistant  Surgeon  W.  Leon  Hammond. 

Abstracts  of  histories  of  gunshot  injuries  of  the  fourth  lumbar  vertebra,  of  cases  in 
which  the  pathological  specimens  are  preserved,  are  introduced  here : 

Case. — Sergeant  Adam  Heim,  Co.  G,  105th  Pennsylvania  Volunteers,  was  wounded  at  Malvern  Hill,  Virginia,  July  2d, 
1862,  the  missile  entering  the  right  lumbar  region,  two  inches  from  the  spinal  column,  fracturing  the  body  of  the  fourth  lumbar 
vertebra,  and  lodging  close  to  the  spinal  canal.  He  was  treated  in  the  field  until  July  7th,  when  he  was  admitted  to  Carver 
Hospital,  Washington.  Fmees  and  gas  passed  freely  from  the  wound.  Oj)ium,  quinine,  and  stimulants  were  given.  He  did 
well,  the  wound  in  the  bowels  closing,  and  his  passages  were  natural  until  an  oflicious  friend  gave  him  fruit  surreptitiously,  when 
diarrhoea  supervened,  and  the  wound  reopened.  He  died  on  August  3,  1862.  The  pathological  specimen  is  numbered  148, 
Section  I,  A.  iM.  M.,  and  was  contributed  by  Acting  Assistant  Surgeon  W.  W.  Keen,  jr. 

Case. — Corporal  L.  P , Co.  F,  14th  New  Jersey  Volunteers,  aged  26  years,  received  a gunshot  wound  of  the  back 

at  Monocacy  Junction,  Maryland,  July  9th,  1864.  He  was  admitted,  on  the  next  day,  to  the  hospital  at  Frederick.  Three 
days  after  admission,  incomplete  paraplegia  set  in.  Ho  suffered,  at  times,  with  excruci.ating  pains  at  seat  of  \vomul  and  in  the 
lower  extremities.  Anodynes  were  freely  given.  Patient  had  no  control  over  the  sphincter  ani  muscle.  He  was,  at  times, 
delirious.  Pulse  slightly  accelerated.  Death  resulted  on  July  18th,  1834.  At  the  necropsy,  a conoidal  ball  was  found  to  have 
entered  at  a point  midway  between  the  anterior  superior  and  the  posterior  superior  spinous  ju-oecsses  of  the  ilium,  one  inch 
below  the  crest,  passed  inward  and  backward,  chipped  the  sacrum  at  its  posterior  superior  angle,  fractured  the  fourth  lumbar 
vertebra,  and  lodged  in  the  canal.  The  pathological  specimen  is  No.  3810,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a 
history  of  the  case,  by  Acting  Assistant  Surgeon  J.  C.  Shinier. 

Case. — Private  John  D , Co.  I,  28th  Pennsylvania  Volunteers,  was  wounded  at  Gettysburg,  July  1st,  1833,  by  a 

conoidal  ball,  which  entered  the  right  side  one  inch  above  the  crest  of  the  ilium,  passed  inward  and  lodged.  He  was  taken  to 
the  Seminary  Hospital,  Gettysburg,  and,  on  the  12th,  transferred  to  Broad  and  Cherry  Streets  Hospital,  Philadelidda.  When 
admitted,  the  wound  looked  well.  The  wound  was  probed  for  the  ball,  but  without  success.  The  bone  was  found  bare,  and  a 
fracture  of  the  vertebral  was  diagnosed.  The  general  condition  of  the  patient  was  very  fair;  pulse,  88;  tongue  slightly  furred, 
and  bowels  constipated.  Neither  paralysis  of  sensation  or  motion  was  perceptible,  but  he  complained  of  severe  pain  in  the 
wound.  Nourishing  diet  was  ordered,  with  an  anodyne  at  night,  and  fhe  wound  was  dres.sed  with  linseed  poultices.  Under  this 
treatment,  he  appeared  to  improve  until  the  20th,  when,  without  any  perceptible  cause,  his  pulse  rose  to  112;  the  wound  became 
more  painful.  He  was  seized  with  a nervous  trembling  and  very  free  diaphoresis,  and  began  to  siidc  rapidly.  Milk  jnmeh  was 
ordered,  and  counter-irritation  made  over  the  lower  part  of  the  sjiine,  but  without  relief.  The  next  day  the  symjitoms  had 
increased,  and  he  was  ordered  a mixture  of  camjdior  and  chloroform  every  four  hours.  He  continued  to  sink,  and  died  on  July 
24th,  1633.  An  autopsy  was  made  eight  hours  after  death,  when  it  was  found  that  the  ball  had  entered  the  signal  coliinm  on 
the  right  side,  at  the  articulation  of  the  fourth  and  fifth  lumbar  vertebra},  just  in  front  of  their  transver.se  jirocesses,  destroyed 
the  continuity  of  the  spinal  canal,  passed  obliquely  upward  through  the  body  of  the  fourth,  and  lodged  in  that  of  the  third 
lumbar  vertebra,  on  the  left  side.  The  pathological  specimen  is  No.  2706,  Section  I,  A.  JI.  M.,  and  consists  of  the  first  thi'ce  and 
a section  of  the  fourth  lumbar  vertebra.  Caries  marks  the  track  of  the  missile.  The  cord  was  impinged  upon  by  a disi)Iac(!d 
fragment  of  the  fourth  vei-tebra.  It  was  contril)uted,  with  a history  of  the  case,  by  Acting  Assistant  Surgeon  William  V.  Keating. 


Fig.  199. — Tliird  and  fourtli  Imnbar 
vertebrie,  with  a ball  lodged  between 
their  arches  and  projecting  into  the  canal. 
S^iec.  3523,  Sect.  I,  A.  M.  M. 


448 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[Chap.  IV, 


Case. — Private  T K , alias  .1 B , Troop  A,  Ctli  United  States  Cavalry,  aged  28  years,  niai  ried, 

was  admitted  to  hospital  at  Austin,  Texas,  April  18th,  186G,  from  Belton,  Texas,  sixty  miles  distant,  with  gunshot  wound  of  the 
posterior  pelvis,  received  on  Maich  26th;  wound  closed.  He  had  been  attended  by  a citizen  phj’sician,  who  made  no  ellicient 
examination  of  the  injiuy.  Patient  states  that  he  received,  while  in  the  act  of  running,  an  accidental  pistol  shot  (conical  bullet, 
calibre  .36  inch),  instantaneously  falling  to  the  ground;  the  muscles  of  the  lower  extremities  jiaralyzed  ; complete  loss  of 
sensation  over  entire  posterior  pelvis ; that  he  was  desirous  of  having  the  bullet  searched  for,  as  he  should  feel  no  jiain  from  any 
incision.  Otherwise  learned  that  on  the  second  day  after  tin;  receipt  of  his  injury,  lie  complained  much  of  pain  across  the 
sacral  region  and  in  the  thighs;  that  he  had  lost  almost  entire  control  of  his  limbs  from  the  haunches  downward;  could  not 
change  the  position  of  the  lower  part  of  his  body,  and  all  attempts  to  move  him  by  others  gave  great  pain,  especially  across  the 
lower  ])ortion  of  the  back.  His  bowels  were  torpid;  micturition  continued  under  his  control,  but  he  lacked  the  expulsive  power 
to  readily  accom]ilish  it.  After  a few  days,  he  was  able  to  be  jflaced  up  in  bed  with  a chair  and  pillow  at  his  back,  and  to  move 
slightly  the  left  thigh  and  leg  ; appetite  increased;  was  quite  cheerful,  and  thought  to  be  recovering:  could  never  rest  the  weight 
of  tlie  body  upon  the  legs;  shortly  previous  to  removal  to  hospital,  would  slowly  drag  the  legs  after  him  when  supported  erect. 
Symj)toms  on  admission  : Much  exhausted,  having  made  the  entire  journey  in  an  army  wagon  ; looks  emaciated  and  anxious ; 
comj)hiins  especially  of  pain  in  i-ight  sacrum,  and  of  severe  pain  in  the  posterior  muscles  of  the  legs,  aggravated  by  pressure.  He 
cannot  stand  without  sujiport,  and  makes  no  attempt  to  walk.  He  slowly  performs  the  act  of  flexion  and  extension  of  the  legs, 
but  cannot  sejiarate  them  when  lying  upon  his  side;  superior  extremities  unaffected;  eating  but  little;  considerable  thirst; 
bowels  in  an  almost  complete  state  of  torpor  ; urine  passed  frequently  and  with  much  difficulty.  He  was  ordered  an  opiate  for 
the  evening.  I’rogress  of  the  case : On  the  day  succeeding  admission,  April  19th,  he  was  ordered  a mild  diuretic  in  mucilage  of 
flaxseed  ; dry  cup.s  to  right  saci-um,  and  a mild  injection  for  the  evacuation  of  the  bowels.  The  application  of  the  cups  gave 
increased  motor  ])ower  from  the  hips  downward,  and  on  the  second  day,  the  patient  was  able  to  separate  the  knees  when  lying 
upon  his  side.  Becoming  rested  from  the  fatigue  of  his  journey,  he  thought  himself  to  have  decidedly  improved;  became  more 
cheeiful ; was  able  to  sit  upon  the  side  of  the  bed  when  placed  up  ; but  could  only  change  his  position  by  the  management  of 
the  hands,  and  continued  very  weak.  April  25th  : Heavy  beer,  one  quart  administered  ; quantity  divided  during  the  day  ; 
urine  ])assed  with  less  difficulty,  yet  voided  frequently.  Having  no  increased  tendency  to  motion  of  the  bowels,  he  was,  April 
25th,  also  ordered  a daily  injection  of  cool  watei-,  and  the  use  of  strychnia  in  small  doses,  combined  with  tonics ; occasional 
cathartics  required  to  relieve  the  torpor  of  tlie  bowels,  which  resjionded  more  readily  to  croton  oil  than  to  other  medicines  of  this 
class.  May  5th  ; Wine,  tablespotjnful  every  three  hours ; beer  discontinued.  To  this  was  early  added  the  use  of  eggs.  Beef 
essence  was  also  given  freely  ; little  desire,  however,  for  food.  May  16th  : W^hisky,  made  rich  with  milk  and  eggs,  substituted 
for  the  wine  ; dry  cups  continued.  Under  the  use  of  stiychnia,  substituted  by  the  nux  vomica,  the  bowels  moved  spon- 
taneously, and  power  obtained  to  promjrfly  elevate  the  legs  while  lying  on  his  back  in  bed,  but  made  no  attempt  to  walk.  The 
medicine,  however,  readily  exhibited  its  undue  stimulating  action,  characterized  by  the  patient  as  of  diminished  sensation  from 
the  haunches  downward,  with  severe  pain  in  the  posterior  muscles  of  the  legs,  and  was  discontinued;  ap])etite  has  decreased, 
gradually  becoming  weaker.  During  the  second  and  earlier  part  of  the  third  week  in  M.ay  his  general  tone-greatly  diminished  : 
the  loss  of  sensation  below  the  knees  becoming  almost  entire,  retaining,  however,  limited  motor  power.  The  jjower  of  exjjelling 
the  urine  was  nearly-  lost ; pa.ssed  in  drops,  with  continued  painful  desire  to  micturate  ; temporarily  relieved  by  the  use  of  the 
catheter  (unable  to  retain  catheter  longer  than  a few  minutes),  lu  this  symptom,  the  administration  of  belladonna  in  doses  of  one- 
fourth  of  a grain  would,  for  quite  a period,  give  the  most  decided  relief.  The  j)atient  lay  chiefly  upon  his  back,  with  the  knees 
drawn  up ; pain  in  legs  and  sacial  region  increased ; faeces  passed  involuntarily  ; wet  cups  applied  near  the  lower  spine,  once  a 
day  during  four  days,  removing,  at  either  time,  for  reason  of  his  weakness,  but  a small  amount  of  blood;  no  benefit  whatever 
accruing,  was  discontinued  ; lungs  in  good  condition.  May  24th,  rejecting  all  food;  May  25th,  active  delirium  ; May  27  th,  had 
continued  the  use  of  the  catheter  twice  daily;  life  only  prolonged  bj^  the  persevering  use  of  stimulants;  pulse,  120;  respiration, 
40,  breathing  almost  exclusively  with  the  diaphragm  ; continued  delirium  ; no  sensation  in  legs,  except  under  hard  pressure ; 
continued  to  keep  tin m flexed  ujion  the  thigh.s,  and  the  thighs  upon  the  pelvis;  complained  of  intense  pain  in  the  back  of  pelvis 
and  thorax,  extending  along  the  sj)ine  upward,,  making  it  difficult  to  rest  the  neck  u])on  the  pillow;  described  the  pain  as  of 
lying  upon  hot  embers;  continued  to  cry  out  in  pain  until  a few  minutes  before  expiring,  which  took  place  on  the  morning  of 
the  following  day.  May  28th.  Autopsy,  twenty-one  hours  after  death;  assisted  by  Acting  Assistant  Surgeon  R.  M.  Kirk. 
Cicatrix  near  ]>osterior  superior  angle  of  the  right  ilium,  some  two  inches  from  spine  ; track  of  wound  passing  rapidly  toward 

the  spinal  column,  fracturing  slightly  the  superior  border  of  the  ilium,  glancing  upward 
ovei'  transverse  process  of  the  fifth  lumbai'  vertebra,  imlx-dding  small  particles  of  the 
Vuillet  in  its  transit,  and  finally  deflecting  against  the  lower  border  the  spinous  process  of 
the  third  hmdwr  vertebra,  penetrated  the  sj)inal  foramen  through  the  posterior  arch  of 
the  fourth  lumbar,  separating  the  u])per  portion  of  the  arch,  and  readily  making  its  way 
by  the  elastic  action  of  the  ligamenta  subflava,  to  which  the  upper  border  of  the  arch 
remained  attached.  Entering  the  foramen,  the  bullet  again  deflected,  turning  its  point 
downward  and  resting  within  the  fourth  lumbar  vertebra.  In  this  position  the  bullet  is 
not  entire,  a considerable  portion  being  detached  and  lying  within  the  upper  section  of 
the  vertebra.  Particles  of  lead  were  also  found  in  the  cavity  of  the  .sections.  The 
bullet  rested  within  the  leash  of  nerves  forming  the  cauda  equina  near  the  lower  left 
angle  of  foramen,  its  jioint  quite  {)enetraling  to  the  lower  border  of  the  vertebra ; and,  in 
passing  to  its  jiosition,  had  fractured  the  right  inferior  articulating  process.  The  nerve 
tissue  within  was  injured;  vertebra  reduced  nearly  to  pultaceous  consistence;  the  softening  white;  membranes  surrounding  the 
point  of  the  bullet,  lacerated,  injected,  and  of  a light  venous  ctdor.  The  fourth  and  part  of  the  third  lumbar  vertebra,  with  the 
ball  attached,  was  contributed  to  the  Army  Medical  Museum,  with  the  above  history  by  Assistant  Surgeon  C.  Bacon,  jr.,  U.  S.  A. 
The  specimen  is  figured  in  the  adjoining  cut. 


Fio.  200.— Fdurtli  lumbar  vertebra,  with 
fragments  (if  a ball  impacted.  Spec.  683, 
Sec.  1,  A.  M.  M. 


Skc't.  II.]  FR.\('TUHES  OF  TIIK  LUMBAR  VERTEBRAE.  449 

Of  gunshot  fractures  of  the  fifth  lumbar,  two  cases  may  he  recorded,  in  wliicli  the 
specimens  have  been  preserved : 

Cask. — Privatu  James  D , Co.  B,  Htli  Minnesota  Volunteers,  aged  21  years,  received  a gunsliot  penetrating  wound 

of  the  abdomen  at  Nashville,  Tennessee,  December  Ifth,  18G4;  he  also  received  a gunshot  fracture  of  the  hones  of  the  face.  He 
was  admitted,  on  the  same  ilay,  to  Hospital  No.  8,  Nashville.  Whem  admitted,  a large  ])iece  of  the  omentmn,  four  inches  in 
breadth  by  five  inches  in  lengtli,  protriuled  from  the  abdominal  woi  nd.  The're  was  great  depression  and  constant  vomiting. 
The  hernia  of  the  omentum  was  reduced.  He  died  on  Dccend)er  18th,  1864.  At  the  necropsy,  a conoidal  ball  was  found  to  have 
entered  three  inches  posterior  to  the  anterior  superior  spinous  process,  one  inch  above  the  crest  of  the  ilium,  passed  inward, 
penetrated  ,the  ileum  at  two  points,  slightly  fractured  the  body  of  the  last  lumber  vertebra,  and  lodged  in  the  right  iliac  fossa. 
There  was  intense  peritonitis  everywhere  prev.alent,  the  membrane  being  injected  and  of  a red  and  green  color,  and,  at  many 
points  over  the  viscera,  layers  of  lymph  were  found.  Facal  matter,  mixed  with  esca})ed  blood,  was  found  about  the  signal  column 
and  in  pelvic  cavity.  The  right  ilium  was  ronghened  and  denuded.  The  pathological  specimen  is  No.  3750,  Section  I,  A.  M.  M., 
and  was  contributed,  with  a history  of  the  case,  by  Acting  Assistant  Suigeon  H.  C.  May. 

Ca.se. — Private  Michael  H , Co.  D,  13th  New  York  Volunteers,  received  a gunshot  penetrating  wound  of  the  lumbar 

region  at  Gaines's  Mill,  Virginia,  June  27th,  1862.  He  was  taken,  prisoner  and  conveyed  to  Richmond,  where  he  remained  until 
July  27th,  when  he  was  paroled  and  sent  to  the  hospital  at  Chester,  Pennsylvania.  About  Sejitember  5th,  ho  was  sent,  with 
others,  to  Fort  Delaware,  for  insubordination,  and  thence  was  transferred  to  Sixteenth  and  Filbert  Streets  Hospital,  on  September 
18th.  From  the  first,  he  suffered  no  unusual  incouvenience;  the  wound  healed  slowlj'  but  entirely,  and  the  general  symptoms 
were  not  sufficient  to  attract  attention.  On  October  20th,  after  dissipation,  he  comjJained  of  pain  in  the  left  knee,  at  times  very 
intense,  depriving  him  of  rest.  The  wound  reopened  and  discharged  freely ; a slough  formed  over  the  lower  part  of  the  sacrum 
three  or  four  inches  in  diameter,  and  so  deep  as  to  lay  the  bone  bare.  A lumbar  and  psoas  abscess  develo]>ed  itself;  the  pain  in 
the  left  knee  increased  greatly,  and  the  leg  became  swollen  and  tender  to  pressure.  The  abscess  in  the  loin  was  opened  by  a 
valvular  incision,  and  three  pints  of  pus  evacuated  with  great  relief  to  the  pain  in  the  leg  and  general  improvement  in  the 
condition  of  the  patient.  The  wound  of  entrance  of  the  ball  was  very  small,  only  admitting  readil}'  an  ej'ed  probe.  About 
December  20th,  both  legs  load  become  swollen,  the  left  one  red  with  local  inflammation  at  its  upper  third.  There  was  not,  at  any 
time,  paralysis  of  motion  or  sensation  of  the  lower  extremities.  There  was  no  diarriioea,  and  the  stomach  generally  retained  the 
anodynes,  stimulants,  and  nouri.shing  diet  with  which  he  was  liberally  supplied.  He  died  of  exhaustion  on  December  27th, 
1862.  The  necropsy  revealed  an  extensive  abscess,  reaching  from  the  left  kidney  to  Poupart's  ligament.  In  the  pelvis,  in 
contact  with  the  sacrum,  was  another  abscess,  while  the  tissues  of  the  pelvis,  at  its  back  part,  were  buried  in  effusions  of  jdastic 
matter.  The  ball  was  found  lodged  in  the  spinal  canal,  opposite  the  fifth  lund)ar  vertebra.  It  had  entered  on  the  right  side  of 
the  spinal  ridge  of  the  sacrum,  about  its  middle,  passed  diagonally  upward,  and  spent  its  force  against  the  left  wall  of  the  canal 
of  th.e  first  sacral  and  fifth  lumbar  vertebra?.  The  left  lamina  of  the  first  sacral  bone  was  carried  awmy.  The  ball  passed  up 
the  canal  outside  the  theca  of  the  spinal  cord.  The  bodies  of  the  fourth  and  fifth  lumbar  vertebrae  were  carious,  and  the  inter- 
vertebral cartilage  between  them  entirely  destroyed,  leaving  a gaping  space  of  the  left  side  of  tin;  first  and  second  sacral  bones, 
which  were  necrosed  and  discolored,  as  was  also  the  fifth  throughout  its  thickness,  and  the  cornea  on  its  back  parts.  The  first 
and  second  left  sacral  nerves  seemed  most  involved  by  the  diseased  bones,  but  the  lumbar  j)lexus  of  the  left  side  w’as  entangled 
in  its  course  in  the  diseased  mass  occupying  the  basin  of  the  pelvis.  The  most  remarkable  feature  of  the  case  was  that  the  ball 
should  enter  and  occupy  the  spinal  canal,  pressing  upon  the  spinal  cord  through  its  mend)ranes  without  affecting  the  movement 
or  sensation  of  the  lower  limbs.  The  complete  closure  of  the  woimd,  and  the  development  of  the  disease  in  the  bony  Structures 
that  had  received  the  shock  of  the  hall,  three  months  after  the  injury,  w'as  also  wortliy  of  remark.  The  pathological  specimen 
is  No.  1198,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Acting  Assistant  Surg(!on  George  R. 
Moorehouse. 

A very  complicated  case,  in  wliicli  the  lumbar  vertebrae  were  imjdicated,  lint  the 

thoracic  and  abdominal  viscera  as  well,  will  be  reverted  to  under  the  head  of  thoracentesis : 

♦ 

Case. — Corporal  Samuel  Foulkrod,  Co.  G,  56th  Pennsylvania  Volunteer,s,  aged  34  years,  was  wounded  at  the  Wilder- 
ness, Virginia,  May  6th,  1864,  by  a conoidal  ball,  which  entered  the  back  in  the  lumbar  region,  and  lodged.  He  was  treated  in 
the  field,  aiid^  on  May  12th,  sent  to  the  3d  division  hospital,  Alexandria.  It  was  thought  that  some  of  the  vertebral  processes 
were  slmttered.  Several  fragments  of  bone  came  away,  and  the  wound  lu'aled  very  slowly.  After  the  wound  healed,  abscesses 
formed  in  the  sacral  region  from  time  to  time,  which  gave  vent  to  considerable  jmrulent  collections.  He  was  transferred,  on 
October  8th,  1864,  to  the  102d  companv',  2d  battalion.  Veteran  Reserve  Corps.  On  February  11th,  1865,  the  ])atient  had  an 
attack  of  acute  plemisy.  Wet  cups  wore  apjilied  to  the  right  chest,  and  six  or  eight  ounces  of  blood  withdrawn.  This  was 
followed  by  fomentations  and  jnirgativcs,  with  an  anodyne  at  night.  February  12th:  Abatement  of  febrile  action.  Effusion  in 
right  pleural  sac,  extending  up  to  the  fifth  rib  anteriorly.  Patient  jdaced  in  an  ui)right  j)osition.  February  20th,  accumulation 
in  right  pleural  sac  has  increased.  Flatness,  on  percussion,  as  high  as  the  third  rib  anteriorly;  no  res])iratory  act  audible 
below  this  point.  No  dy.spncca.  Decubitus  on  right  side.  Appetite  fair;  pulse  90,  and  soft.  Patient  com])lained  of  weakness. 
Februaiy  28th,  marked  increase  of  fluid  in  chest.  On  March  2d.  a rapid  accumulation  was  noticeable;  complete  flatness  on 
right  side,  extending  under.  Liver  de])re.ssed  three  or  four  inches.  Apex  of  heart,  two  inches  to  the  left  of  the  nipi)le.  Great 
dyspnoea;  jndse,  130.  Hectic  fever,  fdlowed  by  ])rofuse  perspiration.  The  operation  of  thoracentesis  was  decided  upon,  and 
was  performed  by  Assistant  Surgeon  Samuel  15.  Ward,  U.  S.  V.  A straight  trochar  was  ))assed  into  the  pleural  sac  between  the 
fifth  and  sixth  ribs,  in  the  lateral  region  of  the  thorax,  and  fourteen  and  a half  pints  of  healthy  pus  withdrawn.  The  ))atient 
experienced  no  faintness  during  the  operation  and  felt  greatly  relieved.  After  the  operation,  the  heart  and  liver  returned  to 


450 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[Chap.  IV, 


tlieir  positions.  The  condition  of  pneuino-liydro-thorax  appeared,  giving  rise  to  the  metallic  tinkling 
and  amphoric  voice.  Stimulants,  anodynes,  and  nutritious  diet,  with  absorbents,  expectorants,  and 
counter-irritants  constituted  the  main  treatment.  During  the  month  of  March,  the  accumulation 
returned  to  a great  extent,  the  dulness  extending  as  high  as  the  fourth  rib.  On  April  1st,  the  incision 
of  operation  burst  open,  giving  vent  to  over  a pint  of  blood,  and  afterward  continued  discharging. 
Several  abscesses  were  opened  on  the  right  thigh  and  leg.  On  April  15th,  erysipelas  appeared  on  the 
face,  terminating  favorably  in  a few  days.  On  the  25th,  he  was  transferred  to  the  Sickel  branch 
hospital,  at  which  time  he  was  gaining  strength,  and  his  case  was  very  hopeful.  Phthisis  pulmonalis 
supervened,  and  death  resulted  on  June  ICth,  1865.  The  case  is  reported  by  Surgeon  Edwin  Bentley 

u.  s.  y. 

Before  summing  up  tlie  results  of  the  entire 
series  of  cases  of  injuries  of  the  spine,  wood- 
cut  illustrations  may  he  introduced,  that  were 
not  available  when  the  abstracts  to  which  they 
belonged  were  printed  ; and  also  a few  more 
abstracts  of  the  more  remarkable  and  compli- 
cated injuries  of  the  vertebral  column.  Fig. 

201  represents  the  appearance  of  the  lower  por- 
tion of  the  spinal  cord  in  the  first  case  described 
on  page  426,  that  of  a soldier  whose  spine  was 
fractured  by  the  falling  of  a tree  across  his 
loins.  The  tubular  nerve  filaments  have  been 
curiously  dissected  out  by  the  pus  in  which  the 
cord  was  bathed,  and  form  a leash.  The  frac- 
tured vertebra  is  represented  in  Fig.  202.  The 
body  is  broken  across  nearly  transversely;  the 
spinous  and  left  transverse  process  impinged 
upon  the  medulla.  Fig.  203  has  reference  to  the  case  of  Sei'geant 

C , 26th  Massachusetts,  detailed  on  page  447.  The  ball, 

penetrating  the  thick  lumbar  muscles,  shattered  the  right  upper 


E'M 


Fig.  201. — Lower  part 
of  spinal  cord  lacerated  at 
the  dorso-lumharjunctH  n. 
Spec.  150,  Sect.  I,  A.  M.  M. 


Fig.  202 Transverse  simple 

fracture  of  first  lumbar  vertebra. 
Spec.  149,  Sect.  I,  A.  M.  M. 


Fig.  203. — Third  and  fourth  lumbar 
vertebra?,  with  a conoidal  ball  imbedded 
in  the  inter-vertebral  disk.  Spec.  379tj, 
Sect.  I,  A.  M.  M. 


oblique  process,  and  buried  itself  so  deeply  in  the  intervertebral 
space  as  to  encroach  but  little  on  the  canal;  the  patient  survived  the  injury  six  weeks. 

To  the  five  examples  of  partial  recovery  from  gunshot  fractures  of  the  cervical  vertebrae 
recorded  on  page  405,  at  the  beginning  of  this  Section,  may  be  added  the  following: 


Case. — Private  Daniel  Eicli,  Co.  B,  55th  Pennsylvania  Volunteers,  aged  21  years,  having  been  wounded  at  the  battle  of 
Pocotaligo,  October  22d,  1862,  was  admitted  to  Hospital  No.  1,  Beaufort,  South  Carolina,  on  the  24th.  A ball  had  entered  the 
sternum  near  the  clavicular  articulation  of  the  left  side  and  lodged  in  the  spinal  column.  The  patient  spat  blood  in  small  quantities 
at  the  moment  of  the  injury,  but  walked  to  the  place  of  embarkation,  a distance  of  five  or  six  miles.  He  was  obliged  to  lie  on  his 
back,  and  had  lost  power  in  both  arms,  to  some  extent.  When  admitted  to  hospital,  his  face  was  flushed  and  dusky,  coarse 
rdles  were  audible  in  the  bronchia,  and  the  pulse  was  accelerated.  Tartrate  of  antimony,  in  doses  of  one-eighth  of  a grain, 
every  four  hours,  was  prescribed,  with  low  diet,  and  wet  dressings  to  wound.  I did  not  deem  it  advisable  to  bleed,  as  the  patient 
said  his  wound  had  bled  much.  October  25th:  Excitement  of  vascular  system  less;  the  medicine  had  sickened  him,  and 
acted  on  the  bowels.  A poultice  was  ordered,  and  medicine  to  be  continued,  with  low  diet.  Decubitus  dorsal,  and  arms  lying 
by  his  side  helpless,  or  rather  unable  to  move  them  without  pain  in  the  shoulders;  his  si)ine  seems  perfectly  rigid,  and  in  being 
raised  to  take  his  food,  which  he  does  in  a chair,  he  allows  no  one  to  touch  him  anywhere,  except  upon  the  head,  and  thus,  as  a 
stick,  is  lifted  into  the  upright  position.  The  cervical  vertebra;  are  tender  to  the  touch,  as  are  also  the  upper  dorsal  vertebrae. 
October  2oth:  Much  in  the  same  condition;  antimony  continued;  low  diet,  and  poultice  to  wound.  October  27th;  Respiration 
easy;  pulse  nearly  natural;  wound  suppurating.  Antimony  discontinued,  and  ordered  half  diet;  feeling  hungry.  Continued 
much  in  the  same  condition  until  October  31st,  when  the  soft  parts  covering  the  upper  portion  of  the  sternum  had  become  red 
and  fluctuating.  The  discharge  could,  with  some  difficulty,  be  forced  out  of  the  wound  on  the  left  side,  but  did  not  do  so  without 
as.sistancc.  I therefore  made  a free  incision  in  this,  and  gave  it  vent.  An  opening  into  the  chest,  through  the  sternum,  was 
apparent  to  the  finger  introduced  through  the  wound;  being  feverish  again,  spirit  of  mindererus  was  ordered.  A coarse  rattle 
annoyed  him  very  much,  but  subsided  under  that  treatment.  The  wound  discharges  freely,  and  is  doing  well  at  this  date. 


Sect.  II.] 


FPw\CTUKP:S  01'’  tup:  LUMBAK  VKRTPIBRyp;. 


451 


November  4th,  but  the  stiffness  of  spine  and  inability  to  move  the  arms  remain.  November  18th : The  poultice  was.  discon- 
tinued yesterday,  and  cerate  dressings  ordered.  The  patient  can  now  move  his  arms  somewhat,  and  sits  up  an  hour  or  two 
daily.  Cough  disappeared  suddenly,  a week  since.  I think  it  was  when  he  first  sat  up,  and  thus  allowed  the  matter  to  run  out 
that  this  symptom  disappeared.  Discharge  is  now  very  slight  and  healthy.  December  1st,  1862 ; Rich  has  been  walking  around 
the  ward  since  the  20th  of  November,  and  complains  only  of  a feeling  of  stifliiess  in  the  spine  and  upper  extremities.  He  walks 
as  if  all  the  parts  above  the  pelvis  were  ossified  together.  Yesterday  a small  piece  of  bone  came  out  of  the  opening  over  the 
sternum;  it  was  evidently  a portion  of  the  sternum,  and  was  of  the  size  of  a ten-cent  piece.  The  three  openings  discharge  but 
little,  and  are  filled  with  very  flabby  granulations,  which  were  penciled  with  nitrate  of  silver.  A cerate  cloth  is  kept  to  the 
wounds.  December  20th:  Rich  has  been  doing  very  well  since  last  report,  sitting  up  much  of  the  time,  and  occasionally 
walking  about  the  room.  Erysipelatous  inflammation  appeared  to-day  on  the  chest.  December  27th:  The  erysipelas  has 
successively  invaded  the  chest,  left  arm,  shoulder,  and  back,  but  is  now  disappearing.  There  is  very  little  discharge  from  the 
wound.  There  still  remains  an  immobility  of  the  spine  and  arms,  which  prevents  him  helping  himself  much.  December  28th  : 
Sent  to  northern  hospital,  per  steamer  Star  of  the  South.  “Washington,  D.  C.,  November,  1865. — This  man  is  now  in  the  1st 
battalion,  V.  R.  C.,  to  which  he  was  transferred  about  a year  since,  and  has  done  military  duty  since  that  time,  and  appears  well 
at  present.”  The  above  details  were  reported  by  Surgeon  R.  B.  Bontecou,  U.  S.  V.  Rich  was  discharged  the  service  on 
November  ICth,  1865,  and  pensioned,  liis  disability  being  rated  total  and  permanent.  Pension  Examiner  C.  H.  Rahter  reports, 
under  date  of  November  20th,  1868,  that  the  patient's  respiration  is  huiried,  and  he  complains  of  constant  pain  in  the  chest. 
On  May  3d,  1871,  Pension  Examiner  S.  M.  Finley  reports  that  “the  wounds  discharge  freely  eveiy  four  or  five  months.  There 
is  great  tenderness  over  the  second  rih ; is  much  troubled  with  cough  and  breathes  hurriedly.  There  is  dulness  on  percussion, 
at  the  base  of  the  left  lung.” 

The  following  are  examples  of  partial  recovery  after  gunshot  injuries  of  the  dorsal 
or  lumbar  spine: 

Case. — Private  Alfred  Frederick,  Co.  B,  16th  New  Y’ork  Artillery,  aged  18  years,  was  wounded  at  Chapin’s  Farm, 
Virginia,  October  7th,  1864,  by  a musket  ball,  which  entered  at  the  dorsal  surface  of  tlie  left  scapula,  below  the  supra-spinous 
process,  and  emerged  posterioily  and  a little  to  the  right  of  the  second  dorsal  vertebra,  fracturing,  in  its  course,  the  spinous 
process  of  the  scapula  and  second  dorsal  vertebra.  He  was  taken  to  the  regimental  hospital,  and,  on  the  next  day,  sent  to  the 
base  hospital  of  the  Eighteenth  Corps.  On  October  26th,  he  was  sent  to  Hampton  Hospital,  Fort  Monroe,  whence  he  was 
returned  to  duty  on  February  Cth,  1865.  Pension  Examiner  A.  P.  Cook,  reports  on  August  5th,  1869,  that  there  is  inability  to 
elevate  the  ann  to  the  head,  from  adhesion  of  the  muscular  sheaths,  incapacitating  him  from  performing  manual  labor. 

Case. — Private  Nicholas  T.  Hall,  Co.  I,  1st  Massachusetts  Volunteers,  aged  19  years,  was  wounded  at  Fair  Oaks,  June 
1st,  1862,  by  a conoidal  ball,  which  entered  near  the  anterior  superior  spinous  process  of  the  left  ilium  .and  lodged  in  a lumbar 
vertebra.  He  was  treated  in  the  field  until  June  29th,  when  he  was  sent  to  Stone  Hospital,  Washington,  whence  he  was 
discharged  from  service  on  August  26th,  1862.  There  was  paralysis  of  the  lower  extremities.  Pension  Examiner  George 
Stevens  Jones  reports,  October  4th,  1862,  “the  ball  has  probably  lodged  in  the  vertebrae,  and  compressed  the  spin.al  marrow. 
The  man  is  a great  sufferer,  and  is  incurable.”  Disability  total. 

The  following  abstracts  relate  to  fatal  complicated  gunshot  injuries  of  clilferent  parts 
of  the  vertebral  column.  It  is  unusual  to  find  balls  perforating  the  lamince  and  dividing 
the  cord  with  comparatively  little  injury  to  the  osseous  structures.  The  following  is  an 
example  of  such  an  injury: 

Case. — Corporal  W.  N , Co.  C,  142d  Pennsylvania  Volunteers,  having  been  wounded  at  Fredericksburg,  December 

1.3th,  was  admitted  to  hospital  at  Alexandria,  December  19th,  1862.  A ball  had  entered  one  inch  and  a h.alf  above  the  outer 
third  of  the  right  clavicle  and  lodged.  The  patient  was  weak,  and  had  an  anxious  countenance;  there 
was  consider.able  dyspnoea,  with  a full  but  weak  pulse,  and  suppuration  from  the  wound  was  profuse. 

On  December  23d,  diarrhoea  set  in,  attended  with  anorexia;  otherwise  the  condition  of  the  p.atient 
remained  unchanged.  The  diarrhoea  became  worse  by  the  28th,  and  dyspnoea  increased,  the  breatli 
passing  through  the  wound.  The  patient  died  on  December  31st,  1832,  with  very  great  dyspnoea.  At 
the  autopsy,  it  was  found  that  the  ball  had  passed  longitudinally  through  the  inferior  lobe  of  the  right 
lung,  impinged  upon  the  body  of  one  of  the  dorsal  vertebrae,  a splinter  of  which  still  adheres  to  the 
ball,  and  lodged  under  the  greater  curvature  of  stomach.  There  was  red  hepatization  of  the  injured 
lung,  and  a little  pus  was  found  in  the  thorax.  There  was  nothing  to  indicate  the  occurrence  of 
hmmoiThage.  The  treatment  of  this  case  was  expectant.  The  missile  was  contributed  to  the  Army 
Medical  Museum,  with  the  foregoing  account,  hy  Acting  Assistant  Surgeon  G.  F.  French.  It  is  repre- 
sented in  the  adjoining  cut  (Fig.  204). 

Case. — Private  li.  H.  Godwin,  Co.  K,  31st  Virginia  Regiment,  aged  26  years,  was  admitted  into  Chimborazo  Hospital 
No.  1,  Richmond,  Virginia,  with  a gunshot  injury  of  the  spine,  received  on  Juno  1st,  1864,  the  ball  entering  the  lirst  lumbar 
vertebra  and  ranging  upward.  He  died  June  3d,  1864.  Paralysis  did  not  occur.  Surgeon  P.  F.  Brown,  1’.  A.  C.  S.,  reports 
the  case. 

Case. — Private  Salvador  Real,  Troop  F,  1st  New  Mexico  Cavalry,  was  .admitted  to  hospital  at  Fort  Wingate,  New 
Mexico,  for  a wound  received  in  an  attack  by  Indians  near  that  post,  on  M.ay  24th,  1865.  A rifle  ball  had  entered  immediately 
below  the  spine  of  the  right  8C.apula,  passed  obliquely  downward  .and  inw.ard,  and  entered  the  thorax  through  one  of  the  l ight 


Fig.  204.— Conoidal  mus- 
ket ballsnmewliat  curved, 
•W’ith  the  apex  obliquely 
flattened  and  a fragment 
rent  ofT.  Spec.  4483,  Sect. 
1,  A.  M.  M. 


452 


WOUNDS  AND  INJUEIES  OF  THE  SPINE. 


[Chap.  IV, 


i-ibs  two  inches  from  the  vertebral  column.  The  cliief  symptoms  were  inflammation  of  the  liglit  lung,  higli  fever,  and  bloody 
expectoration.  The  treatment  pursued  was  strictly  antiphlogistic;  bleeding,  purging,  sedatives,  and  spare  diet.  Death  occurred 
on  May ‘28th,  1835.  At  the  autopsy,  the  right  lung  was  found  completely  hepatized;  the  left  lung  was  in  a healthy  condition. 
A number  of  splinters  of  bone  from  the  fractured  rib  were  imbedded  in  the  right  lung  adjacent  the  wound,  and  a small  quantity 
of  lymph  covered  the  lower  and  back  part  of  the  lung  in  proximity  to  the  wound.  The  ball  was  imbedded  in  the  body  of  one 
of  the  vertebra  nearly  opposite  the  wound  of  entry.  The  case  is  rej)orted  by  Acting  Assistant  Surgeon  Charles  A.  McQueston. 

Case. — Private  John  Lowe,  Co.  C,  31st  Indiana  Volunteers,  aged  23  years,  was  wounded  at  Pittsburg  Landing,  Tennessee, 
April  7th,  1832,  by  a conoidal  hall,  which  entered  near  the  clavicle  to  the  left  of  the  sternum,  and  lodged  near  the  spine  on  the 
same  side.  On  April  11th,  he  was  admitted  to  the  hospital  at  Mound  City,  Illinois.  Haemoptysis  for  first  four  days.  Severe  pain 
in  lung  and  labored  respiration.  Arterial  sedatives  weie  given,  with  an  anodyne  at  night.  On  April  28th,  he  was  transferred  to 
Hospital  No.  4,  Evansville,  Indiana.  The  ball  had  been  extracted  previous  to  admission.  On  May  2d  and  ICth,  haemorrhage 
occurred  from  the  large  vessels  in  iqiper  j)art  of  chest.  He  bled  from  the  mouth  and  posterior  wound  in  both  instances,  and 
became  much  reduced  in  strength  without  syncope  supervening.  Astringents  of  acetate  of  lead  and  opium  were  given,  with  mild 
antiphlogistics,  and  quiet  ordered.  The  wounds  healed.  Death  resulted  August  14,  1862,  from  paralysis,  referred  to  necrosis  of 
the  spinal  colmnn.  The  case  is  reported  by  Surgeon  E.  C.  Franklin,  U.  S.  V. 

Case. — J.  IV.  B , was  killed  on  April  26th,  1865,  by  a conoidal  pistol  ball,  fired  at 

the  distance  of  a few  yards,  from  a cavalry  revolver.  The  missile  perforated  the  base  of  the 
right  lamina  of  the  fourth  cervical  vertebra,  fracturing  it  longitudinally  and  separating  it  by  a 
fissure  from  the  spinous  process,  at  the  same  time  fracturing  the  fifth  vertebra  through  its  pedicle, 
and  involving  that  transverse  process.  The  projectile  then  traversed  the  spinal  canal  almost 
horizontally,  but  with  a slight  inclination  downward  and  backward,  perforating  the  cord,  which  was 
found  much  torn  and  discolored  by  blood.  (See  Specimen  4087,  Sect.  I,  A.  M.  M.)  The  ball  then 
shattered  the  bases  of  the  left  fourth  and  fifth  laminae,  driving  bony  fragments  among  the  muscles, 
and  made  its  exit  at  the  letl  side  of  the  neck,  nearly  opposite  the  point  of  entrance.  It  avoided  the 
large  cervical  vessels  and  the  filaments  of  the  second  and  third  cervical  nerves.  These  facts  were 
determined  at  the  autopsy,  which  was  made  on  Ajnil  28th.  Immediately  after  the  reception  of  the 
injury,  there  was  very  general  paralysis.  The  phrenic  nerves  performed  their  functions;  but  the 
BlKiwitiK  gunshot  fracture  of  respiration  was  diaphragmatic,  of  course,  and  labored  and  slow.  Deglutition  was  impracticable, 
408B,  Sect.  I,  A.  M.  M.  and  one  or  two  attempts  at  articulation  were  unintelligible.  Death,  trom  asphyxia,  took  place  about 

two  hours  after  the  reception  of  injury. 

The  next  is  an  abstract  of  a case  complicated  by  tetanic  symptoms.  Others  have 
been  recorded  on  pp.  444  and  445,  ante. 

• 

Case. — Private  John  Ratteo,  Battery  C,  5th  United  States  Artillery,  aged  28  years,  was  wounded  at  Gettysburg,  July 
1st,  1863,  by  a conoidal  ball,  which  entered  below  the  spine  of  the  left  scapula,  and  lodged  in  the  angle  between  the  spinous  and 
transverse  processes  of  the  eighth  dorsal  vertebra,  fracturing,  but  not  di.splacing  the  .spinous  process.  After  being  wounded,  he 
walked  to  the  field  hospital  without  assistance,  and  was  able  to  move  about  and  help  himself  until  the  6th,  when  clonic  spasms 
of  the  abdominal  muscles  and  diaphragm  set  in,  which  continued  steadily  increasing  in  intensity.  Anmsthetics  were  administered, 
and  the  urine  was  drawn  oft'  by  a catheter.  On  the  evening  of  the  next  day,  he  fell  into  a sleep,  upon  awakening  from  which 
the  spasms  returned,  and  continued  until  death,  which  occurred  at  eleven  o'clock  P.  M.,  July  7th,  1863. 

Concluding  Observations. — Gnnsliot  injuries  of  the  vertebral  column  are,  of  course, 
very  serious.  The  following  table  shows  that  more  than  half  of  those  cases  that  came  under 
treatment  were  fatal;  and  many  who  suffered  from  such  injuries  must  have  rested  on  the  field: 

Table  XLX. 


Hesidts  of  Six  Hundred  and  Forty-two  Cases  of  Gunshot  Injuries  of  the  Vertehroe. 


llEGION. 

Cases. 

Died. 

Discharged. 

Duty. 

UukiiowD. 

Percentage 
of  Mortality. 

Cervical 

91 

63 

19 

8 

1 

70.0 

Dorsal 

niY 

87 

32 

18 



63.5 

Lumbar 

149 

66 

51 

28 

4 

45.5 

2 

1 

1 

.50. 

3 

3 

100. 

Vcrtebrm  not  stated 

260 

1‘29 

72 

50 

9 

51.4 

Aggregate 

642 

349 

175 

104 

14 

55.5 

riG.  205. — Third,  fourth, 
and  fifth  cendcal  vertebrtB, 


Sfxt.  II.]  EEMARKS  ON  GUNSHOT  INJUEIES  OF  THE  VEETEBENi.  453 

Among  the  cases  enumerated  in  the  foregoing  table, — which  includes  those  of  which 
abstracts  have  been  given, — the  following  complications  were  noted : 

j\Iusket  balls  lodged  in  bodies  or  apophyses  of  vertebrse  in  such  a manner  that  their 
precise  position  could  not  be  ascertained,  or  else  So  impacted  that  all  efforts  for  their 
extraction  were  fruitless.  Several  such  examples  are  figured  in  the  preceding  pages  of 
this  Section.  (See  Figuees  190,  192,  193,  194,  195,  196,  197,  198,  199,  200,  203.) 
The  total  number  reported,  of  such  cases,  was  seventy-three  :^Twelve  in  cervical  region, 
with  eight  deaths,  two  complete  recoveries,  one  discharge  with  slight  disability,  and  one 
undetermined  case ; thirty-four  in  the  dorsal  region,  of  which  thirty-one  were  fatal,  one 
recovered,  one  discharged,  one  with  result  unknown  ; twenfiy-one  of  the  lumbar  region, 
with  sixteen  deaths  and  five  discharges  for  disability  ; six  in  which  the  region  was  not 
specified,  with  three  deaths,  tAvo  discharges,  and  one  recovery.  In  fifty-four  cases  of 
gunshot  injury  of  the  vertebrae,  complicated  by  traumatic  lesions  of  the  cord,  forty-two 
were  fatal,  and  twelve  partially  recovered  and  were  discharged,  Avith  various  degrees  of 
physical  disability.  The  cases  of  contusion  and  commotion  of  the  spinal  cord  are  not 
included  in  this  category.  Abstracts  of  fourteen  of  the  fatal  cases  have  been  printed  in 
the  foregoing  pages.  One  of  these,  the  second  on  page  439,  in  Avhich  the  patient  is 
reported,  by  Surgeon  E.  Donnelly,  2d  Pennsylvania  Reserves,  to  have  survived  eight  days, 
after  a conoidal  pistol  ball  had  passed  into  the  spinal  canal  through  the  apophyses  of  the 
eighth  dorsal  and  upAvard  “through  the  medulla  spinalis  as  far  as  the  first  cervical,”  is  so 
extraordinary,  that  the  authority,  accidentally  omitted,  is  here  recorded.  The  fifty-four 
cases,  Avhere  injury  of  the  cord  is  mentioned,  cannot  possibly  include  all  in  Avhich  that  com- 
plication existed.  In  the  Army  Medical  Museum  alone,  there  are  fifty-tAvo  specimens  of 
gunshot  injuries  of  the  sj^ne  involving  the  cord,  nearly  all  procured  from  cases  included  in 
Table  XIX.  The  Museum  contains  seventy-six  specimens  shoAving  the  results  of  gunshot 
fracture  of  the  A-ertebrse.'''  In  nineteen  cases  primarily  fatal,  the  cord  escaped  injury  in  four 
only ; in  fifty-seven  examples  of  secondary  pathological  conditions,  the  cord  Avas  involved 
in  thirty-seven.  Estimating  the  relative  frequency  of  injury  to  the  cord,  in  gunshot  frac- 
tures of  the  vertebrae,  by  the  fatal  cases  alone,  the  percentage  Avould  be  71.0.  Paralysis  is 
mentioned  as  a prominent  symptom  in  only  one  hundred  and  fifty-one  of  the  six  hundred 
and  forty-tAvo  cases  enumerated  in  the  table.  Making  every  alloAvance  for  the  considerable 
proportion  of  cases  in  Avhich  the  lesions  Avere  confined  to  the  apophyses,  it  must  be  regarded 
as  probable  that  this  complication  Avas  not  ahvays  noticed  Avhen  present.  There  Avere  not 
a foAV  instances  in  Avhich  paralysis  Avas  absent  eAmn  Avhere  the  cord  was  injured.  (See 

Cases  of  J.  R , p.  444 ; J.  D p.  447  ; M.  II , p.  449  ; R.  H.  Goodwin,  p. 

451.)  All  of  these  Avere  examples  of  injury  of  the  lumbar  A^ertebrco.'j*  In  the  case  of 
Bowers  (p.  444),  there  Avas  no  paralysis,  except  of  the  bladder.  The  occurrence  of  bed- 
sores is  noted  in  tAventy-tAvo  of  the  six  Imndred  and  forty-tAvo  cases,  eleven  terininating 
fatally.  In  fourteen  cases,  of  which  tAvelve  terminated  fatally,  injuries  of  the  Amrtebrm 
Avere  complicated  by  AAmunds  of  the  lung.  In  fifteen  cases  the  abdominal  caAuty  Avas  pene- 
trated ; there  Avas  a single  partial  recovery.  Abstracts  of  some  of  the  fatal  injuries  of  the 
spine,  complicated  by  penetration  of  the  thoracic  or  abdominal  cavities  or  both,  have  been 
cited  on  pp.  441,  442,  and  446,  ante.  In  several ’instances  the  lung,  diaphragm,  livei’, 
spleen,  or  kidney,  Avere  implicated. 

*Scc  Cat.  of  Surff.y  Sect.  A.  M.  M.,  p.  57,  ct  seq. 

t See  Mr.  SUAW'rt  paper  in  lIOLMES  tt  System  {Op.  ci7.,  Vol.  II,  p.  38iD.  I'  >ur  interesting  cases  of  total  absence  of  paralysis  in  fractures  of  the 
lower  lumbar  rrgi<in. 


454 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[Chap.  IV, 


Tetanus  supervened  in  seven  cases  of  gunsliot  injury  of  the  vertebral  column.  Chloro- 
form, hypodermic  injections  of  morphia,  and  the  extract  of  Calabar  bean  internally,  with 
stimulants  and  nutritious  enemeta,  were  the  medicinal  agents  generally  employed. 

Pycemia  is  noted  as  a complication  in  eight  of  the  three  hundred  and  forty-nine  fatal 
cases  recorded  in  Table  XtX. 

Pyspnoea  is  alluded  to,  either  directly  or  by  implication,  principally  in  cases  of  gun- 
shot injury  of  the  cervical  vertebrae,  and  in  many  of  those  of  the  dorsal.  Mr.  Shaw^  in 
his  able  paper  on  injuries  of  the  spine,  calls  attention  to  the  fact  that  respiration  is  not 
exclusively  diaphragmatic  in  injuries  of  the  cervical  portion  of  the  cord,  for  although  the 
intercostal  and  abdominal  muscles  are  paralyzed,  the  serratus  magnus,  supplied  by  the 
external  thoracic  nerve  (Bell’s  external  respiratory),  and  other  muscles  of  the  outside  of  the 
chest,  are  powerful  auxiliaries  in  inspiration,  and,  indeed,  in  expiration  also  ; for  the  action 
of  these  muscles-  is  to  elevate  the  upper  ribs  to  which  they  are  attached,  and  to  expand  the 
chest,  and,  when  they  relax,  the  ribs  falling  from  the  elasticity  of  the  thorax,  the  lungs  are 
compressed  and  both  actions  of  respiration  are  thus  aided.  Brodie^  explains  the  occurrence 
of  dyspnoea  in  injuries  of  the  dorsal  spine  by  the  removal  of  the  power  of  the  abdominal 
muscles  to  aid  in  expiration.  The  air  not  being  completely  expelled,  mucus  accumulates 
and  cannot  be  expectorated,  and  the  blood  is  imperfectly  oxygenated.  Mr.  Shaw  points 
out  the  additional  reason  that  distension  of  the  hollow  viscera  by  gases  is  permitted  by  the 
deprivation  of  the  compression  normally  exercised  by  the  muscles,  and  that  tympanitis 
thus  produced  disturbs  the  respiration  mechanically. 

Dysphagia  is  noted  in  a number  of  cases,  the  complication  being  generally  dependent 
upon  "wounds  of  the  muscles  of  deglutition  rather  than  upon  injury  of  the  nerve  trunks. 

Costiveness  was  the  general  rule  in  these  injuries,  in  the  early  stages  ; but  when  the 
lower  portion  of  the  cord  became  disorganized,  paralysis  of  the  sphincter  and  involuntary 
foecal  discharges  were  common,  a phenomenon  clearly  explained  by  Mr.  Hilton.^  Disorders 
of  the  urinary  organs  are  frequently  referred  to.  Detention  of  urine,  requiring  the  habit- 
ual use  of  the  catheter,  was  often  followed  by  incontinence,  if  the  patients  lived  long.  The 
occurr-ence  of  suppression  of  urine  or  of  diabetes,  referred  to  by  authors,  was  not  noted. 
Hsematuria  is  reported  in  a single  case,  in  which  the  kidney  had  shared  in  the  injury  of 
the  vertebra.  The  secretion  of  mucus  and  ammoniacal  urine  is  often  alluded  to,  and  in  two 
instances  cystitis  was  pronounced  the  proximate  cause  of  death. 

Priapism  is  reported  in  three  cases  only,  all  of  the  cervical  region.'*  It  will  be  readily 
understood  that  the  figures  cited  here  and  throughout  this  analysis  of  the  table  by  no 
means  furnish  an  exact  estimate  of  the  number  of  instances  in  which  a given  rational 
symptom  was  present ; but  state  simply  how  often  it  was  noted.  The  reports  were 
generally,  of  necessity,  too  brief  to  admit  of  a full  review  of  the  clinical  phenomena. 

’ On  Injuries  of  the  Bade.  In  Holmes’s  System  of  Surgery,  2d  ed.,  1870,  Vol.  II,  p.  392. 

2 It  would  appear  that  this  remark  can  only  apply  to  cases  of  injury  below  the  origin  of  the  sixth  cenical  nerve. — Compiler 

3 Guy’s  Hospital  Deports,  Vol.  XI,  3d  series. 

Another  case  is  reported  in  Circular  3,  S.  G.  O.,  1871,  p.  129. 


Sect.  III.] 


OPEEATIONS. 


455 


Section  III. 


OPERATIONS. 


A few  cases  of  ligations,  on  account  of  secondary  haemorrhages,  a number  of  ball 
extractions,  and  i-emovals  of  fragments  of  bone  constituted  the  examples  of  operative 
interference  resorted  to  in  the  wounds  and  injuries  of  the  spine.  The  number  and  results 
are  exhibited  in  the  following  table  : 

Table  XX. 


Results  of  8ixty-two  Operations  after  Gunshot  Fractures  of  the  Vertebrae 


OPERATION. 

REGION. 

Cases. 

Died. 

Discharged. 

Duty. 

Unknown. 

Cervical 

1 

1 

Do.  (In.  

12 

4 

1 

Do.  do 

Lumbar 

16 

5 

7 

3 

1 

Do.  do 

Not  stated 

5 

3 

1 

1 

Cervical * 

5 

2 

2 

1 

Do.  do 

6 

2 

1 

3 

Do.  do 

Lumbar 

9 

4 

4 

1 

Do.  do 

Not  stated  

4 

2 

2 

Tdit^atioiis 

4 

4 

. Total 

62 

27 

22 

11 

2 

Ligations. — The  complications  of  injuries  of  the  spine  by  haemorrhage  were  not 
numerous.  In  seventeen  only,  of  the  six  hundred  and  forty-two  cases  enumerated  in 
Table  XIX,  is  this  complication  noted  as  of  importance  ; fourteen  of  the  cases  had  a fatal 
termination.  In  a complicated  case,  not  included  in  the  table,  of  gunshot  wound  of  the 
lower  jaw,  tongue,  and  pharynx,  the  first  on  page  355,  the  left  transverse  process  of  the 
third  cervical  vertebra  was  fractured.  The  coats  of  the  vertebral  artery  wore  away  against 
the  jagged  margin  of  the  fracture  ; on  the  eleventh  day  there  was  copious  haemorrhage, 
for  which  the  common  carotid  artery  was  tied.  Seven  days  subsequently  haemorrhage 
recurred  and  was  promptly  fatal,  the  bleeding  point  being  vainly  sought  for.  It  would 
be  difficult  to  adduce  a more  striking  illustration  of  the  soundness  of  Guthrie’s  precept  on 
this  subject.  Apart  from  this  case  which  has  been  recorded  in  a previous  category  on 
account  of  its  complications,  in  four  other  instances  only  were  important  vessels  secured: 

Case. — Ligation  of  Occipital  Artery. — Private  Joseph  Horton,  Co.  D,  57th  Massachusetts  Volunteers,  aged  23  years,  was 
wounded  at  North  Anna,  May  18th,  1864,  by  a conoidal  ball,  which  entered  the  external  ear,  and  passing  inward  and  downward. 


456 


AVOUNDS  AND  INJUlilES  ON  THE  SPINE. 


[Chap.  IV, 


lodged  ill  tlie  fiint-doi  sal  vertelira.  He  also  i cceived  a gunshot  wound  of  the  right  hand.  He  was  conveyed  to  the  field  hospital 
of  the  Ninth  Corps,  where  the  tliimib  and  forefinger  were  anijintati  d.  On  l\Iay  24th,  he  was  transferred  to  Hare-wood  Hospital, 
AVashington.  Secondary  haniorrhage  occurred  frcni  the  right  occipital  artery  on  Alay  31st;  the  artery  was  ligated  by  Surgeon 
E.  I>.  Piontecou,  IT.  S.  A'^..  on  the  same  day.  The  harniorrhagc  recurred  on  June  2d,  when  re-ligation  was  jierforined.  Death 
resulted  in  about  three  hours  after  the  second  operation.  The  case  is  taken  from  the  Harewood  Hospital  reports. 

Tliougli  the  surgeon  fdloAved  the  generally  accepted  practice*  in  the  folloAving  case, 
one  cannot  refrain  from  a feeling  of  regret  that  an  attempt,  at  least,  Avas  not  made  to  place 
a double  ligature  on  the  internal  carotid  at  the  part  Avounded.  If  successful,  it  Avould 
have  been  a glorious  achieA^ement,  and  it  could  not  have  had  a Avorse  result  than  the 
Anellian  operation  that  Avas  adopted : 

Ca.su. — Ligation  of  Common  Carotid  for  Gvnslwt  TTound  of  the  Internal  Carotid. — Orderly  Sergeant  Vincent  L.  Keiflin, 
Co.  K,  lObth  Pennsylvania,  was  wounded  at  Gettysburg,  July  2d,  1863,  by  a conoidal  ball,  which  entered  the  right  side  of  the 
neck,  just  below  and  posterior  to  the  ear,  and  lodged.  He  was  treated  in  the  field  until  July  10th,  when  he  was  sent  to  the 
hospital  at  A'ork.  His  name  does  not  appear  on  the  register  of  the  Third  Corps  Hospital,  where  most  of  the  wounded  of  his 
regiment  were  treated.  On  the  12th,  a severe  liaemorrhage  occurred  from  the  wound,  and  could  not  he  controlled  hy  the  ordinary 
means.  The  right  common  carotid  artery  was  tied  by  Surgeon  Henry  Palmer,  U.  S.  A^.,  on  the  13th.  The  patient  died  on  the 
morning  of  July  14th,  1863.  Necropsy : The  internal  carotid  artery  was  nearly  severed  at  the  point  where  it  enters  the  skull. 
The  right  arch  of  the  atlas  was  shattered,  and  its  fragments  pressed  on  the  vertebral  artery.  Three  jiieces  of  the  hall  were 
extracted.  The  case  is  reported  by  Acting  Assistant  Surgeon  H.  E.  Bowen,  in  charge  of  the  case  hooks  of  Tork  Hospital.  The 
medulla  appears  to  have  escaped  all  injury. 

In  the  next  case  there  is  no  indication  of  the  source  of  bleeding ; but  it  Avas  probably 
a lesion  of  some  of  the  vessels  in  the  axilla,  as  the  operator  Avould  hardly  have  tied  the 
left  subclavian  Avithin  the  scaleni,  Avithout  specifying  the  fact  : 

Case. — lAgation  of  Left  Subclavian. — A.  C.  Howard,  Confederate,  aged  19  years,  received  at  Fair  Oaks,  May  31&t,  1862, 
a gunshot  wound,  the  ball  passing  through  the  left  shoulder,  injuring  the  spine  and  causing  paralysis.  On  June  7th,  the  left 
subclavian  artery  was  ligated  on  account  of  haemorrhage.  He  died  on  June  18th,  1862.  [The  case  is  reported  by  Dr.  H.  L. 
Thomas,  in  the  Confederate  States  Medical  and  Surgical  Journal,  A^ol.  I,  p.  186.t] 

The  folloAving  case,  reported  by  Assistant  Surgeon  Robert  F.  Weir,  U-  S.  A.,  is  very 
instructiA^e  : 

Ca.se. — Diffuse  Traumatic  Aneurism  ; If’ound  of  the  SjAnal  Cord;  lAgation  of  the  Carotid;  Death;  Autopsy. — “In  the 
afternoon  of  .Sejitember  30th,  1862,  I was  requested  to  see  in  consultation,  by  Surgeon  Thurston,  U.  S.  A'^.,  and  Acting  Assistant 
Surgeon  C.  P.  Herrington,  at  Frederick  Hospital  No.  4,  Private  Henry  Herman,  12th  Pennsylvania  Eeserves,  aged  23  years, 
who  was  wounded  at  the  battle  of  Antietam,  by  a buckshot,  which  had  entered  on  the  right  side  of  the  nock  on  a level  with  the 
upper  portion  of  the  thyroid  cartilage  and  on  the  anterior  margin  of  the  sterno-mastoid.  Of  his  history  prior  to  his  entrance  into 
this  hospital,  September  24th,  little  could  be  ascertained,  but  the  following  was  obtained  from  the  patient.  On  the  2Gth  instant, 
some  haemorrhage  had  occurred,  twelve  days  after  the  reception  of  the  injury.  The  bleeding  had  been  checked,  as  was  thought, 
by  ])luggiug  the  small  opening  of  the  wound  with  lint  saturated  with  liquor  ferri  pcrsulphatis.  A pulsating  tumor  then  rapidly 
formed  and  extended  so  that  at  four  o’clock  P.  M.  of  the  same  day  it  had  reached  from  the  maxilla  to  the  clavicle,  and  from  the 
sterno-mastoid  to  the  median  line.  Although  the  course  of  the  missile  was  unknown,  there  had  resulted  paralysis  of  the  right 
leg  and  partial  loss  of  the  functions  of  the  right  arm.  There  was  no  indication  of  urinary  trouhle.  At  the  hour  of  consultation 
the  tumor  w.as  reported  to  have  increased  much  iu  sine  and  had  now  crowded  the  trachea  considerably  to  the  left  side.  The 
covering  of  the  false  aneurism  was  tense,  and  pulsation  and  a harsh  thrill  were  detected  on  palpation.  The  ])lug  of  lint  remains 
in  yet,  held  firmly  by  clotted  blood.  The  mean  pulse  was  65  and  irregular,  but  became  quiet — jirobably  from  the  amount  of 
rereitum  riride  i\\nl  had  been  given  him,  to  wit:  from  eleven  o’clock  A.  M.  (it  now  being  five  o’clock  P.  Jl.),  eight  drops  every 
one  and  a half  hours.  The  respiration  was  slow  and  irregular,  and  somewhat  violent  and  humid,  with  lividity  of  the  face. 
Even  if  the  cord  had  been  injured  by  the  shot,  which  was  not  thought  probable  by  many  of  the  assistants,  it  was  decided  to 
operate,  since  death  was  imminent  from  the  recurrence  of  the  severe  haemorrhage,  and  I was  requested  to  perform  the  operation. 
Having  carefully  assigned  their  duties  to  my  assistants,  the  lint  idug  was  removed,  and  immediately  the  wound  was  enlarged  by 
me,  with  probe  pointed  instruments,  sufficiently  to  admit  my  two  fingers  to  the  bottom  of  the  cavity.  I was  so  fortunate  as  to 
reach  and  compress  the  opening  in  the  artery  with  very  little  difficulty,  and  thus  effectually  control  the  haemorrhage,  which  at 

* I think  tliat  it  is  unfortunate  that  the  last  edition  of  Gray's  Anatomy  (2d  Holmes,  London,  18G6,  p.  35fi),  a work  in  the  hands  of  so  many  students, 
should  recommend  the  ligation  of  the  common  carotid  for  wounds  of  the  intemal  carotid. — Compiler. 

t In  connection  with  this  case,  Dr.  H.  L.  THOMAS,  who  did  much  of  the  statistical  work  in  the  Confederate  Surgeon  General's  Oftice,  remarks:  “In 
many  of  the  reports  the  data  are  so  meagre  as  not  to  furnish  any  satisfactory  conclusiiuis  with  regard  to  the  gravity  of  tlie  case.  Ilrevity  is  a very 
commendable  feature  in  clinical  reports,  but  should  nut  be  pushed  to  the  extent  (f  robbing  the  ease  of  its  interest.  ‘Alexander  died — Alexander  was 
buried ; ’ but  tliere  are  some  people  who  would  be  curious  to  know  how  be  died  and  when  he  was  buried  ; and  it  is  a lean  obituary  that  does  not  give 
these  small  items.'* 


Sect.  III.] 


EEMOVAL  OF  FRAGMENTS  OF  VERTEBRA. 


457 


first  had  been  quite  profuse,  thougli  of  short  duration.  Throughout  the  wliole  of  tlie  protracted  operation,  it  was  noticed  witli 
what  ease  the  bleeding  fi’oni  the  artery  was  checked — so  little  pressure  was  recjuired.  The  clots  were  now  turned  out  and  the 
incision  prolonged  downward  to  the  clavicle,  and  upward  about  one  inch — the  length  of  the  entire  incision  being  three  and  one- 
fourth  to  four  inches.  Owing  to  the  obscurity  of  the  tissues  from  infiltrated  blood  and  the  dis]ilacenient  of  the  parts  from  ])rcssure, 
great  difficulty  was  experienced  in  securing  the  artery  above  and  below  the  opening,  which  the  end  of  the  forefinger  neatly 
closed.  It  was  only  after  long  and  repeated  attempts  that  the  proximal  part  of  the  carotid  was  exposed  and  a ligature  placed 
around  it  b}'  means  of  !Mott’s  aneurism  needle.  The  finger  at  this  time  became  accidentally  displaced  from  the  opening,  and  it 
was  noticed  that  the  blood  welled  from  the  upper  carotid  for  five  or  six  seconds  before  jetting.  The  ligature  of  the  distal  portion 
was  then  applied,  which  entirely  checked  the  bleeding.  At  the  time  the  first  ligature  was  apjdied,  great  disturbance  in  the 
respiratory  movements  occuri'cd,  suggesting  the  idea  that  the  pneumogastric  nerve  had  been  included  in  the  ligature.  After  ten 
or  fifteen  minutes  they  became  more  regular.  It  was  noticed  also,  but  freely  after  six  ligatures  had  been  applied,  that  hemiplegia  of 
the  left  side  had  taken  place,  with  tendency  to  sleep;  patient  was  easily  aroused,  and  that  the  right  arm  alone  was  movable; 
deglutition,  however,  was  not  impaired.  The  opening  in  the  artery  was  plainly  visible  after  the  ligation.  It  was  oval  in  shape, 
and  about  a quarter  of  an  inch  long.  Almost  eight  ounces  of  blood  had  been  lost,  being  much  less  than  anticipated  from  so 
formidable  an  operation,  which  had  occupied  more  than  two  hours.  Six  and  a half  o’clock  P.  M. : At  the  tumefaction,  jndse  (16, 
and  of  moderate  force;  respiration  ranging  from  36  to  48.  No  other  symptoms  appeared  to  justify  the  idea  of  a ligation  of  the 
pneumogastric  nerve.  Vision  of  both  eyes  was  impaired,  though  the  left  pupil  did  not  contract  upon  exposure  to  strong  light ; 
the  condition  of  the  pupils,  jirior  to  the  operation,  had  not  been  noticed.  Seven  and  a half  o’clock  p.  M. : The  trachea  had 
returned  to  its  noiinal  position.  Is  taking  one-half  ounce  of  brandy  every  fifteen  minutes;  pulse  95,  and  a little  weak.  Is  still 
somnolent,  and  an  involuntary  evacuation  of  the  bowels  has  taken  place.  October  1st,  fifteen  minutes  past  six  o’clock  a.  m.  : 
Quite  a severe  haemorrhage  occurred,  which,  however,  was  easily  arrested  by  the  application  of  liquor  fern  persulphatis  by  the 
surgeon  in  attendance.  This  was  thought  to  have  originated  from  some  vessel  divided  during  the  operation.  Paralysis  continued 
the  same,  indicating  cerebral  lesion.  The  patient  gradually  sank,  becoming  more  profoundly  immersed  in  stupor  and  although 
both  pupils  acted  regulaily  when  exposed  to  light,  at  twenty-five  minutes  past  two  o’clock  P.  Si.  he  died.  The  autopsy,  made 
twenty-four  hours  after,  revealed  the  following  facts  : Rigor  mortis  tolerably  well  marked.  The  skin  was  black  from  the  jaws 
to  the  second  rib  on  the  entire  right  side,  and  the  whole  body  greatly  puffed  up.  A careful  dissection  of  the  neck  on  the  right 
side  was  made.  Everything  was  found  gi-eatly  disarranged  and  displaced  by  reason  of  the  false  aneurism  and  the  operation. 
All  the  veins  were  immensely  distended  with  air,  though  no  injury  to  their  calibre  was  discovered.  The  omo-hyoid  had  been 
divided.  The  descendens  noni  nerve  was  not  found,  but  the  communicans  noni  nerve  was  uninjured.  Neither  the  internal 
jugular  vein  nor  the  pneumogastric  nerve  were  found  to  be  included  in  the  ligature,  nor  did  the  nerve  seem  to  have  been  affected 
through  its  pi’oper  sheath  by  the  persulphate  of  iron,  as  was  thought  might  have  occurred.  On  examining  the  artery  it  was 
found  that  the  ligature  had  been  applied  three-eighths  of  an  inch  above  and  five-eighths  of  an  inch  below  the  w'ound,  but  the 
upper  one  was  somewhat  loose,  perhaps  enough  so  as  to  account  for  the  recurrence  of  the  hasmorrhage  after  the  operation, 
though,  as  it  controlled  the  haemorrhage,  at  first,  it  seems  more  reasonable  to  suppose  that  the  haemorrhage  came  from  the  superior 
thyroid,  which  had  itself,  or  some  of  its  branches,  been  divided  in  the  operation.  The  wound  was  made  in  the  sheatli  on  the 
inner  side,  three-eighths  of  an  inch  below  the  border  of  the  superior  thyroid  cartilage  and  one-eighth  of  an  inch  below  the 
bifurcation  of  the  artery.  It  was  about  three-eighths  of  an  inch  long  and  nearly  as  broad,  with  a narrow  connecting  band 
running  longitudinally.  The  ■walls  of  the  artery  seemed  healthy,  save  immediately  about  tlie  wound.  The  three  lower  cervical 
and  two  upj)er  dorsal  vertebrm  and  the  cord  were  exposed  by  sawing  through  the  lamina;.  The  shot  had  entered  the  spine 
anteriorly,  and  at  the  lower  edge  of  the  sixth  cervical  vertebra  of  the  l ight  side,  just  internal  to  the  vertebral  aatery,  which  was 
uninjured.  It  penetrated  the  cord  and  was  found  within  the  theca  in  the  median  line,  just  above  the  lower  border  of  the  seventh 
cervical  vertebra,  posteriorly.  Just  within  the  cord,  at  the  point  of  entrance  of  the  shot,  was  a spicula  of  bone  about  a quarter 
of  an  inch  long.  The  membranes  of  the  cord  for  three-eighths  of  an  inch  above  and  below  the  lodgment  of  the  hall  were  foilnd 
inflamed.  The  brain  was  found,  in  the  middle  lohe  of  the  right  side,  to  be  softer  than  that  of  the  left.  Just  to  tiie  right  of  the 
lamina  cinerea,  where  the  middle  lobe  overlaps  the  anterior,  was  a spot,  of  about  one  inch  in  diameter,  where  the  substance  of  the 
brain  was  greatly  disintegrated,  and  in  a liquid  condition.  It  had  almost  formed  an  abscess — otherwise  healthy.  The  specimens 
were  preserved. 

Remo.val  of  Fragments  of  Vertebrae. — Of  formal  trepanning  of  tlio  vertebrae  no 
instances  were  reported,  but  a few  examples  of  the  extraction  of  recent  spicula3  from  the 
apophyses ; of  exfoliations  and  necrosed  portions  of  the  bodies  and  processes  of  the 
vertebrae ; and  even  of  operations  for  the  removal  of  fractured  fragments  from  the  lateral 
and  posterior  portions  of  the  apophyses,  were  recorded.  In  the  preceding  Section,  on  page 
433,  abstracts  are  given  of  the  cases  of  IMoran,  Weaver,  and  Freeman  in  which  fragments 
were  removed  after  gunshot  fractures  of  the  dorsal  vertebrae.  All  of  these  patients  made 
excellent  recoveries.  The  operator  in  the  case  of  Freeman,  Assistant  Surgeon  J.  S. 
Billings,  U.  S.  A.,  has  since  mentioned  that  quite  lai’ge  portions  of  bone  were  removed. 
Scanty  particulars  of  some  of  the  other  cases  included  in  Table  XX  are  appended : 

Case. — Private  Thomas  Wells,  Co.  C,  20th  New  York  Militia,  aged  21  years,  was  wounded  at  Gettysburg  on  July  1st, 
1863,  by  a round  musket  ball,  which  fractured  and  lodged  in  the  lateral  process  of  the  fifth  dorsal  vertebra.  On  .July  18lh,  he 
■was  admitted  from  Chester  to  the  Haddington  Hospital,  Philadelphia.  The  wound  was  painful  and  discharges!  freely,  and 

5<S 


458 


WOUNDS  AND  INJUEIES  OF  THE  SPINE. 


[Chap.  IV, 


tlie  patient  was  much  debilitated.  The  ball  tvas  removed  through  the  point  of  entry  after  slightly  enlarging  the  wound.  The 
entire  right  lateral  process  of  the  vertebra  was  removed  m four  separate  pieces,  one  of  which  adhered  to  the  flattened  ball. 
Simple  dressings  were  applied,  and  by  November  15th  the  wound  was  nearly  healed.  The  patient  was  unable  to  bend  his  body 
antero-posteriorly ; but  this  disability  improved  after  the  application  of  frictions  with’volatile  liniment.  On  March  21st,  1864, 
he  was  transferred  to  the  Christian  Street  Hospital,  Philadelphia,  and  on  September  21st  was  sent  to  Kingstbu,  New  York,  to 
be  mustered  out  of  service.  The  case  is  reported  by  Acting  Assistant  Surgeon  E.  J.  Lewis.  Pension  Examiner  E.  Loughran 
of  Kingston,  N.  Y.,  reported,  on  October  3d,  1871,  that  there  is  no  especial  paralysis,  but  a general  physical  weakness.  The 
wound  occasionally  becomes  inflamed,  opens  and  discharges.  The  pulse  is  regular  and  respiration  free.  Disability  one-haltj 
and  permanent. 

Case. — Private  Peter  Chester,  Co.  K,  16th  Maine  Volunteers,  aged  22  years,  was  wounded  on  November  7th,  1863,  by  a 
conoidal  ball,  which  entered  over  the  fourth  dorsal  vertebra  and  fracturing  its  spine  passed  upward  toward  the  right  shoulder, 
and  lodged.  There  was  also  a flesh  wound  of  the  middle  third  of  the  left  thigh.  He  was  sent  to  Washington,  and,  on  November 
9th,  was  admitted  into  the  Stanton  Hospital.  There  was  inflammatory  fever,  with  a qtiick  pulse,  and  the  wounds  suppurated 
freely.  Simple  dressings  were  applied;  anodynes  and  stimulants  were  administered,  and  a full  diet  was  allowed.  On  November 
13th,  some  pieces  of  the  spine  of  the  vertebra  were  removed  from  the  wound.  By  November  19th,  the  patient  was  free  from 
pain,  and  the  wound  was  healing.  On  January  5th,  the  ball  was  extracted  from  under  the  edge  of  the  trapezius  muscle  by 
counter  incision.  The  patient  was  returned  to  duty  on  April  24th,  1864.  He  is  a pensioner.  Pension  Examiner  T.  A.  Foster 
reports.  May  18th,  1866,  that  there  is  loss  of  power  in  ai-ms.  His  disability  is  rated  total  and  permanent. 

Case.— Private  William  C.  Patrick,  Co.  E,  104th  New  York  Volunteers,  aged  22  years,  was  ■wounded  at  Gettysburg  on 
July  1st,  1863,  by  a conoidal  musket  ball,  which  passed  across  the  lumbar  region  from  right  to  left,  fracturing  the  spinous  and 
transverse  processes  of  the  fourth  lumbar  vertebra,  and  lodging  in  the  lumbar  muscle.  He  was  admitted  to  the  field  hospitab 
and  thence  was  transferred  to  Camp  Lctterman  on  July  24th.  Spiculm  of  bone  were  removed  on  July  31st;  simple  dressings 
were  applied  to  the  wmund ; tonics  were  administered,  and  a full  diet  was  allowed.  The  patient  was  transferred  to  a convalescent 
hospital  on  September  25th,  the  wound  being  entirely  healed,  and  on  June  25th,  1864,  he  was  discharged  the  service.  Pension 
Examiner  L.  AV.  Fasquelle  reported,  January  29th,  1867,  that  the  ball  has  recently  been  removed,  leaving  a large  fistulous 
opening,  which  stOl  discharges  a large  amount  of  pus  daily.  His  disability  is  total  but  not  permanent. 

Case. — Private  William  Ambrosher,  Co.  C,  49th  Ohio  Volunteers,  aged  25  years,  was  wounded  on  May  27th,  1864, 
near  Dallas,  Georgia,  by  a conoidal  musket  ball  which  entered  the  lumbar  region  and  injured  one  of  the  vertebra;.  On  July  1st, 
he  was  admitted  to  the  AVest  End  Hospital,  Cincinnati.  His  condition  was  scorbutic  and  anmmic,  and  there  were  bed-sores 
over  nearly  every  prominent  part  of  the  body  that  came  in  contact  with  the  bed.  Three  days  after  admission,  some  necrosed 
portions  of  the  spinous  processes  were  removed,  and  two  days  afterward,  the  patient  had  much  fever ; the  parts  around  the 
wound  became  inflamed  and  swollen,  and  an  abscess  formed,  the  contents  of  which  escaped  through  a fissure  running  to  the 
posterior  surface  of  the  left  thigh.  A large  sloughing  ulcer,  four  inches  in  diameter,  took  the  place  of  the  abscess  and  wound, 
and  sloughing  also  commenced  in  the  bed-sores.  Yeast  and  charcoal  poultices  were  applied,  also  oil  of  turpentine  twice  daily. 
The  turpentine  arrested  the  ploughing,  and,  after  the  fourth  application,  was  discontinued.  The  subsequent  treatment  was 
expectant,  and  by  October  the  patient  was  nearly  well.  He  was  transferred  to  the  Veteran  Eeserve  Corps  on  April  4th,  1865. 
The  case  is  reported  by  Acting  Assistant  Surgeon  E.  Bartholow. 

Case.— Private  Smith,  Co.  K,  12th  Alabama  Eegiment,  aged  22  years,  was  wounded  at  Gettysburg  on  July  1st, 

1863,  by  a conoidal  musket  ball,  which  fractured  a process  of  the  third  lumbar  vertebra.  He  was  sent  to  the  field  hospital,  and, 
on  August  8th,  was  admitted  to  Camp  Lctterman  Hospital.  Simple  dressings  were  applied  to  the  wound,  and  a full  diet  was 
allowed.  Several  pieces  of  bone  were  extracted.  The  patient  recovered,  and  was  transfen'cd,  for  exchange,  on  September  6th, 
1863.  Acting  Assistant  Surgeon  AV.  AV.  AA''elch  reports  that  thei-e  were  no  serious  symptoms  at  any  time.  It  was  the  spinous 
process  that  was  splintered. 

Case. — Pi-ivate  Benjamin  AA^right,  Co.  K,  42d  Blinois  Volunteers,  aged  26  years,, was  wounded  at  Chickamauga,  Georgia, 
on  September  20th,  1863,  by  a conoidal  musket  ball,  which  fractured  the  fourth  lumbar  vertebra,  injured  the  spinal  cord,  and 
lodged.  He  was  sent  to  the  field  hospital,  and,  on  November  23d,  was  admitted  to  Brown  Hospital  at  Nashville.  Here  the  ball 
and  a fragment  of  the  spinous  process  were  extracted  by  Surgeon  M.  M.  Chambers,  U.  S.  V.  He  was  subsequently  transferred 
as  follows  : February  15th,  1864,  to  Hospital  No.  19,  Nashville;  March  16th,  1864,  to  Louisville,  Kentucky;  April  7th,  1864,  to 
Madison,  Indiana;  July  24th,  1864,  to  Quincy,  Illinois;  September  20th,  1864,  to  Springfield,  Illinois,  where  he  was  mustered 
out  of  service  on  September  28th,  1864. 

Case. — Private  Charles  Carlen,  Co.  I,  3d  Pennsylvania  Eeserves,  aged  24  years,  was  wounded  in  the  back  at  Bull  Eun, 
August  30th,  1862,  by  a musket  ball,  which  fractured  the  third  lumbar  vertebra,  and  lodged.  On  August  31st,  he  was  admitted 
from  the  field  to  Ascension  Hospital,  AVashington.  Some  paralysis  of  the  lower  extremities  and  the  bladder  followed  the  injury, 
but  the  bowels  remained  normal.  The  patient  was  admitted  to  the  Episcopal  Hospital,  Philadeli)hia,  on  November  12th,  1862, 
and  on  December  5th  a small  piece  of  bone  was  removed.  Several  pieces  of  bone  are  reported  to  have  come  away  at  previous 
times.  The  patient  complained  of  pain  in  the  back  of  the  neck ; the  ball  remained  within  the  wound.  By  December  13th, 
there  was  no  change  in  the  patient’s  condition.  He  was  discharged  the  service  on  February  9th,  1863,  and  pensioned.  His 
))ension  was  increased  on  September  4th,  1865.  A communication  from  Pension  Examiner  T.  B.  Eeed,  dated  September  16th, 
1865,  states  that  the  ball  has  not  been  extracted.  The  pensioner  suffers  from  stiffness  and  neuralgia  of  the  muscles  of  the  back 
of  the  neck  and  head,  and  from  dysuria.  His  disability  is  rated  three-fourths. 

Case. — Private  John  Stiehler,  Co.  G,  184th  Pennsylvania  Volunteers,  aged  18  years,  was  wounded  at  Deep  Bottom, 
Virginia,  August  14th,  1864,  by  a conoidal  musket  ball,  which  entered  to  the  right  of  the  last  dorsal  vertebra,  passed  inward 
and  downward,  and  lodged  in  the  right  iliac  fossa.  He  was  sent  to  AVashington  and  admitted  to  Emory  Hospital  on  the  17th. 


Sect.  III.] 


EEMOVAL  OF  FKAGMENTS  OF  VERTEBRiE. 


459 


On  the  19th,  ether  and  chloroform  were  administered,  and  the  ball  was  remo.ved  from  the  right  iliac  fossa  through  an  incision 
two  inches  in  length.  A small  portion  of  the  right  transverse  spinal  process  and  a splinter  from  the  crest  of  the  ilium  were  also 
removed.  Adhesive  strips  were  applied  to  coapt  the  lips  of  the  wound;  tonics,  stimulants,  and  a nutritious  diet  constituted  the 
remainder  of  the  treatment.  This  man  was  returned  to  duty  on  December  1st,  1834.  The  ball  was  presented  to  the  Army 
Medical  Museum,  wdth  the  above  account,  by  Acting  Assistant  Surgeon  Jos.  Walsh,  and  is  No.  4623  of  the  Surgical  Section. 
Stichler  was  discharged  the  service  on  July  14th,  1835,  and  on  December  T2th,  1870,  was  pensioned.  A communication  from 
Pension  Examiner  G.  Harris,  dated  March  12th,  1872,  states  that  there  is  a depressed  angular  cicatrix  about  one  inch  square 
over  the  original  seat  of  injury  ; the  patient  is  unable  to  do  any  heavy  work,  but  his  general  health  is  good.  His  disability  is 
rated  one-half  and  permanent. 

Case. — Private  Peter  C.  Miller,  Co.  K,  7th  Wisconsin,  aged  36,  was  wounded  at  the  Wilderness,  May  5th,  1864, 
by  a conoidal  musket  ball,  which  passed  transversely  beneath  the  trapezius,  fracturing  the  spinous  process  of  the  seventh 
cervical  vertebra,  and  escaped  at  the  outer  margin  of  the  muscle.  He  was  admitted  to  Douglas  Hospital,  Washington,  on  May 
11th.  Simple  dressings  were  applied  to  the  wound,  and  pieces  of  the  spinous  process  were  removed.  The  motion  of  the  cervical 
region  was  imperfect  and  painful.  The  patient  was  subsequently  transferred  to  the  Satterlee  Hospital,  thence  on  July  9th, 
1864,  to  the  Harvey  Hospital,  Madison,  Wisconsin.  He  was  discharged  on  December  17th,  1864.  Examining  Sm’geon  D.  D. 
T.  Hamlin,  of  Elkhorn,  Wisconsin,  reported,  on  March  12,  1865,  that  the  “ applicant  is  laboring  under  necrosis  of  the  two  lower 
cervical  vertebrae,  producing  partial  loss  of  motion  of  both  arms,  vertigo,  and  constant  pain  in  head  and  shoulders ; unable  to 
labor.  Disability  total  and  permanent.” 

Case. — Private  John  Quaid,  Co.  F,  Gth  Michigan  Cavalry,  aged  18  years,  of  sound  constitution,  was  hit  in  the  loins  by 
a conoidal  musket  ball,  in  an  action  near  Salem  Church,  Virginia,  May  28th,  1864.  He  was  sent  to  the  hospital  of  the  1st 
division.  Cavalry  Corps,  and  his  wound  was  examined  and  dressed  by  Surgebn  W.  H.  Eulison,  9th  New  York  Cavalry.  The 
ball  had  entered  two  inches  to  the  left  of  the  spinous  process  of  the  second  lumbar  vertebra,  passed  transversely  to  the  right, 
inclining  forward  through  the  lumbar  muscles,  and  emerged  five  inches  from  the  median  line.  There  was  complete  paraplegia. 
The  catheter  was  required  for  tliree  days,  and  there  was  obstinate  constipation.  On  June  2d,  the  paralysis  began  to  disappear, 
and  the  patient  was  sent  to  Washington,  and  entered  Stanton  Hospital,  under  the  immediate  charge  of  Assistant  Surgeon  G.  A. 
Mursick,  U.  S.  V.  His  general  condition  was  good ; but  there  was  still  partial  paraplegia.  He  complained  of  pain  in  the 
right  hip,  and  the  paralysis  was  most  marked  on  that  side.  On  June  19th,  Dr.  Mursick  removed  a small  detached  fragment  of 
the  spinous  process  of  the  second  lumbar.  On  July  12th,  he  removed  another  fragment.  At  this  date  the  patient  would  move 
about  on  crutches;  he  could  move  his  lower  limbs  freely  in  bed ; but  had  difficulty  in  standing  upright.  He  complained  of  a queer 
benumbed  sensation  in  the  right  hip  and  thigh.  On  July  21st,  the  exit  wound  was  nearly  healed;  but  the  entrance  wound  was 
sloughy.  A permanganate  of  potassa  lotion  was  prescribed.  On  July  28th,  the  wound  was  granulating  finely,  and  the  patient 
could  walk  pretty  well  with  the  aid  of  a cane.  On  August  18th,  the  wounds  had  healed,  and,  with  the  exception  of  slight 
weakness  of  the  lower  extremities,  he  was  well.  He  was  furloughed  from  the  hospital  at  this  date,  and  failing  to  return,  was 
recorded  as  a deserter,  October  31st,  1834.*  His  name  is  not  on  the  Pension  List,  nor  have  his  heirs  made  application  for  pension. 

Case. — Private  David  Campbell,  Co.  A,  29th  Pennsylvania,  aged  38  years,  was  wounded  at  Gettysburg,  July  3,  1863,  by 
a conoidal  ball,  which  entered  just  above  the  acromion  process  and  passed  deeply  into  the  neck.  He  was  taken  prisoner 
and  remained  in  the  enemy’s  hands  until  July  17th,  when  he  was  admitted  to  hospital  at  Annapolis,  Maryland.  On  October  3d, 
he  was  transferred  to  Satterlee  Hospital,  Philadelphia.  Simple  dressings  were  applied.  On  November  1st,  the  wound  was 
opened  by  free  incision  ; the  transverse  process  of  the  fifth  cervical  vertebra  was  found  coiToded,  and  was  scraped.  Some  necrosed 
portions  of  bone  were  brought  away.  He  was  transferred  to  Veteran  Reserve  Corps  on  December  31st,  1863.  He  had  other 
injuries,  which  have  been  described  at  page  410. 

Referring  to  the  figures  in  Table  XX,  it  will  he  found  that  there  were  twenty-four 
cases  of  removal  of  fragments  of  the  vertehim  after  gunshot  fracture,  with  fatal  results  in 
only  ten  instances.  The  gratification  that  such  a favorable  statistical  exhibit  would  other- 
wise produce,  is  much  diminished  by  a close  examination  of  the  fourteen  examples  of 
complete  or  partial  recovery  mentioned  in  the  foregoing  memoranda.  In  nine  instances 
the  spinous  process  alone  or  portions  of  it  only  were  removed,  and  that  the  injuries  to  the 
vertebral  column  could  not  have  been  of  a very  serious  nature  is  shown  by  seven  of  the 
patients  having  been  speedily  returned  to  duty  or  exchanged.  Dr.  Lidell  {1.  c.  p.  327) 
has  remarked  of  one  of  these  cases  that  it  afforded  “ strong  evidence  of  the  small  amount 
of  danger  which  usually  attends  gunshot  fractures  of  the  spinous  process  of  a vertebra.” 
The  evidence  is  not  weakened  by  the  eight  additional  cases.  In  the  five  cases  of  recovery 
in  which  portions  of  the  lamina3  or  of  the  transverse  processes  were  removed,  the  results 
were  much  less  satisfactory,  and  nearly  all  of  the  patients  still  suffer  from  serious 
disabilities. 


*This  is  tnc  of.the  cases  cited,  under  the  head  of  Concussion  of  the  Spine,  by  Surgeon  .toiix  A.  Lideli.,  U.  S.  V.,  in  liis  admirable  paper: 
On  Injuries  of  the  Spine,  including  Concussion  of  the  Spinal  Cord,  in  the  American  Journal  of  Medical  Sciences,  for  October,  ISC'!,  Vol.  XLVIII, 
p.  305. 


460 


WOUNDS  AND  INJUKIES  OF  THE  SPINE. 


[Chap.  IV, 


Of  the  ten  cases  of  extractions  of  recent  portions  or  sequestrse  of  the  arclies  or  pro- 
cesses of  the  verteliroe  that  terminated  fatally,  the  details  furnished  are  very  scanty.  The 
following  may  serve  as  examples : 

Case. — Private  W.  B , 23d  Pennsylvania  Volunteers,  was  wounded  at  Fair  Oaks,  Virginia,  May  31st,  1862,  by  a 

round  musket  ball,  which  entered  the  left  side  below  the  scapula,  and  lodged.  There  was  no  haemoptysis,  but  the  patient  was 
very  weak,  and  sensation  below  the  knees  was  impaired.  On  June  27th,  a probe  passed  four  inches  into  tlie  wound  came  in 
contact  with  the  tenth  vertebra,  from  which  a piece  of  loose  bone  was  removed.  Death  occurred  on  July  31st,  1862.  The  ball 
was  removed  from  the  body  of  the  tenth  vertebra  at  the  post-mortem  examination.  The  cord  was  free  from  compression. 
Tlie  ball  was  presented  to  the  Army  Medical  Museum,  and  is  No.  4945  of  the  Surgical  Section.  Assistant  Surgeon  William 
Thomson,  U.  S.  A.,  reports  the  case  from  Portsmouth  Hospital,  Virginia,  whither  the  patient  had  been  sent  soon  after  the  recep- 
tion of  the  wound. 

Case. — Private  Joseph  Pollock,  Co.  E,  2d  Missouri  Militia,  was  admitted  to  liospital  at  Kansas  Citj',  Missouri,  on  May 
1st,  1863.  A ball  had  fractured  the  spinous  proctss  of  the  last  dorsal  vertebra  and  buried  itself  in  the  body  of  the  hone.  Com- 
plete paralysis  ensued.  The  ball  and  the  spinous  process  were  removed.  There  was  a slight  return  of  sensation  after  the 
operation.  The  patient  died  on  October  19th,  1863.  Acting  Assistant  Surgeon  J.  Thorpe  reports  the  case  but  not  its  fatal  issue. 

Case. — Private  David  C.  Laird,  Co.  A,  4th  Michigan  Volunteers,  aged  20  years,  was  wounded  at  Gettysburg,  Pennsyl- 
vania, July  2d,  1863,  by  a conoidal  ball,  which  entered  the  lumbar  region  one  inch  to  the  left  of  the  spine,  passed  downward 
and  forward  to  the  right  side,  fractured  the  transverse  process  of  the  fourth  lumbar  vertebra,  and  emerged  near  the  right  ilium. 
He  was  treated  in  the  field  until  July  31st  when  he  entered  the  hospital  at  Camp  Letterman.  When  admitted,  his  general  health 
was  good.  The  discharge  from  the  wounds  was  profuse.  The  patient  experienced  great  difficulty  in  micturition,  and  the  urine 
was  streaked  with  pus.  Tonics,  stimulants,  and  diuretics,  with  nourishing  diet,  were  administered  and  cold-water  dressings 
applied  to  the  wound.  On  August  7th,  several  spiculffi  of  bone  were  removed.  A large  abscess  formed  on  the  10th,  which 
being  incised,  discharged  a large  quantity  of  pus.  The  discharge  of  pus  from  the  wound  increased  and  the  strength  of  the  patient 
began  to  fail.  Death  resulted  on  Septeraber  24th,  1863.  The  case  is  reported  by  Acting  Assistant  Surgeon  W.  B.  Jones. 

Case. — Private  W.  H.  Whitney,  Co.  Iv,  7th  Maine  Volunteers,  having  received  a gunshot  fracture  of  the  spine  at  Cold 
Harbor,  Virginia,  June  3d,  1864,  was  sent  to  the  field  hospital  of  the  Sixth  Corps.  Fragments  of  bone  were  removed,  and  the 
wound  was  dressed  simply.  He  died  on  June  7th,  1864. 

Case. — Captain  W.  H.  Shoppee,  Co.  B,  31st  Maine  Volunteers,  having  received  a gunshot  fracture  of  the  spine  at  Peters- 
burg, Vii'giuia,  on  .Tune  26th,  was  admitted  from  the  field  to  the  Armory  Square  Hospital,  Washington,  on  July  1st,  1864.  The 
ball  and  sjiiculte  of  the  bone  were  removed,  and  the  wound  was  <lressed  simply.  The  patient  died  on  July  2d,  1864. 

Removal  of  Balls. — Abstracts  of  several  cases  of  gunshot  fracture  of  the  vertebrae, 
in  which  the  missiles  were  extracted  during  life,  either  .done  or  in  connection  with  bone- 
splinters,  have  already  been  cited.  (See  cases  of  MacDonald,  p.  441  ; Hogan,  p.  442  ; 
Flalierty,  p.  442  ; all  three  examples  of  recovery  after  removal  of  musket  balls  from  the 

transverse  processes  of  the  second  lumliar.  See  also  case  of  Joseph  R , p.  444,  for  a 

difficult  extraction  of  a ball  from  the  second  lumbar ; the  cord  was  injured  and  fatal  tetanus 

resulted.  See  also  fatal  case  of  Sergeant  R , p.  446,  and  the  case  of  W.  0.  Patrick, 

p.  458.)  The  following  is  an  interesting  case,  the  patient  having  been  under  observation 
for  more  than  seven  years  after  the  reception  of  the  injury  ; 

CAiSE. — Private  James  M.  Carter,  Co.  F,  14th  Iowa  Volunteers,  aged  20  years,  was  wounded  at  Yellow  Bayou,  Louisiana, 
on  May  18th,  1864,  by  two  missiles,  one  a fragment  of  shell,  the  other  a ball,  both  of  which  entered  the  back  in  the  dorsal 
region.  On  Juno  2d,  he  was  admitted  from  Red  River  to  the  Jefferson  Barracks  Hospital,  St.  Louis.  The  spinous  process  of 
the  third  dorsal  vertebra  was  fractured.  The  fragment  of  shell  was  removed  on  May  18th,  the  ball  on  June  20th,  1864.  The 
patient  was  transferred  to  Keokuk,  Iowa,  on  November  3d,  1864.  He  was  discharged  the  service  on  January  28th,  1865,  and 
pensioned.  His  pension  was  increased  on  June  6th,  1866.  Pension  Examiner  A.  W.  McClure  reports,  under  date  of  December 
27th,  1836,  that  this  man  is  partially  paraplegic.  He  is  able  to  walk  on  level  ground,  but  cannot  run  ; sensation  in  the  legs  is 
imperfect ; the  urine  and  faeces  pass  involuntarily.  The  patient’s  disability  is  rated  as  equal  to  the  loss  of  a leg,  and  permanent. 
His  pension  was  last  paid  on  December  4th,  1871,  when  his  condition  was  unchanged. 

The  ten  following  abstracts  are  of  cases  of  partial  recovery  after  ball-extractions  in 
spinal  injuries.  ' Nearly  all  the  patients  are  pensioners,  suffering  from  paralysis  in  various 
degrees ; 

Case. — Private  Albert  C.  Williams,  Co.  I,  53d  Ohio,  aged  24  years,  was  wounded  at  Kenesaw  Alountain,  Georgia,  June 
27th,  1864,  by  a conoidal  ball,  which  entered  the  right  shoulder  one  inch  and  a half  above  the  joint,  and  emerged  at  the  centre 
of  the  dorsal  vertebrae,  fracturing  the  process.  He  was  at  once  admitted  to  the  field  hospital  of  the  2d  division,  Fifteenth  Corps, 
where  the  ball  was  extracted  and  simple  dressings  applied.  He  was  furloughed  on  August  18th,  1864.  On  April  9th,  1835,  he 


Sect.  III.] 


EEMOVAL  OF  BALLS. 


461 


was  admitted  to  the  hospital  at  Gallipolis,  Ohio,  and  discharged  on  June  25th,  1865.  The  case  is  reported  by  Surgeon  Lincoln 
R.  Stone,  U.  S.  V.  On  June  Gth,  1886,  Pension  Examiner  J.  P.  Bing  reports  as  follows:  “Ball  entered  top  of  right  shoulder, 
fracturing  the  necit  of  the  scapula,  and  passing  down^va^d  and  backward,  was  extracted  near  the  right  side  of  eighth  dorsal 
vertebra.  The  arm  is  constantly  supported  in  a sling,  and  is  quite  painful  and  nearly  useless.” 

Case. — Private  Seth  Golden,  Co.  H,  55th  Ohio  Volunteers,  aged  18  years,  was  wounded  at  Peach  Tree  Creek,  Georgia, 
July  20th,  1864.  A buckshot  struck  the  shoulder  and  lodged  against  the  spinal  column,  injuring  the  borders  of  the  lower  dorsal 
vertebrae.  He  was  taken  to  the  field  hospital.  Here  the  ball  was  extracted,  and  he  was  treated  until  August  12th,  when  he 
was  returned  to  duty.  Being  unable  to  march,  he  was  conveyed  by  ambulance  to  Savannah,  Georgia,  and  admitted  to  general 
hospital,  whence  he  was  discharged  on  May  20th,  1865.  In  his  declaration  for  pension  he  states  that  after  reaching  home 
paralysis  of  the  lower  extremities  gradually  came  on.  Pension  Examiner  A.  H.  Agartl  reports,  September  1st,  1870,  that 
necrosis,  abscess,  and  angulation  of  the  spinal  column  fidlowed,  with  complete  paralysis  of  the  lower  extremities,  rendering  him 
soihelpless  as  to  need  the  daily  attention  of  an  assistant  to  dress  and  care  for  him.  This  man  received  a pension  of  $25  per  month. 
The  case  is  re])orted  by  H.  W.  Sawtelle,  M.  D. 

C.VSE. — Adjutant  James  B.  Storer,  29th  Ohio  Volunteers,  aged  25  years,  received  a gunshot  fracture  of  the  spinous 
process  of  the  fifth  dorsal  vertebra  at  Buzzard  Roost,  Georgia,  on  May  8th,  1864.  He  was  treated  in  the  field  hospital  until  the 
12th,  when  he  entered  the  Officer’s  Hospital  at  Nashville.  On  May  28th,  1864,  the  ball  was  extracted.  The  patient  was 
discharged  from  service  on  November  30th,  1864.  The  case  is  reported  by  Surgeon  J.  E.  Ilerbst,  U.  S.  V.  On  November  24th, 
1866,  Pension  Exaininei;  W.  Bowen  reported  that  the  pensioner  had  paralysis  of  the  right  low'er  limb,  and  partial  loss  of  |)owcr 
of  the  left,  also  incontinence  of  the  urine  and  faeces.  His  disability  is  rated  total  and  probably  permanent. 

Case.— Private  Nelson  Tiffany,  Co.  A,  25tli  Massachusetts  Volunteers,  aged  20  years,  was  wounded  at  Petersbin:g, 
Virginia,  ^lay  9th,  1884,  by  a conoidal  ball,  which  struck  the  spine  near  the  lower  dorsal  vertebra,  j)assed  into  the  abdomen, 
and  lodged  in  front  of  the  right  iliac  fossa.  He  was  taken  to  the  field  hospital,  where  the  ball  was  cut  out,  and  sinqde  dressings 
applied.  On  May  12th,  he  was  transferred  to  Hampton  Hospital,  Fort  Monroe,  and,  on  June  7th,  to  Knight  Hospital,  New 
Haven,  Connecticut,  whence  he  was  furloughed  on  June  17th,  1804.  On  August  8th,  he  reported  to  Mason  Hospital,  Boston. 
He  was  finally  discharged  from  service  on  May  15th,  1865.  Pension  Examiner  Oramel  Martin  reports,  June,  1865,  that  the 
skin  adheres  firmly  to  the  vertebrte,  and  that  the  patient  bends  his  body  with  pain  am]  difficulty.  He  is  not  now  a pensioner. 
Assistant  Surgeon  E.  McClellan,  U.  S.  A.,  reports  the  case. 

Case. — Private  Patrick  Spillane,  Co.  D,  3d  Wisconsin  Volunteers,  aged  23  years,  was  wounded,  at  Smithfield,  North 
Carolina,  March  16th,  1865,  by  a conoidal  ball,  which  entered  about  three  inches  to  the  left  of  the  spinal  column  and  two  inches 
above  the  crest  of  the  ilium,  and  lodged.  He  was  at  once  conveyed  to  the  field  hospital  of  the  1st  division.  Twentieth  Corps, 
where  the  ball  was  removed  at  a point  corresponding  with  the  free  extremity  of  the  twelfth  rib  on  the  right  side,  and  simple 
dressings  were  applied.  On  April  11th,  he  was  transferred  to  Foster  Hospital,  New  Berne  ; on  Apiil  16th,  to  HeCamp  Hospital, 
New  York  Harbor,  and,  on  June  1st,  to  Swift  Hospital,  Prairie  Du  Chien,  Wisconsin,  whence  he  was  discharged  fiom  service  on 
September  1st,  1865.  Assistant  Surgeon  J.  W.  Brewer,  U.  & A.,  reports  the  case.  Pension  Examiner  W.  A.  Gordon  reports. 
May  31st,  1866:  “Exercise  produces  slight  tremor  of  the  left  leg.  There  is  manifested  stilfness  of  the  back  and  weakness  across 
the  lumbar  region.  General  health  good ; disability  one-third.”  The  spinous  process  of  the  second  lumbar  was  probably 
fractured. 

Case. — Private  C.  A.  Haywood,  Co.  E,  114th  New  York  Volunteers,  aged  20  years,  was  wounded  at  the  battle  of 
Winchester,  September  19th,  1864,  by  a conoidal  musket  ball,  which  fractured  the  spinous  process  of  a lumbar  vertebra,  and 
lodged  in  the  left  iliac  region.  He  was  admitted  from  the  field  to  the  hospital  of  the  Nineteenth,  Corps  on  September  22d. 
Simple  dressings  were  apidied  to  the  wound,  and,  on  October  8th,  the  ball  was  extracted.  There  was  partial  paralysis  of  the 
left  side.  The  patient  was  transferred  on  October  30th,  1864,  to  Jarvis  Hospital,  Baltimore,  thence,  on  December  10th,  1864,  to 
Cuvier  Hospital,  Germantown.  He  was  discharged  the  service  on  March  17th,  1865.  Pension  Examiner  A.  Willard  reported, 
December  27th,  1865,  that  the  patient  has  so  far  recovered  as  to  be  able  to  do  light  work.  Any  active,  laborious  exercise  jtroduces 
pain  at  the  point  of  injury.  Exercise  or  exertion  in  a bent  position  is  nearly  impossible.  The  lower  limbs  are  still  weak,  and 
easily  give  way  on  walking  either  up  or  down  hill.  He  rates  his  disability  three-fourths  and  probably  not  permanent. 

Case. — Second  Lieutenant  William  A.  C.  Ryan,  Co.  G,  132d  New  York  Volunteers,  aged  21  years,  was  wounded  at 
Bachelor’s  Creek,  North  Carolina,  February  1st,  1864,  by  a conoidal  ball,  which  fractured  the  last  lumbar  vertebra  and  lodged 
in  the  sacrum.  He  was  at  once  conveyed  to  the  Foster  Hospital,  New  Berne,  where  simple  dressings  were  applied  to  the  wound. 
On  April  30th,  he  was  transferred  to  Ladies’  Home  Hospital,  New  York  City.  On  June  12th,  1864,  the  wound  discharged  very 
freely,  and  the  patient  was  in  a very  good  condition,  but  feeble ; an  idcer  had  formed  across  the  sacrum,  about  three  inches  long 
and  about  one  inch  and  a half  wide,  with  a sinus  leading  to  the  ball.  Surgeon  Alexander  B.  Mott,  U.  S.  V.,  slightly  enlarged 
the  sinus,  and,  with  some  difficulty,  removed  the  ball,  which  he  found  firmly  imbedded  in  the  bone.  The  patient  improved  after 
the  operation.  The  treatment  consisted  of  tonics,  with  a generous  diet.  The  wound  healed  rapidly,  and,  on  October  9th,  1864, 
the  lieutenant  was  dismissed  the  service.  There  is  no  record  of  him  at  the  Pension  Office. 

Case. — Private  William  Heald,  Co.  K,  3d  Maine  Volunteers,  aged  45  years,  was  wounded  at  Gettysburg,  July  2d,  1863, 
by  a conoidal  ball,  which  fractured  the  lumbar  vei-tebr®  and  left  iliac  bone  of  the  pelvis,  and  lodged.  Another  ball  fractured 
the  right  wrist-joint,  and  a third  passed  through  the  ffeshy  portion  of  the  left  thigh,  posterior  to  the  femur.  He  was  conveyed  to 
the  Seminary  Hospital,  where  the  ball  was  extracted  from  near  the  lumbar  vertebra;,  and  the  forearm  amputated  at  the  middle 
third.  Simple  dressings  were  applied  to  the  wounds ; on  August  3d,  he  was  transferred  to  Camp  Letterman  Ho.spital,  and  on 
November  14th,  to  the  hospital  at  York,  I'ennsylvania,  whence  he  was  discharged  from  service  on  June  27th,  1874.  Pension 
Examiner  Edmund  Russel  reports,  December  4th,  1866,  “the  wound  is  still  suppurating.  Di.sability  total  and  permanent.” 

Case. — Private  Samuel  F.  Sexton,  Co.  B,  19th  Ohio  Volunteers,  aged  22  years,  was  wounded  at  Dallas,  Georgia,  May 
27th,  1864,  by  a conoidal  ball,  which  entered  the  back  three  inches  to  the  left  of  the  spine,  crossed  the  sj)inal  column  diagonally, 
injured  the  spinous  processes  of  the  first  and  second  lumber  vertebrae,  and  lodged  three  inches  to  the  right  of  the  spine.  He 


462 


WOUNDS  AND  INJURIES  OF  THE  SPINE. 


[Chap.  IV, 


was  takuii  to  the  field  hospital  of  the  3d  division,  Fourth  Corps,  and  simple  dressings  were  apjdied  to  the  wound.  On  June  3d 
he  was  transferred  to  the  hospital  at  Chattanooga;  on  June  22d,  to  Hospital  No.  19,  Nashville;  on  June  29th,  to  Jefierson 

Hospital,  Indiana,  and  on  July  25th,  to  the  hospital  at  Cleveland,  Ohio,  whence  he  was  discharged  from  service  on  June  3d, 

1865.  Pension  Examiner  E.  Mj-gatt,  reports.  May  11th,  18CG  : “ The  ball  was  removed  by  incision  six  months  after  the  recep- 
tion of  the  injury.  There  is  great  loss  of  substance  by  sloughing.  The  region  of  the  wound  is  tender,  and 
becomes  inflamed  and  painful  from  any  ordinary  or  continued  use  of  the  muscles.  Disability  one-half, 
probably  not  permanent.” 

Case. — Private  Thomas  Berry,  Co.  C,  14th  Indiana  Volunteers,  received  a gunshot  fracture  of  the 
spine  at  Antietam,  Maryland,  September  17th,  1862.  The  ball  entered  at  the  lower  and  outer  surface  of  the 

crest  of  the  ilium  and  imbedded  itself  deeply  in  the  side  of  the  last  lumbar  vertebra.  He  was  treated  on  the 

field  until  October  6th,  when  he  entered  Summit  House  Hospital,  Philadelphia,  where  the  ball  was  extracted 
on  the  same  day.  On  December  12th,  1862,  he  was  returned  to  duty.  The  man  is  not  a pensioner.  The 
missile  is  preserved  in  the  Museum,  and  is  figured  in  the  wood-cut.  The  case  is  reported  by  Acting  Assistant 
Surgeon  Winthrop  Sargent. 

The  nine  following  abstracts  relate  to  fatal  cases  of  extractions  of  missiles  after 
o-unshot  fractures  of  the  vertebrie  : 

O 

C.\SE. — Private  W.  Hedden,  Co.  D,  3d  New  Jersey  Volunteers,  aged  32  years,  was  wounded  at  Cbancellorsville,  May 
3d,  1863,  by  a conoidal  musket  ball,  which  entered  the  right  side,  passed  deeply  beneath  the  muscles  of  the  lumbar  region  and 
between  the  first  and  second  lumbar  vertebrae,  fracturing  both,  and  completely  dividing  the  cord.  He  was  admitted  from  the 
field  to  Stanton  Hospital,  Washington.  There  was  complete  paralysis  of  the  lower  extremities,  relaxation  of  the  anal  sphincter, 
and  retention  of  urine.  The  temperature  of  the  body  was  below  the  normal  standard ; the  respiration  laborious,  and  the 
circulation  feeble,  with  a tendency  to  congestion.  The  ball  was  extracted ; .the  patient  was  placed  upon  a water-bed,  and  the 
urine  was  drawn  off  with  a catheter.  Cold-water  dressings  were  applied  to  the  wound,  and  tonics,  stimulants,  etc.,  were 
administered.  On  May  13th,  the  patient  grew  worse.  He  complained  of  pain  in  the  track  of  the  ball,  fever  and  great  rest- 
lessness. The  wound  did  not  discharge  freely,  and  the  urine  dribbled  away.  On  May  15th,  there  was  an  augmentation  of  the 
above  symptoms,  with  low  muttering  deliilum.  By  May  17th,  the  delirium  increased,  with  a tendency  to  convulsions,  and  the 
patient  died.  The  case  is  reported  by  Assistant  Surgeon  P.  C.  Davis,  U.  S.  A. 

Case. — Private  John  H.  Dowling,  Co.  E,  2d  Colorado  Cavalry,  was  wounded  at  Camp  Babbitt,  Colorado,  December  27th, 
1883,  by  a ball  from  a revolver  in  the  hands  of  a fellow  soldier.  The  missile  entered  the  right  side  of  the  neck,  low  down, 
rather  in  front  of  the  median  line,  grazed  the  vertebrae,  and  longed  in  the  other  side,  nearly  opposite  the  point  of  entrance.  An 
hour  or  two  after  the  reception  of  the  injuiy  he  was  admitted  to  the  Post  Hospital,  complaining  of  paralysis  of  the  extremities; 
the  ball  was  removed.  The  paralysis  increased  in  intensity  until  death,  which  occurred  on  December  29th,  1863. 

Case. — Corporal  Frederick  Kuhling,  Co.  I,  56th  Massachusetts  Volunteers,  aged  40  yiiars,  received  a gunshot  wound  of 
the  left  shoulder,  with  injury  to  the  spine  by  a ball  from  a grapeshot,  at  North  Anna  River,  May  24th,  1864.  He  was  taken  to 
the  field  hospital  of  the  1st  division.  Ninth  Corps,  where  the  ball  was  extracted  and  simple  dressings  applied  to  the  wound.  Ho 
died  on  May  24th,  1834.  The  case  is  reported  by  Surgeon  ]\I.  K.  Hogan,  U.  S.  V. 

Case. — Private  Samuel  Jessup,  Co.  C,  4th  Georgia  Regiment,  received  a gunshot  wound  of  the  back  and  shoulder  by  a 
conoidal  ball  at  Petersburg,  Virginia,  March  25th,  1835 ; the  vertebral  column  was  fractured.  He  was  taken  to  the  field  hospital 
of  the  2d  division.  Ninth  Corps,  where  the  ball  was  extracted.  On  the  27th,  he  was  sent  to  the  general  field  hospital  of  the 
Ninth  Corps,  and,  on  April  9th,  was  put  on  board  the  steamer  State  of  Maine,  to  be  transferred  to  Washington.  He  died  on  the 
next  day.  Acting  Assistant  Surgeon  W.  H.  Finn  reported  the  case. 

Case. — Private  John  Fisher,  Co.  E,  2d  Missouri  Militia,  was  shot  in  the  back  at  Independence,  Missouri,  on  August  11th, 
1862..  He  was  sent  to  Kansas  City,  and  admitted  to  hospital  on  August  23d.  The  ball  was  extracted  from  the  first  lumbar 
vertebra.  The  patient  recovered  from  the  operation,  but  sank  into  a typhoid  condition,  and  died  on  September  6th,  1832.  There 
were  immense  bed-sores  on  the  back  and  hips. 

Case. — Private  L.  T.  Jewett,  Co.  A,  1st  Maine  Heavy  Artillery,  aged  23  years,  was  wounded  at  Spotts3dvania,  Virginia, 
INIav’  18th,  1864.  The  missile  entered  the  left  side,  near  the  first  lumbar  vertebra,  and  emerged  on  the  opposite  side,  near  the 
angle  of  the  eleventh  rib.  He  was  treated  in  the  field,  and,  on  Ma\’  22d,  was  admitted  to  Emoiy  Hospital,  Washington,  D.  C. 
On  admission,  there  was  palsy  of  the  lower  extremities,  retention  of  urine,  and  peritonitis.  The  ball  was  extracted,  water 
dressings  were  applied  to  the  wound,  and  the  urine  was  drawn  off  by  the  catheter.  Death  resulted  on  May  25th,  1864. 

Case.— Captain  Charles  Harris,  Co.  H,  7th  Michigan  Volunteers,  received  a penetrating  wound  of  the  spinal  column  by 
a conoidal  ball  at  Spottsj-lvania,  Virginia,  May  12th,  1864.  The  ball  lodged.  He  was  convej'ed  to  the  hospital  of  the  2d 
division.  Second  Corps,  where  the  ball  was  extracted  from  the  spinal  column  and  cold-water  dressings  aj)plied.  He  was  after- 
ward treated  in  private  quarters  in  Washington,  and  was  furloughed  on  May  27th,  1834.  The  Adjutant  General  states  that  he 
died  on  November  4th,  1864.  The  case  is  reported  bv'  Surgeon  J.  F.  D^yer. 

Case. — Private  Eugene  R.  Buckman,  Co.  C,  8th  Penus^dvania  Cavalry,  aged  19  years,  received  a gunshot  wound  of  the 
back,  at  the  junction  of  the  dorsal  and  lumbar  regions,  by  a conoidal  ball  at  Jettersville,  Virginia,  April  5th,  1865;  the  ball 
lodged.  He  was  conveyed  to  the  field  hospital  of  the  Cavalry  Corps,  where  the  ball  was  extracted  and  simple  dressings  applied 
to  the  wound.  On  April  15th,  he  entered  the  1st  division  hospital,  Annapolis.  There  was  complete  paralj'sis  of  the  lower 
extremities,  and  e.xtensive  bed-sores  over  both  trochanters,  which  sloughed  so  far  as  to  expos(!  the  femurs  for  near  their  entire 
upper  third,  especially  the  right  one.  Dry  oakum  dressings  were  applied  and  charcoal  poultices  to  the  hed-sores ; anod^mes 
were  given.  His  appetite  was  very  poor,  and  he  could  retain  no  solid  food.  The  wound  improved  until  about  the  20th,  when 
it  commenced  sloughing.  Death  resulted  on  April  25th,  1865.  Acting  Assistant  Surgeon  William  Pitt  Willis  reports  the  case. 


Fig.  206. — KouikI 
musket  ball  grooved 
by  impact  with  bone. 
Upec.  4467,  Sect.  I, 
A.  M.  M. 


Sect.  III.] 


EXCISION  OF  POKTIONS  OF  THE  VEKTEBRHi. 


463 


Case. — Private  Arthur  Kay,  Co.  F,  62d  Pennsylvania  Volunteers,  was  wounded  at  Fredericksburg,  Virginia,  December 
13tb,  18G2,  by  a grapeshot,  which  entered  the  back  at  the  left  shoulder  and  lodged  in  the  left  hip.  He  was  taken  to  the  field 
hospital  of  the  1st  division.  Fifth  Corps,  where  the  ball  was  removed  and  water  dressings  applied  to  the  wound.  Death  resulted 
on  December  19th,  1862.  Assistant  Surgeon  A.  J.  Hobart,  1st  Michigan  Volunteers,  reports  the  case. 

The  question  of  the  propriety  of  trephining  the  spine,  or  more  properly  speaking,  of 
excising  portions  of  the  vertebrae,  was  discussed  by  Pard,  Heister,  and  many  of  the  older 
authors,  and,  with  great  acerbity,  early  in  this  century,  when  Henry  Cline^  first  performed 
the  operation  at  St.  Thomas’s  Hospital,  June  16th,  1814,  in  the  case  of  a man  of  26  years, 
who  had  fractured  the  spinous  processes  of  the  seventh,  eighth,  and  ninth  vertebrae,  by  a 
fall  from  a second  story  on  the  previous  day.  The  arches  of  the  upper  two  vertebrae  were 
crushed  in  upon  the  cord,  and  were  removed  by  aid  of  a trephine,  Machell’s  circular  saw, 
chisel  and  mallet.  The  patient  lived  seventeen  days,  and  Mr.  Cline  candidly  admitted 
•that  the  operation  hastened  his  end.  TyrrelP  twice  repeated  the  operation,  in  1822,  and 
in  1827,  with  unfavorable  results,  and  mentions  that  Wickham,  of  Winchester,  and  Atten- 
burrow,  of  Nottingham,  had  anticipated  him,  with  no  better  fortune.  No  particulars  are 
given  of  Attenburrow’s  case,  and  it  may  be  identical  with  that  of  Oldknow,^  of  Notting- 
ham (1819).  The  operation  was  first  undertaken  in  this  country  by  John  Phea  Barton'* * 
(1824),  and  was  repeated  by  Dr.  A.  G.  SmitlP  in  1829,  and  by  Dr.  D.  L.  Piogers®  in  1834. 
In  Germany,  Holscher”*  in  1828,  was  as  unsuccessful ; as  was  Mayer,®  in  1846.  ^n  France, 
Laugier**  operated  unsuccessfully  in  1840.  Meanwhile,  in  Great  Britain,  the  operation  was 
occasionally  advocated  and  performed.  South*”  had  a fatal  case,  and  Edwards**  of  New 
South  Wales,  claimed  a success,  but  the  ultimate  result  is  not  given.  Ballingall*'^  relates 
that  Dr.  Blair,  formerly  a surgeon  in  the  Royal  Navy,  had  performed  according  to  Dr. 
Monro,  secundus,  this  operation  successfully  on  a seaman  ; but  adds  that  “very  few  cases 
occur  in  which  the  operation  of  trepanning  the  spine  ought  to  be  performed.”  The  opera- 
tion has,  of  later  years,  been  resorted  to  in  this  country,  twice  by  G.  C.  Blackman,*®  thrice 
by  Dr.  H.  A.  Potter,**  of  Ontario  County,  New  York,  also  by  Dr.  Stephen  Smith,*®  Dr.  J.  C. 
Hutchison*”  and  Dr.  Goldsmith,**"  and  abroad  by  Dr.  G.  M.  Jones,*®  Dr.  R.  McDonnell,*”  Dr. 
H.  J.  Tyrrell,  Dr.  Gordon,  and  M.  Tillaux,^”  M.  Pdlizet,"*  Mr.  Maunder,®"*  and  Mr.  Willett.®® 


* See  Kew  England  Journal  of  Medicine  and  Surgery,  Vol.  IV,  No.  1,  Jan.  1815 ; also  a full  account  in  SOUTH,  Notes  to  Chelius.  Am.  ed.  1847, 
p.  590,  and  nearly  aU  works  on  resection. 

^Notes  to  Lectures  of  Sir  Astley  Cooper,  London,  1829,  Vcl.  11,  p.  11  (case  of  Buckley,  at  St.  Thomas's),  and  London  Lancet,  Vol.  XI,  p.  C85  (case 
of  JIahony,  arch  and  spinous  process  of  twelfth  dorsal  removed). 

*See  Bransby  Cooper's  edition  of  Sir  Astley  Cooper  s Treatise  on  Dislocations  and  Fractures,  London,  1842,  Vol.  VIII,  p.  560. 

‘•Godman's  edition  of  A.  Cooper  on  Fractures. 

^ North  Am.  Med.  and  Surg.  Jour.,  Vol.  VIII,  p.  94,  1829. 

Jour,  of  Med.  Sci.,  O.  S.,  1835,  Vol.  XVI,  p.  91. 

’’  Bannoversche  Annalen  f.  d.  ges.  Ueilkunde,  B.  IV,  1839,  S.  330. 

® V.  Waltheb  und  V.  Ammos’S  Journal  der  Chirurgie,  Bd.  XXXVIII,  1848,  S.  178. 

^Bulletin  Chirurgical,  T.  I,  p.  401,  and  Des  Lisions  traumatiques  de  la  Moelle  epinierc.  These  do  Conoour.s,  1848,  p.  133,  Ohs.  52. 

'’‘A'otes  to  Chelius,  Vol.  I,  p.  540,  Eng.  cd. 

**  British  and  Foreign  Med.  Rev.,  Vol.  VI,  1838,  p.  1C2. 

**  Outlines  of  Military  Surgery,  5th  cd.  1855,  p.  321. 

*^Ed.  of  Jlott's  Translation  of  Velpeau's  Operative  Surgery,  Vol.  II,  p.  392,  and  Am.  Med.  Times,  July  13,  1861,  p.  21. 

**  HUED,  in  New  York  Journal  of  Medicine,  Vol.  IV,  March,  1845 ; and  POTlEit,  Am.  Med.  Times,  1863. 

16  New  York  Journal  of  Medicine,  Vol.  VI,  p.  87. 

*6  Transactions  of  New  York  State  Medical  Society,  1861. 

GUOSS,  S.  D.  (Op.  cit.,  Vol.  1,  2d  ed.),  according  to  Dr.  Ashhurst.  I cannot  find  the  reference  in  the  3d  or  4th  eds.,  and  have  not  access  to  the 
2d,  at  this  moment. 

'6  London  Medical  Times  and  Gazette,  1856,  Vol.  II,  p.  86. 

■6  Ddhlin  Quarterly  Journal,  Aug.  1865,  and  Aug.  1866,  Vols.  51  and  53.  In  the  latter  of  these  excelle:.t  articles  by  Dr.  JIcDonncll,  the  cases  of 
Drs.  Tyrrell  and  Gordon  are  recorded. 

-6  Bulletin  geniral  de  Thirapeutique,  Mar.  15,  1866. 

Archives  genirales  de  Med.,  VI”'  seric,  T.  VI,  pp.  439,  572,  683. 

*6  London  Medical  Times  and  Gazette,  1867.  Vol.  I,  p.  195. 

^'London  Medical  Times  and  Gazette,  1867,  Vol  I,  p.  129. 


464 


WOUNDS  AND  INJUEIES  OF  THE  SPINE. 


[Chap.  IV, 


The  subject  of  the  so-called  trepannation  of  the  spine  has  latterly  attracted  much 
attention,  mainly  through  the  strenuous  advocacy  of  the  operation,  on  physiological  grounds, 
by  Dr.  Brown-ScT|uard  / the  publication  in  the  Archives  genfrales  by  Mr.  Felizet,  of  three 
extended  papers,  and  the  reports  of  the  discussions  in  the  British  medical  societies  on  the 
partially  successful  operation  by  Dr.  Gordon,  the  ptimphlets  published  by  Dr.  McDonnell, 
Mr.  iSlunnelly’s^  address,  and  Dr.  Ashhurst’s  monngraph.^ 

After  Cline’s  unsuccessful  case,  Sir  Astley  Cooper  assured  his  class  that  it  would  be 
unmanly  to  refuse  the  operation,  and  undertook  it  himself,  found  his  diagnosis  wrong,  after 
the  incision  was  made,  the  spinous  process  only  being  involved,  and  did  not  conclude  the 
operation.^ 

Mr.  Solly^  remembers  that  Travers,  who  was  present  at  Tyrrell’s  first  operation,  in 
1822,  expressed  the  opinion  that  the  operation  never  would  succeed  ; and  it  is  noticeable 
that,  in  his  second  case,  Tyrrell  consulted  with  liis  other  colleague.  Green.  No  improve- 
ment followed  the  operation  ; the  patient  survived  eight  days. 

The  cases  of  Wickham,  Attenburrow,* * **^  Oldknow,  Barton,  Rogers,  Holscher,  Mayer, 
Laugier,  South,  Blackman,  S.  Smith,  Hutchison,  Jones,  McDonnell,  Tyrrell,  Willett, 
klaunder,  and  two  of  H.  A.  Potter  terminated  fatally.  The  advocates  of  the  operation 
will  hardly  rest  their  argument  on  Monro’s  vague  recollection  of  Blair’s  case,  or  on  Gold- 
smith’s  case,  in  which  “ no  particular  benefit  ” was  obtained,  or  on  that  of  Edwards,  in 
which  the  “patient  did  well”  for  a time,  but  no  result  is  given,  or  in  the  third  case 
of  Dr.  H.  A.  Potter,  with  no  improvement  after  the  operation,  or  in  Dr.  A.  G.  Smith’s 
case,  which  Dr.  Brown-Sequard  defends  against  Malgaigne’s  telling  criticism,  and  in  which 
the  operator  saw  the  patient  for  the  last  time  a week  after  ; “ since  then,  I have  not  seen 
him,  but  I entertain  considerable  hopes”  (Op.  cit.  p.  96.)  But  those  who  favor  the 
operation,  may  justly  claim  that  the  partial  recovery  of  Dr.  Gordon’s  case  was  due  to  it, 
and  that  in  many  of  the  fatal  cases,  temporary  alleviation  of  distressing  symptoms  was 
obtained.'^  The  operation  has  not  found  favor  with  military  surgeons.  Surgeon  J.  A. 
Lidell  (J  c.,  p.  320),  “after  considerable  investigation  * * has  failed  to  find  one 
completely  successful  case  on  record.”  LegouesP  discountenances  the  operation,  and  thinks 
it  wiser  not  to  interfere  with  gunshot  fractures  of  the  spinous  processes  even,  unless  the 
fragments  are  detached  and  large.  JoberP  is  unmeasured  in  his  condemnation,  character- 
izing the  operation  as  “ barhare  et  ridictde’'  Dr.  E.  GurlP®  replies  seriatim  to  Dr.  Brown- 
Sequard’s  arguments,  and  to  that  derived  from  experiments  on  animals, — from  which 
Professor  Brown-Sequard  pronounces  it  “ quite  evident  that  the  laying  bare  of  the  spinal 
cord  is  not  a dangerous  operation,”  but  few  animals  dying, — Dr.  Gurlt  opposes  the  experience 
of  Dr.  Bernhard  Heine, “ who  resected  vertebrae  of  twenty-four  cats  and  twelve  dogs. 


^ Brown-Sequaud,  Course  of  Lectures  on  the  Pli3"siology  and  Pathologj”  of  the  Central  Nervous  System,  Phihi.,  18G0,  Appendix,  p.  ‘244. 

2 NUKNELLY,  Address  in  Surgery  at  the  Thirty’Seventh  Meeting  of  the  British  Medical  Association.  Held  in  Leeds,  July,  18C9. 

3 ASHHURST,  Injuries  of  the  Spine,  'with  an  Analysis  of  nearly  Four  Hundred  Cases,  Phila.,  1867.  A carefully  written  work,  to  which  I have  had 
frequent  occasion  to  refer  in  compiling  this  chapter. 

^ South's  Notes  to  Chelius,  Vol.  I. 

® Medical  Times  and  Gazette,  1865,  Vol.  II,  p.  639. 

® O.  HEYFELDER,  Lehrhuch  der  liesectionen,  Wien,  1863,  S.  313,  saj’s  that  this  was  a fatal  case.  I cannot  trace  the  source  of  liis  information. 

^ I have  not  included  the  case  of  Dr.  John  B.  Walker  {Catalogue  of  the  Anatomical  Museum  of  the  Boston  Society  for  Medical  Improvement.  By 
J.  B.  S.  Jackson,  M.  D.,  Boston,  1847,  p.  31),  in  which  the  spinous  process  of  the  sixth  cer\  ical  vertebra,  ‘ quite  loose  though  not  driven  in,”  was 
twisted  otf. 

* Chirurgie  d'Armee,  pp.  341,  352. 

® Plaies  d' Amies  d feu,  Paris,  1833,  p.  125. 

Handhuch  der  Lehre  von  den  Knnchcnhruchen,"HQ.mm,  1864,  p.  186. 

**  Wagner,  A.,  tlbcr  den  Ueilungsprocess  nach  Resection  nnd  Extirpation  der  Knochen.  Berlin,  1853,  S.  45. 


Sect.  III.]  EXCISION  OF  PORTIONS  OF  THE  VERTEBEHi:.  465 

All  of  the  cats  died  and  only  two  dogs  survived.  The  result  in  the  case  of  a calf  was 
also  fatal.  Malgaigne  calls  the  operation  a “desperate  and  blind  one.”^ 

The  successful  instances  that  have  been  adduced  in  this  chapter  of  removal  of  frag- 
ments of  vertebrae  after  gunshot  fracture  nearly  all  resemble  the  operation  of  Louis,®  in 
1762,  sometimes  cited  as  the  first  example  of  resection  of  the  spine,  but  in  reality  an 
extraction  of  loose  fragments,  some  of  them,  it  is  true,  “ assez  considerables."  Such 
operations  are  perfectly  rational,  and  have  resulted,  as  has  been  shown,  in  a fair  measure 
of  success.  It  may  be  permissible  to  go  a step  farther,  and  to  excise  with  bone-forceps  or 
gouge  any  sharp  projecting  points  of  the  brolten  arches;  but  it  is  questionable  if  the 
danger  of  wounding  the  membranes  does  not  counterbalance  the  advantages  to  be  derived 
from  this  procedure.  Formal  trephining  of  the  spine  has  hitherto  given  such  unfortunate 
results,  that  without  much  more  positive  favorable  evidence,  it  cannot  be  accepted  as  an 
established  operation. 

Of  Concussion  and  Commotion  of  the  spinal  cord  very  little  is  said  in  the  reports, 
though  these  accidents  are  noted  in  many  of  the  cases  briefly  cited  in  the  first  section  of 
this  chapter.®  Dr.  John  A.  Lidell,  in  the  excellent  memoir  already  referred’  to,  relates  the 
histories  of  several  cases  that  came  under  his  observation  during  the  war,  and  discusses 
the  subject  fully.  He  found  the  use  of  dry  cups  very  advantageous.  Dr.  Chisolm,^  who 
has  epitomized  the  theory  and  practice  on  gunshot  wounds  of  the  spine,  generally  accepted 
by  the  Confederate  military  surgeons,  treats  ^of  concussion  of  the  spinal  cord,  and  of 
myelitis  and  intravertebral  extravasation  as  its  occasional  consequences.  He  speaks  of 
the  explosion  of  a shell  in  the  immediate  vicinity  of  the  back  as  a not  infrequent  cause  of 
such  result!  He  recommends  extract  of  belladonna,  in  half-grain  doses,  in  congestions  of 
the  spinal  cord,  and  advises  the  internal  use  of  strychnia  to  hasten  convalescence  from 
paraplegia.  In  gunshot  fractures  of  the  vertebral  column,  accompanied  by  lesions  of  the 
cord,  his  prognosis  is  gloomy:  “the  patient  dies,  no  course  of  treatment  offering  any 
prospect  of  success.”  Another  Confederate  surgeon.  Dr.  P.  F.  Eve,®  in  a paper  read  before 
the  Tennessee  Medical  Society,  is  of  a different  opinion,  and  cites  two  cases  of  balls  lodged 
in  the  vertebral  column,  in  which  the  patients  survived  for  a long  time. 

Luxations  of  the  Vertebrce  will  be  considered  -in  a separate  chapter  on  simple  fractures 
and  luxations.® 

* Packaud,  Translation  of  Malgai^ne  s Trexitise  on  Fractures^  Phila.,  1851),  p.  345. 

® Louis,  Rimarques  et  Observatiom  sur  lot  Fractures  et  la  Luxation  des  Vertebres.  M6ni.  P<  sth.  Arch.  Gin.  de  Mid.,  1836,  T.  XI,  2«  Serie,  p.  417. 
Captain  Villcdon  received  a gunshot  fracture  of  a dorsal  vertebra,  Nov.  2Cth,  17G2,  and  fell  completely  paraplegic.  IM.  Duplcssis,  his  regimental  surgeon, 
made  free  incisions  and  extracted  the  ball.  Louis  saw  the  patient  tm  the  fourth  day,  and  passing  his  finger  to  the  bi.ttcm  of  the  wound  found  splinters  and 
same  rather  large  fragments  of  bone.  Louis  drew  a jmrallel  between  the  case  and  a depressed  fracture  of  the  cranium.  Duplessis  was  convinced,  and  the 
nc.xt  day  the  fragments  were  removed.  The  paralysis  gradually  sub.sidcd,  and  twelve  years  afterwards  Captain  Villcdon  was  living  on  his  estate  in 
Poitou,  in  good  health,  walking  with  the  aid  of  a cane,  though  his  limbs  were  feeble  and  shrunken. 

® Consult  Mr.  Shaw's  able  paper  {op.  cit.,  p.  370) ; Mr.  Erichsen,  On  Railu'ay  and  other  Injuries  of  the  Nervous  System ; Dr.  Buzzard,  On  Cases 
of  Injury  from  Railway  Accidents,  Lancet,  1867,  p.  389 ; Dr.  Bastian  {Med.  Chir.  Trans.,  Vcl.  I,  p.  499),  and  the  systematic  writers  on  surgery. 

^ Op.  cit.,  p.  333.  ® Amer.  Jour.  Med.  Sci.,  N.  S.,  Vcl.  LVI,  p.  1C3. 

® On  the  subjects  considered  in  this  chapter,  consult  farther:  Blasius,  E.,  Die  traumatishen  Wirhelvcrrcnlcungen ; Bell,  C.,  On  Injuries  of  the 
Spine  and  Thigh-hone,  "Londow,  AXo,  BEiiTHEAU,  R.,  Vher  einige  Fdlle  von  Verletzungen  der  Ilalswirhclsdule,  Diss.  Gottingen,  1869;  BOYlCll, 

Traiti  des  Maladies  Chirurgicales,  5 ed..  Paris,  1846,  T.  Ill,  p.  132;  Bueua,  Della  RachiaJgite  Cenni  l^athologici,  Livonia,  1810,  4to,  pp.  30 ; BkODIE, 
Med.  Chir.  Trhns.,  Vol.  XX,  1837,  p.  118,  and  Works  collected  by  C.  IIawkixs,  London,  18(f5,  Vol.  II.  p.  319,  and  Vol.  HI,  p.  85;  Bkck,  Kriegs 
Chirurgische  Erfahrungen  wdhrend  des  Feldzvges  1866,  in  Suddeutshland,  Freiburg,  1867,  p.  195;  CaspeU,  J.  L.,  tJher  die  Verletzungen  des  Riicken- 
marks  in  Hinsicht  avf  ihr  Leihalitdts-  Verhdltnissl  Berlin,  1823 ; CUKNOTl’E,  F.  A.  F.,  Dissert,  sistens  casum  suhluxationis  veriehrm  dorsi  cum  fractura 
complicatse  post  faclam  repositionem,  etc.,  Argent.  1761;  Ericiisen,  Science  and  Art  of  Surgery,  London,  1869,  Vol.  I,  p.  411;  FI8HKR,  Militdr- 
drztliche  Skizzen  aus  Siiddeutschland  und  Bohmen,  Aumw,  1867,  p.  64;  Fallopius,  Opera  genuina  omnia,  \cTioX.  16C6,  T.  II,  p.  379;  GUAY,  Amer, 
Jour.  Med.  Sci.,  Vol.  Lll,  p.  109,  and  Circular  No.  3,  S.  G.  O.,  1871,  p.  1.39 ; H.EFNER,  Dissertatio  de  meduUte  sjnnalis  infammatione,  Marbourg,  1792 ; 
IIEISTEK,  Institutiones  Chirurgicte,  Amstelodami,  4to,  1739,  T.  I,  p.  199;  IltviN,  Cours  dc  Pathologie  et  de  Therapeutique  Chirurgicales,  Paris,  1785, 
T.  II,  p.  390;  Hilton,  Guy's  Hospital  Reports,  3d  ser.,  Vol.  IJ ; LOIIMEYER,  Die  Schusswunden  und  Hire  Behandlwng,  Gottingen,  1859,  p.  112;  LE 
Gros  Clark,  F.,  Lectures  on  the  Principles  of  Surgical  Diagnosis,  London,  J 870,  p.  187;  Morgagni,  De  sed.  et  causis  morb.,  cd.  Patav.,  1765,  T.  I, 
p.273;  McCormack,  W.,  On  a case  of  injury  of  the  Spine  in  the  Cervical  J^cgioi},  Dublin,  1867;  RaUCII,  J.  F.  L.,  Dc  vertebrarum  ccrvicalium 
luxatione,  Berolini,  1828  ; StrOMEYER,  Maximen  dcr  Kriegsheilkunst,  Hannover,  1861,  p.  473. 

.59 


CHAPTER  V. 


WOUNDS  AND  INJ.URIES  OF  THE  CHEST. 


The  number  of  cases  reported  of  wounds  and  injuries  of  the  chest  is  large,  and  the 
aggregate  would  appear  still  greater,  had  not  the  wounds  of  the  soft  tissues  covering  the 
chest  posteriorly  been  classified  with  the  wounds  of  the  back.  The  punctured,  incised, 
and  miscellaneous  wounds  and  injuries  will  first  be  briefly  noticed, — the  simple  fractures 
and  other  of  the  more  important  of  the  miscellaneous  group  being  discussed  elsewhere; — 
the  second  section  will  be  devoted  to  gunshot  wounds  of  the  thorax  and  its  contents,  and 
the  third  to  the  operations  required  by  the  effects  of  injuries  of  this  division  of  the  body. 


Section  I. 


INCISED  WOUNDS,  CONTUSIONS,  AND  MISCELLANEOUS  INJURIES. 


Excluding  gunshot  contusions  of  the  walls  of  the  chest,  burns  and  scalds,  and  simple 
fractures  of  the  clavicle,  scapula,  ribs,  and  sternum,  the  returns  of  this  Office  during  the 
war  exhibit  only  two  hundred  and  ninety  cases  of  injuries  of  this  group.  Of  these  nine 
were  sabre  wounds,  and  twenty-nine  bayonet  wounds. 

Sabre  Wounds. — Only  one  of  the  nine  cases  that  came  under  treatment,  proved 
fatal;  although  several  were  examples  of  penetrating  wounds  of  the  chest: 

Case. — Private  Leander  Clark,  Co.  G,  123d  Indiana  Volunteers,  aged  40  years,  a recent  recruit,  two  days  before  the 
action  of  Rocky  Face  Ridge,  was  accidentally  wounded  in  the  right  chest  by  a sabre.  The  extent  of  the  injui-y  is  not  noted. 
He  was  admitted  on  May  9th,  1804,  to  Clay  Hospital,  Louisville,  Kentucky.  He  was  here  treated  for  severe  bronchitis  until 
June  25th,  when  he  was  transferred  to  the  hospital  at  Jeffersonville,  Indiana,  and  registered  as  ill  of  chronic  bronchitis.  Subse- 
quently Surgeon  H.  P.  Stearns,  U.  S.  V.,  diagnosticated  phthisis,  and  the  patient  is  recorded  as  having  died  on  August  11th, 
1804,  of  phthisis  puhnonalis.  The  sabre  wound  could  hardly  have  been  regarded  as  an  exciting  cause  of  the  tubercular  affection, 
as  it  is  not  mentioned  in  the  later  reports. 

Case. — Private  James  McCauley,  Co.  C,  1st  United  States  Cavalry,  aged  21  years,  received  a sabre  thrust  of  the  chest 
at  Upperville,  Virginia,  June  21st,  1803.  The  point  entered  about  two  inches  above  and  to  the  inner  edge  of  the  inferior  angle 
of  the  right  scapula,  passed  directly  through  the  upper  lobe  of  the  right  lung  from  behind  fonvard,  and  made  its  appearance 
beneath  the  integument  two  inches  above  the  right  nipple,  producing  a discoloration  at  that  point.  He  also  received  four  sabre 
cuts  of  the  head,  one  of  which,  over  the  right  parietal  bone,  fractured  the  skull ; the  others  were  scalp  wounds.  He  was  treated 
in  the  field,  and,  on  the  24th,  was  sent  to  Emory  Hospital,  Washington.  On  admission,  he  complained  of  very  slight  dyspnoea 
and  some  constipation,  which  was  obviated  by  a potion  of  castor  oil.  Pulse  84 ; tongue  clean  ; appetite  good.  A bandage  was 
placed  around  the  chest  and  cold-water  dressings  applied.  A fragment  of  bone  was  removed  from  the  7’ight  parietal  bone.  He 

466 


Sect.  I.] 


BAYONET  WOUNDS. 


467 


was  furlouglifd  on  July  and  returned  to  duty  to  Carlisle  Barracks,  September  lltli,  18C3.  Pensioner  Examiner  J.  O. 
Stanton  reports,  under  date  of  August  3d,  1871:  “The  pensioner  states  that  he  frequently  has  haemorrhage  from  the  lungs. 
There  seems  to  he  considerable  irritability  of  the  throat  and  fauces.  He  is  strong  and  nmscular;  circulation  good.” 

Case. — Pi-ivate  Joseph  Dangel,  Co.  B,  9th  New  York  Cavalry,  aged  21  years,  received  a perforating  sabre  wound  of  the 
chest  at  Upperville,  Virginia,  June  21st,  1863.  The  weapon  entered  between  the  ninth  and  tenth  ribs,  left  side,  beneath  the 
axilla,  passed  inward  and  backward  through  the  lung  and  ideural  cavity,  and  emerged  two  inches  below  the  inferior  angle  of  the 
left  scapida.  He  also  received  a gunshot  compound  fracture  of  the  vertex  of  the  skull,  a penetrating  wound  of  the  abdomen,  a 
wound  on  the  dorsal  as]iect  of  the  left  foot,  a wound  of  the  right  hand,  carrying  away  the  little  finger,  and  a wound  of  the  hack. 
He  was  taken  prisoner,  and  conveyed  to  Andersonville,  where  he  remained  a period  of  seventeen  months.  He  was  finally  paroled 
and  sent  to  Baltimore,  entering  Jarvis  Hospital  on  Ajuil  5th,  1865.  On  May  23th,  1865,  he  was  discharged  from  service,  at  which 
time  Assistant  Surgeon  DeWitt  C.  Peters,  U.  S.  A.,  who  reports  the  case,  states  that  he  had  entirely  recovered,  with  the  excep- 
tion of  some  pleuritic  adhesions  and  contractions  of  the  left  side,  which,  to  a great  extent,  disabled  him.  He  is  not  a pensioner. 

Case.— Private  Robert  McReery,  Co.  F,  1st  Michigan  Cavalry,  aged  33  years,  was  wounded  at  Gettysburg,  Pennsylvania, 
July  3d,  1863,  by  a sabre,  which  entered  the  posterior  boundary  of  the  left  axilla,  and  jiassed  upward  some  four  inches  through 
the  serratus  magnus  and  pectoralis  muscles.  He  was  conveyed  to  the  field  hospital,  where  he  lemained  until  August  20th,  when 
he  was  transferred  to  the  hospital  at  Camp  Letterman.  When  admitted,  his  general  health  was  feeble,  and  the  wound  discharged 
ichorous  pus.  An  emollient  poultice  was  applied,  and  the  discharge  soon  assumed  a healthy  appearance.  Under  the  adminis- 
tration of  nourishing  diet  and  stimulants,  his  general  health  improved  slowly.  An  abscess  formed  on  September  5th,  which  was 
opened.  The  patient  was  transferred,  oh  October  9th,  to  the  Cotton  Factory  Hospital,  Harrisburg,  Pennsylvania,  and  discharged 
from  service  on  January  6th,  1864,  at  which  time  he  suffered  from  phthisis  pulmonalis.  He  is  a pensioner. 

Case. — Private  William  Cherry,  Co.  C,  2d  New  York  Cavalry,  aged  25  years,  was  wounded  at  Claiborne,  Alabama, 
April  11th,  1865,  by  a sabre,  which  entered  the  body  at  a point  five  inches  below  the  nipple,  in  a line  perpendicular  to  it.  On 
April  25th,  he  was  admitted  to  the  Marine  Hospital,  New  Orleans,  and,  on  the  29th,  was  transferred  to  New  York;  in  the 
hospitals  of  which  State  he  remained  until  finally  discharged  from  service.  He  is  not  a pensioner. 

Nickney,  Anton,  Private,  Co.  B,  12th  Illinois  Volunteers.  Severe  sword  wound  of  right  axilla.  Culpeper,  Virginia, 
October,  1863.  Treated  in  hospital  at  Quincy,  Illinois.  Simple  dressings.  Discharged  on  April  18th,  1864.  Loss  of  power  in 
arm.  Not  a pensioner. 

Earles,  James,  Corporal,  Co.  G,  61st  New  York  Volunteers,  aged  44  years.  Sabre  cut  over  sternum.  May  11th, 
1864.  Treated  in  Stanton  Hospital,  Washington.  Returned  to  duty  on  June  17th,  1864.  Not  a pensioner. 

Britsch,  Christian,  Private,  Co.  B,  82d  Pennsylvania  Volunteers,  aged  50  years.  Sabre  wound  of  left  side.  Treated 
in  hospital  at  Chester,  Pennsylvania.  Returned  to  duty.  Not  a pensioner. 

Clark,  Gavin,  Private^  Co.  I,  1st  Illinois  Artillery,  aged  27  years.  Sabre  wound  right  side.  Treated  in  Clay  Hospital, 
Louisville,  Kentucky.  Returned  to  duty.  Not  a pensioner. 

Bayonet  Wounds. — There  were  twenty-nine  cases  of  this  group  reported.  Nine 
proved  fatal,  six  were  discharged,  twelve  were  returned  to  duty,  and  in  two  cases  the 
results  could  not  he  ascertained.  If  there  was  no  error  in  diagnosis,  the  abstracts  of  the 
two  following  cases  furnish  examples  of  punctured  wounds  of  both  lungs,  when  life  was 
prolonged  for  two  and  seven  days  after  the  reception  of  the  injury : 

Case. — Private  Nicholas  Schenecker,  Co.  E,  35th  Massachusetts  Volunteers,  aged  25  years,  was  wounded  at  Petersburg, 
Virginia,  September  30th,  1864,  by  a bayonet,  which  entered  the  left  side,  between  tbe  second  and  third  ribs,  penetrated  the 
lungs,  and  emerged  anteriorly  near  the  sternum.  He  was  treated  in  the  field,  and,  on  October  5th,  was  transferred  to  Finley 
Hospital,  Washington.  Simple  dressings  were  applied  to  the  wound.  Death  occurred  on  October  7th,  1864.  The  case  is 
reported  by  Surgeon  G.  L.  Pancoast,  U.  S.  V. 

Ray,  William,  Private,  Co.  E,  1st  Washington  Territory  Volunteers.  Perforating  bayonet  wound  of  both  lungs, 
December  3d,  1865.  The  weapon  entered  anteriorly  to  the  lower  portion  of  the  left  lung,  penetrating  the  dia))hragm,  passing 
upward  and  backward,  making  its  exit  through  the  right  lung  posteriorly.  Died,  December  5th,  1865.  The  case  is  reported  by 
Assistant  Surgeon  Clinton  Wagner,  U.  S.  A. 

In  the  four  following  cases,  bayonet  stabs  in  the  chest  were  followed  by  fatal  inflam- 
mation of  the  lung  : 

Phillips,  Crawford,  Private,  Co.  A,  44th  Georgia.  Bayonet  wound  of  right  chest  and  arm,  and  gunshot  wound  of  neck. 
Wilderness,  Virginia,  May  9th,  18()4.  He  was  admitted  to  Douglas  Hospital,  Washington ; transfeired  to  Lincoln  Hospital, 
May  14th,  and  died  on  May  29th,  1864. 

Cromney,  Owen,  Private,  Co.  K,  2d  Connecticut  Volunteers,  aged  19  years.  Bayonet  entered  above  outer  third  of  left 
clavicle  and  passed  downward.  Cold  Harbor,  June  3d,  1864.  Treated  in  3d  divi.sTon  hospital,  Alexandria.  Lung  all'ected, 
cough,  and  slight  expectoration.  Died  on  July  29th,  1864.  Tlie  case  is  rej)orted  by  Surgeon  Edwin  Bentley,  U.  S.  V. 


4G8 


• WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Euazeu,  Edwakd,  Private,  Co,  G,  64th  United  States  Colored  Troops.  Bayonet  wound  in  riglit  side;  the  weapon 
entered  the  pleural  cavity  one  inch  below  the  mamma.  May  28th,  1864.  Treated  in  hospital  at  Natchez,  Mississipjii.  Died 
on  June  2d,  1864,  of  indammation  of  the  ideura  extending  to  the  lung.  The  case  is  reported  by  Assistant  Surgeon  W.  H.  Miles, 
63d  U.  S.  C.  T. 

Delaky,  Michael,  Color  Sergeant,  27th  Illinois,  was  wounded  at  Marietta,  Georgia,  June  14th,  1864,  by  a conoidal 
ball,  which  fractured  the  right  arm  and  jaw.  He  also  received  a bayonet  penetrating  wound  of  the  chest.  He  was  sent  to 
Ackworth,  Georgia,  on  June  28th,  and  thence  to  Chattanooga  on  June  SOth.  He  died  on  July  11th,  1864.  Surgeon  Francis 
Salter,  U.  S.  V.,  reports  the  case. 

In  the  three  succeeding  fatal  cases,  death  resulted  promptly  from  lesions  of  the  large 
vessels  of  the  thorax  : 

Jeffords,  Harrison  H.,  Colonel,  4th  Michigan  Volunteers.  Bayonet  thrust  through  chest.  Gettysburg,  Pennsyl- 
vania, July  3d,  1863.  Died  on  July  3d,  1868. 

Mitchell,  Louis  F.,  1st  Minnesota.  Two  bayonet  wounds  through  chest.  Edward’s  Ferry,  October  21st,  1861.  Died 
on  the  same  day.  The  case  is  reported  by  Surgeon  D.  W.  Hand,  U.  S.  V. 

Case. — Private  B.  H , Co.  A,  Cobb’s  Georgia  Legion,  a prisoner  of  war  at  Newport  News,  Virginia,  received  a 

penetrating  bayonet  wound  of  the  chest.  May  7th,  1865.  Acting  Assistant  Surgeon  William  H.  Helm,  who  reports  the  case, 
states  : “At  half  past  ten  o’clock  P.  M.,  May  7th,  I was  sent  for  to  see  a prisoner  who  had  been  wounded  by  a sentinel.  I found 
him  lying  on  his  left  side,  with  his  knees  drawn  pretty  well  up,  and  his  body  bent  forward.  He  complained  considerably  of  pain 
in  any  position  and  begged  for  some  morphia.  On  examination,  I found  a triangular-shaped  opening  on  the  posterior  portion  ot 
the  thorax,  two  inches  below  the  inferior  angle  of  the  scapula  and  four  inches  to  the  right  of  the  spine.  On  examination  with 
the  probe,  I found  that  the  probe  ran  down  beneath  the  skin  lor  two  or  three  inches,  but  was  unable  to  detect  any  opening  into 
the  thorax.  Pulse  good  but  slightly  accelerated.  Respiration  very  little  if  at  all  afi'ected.  Expression  of  countenance  slightly 
uneasy.  There  was  a very  slight  oozing  from  the  wound.  After  a consultation,  it  was  concluded  that  it  was  a non-penetrating 
wound  of  the  chest.  The  wound  was  covered  by  a piece  of  diy  lint  fastened  by  adhesive  jdaster.  A grain  of  morphia  was 
given  him,  with  directions  to  give  him  half  a grain  in  an  hour  if  he  was  not  relieved.  Toward  morning  he  became  delirious  and 
died  about  sunrise,  without  the  ward-master  having  sent  for  any  of  the  sui'geons.  Necrops3' : On  tracing  the  path  of  the  bayonet 
it  was  found  to  have  gone  downward  and  to  the  left,  some  two  inches  beneath  the  skin,  when  it  entered  the  ninth  intercostal 
space.  Upon  opening  the  thorax  nearly  its  entire  cavity'  was  found  filled  with  clots  and  semi-ttuid  blood,  of  a dark-red  hue. 
The  opening  in  the  ninth  intercostal  space  was  found  and  the  furthei'  course  of  the  baj’onet  was  traced,  where  it  had  torn  through 
the  muscles  to  the  outer  and  light  edge  of  the  intervertebral  disk,  between  the  ninth  and  tenth  dorsal  vertebrae.  The  lungs 
were  found  to  be  uninjured.  The  pericardium  contained  a clot  of  bright-red  hue,  about  the  size  of  a large  hen’s  egg,  and  several 
ounces  of  bloody  serum.  A small  triangular  spot  was  seen  on  the  posterior  portion  of  the  base  of  the  left  ventricle.  The  probe 
sank  into  the  triangular  spot  by  its  own  weight  merely',  and,  on  opening  the  left  ventricle,  it  was  found  to  be  a penetrating  wound 
of  the  heart.  The  opposite  surface  of  the  ventricle  was  entirely  uninjured.  The  vena  cava  ascendens  was  probably  pierced  by 
the  bayonet,  though  it  was  impossible  to  find  the  opening,  owing  to  the  dense  fibrous  clots  surrounding  the  vessels,  and  pervading 
the  cellular  tissue.  This  supposition  accounts  for  the  large  venous  hasmorrhage  and  is  entirely  probable,  as  the  vena  cava 
ascendens  was  in  the  course  of  the  ba\-onet.” 

Of  the  six  men  discharged  for  disability  on  account  of  bayonet  wounds  of  the  chest, 
only  one  is  a pensioner.^  The  other  five  had  wounds  that  probably  seriously  implicated 
the  external  soft  parts  only  : 

Case. — Corporal  Thomas  Powers,  Co.  G,  2d  United  States  Infantry,  aged  40  years,  was  stabbed  bj-  a bayonet  in  the 
hands  of  a refractory  prisoner  on  December  2d,  1862.  The  baj'onet  entered  one-half  inch  to  the  right  of  the  median  line  of  the 
chest,  immediately  next  to  the  middle  of  the  xiphoid  caitilage,  penetrated  four  inches  in  a direction  downward  and  outward, 
entering  the  chest  over  the  costal  cartilages  of  the  eighth,  ninth,  and  tenth  ribs.  On  receipt  of  the  injury  there  was  prostration, 
vomiting  for  two  daj's,  difficulty  of  breathing,  incapacity  to  draw  a long  breath,  total  absence  of  movement  of  ribs  of  lower  part 
of  right  chest,  and  decubitus  on  injured  side ; no  res])iiation  heard  on  lower  part  of  right  chest;  puerile  respiration  above  and 
over  the  whole  of  the  left  chest,  mixed,  however,  in  some  parts  of  the  left  chest,  with  mucous  sounds  of  bronchitis.  Gentle 
stimulants  and  essence  of  beef  were  giVen.  On  December  5th,  the  vomiting  had  ceased.  He  was  transferred  to  Stanton  Hospital, 
W'ashington,  on  December  11th;  at  that  time,  the  wound  was  closed  and  the  orifice  of  it  covered  over  bj'  a small,  dark-colored, 
triangular-shaped  scab.  He  complained  much  of  darting  pains  and  stitches  in  the  right  side.  He  exhibited  d.yspnoca  and 
increased  frequency  of  the  respirator}’  movements.  At  times,  the  dyspnoea  was  so  great  as  to  compel  him  to  sit  up  in  bed.  There 
w.as  a moderate  amount  of  efl'usion  in  cavity  of  right  pleura,  with  fiictiou  sounds  higher  upon  the  same  side.  Hew.as  directed  to 
keep  quiet  in  bed,  to  be  supported  by  a nourishing  diet,  to  take  iluid  extract  of  cinchona,  combined  with  iodide  of  potassium,  and, 
with  a view  to  still  further  pi’omote  absorption  and  combat  the  traumatic  pleurisy,  to  have  a succession  of  blisters  applied  to  his 
right  chest.  About  Christmas,  he  had  a severe  exacerbation  of  all  his  symptoms,  which  was  combated  by  the  application  of  wet 
and  dry  cups.  A fresh  jileurisy  was  lighted  up  in  the  early  part  of  January,  1863,  which  was  treated  in  the  same  way.  Under 
the  tonic  and  supporting  plan  of  treatment,  he  mended  slowly  in  spite  of  the  relapses,  and  by  January  25th,  was  able  to  sit  up 
most  of  the  time.  He  was  discharged  from  sei-vice,  at  his  own  request,  on  Febi'uary  2d,  1863.  He  was  still  Very  feeble  and 
wan,  had  dyspno-'a,  and  percussion  showed  that  the  pleuritic  effusion,  although  diminished  in  quantity,  still  remained,  but  the 
dyspuma  appeared  to  be  much  greater  than, could  be  accounted  for  satisfactorily  by  the  amount  of  the  effusion.  Examining 
'This  case  has  been  reported  by  Surgeon  J.  A.  Lidell,  U.  S.  V.,  in  the  American  Medical  Times,  Vol.  VII,  p.  Itii. 


Sect.  I.] 


BAYONET  WOUNDS. 


469 


Surgeon  Frank  S.  Porter  reports,  October  30th,  1867  : The  bayonet  entered  the  chest  on  the  median  line,  at  the  lower  end  of  the 
sternum,  and,  ranging  downward  and  backward,  wounded  the  diaphragm  and  liver.  The  result  is  enlargement  of  the  left  lobe 
of  the  liver,  severe  cough,  bloody  purulent  expectoration,  haemorrhage  of  the  bowels,  with  great  emaciation.  Disability  total. 

Cosgrove,  Jesse  D.,  1st  Maryland.  Bayonet  wound  of  chest.  Gettysburg,  July,  1863.  Discharged  from  service. 
Not  a pensioner. 

Eddie,  Samuel  E.,  Private,  Co.  D,  37th  Massachusetts  Volunteers,  aged  42  years.  Perf’orafing  bayonet  wound  of  chest. 
Treated  in  Harewood  Hospital,  W^ashington.  Discharged  from  service  on  June  12th,  1865.  Not  a pensioner. 

Hanly,  Timothy,  Priwtite,  ' Co.  E,  52d  New  York  Volunteers,  aged  35  years.  Perforating  bayonet  w’ound  of  chest. 
White  Oak  Swamp,  Virginia,  June  30th,  1862.  Treated  in  Frederick  and  I’hiladelphia  hospitals.  Bloody  expectoration  for 
two  weeks.  Discharged  from  service  on  September  27th,  1862.  Not  a pensioner. 

Kirker,  Ira,  Private,  Co.  F,  140th  Pennsylvania  Volunteers,  aged  21  years.  Bayonet  wound  of  right  breast.  Spott- 
sylvania,  ATrginia,  May  12th,  1864.  Treated  in  Harewood  Hospital,  Washington.  Discharged  from  service.  Not  a pensioner. 

Mohawk,  S.,  Corporal,  Co.  C,  7th  Maine,  aged  28  years.  Bayonet  wmund  of  left  breast.  Wilderness,  Virginia,  May 
6th,  1864.  Treated  in  Emory  and  Lincoln  Hospitals,  Washington.  Discharged  fi-om  service.  Not  a pensioner. 

The  termination  of  the  two  following  Confederate  cases  could  not  he  traced  ; but  it 
may  be  hoped,  from  the  condition  of  the  patients  when  last  reported,  that  they  could 
ultimately  have  been  counted  in  the  list  of  recoveries; 

Case.— Private  William  Tinlder,  Co.  G,  3d  Battalion,  South  Carolina  Infantry,  was  wounded  in  a bayonet  charge  at 
Spottsylvania,  May  8th,  1864.  He  was  conveyed  to  a Confederate  hospital  an  hour  after  the  reception  of  the  injury.  On  exam- 
ination, two  apertures  were  discovered,  one  a triangular,  ragged  opening  in  the  back,  about  one-half  inch  to  the  riglit  of  the 
tenth  dorsal  vertebra,  and  the  other  a small  puncture,  three  inches  below  the  right  nipple,  near  the  angle  of  the  ninth  rib.  The 
patient  stated  that  while  in  a stooping  posture  he  was  transfixed  by  a bayonet,  and  he  asserted  positively  that  he  distinctly  felt 
the  withdrawal  of  the  weapon.  When  admitted  to  hospital,  his  face  was  pallid  and  anxious  and  nostrils  distended.  Skin  cool, 
pulse  weak,  but  somewhat  excited,  breathing  diflicult  and  labored.  There  was  slight  oozing  of  blood  from  the  posterior  orifice, 
which  was  contracted,  and  bloody  expectoration  similar  to  that  occurring  in  gunshot  injuries  of  the  lungs.  These  symptoms, 
conjoined  with  the  direction  of  the  wound,  led  to  the  belief  that  the  right  lung  was  transfixed.  May  9th  : Patient  expectorates 
bloody  mucus,  complains  of  pain  in  right  lung ; has  but  little  cough.  Shock  has  passed  off  and  he  is  tranquil.  May  12th  : 
Bloody  expectoration  ceased,  but  pain  still  continues.  May  13th,  posterior  wound  is  healed  over  by  scabbing.  On  May  16th, 
the  patient  was  doing  finely.  There  was  some  acceleration  of  the  circulation  and  dyspnoea,  but  no  physical  symptoms  of  lung 
disease.  He  was  sent  to  general  hospital,  May  17th,  in  fine  spirits. 

Percival,  G.,  Corporal,  Co.  F,  5th  South  Carolina  Battery.  Perforating  bayonet  wound  of  chest.  Spottsylvania,  Virginia, 
May  8th,  1864.  Treated  in  Confederate  hospital.  Dyspnoea  and  bloody  expectoration.  Doing  well. 

Of  twelve  men  returned  to  duty  or  exchanged,  one  was  afterwards  pensioned.  In 
three  cases,  the  pleural  cavity  was  believed  to  have  been  opened.  The  remaining  cases 
were,  probably,  superficial  flesh-wounds; 

Brady,  Owen,  Private,  Co.  E,  1st  Connecticut  Artillery.  Bayonet  wound  of  thorax,  September  20th,  1863.  Treated 
in  3d  division  hospital,  Alexandria.  Eeturned  to  duty  on  September  28th,  1863.  Not  a pensioner. 

Conroy,  James  C.,  Private,  Co.  G,  16th  United  States  Infantry.  Penetrating  bayonet  wound,  right  breast,  August 
30th,  1865.  Treated  in  Cumberland  Hospital,  Nashville.  Returned  to  duty  on  October  14th,  1865.  Not  a pensioner. 

Dorsey,  Rush,  Private,  Co.  E,  17th  West  Virginia  Volunteers,  aged  21  years.  Bayonet  wound,  inferior  angle  of 
scapula.  Cavity  of  chest  not  opened.  Grafton,  September  26th,  1864.  Tieated  in  hospital  at  Grafton.  Returned  to  duty  on 
October  2d,  1864.  Not  a pensioner. 

Garrett,  J.  W.,  Corporal,  Co.  E,  50th  Pennsylvania  Volunteers.  Bayonet  wound  of  left  side,  April  13th,  1863.  Treated 
in  St.  Aloysius  Hospital,  Washington.  Retui-ned  to  duty  on  October  22d,  1863.  Not  a pensioner. 

Huber,  Jacob,  Private,  Co.  H,  13th  Indiana  Volunteers,  aged  29  years.  Perforating  bayonet  wound  of  chest.  Fort 
Darling,  May  20th,  1864.  Treated  in  hospital  at  Point  Lookout,  Maryland.  Transferred  to  Veteran  Reserve  Corps  on  April 
12th,  1865.  Not  a pensioner. 

Johnson,  John,  Piivatc,  Co.  K,  6th  Pennsylvania  Cavalry.  Bayonet  wound  of  lung,  June  17th,  1863.  Treated  in  1st 
division  hospital,  Annapolis.  Returned  to  duty  on  July  7th,  1863.  Not  a pensioner. 

Moore,  W.  J.,  Private,  Co.  C,  15th  New  York  Engineers,  aged  24  years.  Bayonet  wound  of  breast,  May  6th,  1864. 
Treated  in  3d  division  hospital,  Alexandria.  Returned  to  duty  on  August  29th,  1864.  Not  a i)onsioner. 

Murray,  George,  Private,  Co.  B,  39th  United  States  Colored  Troops,  aged  24  years.  Bayonet  wound  of  left  breast. 
Petersburg,  July  30th,  1864.  Treated  in  Summit  House  Hospital,  Philadelphia.  Returned  to  duty  on  September  27th,  1864. 
Not  a pensioner. 


470 


WOUNDS  AND  INJUKIES  OF  THE  CHEST. 


[Chap.  V, 


O'CONA’OR,  Timothy,  Private,  Co.  G,  138tli  New  York  Volunteers,  aged  35  years.  Bayonet  wound  of  chest.  Septem- 
ber 10th,  1804.  Treated  in  Mansfield  Hospital,  Morehead  City,  North  Carolina.  Returned  to  duty  on  March  27th,  1865.  Not 
a pensioner. 

Sjiith,  Grifpitii,  Drummer,  Co.  D,  168th  New  York.  Bayonet  wound  of  right  breast.  Treated  in  Douglas  Hospital, 
W^ashington.  Returned  to  duty  on  August  22d,  1863.  His  name  does  not  appear  on  the  Pension  Records; 

Squires,  T.  G.,  Private,  Co.  L,  11th  Pennsylvania  Cavalry.  Bayonet  wound  of  left  side,  and  gunshot  wound  of 
shoulder.  Stouey  Creek,  .June  29th,  1864.  Treated  in  1st  division  hospital,  Annapolis.  Returned  to  duty  on  November  16th, 
1865.  Examining  Surgeon  Martin  Rizer,  of  Brookville,  Pa.,  reported,  M.ay  1st,  1866,  that  there  was  “nearly  entire  loss  of 
motion  in  right  arm  from  gunshot  wound  of  right  shoulder,  entering  just  below  the  articulStion,  fracturing  the  spine  of  the 
scapula,  passing  out  near  the  s))ine.  Bayonet  wound  of  right  side,  fracturing  eighth  rib.  Reams’s  Station,  June  20th,  1864. 
Disability  one-half  and  permanent.” 

Case. — Private  James  11.  TV.  Vick,  Co.  G,  8th  Louisiana  Regiment,  aged  19  years,  received  a bayonet  thrust  in  the  left 
chest  at  Rappahannock  Station,  Virginia,  on  November  7th,  1863.  He  was  sent  to  Washington,  and  admitted  to  Armory  Square 
Hospital  on  November  9th.  The  left  lung  was  penetrated  one  inch  below  the  nipple,  ami  the  wound  was  three-fourths  of  an 
inch  long.  Bloody  expectoration,  November  8th,  9th,  10th, — less  on  11th.  Simple  dressings  were  applied.  The  patient  was 
transferred  to  the  Old  Capitol  Prison  on  November  12th,  1863,  foi’  exchange,  having  completely  recovered.  A colored  drawing 
of  the  recent  wound  was  made  by  Hospital  Steward  W.  Schultze.  It  is  No.  79  of  the  Surgical  Series  of  Drawings,  S.  G.  O. 

Punctured  and  Incised  Wounds  hy  Various  Weapons. — Besides  the  sabre-cuts  and 
bayonet  stabs  of  the  chest,  there  were  reported  twenty-seven  instances  of  incised  wounds 
and  six  examples  of  punctured  wounds  penetrating  the  thorax.  Several  of  these  recovered, 
though  attended  by  lesions  of  the  pleura  and  its  contents; 

Case. — Corporal  Phili]i  Carr,  Co.  G,  7th  Louisiana  Infantry,  Colored  Troops,  was  admitted  to  the  Corps  d’Afrique  Hos- 
pital, New  Orleans,  Louisiana,  December  15th,  1863,  with  .an  incised  wound  of  the  chest,  penetrating  the  lower  lobe  of  the  right 
lung,  inflicted  with  a dirk  knife.  Patient  anmmic.  Prognosis  unfavorable.  Discharged  from  service  on  March  10th,  1864  ; 
lung  unsound.  Not  a pensioner. 

Case. — Private  M.  P.  Bailey,  2d  Ohio  Heavy  Artillery,  aged  21  years,  was  wounded  at  Lexington,  Kentucky,  in  an 
affray  in  prison,  July  2Cth,  1864,  by  a sheath  knife  inflicting  a wound  of  the  side  and  injuring  the  lower  lobe  of  the  left  lung. 
He  was  sent  to  general  hospital  on  the  same  day.  Simple  dressings  were  apjdied,  and  he  was  returned  to  jail  on  September  2d, 
1864.  The  case  is  reported  by  Acting  Assistant  Surgeon  Robert  I’eter. 

Case. — Corporal  Richard  L.  Gallatin,  Co.  B,  8th  Iowa  Volunteers,  aged  23  years,  was  wounded  at  Memphis,  February 
9th,  1865,  by  a knife,  which  ))enetr.ated  the  right  side  below  the  twelfth  rib.  Admitted  to  Adams  Hospital  the  following  day, 
simple  dressings  were  applied.  He  w.as  returned  to  duty  on  April  20th,  1865.  His  name  does  not  appear  on  the  pension  rolls. 
Assistant  Surgeon  J.  M.  Study,  U.  S.  V.,  reports  the  case. 

Case. — Piiv.ate  Barney  McGinnis,  Co.  H,  7th  Kansas  Volunteers,  was  admitted  to  the  hospital  .at  Leavenworth  City, 
Kansas,  August  18th,  1862,  with  a punctured  wound  of  the  right  side,  by  a knife  entering  below  the  axilla.  The  wound  was 
received  in  camp  in  a drunken  row.  He  was  discharged  from  service  on  December  29th,  1863,  on  account  of  chronic  pleurisy, 
accompanied  by  empyema,  resulting  from  the  wound.  Not  a pensioner. 

But  a large  number  of  wounds  of  this  group  were  fatal.  It  is  common  to  entertain 
hopes  of  recovery  when  the  patient  has  passed  through  the  immediate  danger  of  such 
wounds  and  safely  survived  the  third  day.  But  several  of  the  following  cases  terminated 
fatally  at  a much  later  date : 

Case. — Private  Nathaniel  Prathei’,  Co.  A,  29th  Illinois  Volunteers,  aged  21  years,  was  wounded  in  a brothel  on  December 
14th,  1864.  A knife  ])enetrated  the  middle  lobe  of  the  right  lung.  He  was  admitted  to  Overton  Hospit.al  at  Memphis,  on  the 
same  d.ay,  and  simjjle  dressings  were  applied.  Death  resulted  on  December  17th,  1864.  The  case  is  reported  by  Assistant 
Surgeon  J.  C.  G.  Hapjiersett,  U.  S.  A. 

Case. — Private  James  R.  Brown,  Co.  E,  2d  Minnesota  Volunteers,  aged  27  years,  was  admitted  to  the  Marine  Hospital, 
Chicago,  March  12th,  1864,  with  two  severe  incised  wounds  through  the  left  mamma,  inflicte<b  two  days  previously  with  a dirk 
knife.  De.ath  resulted  on  March  18th,  1864,  from  penetration  of  lung  and  pleuro-pneumonia.  Ralf)h  N.  Isham,  M.  D.,  reports 
the  case. 

Case. — Private  William  T.  McLean,  Co.  F,  64th  Ohio  Volunteers,  aged  23  years,  on  April  10th,  1865,  was  stabbed  with 
a bowie  knife,  which  entered  to  the  right  of  the  sternum  between  the  eighth  and  ninth  ribs,  penetrating  the  right  lung.  On 
Ajjril  24th,  he  was  sent  to  the  Asylum  Hospital,  Knoxville,  where  simple  dressings  were  applied.  Pleuro-pneumonia  ensued, 
and  death  resulted  from  empyema  on  April  28th,  1865.  The  case  is  reported  by  Surgeon  F.  Me.acham,  U.  S.  V. 

Case. — Private  William  L.  Patch,  Co.  A,  10th  Missouri  Cavalry,  aged  26  years,  received,  on  November  24th,  1864,  a 
wound  from  a knife,  penetrating  the  thorax  on  the  left  side.  Five  days  subsequently  he  was  conveyed  to  the  Overton  Hospital 
at  Memphis,  and  simple  dressings  were  applied  to  the  wound.  Death  resulted  on  December  12th,  1864.  Assistant  Surgeon  J. 
C.  G.  Happersett,  U.  S.  A.,  rejjorts  the  case. 


Sect.  I.] 


INCISED  WOUNDS,  CONTUSIONS,  AND  MISCELLANEOUS  INJUEIES.' 


471 


Case.— Private  John  Purtell,  Co.  G,  16th  Illinois  Volunteers,  aged  24  years,  was  admitted  to  the  hospital  at  Quincy 
Illinois,  February  19th,  1864,  from  Quincy  Barracks,  with  a punctured  wound  of  the  right  side  of  the  body,  between  the  seventh 
and  eighth  ribs,  inflicted  with  a common  pocket-knife  during  a row,  at  Memphis,  while  on  veteran  furlough.  On  admission,  he 
was  exhausted  from  loss  of  blood ; but  reaction  came  on  the  next  day.  The  wound  never  healed,  but  continued  to  discharge 
from  trvo  sinuses  above  and  below.  Severe  cough  and  all  the  symjjtoms  of  consumption  followed.  He  at  one  time  improved 
under  the  use  of  expectorants  and  cod-liver  oil.  The  wound  ceased  discharging  and  he  voluntarily  oflered  to  go  to  duty.  He 
went  out  in  the  city  on  the  next  day,  indulged  too  freely  in  drink,  grew  gradually  worse, -and  finally  died  on  May  1st,  1865. 
The  case  is  reported  by  Acting  Assistant  Surgeon  J.  T.  Wilson. 

Case. — Private  James  T-  Fulton,  Co.  A,  12th  Kentucky  Cavalry,  aged  21  years,  received  an  incised  wound  of  the  chest 
in  an  affray  at  Camp  Nelson,  Kentucky,  January  29th,  1865.  The  weapon,  a pocket-knife,  penetrated  the  cavity  of  the  pericar- 
dium and  slightly  wounded  the  heart.  He  was  immediately  carried  to  the  Convalescent  Hospital  near  the  camp.  There  was 
not  excessive  primary  haemorrhage  ; but  great  prostration.  Absolute  rest  and  low  diet  were  enjoined,  and  the  movements  of  the 
chest  were  restrained  by  simple  dressings.  The  patient  died  on  February  18th,  three  weeks  after  the  reception  of  the  injury. 
Acting  Assistant  Surgeon  A.  C.  Eankin  reports  the  case,  giving  no  further  details  either  in  the  register,  monthly  report,  or  burial 
certificate.  Apparently  no  autopsy  was  made,  and  the  diagnosis  was  hazarded  without  being  verified. 

Miscellaneous  Injuries. — Two  hundred  and  twenty-five  cases  of  injuries  of  the  chest 
of  various  kinds,  caused  by  railroad  accidents,  falls,  kicks  from  horses  and  mules,  and  other 
accidents,  are  recorded.  Only  five  cases  proved  fatal.  It  will  be  remembered  that  the 
grave  cases  of  fracture  of  the  thoracic  walls  have  been  separated  from  this  group  : 

Case. — Private  William  Henry,  Co.  F,  81st  Illinois  Volunteers,  aged  30  years,  was  admitted  to  Lawson  Hospital,  St. 
Louis,  Missouri,  January  13th,  1864,  with  contused  wounds  of  the  chest  and  shoulder,  caused  by  falling  from  a mule  and  being 
dragged  and  trampled  upon.  Simple  dressings  were  applied.  He  was  transferred  to  the  Veteran  Reserve  Corps  on  March 
4th,  1864.  Not  a pensioner. 

Case. — Private  Isaac  G.  Farquhar,  Co.  F,  36th  Indiana,  received  a severe  contusion  of  the  sternum,  by  being  run  over 
by  a wagon  at  Chickamauga,  Georgia,  on  September  20th,  1863.  He  was  treated  in  the  field,  and  afterwards  sent  to  Nashville,  in 
the  hospitals  of  which  city  he  remained  until  Janaary  1st,  1864,  when  he  was  returned  to  duty.  Not  a pensioner. 

Case. — Private  Charles  Winston,  Co.  E,  33d  United  States  Colored  Troops,  was  admitted  to  the  2d  division  hospit.al, 
Beaufort,  South  Carolina,  February  3d,  1865,  from  field,  with  a slight  contusion  of  the  right  side  caused  by  a limb  of  a tree.  He 
was  returned  to  duty  on  March  17th,  1865.  Not  a pensioner.  Assistant  Surgeon  W.  R.  Way,  U.  S.  V.,  reports  the  case. 

Case. — Private  William  Weller,  Co.  C,  1st  New  Jersey  Cavalry,  aged  23  years,  was  admitted  to  Fairfax  Seminary 
Hospital,  Virginia,  May  3d,  1864,  with  a contusion  of  the  chest  and  back,  received  April  30th,  by  falling  from  a horse.  On  May 
7th,  he  was  transferred  to  Cuyler  Hospital,  Germantown,  and  returned  to  duty  on  May  7th,  1864.  Not  a pensioner.  Assistant 
Surgeon  Henry  S.  Schell,  U.  S.  A.,  reports  the  case. 

Case. — Private  Hiram  Rosengrant,  Co.  D,  33d  Illinois  Volunteers,  aged  27  years,  wasadnuttedto  the  St.  Louis  Hospital, 
New  Orleans,  March  2d,  1865,  with  a contused  wound  of  the  chest,  received  in  an  accident  on  the  Opelousas  Railroad  the  same 
day.  He  was  returned  to  duty  on  March  7th,  1865.  Not  a pensioner.  Surgeon  A.  McMahon,  U.  S.  V.,  reports  the  case. 

Case. — Piivate  Walter  Baker,  Co.  D,  33d  Illinois  Volunteers,  aged  22  years,  was  admitted  to  the  St.  Louis  Hospit.al,  New 
Orleans,  March  2d,  1865,  with  an  injury  of  the  chest  received  in  an  accident  on  the  Opelousas  Railroad  the  same  day.  He  was 
returned  to  duty  on  March  7th,  1865.  Not  a pensioner.  The  case  is  reported  by  Surgeon  A.  McMahon,  U.  S.  V. 

Table  XXI. 

Statement  of  Sabre  and  Bayonet  Wounds  and  Miscellaneous  Injuries  of  the  Chest. 


nature  of  injury. 

Cases. 

Died. 

Dischakoed. 

DUTlf. 

UNK.NOWN. 

Sabre  Wounds 

9 

1 

4 

4 

Bavonet  Wounds 

29 

9 

6 

12 

2 

Incised  Wounds  from  various  Weapons 

27 

8 

5 

14 

Punctured  Wounds  from  various  Weapons 

6 

4 

1 

1 

Contusions 

225 

5 

15 

205 

Aggregates 

296 

27 

31 

236 

2 

472 


GUNSHOT  FLESH-WOUNDS  OF  THE  CHEST. 


[Chap.  V, 


Section  II. 


GUNSHOT  WOUNDS  OF  THE  CHEST. 


These  injuries  are  almost  universally,  and  with  great  propriety,  divided  into  pene- 
trating and  non-penetrating  wounds.  Other  subdivisions  are  necessary,  however,  in  the 
study  of  a large  number  of  cases.  Among  the  non-penetrating  wounds  are  to  be  distin- 
guished: first,  those  in  which  the  skin,  fascise,  and  other  soft  coverings  of  the  thoracic 
walls  are  alone  interested,  and  from  this  large  group  are  separated  the  flesh-wounds  of  the 
region  defined  by  the  trapezii  and  posterior  thoracic  portion  of  the  latissimi;  secondly,  the 
wounds  complicated  by  fracture  of  the  clavicle,  scapula,  sternum,  and  ribs,  or  by  injury  of 
the  bones  or  cartilages,  unattended  by  injury  to  the  pleural  cavity;  and  lastly  the  injuries 
to  the  contents  of  the  thorax  produced  by  large  spent  projectiles  causing  solutions  of  con- 
tinuity internally,  without  external  breach  of  surface. 

Gunshot  Flesh-Wounds  of  the  Chest. — The  returns  of  the  flesh-wounds,  though  the 
entries  of  the  individual  cases  were  brief,  were  usually  sufiiciently  detailed  to  permit  an 
approximative  estimate  of  the  position  and  severity  of  the  injury. 

There  were  eleven  thousand  five  hundred  and  forty-nine  cases  of  gunshot  flesh-wounds 
of  the  thoracic  parietes,  exclusive  of  the  dorsal  portion.  The  results  were  ascertained  in 
all  but  six  hundred  and  fifty-eight  cases.*  Of  the  remainder,  eight  thousand  nine  hundred 
and  eighty-eight  returned  to  duty  or  to  modified  duty  in  the  Veteran  Eeserve  Corps,  or  were 
exchanged  after  their  recovery;  seventeen  hundred  and  ninety  were  discharged,  the  fur- 
loughed men  who  failed  to  return  and  the  deserters  from  hospital  being  included  in  this 
aggregate ; f and  one  hundred  and  thirteen  died.  In  the  one  hundred  and  thirteen  cases  last 
mentioned,  death  was  not  always  due  to  the  immediate  or  even  remote  effects  of  the  injury. 
Fifteen  fatal  cases  of  pyaemia,  five  of  tetanus,  eleven  of  hospital  gangrene,  eleven  of 
haemorrhage,  one  of  erysipelas,  and  ten  of  pulmonary  complications, — including  six  cases 
of  pneumonia,  two  of  hydrothorax,  and  one  of  empyema, — in  these  fifty-two  cases,  the  injury 
and  death  were  doubtless  directly  connected  as  cause  and  effect.  Of  fifty  cases, — in  which 
the  fatal  issue  was  referred  to  diarrhcea  and  dysentery  in  nineteen  cases,  to  typhoid  fever 
in  twelve,  to  exhaustion  in  fifteen,  to  consumption  in  two,  to  ansemm  and  anasarca  in 
two, — it  is  difficult  to  determine  what  relation,  if  any,  existed  between  the  injuries  and 
deaths.  Finally  in  eleven  cases, — two  of  malarial  fever,  two  of  cerebritis,  one  of  peritonitis, 
one  of  diphtheria,  and  five  of  small  pox, — it  is  fair  to  conclude  that  the  original  injuries 
were  less  closely  connected  with  the  fatal  results  than  were  hospitalism  and  other  morbific 

* The  undetermined  cases  were  oliiefly  taken  from  Confederate  reports,  and  there  were  no  means  cf  tracing  tlicm.  Tliis  ohservation  applies  to 
all  classes  of  cases  derived  from  this  source.  Only  in  important  instances  of  extraordinary  injuries  cr  operations,  information  has  been  sought  by  special 
correspondence  with  the  medical  officer  or  the  patient,  and  has  commonly  been  freely  communicated  when  possible. 

tSee  page  (il,  anU.  • 


Sect.  II.] 


GUNSHOT  FLESH  WOUNDS. 


473 


causes.  It  appears,  tlien,  that  in  uncomplicated  superficial  gunshot  wounds  of  the  soft 
coverings  of  the  chest  the  mortality  is  exceedingly  small.  They  commonly  cause  but 
little  pain,  and  seldom  interfere  with  the  exploration  of  the  lungs  by  auscultation.  They 
have  the  disadvantage,  however,  of  healing  very  slowly,  especially  when  they  produce  a 
long  groove  or  canal,  or  a fistulous  track  beneath  the  skin  or  through  the  muscles,  forming 
what  the  French  denominate  plaies  en  seton.  Their  tedious  cicatrization  is  doubtless  due 
to  the  want  of  that  absolute  rest  and  immobility  requisite  for  prompt  reparation, — the 
muscular  movements,  especially  those^  of  respiration,  being  with  difficulty  restrained. 

Foreign  Bodies  Lodged. — The  lodgment  of  balls,  bits  of  cloth,  or  other  foreign 
bodies  beneath  the  skin  or  in  the  muscles  of  the  chest  was  not  very  infrequent.  The 
following  may  serve  as  examples: 

Case. — Private  Gilbert  McHurtree,  Co.  F,  25tli  New  York  Volunteers,  was  wounded  at  Fred- 
ericksburg, December  13tli,  18G2,  by  a colloidal  ball,  wbicli  entered  just  above  the  interclaviciilar 
notch  of  the  sternum  and  lodged  near  the  superior  angle  of  the  scapula.  He  was  treated  in  the  field 
until  the  19th,  when  he  was  transferred  to  the  3d  division  hospital,  Alexandria,  where,  on  the  next 
day.  Assistant  Surgeon  W.  A.  Conover,  U.  S.  V.,  removed  the  missile.  Simple  dressings  were  applied 
to  the  wound.  On  January  9th,  he  was  transfen-ed  to  Lovell  Hospital,  Portsmouth  Grove,  Rhode 
Island,  whence  he  was  returned  to  duty  on  February  5th,  1863,  and  probably  had  no  further  incon- 
venience from  the  wound  as  his  name  does  not  appear  on  the  Pension  List.  The  missile^  represented 
in  the  adjacent  cut  (Fig.  207),  was  contributed  to  the  Museum  by  the  operator.  The  longitudinal 
groove  may  have  been  caused  by  contact  with  bone ; but  there  was  no  symptom  of  injury  of  the  osseous  tissue. 

Case. — Private  B.  F.  Pierce,  Co.  A,  Cth  New  Hampshire  Volunteers,  was  admitted  to  Filbert  Street  Hospital,  Phila- 
delphia, September  3d,  1862.  He  had  been  hit  in  the  side,  at  the  second  battle  of  Bull  Run,  August  30th,  by  a musket  ball, 
which  had  run  around  under  the  fascim,  externally  to  the  chest,  and  had  made  its  exit  at  a point  between  the  fifth  and  sixth  ribs, 
about  the  junction  of  their  anterior  and  middle  thirds.  The  wounds  of  exit  and  entrance  were  dressed  by  compresses  spread 
with  simple  cerate.  A profuse  discharge  of  thin  yellowish  pus  persisted  for  several  days,  when  a large  piece  of  cloth  was 
removed  from  the  track  of  the  hall.  The  wound  now  cicatrized  readily,  and,  on  October  2d,  he  was  nearly  well  enough  to  leave 
hospital.  But  subsequently,  there  was  some  pulmonary  difficulty,  and  the  man  was  discharged  from  service  on  December  4th, 
1862.  Examining  Surgeon  Ira  S.  Chase,  of  Grafton  County,  New  Hampshire,  reported,  on  June  8th,  1863,  that  the  man  was  in 
feeble  health,  with  cough  and  hepatized  lungs  at  the  lower  part  on  each  side,  with  violent  palpitation  fi’om  the  least  exertion  or 
labor  of  any  kind.  Disability  total  and  apparently  permanent. 

Case. — Private  Thomas  Hagerty,  Co.  K,  3d  Pennsylvania  Cavalry,  aged  37  years,  was  admitted  to  McVeigh  branch 
3d  division  hospital,  Alexandria,  Virginia,  December  4th,  1863,  having  been  wounded  at  the  battle  of  Mine  Run,  November 
27th,  hy  a conical  ball,  which  entered  one  inch  to  the  left  of  and  exactly  in  line  with  the  point  of  the  sternum,  passed  directly 
across  the  body  and  was  e.xtracted  at  the  lower  edge  of  the  middle  of  the  eighth  rib.  When  wounded,  he  had  in  his  coat-pocket 
a letter  containing  a quantity  of  hog’s  bristles,  a looking-glass  cased  in  a wooden  frame,  and  a gutta-percha  comb,  portions  of  alt 
of  which  were  driven  into,  and  were,  at  different  times,  extracted  from  the  wound,  large  portions  of  the  looking-glass  case  being 
extracted  at  four  different  points  in  the  course  of  the  ball.  When  admitted,  the  patient  was  much  prostrated,  having  been 
exposed  to  all  tlie  inclemencies  of  the  season,  without  rations  for  several  days,  and  transported  in  an  army  wagon  some  forty 
miles.  He  lingered  for  a long  time  at  the  point  of  death,  and  exhibited  some  .symptoms  of  jiytemia,  of  which  there  ivere  many 
cases  in  the  hospital  at  that  time,  but,  aided  by  constant  care,  together  with  the  liberal  exhibition  of  tonics  and  stimulants,  with 
extra  diet,  the  powers  of  nature  overcame  the  prostration,  and  he  recovered  so  far  as  to  receive  a furlough  to  go  to  Philadelphia 
on  the  18th  of  May,  1864.  He  returned  from  furlough  in  July  somewhat  improved,  but  suffering  greatly  from  pain  in  the  region 
of  the  wound  on  any  sudden  movement,  or  upon  being  obliged  to  stoop.  He  was  discharged  from  service  on  August  8th,  1864. 
Surgeon  Edwin  Bentlej",  U.  S.  V.,  reports  the  case.  % 

Non-penetrating  Injuries  of  Bones. — In  this  class,  it  has  been  sought  to  include  only 
those  gunshot  wounds  complicated  by  injury  of  the  hones,  or  cartilaginous  portion  of  the 
parietes  of  the  chest,  but  unaccompanied  by  opening  of  the  chest  cavity  or  direct  lesion  of  its 
contents.  Many  such  cases  recover  without  serious  symptoms,  but  in  others,  inflammation 
of  the  pleura  is  induced  either  by  the  concussion  caused  by  the  projectile  or  by  depression 
of  the  bone  upon  the  pleura,  or  disease  of  the  bones  may  ensue,  with  abscess  and  necrosis, 
and  consecutive  pneumonic  inflammation  may  be  lighted  up. 

Shot  Fractures  of  the  Bibs,  Sternum,  and  Clavicle. — The  following  are  illustrations : 

Case. — Corporal  Waltur  Gregory,  Co.  F,  173d  New  York  Volunteers,  aged  22  years,  was  wounded  at  Pleasant  Hill, 
liOuisiana,  April  9th,  1864,  by  a conoidal  ball,  which  fractured  the  ninth  rib.  He  was  taken  prisoner  and  remained  with  tbe 

GO 


Fio.  207. — Conoidal  ball 
rounded  at  apex  and  deeply 
grrooved  longitudinally. — 
Spzc.  4400,  Sect.  I,  zV.  M. 


474 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chai>.  V, 


enemy  until  .Tune  16tli,  when  lie  was  paroled  and  sent  to  the  University  Hospital,  New  Orleans.  Simple  dressings  were  applied. 
He  was  transferred  to  Camp  Parole  on  February  2d,  18G4,  and  W'as  mustered  out  of  service  on  October  18th,  18G5.  The  Pension 
E.xamiuing  Board  at  Brooklyn,  New  York,  report,  December  6th,  1871  : “gunshot  wound  of  left  thorax,  with  injury  to  eighth 
and  ninth  ribs.  The  integuments  are  adherent  to  the  ribs  at  the  point  of  injury,  and  the  muscles  attached  to  the  parts  are 
diminished  in  power.” 

Ca.se. — Private  Edward  Dillingham,  Co.  M,  1st  United  States  Cavalry,  aged  21  years,  was  wounded  near  Boonsboro’, 
Maryland,  July  8th,  1863,  by  a conoidal  ball,  which  passed  through  the  anterior  portion  of  the  upper  third  of  the  left  arm, 
grazing  the  bone,  emerged,  and  entered  the  left  breast,  one  inch  above  the  nipple,  passed  in  a direct  line  transversely  across  the 
chest,  fracturing  the  sternum,  and  lodged  in  the  anterior  fold  of  the  right  axilla.  He  was  admitted,  on  the  next  day,  to  the 
hospital  at  Frederick,  Maryland,  breathing  rapidly  and  with  considerable  difficulty.  The  ball  was  immediately  extracted.  On 
the  next  day  dyspnoea  set  in,  due  to  double  pleurisy  from  contiguity  of  wound  to  the  pleura  and  depression  of  the  sternum. 
Stimul.ants  and  anodynes  were  administered,  and  dry  cups  applied  on  the  right  side  of  the  chest.  The  patient  improved  rapidly. 
Bv  October  19th,  the  wounds  were  healed,  and  he  was  returned  to  duty.  He  was  discharged  on  March  26th,  1864.  A consid- 
erable portion  of  the  sternum  had  exfoliated.  Examining  Surgeon  William  D.  Scarff  examined  the  man  on  July  27th,  1864,  but 
gives  no  additional  information. 

Case. — Private  John  Kearney,  Co.  G,  69th  New  York  Volunteers,  was  wounded  at  Malvern  Hill,  July  1st,  1862,  a 
bullet  striking  his  chest,  about  two  inches  to  the  left  of  the  median  line,  at  the  fourth  rib,  and  lodging  in  the  lower  portion  of  the 
body  of  the  sternum.  Various  efforts  were  made  to  remove  it  by  counter  openings,  but  iu  vain,  and,  after  nine  months  in 
general  hos))itals  iu  Washington  and  New  York,  he  was  discharged,  as  unfit  for  service.  The  wound  had  healed  to  a certain 
extent,  and  he  went  to  work  at  his  trade  of  shipwright.  He  reenlisted  in  February,  1864,  the  wound,  at  the  time  of  examination, 
presenting  the  ordinary  a])pearances  of  old  gunshot  wounds.  He  was  immediately  sent  to  EikeFs  Island,  New  York  Harbor, 
where  he  underwent  a great  deal  of  unnecessary  exposure  to  the  elements,  and  also  to  other  deleterious 
intiuences  for  which  that  depot  was,  at  one  time,  notorious.  The  wound  broke  out  afresh,  the  surrounding 
parts  became  swollen,  red,  and  painful,  and  an  attack  of  broncho-pneumonia  was  superadded.  An 
examination,  by  Nblaton’s  probe,  indicated  the  nature  and  position  of  the  bullet,  the  existence  of  which 
had  been  previously  dovbted  or  denied.  It  was  removed,  without  difficulty,  by  simple  incision.  No 
spiculae  of  cai'ious  bone  were  found  loose,  though  the  sternum  exhibited  a depression  corresponding, 
in  some  measure,  to  the  size  of  the  bullet.  About  an  ounce  of  foetid  pus  was  discharged  fi’om  the 
surrounding  tissues.  The  inissile  was  contributed  to  the  Army  Medical  Museum,  with  the  foregoing 
account,  by  Surgeon  William  O'Meagher,  69th  New  York  Volunteers.  It  is  shown  in  the  adjoining 
wood-cut.  Not  a pensioner. 


Fig.  208. — A flat- 
tened conoidal  musket 

bail  successfully  re- 
moved from  the  ster- 
num. Spec.  1558,  .Sect. 
1,  A.  M.  JI. 


Ca.se. — Private  J.  E.  A- 


-,  Co.  I,  32d  New  York  Volunteers,  having  been  wounded  in 


front  of  Eichmond,  on  June  25th,  1862,  was  sent  to  Washington,  and  admitted  into  Mount 
I’leasant  Hospital.  The  sternum  was  transversely  fractured  at  the  articulation  of  the  third  and 
fourth  ribs  by  a round  ball,  which  did  not  penetrate  the  chest.  The  wound  was  perfectly  round, 
and  from  the  first  showed  no  healthy  action,  being  covered  with  a thick,  unhealthy  slough, 
accompanied  by  a copious,  foetid  discharge,  and  inffammation  of  the  surrounding  tissues.  The 
administration  of  tonics  and  stimulants,  and  the  application  of  cold-water  dressing  failed  to  avert 
the  fatal  issue,  which  occurred  on  August  1st,  1832.  The  autopsy  revealed  destruction  of  the 
costal  cartilages  in  the  vicinity  of  the  wound,  which  was  about  two  inches  in  diameter,  and 
ulceration  of  the  mediastinum  beneath.  There  were  very  fine  adhesions  of  the  pleural  to  the 
thoracic  parietes,  particularly  of  the  right  side ; the  heart  was  considerably  hypertroiihied,  and 
showed  evidence  of  fatty  degeneration.  The  fractured  sternum,  shown  in  the  adjoining  wood- 
cut  (Fig.  209),  was  contributed  to  the  Army  Medical  Museum,  with  the  history,  by  Assistant 
Surgeon  C.  A.  McCall,  U.  S.  A. 

Case. — Private  Chalkley  Berry,  Co.  I,  28th  New  Jersey  Volunteers,  aged  24  years,  was 
wounded  at  Fredericksburg,  December  12th,  1832,  by  a ball,  which,  entering  the  back  on  the 
right  side,  within  a half  inch  of  the  vertebral  column,  opposite  the  spinous  process  of  the  sixth 
dorsal  vertebra,  and  apparently  ))assing  upward  beneath  the  scapula  and  over  the  shoulder, 
fractured  the  right  clavicle  just  within  the  coraco-clavicular  ligament,  making  a complete  transverse  fracture,  and  lodging  in  the 
soft  tissues  below  and  in  ii  vertical  line  with  the  point  of  fracture,  where  it  was  readily  recognized.  He  was  treated  in  the  field 

hospital  of  the  2d  division.  Second  Corps,  and  on  the  18th  was  transferred  to  the  Presbyterian  Church  Hospital,  Georgetown  ; 

on  December  30th,  1832,  to  Harewood  Hospital,  Washington,  and,  on  January  31st,  1863,  to  Broad  and  Cherry  Streets 
Hospital,  Philadeljihia.  When  admitted,  the  wound  of  entrance  had  entirely  healed,  and  firm  union 
had  taken  place  at  the  seat  of  fracture,  the  inner  fragment  overlapping.  The  patient  stated  that,  a 
few  days  after  the  reception  of  the  injury,  he  spat  a small  amount  of  clotted  blood,  and  continued  to 

do  so  at  intervals  for  two  days,  after  which  it  entirely  ceased.  He  also  had  some  difficulty  of 

respiration  for  a short  period  but  was  not  treated  for  any  disease  of  the  lung.  On  February  22d,  1863, 
the  ball  was  cut  out  by  Surgeon  John  Neill,  U.  S.  V.  Berry  recovered  without  any  serious  symptoms 
at  any  time,  and  was  discharged  from  service  on  March  12th,  1863.  The  missile,  represented  in  the 
adjacent  wood-cut  (Fig.  210^,  was  a musket  ball,  notched  at  the  apex,  and  grooved  on  the  side.  It 
was  contributed,  with  the  history,  by  the  operator.  Not  a pensioner. 


Fio.  209. — Sternum  trans- 
versely fractured  by  a round 
ball.  Spec.  84,  Sect.  I,  A.M.M. 


Fig.  210. — An  elongated 
ball  grooved  by  impact  on 
the  clavicle.  Spec.  378, 
.Sect.  I,  A.  SI.  M. 


Sect.  II.] 


NON-PENETRATING  INJURIES  OF  BONES. 


475 


Ca.se. — Private  William  A.  Furbusli,  Co.  G,  16th  Maine  Volunteers,  aged  18  years,  was  wounded  at  Fredericksburg, 
Virginia,  December  13tli,  1862,  by  a ball,  which  struck  about  the  junction  of  the  external  and  middle  thirds  of  the  right  clavicle, 
passed  downward,  backward,  and  inward,  and  emerged  some  inches  below  the  spine  of  the  scapula.  There  was  some  comminu- 
tion of  the  external  part  of  the  clavicle,  and  the  direction  of  the  ball  made  it  certain  that  injury  had  been  inflicted  in  the  scapula. 
He  was  treated  in  the  field,  and,  on  the  18th,  sent  to  St.  Aloysius  Hospital,  Washington.  When  admitted,  there  were  symptoms 
of  pneumonia,  though  otherwise  there  was  no  evidence  of  injury  to  the  lung.  Soon  afterward,  persistent  diarrhoea  set  in,  which, 
with  profuse  suppuration  from  the  wound,  gradually  prostrated  him.  Some  detached  pieces  of  bone  were  removed,  and  the 
sharp  ends  of  the  clavicle  taken  off.  Supporting  treatment.  Death  resulted  on  January  13th,  1863.  Necropsy : Aside  from  the 
injury  of  the  clavicle,  the  coracoid  process  was  found  entirely  detached,  the  spine  of  the  scapula  fractured  along  the  line  of  its 
junction  with  the  body,  the  ball  having  struck  at  the  junction  of  the  spine  and  body,  carrying  away  spiculaj  from  both.  On 
opening  the  joint  an  interesting  complication  was  found,  not  suspected  during  life.  The  cartilages  were  eroded,  and  the  head  of 
the  humerus  presented  a c;irious  appearance,  and,  at  one  point,  looked  as  if  it  had  been  injured  by  some  detached  fragment. 
From  this  ])oint,  there  was  free  communication  with  the  wound,  admitting  a flow  of  pus  into  the  joint.  There  was  no  opening  in 
the  cavity  of  the  chest.  The  right  pleura-pulmonalis  was  covered  with  lymph.  Both  lungs  were  congested  posteriorly,  and  a 
small  superficial  abscess  was  found  in  the  inferior  lobe  of  the  right.  Liver  considerably  enlarged  but  otherwise  healthy.  The 
pathological  specimen  is  No.  720,  Section  I,  A.  M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Assistant  Surgeon 
Alexander  Ingram,  U.  S.  A. 

Several  hundred  cases  were  returned  as  non-penetrating  gunshot  fractures  of  the  ribs, 
but  without  adequate  evidence  that  the  costal  and  visceral  pleurae  and  the  pulmonary 
parenchyma  had  absolutely  escaped  injury. 

Shot  Fractures  of  the  Scapula. — The  two  following  abstracts  relate  to  cases  of  frac- 
ture of  the  scapula,  in  which  the  thoracic  cavity  was  not  opened  primarily,  but  consecutive 
pleuritis  or  pleuro-pneumonia,  and  empyema  resulted  from  the  injuries: 

Case. — Private  J.  P , Co.  H,  14th  Indiana  Volunteers,  aged  24  years, 

was  wounded  at  Antietam,  on  September  17th,  1862,  and  was  admitted  to  hospital  at 
Eredei’ick  on  September  27th.  A ball  had  entered  at  the  spine  of  the  right  scapula, 
and  emerged  just  below  and  ])osterior  to  the  acromion  process  of  the  same  side, 
fracturing  the  entire  spine  and  comminuting  it  to  a great  extent.  On  October  14th, 
the  posterior  wound  being  enlarged  by  an  incision,  two  inches  of  the  spine  of  the 
scapula  was  removed,  and  its  body  found  to  be  fractured  to  some  extent.  Subse- 
quent treatment  consisted  in  the  application  of  lead-water  and  laudanum  to  the 
wound,  and  the  administration  of  tonics  and  stimulants.  The  case  progressed  favor- 
ably. On  November  2d,  the  wounds  were  reopened  to  allow  the  evacuation  of  pus, 
and  a tent  of  oakum  smeared  with  resin  cerate  was  introduced.  On  Novemb(‘r  6th, 
it  was  discovered  that  the  capsular  ligament  was  destroyed ; the  patient  was  seized 
with  chills;  his  general  condition  failed,  and  he  died  of  pleurisy,  with  effusion,  on 
November  15th,  1862.  The  autopsy  revealed  extensive  pleurisy,  with  effusion  over 
the  left  side;  a considerable  quantity  of  pus  in  the  vicinity  of  the  scapula,  and  the 
absence  of  cartilage  from  the  head  of  the  humerus,  wliich  had  undergone  slight 
necrosis  about  the  head  and  anatomical  neck.  The  fractured  scapula,  having  the 

upper  third  of  the  humerus  attached,  was  contributed  to  the  Army  Medical  Museum,  with  the  history,  by  Acting  Assistant 
Surgeon  W.  W'’.  Keen,  jr.,  and  is  figured  in  the  adjoining  wood-cut  (Fig.  211).  [See  also  Fig.  204,  p.  564]. 

Ca.se. — Private  F.  T , Co.  D,  5th  New  Jersey  Volunteers,  aged  46 

years,  was  admitted  to  Caiwer  Hospital,  Washington,  on  May  9th,  1863.  He  had 
been  wounded,  on  the  3d,  at  the  battle  of  Chancellorsville.  The  shock  to  the  system 
had  been  very  severe.  lie  was  conveyed  to  the  1st  division  hospital  of  the  Third 
Corps,  and  his  wound,  attend(‘d  by  great  laceration  of  the  soft  parts,  was  dressed 
under  the  direction  of  Surgeon  J.  S.  Jameson,  86th  New  York  Volunteers.  When  the 
patient  rallied  he  was  sent  to  Washington  on  an  hospital  steamer.  A fi-agment 
of  shell  had  struck  the  back,  over  the  right  scapula,  causing  a com])ound  com- 
minuted friicture.  The  wound  was  closed  with  sutures,  and  a linseed  poultice 
apj)lied;  the  patient  was  allowed  sixteen  ounces  of  wine  in  the  twenty-four  hours, 
and  half  diet.  Brandy  and  (piinia  were  subsequently  pre.scribed.  Death  occurred 
on  May  12th,  1863.  At  the  autopsy,  the  tissues  surrounding  the  wound  were  found 
to  be  involved  to  a very  considerable  extent;  serous  effusion  had  taken  place,  and 
a collection  of  pus  was  found  below  the  neck  of  the  scapula.  The  extent  of  the 
injury  to  the  bone  is  shown  in  the  adjoining  wood-cut  (Fig.  212).  The  spine  and  a 
large  portion  of  the  dorsum  of  the  scapula  are  carricid  away,  and  a fissure  extends 
into  the  glenoid  cavity.  The  extremity  of  the  acromion  process,  separated  from  its 
attachments,  is  present,  but  is  misplaced  in  the  cut.  The  specimen  wi^s  contributed  tured  by  a fnigment  of  shell.  A>ec.  1217,  Sect, 
to  the  Army  Medical  Museum,  with  the  history,  by  Surgeon  O.  A.  Judson,  U.  S.  V.  > ■ • • 


Fio.  211. — Scapula  and  portion  of  hmnenis 


476 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[ClIAl>.  V, 


In  a third  case  of  shot  fracture  of  the  scapula,  the  complications  were  probably  due  to 
embolism  rather  than  to  the  extension  of  inflammation  by  contiguity : 

Case. — Private  W.  F , Co.  F,  18th  Massachirsetts  Volunteers, 

aged  30  years,  was  wounded  at  Bull  Run,  August  30th,  18G2,  and  was  admitted 
to  hospital  at  Alexandria,  on  the  following  day.  There  was  a wound  of  the 
left  .arm,  about  four  inches  below  the  acromion  process  of  the  scapida,  to  which 
cold  water  was  applied.  On  the  3d,  and  again  on  the  5th  of  September,  frag- 
ments of  the  ball,  with  a few  pieces  of  comminuted  bone,  were  removed  through 
an  incision  on  the  outer  edge  of  the  scapula,  affording  the  patient  considerable 
relief.  A profuse  discharge  from  the  wound  soon  followed,  and  on  the  19th, 
symptoms  of  purulent  infection  set  in.  An  active  treatment  by  stimulant,  quinia, 
iron,  and  ammonia,  was  instituted,  but  unavailingly.  Death  resulted  on  Septem- 
ber 25th.  The  necropsy  showed  a fracture  of  the  head  and  dorsum  of  the 
scapula,  extending  below  and  parallel  to  its  spine.  A large  collection  of 
extravasated  blood  was  found  beneath  the  scapula  and  between  the  muscles  of 
the  shoulder,  which  were  disorganized,  and  of  a greenish  hue.  There  was 
extensive  serous  effusion  in  the  left  pleural  cavity,  and  numerous  metastatic  foci 
in  both  lungs.  The  fractured  scapula,  with  two  fragments  of  ball  attached, 
and  having  upon  its  venter  a thin  layer  of  friable,  yellowish  exudation,  was 
contributed  to  the  Army  Medical  Museum  by  Acting  Assistant  Surgeon  W.  H. 

Fig.  213.— Left  scapula,  showing  a fracture,  nearly  Butler,  and  is  figured  in  the  adjoining  wood-cut  (FiG.  213). 
pjirallel  with  the  spine  of  the  scapula,  with  two  fragments 
of  a conoidal  musket-ball.  Spec.  178,  Sect.  I,  A . M.  M. 

Internal  Injuries  without  External  Wounds.— The  third  and  last  subdivision  of  non- 
penetrating gunshot  injuries  of  the  chest,  comprises  those  infrequent  cases  in  which  lesions 
of  the  contents  of  the  cavity  are  produced  without  fracture  of  the  bony  or  cartilaginous 
case  or  even  solution  of  continuity  in  the  soft  parts.  The  pension  returns  would  indicate 
that  such  accidents  were  not  uncommon ; but  the  instances  in  which  the  diagnosis  of  the 
internal  lesions  has  been  made  out  with  precision  at  the  time  of  the  reception  of  the  injury 
are  very  rare.  The  truth  is  that  the  severe  contusions  by  large  spent  shot,  causing  ruptures 
of  the  lung  and  heart,  or  laceration  and  great  extravasation,  are  fatal  on  the  field,  and  very 
rarely  came  under  the  surgeon’s  observation,  while  the  slight  concussions  of  the  contents  of 
the  chest  cavity  often  pass  unnoticed : 

Case. — Private  H.arry  Morris,  Co.  A,  115th  Pennsylvania  Volunteers,  aged  24  j'ears,  was  wounded  at  Gettysburg,  July 
1st,  1803,  by  a large  spent  fr.agment  of  shell,  which  caused  a very  serious  concussion  of  the  left  chest.  He  was  conveyed  to  tho 
hospital  of  the  First  Corps,  where  ho  remained  until  the  24th,  when  he  was  transferred  to  Camp  Letterman  Hospital.  On 
admission  at  C.amp  Letterman,  the  patient’s  condition  was  very  low.  There  was  extensive  ecchymosis  of  the  left  side,  and  he  was 
troubled  with  cough  and  dyspnoea,  and  was  unable  to  take  any  solid  food.  There  appeared  to  be  extensive  inflamm.ation  of  the 
left  lung.  Cough  .mixtures,  tonics,  and  stimulants  were  administered,  and  the  chest  was  rubbed  with  a stimulating  lotion.  On 
the  27th,  he  rtiised  some  bloody  matter  with  difficulty.  He  gradually  sank,  and  died  on  August  3d,  1863.  There  was  no  oppor- 
tunity of  making  an  autopsy.  Assistant  Surgeon  C.  A.  Hamilton,  76th  New  York  Volunteers,  reports  the  case. 

Case. — Private  H.  H.  Bonham,  Co.  F,  7th  Wisconsin  Volunteers,  aged  17  years,  was  wounded  atthe  Wilderness,  Virginia, 
May  7th,  1864,  by  a fragment  of  shell,  which  struck  the  left  breast  near  the  sternum,  two  inches  below  the  clavicle.  Tho  cavity 
of  the  chest  was  not  opened;  but  there  was  lesion  of  its  contents  by  contusion.  He  was  carried  to  the  hospital  of  the  4th  division. 
Fifth  Corps,  and  a simple  bandage  was  placed  about  the  chest.  On  May  11th,  he  was  transferred  to  Harewood  Hospital  at 
W'ashington;  on  the  15th,  to  Cuyler  Hospital,  Germantown,  whence  he  returned  to  duty  on  July  5th,  1834.  Discharged  from 
service  on  August  7th,  1865.  Pension  Examiner  J:  H.  Hyde,  M.  D.,  reports.  May  23d,  1833,  that  Bonham  “suflers  from  palpi- 
tation of  the  heart.  He  expectorates  blood,  and  has  almost  entirely  lost  the  use  of  his  left  arm.” 

Case. — Corporal  Joseph  Kiukade,  Co.  B,  68th  United  States  Colored  Troops,  aged  25  years,  received  a contusion  of  the 
chest,  with  internal  injury,  caused  by  the  bursting  of  a torpedo  at  Fort  Blakely,  Alabama,  April  10th,  1835.  On  the  15th,  he  was 
adinitt(*d  to  the  Corps  d’Afrique  Hospital,  New  Orleans,  and  simjile  dressings  applied.  lie  recovered  and  was  discharged  from 
service  on  Juno  17th,  1835.  Surgeon  Francis  E.  Pi(|uette,  86th  United  States  Colored  Troops,  reports  the  case. 

Case. — Corjioral  William  H.  Mix,  Co.  H,  2d  New  Hampshire  Volunteers,  aged  22  years,  received  a contusion  of  the  left 
side  of  the  thorax  by  a cannon  ball,  at  Gettysburg,  July  2d,  1833.  He  was  taken  to  the  field  hospital  of  the  Third  Corps,  where 
he  remained  until  the  11th,  when  he  was  transferred  to  Summit  House  Hospital,  and  on  the  23th,  to  Mower  Hospital,  Philadelphia. 
H e stated  that  when  hit  his  breast  was  protected  by  a book  and  blanket.  Blood  was  discharged  from  the  lungs,  in  considerable 
(luantities,  for  live  days  after  the  reception  of  the  injury.  When  admitted,  the  patient  rested  badly  and  complained  of  pain  in 
the  injunHl  breast ; he  expectorated  considerable  muco-purulent  matter.  Volatile  liniment  was  applied  with  fi  iction.  He  improved 
rajiidly,  and,  on  Seiiteinber  25th,  1863,  was  returned  to  duty.  Surgeon  J.  Hopkinson,  U.  S.  V.,  reported  the  case.  • 


Sect.  II.] 


INTERNAL  INJURIES  WITHOUT  EXTERNAL  WOUNDS. 


477 


Case. — Private  Dominick  Barrett,  Co.  D,  6tb  Indiana  Volunteers,  aged  42  years,  was  wounded  at  Dallas,  Georgia,  May 
27tli,  1864,  by  a conoidal  ball,  wbicb  struck  the  thorax  anteriorly,  producing  a very  serious  concussion  of  tlie  lung  without 
external  injury ; be  also  received  a wound  of  the  band.  He  was  carried  to  the  hospital  of  the  3d  division.  Fourth  Corps.  On 
June  Gth,  he  was  transferred  to  Totten  Hospital,  Louisville;  on  July  3d,  to  the  hos])ital  at  Madison,  Indiana,  and  on  September 
17th,  18G4,  to  Indianapolis,  for  muster  out  of  service.  Not  a pensioner.  Surgeon  A.  C.  Swartzwelder,  U.  S.  V.,  reports  the  case. 

Case. — Sergeant  Heni’y  Alic,  Co.  A,  12th  United  States  Infantry,  was  admitted  to  llarewood  Hospital,  W’ashington,  May 
Gth,  1863,  with  a contused  wound  of  the  left  side  of  the  chest,  received  at  the  battle  of  Chancellorsville,  on  May  3d.  A cannon 
ball  of  spent  force  struck  the  chest  between  the  fifth  and  twelfth  i-ibs,  discoloring  the  whole  side  fif  the  chest.  The  patient 
expectorated  a large  amount  of  blood,  and  sufiered  greatly  from  dyspnoea  and  other  symptoms  of  injured  lung.  He  gradually 
improved,  and  was  returned  to  duty  on  July  28th,  1863.  Not  a pensioner.  Surgeon  Thomas  Antisell,  U.  S.  V.,  reported  the  case. 

Case. — Private  Henry  Bloss,  Co.  A,  31  Michigan  Volunteers,  aged  28  years,  received  an  injury  of  the  lung  by  concus- 
sion of  the  chest  from  a large  fragment  of  shell,  at  the  WTlderness,  May  Gth,  1864.  He  was  treated  in  the  field  until  May  24th, 
when  he  was  transferred  to  Harewood  Hospital,  W^ashington.  Anodynes  were  administered  and  rest  enjoined.  On  February 
20th,  186.5,  he  w’as  transferred  to  the  Post  Hospital  at  Camp  Chase,  Ohio,  and,  on  February  25th,  to  Tripler  Hospital,  Columbus, 
whence  he  was  discharged  from  service  on  April  10th,  1865,  on  account  of  expiration  of  term  of  service.  Acting  Assistant 
Surgeon  C.  A.  Perdue  reports:  “In  this  case  there  is  a tendency  to  mental  aberration.  The  lung  is  in  a bad  condition.” 

Case. — Private  James  Lloyd,  Co.  G,  1st  New  Jersey  Cavalry,  aged  26  j'ears,  received  a severe  contusion  of  the  chest, 
with  laceration  of  the  lungs,  by  a solid  shot,  at  Sailor’s  Creek,  Virginia,  April  Gth,  1865.  He  was  at  once  conveyed  to  the  field 
hospital  of  the  2d  division.  Cavalry  Corps,  where  morphia  was  administered.  On  the  12th,  he  was  transferred  to  the  Ninth 
Corps  Hospital;  on  May  7th,  to  Armory  Square  Hospital,  Washington,  and  on  May  27th,  to  Whitehall,  Pennsylvania,  whence 
he  was  discharged  on  June  23d,  1865.  He  is  not  a pensioner.  Assistant  Surgeon  E.  .1.  IMarsh,  U.  S.  A.,  reports  the  case. 

Seventeen  other  cases,  believed  to  belong  to  this  group,  were  received  at  the  field  hos- 
pitals. Thirteen  terminated  fatally  in  from  twelve  hours  to  four  days  from  date  of  injury. 
Unfortunately,  the  notes  are  very  brief,  and  no  autopsies  were  made.  But  the  experienced 
surgeons  who  observed  these  cases  would  not  have  discriminated  them  in  their  reports  on 
trivial  grounds,  and  the  mention  of  the  existence  of  pneumothorax  or  hemothorax  or  profuse 
hemoptysis  as  attendant  symptoms,  and  of  pleurisy  and  pneumonia  in  the  survivors,  indicate 
that  these  cases  were  regarded  as  lesions  of  the  contents  of  the  thorax  without  external 
breach  of  surface.  M.  Gosselin*  suggests,  as  the  probable  mechanism  of  this  lesion,  that 
the  lungs  being  distended  in  inspiration,  and  the  glottis  being  spasmodically  closed  at  the 
moment  the  external  violence  is  applied,  the  pulmonary  tissue  must  rupture,  if  the  force  is 
great  enough,  as  it  cannot  yield.  This  is,  doubtless,  the  true  explanation  in  the  cases  to 
which  this  writer  restricts  his  inquiries,  but  is  not  required  in  those  instances  in  which  the 
lung  is  lacerated  by  fractured  ribs,  the  integument  remaining  intact, 

Mr.  Le  Gros  Clark  [Lectures  on  the  Principles  of  Surgical  Diagnosis,  1870,  p.  210) 
believes  that  a condition  of  “serious  functional  derangement,  without  organic  lesion,”  is 
sometimes  the  result  of  external  violence,  and  proposes  the  name  of  concussion  of  the  lung 
for  this  condition,  from  its  analogy  to  concussion  of  the  brain.  He  frankly  admits,  however, 
that  he  is  “unacquainted  with  any  special  diagnostic  sign  by  which  to  recognize  it  apart, 
that  is,  from  the  general  indications  of  disturbed  function,  and  possibly  local  pneumonia, 
unless  we  may  accept  as  evidence  the  secondary  expectoration — usually  after  the  lapse  of 
forty-eight  hours — of  blood-stained  niucys,  where  no  pneumonia  exists.” 

* GOSSELIX,  I.,  liechercJies  sur  les  Dechirures  du  Poumon  sans  Fractures  des  Cotes  correspondayites^  en  Mem.  de  la  Soc.  de  Chir.,  Paris,  1847,  T.  J, 
p.  201 ; IlEWSOX  {Med.  Ohs.  and  Inq.^  Vol.  Ill,  p.  372)  appears  to  have  first  called  attention  to  this  particular  point  in  chest  injuries.  lie  cites  examples 
from  Mery  {Mem.  de  V Acad.  Royale  des  Sciences^  1713),  and  ClIESTON,  {Path.  Inquiries  from  Dissec.  of  Murh.  Bodies,  Gloucester,  177(5).  Laenxec,  in 
describing  pneumothorax,  quotes  IlEWSOX.  UUESCHET  {Diet,  des  Sci.  Med.,  Paris,  1815,  T.  XII,  AUT.  Emphyslme),  JIUKAT  {Nouveau  Diet.  dcMid.,  Paris, 
1842,  Art.  Emphyseme),  and  BOYEU  {TraiU,  5th  ed.),  allude  to  the  possibility  of  the  accident  under  consideration.  GOSSELIN  enters  fully  into  the  subject 
and  cites  cas<»s  reported  by  ROQUES  {Arch.  gin.  de  Med.,  1829),  Saussier  {Theses  de  l^aris,  1841),  Smith,  {Dublin  Quart.  Jour.,  1840),  Paillaru  {Legons 
OraUs  of  DUI’UYTREX,  T.  VI,  p.  308),  and  Latargue  {Jour,  de  Med.  de  Bordeaux,  1840,  p.  105).  Paillard's  cases  alone  were  examples  of  gunshot  injury. 
They  are  detailed  in  his  Relation  of  the  Surgery  at  the  Siege  of  .\ntwcrp,  where  he  gives  also  (p.  22)  the  interesting  case  of  (Captain  Coultault,  an  engineer 
officer,  struck  in  the  trenches  at  Antwerp,  by  a large  spent  cannon  ball,  over  the  lower  lateral  portion  of  the  chest,  and  almost  instantly  killed.  The 
clothing  and  integuments  were  uninjured ; but  Professor  FORGET  found  five  ribs  fractured,  with  such  comminution  as  to  jicnnit  the  hand  to  be  passed 
behind  the  skin  and  pulpified  subjacent  soft  parts,  far  into  the  cavitj’  of  the  thorax.  Jorert  {Plaies  d' Armes  d feu,  pp.  1(52,  109)  gives  a good  account 
of  this  form  of  injury  for  the  militar}*  surgeon.  lie  does  not  exclude  the  cases  in  which  the  ribs  are  fractured,  as  does  M.  GossELIN.  Professor  8.  J>. 
GROSS  {S jst'im,  5th  cd.,  Vol.  II,  p.  444)  accepts  M.  Go.sSEUX’s  explanation  of  the  accident,  as  docs  Dr.  .JOHN  ASHIIURST,  jr.  {Principles  and  ] Practice  of 
Surgery,  Phila.,  1871,  p.  375).  The  latter  has  collected  si.xteca  cases  of  this  nature  from  the  records  of  the  surgery  of  civil  life,  including  tliose  observed 
at  the  Pennsylvania  and  Fpisoopal  Hospitals,  Philadelphia,  by  Dr.  E.  IlAUTSHOUXE  and  Dr.  C.  0.  Lee. 


478 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Penetrating  Gunshot  Wounds  of  the  Chest. — We  pass  now  to  the  consideration 
of  a class  of  very  serious  injuries  of  the  chest,  comprising  complicated  lesions  of  the  bony, 
cartilaginous,  and  muscular  case  composing  the  thorax, — the  vertebrae,  sternum,  ribs,  costal 
cartilages,  and  diaphragm, — of  the  contained  viscera, — the  lungs  and  pleurae,  heart  and 
great  vessels  and  nerves,  the  oesophagus  and  thoracic  duct, — and  also  of  the  clavicle  and 
scapula,  which  partly  protect  the  cavity. 

Of  the  twenty  thousand  two  hundj.’ed  and  sixty-four  cases  of  shot  wounds  of  the  chest 
returned  in  the  war,  eleven  thousand  five  hundred  and  forty-nine  have  been  briefly  discussed 
in  the  preceding  subsection  as  wounds  of  the  thoracic  walls,  and  eight  thousand  seven  hun- 
dred and  fifteen  are  to  be  considered  here  as  penetrations  of  the  cavity. 

Viewed  in  the  aggregate,  the  ratio  of  mortality  of  cases  of  this  category  is  very  great, 
while  in  some  of  the  divisions,  recoveries  are  exceptional,  and  the  fatality  may  be  regarded 
as  nearly  uniform.  Abstracting  three  hundred  and  twelve  cases,  the  terminations  of  which 
cannot  be  traced,  the  death-rate  of  the  remaining  eight  thousand  four  hundred  and  four  is 
62.5;  but  in  the  division  of  wounds  of  the  heart,  for  example,  it  rises  to  99.9.  Hence  the 
necessity  for  numerous  subdivisions,  in  order  that  similar  cases  may  be  compared. 

Penetrating  and  Perforating  Wounds  without  Fracture. — Many  cases  were  reported  of 
perforation  of  the  chest,  through  intercostal  spaces,  by  small  projectiles,  without  any  lesion 
of  the  bones.  In  the  fatal  cases,  in  which  the  course  of  the  ball  was  traced,  it  was  generally 
found  to  have  traversed  the  lung,  and  that  death  had  resulted  from  haemorrhage  or  from 
empyema.  In  the  cases  of  recovery,  the  existence  of  wounds  of  the  lung  was  not  always 
determined  with  satisfactory  precision,  and,  in  some  instances,  the  missile  probably  ran  around 
the  pleural  surface  of  a rib  or  aponeurosis,  without  lesion  of  the  lung  substance.  Such 
injuries  are  unquestionably  less  fatal,  other  conditions  being  equal,  than  those  accompanied 
by  fracture,  and  particularly  by  fracture  at  the  entrance  wound.  Indeed  the  complications 
produced  by  the  splinters  forced  inward  are  often  more  formidable  than  the  lesions  caused 
in  the  lung  by  the  ball  itself. 

§ Recoveries. — Some  examples  of  these  wounds,  confined  to  the  soft  parts,  which  had  a 
favorable  termination  notwithstanding  the  injury  to  the  lung,  may  here  be  cited.  The  first 
two  abstracts  refer  to  instances  complicated  by  injury  to  the  brachial  plexus  of  nerves: 

Case. — Private  Edward  Parsons,  Co.  D,  ISth  New  York  Cavalry,  aged  21  years,  having  been  accidentally  wounded  at 
Berlin,  Maryland,  on  .July  19th,  was  admitted  to  hospital  at  Frederick,  on  July  24th,  1863.  A conoidal  ball  had  entered  at  the 
anterior  fold  of  the  right  axilla,  grazed  the  right  lung,  and  emerged  three  inches  above  the  right  nipple.  The  patient  spat  blood 
in  small  quantities,  and  complained  of  pain  in  the  right  side ; his  general  health  and  appetite  were  good.  Wet  cups  were  applied 
to  the  seat  of  pain.  On  July  28th,  there  was  traumatic  neuralgia  of  the  median  and  ulnar  nerves,  which  was  alleviated  by  the 
ap])lication  of  a blister.  August  3d,  the  neuralgia  was  confined  to  the  wrist  and  hand.  August  9th,  neuralgia  in  the  little  and 
ring  fingers  only.  By  September  10th,  the  patient  was  much  improved,  but  had  dyspnoea  on  exposure.  He  was  discharged 
the  service  on  December  9th,  1863,  at  which  time  the  neuralgia  had  entirely  subsided,  leaving  the  wrist  and  hand  slightly  rigid. 
On  December  17th,  1863,  Pension  Examiner  Charles  Rowland  reports,  “this  soldier  is  totally  disabled;  his  forearm  is  at  present 
entirely  useless,  hut  will  improve  and  finally  recover.”  A communication  from  the  Commissioner  of  Pensions,  May  5th,  1868, 
informs  us  that  this  man’s  claim  for  pension  was  rejected,  there  being  no  evidence  of  his  being  wounded  in  the  line  of  duty. 

Case. — Private  John  Couthard,  Co.  D,  123d  Indiana  Volunteers,  aged  21  yeai-s,  was  wounded,  at  Kenesaw,  Georgia, 
June  17th,  1864,  by  a conoidal  ball,  which  passed  through  the  soft  part  of  the  left  arm,  entered  the  thorax  between  the  fifth  and 
sixth  ribs,  passed  through  the  posterior  portion  of  the  left  lung,  and  emerged  between  the  sixth  and  seventh  ribs,  three  inches 
from  the  spine.  He  was  treated  in  the  field,  and,  on  July  1st,  sent  to  the  hospital  at  Knoxville,  Tennessee.  Simple  dressings 
were  applied  to  the  wound.  He  received  a furlough  on  .July  26th,  at  the  expiration  of  which  he  reported  to  Washington  Park 
Hospital,  Cincinn.ati,  Ohio.  Discharged  from  service  on  January  2d,  1865.  Pension  Examiner  Edward  Mead  reports,  the  day 
after  discharge,  that  “the  ball  entered  upjter  third  of  left  arm,  passed  inward  and  entered  the  u|)per  portion  of  left  lung  and  out 
at  right  side  of  spine  in  dorsal  region.  Gangrene  followed,  leaving  a large  cicatrix.  Haemoptysis  continued,  as  alleged,  until 
three  weeks  ago.  Hand  is  paralyzed  .and  action  of  shoulder  limited.  Probable  fracture  of  spinous  ])rocesses  of  two  dors.al 


Sect.  II.] 


PENETEATING  SHOT  WOUNDS  WITHOUT  FRACTURE. 


479 


vertebrae.  Arm  nearly  useless.  Functions  of  lung  impaired.  Disability  total  and  permanent.”  Pension  Examiner  W^illiam  Owens 
reports,  September  25tli,  1866,  that  the  pensioner’s  health  was  good.  The  lung  can  be  fully  inflated,  but  gives  indications  ot 
weakness  in  talking,  walking,  or  running  briskly.  No  haemorrhage  has  occurred  for  a year  past.  Pension  Examiner  John  L. 
Neilaun  reports,  November  30th,  1869,  that  the  brachial  plexus  is  injured,  consequently  paralysis  of  arm.  The  left  arm  and  shoulder 
are  shrunken,  and  he  has  very  imperfect  use  of  the  hand,  although  the  forearm  seems  well  developed.  The  left  shoulder  is 
depressed  and  the  pectoral  muscles  wasted.  Auscultation  shows  nothing  more  than  bronchial  mucous  rales.  Numbness  of  hand 
and  imperfect  circulation.  Pain  at  seat  of  wounds  is  aggravated  by  cold  or  stormy  weather.  The  Pension  Examining  Board, 
consisting  of  Drs.  McEeynolds,  White,  and  Conner,  reports.  May  4th,  1870,  that  the  “ball  entered  inside  of  left  deltoid  and 
passed  out  of  right  side  of  spine,  * * injury  of  median  nerve,  * “ two  inches  expansion  of  chest,  respiration  a little  rude, 

* * wound  of  median  nerve.” 

Case. — Corporal  Joseph  J.  Young,  Co.  D,  1st  Minnesota  Volunteers,  aged  34  years,  was  wounded  at  Antietam,  Mary- 
land, September  17th,  1862,  by  a musket  ball,  which  entered  the  chest  between  the  fourth  and  fifth  ribs,  one  and  a half  inches 
from  the  sternum,  passed  through  the  right  lung,  and  emerged  at  the  lower  and  anterior  edge  of  the  right  scapula,  the  ball  having 
glanced  on  striking  the  scapula.  He  was  treated  in  the  field,  and,  on  September  21st,  transferred  to  the  hospital  at  Frederick. 
Maryland.  When  admitted  he  was  in  a very  debilitated  state,  having  lost  much  blood.  There  was  slight  pneumonia,  which 
soon  subsided.  Htemorrhage  from  the  wound  occurred  daily.  A supporting  treatment  was  adopted.  Erysipelas  supervened 
October  16th,  but  subsided  under  the  application  of  a solution  of  lead  and  opium.  On  December  27th,  he  was  transferred  to 
Falmouth,  Virginia,  and  discharged  from  service  on  January  1st,  1863.  Pension  Examiner  A.  E.  Ames  rej)orts.  May  25th, 
1867,  “wound  opening  and  frequently  discharging.  Is  much  troubled  with  pain  in  region  of  liver.  Disability  permanent  and  equal 
to  loss  of  limb.”  No  later  report  at  the  Pension  Office,  except  that  the  pensioner  had  removed  to  Oregon,  and  was  last  paid  at 
San  Francisco,  September  4th,  1871. 

Case. — Private  Samuel  Graves,  Co.  B,  7th  Kansas  Cavalry,  was  wounded  at  Arkansas  Post,  Arkansas,  January  11th, 

1863,  by  a pistol  ball,  which  entered  above  the  right  nipple,  passed  through  the  lung,  and  emerged  below  the  right  scapula. 
Free  haemoptysis  occurred  directly  upon  injury.  Sputa  were  bloody  for  a long  time.  He  was  admitted,  on  January  23d,  to 
Adams  Hospital,  Memphis.  Being  of  a feeble  constitution,  naturally,  he  did  not  gain  strength  rapidly.  He  was  discharged 
from  hospital  about  April  1st,  1863,  at  which  time  he  complained  of  a tightness  of  the  thorax,  preventing  him  from  taking  a full 
inspiration.  There  was  probably  an  adhesion  of  the  lung  both  at  the  anterior  and  posterior  perforation.  Both  the  external 
wounds  had  entirely  healed.  He  had  very  little  cough  and  no  bloody  sputa.  He  is  not  a pensioner. 

In  reporting  the  following  case,  Surgeon  D.  C.  O’Keefe*  remarks:  “This  case  presents 
two  points  of  deep  interest.  The  first  is  that  of  an  unquestionable  wound  through  the 
lung  without  any  symptom  indicating  that  injury,  except  the  original  haemoptysis.  The 
second  was  the  undoubted  severing  of  the  left  subclavian  artery,  as  indicated  by  the 
absence  of  pulsation  in  the  radial  or  brachial  artery,  which  was  carefully  and  frequently 
sought  for,  and  of  the  absence  of  which  there  could  have  been  no  mistake:” 

Case. — Sergeant  Cyrus  L.  Nabors,  Co.  F,  2d  Arkansas  Regiment,  aged  29  years,  constitution  good,  occupation  farmer; 
wounded  on  May  19th ; admitted  to  the  Institute  Hospital,  Atlanta,  May  20th,  1864.  Gunshot  wound  by  minie  ball,  which 
entered  posteriorly  two  and  a half  inches  to  the  left  of  the  spinal  column,  opposite  the  body  of  the  fifth  dorsal  vertebra,  and, 
pa.ssing  obliquely  forward,  made  its  exit  between  the  third  and  fourth  ribs,  at  a point  three  inches  to  the  left  of  the  sternum. 
Alarming  haemorrhage  and  haemoptysis  followed  the  receipt  of  the  injury.  On  admission,  the  patient  was  greatly  debilitated 
from  haemorrhage ; there  was  neither  cough,  constitutional  disturbance,  nor  haemoptysis;  no  pulse  could  be  felt  at  the  wrist  in 
the  radial  artery  of  the  affected  side,  nor  in  the  bracial  as  far  as  the  axilla.  From  admission,  this  patient  continued  to  do  well 
without  a single  bad  symptom.  The  arm  on  the  wounded  side  was  considerably  atrophied  and  somewhat  paralyzed,  due, 
doubtless,  to  the  cutting  off  of  the  supply  of  blood  and  nervous  influence.  June  30th,  doing  well ; furloughed  home. 

Case. — Private  .Joseph  Forrest,  Co.  F,  13th  Missouri  Cavalry,  aged  21  years,  was  wounded  at  Osage,  Missouri,  October  25th, 

1864, the  ball  entering  at  the  outer  margin  of  the  left  axilla  and  penetrating  the  thorax.  He  was  admitted  to  the  hosj)ital  at  Fort 
Scott,  Kansas,  on  the  next  day  and  water  dressings  were  applied  to  the  wound.  Discharged  from  service  April  27th,  1865. 
Pension  Examiner  Julian  Bates  reports,  June  7th,  1865,  that  “the  ball  is  believed  to  be  still  lodged  in  the  chest.  The  pensioner 
suffers  from  cough  and  disturbed  respiration  through  the  chest,  and  is  greatly  emaciated.”  He  imj)roved  afterward,  and  his 
pension  was  discontinued  on  March  3d,  1869. 

Shot  Penetrations  of  the  Chest  with  Lodgment. — In  the  four  following  cases  missiles 
deeply  penetrated,  traversed  the  thoracic  cavity,  and  lodged  within  it: 

Case. — Private  Ludwig  Kuhn,  Co.  D,  26th  Wisconsin  Volunteers,  aged  24  years,  very  robust,  having  been  wounded  at 
Gettysburg,  on  .July  1st,  was  sent  to  Philadeljdiia,  and  admitted  to  Satterlee  Hospital  on  July  9th,  1863.  A conoidal  musket 
ball  had  entered  to  the  right  of  the  inferior  angle  of  the  right  scapula,  j)enetrated  the  thoracic  cavity  and  lodged.  For  s(!veral 
days  after  the  reception  of  the  injury,  there  was  haemoptysis,  which  isre[)orted  to  have  ceased  after  the  ))atient  was  bled  from  the 
left  arm.  The  remaining  treatment  consisted  of  cold-water  dressings,  linseed  poultices,  and  cerate  dressings  to  the  wcunid  after 
^Confederate.  States  Medical  and  Surgical  Journal,  Uichmond,  18U5,  Vol.  II,  No.  2,  p.  33. 


480 


WOU^IUS  AND  INJUKIES  OF  THE  CHEST. 


[Chap.  V, 


the  reniov'al  of  the  ball.  There  were  no  serious  symptoms  during  the  progress  of  the  case,  and  but  slight  indication  that  the 
lung  had  been  penetrated.  The  patient  had  nearly  recovered  his  health  by  December  31st,  18G3,  when  he  was  transferred  to 
the  Veteran  Eeserve  Corps.  He  was  discharged  from  service  on  June  9th,  1864,  and  subsequently  enlisted  in  Co.  I,  214th 
I’eunsylvania  Volunteers.  During  his  second  enlistment  he  was  treated  in  the  hospitals  at  Washington  and  Philadelphia.  •The 
patient  stated  that  his  wound  was  so  painful  as  to  deprive  him  of  re.st,  and  he  was  unable  to  lie  upon  his  back.  The  wound  had 
healed,  with  the  exception  of  a fistulous  opening,  and  the  constitutional  condition  was  good.  In  February,  1866,  Pension 
Examiner  James  Neil  reports  “there  are  pleuritic  adhesions  and  partial  consolidation  of  the  lung.  The  patient  looks  well.” 

C.VSE. — Captain  Theodore  A.  Hope,  Co.  E,  91st  Pennsylvania  Volunteers,  aged  26  years,  was  wounded  at  Five  Forks, \ • 
Virginia,  March  31st,  1835,  by  a conoidal  ball,  which  entered  the  right  chest  three  inches  above  the  nipple,  between  the  second 
and  third  rib.s,  passed  downward  through  the  lung,  and  lodged  in  the  left  side  of  the  diaphragm.  Haemoptysis  occurred  on  the 
reception  of  the  injury.  He  was  taken  to  the  hospital  of  the  1st  division.  Fifth  Corps,  where  he  remained  until  April  29th,  when 
h(i  was  transferred  to  Armory  Square  Hospital,  Washington.  There  was  pneumonia  of  right  side  when  admitted.  Poultices 
were  applied  to  the  wound,  and  anodynes  and  stimulants  given.  Morphia,  in  half-grain  dose.s,  was  given  hypodermically  twice 
a day.  On  .June  1st,  the  patient  vomited  a large  amount  of  bilious  matter,  which  would  also  flow  from  the  wound  after  a short 
cough.  On  August  19th,  he  was  transferred  to  Douglas  Hospital,  Washington,  and  on  the  30th  to  Mower  Hospital,  Philadelphia, 
whence  he  was  discharged  from  service  on  October  28th,  1865.  Pension  Examiner  .1.  H.  Gallagher  reports,  February  14th, 
1866,  that  “walking  and  exercise  cause  lancinating  pains  in  the  chest,  and  dy.spnoea.  There  is  constant  dull  heavy  pain  in  the 
left  side,  at  the  point  of  lodgment  of  the  ball.  In  dull  and  changeable  weather  he  is  weak  and  depressed;  countenance 
distressed.”  No  further  report  to  March,  1872,  when  the  Captain  was  still  an  invalid. 

Case. — Priviite  John  Fonts,  Co.  D,  5th  Ohio  Volunteers,  aged  17  years,  was  wounded  at  Dallas,  Georgia,  May  27th, 

1864,  by  a musket  ball,  which  entered  the  posterior  part  of  the  thorax,  two  inches  to  the  left  of  the  spine,  and" on  a levml  with 
the  nipple,  penetrated,  and  lodged  within  the  chest.  Jle  was  treated  in  the  field  hospital  of  the  2d  division.  Twentieth  Corps, 
and  on  .Tune  4th,  sent  to  No.  1 Hospital,  Nashville.  On  June  7th,  he  was  transferred  to  Totten  Hospital,  Louisville,  and  on 
June  24th,  to  Camp  Dennison  Hospital,  Ohio,  whence  he  was  transferi-ed  to  the  VetcT’an  Reserve  Corps  on  November  29th,  1864. 
Di.scharged  from  service  on  .July  26th,  1865.  Pension  Examiner  Adams  Jewett  states  that  he  examined  Fonts,  August  26th, 

1865,  and  “noticed  nothing  abnormal  on  c.areful  auscultation  and  percussion.  Respiration  24.  Pulse  93,  and  regular.  Complained 
of  occasional  attacks  of  dyspnoea.” 


Case. — Private  John  Howard,  Co.  I,  148th  Pennsylvania  Volunteers,  aged  35  years,  was  wounded  at  Gettysburg,  July 
2d,  1863;  the  missile  struck  the  left  hand  near  the  palmar  end  of  the  third  finger  and  passed  out  near  the  palmar  end  of  the 
thumb;  it  then  entered  the  chest  two  inches  above  the  left  nipple,  pas.sed  through  and  lodged  near  the  inferior  angle  of  the  left 
scapula.  He  was  conveyed  to  the  field  hospital  of  the  Second  Corps,  where  he  remained  until  the  15th,  when  he  was  transferred 
to  McKim’s  Mansion  Hospital,  llaltimore.  Cold-water  dressings  and  poultices  were  applied  to  the  wounds.  On  Jidy  22d,  the 
missile  was  extracted  by  Surgeon  L.  Quick,  U.  S.  V.  August  13th,  wound  of  hand  doing  well;  that 
of  chest  healed  externally.  He  was  transferred  to  Cuyler  Hospital,  Germantown,  Pennsylvania, 
October  2d;  to  Camden  Street  Hospital,  Baltimore,  November  2d,  and  to  the  Veteran  Reserve 
Corjis,  November  12th,  1833,  with  which  corps  he  served  until  discharged  from  service  on  August 
14th,  1865.  The  missile,  an  elongated  smooth-bore  ball,  notched  at  the  apex  and  compressed  at  the 
base,  was  forwarded  to  the  Army  Medical  Museum,  with  a history  of  the  case  by  the  operator, 
and  is  represented  in  the  adjoining  wmod-cut  (FiG.  214).  Pension  E.xaminer  William  .1.  McKnight 
reports,  September  5th,  1865,  “the  fingers  are  all  cro(dved  and  deformed  permanently,  and  the  spine 
inuscle  injured ; a b.ad  case.  Disability  total.”  In  March,  1872,  the  pensioner’s  name  was  on  the 
rolls,  his  condition  reported  as  little  changed  in  the  eight  years  succeeding  his  injuries. 

§ Fatal  Cases. — The  following  abstracts  relate  to  fatal  penetrations  of  the  lung  through 
intercostal  spaces.  In  these  it  is  to  be  regretted  that  the  post-mortem  appearances  are  not 
fully  described: 


Fig.  214. — Ball  extracted 
from  soft  parts  near  lower 
.angle  of  left  scapula.  Spec. 
1519,  Sect.  I,  A.  M.  M. 


0_.VSE.— Private  John  Vexter,  Co.  D,  98th  Pennsylvania  Volunteers,  aged  40  yeais,  was  wounded  before  Petersburg, 
Vii’trini.a,  June  7th,  1864,  by  a conoidal  ball,  which  passed  directly  across  the  neck.  He  also  received  a gunshot  fracture  of  the 
lower  jaw,  and  a penetrating  wound  of  the  chest.  He  was  taken  to  the  hospital  of  the  2d  division.  Sixth  Coi-ps,  and,  on  .June 
10th,  was  sent  to  Emory  Hosiiital,  Washington.  The  wounds  were  cleaned  and  iced-water  dressings  applied,  with  stimulants, 
expectorants,  anodynes,  and  nourishing  diet  internally.  When  admitted,  the  patient  was  much  exhausted  from  loss  of  blood 
and  exposure;  respiration  dilBcult ; pulse  83,  and  irritable  cough  and  orthopnoea.  By  June  11th,  the  patient  hreathcd  easier 
and  was  able  to  lie  down.  The  swelling  was  subsiding,  and  the  wounds  discharging  slightly.  He  was  unable  to  swallow  any- 
thing except  liquids.  On  June  13th,  the  breathing  became  more  difficult,  and,  on  the  14th,  the  wound  of  the  chest  commenced 
discharging  slightly,  blood  and  air  passing  from  the  orifice.  Death  resulted  on  June  15th,  1864. 

Case. — Private  Frederick  Livinhagen,  Co.  B,  95th  New  York  Volunteers,  aged  25  years,  was  wounded  at  Petersburg, 
Virginia,  April  1st,  1865,  by  a conoidal  ball,  which  entered  the  left  side  and  penetrated  the  lower  lobe  of  the  left  lung  anteriorly 
through  the  fourth  intercostal  space.  He  was  treated  in  the  field,  at  the  hospital  of  the  3d  division.  Fifth  Corps,  in  charge  of 
Surgeon  A.  S.  Coe,  147th  New  York  Volunteers.  There  was  hmmoptysis  anil  some  difficulty  of  respiration;  but  it  was  not 
urgent.  The  wound  was  left  open  for  the  escape  of  secretions.  Afterwards  there  was  considerahle  ))neumonic  inflammation. 
Demulcents,  slight  anodynes,  and  low  diet,  with  absolute  rest,  constituted  the  treatment.  His  condition  improving  somewhat, 
and  the  hospital  being  overcrowded,  the  patient  was  placed  on  a hospital  steamer,  and,  on  April  10th,  was  sent  to  Armory  Square 
Hospital,  Washington.  Pymmia  supervened,  and  death  resulted  on  April  17th,  1835. 


Sect.  II.] 


PENETKATING  SHOT  WOUNDS  WITHOUT  FRACTURE. 


481 


Case.— Sergeant  Daniel  O'Shea,  Co.  K,  28th  Massachusetts  Volunteers,  aged  29  years,  strong  and  plethoric,  received  a 
jienetrating  wound  of  the  thorax,  by  a musket  ball  through  the  third  intercostal  space,  at  Deep  Bottom,  Virginia,  on  July  27th, 
1834.  He  had  htemoptysis,  hurried  respiration,  anxiety  of  countenance,  and  sharp  pain  at  the  seat  of  injury.  Simple  dressings 
were  d^plied  at  the  field  hosi>ita]  of  the  1st  division  of  the  Second  Corps,  and  cool  drinks,  with  a little. morphia  to  quiet  the 
harassing  cough,  were  prescribed.  It  was  necessary  to  remove  him  by  rail  to  City  Point,  whence  he  was  sent  to  Wasliiugton 
hv  hosintal  steamer,  and  admitted  to  Lincoln  Hospital  on  July  30th,  1864.  Tonics,  stimulants,  expectorants,  and  arterial 
sedatives  were  administered  ; dry  and  wet  cups  and  blisters  were  applied,  and  a nourishing  diet  was  allowed.  The  patient  died 
on  the  afternoon  of  August  11th,  1864,  of  pneumonia.  At  the  autopsy,  sixteen  hours  subse- 
quently, a penetrating  wound  of  the  anterior  surface  of  the  upper  lobe  of  the  right  lung  was 
found ; the  heart  weighed  fifteen  ounces  and  a half,  and  the  cada  ver  was  in  such  an  advanced 
stage  of  decomposition  that  the  dissection  was  not  prosecuted  farther.  Acting  Assistant 
Surgeon  H.  M.  Dean  reports  the  case. 

Case.— Private  B.  A , Co.  D,  151st  Pennsylvania  Volunteers,  aged  19  years, 

was  wounded  at  Gettysburg,  July  2d,  1863.  A ball  passed  through  the  left  wrist  and 
another  through  the  upper  part  of  the  left  lung.  He  was  admitted  to  the  field  hospital 
at  Gettysburg,  and,  on  July  9th,  transferred  to  McKim’s  Hospital,  Baltimore.  He  was 
placed  on  full  diet,  with  ale  and  ten  drops  of  tincture  of  sesquichloride  of  iron  thrice  daily. 

The  wound  of  the  wrjst  becoming  unhealthj’  in  character,  necessitated  amputation  of  the 
forearm  of  the  middle  third.  On  August  31st,  the  patient  was  taken  with  pyaemic  symptoms, 
and  was  ordered  cinchona,  with  beef  tea  and  milk-punch.  On  September  1st,  the  general 
condition  was  much  worse,  and  the  exhalations  from  the  lungs  and  skin  were  very 
offensive.  The  stomach  was  irritable,  and  vomiting  was  not  arrested  by  the  administra- 
tion of  morphia  in  small  doses,  lime-water,  etc.  The  patient  continued  to  sink,  and  death 
occurred  on  September  6th,  1863.  The  perforated  portion  of  the  lung  was  contributed  to 
the  Army  Medical  Museum,  with  this  history,  by  Medical  Cadet  W.  H.  Bradley.  (See 
Fig.  215.) 


Fig.  215. — Portion  of  the  left  lung 
perforated  by  a bullet.  Spec.  1798,  Sect. 
I,  A.  M.  M. 


Collapse  of  the  Lung. — The  two  following  examples  of  collapse  of  the  lung  after  gun- 
shot perforation,  presented  the  usual  phenomena  of  extreme  dyspnoea,  feeble  pulse,  pallor  of 
countenance,  clammy  skin,  inability  to  lie  on  the  sound  side,  absence  of  respiratory  murmur 
and  alteration  of  the  percussion  sounds  on  the  wounded  side: 


Case. — Private  Joseph  Barnham,  Co.  A,  125th  New  York  Volunteers,  was  admitted  to  McKim’s  Mansion  Hosjiital, 
Baltimore,  July  9th,  1833,  with  a gunshot  penetrating  wound  of  the  chest,  received  at  Gettysburg  on  the  3d.  The  ball  entered 
the  cavity  of  the  thorax  on  the  right  side  between  the  third  and  fourth  ribs,  about  three  inches  from  the  median  line.  When 
admitted  he  was  in  a state  of  delirium.  He  suff'ered  with  dyspnoea  and  severe  pain  in  the  chest, 
unattended  by  cough  or  haemoptysis.  Being  unable  to  partake  of  nourishment,  he  sank  rapidly, 
and  died  on  July  12th,  1833.  At  the  necropsy  the  cavity  of  the  thorax,  right  side,  contained  about 
four  quarts  of  sero-purulent  fluid.  The  right  liing  was  closely  compressed  against  the  vertebral 
column  and  completely  solidified.  The  middle  lobe  was  perforated  by  the  ball,  which  was  found 
lying  loose  in  the  lower  part  of  the  thorax  within  the  pleura.  The  costal  and  pulmonary  pleura 
showed  evident  marks  of  inflammation.  The  missile,  a couoidal  ball,  with  one  side  of  the  body 
obliquely  flattened  and  grooved,  was  forwarded,  with  a history  of  the  case,  by  Surgeon  Lavington 
Quick,  U.  S.  V.  (See  Fig.  216.) 

Case. — Private  Henry  J.  Ricker,  Co.  H,  10th  Maine  Volunteers,  was  wounded  at  Cedar  Jlountain, 
Virginia,  August  9th,  1832,  by  a round  ball,  which  entered  two  inches  below  the  right  acromion,  passed 
between  the  second  and  third  ribs,  through  the  base  of  the  right  lung  without  injuring  the  large  vessels, 
and  lodged  against  the  body  of  the  vertebra  just  above  the  diaphragm.  On  the  12th,  he  was  admitted  to 
Fairfax  Street  Hospital.  On  admission,  there  was  severe  dyspncea.  Death  resulted  on  August  17th,  1862. 
The  necropsy  revealed  the  course  of  the  ball ; the  right  lung  was  found  to  be  completely  collapsed  and  the 
pleural  sac  contained  one  hundred  and  twenty  ounces  of  bloody  fluid.  The  missile,  represented  in  the  wood- 
cut  (Fig.  217),  with  a history  of  the  case,  was  forwarded  by  Acting  Assistant  Surgeon  James  Robertson. 


Fig.  217. — Slightly 
contused  rifle  ball. 
Spec.  4403,  Sect.  I, 
A.  M.  M. 


Fig.  216. — Conoidal  mus- 
ket-ball flattened  by  impact 
on  bone.  Spec.  2G43,  Sect. 
I,  A.  M.  M. 


Injudicious  Probing. — The  next  case  illustrates  the  hazard  attending  too  diligent  explo- 
rations of  the  wound  of  the  lung,  a danger  famili’ar  to  the  practical  surgeon,  but  often  disre- 
garded by  the  inexperienced.  Mr.  Poland*  justly  denounces  such  manipulative  examina- 
tions as  “perfectly  unwarrantable,  being  attended  with  highly  dangerous  results,  by  dis- 
turbing nature’s  efforts  to  effect  a repair,  disarranging  the  clot,  and  exciting  irritation  and 
inflammation;  a proceeding,  only  tending  to  gratify  curiosity,  without  the  slightest  benefit 
to  the  patient.” 


On  Injuries  of  the  Chest,  in  Holmes’s  System,  trp.  cit.  Vol.  II,  p.  579. 

G1 


482 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Case. — Private  Albert  M.  Carley,  Co.  H,  llltb  New  York  Volunteers,  aged  18  years,  was  wounded  ae  Petersburg, 
at  the  general  assault,  Ajiril  2d,  18C5,  by  a conoidal  ball,  ^vbicb  entered  the  left  side  near  the  spine,  between  the  eighth  and 
ninth  ribs,  penetrated  the  thorax,  and  lodged.  lie  was  taken  from  the  field  and  sent  by  rail,  with  over  two  hundred  other 
wounded  of  the  corps,  to  City  Point,  to  the  field  hospital  of  the  Second  Corps,  under  AAing  Staff  Surgeon  John  Aiken,  U.  S.  V. 
lie  had  rallied  from  the  shock  of  the  injury,  but  was  de])ressed  by  haemorrhage,  and  had  labored  breathing  and  ha,‘mo]etysis. 
Simple  dressings  were  applied,  and  the  patient  was  jilaced  on  an  hospital  steamer,  and  on  April  hth  was  admitted  to  Armory 
Square  Hospital,  Washington.  He  died  on  April  Gth,  18G5,  while  the  wound  was  being  examined. 

Casp:. — Private  Leonidas  Miller,  Co.  A,  26th  Iowa  Volunteer.s,  was  wounded  at  the  battle  of  Big  Shanty,  Georgia,  June 
IGth,  18G4,  the  missile  passing  through  the  upper  portion  of  the  middle  lobe  of  right  lung,  entering  between  the  fourth  and 
fifth  ribs  anteriorly,  and  lodging  in  the  jdeural  cavity.  He  was  admitted  on  the  same  day  into  the  field  hospital  of  the  1st 
division,  Fifteenth  Corps,  in  charge  of  Surgeon  M.  W.  Robbins,  4th  Iowa  Infantry.  There  was  profuse  haemorrhage,  with 
greatly  oppressed  breathing,  inability  to  lie  in  a recumbent  posture,  or  on  the  sound  side,  with  feeble  pulse.  The  bleeding  was 
arrested  by  cold  applications  to  the  chest,  and  opiates  were  given.  In  spite  t)f  supjwrting  treatment  he  failed  gradually,  and  was 
transferred  to  the  general  hospital.  Fifteenth  Corps,  at  Barton's  Iron  Works,  Georgia,  on  June  29th.  On  admission,  the  patient 
was  much  emaciated  and  had  a large  bed-sore  in  the  sacral  region  ; his  countenance  was  pale  and  expressed  great  anxiety  ; 
breathing  was  difficult  and  attended  with  excruciating  pain;  pulse  120;  the  wound  presented  externally  the  usual  healthy 
appearance.  Stimulants  and  anodynes  were  administered,  simple  dressings  a])plied  to  the  wound,  and  a generous  diet  ordered. 
The  patient  died  on  July  3d,  1864.  The  case  is  reported  by  Surgeon  J.  C.  Hilburn,  97th  Indiana  Volunteers. 

Case. — Private  Francis  Smith,  Co.  K,  46th  Ohio  Volunteers,  was  wounded  at  the  battle  of  Kenesaw  Mountain,  June 
27th,  1864,  by  a conoidal  ball,  which  entered  the  left  chest,  penetrated  the  fourth  intercostal  space  near  the  nipple,  passed 
through  the  lung,  and  made  its  exit  between  the  sixth  and  seventh  ribs,  close  to  the  spinal  column.  He  was  received  into  the 
field  hospital,  Fifteenth  Corps,  at  Barton’s  Iron  Works,  Georgia,  on  J une  30th.  On  admission,  the  patient  was  suffering  severely. 
His  wound  was  dressed  and  an  opiate  given,  after  wdiich  he  rested  well  for  the  remainder  of  the  day.  The  same  treatment  was 
followed  from  day  to  day,  giving  him  enough  opium  to  control  the  pain,  but  he  continued  to  sink  gradually,  and  died  on  July 
14th,  1864.  Acting  Assistant  Surgeon  R.  H.  McKay,  who  reports  the  case,  says : “ In  this  case  the  patient  did  not  seem  to 
rally  at  any  one  time,  and  for  a great  portion  of  the  time,  during  the  last  week,  he  was  deliiious.” 

Case. — Private  Jesus  Garcia,  Troop  F,  1st  New  Mexico  Cavalry,  in  attempting  to  escape,  after  being  a})prehended  as  a 
deserter  at  Cubero,  New  Mexico,  on  October  10th,  1865,  was  wounded  by  a conoidal  ball  from  a Remington  pistol,  which  entered 
the  right  breast,  one  inch  below  and  somewhat  to  the  left  of  the  nipple,  passed  directly  through,  and  emerged  at  the  inferior 
angle  of  the  scapula.  Another  ball  passed  through  the  soft  part  of  the  outer  portion  of  the  left  thigh.  He  was  admitted  to 
hospital  at  Fort  Wingate.  The  symj)toms  were  excessive  dyspnoea  and  high  fever.  The  treatment  pursued  was  strictly  anti- 
phlogistic, and  the  patient  was  kept  recumbent,  with  the  shoulders  slightly  elevated.  He  died  on  October  13th,  1865.  The  ball 
had  passed  through  the  middle  lobe  of  the  right  lung,  making  its  exit  through  the  seventh  intercostal  space.  The  case  is  reported 
by  Acting  Assistant  Surgeon  R.  H.  Longwill. 

Grunshot  Fractures  of  the  Clavicle. — This  form  of  injury  was  usually  complicated  by 
wounds  of  the  lung,  or  by  fractures  of  the  ribs  or  scapula,  or  by  injuries  of  arteries  or 
nerves,  and  the  complications  were  frequently  the  most  important  elements  of  the  case. 
A nearly  uncomplicated  case  of  gunshot  fracture  of  the  clavicle,  with  recovery,  is  detailed 
on  page  474.  All  of  the  varieties  of  fracture  observed  in  long  bones  are  met  with  in  the 
clavicle.  The  following  is  an  interesting  example  of  transverse  fracture : 

Case. — Sergeant  Samuel  A , Co.  F,  125th  Pennsylvania  Volunteers,  aged  40  years,  was  wounded  at  Chancellors- 

ville,  Virginia,  on  May  3d,  1863,  and  was  admitted  to  Carver  Hospital,  Washington,  on  the  9th.  A bullet  wound  was 
found  on  the  right  side  of  the  back,  near  the  spine,  and  in  the  neighborhood  of  the  third  dorsal  vertebra.  There  was  a fi’acture 
of  the  clavicle  on  the  same  side,  with  considerable  swelling,  and  some  deformity  of  the  shoulder.  The  patient  had  frequent 
cough  and  bloody  expectoration.  The  fracture  of  the  clavicle  was  treated  by  a pad  in  the  armpit  and  a sling,  and  the 
wound  in  the  back  was  dressed  with  wet  lint  covered  with  oiled  silk.  Small  doses  of  morphia  were  given,  with  the 
effect  of  diminishing  very  much  the  frequency  of  the  cough.  The  patient  was  feeble,  and  the  discharge  fi’om  the  wound 
considerable,  but  no  very  serious  symptoms  })resented  themselves  until  the  16th,  when  the  patient  was  seized  with  considerable 
oppression  of  breathing,  and  with  pain  on  the  wounded  side.  Dulness  over  the  upper  side  of  the  right  lung  was  observed  on 
percussion.  A discharge  of  blood  and  sei'um  from  the  wound  seemed  to  relieve  the  pneumonic  symptoms  in  a few  hours  after 
their  first  occurrence.  The  breathing  became  easier,  and  pain  was  no  longer  complained  of.  Bleeding  from  the  wound  ceased 

on  the  17th,  but  a cojiious  discharge  of  serous  j)us  remained,  and  the  patient  became 
gi-adually  weaker,  notwithstanding  the  free  use  of  stimulants  and  of  as  much 
nourishment  as  could  be  administered.  His  sinking  was  slow  but  constant,  and  he 
died  on  the  afternoon  of  May  20th.  At  the  autopsy,  the  bullet  was  found  just 
below  the  clavicle,  near  its  middle,  having  fractured  the  bone  transversely  after 
passing  between  the  third  and  fourth  ribs,  and  fracturing  the  neck  of  the  third 
near  its  angle.  The  specimen  figured  in  the  adjoining  cut  (FiG.  218),  was  presented 
to  the  Army  Medical  Museum,  with  the  above  account,  by  Acting  Assistant  Surgeon 
B.  F.  Craig.  [A  better  view  is  given  in  the  Second  Volume,  p.  475.] 


Fig,  218. — Transverse  fracture  of  the  right  cla- 
vicle, with  a conoidal  bullet  attached.  Spec.  1210, 
Sect.  I,  A.  51.  M.  (Vertical  view.  Reduced  to 
one-third.) 


Sect.  II.] 


SHOT  FEACTUKES  OF  THE  CLAVICLE. 


483 


Case. — Private  Andrew  G , Co.  I,  Tjtli  Michigan  Volunteers,  aged  21  years,  wtis  wounded  at  I'h'edericksburg, 

December  13tli,  18C2,  by  a missile,  which  fractured  the  clavicle,  pas.scd  through  the  a]>ex  of  the  right  lung,  and  emerged  near 
the  eighth  dorsal  vertebra.  He  was  admitted  to  Ilarewood  Hospital,  Washington,  on  December  17th,  sufl'ering  from  traumatic 
pneumonia,  the  more  formidable  symptoms  of  which  appeared  to  be  relieved  after  venesection,  and  the  administration  of  tartar- 
emetic  and  morphia.  On  January  1st,  irritative  fever,  chills,  profuse  sweating,  and  vomiting  set  in,  attended  with  haemorrhage 
and  foetid  suppuration  from  the  wound  to  the  amount  of  four  ounces.  A compress  and  bandages  were  apjtlied ; stimulants  and 
tonics  administered.  This  hectic  condition  continued,  with  brief  periods  of  amendment,  till  January  7th,  1863,  when  death 
occurred.  The  case  is  reported  by  Surgeon  Thomas  Antisell,  U.  S.  V. 

In  the  following  case  of  gunshot  fracture  of  the  clavicle,  there  appears  to  have  been 
little,  if  any,  direct  lesion  of  the  lung.  Hospital  gangrene,  which  was  the  scourge  of  the 
Hashville  hospitals  at  the  time,  gave  the  coup-de-grace,  as  it  were,  at  the  end  of  sixteen 
weeks  : 

Case. — Sergeant  Lemuel  A.  J.  B , Co.  I,  27th  Mississippi  Eegiment,  aged  22  years,  was  admitted  to  hospital  at 

Nashville,  on  January  27th,  1864,  fi-om  another  hos]ntal,  for  a gunshot  fracture  of  the  clavicle,  which  was  thought  to  be  united. 
The  wounds  of  entry  and  exit  being  nearly  healed,  and  the  patient 
doing  well,  nothing  more  than  simj)le  dressings  were  required.  On 
February  11th,  the  patient  had  a severe  chill,  followed  by  fever, 
cough,  and  pain  in  the  chest,  for  which  quinine  and  whiskey  were 
prescribed.  On  the  13th,  pneumonic  symptoms  setting  in,  treatment 
was  directed  to  their  relief.  On  the  15th,  the  wound  became  re- 
inflamed and  gangrenous.  On  the  day  following,  the  patient  being 
very  restless  and  suffering  much  from  his  wound,  ether  and  chloro- 
form were  administered,  and  bromine  in  full  strength  applied.  He 
rallied  slowly,  reaction  being  rather  imperfect.  Becoming  more 
exhausted  and  restless,  he  died  on  the  afternoon  of  the  17th.  The 
specimen  was  contributed  to  the  Army  Medical  Museum,  with  the 
history,  by  Acting  Assistant  Surgeon  E.  T.  Higgins,  and  is  figured 
in  the  adjoining  cut  (FiG.  219).  [This  patient  was,  probably,  6horteDiD|,  posterior  displacement,  and  necrosis,  ^pec.  2194,  Sect. 

wounded  at  Mission  Eidge,  November  25th,  1863,  as  he  was  received 

at  Nashville  fi’om  the  hospital  for  prisoners  at  Stevenson,  Alabama,  December  11th,  1863.  A musket  ball  had  entered  at  the 
junction  of  the  outer  with  the  inner  two-thirds  of  the  left  clavicle,  had  passed  downward,  inward,  and  backward,  emerging 
between  the  scapula  and  spine,  probably  injuring  the  pleural  cavity,  though  the  diagnosis  was  not  made  out  positively.  The 
lung  trouble  was  mainly  secondary.] 

Case. — Private  IF.  H.  C , Co.  H,  31st  Georgia  Eegiment,  wounded  at  Fredericksburg,  December  13th,  1862,  was 

admitted  to  Carver  Hospital,  Washington,  and  died  exhausted  on  January  8th,  1863.  A couoidal  musket  ball  had  entered  the 
back  on  the  left  side,  about  three  inches  from  the  point  of  the  acromion  process,  penetrated  the  spine  of  the  scapula  just  below 
the  crest,  passed  inward  and  forward,  and  fractured  the  clavicle  at  the  point  where  the  conoid  ligament  is  attached.  From  this 
point,  its  course  was  traced  behind  the  large  blood  vessels  of  the  neck  and 
betvveen  the  oesophagus  and  spinal  column.  Here  an  abscess  was  formed  which 
reached  upward  five  or  six  inches  along  the  spine  and  downward  in  the  medias- 
tinum to  the  bifurcation  of  the  trachea,  where  the  ball  was  found  point  downwai-d 
and  resting  against  the  right  bronchial  tube.  An  opening  was  found  commu- 
nicating with  the  abscess  and  the  right  pleural  cavity.  The  track  of  the  ball 
. and  the  large  abscess  were  filled  witli  pus,  and  clots  of  blood  undergoing  puti-e- 
faction.  Portions  of  the  left  scapula  and  clavicle  were  contributed  to  the  Army 
Medical  Museum,  with  the  above  account,  by  Surgeon  O.  A.  Judson,  U.  S.  V. 

The  specimen  is  partly  represented  in  the  adjoining  cut  (Fig.  220). 

Case. — Private  Edward  Osborn,  Co.  H,  9th  PennsyU’ania  Eeserves,  aged  24  years,  was  wounded  at  South  Mountain, 
JIaryland,  September  14th,  1862,  by  a conoidal  ball,  which  entered  the  right  side  between  the  clavicle  and  first  rib,  passed 
through  the  upper  portion  of  the  lung,  and  emerged  at  the  lower  border  of  the  scapula.  He  was  taken  to  a farm-house  and 
thence  to  Middletown,  where  he  remained  until  October  1st,  when  he  was  sent  to  Hospital  No.  3,  Frederick.  On  January  24th, 
1833,  he  was  transferred  to  Hospital  No.  1.  When  admitted,  he  had  a severe  cough ; pulse  88,  but  weak.  Patient  very  much 
emaciated  and  tongue  furred.  Stimulants,  tonics,  and  expectoralits  were  administered.  January  28th : Abscess  formed  on  posterior 
aspect  of  right  arm,  which  was  opened,  evacuating  about  three  ounces  of  pus.  January  30th  : During  attempts  to  cough,  pus 
escapes  freely  from  the  wound.  Expectoration  copious  but  diminishing,  and  sometimes  streaked  with  blood.  February 
5th  : Slowly  improvnig.  When  coughing,  air  passes  through  the  anterior  wound,  and  pus  through  the  posterior  one  ; discharge 
profuse  but  healthy.  Cough  worse  when  lying  down  and  at  night.  February  10th  : Expectoration  diminished;  air  has  cea.sed 
to  j)ass  through  the  wound.  He  continued  to  imi)rove,  and,  by  February  15th,  was  able  to  move  about  the  ward.  Wound  look- 
ing healthy  and  suppurating  freely.  On  March  30th,  a i)iece  of  bone  about  the  size  of  a h;izel-nut  came  away  from  the  clavicle, 
which  had  been  splintered  by  the  ball.  April  18th  : Eight  lung  almost  consolidated,  and  sinking  away  of  chest  very  noticeable. 
He  was  transfen-ed  to  Baltimore,  and  finally  discharged  fi'om  service  on  November  12tli,  1863.  Pension  Examiner  E.  McCook 


Fig.  220. — Conoidal  musket-ball,  with  a portion  of 
the  left  scapula,  which  it  has  pertbrated.  Spec.  n3(). 
Sect.  I,  A.  M.  M. 


Fig.  219. — Left  clavicle,  showing  a partially  united  fracture  with 


484 


WOUNDS  AND  INJUEIES  OF  THE  CHEST, 


[Chap.  V, 


reports,  November  18th,  1863,  “ arm  useless,  fingers  partially  paralyzed.  Air  still  passes  out  of  the  posterior  opening  fi’om  the 
lung.”  The  Pittsburgh  Examining  Board  reports,  October  4th,  1871 : “ Gunshot  wound  of  clavicle  and  lung,  in  consequence  of 
which  his  arm  and  hand  are  almost  useless,  his  body  emaciated  and  feeble.  Disability  total  and  permanent;  no  evidence  of 
vicious  habits.”  He  was  last  paid  on  March  4th,  1872. 


A case  of  fracture  of  tlie  clavicle  associated  with  fractures  of  the  transverse  processes 
of  the  cervical  vertebra  is  related  at  the  foot  of  page  431. 

The  Army  Medical  Museum  contains  twenty-one  specimens  of  gunshot  fractures  of 
the  clavicle.  Besides  those  noted  in  the  text,  consult,  for  appearances  in  recent  fractures 
of  sternal  and  middle  portions,  Specs.  1644  and  2984,  and  of  outer  third.  Spec.  3460, 
Sect.  I ; for  necrosis,  Spec.  2193;  for  oblique  fracture,  with  attempt  at  union.  Specs.  309, 
3737  ; for  longitudinal  fracture,  Spec.  137. 


G-unshot  Fractures  of  the  Scapula— Several  illustrations  of  this  injury  have  been 
cited  among  the  non-penetrating  shot  wounds  of  the  chest  (p.  475).  But  the  scapula 

is  more  frequently  injured  in  penetrating  wounds  of  the 
thorax,  and  especially  in  antero-posterior  perforations.  A 
good  example  of  the  latter  injury  is  shown  by  the  wood-cut 
(Fig.  221) : 

Case-shot,  passing  from  before  backward  through  the  right  chest,  have  shat- 
tered the  upper  part  of  the  right  scapula.  There  are  two  perfoiations  of  the  lower 
])late,  near  its  middle,  connected  by  a fissure.  The  supra-spinous  fossa  has  been 
chiefly  carried  away.  The  thin  splintered  laminas  of  the  body  of  the  bone  are  forced 
outward  about  the  perforations.  The  specimen  was  contribut(‘d  by  Surgeon  Jerome 
B.  Green,  1st  Rhode  Island  Volunteers.  It  was  brought  fiom  the  First  Bull  Run 
battle-field. 

Starred  fractures  of  the  body  of  the  shoulder-blade  were 
produced  by  balls  entering  perpendicularly  from  without  or, 
in  about  equal  proportion,  by  those  emerging  from  the  chest 
or  axillary  fossa.  Projectiles  impinging  laterally  or  obliquely, 
caused  longitudinal  or  grooved  fractures,  with  fissures  limited  usually  by  the  spine  or  thick 
border.  Forms  of  fracture  of  the  neck,  processes,  and  spine,  seldom  or  never  occurring 
from  other  external  violence,  are  not  infrequent  after  gunshot.  Thus  perforations  of  the 
spine,  fracture  of  the  coracoid,  and  of  the  neck  close  behind  the  glenoid  cavity,  are  not 
rare.  Secondary  hsemorrhages  from  the  trunk  or  minor  divisions  of  the  transversalis  colli, 
suprascapular,  posterior  cervical,  princeps  cervicis,  and  subscapular  \vere  sometimes  very 
troublesome,  the  inosculations  of  these  branches  of  the  carotid,  subclavian,  and  axillary 
perplexing  the  operator,  and  occasionally  leading  him  in  desperation  to  tie  a vessel  of  the 
first  order.  Lodgment  of  foreign  bodies  beneath  the  scapula,  and  accumulations  of  blood 
and  pus  were  more  frequent  and  fatal  complications  in  those  cases,  and  it  is  feared  that 
lives  were  lost,  perhaps,  from  lack  of  boldness  in  their  removal  or  evacuation. 


Fig.  2S21. — Gunsliot  perforation  of  the  right 
scapula.  Spec.  851,  Sect.  I,  A.  M.  M. 


Case. — Private  John  F.  Scites,  Co.  H,  5th  West  Virginia  Volunteers,  aged  21  years,  was  wounded  at  Winchester, 
Virginia,  July  24th,  1864.  The  missile  fractured  the  first  and  second  ribs,  left  side,  passed  backward,  and  slightly  downward 
and  inward,  fractured  the  third  rib  about  one  inch  external  to  the  tubercle,  and  passed  through  the  scapula  at  its  inner  border, 
near  the  middle.  He  was  taken  prisoner  and  retained  until  September  26th,  when  he  was  sent  to  St.  John’s  College  Hospital, 
Annapolis.  He  was  transferred,  on  October  6th,  to  Camp  Parole,  whence  he  was  discharged  from  service  on  October  7th,  1864. 
Pension  Examiner  William  Owens  reports.  May  15th,  1866,  “ there  is  an  aneurism  of  the  left  subclavian  artery  through  the  space 
left  by  the  loss  of  portions  of  the  first  and  second  ribs.  The  left  arm  and  shoulder  are  quite  weak.”  Examining  Surgeon  Jona- 
than Morris,  Ironton,  Ohio,  reports,  March  1,  1867,  that  “ujiper  portion  of  the  left  lung  is  injured;  the  ball  passed  through  left 
lung  and  left  scapula;  shoulder  weak,  and  forward  motion  of  arm  painful.  Disability  one-half;  duration  one  year.” 

Case. — Private  IF.  Oylesly,  Co.  H,  38th  Georgia  Regiment,  aged  35  years,  having  been  wounded  at  Fredericksburg, 
December  13th,  was  sent  to  Richmond,  and  admitted  into  Chimborazo  (Confederate)  Hospital  on  December  15th,  1862.  A 
missile  had  entered  the  right  breast  between  the  first  and  second  libs,  passing  entirely  through  the  lung  and  lower  portion  of  the 


Sect.  II.] 


SHOT  FRACTURES  OF  THE  SCAPULA. 


485 


Fig.  222. — Gunshot  fracture  of  the  right 
scapula.  Spec.  286,  Sect.  I,  A.  M.  M. 


scapula.  When  admitted,  the  prognosis  was  unfavorable,  the  patient  having  lost  a considerable  amount  of  blood  from  the  lungs, 
and  bein<T  much  prostrated.  He  rallied  under  treatment,  which  consisted  of  fi-ee  bleeding  from  the  arm  and  the  antiphlogi.stic 
regimen  generally,  followed  by  liberal  doses  of  tincture  of  iron.  The  wound  assuming  a 
liealthy  appearance,  soon  healed,  and,  on  December  28th,  the  patient  was  almost  entirely 
recovered.  He  was  furloughed. 

The  next  case  is  from  a prisoner  wounded  at  Fort  Donel- 
son,  February  15th,  1862.  He  was  23  years  of  age,  and  tem- 
perate. A musket  hall  entered  below  the  right  clavicle  and 
passing  inward  and  backward  injured  the  upper  lobe  of  the  lung 
and  fractured  the  scapula  (Fig.  222) : 

The  patient  survived  the  injury  until  after  August  21st,  1862,  when  he  was  sent  to 
the  prison  hospital  at  Alton,  Illinois.  In  the  specimen,  a transverse  fracture  extends  across 
the  dorsum,  parallel  with  the  spine.  From  this  a vertical  fracture  separates  the  superior 
anterior  fourth  from  the  remainder  of  the  bone.  A longitudinal  fi-acture  occupies  the 
anterior  border  for  one  inch  below  the  chief  injury,  and  a fissure  of  similar  length  extends 
parallel  to  the  posterior  border.  There  are  traces  of  periosteal  disturbance.  The  specimen 
was  contributed  to  the  Anny  Medical  Museum  by  Surgeon  J.  T.  Hogden,  U.  S.  V. 

Case. — Private  G.  W , Co.  E,  93th  New  York  Volunteers,  aged  24  years,  was  admitted  to  hospital  at  Philadelphia 

from  "Winchester,  Virginia,  on  October  26th,  1864,  for  a gunshot  fracture  of  the  left  scapula,  received  at  the  battle  near  Cedar 
Creek  on  October  19th.  A conoidal  musket  ball  had  entered  the  left  shoulder,  just  beneath  the  acromion  process  of  the  left 
scapula,  passed  transversely  downward  beneath  the  scapula,  and  imbedded  itself  just  beneath  its  spine.  The  wound  was  quite 
unhealthy,  the  shoulder  being  enormously  swollen  and  discolored,  with  a large  amount  of 
pus  concealed  beneath  the  scapula.  The  patient’s  breathing  was  oppressed;  there  was 
dullness  on  percussion,  with  absence  of  the  vesicular  murmur  over  the  upper  portion  of  the 
left  lung,  and  the  general  health  was  much  impaired.  The  expectant  plan  of  treatment 
was  pursued.  On  October  27th,  the  patient  was  etherized,  and  the  ball  removed  through 
a counter  opening  beneath  the  inferior  border  of  the  scapula.  Some  eight  or  ten  ounces 
of  very  unhealthy  pus  and  broken  bone  were  evacuated  at  the  same  time.  In  the  after- 
noon a severe  chill  occurred,  followed  by  slight  fever,  profuse,  cold,  clammy  perspiration, 
and  low  muttering  delirium.  Ten  grains  of  bisulphite  of  soda,  in  an  infusion  of  quassia, 
was  directed  to  be  taken  every  hour,  iii  addition  to  tonics  and  stimulants.  Delirium  and 
chills  continued  on  the  28th,  with  an  increase  of  swelling  and  disorganization  of  the  soft 
parts.  On  the  29th,  none  of  these  symptoms  had  abated.  The  patient  sank  rapidly,  and 
died  on  the  morning  of  October  30th,  1864.  Tlie  autopsy  revealed  a bad  fracture  of  the 
scapula,  a disorganized  condition  of  the  subscapular  and  pectoral  muscles,  and  an  opening 
in  the  .apex  of  the  chest.  The  left  lung  was  highly  congested;  the  abdominal  viscera 
healthy.  There  was  congestion  of  the  membranes  of  the  brain,  with  effusion  of  serum  at  its 
base  and  in  the  ventricles.  The  pathological  specimen  was  contributed  to  the  Army  Medical  tiore*  3*^,' 

Museum,  with  the  history,  by  Acting  Assistant  Surgeon  A.  A.  Smith.  (See  Fig.  223.)  Sect.  I,  A.  M.  M. 


Gunshot  fractures  of  the  scapula  were  often  associated 
humerus,  as  in  the  following  case  : 


with  those  of  the  ribs  and 


Case. — Private  Thomas  L , Co.  K,  1st  Massachusetts 

Volunteers,  aged  42  years,  having  been  wounded  at  Fredericks- 
burg, Virgini.a,  on  May  3d,  1863,  was  sent  to  Washington,  and 
admitted  to  Carver  Hospital  on  the  9th.  An  unknown  missile  had 
entered  the  right  shoulder  about  two  inches  below  the  acromion 
process,  and,  passing  backward  and  inward,  had  emerged  above  the 
inferior  angle  of  the  scapula.  The  patient’s  pulse  was  120,  and 
quite  weak,  and  his  skin  was  bathed  in  perspiration.  Percussion 
over  the  right  lung  elicited  considerable  dullness.  The  treatment 
consisted  in  the  frequent  administration  of  anodynes,  stimulants, 
and  tonics,  with  a low  diet.  The  patient  suffered  from  anorexia 
and  insomnia,  and  bloody  serum  was  discharged  through  the  pos- 
terior wound  during  inspiration.  Air  was  also  forced  through  at 
the  same  time.  He  died  on  the  morning  of  the  11th.  The  autopsy  Fig.  224. — Gunshot  fracture  of  the  humerus,  scapula,  and  ribs, 
discovered  a fracture  at  the  surgical  neck  of  the  humerus ; the 

sixth,  seventh,  and  eighth  ribs  were  comminuted,  and  portions  of  bone  were  forced  through  the  pleura,  the  cavity  of  which 
contained  a large  quantity  of  bloody  serum.  The  scapula  was  also  fractured,  and  the  tissues  surrounding  the  wound  were  much 
inflamed.  The  costal  surface  of  the  pleura  was  coated  with  fibrinous  exudations.  The  p.athological  specimen,  consi.sting  of  the 


riglit  sc.apula,  upper  third  of  the  humerus,  and  si^ctions  of  the  fifth,  sevcntli,  .and  eiglith  ribs,  was  contributed  by  Surgeon  O.  A. 
Judson,  U.  S.  V.,  and  is  represented  in  the  wood-cut  (Fig.  224). 


486 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


In  other  instances  the  clavicle,  scapula,  and  ribs  were  shattered  by  the  same  projectile, 

as  in  the  case  of  Private  J.  M.  W , illustrated  by  Spec.  No.  1304  of  the  Museum; 

that  of  Private  W.  A.  P , narrated  on  page  475,  and  in  the  following  case: 

Case. — Private  Edward  L , Co.  A,  87tli  New  York  Volunteers,  was  wounded  at  Bull  Run,  August  27tb,  18C2,  by  a 

conoklal  musket  ball,  which  struck  the  left  clavicle  about  three  inches  from  its  sternal  extremity,  passed  through  the  chest,  and 
emerged  near  the  posterior  border  of  the  left  scapula.  Five  days  subsequently  he  was  admitted  into  the  Cranch  Hospital  at 
Washington,  in  a feeble  condition.  There  was  constipation  and  troublesome  cough  accompanied  by  hasmoptysis.  The  howels 
were  relieved  hy  sulphate  of  magnesia,  and  Uie  cough  was  alleviated  by  ipecac  and  o[)iuin.  An  engorged  condition  of  the  injured 
lung,  with  sanguineous  expectoration  and  dyspnoea,  continued  for  some  twelve  days,  when  the  patient  began  to  grow  better. 
His  general  health  improved,  and,  to  all  appearance,  resolution  was  taking  place  in  the  lung.  Improvement  continued  till 
October  12th,  when  the  patient  took  cold  through  indiscretion,  and  had  a chill.  After  appropriate  treatment  he  had  partially 

recovered  by  October  27th,  when  he  again  exposed  himself  unnecessarily, 
took  a fresh  cold,  and  had  another  chill,  lasting  an  hour  and  a half,  followed 
by  fever  and  pneumonia  of  the  right  lung.  Wet  cups  were  now  applied,  and 
a dose  of  ten  grains  of  calomel  was  administered.  On  October  30th,  the  cups 
were  rejieated,  and  another  expectorant  mixture  was  presciibed.  There  was 
no  reaction,  however,  dyspnoea  continuing  unabated,  and  terminating  in  death 
on  November  3d,  1832.  The  autopsy  showed  the  left  clavicle  fractured  at  the 
junction  of  the  middle  with  the  outer  third,  the  distal  portion  being  driven  in. 
There  was  a formation  of  callus,  but  no  union  of  bone.  The  third,  fourth,  and 
fifth  ribs,  of  the  left  side,  W’cre  fractured  near  their  spinal  articulations,  and 
the  dorsum  of  the  left  scapula  w’as  perforated.  The  af)ex  of  the  left  lung  w’as 
grooved  by  the  passage  of  the  ball  and  appeared  entirely  solidified.  The 
track  of  the  wound  through  the  lung  was  entirely  cicatrized,  and  seemed 
cartilaginous  to  the  touch.  There  were  also  pleuritic  adhesions  in  the  right 
side,  .and  the  right  pleural  cavity  contained  from  tw'o  to  three  pints  of  flidd. 
The  specimen,  rejmesented  in  the  adjoining  w'ood-cut.  Fig.  225,  was  contributed 
to  the  Anny  Medical  kluseum,  with  the  history,  by  Surgeon  A.  Wynkoop, 
U.  S.  V. 

Gunshot  fractures  of  both'  scapulae  by  the  same  ball  are  occasionally  seen.  In  such 
instances  the  projectile,  passing  parallel  to  the  posterior  plane  of  the  thorax,  usually 

fractures  one  or  more  vertebral  spinous  processes,  as  in  the  case  of  Private  J.  T.  L , 

Co.  G,  18th  Massachusetts  Volunteers,  recorded  on  page  435;  see  Spec.  699  of  the 
Surgical  Section  of  the  Army  Medical  Museum.  The  specimen  of  fractured  vertebrae  is- 
No.  843  of  the  same  section.  Cases  of  fractured  scapula  complicated  by  injuries  of  the 

vertebrae  have  been  reported  in  the  last  chapter;  see  cases  of  Corporal  G.  AV.  M , 

p.  438,  Pig.  19(X  The  scapula  is  Spec.  3089,  Sect.  I,  of  the  Museum.  Also,  the  case  of 

Sergeant  J.  H.  R , page  431,  and  that  of  Private  C.  B , Spec.  4092,  Sect.  I. 

The  Museum  possesses  thirty-two  specimens  of  gunshot  fracture  of  the  scapula.  Besides 
those  that  have  been  cited,  or  that  will  be  noted  in  the  section  on  operations,  interesting 
illustrations  of  attempt  at  reparation  in  the  scapula  are  afforded  by  Specs.  2792,  2186, 
1211,  from  patients  who  survived  their  injuries  thirty-three,  sixty-thfee,  and  twenty-two 
days,  respectively.  Specs.  832,  2585,  2124,  and  4862  show  various  forms  of  associated 
fractures  of  the  shoulder-blade  and  ribs. 

Penetrating  Shot  Fractures  of  the  Sternum. — A number  of  examples  of  recovery 
after  this  severe  form  of  injury  were  reported.*  One  of  the  most  interesting  is  that 
represented  in  the  accompanying  chromolithograph  (Plate  X)  of  a soldier  wounded  in  the 
anterior  mediastinum  in  General  Sedgwick’s  movement,  at  the  battle  of  Chancellorsville : f 

Case. — Private  Charles  P.  Betts,  Co.  I,  26th  New  Jersey  Volunteers,  aged  22  years,  was  struck  by  a three-ounce  grape- 
shot,  on  the  morning  of  ]\Iay  3d,  1863,  in  a charge  upon  the  heights  of  Fredericksburg.  Tlie  ball  comminuted  the  sternum,  at 


* For  instances  of  non-penetrating  gunshot  fractures  of  the  sternum,  see  page  474,  ante. 

tThe  drawing  was  made  at  the  Potomac  Creek  Hospital  of  the  2d  division.  Sixth  Corps,  and  so  faithfully  was  the  likeness  of  the  patient  preser\*ed, 
as  well  as  the  features  of  the  wound,  that  Surgeon  S.  A.  Holman,  U.  S V.,  medical  director  of  the  Sixth  Corps,  in  1865,  turning  over  a portfolio  at  the 
Sui'geon  General’s  Office,  and,  observing  this  drawing,  exclaimed : “ I know  that  man  ; that’s  Betts,  2d  division,  Sixth  Corps  ! ” . 


Med. ft  Supo.  Hist,  of  the  War  of' the  Rebellion, PaiH  I.  Vol.II. 


Op.  page  4-8r>. 


£d.StaucK.  prnxt 


T Sinclair  ft  Son,  Cliromo-lHh . 


PI . C lltirlcs  Belts  . ( See  pa2C  'IBS.) 

PLATE  X.  PENETRATION  OF  ANTERIOR  MEDIASTINUM  BY  CANISTER. 


Sect.  II.  ] 


SHOT  PENETEATIONS  OF  THE  STEENUM. 


487 


the  level  of  the  third  rib,  on  the  left  side,  and  tore  through  the  costal  pleura.  It  remained  in  the  wound  and  was  removed  by 
the  patient.  On  the  following  day,  Betts  entered  the  hospital  of  the  2d  division  of  the  Sixth  Corps.  Through  the  wound,-  the 
arch  of  the  aorta  was  distinctly  visible,  and  its  pulsations  could  be  counted.  The  left  lung  was  collap.sed.  Wlien  sitting  up 
there  was  but  slight  dys]inoca.  Several  fragments  of  the  sternum  wereiemoved,  and  the  wound  soon  granulated  kindly.  On 
May  10th,  a colored  drawing  of  the  wound  was  made.  (No.  19,  Surgical  Series  of  Drawings,  S.  G.  O.)  On  July  ;'tli,  the 
patient  was  transferred  to  Washington,  convalescent.  He  ultimately  recovered  ])erfectly.  This  man  was  discharged  the  service 
on  June  27th,  1863,  and  was  subsequently  pensioned,  his  disability  being  rated  three-fourths  and  permanent.  On  April  5th, 
1864,  Pension  Examiner  L.  A.  Smith  reports  that  the  injured  lung  “still  continues  defective  somewhat,  causing  dyspnoea.”  The 
following  is  an  extract  from  the  patient’s  letter,  dated  Newark,  New  Jersey,  April  22,  1872,  in  reply  to  an  inquiry  regarding  his 
condition  : “My  wound  is  not  what  you  would  call  a running  sore  exactly,  but  still  there  is  all  the  while  a kind  of  dry  scab 
forming  and  coming  off  one  after  the  other,  and  it  is  very  tender.  I have  spoken  to  several  doctors  about  it,  and  they  say  that 
it  will  always  be  so  on  account  of  the  bone  being  broken  in  such  a waj'  that  it  is  ragged  and  does  not  heal  solid.  My  health  is 
as  good  as  I ever  ex]iect  it  to  be  again.  My  left  lung  is  a very  delicate  thing,  and  the  least  cold  seems  to  go  right  to  it,  and 
the  weather  we  have  here  at  this  season  of  the  year  is  very  rough  on  me;  but  I suppose  there  is  no  use  of  crying  over  spilt 
milk,  but  must  only  try  to  make  the  best  of  a bad  job.” 

Case. — Private  P.  H.  B , Co.  C,  147th  Pennsylvania  Volunteers,  was  wounded 

at  Chancellorsville,  5Iaj'  2d,  1863,  by  a conoidal  mu.sket-ball,  which  entered  between  the 
second  and  third  ribs,  on  tin;  right  side,  two  indies  from  the  median  line,  fractured  the 
sternum,  and  lodged  beneath  it.  The  wound  bled  prxifusely,  but  the  hannorrhage  was 
arrested  by  pressure.  The  patient  was  conveyed  to  Douglas  Hospital,  Washington,  on 
!May  8th,  and  died  the  following  day.  He  had  haemojitysis  and  the  symptoms  of  traumatic 
pneumonia.  The  pathological  specimen,  contributed  to  the  Army  ISIedical  Slusenm  by 
Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  is  figured  in  the  adjoining  wood-cut  (EiG.  226). 

Case. — Private  H.  B , 27th  Michigan  Volunteers,  aged  21  years,  was  wounded 

at  Spottsylvania,  May  12th,  1864,  by  a fi-agment  of  shell,  which  contused  the  iqiper  anterior 
portion  of  the  chest  without  lesion  of  the  integument.  He  was  admitted  to  Fairfax 
Seminary  Hospital  on  the  16th;  there  was  a large  tumor  at  the  point  of  injury  and  exten- 
sive suggillation.  Cold-water  dressings  were  applied,  and  extra  diet  allowed.  On  the  I'^A  'm'm  a*‘‘‘clicd. 

17th,  the  tumor  was  evacuated  by  an  incision,  leaving  a cavity  some  two  inches  in  diameter. 

The  patient  did  extremely  well  under  the  administration  of  quinia  in  small  doses,  and  an  extra  diet,  until  June  ICth,  when 
there  was  anorexia,  dry  tongue,  an  apparently  healthy  discharge  from  the  wound,  troublesome  cough,  and  inuco-inirulent 
sputum.  To  combat  these  symptoms,  tonics,  stimulants,  and  an  extra  diet  were  directed.  The  patient  sank  gradually, 
and,  by  July  5th,  complained  of  great  pain  in  the  lower  part  of  the  abdomen.  There  was 
also  difficulty  in  micturition,  which  lasted  five  days.  On  the  10th  there  was  difficulty  in  speak- 
ing; great  dy.spncca;  respiratory  murmur  around  the  wound,  and  pulse  varying  from  100  to  110. 

This  was  followed  by  coma,  and  the  patient  died  on  the  15th.  The  autopsy  revealed  a fracture 
of  the  sternum — small  pieces  of  the  manubrium  being  driven  in — with  two  apertures  in  the 
bone  communicating  with  the  lung.  There  was  a large  abscess  in  the  left  lung,  with  evidences 
of  extensive  pleuritis  and  effusion  in  the  ])leural  cavities.  The  remaining  organs  exhibited 
nothing  worthy  of  remark.  The  pathological  specimen  is  carious  within  to  a considerable  extent, 
and,  on  the  internal  surface,  is  partly  covered  with  a plate  of  new  deposit.  It  was  contributed  to 
the  Army  Medical  Museum  by  Assistant  Surgeon  TI.  Allen,  U.  S.  A.,  and  is  figured  in  the 
adjoining  cut  (FiG.  227). 

Case. — Private  Edwin  Steele,  Co.  A,  3d  Missouri  State  ililitia  Cavalry,  aged  23  years,  was  wounded  at  Caledonia,  Missouri, 
September  13th,  1864,  by  a round  ball,  which  entered  through  upper  part  of  sternum,  passed  backward,  and  lodged  under  the  left 
scapula.  He  was  treated  at  Caledonia  until  October  11th,  when  he  was  sent  to  the  post  hospital  at  Cape  Girardeau.  Discharged 
from  service  February  27th,  1865.  Pension  Examiner  E.  \V.  Bartlett  reports,  Juno  22d,  1869,  “the  missile  interferes  with  the 
motion  of  the  arm  and  causes  hajmorrhage  of  the  lungs.  Is  unable  to  labor  and  not  likely  to  improve.”  He  was  still  a pensioner 
in  March,  1872. 

Case. — ^Private  George  W.  Edkin,  Co.  D,  12th  Michigan  Volunteers,  aged  27  years,  received  a gunshot  penetrating 
wound  of  the  chest,  at  Shiloh,  April  7th,  1862.  The  missile  entered  through  the  centre  of  the  sternum,  jiassed  through  the 
mediastinum,  and  lodged  beneath  the  posterior  border  of  the  left  scapula.  Fie  was  taken  to  the  field  hospital,  where  the  wound 
was  dressed  with  adhesive  plaster.  During  the  first  twenty-four  hours,  the  external  haemorrhage  was  profuse,  and  air  passed 
through  the  wound  for  three  days.  Three  days  after  the  reception  of  the  injury,  the  ball  was  extracted  by  Surgeon  E.  C. 
Kedzie,  12th  Michigan  Volunteers.  The  internal  haemoiThage  was  considerable  and  frothy,  and  bloody  expectoration  continued 
for  some  three  weeks.  Morphia  was  administered  regularly,  and  the  patient  was  kejjt  upon  a light  diet ; stimulants  were 
prohibited.  During  -three  months  the  sputa  were  bloody,  gradually  lessening  but  not  entirely  ceasing  for  more  than  a year. 
He  was  removed  to  the  Infirmary  Hospital,  Pittsburgh.  The  wound  finally  healed  about  the  middle  of  July,  1862.  He  was 
discharged  from  service  on  November  7th,  1862.  Pension  Examiner  Ira  C.  Backus  rciports,  December  Ist,  1863,  that  “ there  is 
permanent  lameness  of  the  left  shoulder.”  Dr.  M.  Gill,  in  a letter  to  this  office,  dated  March  26th,  1866,  says  that  “ the  track 
of  the  ball  is  tender;  constant  pricking  pain  through  the  lungs ; dyspnoea  increased  by  exercise.  Severe  coughing  excited  by 
fatigue  or  cold  produces  haemoptysis.  Does  not  have  constant  cough.  Cannot  lie  upon  either  side  long  .at  once  ; more  difficult 
upon  left,  easiest  upon  the  back,  requires  frequent  change  of  position,  but  at  all  times  needs  to  lie  with  his  head  elevated.” 


Fig.  2:37. — FpjuT  pertiou  of 
the  stornuin  fractnrcil  longi- 
tudinally and  ohliipiely,  with 
displacement.  21)1 1.  Sect. 
I,  A.  M.  M. 


Fig.  22<i. — Sujicrior  pt'rtioii  of  stt'nmm 


488 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CiLvr.  V, 


Case. — Private  James  Brownlee,  Co.  G,  134th  New  York  Volunteers,  aged  21  years,  was  wounded  at  Gettysburg,  July 
1st,  1863,  by  four  balls  and  three  buckshot.  One  ball,  probably  conoidal,  entered  the  sternum  about  an  inch  below  the  jugular 
fossa,  and  passing  downward  and  outward,  underneath  the  second,  third,  and  fourth  ribs,  perforated  the  upper  lobe  of  the  right 
lung  superficially,  and  emerged  between  the  fourth  and  fifth  ribs,  about  three  inches  to  the  right  of  the  nipple  of  the  same  side. 
Three  buckshot  took  effect  just  above  the  pubes,  some  of  them  passing  through  the  bladder.  One  ball  entered  the  right  thigh 
and  lodged  ; another  (conoidal)  entered  the  left  thigh  and  passed  nearly  through.  It  was  removed  on  the  fourth  day.  A nearly 
spent  conoidal  ball  entered  the  back  of  the  sacrum,  near  its  middle,  and  buried  itself  slightly  beneath  the  skin,  whence  it  was 
immediately  removed  by  the  patient.  In  addition  to  the  injuries  already  stated  the  patient  affirms  that  he  was  finally  struck 
upon  his  knapsack,  and  knocked  down  by  a piece  of  railroad  iron  about  eighteen  inches  long,  which  was  fired  from  one  of  the 
enemy’s  guns.  Being  made  a prisoner  soon  after,  a Confederate  surgeon  removed  some  fragments  of  the  sternum  from  the 
wound  of  exit,  and  dressed  the  wound  with  pledgets  of  lint,  removing  them  every  hour  or  two.  He  observed  that  whenever 
the  dressing  was  removed  he  breathed  with  difficulty,  but  on  being  replaced  he  felt  immediate  relief.  The  patient  was  admitted 
to  Camp  Letterman,  Pennsylvania,  on  August  6th,  and  was  furloughed  on  October  30th,  1863.  He  was  admitted  to  Central 
Park  Hospital,  New  York,  on  December  9th,  1863,  and  came  under  the  observation  of  Professor  Frank  H.  Hamilton,  who  stated 
that  “ after  a lapse  of  nine  months  there  is  a copious  purulent  discharge  from  both  orifices,  and  the  walls  of  the  thorax  upon 
the  injured  side  have  ah’eady  contracted  considerably.  The  posterior  portion  of  the  right  lung  admits  air  freely,  nearly  to  its 
base.  In  front,  no  auscultatory  sounds  are  detected.  When  he  stands  erect  the  right  shoulder  falls  considerably.  Most  of 
the  time  he  has  a troublesome  diarrhcea,  yet  under  a generous  diet  he  is  gradually  gaining  in  strength  and  health.”  On  June 
3d,  1865,  Brownlee  was  admitted  to  Ira  Harris  Hospital,  Albany.  He  was  discharged  the  service  on  August  12th,  1865. 
Examining  Surgeon  William  H.  Craig  states,  August  22d,  1866,  that  “a  fistulous  opening  remains  in  the  breast,  at  which  the 
air  escapes  in  inspiration.  About  four  ounces  of  pus  is  discharged  from  this  opening  each  day.  Disability  probably  permanent.” 
On  January  29th,  1867,  Examining  Surgeon  E.  S.  Delavan,  at  Albany,  reports:  “Three  buckshot  entered  in  front  near  the 
symphysis  pubis,  perforating  the  bladder.  Strange  to  say,  he  recovered  from  the  wound.  Ball  entered  the  breast  and  sternum 
and  passed  out  (probably,  though  he  never  saw  the  ball) ; it  may  be  in  the  chest  below  the  right  nipple.  The  right  lung  is 
almost  totally  useless.  I can  detect  no  respiratory  murmur,  and  he  has  cough  and  feeble  pulse.  In  my  opinion,  the  disability 
is  permanent.” 

Gunshot  Fractures  of  the  Ribs.— The  ribs  are  sometimes  fractured,  as  has  been  seen 
(pp.  473-4),  by  balls  that  do  not  penetrate  the  chest  cavity,  but  much  more  frequently  by 
projectiles  that  penetrate  or  perforate.  Surgeon  J.  H.  Brinton,  U.  S.  V.,  called  the  writer’s 
attention,  during  the  war,  to  the  greater  danger  attending  fractures  at  the  point  of  entrance 
of  the  missile  than  those  at  the  point  of  exit ; and  mentioned  that,  in  a large  series  of  chest 
wounds  that  he  had  observed,  an  unfavorable  prognosis  might  be  almost  uniformly  given 
when  a ball  struck  a rib  on  entering,  deflected  inward  the  sharp  points  of  the  broken  rib 
and  drove  before  it  bony  spiculse;  whereas,  if  the  projectile  passed  in  through  an  intercostal 
space,  and  fractured  the  ribs  on  emerging  from  the  thorax,  far  less  apprehension  need  be 
felt.  This  is  undoubtedly  a very  important  practical  distinction,  and  it  has  been  fully 
justified  by  the  facts  reported ; 

Case. — Private  C.  S , Co.  I,  14th  Connecticut  Volunteers,  aged  22  years,  was  wounded  in  the  chest  at  Morton’s 

Ford,  Virginia,  on  February  6th,  and  died  with  pleurisy  on  February  28th,  1864.  He  was  struck  on  the  anterior  part  of  the 
left  chest  by  a conoidal  musket-ball  which  fi-actured  the  sixth  and  seventh  ribs,  two  inches  or  more  from  the  junction  of  the 
cartilages.  The  ball  was  slightly  impacted  and  readily  removed.  It  had,  however,  produced  much  splintering.  The  patient 

was  conveyed  to  the  hospital 
of  the  Second  Corps,  at  Bran- 
dy Station,  under  charge  of 
Surgeon  Frederick  A.  Dud- 
ley, 14th  ConnecticutVolun- 
teers.  There  was  haemop- 
tysis, dyspnoea,  and  great 
prostration.  The  accessible 
fragments  of  bone  were  re- 
moved, and  other  foreign 

, 1 .1  1 t Fig.  229. — A posterior  view  of  the  same, 

bodies,  and  the  haemorrhage  ^ 

being  suppressed,  the  wound 

was  dressed  with  simple  dressings.  An  expectant  treatment  was  pursued,  until  symptoms  of  pneumonia  appeared,  when  mild 
antiphlogistics  and  anodynes  were  resorted  to.  But  pericardeal  complications  supervened,  and,  in  three  weeks  the  case  terminated 
fatally.  At  the  autopsy  the  substance  of  the  lung  was  found  to  be  slightly  injured  ; there  was  great  effusion  in  the  cavity  of 
the  left  chest  and  within  the  pericardium.  The  pathological  specimen  was  contributed  to  the  Army  Medical  Museum  by  Surgeon 
Justin  Dwinelle,  106th  Pennsylvania  Volunteers.  (See  Figs.  228  and  229.) 


Fig.  228. — W et  preparation  of  portions  of  four  ribs,  with 
the  central  ones  fractured.  Spec.  2119,  Sect.  I,  A.  M.  M. 


Sect.  II.] 


SHOT  FEACTURES  OF  THE  RIBS. 


489 


The  next  two  abstracts  refer  to  cases  of  partial  recovery  after  perforation  of  the  chest 
by  balls,  with  fracture  of  the  rib  on  their  exit  from  the  cavity.  The  lung  injuries  were 
apparently  slight  in  both  instances; 

Case. — Private  Melchior  Breitel,  Co.  I,  12th  New  Jersey  Volunteers,  was  wounded  at  Chancellorsville,  May  3d,  18C3,  by 
a conoidal  ball,  which  entered  the  lower  lobe  of  the  left  lung,  and  lodged  beneath  the  integuments  of  the  opposite  side,  after 
fracturing  the  seventh  lib  near  the  sternum.  He  was  sent  to  the  field  hospital,  thence  was  aSmitted,  on  June  14th,  to  Point 
Lookout  Hospital,  Maryland,  whence  he  was  transferred  to  the  Ward  Hospital,  New  Jersey,  on  September  9th,  18G3.  Eight 
months  after  the  reception  of  the  injury  the  rib  was  found  necrosed,  and  the  wound  still  discharging  pus ; several  fragments  ot 
bone  had  escaped  from  time  to  time  ; the  patient’s  breathing  was  unembarrassed,  and  his  general  health  good.  This  man  was 
discharged  the  service  on  March  28th,  1864,  and  pensioned.  The  wound  was  still  unhealed;  but  his  general  health  was 
excellent.  His  disability  was  rated  total  and  temporary.  Eight  years  afterward,  March,  1872,  this  pensioner  is  recorded  ns 
having  received  his  pay;  but  no  report  is  given  of  his  state  of  health. 

Case. — Private  Samuel  McCalecher,  Co.  D,  3d  Pennsylvania  Reserves,  was  wounded  at  Bull  Run,  Virginia,  August  28th, 
1862,  by  a round  ball,  which  entered  two  inches  above  the  right  nipple  and  lodged  beneath  the  skin  three  inches  below  the 
inferior  angle  of  the  right  scaj)ula,  comminuting  the  tenth  rib  in  its  exit  from  the  chest  cavity.  He  was  treated  in  the  field  till 
September  3d,  and  then  transferred  to  the  Baptist  Church  Hospital,  Alexandria.  Bloody  sputa  occurred  occasionally  for  two  days 
after  admission,  and  the  patient  suffered  from  pain  in  the  right  lower  lobe  on  drawing  a full  breath.  These 
symptoms  soon  ceased.  On  September  12th,  slight  crepitation  was  heard  over  the  lower  part  of  the  right 
lung.  On  September  15th,  Acting  Assistant  Surgeon  George  F.  French  extracted  the  ball  from  beneath  the 
skin.  The  patient  continued  to  improve,  and  by  November  11th,  was  apparently  well,  with  diminished 
respiratory  murmur  in  the  lower  right  lobe.  He  was  discharged  from  service  on  December  1st,  1862.  The 
missile,  which  is  irregularly  and  roughly  battered,  was  forwarded  to  the  Aluseum.  It  is  represented  in  the 
wood-cut  (Fig.  230).  Pension  Examiner  II.  M.  Nagle  reports,  April  11th,  1867,  that  “the  right  lung  is 
affected ; has  great  pain,  with  weakness  in  chest,  considerable  cough  and  dysjinoea,  which  is  on  the  increase, 
so  that  he  is  unable  to  perform  any  but  light  manual  labor.  General  health  very  good.  Disability  three- 
fourths  and  permanent.” 

The  following  abstract  illustrates  a common  variety  of  gunshot  injury  of  the  cliest, 
in  which  a musket  ball,  having  fractured  a rib,  perforates  a lung,  and  then,  its  momentum 
exhausted,  is  reflected  from  the  opposite  w’all  of  the  thorax,  and  gravitates  to  the  floor  of 
the  diaphragm : 

Case. — Private  F.  H , Co.  B,  14th  Connecticut  Volunteers,  aged  21  years,  was  wounded  in  the  right  chest  at 

Morton’s  Ford,  Virginia,  on  February  6th,  1864,  and  death  followed  in  four  days.  A conoidal  musket  ball  entered  the  third 
intercostal  space,  three  inches  from  the  edge  of  the  sternum,  fracturing  the 
upper  border  of  the  fourth  rib  badly,  and,  traversing  the  middle  lobe  of  the 
right  lung,  lodged.  The  patient  was  taken  to  the  hospital  of  the  3d  division 
of  the  Second  Corps,  in  charge  of  Surgeon  F.  A.  Dudley,  14th  Connecticut 
Volunteers.  There  was  urgent  dyspnoea  and  prostration,  and  apparently 
internal  bleeding.  After  the  partial  collapse  had  passed  off,  these  symptoms 
were  mitigated  by  position,  cold  drinks,  and  simple  dressings,  secured  by  a 
bandage  about  the  thorax.  Low  diet  and  absolute  rest  were  enjoined. 

Traumatic  pneumonia  set  in  and  progressed  rapidly  to  a fatal  termination. 

The  autopsy  revealed  considerable  laceration  of  the  right  lung;  the  bullet 
lay  upon  the  diaphragm.  The  specimen  was  contributed,  with  the  history, 
by  Surgeon  Justin  Dwinelle,  106th  Pennsylvania  Volunteers.  It  is  shown 
in  the  adjoining  cut  (Fig.  231). 

The  next  cases  are  illustrations  of  those  illusory  recoveries,  in  which  the  irritation 
excited  by  a fractured  rib  induces  pulmonary  symptoms  closely  resembling  those  caused 
by  tuberculosis,  and  often  described  as  such : 

Case.  Private  Patrick  Dolan,  Co.  F,  69th  New  York  Volunteers,  aged  27  years,  having  been  wounded  at  Antictam, 
September  1/th,  1862,  was  admitted  to  hospital  at  irederick,  Maryland,  on  the  2Gth.  A conoidal  musket  ball  had  entered  three 
inches  below  the  right  nipple,  fractured  the  eighth  rib,  passed  through  the  body,  and  lodged  on  the  left  side  of  the  spine,  under 
the  twelfth  rib.  The  right  side  of  the  lung  was  dull  in  front  and  behind,  and  there  was  a continual  discharge  of  ])us  through  the 
wound  of  entry.  Good  diet  and  cod-liver  oil  caused  the  patient  to  improvij  by  November  22d,  and,  on  April  20th,  1863,  he  was 
discharged  cured.  He  was  transferred  to  West’s  Building  Hospital,  Baltimore,  on  April  21st,  and  to  Fort  Wood,  New  York 
Harbor,  on  May  1st,  where  he  was  discharged  the  service  on  May  30th,  1863.  On  December  17th,  1863,  I’ension  Examiner 
Charles  Rowland  reports  that  the  patient  suffers  from  chronic  pain  ami  extreme  prostration.  He  rates  his  disability  three-fourths. 
On  February  8th,  1864,  this  man  is  reported  to  bo  sulfering  from  cough  and  symi)toms  of  iditliisis.  He  died  on  March  4th,  1864, 
“ of  phtliisis  resulting  from  the  wound.” 

G13 


Fig.  231. — Wet  preparation  of  three  ribs  of  the  right 
side,  showing  the  middle  one  fractured  by  a conoidal  ball. 
Spec.  2117,  Sect.  I,  A.  M.  M. 


Fig.  230.— Kitle 
ball  deformed  by 
impact  on  tenth  ri  1 », 
in  its  exit  from  the 
chest.  Spec.  4479, 
Sect.  I,  A.  M.  M. 


490 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


Case. — Lieutenant  Robert  Henry,  Co.  II,  131st  New  York  Volunteers,  was  wounded  at  Cedar  Creek,  October  19th,  1804, 
by  a colloidal  ball,  which  entered  the  right  side  of  the  chest,  fractured  two  ribs  and  lacerated  the  right  lung.  He  was  discharged 
from  service  on  February  2d,  1865.  Pension  Examiner  Charles  Rowland  reports,  April  24th,  1865,  that  pulmonary  consumption 
has  resulted,  confining  the  pensioner  to  bis  bed.  The  wound  discharges  freely.  Dr.  W.  E.  Mulhallen,  of  Brooklyn,  New  York, 
reports,  September  21st,  1866 : I attended  Lieutenant  Henry  for  some  twelve  months  previous  to  his  death,  which  occurred  at 
Brooklyn,  August  16th,  1866.  He  was  wounded  near  the  si.xth  rib  anteriorly ; the  wound  healed  up  and  inflammation  set  in, 
and  it  again  opened  in  two  places  about  the  fourth  rib  and  continued  to  discharge  until  his  death.  The  right  lung  was  affected 
by  this  wound,  and  became  entirely  useless  and  wasted  away.  There  can  be  no  possible  doubt  but  that  his  death  was  caused 
by  the  wound. 

Opportunities  were  sometimes,  though  rarely,  afforded  of  observing  the  attempts  at 
repair  in  fractured  ribs,  when  young  and  robust  patients  survived  their  injuries  for  several 
weeks.  The  following  is  an  instance,  in  which  the  pathological  appearances  of  the  lungs 
are  described,  and  the  collapsed  right  lung  imperfectly  figured: 

Case. — Private  S.  B , Co.  A,’ 83d  New  York,  having  been  wounded  at  Fredericks- 

burg, December  13tli,  1862,  was  admitted  into  Lincoln  Hospital,  Washington,  on  December 
23d,  1862.  A conoidal  musket  ball  had  entered  the  right  chest  posteriorly,  over  the  attachment 
of  the  eleventh  rib,  and  passed  forward.  The  missile  was  extracted  on  the  26th,  and  simple 
dressings  were  applied.  Pleuro-pneumonia  ensued,  and  resulted  in  empyema.  On  January  3d, 

1863,  a pint  of  pus  was  evacuated  from  the  pleural  cavity.  The  case  terminated  fatally  on  January 
21st,  1863.  Nine  hours  subsequently  a post-mortem  examination  was  performed  by  Assistant 
Surgeon  G.  M.  McGill,  U.  S.  A.  Bigor  mortis  was  well  marked.  The  brain  weighed  forty-five 
ounces  and  two  drachms.  A healthy  fluid  was  found  in  the  lateral  ventricles.  The  bronchial 
glands  wei-e  enlarged.  The  right  lung  was  compressed  and  crowded  into  the  superior,  posterior, 
and  internal  part  of  its  chamber.  It  was  adherent  to  the  costal  parietes  by  fibrinous  bands. 

Anteriorly,  inferiorly,  and  externally,  occupying  tbe  cavity  left  by  tbe  retreating  lung,  was  found 
a collection  of  pus,  between  the  two  walls  of  pleura,  measuring  one  pint  and  a half.  This  cavity 
was  lined  by  a thick  membrane  presenting  internally  a mucoid  appearance.  The  left  lung  showed 
gray  hepatization  in  the  upper  and  posterior  portions,  the  inferior  and  anterior  being  congested, 
and  thick,  tenacious  bronchial  secretion  exuded  from  the  bronchial  tubes.  Anteriorly,  tins  hmg 
was  firmly  adherent  to  the  pericardium.  Tlie  right  lung  weighed  fourteen,  the  left  twenty-six 
ounces.  The  pericardium  was  filled  with  two  ounces  of  yellowish  fluid.  The  heart,  with  the 
perieardhim,  weighed  ten  and  a half  ounces.  Firm  fibrinated  clots  existed  in  both  auricles, 
contimlous  within  the  auriculo-ventricular  openings,  and  a black  clot  was  found  in  the  left 
ventricle  and  aorta.  The  liver,  weighing  sixty-four  ounces,  was  “ nutmegged.”  Each  kidney  weighed  five  and  a half  oimces. 
The  spleen  was  firm,  and  weighed  seven  and  a half  ounces.  The  pancreas  weighed  four  ounces.  The  greater  omentum 
extended  a short  distance  below  the  umbilicus ; the  intestines  were  much  inflated;  the  lymphatics  of  the  lumbar  region  and 
the  mesenteric  glands  were  enlarged.  The  stomach  and  duodenum  were  normal ; patches 
of  congestion  were  scattered  through  the  jejunum  and  ileum;  the  mucous  membrane  of  the 
small  intestine  was  softened  ; the  walls  of  the  large  intestine  were  thickened.  Portions  of 
the  eleventh  and  twelfth  ribs  of  the  right  side,  completely  fractured  and  surrounded  at  the 
points  of  solution  with  large  irregular  formations  of  callus,  were  contributed  to  the  Army 
Medical  Museum  by  Surgeon  H.  Bryant,  U.  S.  V.,  and  the  particulars  of  the  autopsy  were 
furnished  by  Assistant  Surgeon  J.  Cooper  McKee,  U.  S.  A.  The  specimens  are  figured  in 
the  accompanying  wood-cuts  (Figs.  232  and  233),  on  a much  reduced  scale,  the  cut  used  in 
Circular  6,  and  in  the  Catalogue,  being  utilized. 

Other  illustrations  of  gunshot  fractures  of  the  ribs  will  appear  in  the  sub-division  on 
Hcemorrhage,  others  again  among  the  Operations  in  the  next  Section.  The  Army  Medical 
Museum  contains  altogether  thirty-three  specimens  belonging  to  this  class.  For  fracture 
of  the  neck  of  the  right  first-  rib  by  a small  round  iron  ball,  see  Specimen  1472.  For  a 
well-marked  willow  fracture  of  the  left  ninth  rib,  by  a conoidal  musket  ball,  striking 
side-wise,  from  a youth  of  twenty,  see  Specimen  1441.  For  an  example  of  moderate 
osseous  deposit  in  thirty-three  days,  in  a fracture  of  the  eighth  rib  in  a boy  of  nineteen, 
see  Specimen  1901.  For  examples  of  necrosis,  see  Specimens  2809  and  3843.  For  an 
instance  of  consolidated  fracture,  see  Specimen  877.  For  a curious  incomplete  fracture, 
without  penetration  by  the  missile,  see  Specimen  3823, — from  a cavalry  soldier,  aged  28 
years,  who  died  from  pleuro-pneumonia  five  days  after  the  reception  of  the  injury. 


Fig.  233.  — Attempted  repair  after 

? unshot  fracture  of  floating  ribs.  Spue. 
45,  Sect.  I,  A.  M.  M. 


Fig.  232. — Right  lung  collapsed 
after  gunshot  wound.  ♦S’/^ec.  840, 
Sect.  1,  A.  M.  M. 


Sect.  II.] 


COMPLICATED  WOUNDS  OF  THE  LUKG. 


491 


Complicated  Gunshot  Wounds  of  the  Lung. — The  following  abstracts  comprise  several 
remarkable  instances  of  recovery  after  gunshot  wounds  believed  to  have  involved  the  pul- 
monary parenchyma,  and  also  accounts  of  interesting  cases  that  had  a fatal  termination  ; 

Case. — Color  Sergeant  Samuel  McQuaid,  Co.  I,  124tli  New  York  Volunteers,  aged  28  years,  was  wounded  at  Gettysburg, 
Pennsylvania,  July  2d,  1863,  by  a conoidal  ball,  whicli  entered  about  an  incli  above  the  left  nipple,  passed  entirely  through  the 
chest,  fracturing  two  ribs  in  its  passage,  and  lodged  in  the  back  near  the  lower  edge  of  the  scapula,  from  whence  it  was  extracted. 
He  was  treated  at  the  field  hospital  of  the  1st  division.  Third  Corps,  and,  on  July  10th,  transferred  to  Satterlee  Hospital,  Phila- 
delphia. When  admitted,  the  wound  was  of  small  dimensions;  not  painful.  The  discharge  was  very  profuse  .md  seemed  to 
come  from  the  thoracic  cavity,  great  quantities  being  discharged  when  the  body  was  bent  forward  so  as  to  favor  its  free  exj)ulsiou. 
On  the  morning  of  July  24th,  symptoms  of  internal  disturbance  became  manifest;  faintness  and  depression,  followed  by  coldness 
of  the  extremities,  with  dyspnoea,  indicated  a collection  of  pus  in  the  pleural  cavity.  His  strength  soon  began  to  give  way,  and 
he  was  only  kept  alive  by  the  free  administration  of  stimulants  and  such  nutritious  diet  as  he  could  swallow.  The  first  attack 
lasted  during  the  greater  part  of  the  d.ay,  growing  gradually  less  severe  until  evening,  when  he  had  almost  entirely  recovered 
from  its  effects.  Several  slight  attacks  of  the  same  kind  were  experienced  during  the  next  three  days.  The  wound  began  to 
.assume  an  unhealthy  appearance  and  was  soon  covered  with  sloughs  of  a gangrenous  character,  which  continued  to  extend  until 
it  became  more  than  thrice  its  original  size.  A wash,  composed  of  equal  parts  of  creasote,  alcohol,  and  water,  was  applied  to  the 
wound,  which  was  afterward  dressed  with  yeast  poultice.  Under  this  treatment  the  sloughs  began  to  separate  and  come  away, 
h'aving  a healthy  granulating  wound.  The  patient  soon  began  to  improve,  and,  on  August  8th,  was  able  to  go  home  on  furlough, 
the  wound  at  that  time  being  almost  entirely  closed.  His  respiration  was  perfect.  He  was  transferred  to  the  Veteran  Eeserve 
Corps,  January  30th,  1864.  He  is  not  a pensioner.  Surgeon  1. 1.  Hayes,  U.  S.  V.,  reports  the  case. 

Case. — Private  Summerlin  Berrien,  Co.  G,  47th  Georgia  Regiment,  aged  35  years,  was  admitted  to  the  Institute  Hospital, 
Atlanta,  Georgia,  May  18th,  1864,  with  a gunshot  penetrating  wound  of  the  chest,  received  on  May  13th,  1864.  A conoidal  ball 
entered  the  back,  about  two  and  one-half  inches  to  the  left  and  opposite  the  sixth  dorsal  vertebra,  passed  directly  forward,  and 
emerged  four  inches  to  the  left  of  the  median  line  and  between  the  floating  ribs.  When  admitted,  the  wound  of  entrance  was 
clean  and  healthy,  and  suppurating  kindly.  Tlie  wound  of  exit  had  closed  and  h.ad  the  appearance  of  a hard  tumor;  general 
condition  good;  free  from  cough,  fever,  and  pain.  The  patient  continued  to  improve  until  June  4th,  when  he  was  seized  with'a 
troublesome  hacking  cough,  each  paroxysm  of  which  caused  a jet  of  dark,  sanious,  and  very  offensive  fluid  to  flow  from  wound 
of  entrance;  no  pain  and  but  little  constitutional  disturbance.  Expectorants  and  nutritious  diet.  June  5th:  Dark  sanious  matter 
continues  to  flow  from  wound  of  entrance  in  forcible  jets,  during  each  expiratory  effort  of  coughing ; during  inspiration,  air 
rushes  into  the  wound  with  a hissing  sound;  cough  continued  troublesome,  but  without  expectoration,  except  white  mucus. 
Auscult.ation  revealed  both  amphoric  respiration  and  metallic  tinkling.  Patient  l;ad  considerable  fever.  General  treatment 
continued.  In  this  way  the  patient  continued,  without  much  change  of  interest,  until  .June  13th,  when  the  dar-k  sanious  discharge 
was  substituted  by  healthy  pus  in  moderate  quantities.  Shortly  after  this,  an  abscess  formed  around  the  wound  of  exit  and 
discharged  pus  freely.  June  30th:  Patient  doing  well,  with  a good  prospect  of  recovery.  The  case  is  reported  by  Surgeon  D. 
C.  O’Keefe,  P.  A.  C.  S. 

Case. — Private  John  Collins,  Co.  G,  26th  Iowa  Volunteers,  was  wounded  at  Arkansas  Post,  Arkansas,  January  11th,  1863, 
by  a musket  ball,  which  entered  the  left  side  between  the  clavicle  and  first  rib,  passed  downward  and  backward,  perforated  the 
lung,  and  emerged  to  the  right  of  the  sixth  dorsal  vertebra.  According  to  the  statement  of  the  patient,  he  expectorated  a con- 
siderable quantity  of  blood  and  experienced  a very  severe  pain  in  the  left  side.  He  w’as  removed  to  the  hospital  and  adliesive 
plaster  placed  over  the  wounds.  The  obliquity  of  the  external  wounds  seemed  to  prevent  the  admission  of  external  air.  The 
surgeon  evidently  seemed  to  consider  it  a hopeless  case,  and  paid  but  little  attention  to  him,  so  that  after  a month  he  had  become 
very  much  bent  over,  forward  and  laterally.  Discharged  from  service  on  June  1st,  1863.  Pension  Examiner  A.  H.  Ames  reports, 
July  17lh,  1863,  that  the  wound  had  always  been  open  at  exit.  “Great  pain  has  existed  along  the  course  of  the  ball,  and  now  a 
fistula  e.xtends  from  point  of  exit  into  the  substance  of  the  lung.  His  lungs  are  much  diseased  in  consequence.  Coughing, 
together  with  the  pain,  and  great  emaciation  consequent  upon  the  suppuration  from  the  wound,  will  not  let  him  live  long.”  Dr. 
P.  J.  Farnsworth,  of  Lyons,  Iowa,  states,  in  a communication  to  The  Medical  and  Surgical  Reporter,  Vol.  XIII,  No.  15  : “ His 
appearance,  when  he  first  came  into  our  hands,  was  of  extreme  emaciation.  The  left  shoulder  dropped  down  and  the  spine  bent 
forward  and  sidewise.  The  wound  in  front  was  healed,  but  the  one  on  the  back  was  open,  and  when  he  coughed  violently,  air 
escaped.  The  cough  was  troublesome;  the  expectoration,  bloody  pus,  in  large  quantities.  The  whole  aspect  was  that  of  the  last 
stages  of  tubercular  disease.  He  had  night  sweats  and  swelling  of  the  lower  extremities,  and  a peculiar  clubbing  of  the  fingers. 
Cod-liver  oil  and  stimulants  were  administered,  with  as  generous  a diet  as  he  could  bear.  He  lingered  along  for  two  or  three 
months  with  slight  improvement.  There  was  every  indication  of  tubercular  disease  and  of  a large  cavity  in  the  lung.  A Soldiei  s’ 
Home  having  been  opened  in  Chicago,  we  obtained  permission  to  send  him  there,  he  having  no  friends  here.  We  procured  a 
carriage  and  carried  him  carefully  to  the  depot,  and  saw  him  aboard  a sleeping  car,  never  expecting  to  see  him  again.  I'his  was 
in  August,  and  we  heard  no  more  from  him  until  December,  when  he  returned  in  the  uniform  of  an  invalid  veteran.  His  appear- 
ance was  much  improved,  and  he  informed  us  that  he  did  regular  guard  duty  over  the  rebel  prisoners  at  Camp  Douglas.  He  was 
not  quite  well,  but  much  of  the  cachectic  look  had  passed  away.  The  wound  on  the  hack  had  healed,  and  he  was  not  much 
troubled  with  cough.  The  clubbed  appearance  of  the  fingers  had  disappeared,  and  he  had  become  straight,  llis  duties  were 
light,  and  he  was  able  to  perform  them.  He  is  now  here,  having  been  lately  discharged,  and  is  in  good  health.  There  is  a little 
dullness  over  the  left  lung,  but  nothing  more.  He  informed  us  that  he  was  in  hospital  but  once  after  re-enlisting,  about  eleven 
mouths  after  he  was  wounded.  The  points  of  interest  in  the  case  are  the  appearance  put  on  from  an  evidently  severe  wound 
through  the  lungs  and  the  apparent  entire  recovery  therefrom.  The  entire  recovery  did  not  take  i)laco  in  the  eleven  months,  for 
when  re-enlisted  he  must  have  been  far  from  well,  and  only  fit  for  the  lightest  duty ; but  before  the  term  of  his  enlistment  expired, 
he  was  fit  for  field  duty,  and.  to  all  appearance,  is  now  in  pei-fect  health.” 


492 


WOUNDS  AND  IN.JUEIES  OF  THE  CHEST. 


[Chap.  V, 


Tlie  six  following  are  abstracts  of  fatal  cases  presenting  some  points  of  interest: 

Case. — Piivate  G.  P.  L , Co.  F,  4tli  New  York  Artillery,  aged  28  years,  was  admitted  into  Douglas  Hospital, 

Wasliiiigton,  April  5tli,  1865,  with  a penetrating  gunshot  wound  of  the  chest,  received  at  South  Side  Railroad,  Virginia,  on 
April  2d.  He  stated  that  he  spat  blood  upon  the  reception  of  injury.  Pleurisy  of  the  right  side  was  well  marked,  with  slight 

emphysema  of  the  cellular  tissue  near  the  posterior  w’ound,  from  which  issued  a thin  sero- 
purulent  fluid.  The  pulse  and  respiration  were  rapid;  air  entered  and  escaped  freely  from 
the  posterior  wound;  the  patient  rapidly  grew  worse  in  spite  of  a generous  diet  and  support- 
ing treatment,  and  died  on  April  9th,  1865.  Fifteen  hours  subsequently  the  entry  of  the  ball 
w'as  noticed  on  the  back,  a little  to  the  right  of  the  spinous  process  of  the  ninth  dorsal 
vertebra,  whence  it  had  passed  inward  and  upward,  fracturing  the  transveree  process,  chip- 
ping the  eighth  rib,  fracturing  the  fifth,  and  escaping  from  the  axilla  of  the  same  side.  The 
right  pleural  cavity  contained  thirty-four  ounces  of  a dark,  offensive,  sero-purulent  fluid. 
The  parietal  and  visceral  pleura;  were  covered  with  a greenish,  soft,  cacoplastic  lymph,  and 
the  right  lung,  perforated  by  the  bullet  through  the  lower  lobe,  was  compressed  and  collapsed. 
There  was  a slight  serous  effusion  in  the  left  pleural  cavity : the  remaining  thoracic  and 
abdominal  viscera  appeared  healthy.  Two  sjiecimens  accompanying  this  history  were 
contributed  to  the  Army  Medical  Museum  by  Assistant  Surgeon  W.  F.  Norris,  U.  S.  A. 
The  first.  No.  2411  of  the  Surgical  Section,  consists  of  the  seventh,  eighth,  and  ninth  dorsal 
vertebra;,  with  the  fifth,  seventh,  and  eighth  ribs  of  the  right  side.  The  right  transverse 
process  of  the  eighth  vertebra  and  the  dorsal  extremity  of  the  corresponding  rib  are  chipped 
by  a bullet.  The  fifth  rib  is  obliquely  broken,  and  comminuted  on  its  internal  surface,  with  a 

FIG.  234.— Preparation  of  the  right  transverse  fracture  e.xternally . The  second,  a preparation  of  the  lung,  is  shown  in  the  adjoining 
lung,  showing  perforation  by  a bullet.  i i r j o 

Spec.  2707,  Sect.  I,  A.  M.  M.  cut.  (See  FiG.  234.) 

Case. — Corporal  Josiah  Burton,  Co.  H,  15th  Indiana  Volunteers,  aged  22  yp.ars,  received  a gunshot  penetrating  wound  of 
the  right  chest,  at  Mission  Ridge,  Tennessee,  November  25th,  1863,  the  ball  entering  about  four  inches  below  the  clavicle  and 
passing  directly  through.  He  was  taken  to  the  hospital  of  the  2d  division.  Fourth  Corps,  where  he  remained  until  December  23d, 
when  be  was  transferred  to  Cumberland  Hospital,  Nashville.  When  admitted,  his  health  was  fair  and  the  wounds  had  nearly 
healed.  Simple  dressings  were  applied.  On  December  25th,  he  had  a severe  chill,  followed  by  high  fever.  On  the  26th,  he  com- 
plained of  a severe  pain  in  the  right  side,  which  increased  on  inspiration.  There  was  dullness  on  percussion  over  the  right  side, 
and  feeble  respiratory  murmur  on  auscultation.  The  pulse  was  full  and  somewhat  accelerated ; tongue  coated  with  a dense  white 
fur;  bowels  constip.ated;  breathing  labored  and  hurried.  Purgatives  and  diuretics  were  given,  and  the  patient  was  cupped  to  the 
extent  of  ten  or  twelve  ounces.  27th:  Condition  somewhat  improved;  bowels  moved  freely.  28th:  Bronchial  symptoms  much 
worse;  pain, and  tenderness  in  the  hepatic  region,  less  severe;  breathing  extremely  laborious;  expectorants,  stimulants,  and 
diaphoretics  were  administered.  December  29th:  Much  worse;  countenance  anxious;  breathing  more  hurried  and  labored; 
gi-eat  prostration.  Death  occurred  on  December  30th,  1863.  Necropsy:  Right  pleural  .sac  contained  three  quarts  of  sero-purulent 
fluid  in  which  flakes  of  lymph  were  floating.  The  pleura-costalis  showed  marked  effects  of  inflammation.  Purulent  lymph 
adhered  at  every  point  to  the  w.alls  of  the  chest.  The  lung  was  completely  carnified  and  attached  to  the  wall  at  the  points  of 
entrance  and  exit  of  the  missile,  and  the  lower  lobe  to  the  diaphragm.  The  lung,  upon  section,  closely  resembled  muscle,  all 
vestiges  of  cellular  tissue  being  entirely  obliterated.  The  bronchus  was  open  to  the  first  ramification,  where  a mass  of  crude 
tubercles,  of  the  size  of  a sparrow’s  egg,  was  found.  Miliary  tubercles  were  thickly  scattered  through  the  fleshy  structure.  The 
mucous  membranes  of  the  air-jiassages  were  highly  inflamed,  and  the  air-tubes  filled  with  muco-purulent  matter.  The  left  lung 
was  somewhat  congested.  The  pericardium,  thickened  to  the  extent  of  half  an  inch,  was  indurated  and  contained  a jiint  of  sero- 
purulent  fluid.  The  serous  lining  was  roughened  by  lymph  exudation,  which  was  rapidly  assuming  a purulent  character.  The 
heart  presented  a singularly  roughened,  corrugated  appearance;  the  walls  being  greatly  thickened  and  indurated.  The  liver 
was  highly  congested.  The  case  is  reported  by  Surgeon  C.  McDermont,  U.  S.  V. 

Case. — Private  Morris  Ward,  Co.  H,  63d  New  York  Volunteers,  aged  32  years,  received  two  gunshot  wounds  at  Antietam, 
M.aryland,  September  17th,  1862.  One  ball  entered  the  back  between  the  eighth  and  ninth  ribs,  left  side,  half-way  between  the 
angle  and  the  junction  with  the  costal  cartilage,  and  lodged;  the  other  entered  two  inches  posterior  of  anterior  superior  spinous 
process  of  the  ilium  of  left  side  and  lodged  in  the  gluteal  muscles.  He  was  at  once  conveyed  to  the  field  hospital  of  the  Second 
Corps,  where  water  di’essings  were  applied.  On  September  30th,  he  was  transferred  to  the  hospital  at  Frederick,  Maryland. 
Previous  to  admission,  the  patient  did  not  complain  of  cough  or  pain  in  the  chest.  On  October  5th,  a ball  could  be  distinctly 
felt  beneath  the  nipple,  but  as  the  patient  was  quite  weak  from  profuse  suppuration  from  the  wound  in  the  gluteal  region,  the 
removal  of  the  ball  by  excision  was  deferred.  October  8th,  burrowing  of  pus  among  the  gluteal  muscles  and  accumulation  of 
gas.  An  incision  was  made  an  inch  above  the  folds  of  the  nates;  but  little  evacuation  of  pus.  Poultice  ordered.  On  the  12'.h, 
another  incision  was  made  just  below  the  crest  of  thefllium  and  a seton  passed  through  the  wound  of  entrance.  The  patient 
seemed  much  prostrated,  but  had  no  cough  or  expectoration.  Tonics  and  stimulants  administered.  On  the  night  of  the  13th,  he 
expectorated  a small  quantity  of  blood,  and,  on  the  next  day,  complained  of  pain  in  the  chest  where  the  ball  had  lodged.  On 
examining  the  chest,  a tumor  was  found  to  extend  from  the  left  nipple  downward  and  inward  for  two  inches,  and  of  the  same 
dimensions  in  breadth.  On  applying  the  ear  to  the  tumor,  a sound  was  heard  resembling  the  passage  of  air,  with  a small 
quantity  of  liquid,  through  a slight  opening.  Tumor  tympanitic  on  percussion  ; respiration  but  slightly  embarrassed,  but  patient 
very  restless,  'fhe  tumor  continued  to  increase,  and  the  patient  failed  rapidly,  notwithstanding  the  free  administration  of  stimu- 
lants ; death  occurred  on  the  morning  of  October  17th,  1862.  Necropsy-:  Rigor  mortis  well  marked.  Body  considerably 
emaciated.  On  laying  open  the  wound  on  the  jiosterior  portion  of  the  chest,  the  ninth  rib  was  found  fractured  at  that  point.  On 


Sect.  II.  1 


COMPLICATED  WOUNDS  OF  THE  LUNG. 


493 


dissecting  up  the  skin  over  the  tumor,  some  extravascation  of  blood  was  found 
underneath.  No  opening  where  the  ball  could  have  entered  the  chest  could  be 
found,  and  it  seemed  probable  that  it  had  passed  externally,  glancing  on  the 
ninth  rib,  yet  no  external  track  was  visible.  The  j)ericardium  over  the  apex  of 
the  heart  was  adherent  to  the  ribs.  Eecent  pleuritic  adhesions  on  both  sides, 
and  left  lung  adherent  to  ribs  for  a large  space,  where  the  ball  was  found 
underneath.  Missile  had  ulcerated  through  the  intercostal  muscle  into  the  lung 
and  was  found  resting  against  the  diaphragm  at  the  bottom  of  a large  abscess 
which  contained  air  and  pus.  Pieces  of  clothing  and  bone  were  also  discovered 
in  the  diaphragm.  The  pathological  specimen,  showing  a wet  preparation  of  a 
jiortion  of  the  left  lung  adherent  to  sections  of  the  third,  fourth,  fifth,  and  sixth 
ribs,  is  represented  in  the  wood-cut  (ElG.  235),  and  was  contributed,  with  a 
history  of  the  case,  by  Acting  Assistant  Surgeon  Alfred  North.  [It  must  be 
understood  that  the  ball  entered  posteriorly  between  the  eighth  and  ninth  ribs,  on 
a level  with  the  sixth  rib  anteriorly.  The  description  of  its  course  is  not  very 
clear.  If  it  did  not  fracture  the  rib,  whence  came  the  bits  of  bone  found  imbedded 


Pig.  23.5. — .Segments  of  anterior  portion  of  ribs, 
with  condensed  portion  of  nj'pcr  lobe  of  left  lung, 
with  a round  ball,  which  lay  against  the  diaphragm. 
Spec.  962,  Sect.  1,  A.  M.  HI. 


in  the  diaphragm  ?] 


Case. — Pritmte  Carl  Behling,  Co.  E,  26th  Wisconsin  Volunteers,  aged  22  years,  received  a gunshot  wound  through  the 
upper  lobe  of  the  left  lung,  at  Gettysburg,  Pennsylvania,  July  1st,  1863.  He  was  at  once  conve3’ed  to  the  hospital  of  the 
Eleventh  Corps,  where  he  remained  until  July  10th,  when  he  was  transferred  to  Jarvis  Hospital,  Baltimore.  When  admitted, 
he  was  suffering  from  a profuse,  exhausting  haemorrhage.  It  ceased,  but  recurred  on  the  23d,  continuing  for  two  hours.  On 
August  0th,  after  eating  a hearty  dinner,  he  was  about  to  walk  from  his  bed  to  the  door,  when  a sudden  and  profuse  hmmorrhage 
occurred.  Death  resulted  in  ten  minutes.  The  case  is  reported  by  Assistant  Surgeon  D.  C.  Peters,  U.  S.  A. 


Case. — Private  Medad  Beck,  Co.  G,  11th  Vennont  Volunteers,  aged  46  jmars,  was  wounded  at  Petersburg,  Virginia, 
April  2d,  1805,  by  a conoidal  ball,  which  entered  the  left  side  at  fourth  rib,  about  two  inches  from  sternum,  perforated  the  right 
lung,  and  emerged  below  the  inferior  angle  of  the  scapula.  He  was  treated  in  the  field  ho.spital  of  the  Sixth  Corps  until  April 
12th,  when  he  entered  Harewood  Hospital,  Washington.  On  admission,  the  injured  parts  were  in  tolerably  good  condition. 
The  patient,  however,  suffered  from  dj'spnoea,  extensive  emphysema  of  surrounding  cellular  tissues,  anxious  expression  of  counte- 
nance, and  s^-mptoms  of  pneumo-thorax.  Surgeon  E.  B.  Bontecou,  LL  S.  V.,  freely'  opened  tlie  chest  by  posterior  incision,  and 
removed  a large  amount  of  sanious  pus.  Supporting  treatment.  Patient  died  on  April  17th,  1865,  from  exhaustion.  Necropsy: 
Fourth  rib  fractured  anteriorly,  and  eighth  and  ninth  ribs  posteriorly'. 

Case. — Private  C.  Eobinson,  Co.  E,  8th  New  York  Heavy  Artillery,  aged  39  years, 
was  wounded  at  Cold  Harbor,  June  3d,  1864,  by  a conoidal  ball,  which  entered  the  left 
supra-clavicular  space,  and  emerged  one  inch  to  the  left  of  the  middle  dorsal  vertebras. 

He  was  treated  in  tlie  field  until  June  11th,  and  was  transferred  to  Lincoln  Hospital, 

Washington.  When  admitted,  his  condition  was  one  of  very  great  prostration;  suppu- 
ration profuse  and  sanious.  Simple  dressings  were  applied  to  the  wound.  Death  took 
place  on  June  21st,  1834,  from  exhaustion.  At  the  necropsy,  the  ball  was  found  to  have 
entered  the  left  supra-clavicular  space,  passed  downward  through  the  thoracic  cavity,  and 
emerged  in  the  middle  of  the  dorsal  region,  one  inch  to  the  left  of  the  eighth  vertebra, 
having  fr.actured  the  clavicle  one  and  a half  inches  from  its  articulation  with  the  acromion 
process,  also  the  first,  second,  third,  fourth,  fifth,  and  sixth  ribs,  close  to  their  attach- 
ment to  the  spine  and  grooved  the  posterior  surface  of  the  lung,  left  upper  portion.  On 
opening  the  body  the  veins  were  found  turgid  with  exceedingly  thin  blood,  which  flowed 
out  in  large  cpiantity.  The  right  lung  was  attached  to  the  wall  by  recent  adhesions,  and 
the  left  lung  by  older  adhesions.  The  left  cavity  contained  about  two  quarts  of  bloody 
.serous  fluid.  The  upper  lobe  of  the  right  lung  presented  two  large  bulloe,  filled  with 
thin  blood.  There  was  a wound  three  and  a half  inches  long  in  the  posterior  portion  of 
the  upper  lobe  of  the  left  lung.  The  base  of  the  lower  left  lobe  was  carnified.  The 

fractured  clavicle  and  injured  ribs  were  contributed  to  the  Museum,  with  the  foregoing  left  side,  with  plcuntic. adhesions  to  attaelu'd 
•’  too  portion  ot  lung.  Spec.  2630,  Sect.  I,  A.  M. 

memoranda,  bv  Acting  Assistant  Surgeon  H.  M.  Dean.  The  clavicle  is  No.  3460  in  the  M- 
Surgical  Section.  The  ribs  are  represented  in  the  accompanyitig  wood-cut  (Fig.  233). 

The  next  case,  of  a survival  for  seven  years  of  an  alleged  lodgment  of  a shell 
fragment  in  the  substance  of  the  left  lung,  is  followed  by  an  abstract  of  a chest  wound 
believed  to  have  been  caused  by  an  explosive  musket-ball ; which  is  succeeded  by  a very 
remarkable  case  of  recovery  after  the  passage  of  a large  projectile  through  the  cavity  of 
the  right  chest; 

Ca.se.  Private  Patrick  F . Bushell,  Co.  L,  5th  Lnitcd  States  Artillery,  .aged  30years,  was  wounded  .at  Winchestta’,  Virginia, 
September  5th,  1864,  by  a fragment  of  shell,  which  entered  over  thefoui'th  rib,  three  inches  to  the  left  of  the  median  line,  wounding 
the  upper  lobe  of  the  left  lung.  He  was  treated  in  the  field,  and  on  the  29th  sent  to  the  hosjiital  at  Sandy  Hook,  Maryland. 
Simple  dressings  were  applied  to  the  wound.  On  January  2d,  183.5,he  was  transferred  to  I’ort  Hamilton,  New  York  Harbor,  and 
discharged  from  service  May  12th,  1865.  Pension  Examiner  .1.  H.  Oliver  repoUs,  December  10th,  1867;  statement  of  ])ensioner; 
Shell  wound  ot  left  breast,  throwing  him  from  his  horse  and  rendering  him  insensible  for  about  four  days.  I’rofuse  lucmorrh.ago 


Fig.  23(1. — .Segments  of  finst  six  ribs  of 


494 


AVOUNPS  AND  INJURIES  OF  TTIE  CHESTr 


[CHAP.  V, 


occiirml  from  the  lung  ami  wound.  That  from  the  Inng  lias  continued,  modified,  almost  daily,  up  to  present  time;  also  cough 
expectoration,  dull  pain,  and  a sense  of  stricture  through  the  left  thorax.  Breathing  difficult.  I’alpitation  of  the  heart,  impaired 
appetite  and  physical  debility.  The  cough  has,  in  a measure,  ceased,  and,  though  feeble,  he  has  partially  regained  his  strength. 
On  examination,  an  irregular  cicatrix  and  a superficial  depression  were  found  near  the  anterior  extremity  of  the  left  third  rib, 
looking  as  if  the  bone  had  been  driven  in.  He  supposes  a fragment  of  shell  penetrated  the  cavity  at  that  point  and  lodged  within 
the  substance  of  the  lung,  where  it  still  remains.  Auscultation  and  percussion  indicate  lesion  in  the  lower  part  of  the  left  lung. 
Tongue  furred;  skin  clammy,  with  tendency  to  night  sweats.  I’ension  Examiner  J.  M.  Adler  reports,  June  8th,  1888,  the  ball 
entered  about  two  inches  above  the  left  nipple,  producing  compound  comminuted  fracture  of  the  fourth  rib.  Portions  of  bone 
w’ere  probably  forced  into  the  substance  of  the  lung ; consequent  inflammation  and  abscess  of  the  lung.  General  debility  and  great 
emaciation.  Hectic  fever,  night  sw’eats,  and  purulent  expectoration.  Occasional  haemorrhage  from  lung,  sometimes  of  a very 
profuse  character.  The  pensioner  was  last  paid  on  March  4th,  1872. 

. Case. — Private  Philo  T.  White,  Co.  I,  7th  Michigan  Volunteers,  aged  19  years,  was  wounded  at  Antietam,'  September  17th, 
1882,  by  an  explosive  ball,  which  entered  the  arm  above  the  elbow,  and  exploded  in  the  belly  of  the  pectoral  muscle,  making  a 
cavity  large  enough  to  admit  the  fist.  He  was  treated  in  the  field  by  simple  dressings,  with  anodynes,  until  the  27th,  when  he 
was  transferred  to  Master  Street  Hospital,  Philadelphia.  On  the  30th,  opisthotonos  occurred  and  was  regarded  as  a symptom  of 
tetanus.  Opium  was  administered  internally  and  externally,  and  carried  to  the  point  of  narcotization.  The  pupil  was  contracted 
to  the  size  of  a pin-hole  during  the  whole  treatment.  The  patient  made  a complete  recovery,  and  was  discharged  from  service 
on  December  19th,  1882.  Surgeon  Paul  B.  Goddard,  U.  S.  V.,  reported  the  case.  Examining  Surgeon  William  B.  Thomas,  of 
Ionia  County,  Michigan,  gave,  May  14th,  1833,  a different  account:  “Ball  entered  one  inch  external  to  the  sternal  articulation 
of  the  fourth  rib  on  right  side,  fractured  the  rib,  passed  into  the  cavity  of  the  thorax,  and  emerged  one  inch  below  the  axilla  of 
right  side.  Tlio  man  has  frequent  haemoptysis  and  cough.  Disability  one-half  and  temporary.” 

Case. — Major  G.  N.  Lewis,  12th  Connecticut  Volunteers,  was  wounded  May  27th,  1883,  at  Port  Hudson,  by  an  iron 
grape-shot,  one  and  a half  inches  in  diameter  and  a half  pound  in  weight.  This  shot,  being  deflected  from  a horizontal  course  to 
one  almost  vertical,  by  the  limb  of  a tree,  struck  the  patient  on  the  upper  surface  of  the  right  clavicle,  and  fractured' that  bone; 
then  taking  a course  downward,  backward,  and  toward  the  median  line  of  the  body,  plunged  through  the  apex  of  the  right  lung, 
emerging  from  the  chest  about  the  third  dorsal  vertebra,  and  in  contact  with  the  column.  Here,  meeting  the  resistance  of  the 
skin,  and  its  force  nearly  spent,  it  crossed  the  spine,  and  lodged  under  the  skin  on  the  left  side  near  the  fifth  dorsal  vertebra, 
whence  it  was  removed,  on  the  field,  by  Surgeon  M.  D.  Benedict,  7Cth  New  York  Volunteers.  There  was  considerable  primary 
haemorrhage,  and,  of  course,  great  prostration.  When  the  patient  had  rallied  he  was  sent  on  an  hospital  transport  to  New 
Orle.ans  and  placed  in  the  St.  James’s  Hospital,  in  charge  of  Assistant  Surgeon  J.  Homans,  U.  S.  A.,  on  May  29th.  Simple 
dressings  and  expectant  measures  w'ere  employed  until  the  inflammatory  symptoms  had  abated,  and  then  tonic  medicines  and  a 
suiqiorting  treatment  were  substituted.  On  July  19th,  the  patient  was  well  enough  to  take  the  steamer  for  New  York,  and  was 
furloughed.  He  remained  a month  in  Brooklyn,  taking  iron,  mineral  acids,  and  cod-liver  oil,  and  other  restoratives,  and  morjflda 
continuously,  and  then  went  to  his  mothePs  house  in  Middletown,  Connecticut,  and  came  under  the  cai’e  of  Dr.  John  Ellis 
Blake,  who  has  published*  an  instructive  history  of  the  progress  and  treatment  of  the  case.  His  narrative  is  freely  quoted  in 
this  abstract.  In  September,  1883,  Dr.  John  Ellis  Blake  found  the  patient  greatly  emaciated,  with  an  harassing  cough  and  profuse 

muco-purulent  expectoration,  with  great 
pain  in  the  right  chest,  with  diurnal  chills, 
night-sweats,  and  diarrhoea.  There  were 
many  of  the  rational  signs  of  advanced 
phthisis.  It  was  learned  that  an  exfoli- 
ation had  been  eliminated  on  the  voyage, 
and  an  examination  of  the  track  of  the 
ball  showed  that  it  had  become  con- 
verted into  a fistulous  canal  with  indu- 
I’ated  walls,  communicating  directly 
with  some  of  the  larger  bronchi,  and 
containing  fragments  of  bone.  A forced 
expii'ation,  with  the  mouth  and  nostrils 
closed,  caused  air  and  jets  of  pus  to  be 
expelled  from  the  orifices  of  entr.ance 
and  exit;  the  lung  having  formed 
adhesions  at  both  jflaces.  Pneumo- 
thorax had  existed,  but  the  lung  early 
resumed  its  functions,  and  was  scarcely 
at  all  collapsed  in  the  early  part  of 
August.  Dr.  John  Ehis  Blake  checked 

the  diarrhoea,  and  then  removed  a small  , Jf’  238.-Cicatris  of  exit  wound  in  the  same 
fragment  of  the  clavicle  from  the  anterior 
wound,  and  laid  open  the  subcutaneous  fistula  that  connected  the  point  at  which  the  shot  was  cut  out  between  the  left  fifth 
and  sixth  ribs,  and  that  of  its  emergence  from  the  thorax,  near  the  third  dorsal  vertebra.  Subsequently  the  posterior  opening 
of  the  true  sinus  was  enlarged,  and  fragments  of  bone  were  felt,  three  and  a half  inches  from  the  surface,  imbedded  in  fine  pulmonary 

^Blaicic,  (J.  E.)  Report  of  a Case  of  Grape-shot  Wound  of  the  Chest,  in  New  York  Medical  Journal,  VOL.  XIV,  p.  511. 


Fig.  2.57. — Cicafri.x  of  entrance  wound  of  a 
lialf-pound  grape-shot.  (From  a pliotograph.) 


Sect.  II.] 


GUNSHOT  WOUNDS  OF  BOTH  LUNGS. 


495 


tissue.  These  explorations  produced  extreme  irritation,  convulsive  cough,  and  hloody  expectoration.  Several  attempts  at 
extraction  were  made  at  intervals  of  several  days.  The  patient  refused  to  take  any  anaesthetic,  which  embarrassed  the  surgeon’s 
attempt  to  extract  the  larger  fragment.  Finally,  seizing  the  bone  with  dressing-forceps,  dividing  the  deep  tissues  with  a narrow- 
bladed  knife,  and  twisting  the  exfoliation  into  the  axis  of  the  sinus,  it  was  extracted.  A jirofuse  discharge  of  pus  poured  from 
the  opening,  but  there  was  very  little  hfeniorrhage.  Some  small  hits  of  bone  and  shreds  of  foreign  material  were  then  removed. 
There  were  two  subsequent  attacks  of  luemoptysis,  in  the  next  fortnight ; afterward  the  patient  convalesced  rapidly.  “The 
wound  remained  open  for  neai-ly  a year  from  its  recejition,  and  a small  stick,  three-eighths  of  an  inch  in  diameter,  could  be 
readily  thrust  through  the  body  without  causing  him  much  inconvenience,” — experiments  of  more  than  doubtful  utility,  interrupted 
by  the  closure  of  both  orifices  in  June,  18(14.  In  the  middle  of  October,*  promoted  to  a lieutenant-colonelcy,  this  brave  officer 
rejoined  the  Nineteenth  Corps,  .and  p.articipated  in  the  c.ampaign  in  the  Shenandoah  Valley.  The  long  impacted  piece  of  bone 
proved  to  be  a fragment  of  rib.  The  wood-cuts  (FiGS.  237,  238)  are  reduced  copies  of  those  inserted  in  Dr.  John  Ellis  Blake’s 
j)aper,  which  were  dr.awn  from  photographs.  On  August  12th,  18G5,  Lieutenant  Colonel  Lewis  was  honorably  mustered 
out  of  service.  Examining  Surgeon  J.  W.  Ellsworth,  of  Hartford,  December  2(!th,  1865,  gives  the  following  report  of  the 
case : “A  grape-shot  (presented),  weighing  one-fourth  of  an  ounce  less  than  half  a pound,  entered  about  the  right  clavicle  at 
the  point  of  ligation  of  the  subclavian  artery  as  it  passes  the  first  rib.  It  fractiu-ed  the  clavicle,  and,  passing  downward  and 
backward,  tore  up  the  ribs  and  was  extracted  between  the  scapulm.  The  right  lung  was  badly  wounded,  air  passing  through 
the  opening  for  a year.  At  present  the  health  is  better  than  could  be  anticipated.  Respiration  is  very  fixint,  all  over  the  back 
part  of  right  lung,  right  arm  quite  weak ; cough  at  times,  with  a good  de.al  of  tenderness  on  right  side  of  chest.  At  manual 
labor  he  could  scarcely  be  rated  as  capable  of  one-third  work.  Many  fragments  of  bone  were  removed  formerly',  leaving  a very 
bad  and  depressed  cicali-ice  between  the  scapulae.  Dis.ability  two-thirds,  and  to  a gi’eat  degree  permanent.”  This  officer  was 
pensioned,  and,  in  March,  1872,  his  name  was  still  borne  on  the  rolls,  and  no  change  for  the  worse,  in  his  health,  had  been 
reported. 

Gunshot  Wounds  of  both  Lungs. — Many  cases  were  reported  of  recovery  after  pene- 
tration of  both  lungs  by  gunshot  missiles.  That  life  may  be  prolonged  for  many  days 
under  such  circumstances,  has  been  unequivocally  demonstrated  by  dissections ; but  the 
probabilities  are  remote  of  anything  like  a permanent  restoration  to  even  a partial  degree 
of  health  after  such  an  accident.  The  well-known  fact  that  every  one  of  the  signs  of  lung 
injury  that  were  formerly  regarded  as  pathognomonic  may  exist  singly,  and  that  several 
of  them  even  may  co-exist  without  there  being  the  slightest  lesion  of  the  lung  tissue, 
should  admonish  the  observer  to  extreme  caution  in  committing  himself  to  a diagnosis  of 
penetration  of  both  lungs  by  a ball,  and  lead  liim  to  demand  the  proof  of  physical  as  well 
as  rational  signs  before  arriving  at  an  affirmative  conclusion.  The  following  cases  are  cited, 
but  the  writer  is  not  satisfied  that  the  evidence  in  any  of  them  is  incontestable.  Again  and 
again  he  has  received  from  professional  friends  photographs  representing  cicatrices  on  the  chests 
of  patients  in  whom,  had  the  missile  passed  in  a direct  line  from  one  to  the  other  wound, 
both  lungs  would  necessarily  have  been  transfixed.  But  the  proof  that  the  projectile  had 
pursued  this  course  was  wanting  or  defective,  and  the  surgeons  who  reported  these  cases 
have,  without  exception,  receded  from  their  earlier  convictions,  either  yielding  to  the  argu- 
ments suggested  by  reading  and  reflection,  or  to  the  more  cogent  evidence  afibi’ded  by 
necropsies  in  the  supposed  cases  of  recovery.  That  two  musket-balls  should  strike  opposite 
portions  of  the  two  sides  of  the  chest,  and  one  or  both  missiles  should  inflict  only  a flesli 
wound,  or  that  a ball  should  make  the  circuit  of  the  thorax  beneath  the  muscular  planes, 
or  should  run  around  the  costal  pleura  and  emerge  opposite  its  entrance, — these  occurrences, 
though  rare,  indisputably  take  place  and  are  not  extremely  infrequent,  and  they  aflbrd 
better  solutions  of  the  cases  recorded  in  this  group  than  the  supposition  that  the  functions 
of  both  lungs  can  be  so  seriously  impaired  as  gunshot  penetration  implies,  without  the 
supervention  of  fatal  asphyxia  at  a comparatively  early  period ; 

Case. — Private  R.  P.  Peck,  Co.  E,  114th  New  York  Volunteers,  was  wounded  at  Port  Hudson,  Louisiana,  .Tune  14tli, 
1863,  and  was  admitted  to  hospital  .at  Baton  Rouge  on  .Inly  6th.  'There  was  a gunshot  wound  of  both  lungs ; a conoidal  musket 
ball  having  entered  between  the  third  and  fourth  ribs,  two  inches  to  the  loft  of  the  sternum,  and  escaped  between  the  seventh 

''Report  of  the  Adjutant  General  of  Connecticut,  fur  18C3,  mentions  the  case  of  “ Major  Lewis,  severe  shot  through  body  ” (p.  142),  and  the  report 
of  the  same  officer,  for  J8G5,  states ; “ Lieutenant  Colonel  Lewis  reported  for  duty  October  15,  18C4.” 


496 


WOUNDS  AND  INJUEIES  OF  THE  CITEST. 


[ClLAT.  V, 


and  eighth  riba,  below  the  posterior  border  of  the  riglit  axilla.  This  man  was  transferred  to  the  Veteran  Reserve  Corps,  and 
w^s  subsequently  .admitted  to  liospital  at  Point  Lookout,  Maryland.  On  October  8th,  1864,  he  was  examined  by  a Medical 
Board,  of  which  Assistant  Surgeon  W.  H.  G.ardner,  U.  S.  A.,  was  president,  and  recommended  to  be  returned  to  duty.  Ilis 
general  health  and  condition  were  then  good;  there  was  no  evidence  of  lung  disease,  and  no  inconvenience  had  been  occasioned 
by  the  wound,  except,  according  to  the  p.atient’s  statement,  some  pain  in  damp  weather. 

Case. — Serge.ant  George  E.  Grover,  Co.  C,  3d  Maine  Volunteers,  aged  40  yeai’s,  h.aving  been  wounded  at  Manassas, 
Virginia,  on  August  30th,  1862,  was  sent  to  Washington,  and  admitted  to  Mount  Pleasant  Hospital  on  September  1st.  A conoidal 
ball  had  passed  through  the  right  arm,  thence  into  the  chest  near  the  right  nijiple,  through  both  lungs,  badly  injuring  them,  and 
fracturing  the  sternum,  emerged  outside  of  the  left  nipple.  Bleeding  from  the  lungs  occurred  on  September  8th,  9th,  and  10th. 
The  wounds  were  stopped  with  plugs  of  lint  and  dressed  simply ; brandy,  iron,  and  quinine  were  administered,  and  the  ]iatient, 
recovering,  was  discharged  from  service  on  May  20th,  1863,  and  pensioned.  A communication  ft’om  Pension  Examiner  J.  W. 
Toward,  under  date  of  September  30th,  1867,  reports  that  the  patient’s  sternum  is  quite  tender  and  sore.  He  has  raised  blood 
from  the  lungs  very  often.  The  lungs  are  very  painful  and  irritable ; there  is  severe  cough,  especially  on  lying  down,  and  <he 
patient  is  unable  to  perform  any  severe  manucfl  labor.  His  disability  is  rsited  total  and  probably  permanent. 

Case. — Corpor.al  W.  H.  Burns,  Co.  C,  6th  United  States  Cavalry,  was  wounded  at  the  b.attle  of  Beverlj'  Ford,  Virginia, 
June  9th,  1863,  by  a round  ball,  which  entered  immedi.ately  in  front  of  the  inner  third  of  the  left  clavicle,  passed  through  the 
apex  of  each  lung  and  lodged  beneath  the  right  scapula.  On  the  following  day  he  reached  the  Lincoln  Hospital  at  Washington, 
D.  C.,  where  he  remained  under  treatment  until  December  25th,  1863,  when  lie  was  discharged  from  service.  The  case  is 
reported  by  Assistant  Surgeon  J.  C.  IklcKee,  U.  S.  A.  On  July  15th,  1864,  the  man  was  examined  by  Dr.  Cameron,  pension 
examining  surgeon,  at  La  Crosse,  Wisconsin,  who  reports  his  right  shoulder  and  arm  atrophied  and  the  use  of  the  right  arm 
considerably  impaired;  also,  that  an  effort  had  been  made  to  extract  the  ball  through  an  incision  above  the  right  scapula,  and  that 
a number  of  splinters  of  bone  were  removed,  but  that  the  missile  could  not  be  found. 

Case. — Private  Albert  Ullman,  Co.  I,  51st  Ohio  Volunteers,  aged  22  years,  wtis  wounded  at  the  batlle  of  Jonesboro’, 
Georgiii,  August  30th,  1864,  by  a musket  b.all,  which  entered  the  left  shoulder  and  penetrated  the  thorax.  He  was  treated  .at 
various  hospitals  and  lastly  at  Camp  Dennison,  Ohio.  On  December  20th,  1664,  the  man  was  discharged  from  service,  the 
wound  having  resulted  in  partial  paralysis  of  the  upper  lobe  of  the  left  lung.  On  .lanuary  10th,  1865,  he  was  examined  by 
Enoch  Sapp,  pension  examining  surgeon,  at  Spring  Mountain,  Ohio,  who  reports  him  suffering  fiom  haemorrhage  of  the  lungs 
on  much  exertion;  also,  that  the  missile  entered  at  the  angle  of  the  left  scapula,  passed  through  the  left  lung,  and  is  lodged  in 
the  right  lung. 

Case. — Private  George  P.  Brown,  Co.  C,  1st  United  States  Sharp-shooters,  was  wounded  by  a musket  ball  tJirough  both 
lungs  at  the  battle  of  Chancellorsville,  Virginia,  May  3d,  1863.  On  the  retreat  of  the  Army  he  was  left  behmd  with  some  other 
wounded  men  under  charge  of  Surgeon  G.  P.  Oliver,  111th  Pennsylvania  Volunteers,  at  a log-house  in  the  vicinity  of  the  battle- 
field, where  he  remained  until  May  14th,  when  he  was  exchanged  and  removed  to  the  field  hospital  of  the  Third  Division,  Third 
Army  Corps.  About  two  weeks  afterward,  the  patient  was  allowed  to  leave  for  his  home  on  furlough,  and  on  October  3d,  1863, 
he  was  discharged  from  service  at  Boston,  Massachusetts.  Dr.  Charles  L.  Fisk,  pension  examining  surgeon,  at  Greenfield, 
Massachusetts,  reports,  under  date  of  April  27th,  1867,  at  follows;  Ball  entered  right  side  at  eighth  rib,  posterior  to  the  nipjile, 
passed  through  the  lungs,  .and  escaped  on  the  other  side  of  the  chest,  exactly  opposite  the  point  of  entrance.  He  also  states  that 
his  right  side  swells  ; that  he  cannot  make  much  exertion,  has  cough,  and  can  sleep  only  in  a semi-sitting  posture;  that  he  also 
suffers  from  dyspnoea  on  exertion,  and  a great  deal  of  paiu  in  the  right  side  and  shoulder.  He  further  repoi  ts  that  i-ibs  were 
fractured  on  both  sides  and  are  badly  united. 

Case. — “The  patient  was  Harvey  McGuire,  at  the  time  a private  or  non-commissioned  officer  (sergeant,  perhaps)  of  the 
44th  Tennessee  Regiment,  a native  Tennesseean,  about  40  years  of  age,  and  of  stout,  wiry  make,  weighing,  I suppose,  one 
hundred  and  sixty  pounds.  It  was  in  June  of  1864,  in  front  of  Petersburg,  Virgini.a,  he  was  wounded,  the  missile  being  supposed 
to  be  from  a Whitworth  rifle.  The  bullet  passed  into  one  axilla  and  out  at  the  other,  fracturing  a rib  at  the  entrance  and  exit. 
From  the  orifice  of  exit,  I removed,  when  he  was  brought  in,  several  small  fragments  and  spioulae  of  bone.  When  I first  saw 
him,  some  two  hours  after  receiving  his  wound,  he  was  laboring  under  great  dyspnoea,  and  at  every  few  inspirations  coughing 
and  spitting  out  mouthfuls  of  frothy  blood.  Auscultation  revealed  in  the  track  of  the  wound,  entirely  across  the  chest,  loud 
moist  rMes.  To  sum  up  the  case,  he  recovered,  and  though  for  six  or  eight  months  was  subject  to  slight  brnmoptysis  on  violent 
exercise,  that  I did  not  believe  he  would  be  returned  to  ranks  any  more,  yet  he  remained  with  the  command,  I think  attached  to 
the  wagon  train,  and  was  with  us  at  the  surrender  at  Appomattox  Court-house.  The  year  following  the  close  of  the  war,  he  was 
living  somewhere  near  Fayetteville,  Tennessee,  from  which  pl.ace  he  wrote  me  a letter,  in  which  he  said  that  he  had  fully 
recovered  his  health  and  was  able  to  undergo  active  exercise  with  impunity.”  Dr.  J.  D.  Jackson,  of  Danville,  Kentucky, 
communicated  the  foregoing  case  in  a private  letter  to  the  compiler. 

Case. — Sergeant  IF.  J.  Carder,  Co.  F,  4th  Mississijipi  Regiment,  was  wounded  at  the  battle  of  Kenesaw  Mountain,  June 
27th,  1864,  by  a conoidal  ball,  which  entered  under  the  pectoral  muscle  of  the  left  side,  passed  through  the  breast,  .and  emerged 
between  the  second  and  third  ribs,  about  three  inches  to  the  right  of  the  sternum.  On  June  30th,  he  was  admitted  to  the 
Fifteenth  Army  Corps  Field  Hospital,  at  Barton’s  Iron  Works,  Georgia.  On  his  admission  to  hospital,  the  wound  looked  well 
and  the  patient  felt  comfortable;  cold-water  dressings  were  applied,  and  the  patient  continued  to  feel  comfortable  until  July  4th; 
that  evening,  the  wound  luaving  bled  considerably  while  being  dressed,  he  was  attacked  with  a severe  chill.  On  the  morning 
of  the  5th,  he  was  much  prostrated,  he  breathed  with  difficulty,  and  perspired  profusely ; his  pulse  was  slow,  but  regular ; 
stimulants  ordered.  In  the  evening  he  seemed  better,  but  had  another  chill  during  the  night.  On  July  6th,  his  respiration  was 
very  rapid  and  difficult,  and  his  pulse  fast  and  flickering;  he  felt  but  little  pain  and  that  mostly  in  his  bowels.  He  continued 


.Sl-CT.  II.] 


TIIKATMKXT  T!Y  IIKRMKTICAIJ.Y  SEALING. 


■497 


to  sink,  and  diod  at  11  A.  51.,  Jnly  (itli,  1804.  Tin-  antojisy  slinwod  tliat  tlio  ball  bad  cut  tlie  snporior  lobe  of  tin;  loft  lung, 
divided  the  sternum  tbrongh  tbe  niannbrinin,  and  cut  very  slightly  the  sn|)orior  lobe  of  the  right  lung.  In  the  left  half  of  the 
thoracic  cavity  the  lung  was  collapsed  and  the  cavity  filled  with  blood,  mostly  coagnlated,  while  but  a small  clot  was  found 
in  the  right  thoracic  cavity.  The  other  organs  were  normal.  Acting  Assistant  Surgeon  IL  II.  McKay  reported  the  case. 

The  last  case  proves  unequivocally  that  a patient  may  survive  a serious  shot  wound  of 
both  lungs  for  nine  days  at  least.  Of  the  many  cases  returned  as  shot  iterfo rations  of  hoth 
lungs,  this  is  the  only  one  in  which  an  autopsy  was  made  at  so  long  an  interval  from  the 
reception  of  the  injury.* 

Hermetically  Sealing. — It  has  been  often  remarked  that  the  histories  of  all  inventions 
and  innovations  have  tliis  in  common,  that  it  is  customary  first  to  deny  their  utility,  and,  if 
this  is  estahlished,  to  contest  their  originality.  Its  advocates  believe  that  the  })lan  of 
hermetically  closing  penetrating  gunshot  wounds  of  the  chest,  proposed  by, Assistant  Surgeon 
Benjamin  Howard,  U.  S.  Army,  has  shared  this  fate  of  successful  discovery,  and  now 
deserves  the  merit  accorded  to  useful  advances  in  surgery.  The  subject  has  been  the 
occasion  of  much  discussion,  and  it  is  proposed,  to  enable  the  reader  to  judge  impartially, 
to  place  before  him  all  the  evidence  on  the  subject  that  has  been  obtained  by  this  Office. 
It  will  not  be  a work  of  supererogation  or  an  unnecessary  occupation  of  space  to  show 
conclusively  that  what  has  been  bruited  abroad  as  the  American  Plan  of  treating  gunshot 
penetrating  wounds  of  the  chest,  was  fairly  tested  during  the  war,  and  its  indiscriminate 
application  found  to  be  pernicious. 

On  June  25th,  1863,  Assistant  Surgeon  Howard  addressed  a letter  to  Surgeon 
General  Hammond,  in  which  he  “respectfully  submits  a new  mode  of  treatment  of  Gunshot 
and  penetrating  wounds  of  Chest  and  Abdomen,  requesting  that  necessary  arrangements 
be  made  to  enable  him  to  test  its  merits  at  the  earliest  opportunity.”  The  letter  is  as 
follows : 

Sir  : I Lave  tbe  honor  to  submit  for  your  consideration  tbe  following  mode  of  treatment  of 
gnnsbot  and  penetrating  wounds  of  tbe  chest  and  abdomen  in  which  suppuration  has  not  com- 
menced. All  foreign  bodies  within  reach  having  been  removed,  and  bleeding  of  the  wound  having 
ceased,  if  it  be  from  gunshot,  pare  the  edges  of  tlie  wound  all  round  as  in  the  operation  for  vesico- 
vaginal fistula;  bring  the  opposite  edges  together,  and  retain  them  in  accurate  apposition  by 
metallic  sutures;  carefully  dry  the  wound  and  xiarts  immediately  surrounding ; place  thereon  a 
few  shreds  of  charpie  arranged  crosswise  after  the  manner  of  warp  and  woof;  pour  on  tlie  charpie 


* “If  both  lungs  be  wounded  at  the  same  time,’'  says  ]\Ir.  Erichsen  {Science  and  Art  of  Surgery^  Vol.  I,  j>.  317).  “ the  result  is  almost  inevitably 
fatal,”  but  enough  cases  are  on  record  to  prove  that  the  double  injury  is  not  necessarily  fatal  either  from  haemorrhage  or  collapse  of  lungs  and 
aspljysia.  Hut  in  a somewhat  extensive  examination,  I lind  veiy  few  allusions  to  this  form  of  injury.  It  is  true  that  Sir  Evkuard  lIOilK  has  given 
( Trans,  of  a Society  for  the  Improvement  of  Med.  and  Chir.  Knowledge,  London,  1800,  Vol.  II,  p.  171)  an  account  of  a case  in  which  he  traced,  thirty- 
two  years  alter  the  injury  had  been  received,  the  course  of  a ball  from  where  it  entered  the  left  lung  through  the  upper  lobe  of  the  right  lung.  Hut  I 
believe  Sir  E.  Horae's  explorations  enjoy  little  credit  among  his  countrymen.  DemmE  (Miliidr-Chirurgische  Studien,  'Wurzburg,  1804, 

p.  158)  records  10:1  cases  of  gunshot  wounds,  with  orifices  of  entry  and  emergence,  of  which  eleven  were  examples  of  lesions  of  both  lungs.  Of  the 
latter,  nine  proved  fatal.  MaCLEOD  {op.  cit.  p.  240)  observes : “ Of  wounds  penetrating  both  sides  of  the  chest,  I met  with  four  examples  only.  In  all 
these  the  wound  was  inflicted  by  grape,  and  all  died  in  a short  time.”  Gant,  F.  J.,  Science  and  Practice  of  Surgery,  London.  1871,  p.  883),  says: 
“ Wound  of  b.Rh  lungs  simultaneously  is  pr.iportionately  more  dangerous ; and  principally  owing  to  double  pneumothorax,  with  collapse  of  the  lung, 
inducing  more  complete  asphyxia.  Recovery  is,  however,  an  occasional  termination,  even  in  such  cases.”  Hut  these  dicta  appear  to  be  suggested  by 
inference  ratlier  than  (>bscr\'ation.  L>r.  Frazer  {op.  cit.,  p.  52)  mentions  a case  of  a gunshtd  w<mnd,  opening  both  cavities  of  the  chest  and  wounding 
one  lung.  The  patient  lived  three  days.  Surgeon  C.  S.  Woods,  Gfith  New  York  Volunteers  {Appcjidix  to  Part  /,  Med.  and  Surg.  Hist.,  p.  88),  says 
that  after  Fair  Gaks  “ a few  patients  recovered  where biAh  lungs  were  traversed  by  the  same  ball.  T'hey  were  doing  remarkably  well  when  transferred  to 
general  h(;spital.”  It  is  mai^'ollous  that  several  such  exce[)tional  recoveries  should  occur  after  <me  action  within  the  personal  observation  of  a single 
surgeon,  and  implies  a liugc  number  of  chest  wounds  under  his  charge.  Dr.  J.  Mason  Warren  records  a case  (op.  cit.,  p.  5fi4,  case  331))  of  a ^^Pistol  hall 
passing  through  Lungs.''  The  missile  “passed  directly  through  the  right  side  of  the  chest,  and  lodged  under  the  integuments  tif  the  back.”  There 
was  dyspncea,  faintness,  lixonoptysis,  and  extreme  mental  depression.  After  reassuring  langimge,  an<l  the  administration  of  stimulants.  Dr.  Warren 
removed  the  bullet.  The  jiatient  “eventually  recovered  after  an  attack  of  jileiiritis  and  pneumonitis.”  This  case  should  jirobably  be  classed  with 
those  at  the  beginning  of  this  subsection,  as  a perforation  through  the  intercostal  spaces.  At  least  there  is  not  the  slightest  evidence  of  injury  to  the  left 
lung,  and  the  author  must  have  used  the  plural  inadvertently. — COMITLEII.  .Sec  also  IIE.M.MAN',  J.  A,,  Medicinisch  chirurgischc  Anfsdtze,  Berlin,  1778  ; 
and  SCIII.ICHTING,  .1.  I).,  Trauniatologia  nora  antigiia,  Ainstenlam,  17.51. 

g;j 


498 


WOUNDS  AND  INJUIIIES  OF  THE  CHEST. 


[Chap,  V, 


few  drops  of  collodion  so  as  to  saturate  it  and  form  a sort  of  collodion  cloth  ; let  it  dry ; then 
ai)pl,v  one  or  two  additional  coats  of  collodion  with  a camel  hair  pencil,  and  repeat  the  process  until 
satistied  that  the  wound  is  hermeticaJhj  sealed.  A dossil  of  lint  may  then  be  applied  over  it  as  a 
compress,  secured  by  adhesive  straps  and  roller  bandajte.  The  natural  condition  of  the  parts  is 
now  approximately  restored;  the  lung  is  suspended  in  a closed  cavity;  the  volume  ot  air  admitted 
while  the  w ound  was  open  soon  becomes  absorbed,  and  the  lung  is  again  at  liberty  to  expand  freely. 
Tlie  most  distressing  symi)tom,  dyspnoea,  is  relieved  immediately.  At  the  hospital  of  the  2d 
division.  Fifth  Corps,  I applied  this  dressing  to  two  cases  of  gunshot  wounds  of  the  chest,  several 
days  after  they  were  received  at  the  battle  of  Chancellorsville,  both  of  them  suffering  greatly  from 
dyspnoea.  In  both,  the  symptoms  were  alleviated  at  once,  and  the  next  day  one  said  he  felt  quite 
well,  and  the  other  continued  to  feel  better ; the  next  day  they  were  sent  to  general  hospital  and 
were  lost  sight  of.  Siq)pnratiou,  which  is  apt  to  be  so  excessive  and  foetid  in  consequence  of  the 
admission  of  constantly  renewed  currents  of  atmospheric  air,  promises  to  be  prevented  or  very 
much  modified  in  extent  and  character.  The  coagulated  blood  in  the  pleural  cavity,  w^hich  becomes 
decomposed  and  foetid,  producing  a direct  depression  of  the  vital  powers,  is  reduced  to  a simply 
mechanical  inconvenience,  and  gradually  becomes  absorbed.  The  dressing  is  economical  in  point 
of  time  as  it  is  quickly  applied,  and  may  seldom  need  renewing.  In  the  case  of  a private  of  the 
18th  United  States  Infantry,  in  which  I used  this  dressing,  in  1801,  for  the  first  time,  for  bayonet 
wound  of  the  abdomen,  it  remained  intact  until  after  the  wound  had  entirely  healed.  It  is  simple 
and  cleanly,  and  if  successful  will  prevent  the  patient  becoming  obnoxious  to  himself  and  to  all 
around  him.  If  this  mode  of  treatment  were  carried  out,  I believe  the  fatality  of  these  wounds 
Avonld  be  greatly  diminished.  I have  been  unable  to  demonstrate  the  value  of  this  treatment,  as 
every  case  but  one  (which  w'as  remarkably  successful)  has  been  sent  away  to  some  hospital  where 
the  dressing  has  invariably  been  removed  and  replaced  by  water  or  other  dressing.  I therefore 
respectfully  request  that,  if  it  meet  your  approbation,  such  arrangements  be  made  as  Avill  enable 
me  on  the  first  opportunity  fairly  to  test  the  value  of  this  plan  of  treatment.  The  medical  director 
of  this  corps,  and  the  medical  directors  of  the  two  divisions,  coincide  with  me  as  to  the  probable 
success  of  this  treatment,  and  as  far  as  they  are  able  will  generously  assist  me  in  carrying  it  out. 
At  the  next  engagement,  my  duties  will  require  me  to  be  occasionally  at  both  the  division  hospitals 
of  the  corps,  where  the  medical  director  of  corps  kindly  proposes  that  I treat  a given  number  of 
these  cases  separately.  I would  respectfully  request  that  I may  be  enabled  to  superintend  the 
subsequent  treatment  of  a certain  number  of  cases  and  report  to  jmu  the  result.*’  * * * 

The  permission  requested  having  been  accorded,*  Assistant  Surgeon  Howard  soon  had 
opportunity  to  practice  his  method,  especially  after  the  great  battle  of  Gettysburg,  which 
was  fought  shortly  afterward.  Other  surgeons  adopted  the  practice  recommended  by  Dr. 
Howard,  and  the  treatment,  as  applied  to  gunshot  penetrating  wounds  of  the  chest,  was 
employed  in  a large  number  of  cases.  It  has  been  sought  to  collect  all  the  cases  thus  treated 
at  Gettysburg  and  later  engagements,  and  though  this  object  may  not  have  been  fully 
attained,  yet  a sufficient  number  have  been  collected  to  afibrd  a fair  average  of  results.  Dr. 
Howard  and  the  other  operators  necessarily  lost  sight  of  many  of  their  patients  before  the 
conclusion  of  the  treatment,  but  in  such  instances  the  progress  and  termination  of  the  cases 
have  been  ascertained  from  hospital  records.  Dr.  Howard  had  the  kindness  to  furnish  the 
compiler  of  this  work,  in  1864,  wdtli  the  list  of  such  patients  as  he  had  been  unable  to  trace. 
The  results  of  all  of  these  have  been  determined. 

The  successful  cases  will  be  first  enumerated,  and  then  those  that  ended  fatally.  It 
has  been  necessary  to  abbreviate  the  abstracts  greatly,  but  when  evidence  of  lesion  of 
the  lung  tissue  was  recorded,  that  fact  has  never  been  omitted.  Where  the  abstracts  are 


*TUe  endorsement,  signed  by  Surgeon  J.  R.  Smith,  U.  S.  A.,  by  order  of  the  Surgeon  General,  was  as  follows:  “ Re.spcctfully  returned  thro’ 
Surgeon  Letterman.  The  Surgeon  General  desires  that,  at  the  next  battle  of  the  Army  of  the  Potomac,  Assistant  Surgeon  Howard  bo  placed  in  charge 
of  a Held  hospital  for  the  treatment  of  wounds  of  the  cliest  and  abdomen.  If  necessary  to  sen<l  those  cases  fi;om  the  Army  he  may  bo  sent  with  them.” 


Skct.  II.] 


TREATMENT  BY  HERMETICALLY  SEALING. 


499 


accredited  to  tlie  operator  or  other  reporter,  it  is  not  intended  to  imply  that  his  language  is 
employed,  or  that  the  result  of  the  case,  or  other  important  facts,  may  not  have  been  sup- 
plied from  other  sources. 

Case. — Private  John  Erlee,  Co.  A,  12th  United  States  Infantry,  received  a gunshot  rvound  of  the  right  lung  at  Chancel- 
lorsville,  Virginia,  May  3d,  1863.  The  wound  was  liermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.,  at  the  hospital 
of  the  2d  division.  Fifth  Corps.  Erlee  was  returned  to  duty  on  July  12th,  1863.  He  is  not  a pensioner.  The  case  is  rejairted 
hy  the  operator. 

Case. — Private  George  Loin’,  Co.  K,  12th  United  States  Infuntry,  was  wounded  .at  Gettyishurg;  the  hall  struck  the  right 
eliest.  below  and  to  the  right  of  the  nipple,  entered  the  cavity,  and  was  extracted  in  the  back.  He  was  at  once  taken  to  the 
hospital  of  the  Fifth  Corps,  where  the  wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  On  July  24th, 
he  was  transferred  to  Mulberry  Street  Hospital,  Harrisburg,  and,  on  September  Gth,  h-  the  hospital  at  Fort  Columbus,  New  York 
Harbor,  whence  he  was  returned  to  duty  on  November  nth,  1864.  The  Pension  Examining  Board  at  St.  Louis,  Missouri,  reports, 
March  2d,  1870,  that  the  pensioner  sufi'ers  from  adhesion  of  the  jJeura  jiuhnonalis  of  right  side,  pain  in  right  lung,  dullness  on 
j)crcussion,  cough,  and  general  debilit}’,  which  is  greatly  aggravated  by  cold  and  exposure.  The  case  is  reported  by  the  ojierator. 

Case. — Private  . Frederick  Hoffman,  Co.  G.  14fh  LTnited  States  Infantry,  received  a gunshot  penetrating  wound  of  the 
right  chest  at  Gettysburg,  July  3d,  1863.  The  hall  entered  on  the  left  side  of  the  lumbar  vertebrae  and  emerged  at  the  right  side 
of  the  lower  doreal  vertebrae.  He  was  taken  to  the  hospital  of  the  Fifth  Corps,  where  the  wound  was  hermetically  sealed  by 
Assistant  Surgeon  B.  Howard,  U.  S.  A.  On  July  20th,  he  was  transferred  to  the  hospital  at  York,  Pennsylvania,  whence  he 
was  transferred  to  Foi’t  Trumbull,  Connecticut,  Hecemher  18th,  1863,  for  assignment  to  the  Veteran  Reserve  Corps.  He  was 
discharged  from  service  on  February  19th,  1865.  Pension  Examiner  E.  E.  Watson  reports,  February  Gth,  1871,  that  “Hoffman 
cannot  use  much  exertion  ; draws  his  legs  after  him  rather  than  lifts  them  up  ; sutlers  a good  deal  of  pain  in  the  back,  and  is  not 
able  to  carry  anything  heavy.”  The  case  is  reported  by  the  operator. 

Case. — Pi’ivate  Monroe  P.  Sanders,  Co.  F,  93d  Pennsylvania  Volunteers,  aged  17  ja'ars,  was  wounded  at  the  Wilderness, 
Virginia,  May  5th,  1864,  by  a conoidal  ball,  which  fi’actured  the  clavicle  of  the  right  side,  passed  through  the  right  lung,  and 
enrei’ged  immediately  under  the  right  scajrula.  He  was  taken  to  the  hospital  of  the  2d  division,  Si.xth  Corps,  where  the  wound 
was  hermetically  sealed  by  Assistant  Surgeon  B.  Howai'd,  U.  S.  A.  Oir  M.ay  25th,  he  was  transferred  to  Lincohr  Hospital, 
Washington,  and,  on  July  19th,  to  Mower  Hospital,  Philadelphia.  When  admitted,  both  wounds  had  healed  ; fi’acture  united. 
Patient  stooped  a little,  and  could  irot  take  a full  ins])iration  on  the  right  side.  He  was  transfei’red  to  the  118th  company,  2d 
battalion.  Veteran  Reserve  Corps,  Januar’y  27th,  1865,  atrd  discharged  from  service  on  May  29th,  1885.  Petrsiotr  Examiner 
George  P.  Liueweaver  reports,  June  10th,  1869,  that  “the  posterior  wound  is  unhealed  atrd  coirstantly  discharging.  He  has 
cough,  with  cxpectoratiorr  of  ntiicus,  and  complains  of  difficulty  of  respiration.  Disability  total  and  permanent.” 

Case. — Private  William  E.  Stouffer,  Co.  E,  184th  Pennsylvania  Volunteers,  aged  17  years,  was  wounded  at  Petershirrg, 
Virginia,  June  22d,  1864,  hy  a conoidal  ball,  which  entered  the  right  pectoralis  major  mrtscle,  and  emerged  at  the  lower  angle 
of  the  scapula,  perforating  the  cavity  and  lung.  He  was  takerr  to  the  hospital  of  the  2d  division.  Second  Corps,  where  the 
wound  was  hermetically  sealed  hy  Assistarrt  Surgeon  B.  Howard,  U.  S.  A.  On  July  16th,  he  was  sent  to  Sixteenth  and  Filbert 
Streets  Hospital,  Philadeljrhia,  whence  he  W’as  transferred  to  the  Veteran  Reserve  Corps  on  January  25th,  1835,  and  assigned  to 
duty  at  Satterlee  Hospital.  Surgeon  Charles  I’age,  U.  S.  A.,  reports,  December  22d,  1868 : “ Stouffer  has  now  enlisted  for 
special  service  at  the  artillery  school  of  Fort  Monroe.  His  present  condition  is  one  of  robust  health,  cheeks  ruddy,  and  muscles 
firm  and  well  devHlo])ed.  The  respiratory  murmur  is  perfect  in  the  vicinity  of  the  wound,  at  least  I can  detect  no  al)normal 
sounds,  and  there  is  perfect  resonance  on  i)ercussion.  His  chest  measures  29-i-  inches,  and  expands  to  32-|-  inches.”  A communi- 
cation from  Surgeon  John  E.  Summers,  U.  S.  A.,  dated  Fort  Itlonroe,  Virginia,  April  20th,  1872,  states  that  no  ti’ace  of  this  man 
can  be  found  on  the  records  of  that  post. 

Case. — Private  Thomas  Larkin,  Co.  F,  70th  New'  Y'ork  Volunteers,  w'as  wounded  at  Manassas  Gap,  July  23d,  1863,  by  a 
musket  hall,  which  entered  between  the  fourth  and  fifth  ribs  of  the  right  side,  passed  upward  and  obliquely  backward  through 
the  left  lung,  and  emerged  near  the  left  shoulder.  The  wounds  were  dosed  by  silver  sutures,  and  hermetically  sealed  on  the 
field  hy  Assistant  Surgeon  B.  Howard,  U.  S.  A.  The  anterior  wound,  however,  opened  during  the  patient’s  conveyance  to 
Washington.  He  was  admitted  into  Mount  Pleasant  Hospital  on  July  30th,  1833,  at  which  time  there  was  pain  in  the  left  side; 
some  cough,  with  expectoration  of  bloody  sputa  ; a tolerably  full  pulse  at  90  per  minute;  and  a free  and  healthy  discharge  from 
the  wound.  The  pain  and  cough  yielded  readily  to  the  treatment  adopted;  the  w'ound  healed  rapidly,  and,  at  the  end  of  three 
week.s,  thediatient  was  dismissed  from  further  medical  attention,  and  returned  to  duty  on  August  21st,  1863.  The  case  is  rejwrtc^d 
hy  Assistant  Surgeon  C.  A.  McCall,  U.  S.  A.  This  soldier  has  not  applied  for  a pen.sion. 

Case. — Sergeant  Frank  C.  Jones,  Co.  B,  64th  New  Y’ork  Volunteers,  aged  22  years,  was  wounded  at  Spottsylvania, 
VirgiTiia,  May  12th,  1864,  by  a conoidal  ball,  which  entered  the  left  axilla,  passed  down  the  back  part  of  the  chest,  and  emerged 
to  the  right  of  the  spine,  near  the  eleventh  dorsal  vertebra,  striking  its  spinous  process  and  injuring  the  posterior  ])ortion  of  the 
left  lung.  Ho  was  at  once  taken  to  the  field  liospital  of  the  1st  division,  Second  Coi'ps,  where  the  wound  was  hermetically  sealed 
hy  Assistant  Surgeon  B.  Howard,  U.  S.  A.  On  May  25th,  he  was  sent  to  Emory  Hosjjital,  Washington.  Water  dressings  were 
apjdied.  He  was  furloughed  on  June  1st,  and  remained  at  home  for  six  months,  during  which  time  he  was  commissioned  as 
lieutenant.  He  returned  to  duty,  was  commissioned  as  captain,  and  remained  with  his  regiment  until  final*  imister-out,  May  8th, 
1865.  Pension  Examiner  YVilliam  Loughridge  reports,  December  9th,  1838,  that  “the  injury  was  followed  by  ha'inorihage  and 
inflammation  of  the  lungs.  He  still  suffers  from  frequent  attacks  of  inflammation  of  the  left  lung  and  from  the  in  jury  to  the  spine, 
and  is  incapacitated  from  peiforming  any  kind  of  manual  labor.”  4’he.  case  is  reporttsl  by  the  openitor. 


WOUNDS  ANT)  INJUITIT'.S  OF  TITT:  OIIEST, 


[Chap.  V, 


500 

Cash. — Private  Francis  McCaTic,  Cn.  A,  l/th  Iniited  States  lutantrv,  aged  23  years,  was  wounded  at  Spottsylvania, 
Virginia,  l)y  a conoidal  ball,  which  entered  about  three  inches  below  the  middle  of  the  left  clavicle,  passed  through  the  chest,  and 
emerged  about  the  centre  of  the  scapula,  lie  was  at  once  taken  to  the  hospital  of  the  1st  division.  Fifth  Corps,  where  the  wound 
was  hermetically  sealed  by  Assistant  Surgeon  U.  Howard,  U.  S.  A.  On  May  Mth,  he  was  transferred  to  Cohunbian  Hospital, 
'Washington.  Simple  dressings  were  applied.  He  was  sent  to  New  York  on  August  3d,  and  discharged  from  service  on  August 
25th,  1834.  I’ension  Examiner  Tiieodore  11.  Jewett  rcj)orts  that  '■  the  left  .arm  is  helidess  and  the  left  lung  damaged.  He  will 
probably  recover  in  time.”  The  case  is  rejiorted  by  the  operator. 

Case. — Corporal  IMichael  Cunningham,  Co.  F,  1st  Ihiited  States  Sharp-shooters,  aged  21  years,  received  a gunshot 
penetrating  wound  of  the  left  side  of  the  thorax  at  the  Vfilderness,  Virginia,  May  5th,  18154.  He  was  conveyed  to  the  hospital 
of  the  3d  division.  Second  Corps,  where  the  wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  Ho 
was  transferred,  on  May  25th,  to  the  1st  division  hosj)ital,  Alexandria;  on  June  5th,  to  Lovell  Hospital,  Portsmouth  Grove, 
Khode  Island,  and,  on  September  25th,  to  Baxter  Hospital,  Burlington,  Vermont,  whence  he  was  returned  to  duty  on  October 
23th,  1834.  He  is  not  a pensioner.  Tiie  case  is  rej)orted  by  the  operator. 

Case. — Corporal  Joseph  Loll,  Co.  K,  63d  Pennsylvania,  was  wounded  at  Chancellorsville,  May  3, 18G3,by  a musket  ball, 
which  perforated  or  penetrated  the  left  lung.  The  wound  was  hermetically  sealed  on  the  field  by  Assistant  Surgeon  B.  Howard, 
U.  S.  A.,  after  which  he  was  conveyed  to  the  field  hosj)ital  of  the  1st  division,  Third  Corps.  On  May  7th,  ho  was  transferred  to 
St.  Aloysius  Hosjtital,  Washington,  and  returned  to  duty  on  September  16,  1833.  He  is  not  a pensioner. 

Case. — Corpor.al  Peter  Welker,  Co.  A.,  1st  United  States  Sharp-shooters,  was  wounded  at  Manass.as  Gap,  July  23d,  1363, 
by  a conoidal  musket  b.all,  which  entered  above  the  right  nipple,  between  the  fourth  and  fifth  ribs;  p.assed  through  the  hmg  and 
emerged  at  the  inferior  border  of  the  scapnha,  fracturing  at  the  same  time  the  sixth  rib.  The  wounds  were  hermetically  sealed 
on  the  field  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  The  patient  was  sent  to  Washington,  and  admitted  into  Mount  Pleasant 
Hospital,  July  30th,  sufi'ering  from  i)ain  in  the  right  hmg  and  some  dyspnoea,  otherwise  doing  well.  The  dyspnoea,  attended 
with  pain,  increased  almost  to  sutlbcation;  i)ulse  becoming  greatly  .accelerated  until  the  night  of  July  31st,  when  the  posterior 
dressing  burst  open,  and  a profuse  discharge  of  clotted  blood  and  purulent  matter  took  phace;  a similar  collection,  amounting  to 
ne.aiTy  a pint,  gushed  from  the  anterior  wound,  upon  the  removal  of  its  dressings,  the  following  morning.  Immediate  relief  was 
obtained  and  general  improvement  commenced  ; the  respii-atory  murmur,  which  had  been  absent  in  the  lower  portion  of  the  hmg, 
retui'ned  and  was  perceptible  everywhere,  except  in  the  immediate  vicinity  of  the  wound.  The  purulent  discharge  continued 
profuse,  until  about  the  first  of  October,  but,  by  the  13th  of  this  month,  it  had,  in  a great  measure,  ceased,  and  the  patient  was 
allowed  a furlough.  He  returned  on  December  13th,  1863,  gi’eatly  improved.  The  anterior  opening  had  closed  and  the  posterior 
nearly;  from  the  latter,  necrosed  bone  was  subsequently  removed.  Opiates  and  stimulants  were  administered  throughout  the 
treatment,  according  to  the  requirements  of  the  case.  On  February  29th,  1864,  crepitant  rales  were  heard  only  in  the  region  of 
the  wound,  and  some  pain  felt  about  the  shoulders.  This  man  was  discharged  from  service  on  March  29th,  1834,  and  was 
subsequently  pensioned.  Pension  Examiner  S.  A.  Fisk  reports,  July  20th,  1867,  ‘'the  pensioner  suffers  from  an  inward  sore- 
ness and  spitting  of  blood;  can  only  do  light  work,  and  has  pains  in  the  he.ad.”  The  case  is  reported  by  Assistant  Surgeon 
C.  A.  McCall,  U.  S.  A.*  [In  .Inly,  1873,  Dr.  G.  Cox,  of  South  Hadley  Falls,  Massachusetts,  wrote  that  Corporal  Welker  was 
well  at  that  date,  “ with  a good,  driving  business  at  cigar-making.”  His  chest  gave  lum  “ no  trouble,  more  than  an  adhesion 
from  pleurisy  would.”] 

Case. — Private  J.  IF.  Jones,  Co.  E,  43th  Georgia  Kegiment,  was  wounded  at  Manassas  Gap,  July  23d,  1833,  by  a conoidal 
musket  ball,  which  entered  half  an  inch  above  the  left  nip])Ie,  traversed  the  hmg,  and  emerged  near  the  spine  of  the  left  scapula. 
The  wounds  were  closed  on  the  field  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.,  with  silver  sutures,  and  hermetically  sealed. 
The  patient  was  conveyed  to  Washington,  and  admitted,  on  July  30th,  into  Mount  Pleasant  Hospital,  complaining  of  severe  pain 
in  the  left  side  and  shoulder ; his  breathing  was  short  and  jiainful ; crepitant  rales  w'ere  distinguished  over  the  left  mammary 
region,  and  at  the  apex  of  the  lung;  ])ulse  100  per  minute,  and  h.ard ; countenance  flushed;  skin  hot  and  dry;  tongue  white. 
On  removing  the  dressings,  there  was  a moderate  discharge  of  tolerably  healthy  pus,  attended  by  an  almost  instantaneous  relief 
from  dyspnoea  and  pain.  The  pneumonia  yielded  to  treatment  in  a few’  days  ; and  in  about  throe  weeks  the  wounds  h.ad 
liealed,  and  the  patient  was  dismissed  from  further  treatment.  On  September  23,  he  was  transferred  to  Lincoln  Hosjiital,  thence 
to  the  Old  Capitol  Prison  on  October  14,  1833.  The  case  is  reported  by  Assistant  Surgeon  C.  A.  McCall,  U.  S.  A. 

Ca.se. — Corporal  Henry  G.  Powles,  Co.  K,  2d  Wisconsin  Volunteers,  was  wounded  at  the  Wilderness,  Virginia,  May  10th, 
1834,  by  a musket  ball,  which  entered  between  the  second  and  third  ribs,  p.assed  through  the  right  lung,  and  emerged  below  the 
right  scapula.  The  wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  On  May  14th,  he  was  sent  to 
Campbell  Hospital,  Washington,  wdience  he  was  transferred  to  the  Veteran  Keserve  Corps,  A))ril  18th,  1865.  He  was  discharged 
from  service  on  June  19th,  1865.  Pension  Examiner  1’.  K.  Hoy  rtq)orts,  February  10th,  1836,  “the  j)ensioner  sutfers  from 
ailhesions  and  spitting  of  blood.”  He  re-examined  him  on  September  11th,  1837,  and  stated  that  the  consolidation  of  the  lung 
and  spitting  of  blood  had  steadily  increased.  The  case  is  reported  by  the  operator. 

Ill  ten  of  the  thirteen  preceding  abstracts,  it  is  specilied  that  an  injury  of  the  lung 
existed.  In  seven  of  the  thirteen,  recovery  was  partial,  the  patients  being  pensioned, 
with  various  degrees  of  disability. 


* A liistory  of  this  case  was  inserted  in  the  surgical  report  in  Circular  No.  6,  S.  G.  O.,  18G5,  with  the  observ'ution  that : The  histories  of  the  cases,  iu 
M'hich  this  plan  (of  hermetically  sealing)  was  adopted,  have  beeu  traced,  in  most  instances,  to  their  rapidly  fatal  conclusion.  The  following  case  is  the 
only  recorded  exception.”  This  statement  was  exact  at  that  date  ; but.  as  is  seen,  many  other  instances  of  favorable  terminations  have  since  been  traced. 
] believe  the  ev  idence  still  fully  sustains  tlie  *■  unqualified  condemnation  of  tlie  practice,  ' then  expressed. 


Skct.  II.] 


TEEATME^’T  E.Y  IIEEMETR'AI.LY ' SEALEAG. 


501 


The  plan  succeeded,  or  patients  treated  liy  it  survived,  in  the  hands  of  many  other 
surgeons,  as  the  following  abstracts  show: 

Case. — Captain  W.  E.  Peddle,  Co.  A,  ISTtli  Penn.sylvania  Volunteers,  received  a gnnsliot  penetrating  vvonnd  of  the 
thorax  and  a llesh  wound  of  the  ann  at  Petersburg,  Virginia,  Jidy  7th,  1804.  The  wound  was  hermetically  sealed  at  the  hospital 
of  the  Eifth  Corps,  where  he  remained  nntil  July  E’th,  when  he  was  sent  to  l)(>Canii)  Hospital,  Ahnv  York  Harbor.  On 
September  loth,  he  was  admitted  to  Officers’ Hospital,  Annapolis,  Maryland,  and  discharged  from  service  on  September '27th, 
1804.  A’ot  a pensioner.  The  case  is  re])orted  by  C.  N.  Chamberlain,  U.  S.  V. 

Ca.se. — Corporal  Lucius  G.  Bradley,  Co.  B,  136th  E^ew  A’ork  Volunteers,  aged  '29  years,  was  wotinded  at  Gettysburg, 
July  2d,  1863  ; the  missile  entered  the  right  chest  beneath  the  clavicle  at  its  articulation  with  the  sternum,  and  lodged  between 
the  spine  .and  scapula.  The  patient  stated  that  the  wound  bled  vcT-y  freely  at  first,  and,  in  a few  minutes,  he  discovered  that  he 
could  not  breathe  without,  in  the  first  place,  closing  the  wound  with  his  hand.  The  haemorrhage  ceased  when  he  lay  upon  his 
back.  The  surgeon  of  his  regiment  and  the  brigade  surgeon  pronounced  his  case  hopeless.  The  wound  was  closed  with  metallic 
sutures  and  hermetic.ally  sealed  with  collodion,  by  Surgeon  John  J.  Milh.an,  U.  S.  A.,  medical  director  of  the  Fifth  Corps. 
Nourishing  diet  was  administered  and  quiet  enjoined.  On  July  24th,  he  was  transferred  to  Chestnut  Street  Hos)utal,  Harrisburg, 
Pennsylvania.  When  admitted,  he  was  very  weak,  and  had  entirely  lost  his  voice.  The  wound  had  never  been  interfered  with 
after  the  first  dressing  was  applied  on  the  battle-field.  On  August  15th.  the  dressings  became  loose,  and  were  removed,  with  the 
sutures ; the  wound  wgs  found  to  be  quite  healed.  He  was  discharged  from  service  on  August  18th,  1803.  On  one  occasion 
during  his  stay  at  the  Harrisburg  Hospit.al,  he  ex])ectoriated  a little  bloody  pus.  Pension  Examiner  W.  M.  Herron  rejiorts,  on 
Felu'uary  16th,  1866,  that  the  jtensioncr  suffers  from  pain  at  the  point  where  the  b.all  lodged.  The  case  is  repoi-ted  by  Acting 
Assistant  Surgeon  W.  S.  Woods.  Bradley  was  in  tolerably  good  health  on  March  4th,  1872,  when  he  drew  his  half  pension.* 

Ca.se. — Private  John  P.  Frink,  Co.  F,  17th  Maine,  aged  19  ye.ars,  was  wounded  at  Deep  Bottom,  August  18,  1864,  by  a 
conoidal  ball,  which  penetrated  the  left  chest  in  the  seventh  intercostal  space,  one  inch  outside  of  a vertical  line  through  the  nipple, 
and  emerged  near  the  angle  of  the  seventh  rib.  The  wound  was  hermetically  sealed  at  the  hospital  of  the  3d  division.  Second 
Corps.  On  August  27th,  he  was  transferred  to  Finley  Hospital,  and  discharged  on  June  8, 1865.  Pension  Examiner  E.  F.  Sanger 
rejiorts,  October  27,  1868  : Necrosis  followed,  and  spitting  of  blood.  Dulness  in  region  of  wound  and  adhesion  of  lung  to  pleura. 
I’ain,  soreness,  and  dj'spnosa  upon  exposure  and  hard  work.”  Keported  by'  Surgeon  O.  Evarts,  20th  Indiana. 

Case. — Lieutenant  Adolphus  F.  Vogelbach,  Co.  B,  27th  Pennsylvania,  received  a penetrating  shot  wound  of  the  chest  at 
Mission  Eidge,  November  25,  1863 ; the  ball  entered  betw'cen  the  seventh  and  eighth  ribs,  and  passed  through  the  middle  lobe  of 
the  right  lung.  He  was  taken  to  the  hospital  of  the  2d  division.  Eleventh  Corps,  and  the  wound  was  hermetically  sealed  with 
sutures  and  collodion,  by  Surgeon  B.  L.  Hovey,  133th  N’ew  York.  On  December  •22d,  he  was  convalescent,  and  was  trans- 
ferred to  Officers’  Hospital,  Lookout  Mountain,  whence  he  w'as  furloughed  February^  3d,  1864.  Having  returned  to  duty,  he  was 
promoted  to  the  rank  of  Captain,  April  '27,  and  mustered  out  with  his  company  on  June  10, 1864.  Pension  Examiner . I.  Cummisky 
reported,  June  17,  1864,  that  Vogelbach  was  much  -weakened  and  unable  to  do  the  lightest  kind  of  work.  Pension  Examiner 
Win.  M.  Cornell  reported,  October  26,  1865 : Wound  more  painful ; raises  more  blood,  and  has  greater  difficulty  of  respiration. 
May  8,  1873,  Dr.  Hovey  wrote  that  in  Lieutenant  Vogelbach’s  case  the  anterior  wound  healed  kindly,  the  posterior  did  not.” 
He  adds,  “ Two  soldiers  reside  in  this  city  (Eochester)  who  were  treated  by  me  after  this  plan  ; they  are  in  good  health.”  The 
names  ave  not  given. 

C.VSE. — Private  Henry  Herrick,  Co.  II,  5th  IMichigan  Volunteers,  aged  20  y'ears,  was  wounded  at  Petersburg,  Virginia, 
June  16th,  1864,  by'  a conoidal  ball,  which  entered  anteriorly  between  the  second  and  third  ribs,  injured  the  apex  of  the  right 
lung,  and  passed  out  behind  the  scapula.  He  was  taken  to  the  hospital  of  the  Second  Corps,  wlicre  the  wound  was  hermetically 
sealed.  On  the  24th,  ho  was  transferred  to  Mount  Pleasant  Hospital,  Washington.  On  .Tanuary  4th,  186.5,  he  was  sent  to 
Hai-per  Hospital,  Detroit,  Michigan,  whence  he  was  discharged  from  service  on  February  5th,  1865.  A communication  from  the 
Commissioner  of  Pensions,  dated  April  8th,  1868,  states  that  Herrick  is  a pensioner,  his  disability  being  rated  one-half  and 
pei-manent.  The  case  is  reported  by  Surgeon  O.  Evarts,  20th  Indiana  Volunteers. 

Case. — Private  Horace  B.  Walters,  Co.  D,  84th  Indiana  Volunteers,  aged  21  y’ears,  was  wounded  at  Kenes.aw,  Georgia, 
June  27th,  1864,  by’  a conoidal  b.all,  which  penetr.ated  the  left  side  of  the  thorax.  Ho  was  taken  to  the  hospital  of  the  1st 
division.  Fourth  Corps,  where  the  wound  was  hermetically  sealed  by  Assistant  Surgeon  William  H.  Matchett,  4()th  Ghi'o  Volun- 
teers. On  .Inly  3d,  he  was  transferred  to  Hospit.al  No.  ‘2,  Chattanooga;  on  .July23d,to  Hospital  No.  8,Nashvillo;  on  Septemlau' 
9th,  to  .Jefferson  Hospital,  Indiana,  and,  on  December  12th,  to  Cumberland  Hospital,  Nashville,  whence  he  was  returned  to  duty 
on  December  20th,  1864.  He  is  not  a pensioner.  The  case  is  reported  by  Surgeon  .1.  D.  Brumley,  IT.  S.  V. 

Ca.se. — Lieutenant  I’ercival  Knowle.s,  Co.  K,  6th  Maim;  Volunteers,  aged  ‘23  years,  was  wounded  at  Eai)p<ahannock 
Station,  Virginia,  November  7th,  1863,  by  a conoidal  liall,  which  entered  three  inches  above  the  right  ni])j)le,  passed  backward 
and  downward  through  the  right  lung,  and  lodged  in  the  muscles  of  the  back,  at  the  lower  border  of  the  sjjicnla.  On  the  9th, 
he  was  admitted  to  Stanton  Hospital,  Washington.  There  was  slight  dys|)na'a.  with  a full  and  irregular  pulse  ; an  absence  of 

* In  a letter  from  Ann  Arbor,  of  July  1867,  to  Surg’eon  General  Ilamcs,  Dr.^Wm.  1\  Tlreakoy,  late  Assistant  Surgeon  lOtli  Michigan  Volun- 
teers, transmits  what  purports  to  be  “a  tabular  statement  of  eighteen  cases  of  penetrating  wounds  of  ehest,  operated  on  by  11.  Howard,  Assistant 
Surgeon  U.  S.  A.,  at  Gettysburg,  by  hennetically  closing  them,”  and  further  remarks,  alluding  to  the  rase  of  IJradley,  that  “it  would  he  interesting  to 
know  whether  the  one  case,  shown  by  the.se  tables  to  have  recovered,  united  witli  first  intention  or  became  an  open  wound.  ’ Gr.  llreakoy  subsequently 
published  (Mich,  fnirersity  Med.  Jour.  Ocf.^  1871)  a repetition  of  his  statement,  which  is  a curious  example  of  the  abuse  of  statistical  enquiry.  It  is 
interesting  to  know  that  Dr.  Howard  was  not  tlie  ifperatur  in  tlio  ease  (»f  llradloy. — that  the  wound  did  not  reopen, — that  the  ease  was  no/  a solitary 
sueeess  among  those  enumerated  in  his  tabular  .statement. — both  Loilit  and  HuMOlAN  having  recovered, — and  then  to  consider  wliat  weight  should  bo 
accerded  to  Dr.  llrcakey's  argument. — Co.Ml’ILKlt. 


502 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CiiAr.  Y, 


the  rospiratory  murmur  below  the  lower  end  of  the  scapula,  and  complete  dulness  on  percussion;  be  suflered  no  pain,  and  but 
slight  constitutional  disturbance.  The  track  of  the  wound  was  excised  down  to  the  ribs;  the  edges  united  by  sutures  deeply 
inserted,  and  the  whole  covered  by  isinglass  plaster  and  collodion.  On  the  12th,  there  was  some  pain.  The  dyspnoea  and 
effusion  had  increased,  and  a slight  friction  sound  was  heard  at  the  upper  and  lateral  part  of  the  chest.  The  dressings  were 
removed  on  the  14th ; there  was  no  evidence  of  union  by  first  intention ; the  wound  was  suppurating.  The  bowels  being 
confined,  a light  cathartic  was  given.  On  December  4tb,  the  ball  was  extracted,  and  water  dressings  were  applied.  By 
December  22d,  both  wounds  had  healed,  and  effusion  in  the  chest  was  nearly  all  absorbed.  The  patient  was  discharged  from 
service  on  August  15th,  18G4.  Pension  Examiner  W.  L.  Nicholson  reports,  April  20th,  1870,  that  “ solidification  of  the  lung  has 
taken  place.  Haemorrhage,  which  was  not  present  at  the  date  of  his  discharge  to  any  marked  extent,  now  occurs  on  an  avei-age 
every  tw'O  or  three  weeks,  and,  in  my  opinion,  tubercles  have  formed.  His  strength  has  so  diminished  as  to  render  labor 
impossible.  Habits  regular  and  moral.”  The  case  is  reported  by  Assistant  Surgeon  G.  A.  Mursick,  U.  S.  V. 

Ca.se. — Sergeant  Jonathan  jMcAllister,  Co.  I,  12Gth  Oldo  Volunteers,  aged  31  years,  was  w'ounded  at  the  Wilderness, 
Virginia,  IMay  12th,  1864,  by  a conoidal  ball,  which  penetrated  the  left  lung.  He  was  taken  to  the  hospital  of  the  3d  division. 
Sixth  Corps,  where  the  wound  was  stitched  and  collodion  applied.  On  May  24th,  he  was  transferred  to  the  1st  division  hospital, 
Alexandria,  whence  he  was  discharged  from  service  on  February  20th,  1865.  The  use  of  the  left  arm  was  impaired.  He  is  not 
a pensioner.  Surgeon  Eobeit  Barr,  67th  Pennsylvania  Volunteers,  reports  the  case. 

Case. — Captain  George  W^.  Tomlinson,  Co.  I,99th  Pennsylvania  Volunteers,  aged  40  years,  was  wounded  at  Deep  Bottom, 
Virginia,  August  15th,  1864,  by  a conoidal  ball,  which  entered  about  the  fourth  rib  near  the  nipple,  passed  downward  through  the 
lung,  and  lodged  in  the  back  near  the  seventh  or  eighth  ribs.  He  was  taken  to  the  hospital  of  the  3d  division.  Second  Corps,  where 
the  wound  was  hermetically  sealed  and  the  ball  extracted.  On  August  23d,  he  w'as  transferred  to  Seminary  Hospital,  George- 
town, D.C.;  simple  dressings  were  applied.  He  was  furloughed  on  October  20th,  and  admitted  to  Oflicers’  Hospital,  Phila- 
delphia, December  12th.  On  February  13th,  1865,  his  debility  was  on  the  increase,  owing  to  a profuse  discharge  from  the 
wound.  There  were  no  .S3'mj)toins,  except  a diminished  vesicular  murmur  along  the  course  of  the  wound.  Tonics,  stimulants, 
and  expectorants  were  administered.  The  discharge  gradually  diminished,  and  the  j)atient  improved.  On  March  1st,  after  some 
exposure,  he  had  a severe  attack  of  coughing,  attended  with  copious  muco-purulent  expectoration.  He  was  returned  to  duy  on 
Ma_v  15th,  1865,  at  which  time  his  general  health  was  fair;  but  the  wound  was  still  discharging,  and  he  suffered  occasionally 
with  violent  attacks  of  coughing,  from  ulceration  of  the  fauces  and  elongation  of  uvula.  The  upper  portion  of  the  lung  was 
healthy  ; but  there  were  indications  of  consolidation  of  the  lower  portion.  Pension  Examiner  Wilson  Jewell  reports,  November 
28th,  1865  ; “wound  not  healed;  suppuration  from  diseased  bone  going  on.  Some  cough  and  slight  expectoration.  Disability 
total  and  temporary.”  The  case  is  reported  by  Surgeon  O.  Evarts,  20th  Indiana  Volunteers. 

Case. — Private  Thomas  Conanton,  Co.  F,  56th  New  York  State  Militia,  aged  19  years,  while  on  duty  at  “ Pebel  Camp,” 
Elnura,  New  York,  August  13th,  1864,  was  wounded  by  the  accidental  discharge  of  an  Enfield  rifle.  A conoidal  ball  entered 
half  an  inch  to  the  right  of  and  below  the  right  nipple,  passed  through  the  lung,  and  emerged  at  the  margin  of  the  postei  ior 
border  of  the  inferior  angle  of  the  right  scapula.  The  same  ball  mortally  wounded  a second  man,  and  passed  through  the  knap- 
sack of  a third.  Conauton  felt  faint  from  the  loss  of  blood  which  followed,  but  did  not  fall  immediately.  Cold-water  dressings 
and  Inmdage  were  applied.  Half  an  hour  later,  whiskey  was  administered,  upon  swallowing  which,  he  raised  blood,  and,  at 
each  eff'ort  to  cough,  the  blood  ran  freely  from  his  mouth  until  he  was  nearly  exhausted.  Three  hours  after  the  recejuion  of  the 
injury,  he  was  admitted  to  the  hospital  at  Elmira.  There  was  considerable  ha?morrhage  from  both  wounds  and  great  d^'sjmoea. 
On  the  removal  of  the  dressings,  the  dyspnoea  increased  to  almost  immediate  suffocation ; but  could  readily  be  relieved  by 
drawing  the  integument  so  as  to  close  the  external  wounds.  The  anterior  and  posterior  wounds  were  at  once  converted  into 
incised  wounds  by  Assistant  Surgeon  Charles  A.  Leale,  U.  S.  V.,  and  the  edges  brought  together  and  retained  in  position  by 
silk  sutures  and  adhesive  straps,  and  hermetically  sealed  with  collodion.  A bandage  was  then  applied,  producing  moderate 
pressure  over  both  wounds.  An  opiate  having  been  administered,  the  patient  was  laid  on  his  back.  He  passed  a very  comfort- 
able night ; on  the  next  morning  there  was  considerable  febrile  movement,  increased  bronchial  respiration,  and  a slight  cough. 
Pulse  120.  For  four  or  five  days,  blood,  of  a bright  arterial  color,  mingled  with  sputa,  came  away  in  mouthfuls,  amounting  to 
at  least  eight  ounces  a day.  The  dressings  came  off'  in  three  days  ; the  wounds  had  both  closed  by  adhesion  ; not  the  slightest 
supjiuration  took  place  from  the  anterior  wound,  and  only  a few  drops  from  the  integumentary  surface  of  the  posterior  wound. 
Acute  pneumonia  supervened  in  the  right  side,  which  lasted  between  two  and  thriTe  weeks.  The  patient  convalesced  without  an 
unfavorable  symptom,  and  was  returned  to  duty  in  less  than  five  weeks  from  the  reception  of  the  wound.  On  March  19th,  186(), 
he  was  carefully  examined.  Externall_y,  nothing  could  be  seen  except  the  cicatrices  and  marks  of  the  sutures,  while  on  auscul- 
tation .and  percussion,  a dulness  was  found  at  the  middle  lobe  of  the  right  lung,  confined  to  a space  of  about  four  inches  in 
circumference,  'where  jdeuritic  adhesion  had  taken  place.  Otherwise  that  lobe  was  perfectly  healthy,  as  were  the  remaining  lobes 
of  both  right  and  left  lungs.  He  was  in  perfect  health.  The  case  is  reported  by  the  operator. 

Ca.se. — Private  Joseph  Douricott,  Co.  C,  26th  Georgia  llegiment,  aged  17  j-ears,  was  wounded  at  Winchester,  Virginia, 
September  19th,  1834,  by  a conoidal  ball,  which  penetrated  the  left  lung.  He  was  at  once  conveyed  to  the  depot  field  hospital, 
where  the  wound  was  hermetically  sealed.  On  January  4th,  1865,  he  was  transferred  to  West’s  Buildings  Hospital,  Baltimore, 
whence  ho  was  sent  to  FortMcHeniy,  Maiyland,  May  9th,  1865,  for  j)arole. 

Ca.se. — Private  Patrick  Doming,  Co.  F,  15th  United  States  Infantry,  aged  28  years,  w'as  wounded  in  a street  brawl  at 
Mobile,  November  1st,  1865,  by  a buckshot,  which  penetrated  the  left  lung.  He  was  admitted,  on  the  next  day,  to  the  post 
hospital  at  Mobile.  The  wound  was  sealed  at  first,  after  which  simple  dressings  w’ere  applied.  The  patient  was  doing  well  on 
December  31st,  1865.  He  deserted  on  February  20th,  18o().  There  is  no  later  account  of  him  on  the  rolls  of  the  Adjutant 
Geueral'.s  Office.  iSurgeon  Samuel  Kneelaiid,  U.  8.  V.,  reiiorts  the  case. 


Sect.  II.] 


TREATMENT  RY  HERMETICALLY  SEALING. 


503 


Two  cases,  in  which  this  plan  of  troatinent  was  successfully  employed,  are  found  in 
the  Confederate  records.  At  least  we  may  infer  that  the  case  referred  to  in  the  first 
abstract  was  successful  as  the  patient  was  strong  enough  to  escape  from  hospital  after  six 
weeks  of  treatment : 

Case. — Private  IF.  D.  Wheeler,  Co.  K,  2d  Virginia  Cavalry,  received  a penetrating  gunshot  wound  of  the  chest  at 
Winchester,  Virginia,  September  19th,  1864,  a conoidal  ball  passing  through  the  apex  of  the  right  lung.  He  was  conveyed  to 
the  field  hospital,  where  the  wound  was  hermetically  sealed.  He  escaped  on  October  25th,  1864.  Operator  unknown. 

Case. — Private  J.  IF.  Branson,  Co.  C,  9th  Virginia  Cavalry,  aged  27  years,  of  robust  constitution,  was  wounded  on  .Inly 
29th,  1864,  by  a conoidal  ball,  which  entered  the  right  chest  three  inches  below  the  axilla,  traversed  the  right  lung,  and  lodged 
near  the  spinal  column  on  a level  with  the  wound  of  entrance.  Hmmorrhage  from  the  lung  followed  the  reception  of  the  injuiy. 
The  ball  was  removed  by  counter  incision.  He  was  admitted,  on  the  next  day,  to  Chimborazo  Hospital,  Richmond.  It  was 
decided,  as  the  wound  had  been  so  recently  received,  and  his  condition  every  way  favorable,  to  treat  the  case  by  hennetically 
sealing  the  wound.  The  orihee  of  entrance  was  carefully  closed  by  means  of  thin  layers  of  cotton,  saturated  with  collodion. 
These  were  renewed  as  often  as  found  necessary  to  prevent  the  introduction  of  air  into  the  chest.  The  case  progressed  favorably, 
attended  by  only  slight  circumscribed  inflammation  of  the  lung,  some  effusion  in  the  pleural  cavity,  and  a little  fever,  so  slight, 
however,  as  to  require  but  little  treatment.  The  patient,  at  the  time  of  his  admission,  and  for  several  weeks  afterward,  com- 
plained of  great  soreness  of  both  sides  of  the  chest — more  of  the  left  than  of  the  right.  This  soreness  w'as  attributed  to  a severe 
fall  from  his  horse  at  the  time  he  was  wounded.  Under  appropriate  treatment  and  rest,  the  soreness  gradually  subsided,  and  the 
patient,  when  fairly  convalescent  and  walking  about  the  ward,  was  furloughed,  and  left  in  a carriage  for  his  home  in  Westmore- 
land County,  Virginia,  with  every  reason  to  expect  a speedy  and  perfect  recovery.  The  case  is  reported  by  the  operator.  Surgeon 
P.  F.  Browne,  P.  A.  C.  S.,  in  the  Confederate  States  Medical  and  Surgical  Journal  for  October,  1864. 

In  this  group  of  partial  or  entire  recovery  in  fourteen  cases,  treated  on  the  plan  under 
consideration  by  other  operators  than  Dr.  Howard,  it  is  stated  in  ten  instances  that  the 
substance  of  the  lung  was  wounded.  Six  of  the  fourteen  patients  are  now  (1872)  pension- 
ers, with  serious  disabilities, — two  deserted  and  two  were  paroled  or  furloughed,  and  their 
ultimate  histories  are  unknown.  Uniting  this  with  the  preceding  group,  a total  is  presented 
of  twenty-seven  cases  of  gunshot  penetrating  wounds  of  the  chest,  including  twenty 
instances  supposed  to  be  attended  by  wound  of  the  luUg,  in  which,  it  is  claimed,  recovery 
took  place  under  the  method  of  treatment  by  hermetically  sealing.  The  validity  of  these 
claims  will  be  discussed  at  the  close  of  this  subsekion. 

In  contrast  to  the  foregoing  cases  of  more  or  less  complete  success  of  the  treatment  of 
gunshot  wounds  of  the  chest  by  “hermetically  sealing,”  we  have  now  to  examine  a series 
in  wdiich  this  method  was  unsuccessfully  employed  ; 

Case. — Private  Joseph  Mallenbry,  Co.  B,  16tli  Michigan  Volunteers,  aged  30  years,  received  a gunshot  penetrating 
wound  of  the  chest  and  left  arm  at  Gettysburg,  July  2d,  1863.  He  was  taken  to  the  hospital  of  the  Fifth  Corps,  where  the 
wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  Pyaemia  set  in  on  July  20th;  stimulants,  tonics, 
and  nourishment  were  administered.  Death  resulted  on  Jidy  24th,  1863.  The  autopsy  showed  infiltration  of  the  right  lung,  and 
a conoidal  ball  was  lodged  in  its  middle  lobe.  There  was  no  accumulation  in  the  pleura.  The  case  is  reported  by  Surgeon  A. 
M.  Clark,  U.  S.  V. 

Case. — Corporal  Martin  Noonan,  Co.  H,  G4th  New  YMrk  Volunteers,  received  a gunshot  wound  of  the  lung  at  Spottsyl- 
vania,  Virginia,  May  12th,  1864.  He  was  taken  to  the  hospital  of  the  1st  division.  Second  Corps,  where  the  wound  was 
hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  Death  resulted  on  May  18th,  1864.  This  case  is  reported  by 
the  operator. 

Case. — Lieutenant  Edward  S.  Abbott,  17th  United  States  Infantry,  received  a gunshot  wound  of  the  lung  at  Gettysburg, 
July  3d,  1863.  Assistant  Surgeon  B.  Howard,  U.  S.  A.,  hermetically  sealed  the  wound  at  the  hospital  of  the  Fifth  Corps. 
Death  occurred  on  the  same  day.  The  case  is  reported  by  the  operator. 

Case. — Sergeant  Aaron  E.  Banker,  Co.  E,  140th  New  York  Volunteers,  received  a gunshot  wound  of  the  lung  fit  Gettys- 
burg, July  3d,  1863.  He  was  taken  to  the  hospital  of  the  Fifth  Corps,  where  the  wound  was  hermetically  scaled  by  Assistant 
Surgeon  B.  Howard,  U.  S.  A.  Death  on  July  12th,  1863.  The  case  is  reported  by  the  operator. 

Case. — Corporal  Daniel  Norcross,  3d  Massachusetts  Battery,  received  a gunshot  wound  of  the  lung  at  the  Wilderness, 
Virginia,  May  8th,  1864.  The  wound  was  hermetically  scaled  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  Death  resulted  on 
May  11th,  1864.  The  case  is  reported  by  the  operator. 

Case. — Private  Henry  A.  Amidon,  Co.  K,  4th  Vermont  Volunteers,  received  a gunshot  wound  of  the  lung  at  the  Wilder- 
ness, Virginia,  May  5th,  1864.  The  wound  was  hennetically  sealed  by  Assistant  Surgi^on  B.  Howard,  U.  S.  A.  Death  at  the 
field  hospital.  The  case  is  rejiorted  by  the  operator. 


504 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


Case. — Di  ivate  Charles  McGordas,  Co.  I,  1st  Massachusetts  Artillery,  received  a gunshot  wound  of  the  lung  at  Peters- 
hui’g,  Virginia,  June  18th,  18j4.  The  wound  was  hermetically  sealed  at  the  hospital  of  the  Jd  divisioti,  Second  Corps,  by 
Assistant  Surgeon  B.  Howard,  U.  S.  A.  The  patient  died  on  June  24th,  1834.  The  case  is  reported  by  the  operator. 

Case. — Private  William  S.  Jordan,  Co.  G,  20th  ^Maine  Volunt(!ers,  aged  18  years,  received  a gunshot  wound  of  the  left 
lung  at  Gettysburg,  July  2d,  1833.  He  was  taken  to  the  hospital  of  the  Fifth  Corps,  where  tlie  wound  was  hermetically  scaled 
by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  Pyremia  developed  on  July  20th;  stimulants  and  tonics  wore  administered.  Death 
resulted  on  July  24th,  1833.  At  the  necropsy,  the  left  side  of  the  chest  was  found  filled  with  pus,  displacing  the  heart.  The 
case  is  reported  by  Surgeon  A.  M.  Clark,  U.  S.  V. 

Case. — Private  Edward  kIcGoldrig,  Co.  G,  GOth  New  York  Volunteers,  received  a gunshot  wound  of  the  right  lung  at 
Ny  Eiver,  Virginia,  May  12th,  1834.  The  wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.,  at  the 
hospital  of  the  1st  division  of  the  Second  Corps.  Death  on  the  same  day.  The  case  is  reported  by  the  operator. 

Case. — Sergeant  Alexander  G.  Ross,  Co.  E,  140th  New  York,  w’as  wounded  on  July  2d,  1883,  at  Getty.shurg,  by  a musket 
ball,  which  penetrated  the  lung.  The  wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.,  after  which 
he  was  sent  to  Seminary  Hospital,  Gettysburg.  Death  resulted  on  July  Oth,  1833.  The  case  is  reported  by  the  operator. 

Case. — Private  John  Mellott,  Co.  D,  7th  West  Virginia  Volunteers,  aged  24  years,  received  a gunshot  wound  of  the 
right  lung  at  the  Wilderness,  Virginia,  May  Cth,  1834.  He  was  taken  to  the  hospital  of  the  2d  division.  Second  Corps,  where 
the  wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  The  patient  died  on  May  8th,  1864.  The  case  is 
reported  by  the  operator. 

Case. — Private  Michael  H.  Moffatt,  Co.  F,  10th  Massachusetts  Volunteers,  aged  22  years,  received  a gunshot  wound  of 
the  lung  at  the  Wilderness,  Virginia,  May  3th,  1834.  He  was  taken  to  the  hospital  of  the  2d  division.  Sixth  Corps,  where  the 
wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  Death  on  May  8th,  1884.  The  case  is  reported 
by  the  operator. 

Case. — Private  Jeremiah  Dorgan,  Co.  D,  7th  Massachusetts  Volunteers,  received  a gunshot  wound  of  the  lung  at  the 
W^ilderness,  Virginia,  May  5th,  1884.  He  was  taken  to  the  hospital  of  the  2d  division,  Si.xth  Corps,  where  the  wound  was 
hermetically  sealed  by  Assistant  Surgeon  B.  Ploward,  U.  S.  A.  Death  resulted  on  May  8th,  1864.  The  case  is  reported  by  the 
operator. 

Case. — Private  Charles  H.  'Wilson,  Co.  H,  4th  Michigan  Volunteers,  received  a gunshot  wound  of  the  left  lung  at  Gettys- 
burg, I'ennsylvania,  July  3d,  1883.  The  wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  Dcaih 
on  July  5th,  1883.  The  c.ase  is  reported  by  the  operator. 

Case. — Sergeant  Alva  C.  IVilcox,  Co.  D,  17th  Connecticut  Volunteers,  received  a gunshot  wound  of  the  lung  at  Gettys- 
burg, Pennsylvania,  July  3d,  1863.  The  wound  was  hermetically  sealed  on  the  field  by  Assisfant  Surgeon  B.  Howard,  U.  S.  A. 
Death  resulted  on  July  7th,  1863.  The  case  is  reported  by  the  operator. 

Ca.se. — Private  John  Contoil,  Co.  G,  6th  United  States  Infantr}’,  aged  22  years,  was  wounded  at  Gettysburg,  Penn 
sylvania,  July  3d,  1863,  by  a musket  ball,  which  penetrated  the  lung.  The  wound  was  hermetically  sealed  on  the  field  by 
Assistant  Surgeon  B.  Howard,  U.  S.  A.,  after  which  the  patient  was  conveyed  to  the  Seminary  Hospital,  Gettysburg,  where  he 
died  on  July  5th,  1863,  from  secondary  haemorrhage.  The  case  is  reported  by  the  operator. 

C.ASE. — Private  Henry  Williams,  Co.  D,  1st  Connecticut  He.avy  Artillery,  was  admitted  to  the  base  hospital  of  the 
Eighteenth  Corps,  July  1st,  1864,  with  a gunshot  penetrating  wound  of  the  chest,  received  at  Petersburg  on  the  day  previous. 
The  hall  entered  below  the  right  clavicle,  an  inch  and  a half  from  the  sternum,  and  passed  out  through  the  left  scapula  near  the 
middle  of  the  inferior  edge.  The  wound  had  been  hermetically  sealed  at  the  field  hospital  by  Assistant  Surgeon  B.  Howard, 
U.  S.  A.  The  patient  remained  under  his  care,  his  peculiar  method  of  treatment  being  fully  adopted.  Death  resulted  on  July 
7th,  1884.  Assistant  Surgeon  C.  E.  Munn,  27th  Massachusetts  Volunteers,  and  executive  oflicer  at  the  base  hospital,  states,  in 
a communication  to  the  Surgeon  General  of  Massachusetts  : “A  pogt-mortem  was  made,  ten  hours  after  death,  by  Dr.  Wendell,  of 
New  Hampshire,  Drs.  Munn  and  Emery,  of  Massachusetts,  and  Storrs,  of  Connecticut,  also  present.  External  e.xamination  : 
Chest  well  formed  ; wound  in  front,  the  appearance  of  being  closed  by  metallic  sutures  a few  hours  before  death  ; the  wound  of 
exit  closed  by  adhesive  straps  and  collodion.  Two  small  wounds,  made  by  tap])ing,  on  the  right  side,  wei’C  dressed  in  the  same 
manner.  The  attendants  report  the  first,  made  on  .July  3d,  w’as  between  the  sixth  and  seventh  ribs,  two  inches  hack  of  the 
nipple;  the  other,  made  fourteen  hours  before  death,  between  the  fifth  and  sixth  ribs.  Percussion  was  resonant  on  the  right  side; 
on  the  left,  somewhat  dull.  Internal  examination  : The  ball  was  found  to  have  passed  through  the  external  and  upper  part  of 
the  sternum,  entering  the  pleural  cavity  at  the  junction  of  the  first  rib,  thence  through  the  upper  lobe  of  the  left  lung  outward, 
backward,  leaving  the  cavity  three  inches  from  the  spine,  between  the  third  and  fourth  iJbs,  and  opening  externally  through  the 
scapula.  The  lung  on  the  right  side  was  uninjured  and  healthy  in  appearance,  except  somewhat  more  than  usual  post-mortem 
congestion  in  the  posterior  jiortion.  Left  lung  congested  throughout  and  firmly  adherent  to  the  walls  of  the  chest.  Thi'ough 
the  upper  lobe  was  the  suppurative  track  of  the  ball.  No  fluid  was  found  on  the  right  side.  Five  ounces  of  pus  were  found  on 
the  left,  close  upon  the  diaphragm,  having  a connection  with  the  upper  part  of  the  lung.  There  was  a small  quantity  of  serum 
in  other  parts  of  the  side.  The  two  wounds,  from  tapping,  were  traced  through  the  walls  of  the  chest,  into  ami  through  the 
diaphragm,  into  the  liver.  Remarks:  First,  hermetically  closing  the  wounds  did  not,  in  this  case,  prevent  the  formation  of  pus. 
Second,  paracentesis  thoracis  of  the  left  side,  the  side  containing  the  jms  and  serum,  could  not  have  reached  the  fluid  without 
endangering  the  lung  and  other  organs.  Third,  the  operation  ])erformed  on  the  right  or  wrong  side,  was  an  error  in  diagnosis, 
l)roved  by  the  failure  to  obtain  fluid,  and  by  i\i(i  post-mortem  presenting  a healthy  condition  of  the  parts,  and  was  a greater  error, 
in  puncturing  so  important  an  organ  as  the  liver.  The  t('stimony  of  those  watching  the  case  was  that  the  patient,  up  to  that 
time  doing  well,  soon  began  to  fail.”  The  case  is  imported  also  thi  ough  burgeon  George  Suckley,  U.  >S.  V.,  medicid  director  of 
the  Eighteenth  Corps. 


Skct.  II.] 


TREATMENT  r,Y  HERMETICALLY  SEALING. 


50o 


Case. — Rrivate  Miles  Fincli,  Co.  L,  Sd  reiins3Tvaiiia  Cavaliy,  aged  3G  years,  was  wounded  at  To<ld's  Tavern,  Viiginia, 
Maj'  Sth,  1804,  bj'  a conoidal  ball,  which  perforated  the  right  side  of  the  thorax.  He  was  admitted,  on  the  same  day  to  the  iield 
hospital  of  the  2d  division,  Cavahy  Corps,  where  the  wound  was  hermeticallj'  sealed  by  Assistant  Surgeon  1!.  Howard,  U.  S.  A. 
On  Mav'  12th,  he  was  sent  to  Douglas  Hospital,  ^Yashing•ton.  Stimulants  tvere  administered.  Death  resulted  on  May  23d,  1804, 
from  asthenia.  The  case  is  reported  bj'  the  operator. 

Case. — Sergeatit  Thomas  N.  Hillard,  Co.  H,  70th  New  York  Volunteers,  aged  22  years,  was  wounded  at  Manassas  Gap, 
Virginia.  J ulj-  23d,  1803,  bv  a conoidal  ball,  which  entered  the  right  side  of  the  thorax,  one  inch  below  the  clavicle  and  three  and 
a h;df  inches  to  the  left  of  the  acromion  process,  fracturt'd  the  second  rib  near  its  sternal  extremit_v,  passed  directly  through  the 
lung,  and  emerged  one  inch  to  the  right  of  the  s])inal  column,  opposite  the  spine  of  the  scapula.  The  lifth  rib  was  shattered  at  its 
superior  surface,  near  its  angle,  but  its  continuity  was  not  severed.  He  was  taken  to  the  hospital  of  the  2d  division.  Third  Corps, 
where  the  wound  was  hermeticall}'  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  On  July  30th,  he  w'as  transferred  to 
Lincoln  Hospital,  Washington.  When  admitted,  the  wounds  had  partially'  opened,  and  were  ragged  from  the  tearitig  out  of  the 
sutures.  The  patient  coughed  incessantlj-,  and  spat  up  large  quantities  of  frotly  sputa,  more  or  less  mixed  with  blood.  Respira- 
tion was  4G  per  minute,  and  labored,  with  extreme  orthopnoea.  The  ))ulse  was  9G,  and  small.  Every  lit  of  coughitig  was  accom- 
panied by  a profuse  discharge  of  dark  sanguineus  fluid  through  either  w’ound.  It  was  evident  that  the  attempt  to  permanently 
close  the  orifice  had  proven  a failure.  Acting  under  instructions  from  the  Medical  Director  of  the  department  the  treatment 
;dread_v  inaugurated  W'as  cotitinued.  An  attempt  was  made  to  renew  the  coating  of  collodion,  yvhich  was  accomplished  after  some 
difliculty ; but  before  the  ether  had  had  time  to  evaiiorate,  a profuse  discharge  of  the  pleuritic  fluids  took  place  which  rendered 
every'  efibrt  at  restoration  impracticable.  By  August  5th,  the  discharge  from  the  posterior  wound  had  almost  entirely  ceased,  while 
that  from  the  anterior  one  continued  to  be  large  in  quantity  and  of  a purulent  character.  The  discharge  of  this  fluid  was  invariably 
accompanied  with  cougliing,  and  ahvaj’s  followed  by  an  amelioration  of  all  the  rational  symptoms.  The  hope  yvas  therefore 
entertained,  that  the  accumulation  of  pus  in  the  pleural  cavity  would  be  prevented,  and  that  recoveiy  would  eventuallj'  take 
place;  but  as  the  necessity  for  repeated  effort  to  throyv  off  the  pus  became  more  frequent,  the  strength  of  the  patient  became 
proportionately  exhausted.  On  the  evening  of  August  12th,  he  was  seized  with  an  unusually  severe  paroxysm  of  coughing, 
folloyved  by  a copious  discharge  of  pus,  which  flooded  his  person  and  the  bedding,  and  reduced  him  to  a state  of  syncope  from 
which  he  was  imperfectly  aroused  under  the  administration  of  stimulus,  but  expired  in  a short  time.  The  necropsy  revealed 
extensive  deposit  of  Ij'inph  over  the  entire  right  lung,  and  one-half  pint  of  thick  empyemic  fluid  in  the  cavity.  The  track  of  the 
wound  was  closed  anteriorly.  The  upper  portion  of  the  right  lung  yvas  permeable  to  air.  Old}’  part  of  the  first  and  the  whole 
of  the  second  and  third  lobes  were  impermeable  and  compressed.  The  left  lung  was  yvell  filled  with  air  and  weighed  thirteen 
ounces;  right  lung  eighteen  ounces.  The  case  is  reported  by  Assistant  Surgeon  H.  Allen,  U.  S.  A. 

Case. — Sergeant  Robert  C.  'Ware,  Co.  E,  1st  Noyv  Y'ork  Dragoons,  was  wounded  at  the  Wilderness,  May  Gth,  1864,  by  a 
CDiioidal  musket  ball,  which  fractured  the  fourth  and  fifth  ribs  of  tile  right  side,  involving  the  lung.  Assistant  Surgeon  B. 
Hoyyard,  U.  S.  A.,  hermetically  sealed  the  wound  upon  the  field.  Being  conveyed  to  Washington,  the  patient  was  admitted  into 
the  Douglas  Hospital,  on  May  11th,  where  he  suffered  from  traumatic  pleuro-pneumonia,  from  which,  in  spite  of  c.areful  treatment, 
he  died  on  May  18th,  1834.  The  case  is  reported  by  the  operator. 

Case. — Private  Charles  Kochendoffer,  Co.  E,  74th  New  York  Volunteers,  was  wounded  at  Manassas  Gap,  July  23d,  18G3, 
by  a conoidal*  musket  ball,  which  entered  one  inch  and  a half  above  and  external  to  the  right  nipple,  and  passed  upward  and 
backward  through  the  lung,  making  its  exit  on  the  dorsal  aspect  of  the  right  scapula,  near  the  outer  portion  of  its  spine.  The 
wounds  were  closed  by  silver  sutures  and  hermetically  sealed  with  collodion  dressing  by  Assistant  Surgeon  B.  Howard,  U.  S.  A., 
on  the  field.  Being  conveyed  to  Washington,  the  patient  was  admitted  into  the  Mount  Pleasant  Hospital  on  July  30th,  1863,  in 
the  following  condition:  breathing,  short  and  labored;  pulse,  130  per  minute  and  small ; countenance  anxious;  cold,  cadaverous 
skin,  and  every  appearance  of  confirmed  collapse.  On  the  removal  of  the  dressings,  a profuse  discharge  of  sauious  foetid  pus 
occurred,  which  temporarily  relieved  the  dyspnoea;  but  itt  spite  of  stimulants  the  patient  sank  rapidly,  and  died  on  August  1st, 
181)3.  The  case  is  reported  by  Assistant  Surgeon  C.  A.  McCall,  U.  S.  A. 

Ca.se. — Private  Robert  Baker,  Co.  E,  140th  New  York  Volunteers,  was  wounded  at  Getty.sburg,  July  3d,  18G3,  by  a musket 
ball,  which  penetrated  the  lung.  He  was  taken  to  the  hospital  of  the  Fifth  Corps,  where  the  wound  was  hermetically  sealed  by 
Assistant  Surgeon  B.  Howard,  U.  S.  A.  The  wound  afterwards  became  ojten  and  suppurative.  Death  resulted  on  July  24tli, 
1863.  The  case  is  reported  by  the  operator. 

Case. — Private  Charles  Horton,  Co.  G,  11th  United  States  Infantry,  received  a gunshot  woutid  of  the  lung  at  Gettysburg, 
July  3d,  1833.  The  wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  Death  resulted  on  July  12th, 
18G3.  The  case  is  reported  by  the  operator. 

C.\SE. — Private  Isaac  T.  Sperry,  Co.  G,  73d  Ohio  Volunteers,  received  a gunshot  penetrating  wound  of  the  thorax  at 
(fettysburg,  .Inly  3d,  1333.  The  wound  was  hennetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  Death  at  the 
hospital  of  the  Elevetith  Corjts,  on  July  5th,  1833.  The  case  is  reported  by  the  operator. 

Case. — Private  Levi  Ells,  Co.  C,  12th  United  States  Infatitry,  received  a gutislmt  penetrating  wound  of  the  chest  at 
Gettysburg,  .luly  1st,  16G3.  The  wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  The  patient  died 
on  .July  4th,  1833.  The  case  is  reported  by  the  o])erator. 

C.V.SE.— Private  W.  D.  Hammond,  Co.  F,  14th  l.’nited  States  Infantry,  received  a gunshot  penetrating  wound  of  the  left 
side  at  Getty.sburg,  July  3d,  1833.  The  wound  wtis  hermetically  sealed  by  Assistant  Surgeon  B.  Howard,  U.  S.  A.  Death 
resulted  on  .July  l.jth,  1833.  The  case  is  re|)orted  by  \V.  F.  Breakey,  -Vssistant  Surgeon  IGth  Michigatt  Volunteers. 

01 


506 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CiiAr.  V, 


Ga.se. — Private  G.  W.  Stevons,  Co.  D,  Kith  IMicliigaii  Yohiiiteers,  ruceivofl  a gunshot  wound  of  the  right  lung  .at  Gettys- 
burg, July  3d,  1863.  The  wound  was  hermetically  sealed  by  Assistant  Surgeon  B.  Ilow.ard,  U.  S.  A.,  at  the  field  hospital  of  the 
Fifth  Corps.  Death  on  July  10th,  18G‘i.  The  case  is  reported  by  W.  F.  Breakcy,  M.  D.,  Assistant  Surgeon  lGthMichig.au 
^h)lunteers. 

Case.. — Private  Jacob  Gamier,  Co.  G,  16th  Michigan  Volunteers,  received  a gunshot  penetrating  w'ound  of  the  chest  and 
left  arm  at  Gettysburg,  July  3d,  1863.  The  wound  ivas  hermetically  sealed,  at  the  field  hospital  of  the  Fifth  Corps,  by  Assistant 
Surgeon  B.  Howard,  U.  S.  A.  The  patient  died  on  July  lOtb,  1883.  The  c.ase  is  reported  by  W.  F.  Bre.akey,  M.  D.,  Assistant 
Surgeon  16th  Michigan  Vidunteers. 

Case. — Private  Ambrose  Weiss,  Co.  II,  93d  New  York  Volunteers,  aged  19  years,  received  a gunshot  ivound  of  the  chest 
at  Deep  Bottom,  Virginia,  August  14th,  1864,  by  a conoidal  ball,  which  perforated  the  right  lung.  He  Avas  conveyed  to  the  field 
hosjiital  of  the  3d  division.  Second  Corps,  where  the  wound  was  hermetically  sealed.  On  August  18th,  he  was  transferred  to 
Campbell  Hospital,  Washington.  Death  resulted  on  September  10th,  1864.  The  case  is  reported  by  Surgeon  0.  Evarts,  ‘JOth 
Indiana  Volunteers. 

Case. — Sergeant  Peter  Goldie,  Co.  A,  11th  Mass.achusetts  Volunteers,  received  a gunshot  penetrating  wound  of  the  thorax 
at  1‘etersburg,  Virginia,  September,  1864.  The  Avouud  was  hermetically  sealed  at  the  hospital  of  the  3d  division.  Second  Corps. 
The  patient  died  on  September  13th,  1864.  The  case  is  re])ortcd  by  Surgeon  0.  Evarts,  20th  Indiana  Volunteers. 

Case. — Private  Earl  Halbard,  Co.  F,  5th  IMichig.an  Volunteers,  received  a gunshot  penetrating  Avound  of  the  thorax  at  Peters- 
burg, Virginia,  September,  1864.  The  Avound  AAms  hermetically  sealed  at  the  ho.spital  of  the  3a1  division.  Second  Corps.  The 
patient  died  on  September  16th,  1864.  The  case  is  reported  by  Surgeon  O.  Evarts,  20th  Indiana  Volunteers. 

Case. — Private  .lolm  W.  Smith,  Co.  F,  126th  Ohio  Volunteers,  received  a gunshot  Avound  of  the  left  shoulder,  penetrating 
the  lung,  by  a conoidal  ball,  at  Spottsylvania,  Virgini.a,  M.ay  12th,  1864.  He  Avas  taken  to  the  hospital  of  the  3d  division.  Sixth 
Corps,  Avhere  the  Avound  Avas  stitched  and  closed  Avith  collodion.  On  Jlay  26th,  he  Avas  transferred  to  the  3d  division  hospital, 
Alexandria.  Death  resulted  on  May  27th,  1864.  The  case  is  reported  by  Surgeon  E.  Barr,  67th  Pennsylvania  Volunteers. 

Case. — Colonel  Daniel  Chaplin,  1st  Maine  HeaA’y  Artillery,  aged  50  years,  received  a gunshot  penetrating  Avound  of  the 
left  side  of  the  chest,  at  Deep  Bottom,  Virginia,  August  17th,  1834.  The  Avound  Avas  hermetically  sealed  at  the  field  hospital  of 
the  3d  division.  Second  Corps.  On  August  20th,  he  was  admitted  to  Turner’s  Lane  Hospital,  Philadelphia,  Avhere  he  died  on  the 
same  day.  The  case  is  reported  by  Surgeon  O.  Evarts,  20th  Indiana  Volunteers. 

Case. — Private  Isaac  Evans,  Co.  I,  30th  Indiana  Volunteers,  receiA-ed  a gunshot  penetrating  AVOund  of  the  thorax,  near 
Marietta,  Georgia,  June,  1864.  The  Avound  Avas  hermetically  sealed  by  Assistant  Surgeon  W.  H.  Matchett,  40th  Ohio  Volunteers. 
Death  resulted  on  June  28th,  1864.  The  case  is  reported  by  Surgeon  J.  D.  Brumley,  U.  S.  V. 

C.\SE. — Corporal  Evan  Francis,  Co.  H,  81st  Indiana  Volunteers,  received  a gunshot  penetrating  AVound  of  left  side  of 
thorax,  near  Marietta,  Georgia,  June.  1864.  The  Avound  Avas  hermetically  sealed  by  Surgeon  S.  H.  Kersey,  36th  Indiana  Volun- 
teers, at  the  hospital  of  the  1st  division  of  the  Fourth  Corps.  The  patient  died  on  June  29th,  1864.  The  case  is  reported  by 
Surgeon  J.  D.  Brumley,  U.  S.  V.  * 

Case. — PriA^ate  Samuel  W^est,  Co.  K,  84th  Indiana' Volunteers,  received  a gunshot  penetrating  Avound  of  thorax  and 
scapula,  near  Marietta,  Georgia,  June,  1864.  The  Avound  Avas  hermetically  sealed  by  Assistant  Surgeon  W.  H.  Matchett,  40th 
Ohio  Volunteers.  The  patient  died  on  June  26th,  1864.  The  case  is  reported  by  Surgeon  J.  D.  Brumley,  U.  S.  V. 

Case. — Pri\'ate  Thomas  Hayden,  Co.  K,  45th  Ohio  Volunteers,  received  a gunshot  penetrating  wound  of  the  thorax,  at 
KenesaAV  ^Mountain,  Georgia,  June  26th,  1864.  The  AVound  Avas  hermetically  sealed  by  Surgeon  C.  J.  Walton,  21st  Kentucky 
Volunteers.  Death  on  June  27th,  1864.  The  case  is  reported  by  Surgeon  J.  D.  Brumley,  U.  S.  V. 

Case. — Private  David  Gallagher,  Co.  K,  14th  NeAV  Jersey  Volunteers,  received  a gunshot  Avound  of  the  lung,  at  Locust 
Grove,  Virginia,  November  27th,  1863,  the  ball  in  its  exit  extensively  comminuting  the  fourth  rib.  He  Avas  convoyed  to  Brandy 
Station,  Avhere  the  fr.actured  part  of  the  rib  Avas  removed  by  a process  of  exsection;  the  edges  of  the  wound  Averu  trimmed  and 
brought  together  A'ery  neatly  with  Avire  sutures  and  seahid  Avith  collodion.  Death  resulted  on  November  30th,  1863.  Surgeon 
A.  TreganoAvan,  14th  NeAV  Jersey,  Avho  reports  the  case,  says:  “The  case  Avould,  in  all  probability,  have  terminated  differently, 
hut  for  the  great  imprudence  of  the  patient.  Ten  hours  after  the  operation,  feeling  so  'bully,'  as  he  termed  it,  he  indulged  in 
immoderate  exercise,  resulting  in  almost  sudden  death.” 

Case. — Private  Patrick  Daley,  Co.  E,  70th  Nbav  York  Volunteers,  received  a gunshot  penetrating  Avound  of  the  chest  at 
IManassas  Gap,  Virginia,  July  23d,  1863.  He  Avas  conveyed  to  the  hospital  of  the  2d  division.  Third  Corps,  and  IIoAvard’s  treat- 
ment adopted.  The  case,  teripinated  fatally  the  same  day  ; it  is  reported  by  Surgeon  James  Ash,  70th  Netv  York  Volunteers,  and 
by  Surgeon  C.  H.  IrAvin,  72d  Ncav  York  Volunteers. 

Case. — Private  W.  Devausa,  Co.  B,  81st  Indiana  Volunteers,  received  a gunshot  penetrating  Avound  of  the  thorax  near 
Marietta,  Georgia,  June,  1834.  The  Avound  Avas  hermetically  sealed  by  Surgeon  C.  J.  Walton,  21st  Kentucky  Volunteers.  Died 
June  26th,  1864.  The  case  is  reported  by  Surgeon  J.  D.  Brumley,  U.  S.  V. 

Case. — Corporal  LeAvis  Burgess,  Co.  G,  86th  Ncav  York  Volunteers,  received  a severe  gunshot  penetrating  Avound  of  the 
thorax  at  Petersburg,  Virginia,  June  23d,  1834.  He  Avas  taken  to  the  hospital  of  the  3d  division.  Second  Corps,  whei’c  the 
Avound  Avas  closetl  Avith  sih'er  Avire  and  collodion,  lie  tlied  on  June  29th,  1864.  The  case  is  reported  by  Surgeon  O.  Evarts, 
20th  Indiana  Volunteers. 


Sect.  II.] 


TKEA.TMENT  BY  HEEMETICALLY  SEALTEG. 


507 


Case. — Private  TV.  I).  Thompson,  Co.  I,  61st  North  Carolina  Eegimcnt,  aged  52  years,  rvas  admitted  to  Chimborazo 
Hospital,  Eichmond,  October  1st,  1864,  with  a gunshot  penetrating  wound  of  the  chest ; the  missile  entered  the  right  side 
between  the  third  and  fourth  ribs,  four  inches  from  the  sternum,  passed  through  the  lower  portion  of  the  ujiper  lobe  of  the  lung, 
and  emerged  through  the  lower  angle  of  the  scapula.  The  wounds  W'ere  hermetically  sealed.  When  admitted,  he  was  suffering 
from  great  dyspnoea ; bloody  saliva  oozed  from  the  angles  of  the  mouth  ; pulse  slow'  and  weak ; skin  cold  and  bowels  costive. 
Occasionally,  with  much  effort,  the  patient  spat  clots  of  blood.  October  2d,  pain  in  liypochondriac  region,  and  some  tympanitis. 
Death  occurred  on  October  4th,  1864.  The  case  is  taken  from  Confederate  case  book. 

It  is  specified  in  all  but  fifteen  of  the  foregoing  forty-two  fatal  cases,  that  the  lung 
was  injured.  The  precise  date  of  injury  is  ascertained  in  thirty-five  instances,  the  seven 
other  patients  having  been  reported  in  return  covering  several  days  of  fighting.  The 
inten^al  between  the  reception  of  the  injury  and  death  was  as  follows:  Died  on  the  day  of 
operation,  3 ; on  the  first  day  following,  1 ; on  the  second  day,  3 ; on  the  tliircl,  8 ; on  the 
fourth,  1;  on  the  sixth,  4;  on  the  seventh,  3;  on  the  eighth,  1;  on  the  ninth,  2;  on  the 
twelfth,  1;  on  the  thirteenth,  1;  on  the  fifteenth,  2;  on  the  eighteenth,  1;  on  the  twenty- 
first,  1;  on  the  twenty-second,  2;  and  on  the  twenty-seventh,  1;  a total  of  35.  Hone  of 
the  seven  other  patients  lived  more  than  four  days.  The  average  of  survival  of  the  forty- 
two  was,  therefore,  about  a week.  The  complications  were;  fatal  intermediary  hsemor- 
rhage  on  the  second  day,  fracture  of  the  scapula,  extended  comminution  of  the  ribs, 
lodgment  of  balls,  hsemothorax,  and  empyema.  All,  or  nearly  all,  of  the  foregoing  group 
of  sixty-nine  cases  were  submitted  to  the  treatment  by  occlusive  dressing  on  the  day  of 
the  reception  of  the  injury,  or  the  following  day  at  the  farthest,  and  it  would  appear  that 
the  dressings  were  not  removed  in  any  instance  in  the  general  hospitals,  unless  the 
reopening  of  the  wound  or  the  necessity  of  evacuating  extravasated  fluids  made  some 
modification  in  dressing  imperative.  Viewing  the  group  numerically,  surgeons  riglitly 
appreciating  the  gravity  of  gunshot  penetrating  wounds  of  the  chest  will  not  regard  the 
mortality  as  large,  especially  when  it  is  considered  that,  in  the  opinion  of  observers 
presumed  to  be  competent,  nearly  two-thirds  of  the  cases  were  attended  by  injury  of  the 
substance  of  the  lung.  Twenty-seven  recoveries  in  sixty-nine  cases  given,  if  the  figures 
may  be  relied  on,  is  a mortality  of  60.8  only.  But  we  fear  that  the  statistical  statement 
is  open  to  many  criticisms.  Undoubtedly  there  are  on  the  Pension  Polls  the  names  of 
thirteen  patients  who  recovered  from  alleged  penetrating  gunshot  wounds  of  the  chest  under 
the  treatment  by  hermetically  sealing,  and  have  survived  their  injuries  from  seven  to  nine 
years.  Only  one,  Bradley  (p.  501),  enjoys  good  health.  He  has  carried  a musket  ball  in 
his  chest  for  nearly  nine  years  without  great  inconvenience.  Two  of  the  twelve  other 
pensioners  have  necrosis  and  empyema,  and  interminably  open  sinuses;  five  suffer  from 
hiemoptysis;  two  have  partial  paralysis;  the  others  suffer  from  chronic  cough,  solidification 
of  portions  of  the  lung,  dyspnoea,  and  other  evidences  of  damage  to  the  respiratory 
apparatus.  Several  have  recently  applied  for  increase  of  pension.  With  all  these 
disabilities  they  still  live.  Of  five  cases,  reported  as  rapid  recoveries  (from  lung  wounds 
in  each  instance),  there  are  no  late  histories,  J.  E.  Jones  and  J.  Douricott  were  paroled  in 
three  and  eight  months.  Doming  and  AVheeler,  deserters,  disappear  after  four  months 
and  six  weeks  respectively.  Branson  was  furloughed  in  six  weeks.  During  the  brief 
period  they  remained  under  observation,  these  five  cases  presented  very  favorable  illustra- 
tions of  the  plan  of  treatment  under  consideration.  There  remain  of  the  twenty-seven 
reported  recoveries,  nine  cases,  two  of  which  (Stauffer,  p.  499,  and  Conauton,  }).  502) 
appear  to  be  satisfactory,  wliile  seven  are  open  to  objection.  These  seven  are  the  cases  of 
Brice  and  Larkin  (p.  499j,  Cunningham  and  Loll  (p.  500),  Pod<l!o  and  Walters  (p.  591), 


508 


AVOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CiiAr.  V, 


and  McAllister  (p.  502).  Peddle  and  McAllister  were  discharged  for  disability,  and  the 
other  five  were  retnrned  to  dnty  in  I'rom  ten  weeks  to  six  months  from  the  date  of  the 
reception  of  their  injuries.  It  is  almost  incredible  that  Dr.  McCall  should  have  sent  Larkin 
to  the  ranks,  knowing  that  he  had  been  shot  through  the  left  lung  one  month  before,  no 
matter  how  complete  his  convalescence  might  appear ; yet  such  is  the  record.  Captain 
Peddle  was  discharged,  and  may  have  had  the  nnusnal  generosity  to  waive  his  claim  for 
pension ; but  it  is  so  extraordinary  that  the  six  enlisted  men  reported  to  have  been  shot 
through  the  chest  should  all  have  failed  to  make  application  for  pension,  that  it  is  difficult 
to  avoid  the  conviction  that  either  the  gravity  of  the  injuries  sustained  by  these  men  was, 
happily,  greatly  exaggerated  originally,  or  else  that  the  men  imprudently  returned  to  duty, 
were  killed  in  action,  or  died  in  captivity.  In  the  writer’s  judgment,  only  three  of  the 
series  of  twenty-seven  cases,  viz:  Bradley,  Stouffer,  and  Conauton  are  authenticated  as 
complete  and  permanent  recoveries.  The  five  who  deserted  or  were  paroled  or  furloughed 
Avere  perhaps  ecpially  satisfactory  recoveries;  and  then  there  are  the  twelve  disabled 
pensioners. 

If  twenty  recoveries  in  sixty-nine  cases  were  conceded,  the  mortality  rate  of  71.01 
would  still  be  too  low,  if  it  be  assumed  that  these  twenty  were  all  examples  of  perforation 
or  laceration  of  the  lung.  There  is  reason  to  believe  that  those  signs,  which,  when  several 
co-exist,  afford  a strong  presumption  of  lesion  of  the  lung,  were  Avanting  in  many  of  the 
cases,  and  that  the  diagnoses  given  Avere  unAvarranted.  There  is  no  doubt  that,  in  some  of 
the  cases,  threatened  asphyxia  from  hsemothorax  or  empyema  made  it  impracticable  to 
persevere  in  the  occlusiAm  treatment,  and  that  the  AAmimds  Avere  open  during  convalescence. 
The  fatality  of  gunshot  wounds  really  penetrating  or  perforating  the  lung  is  so  great,  that 
science  Avould  have  been  immeasurably  indebted  to  Dr.  IToAvard  for  an  improvement  upon 
ordinary  methods  of  dealing  Avith  these  serious  injuries.  It  is  obAuous  that  such  a pretension 
is  far  from  having  been  established;  it  is  probable  that  the  routine  application  of  the  plan 
has  not  been  unattended  by  disastrous  results;  and  it  is  to  be  lamented  that  the  numerous 
experiments  have  not  even  advanced  our  pathological  knoAvledge. 

Occlusive  dressings  in  such  Avounds  are  not  neAv,  nor  are  sutures,  debridement,  and 
thoracentesis;*  but  such  cavils  Avould  have  been  silenced  had  the  combination  of  these 
means  diminished  the  mortality  of  penetrating  AVounds  of  the  chest.  Unhap])ily,  that 

*liENNEN  observes  {-Frincix>les  of  MUitary  Surgery,  lid  ed.,  1829,  p.  378)  that;  “This  immediate  clcsure  of  the  wound  has  been  recently 
adoi>tcd  by  Larre^’-  with  success.  The  practice  is  not  novel.  John  de  Vif^o,  in  the  tenth  chapter  of  his  third  book,  has  given  an  account  of  it ; and 
I’are  says  that  the  practice  is  founded  on  reason  and  truth,  if  there  is  little  or  no  blood  poured  forth  into  the  cavity  of  the  chest ; he,  however,  does 
not  close  the  wound  fur  the  first  two  or  three  days,  to  prevent  accumulation  of  blood.  La  Motte  closed  all  wounds  of  the  chest  most  accurately  with  a 
tent ; hence,  perhaps,  it  is,  that,  in  the  whole  course  of  his  work,  he  scarcely  moniions  emphysema.  Ills  history  of  the  secret  dressing,  which  consisted 
in  sucking  out  the  blood,  and  then  closing  the  wound,  is  highly  worthy  of  notice,  and  is  given  witli  great  fidelity  in  his  Traill  Complet  de  Chirurgie, 
Vol.  Ill,  p.  20,  I’aris  edition,  1732.  But  Bclloste  seems  to  have  done  more  practical  goed  in  this  way  than  any  other  French  surgeon.  lie  argues 
strenuously  and  successfully  against  keeping  the  injuries  of  the  chest  open,  in  his  Chirxirgicn  d'Uopital,  and  he  sets  a very  valuable  example  to  writers 
if  a more  modern  date;  for,  in  a letter  in  e.vplanation  of  Sancassani’s  Italian  translation  of  his  work,  he  acknowdedges  his  obligations  to  honest  old 
Magatus,  who  wrote  nearly  one  hundred  years  before  him.  [D.  J.  Larrey  treats  of  the  subject  in  his  Memoircs  de  Chirurgie  Militaire  ct  Campagnes, 
T.  II,  p.  154,  in  speaking  of  incised  wounds  of  the  chest  observed  in  the  campaign  in  Egypt.  Pare  {Qiluvres  Comjdetcs,  T.  II,  p.  94,  Livre  8,  Chap. 
XXXll)  has,  as  Malgaigne  remarks,  borrowed  from  Vigo.  (The  edition  in  the  Surgeon  General's  Library  is  the  Munich  edition  of  1521,  Practica  in 
chirurgia  cojnosa,  small  folio.)  The  allusion  to  healing  wounds  of  the  chest  by  first  intention  is  in  the  first  part  of  the  third  book,  fol.  LXXIV.  Vigo 
in  his  turn  copied  from  Guy  de  Chauliac  (La  Grande  Chirurgie,  composec  1‘an  de  grace,  1353).  See  Joubert’s  restoration,  published  at  Toumon  in 
1(119,  Chap.  V,  p.  290.  The  admonition  which  Dr.  Howard  has  unheeded  is  funiished  by  Belloste  in  his  eighth  chapter.  Cesari  Magati,  professor  at 
I’^errara,  published  his  work  "De  rara  Medicatione  Vidnernm,  Folio,  apud  Venetiis,  in  KilO:  Unionem  labiorum,  mitem  medical icnem,  clausum 
vidtius  commoidat.''' — (Crcutzenfeld.)  Pai6  condemns  the  application  of  stitches  in  penetrating  wounds  of  the  chest,  in  the  thirty-second  chapter  of  h.s 
eighth  book,  and  also  in  the  Playes  d’kacquebufes,  1.552,  fol.  76.  Felix  WiuTz,  in  157(),  advanced  the  treatment  of  penetrating  wounds  of  the  chest  by 
sewing  them  up  as  a general  method.  (Practica  der  Wundarzney.  darinn  allerlc.y  schddliche  Misshrduche  der  Wunddrzte  abgeschajft  werden.  Aus 
den  llandschriften  des  Autors,  vou  neuen  ubersehen  und  vermehiet  diu'ch  Budolph  Wurtzen,  Basil,  1576) ; Professor  'W  Longmore  remarlvs  that 
“ ‘ hermetically  scaling’  is  only  a new  term  but  even  tliis  admission  is  erroneous  ; for  in  1827,  Graefe,  of  Berlin,  in  the  case  of  a man  of  thirty-two, 
who  had  stabbed  himself  between  the  fifth  and  sixth  ribs,  near  the  sternum,  the  knife  iienetrating  two  inches,  blood  and  air  escaping  freely  fr;  m the 
woiiu<l,  etc.,  etc.,  directed  the  following  treatment:  La  plaie  fut  hcrmetigacinent  fermec,  etc.,  etc.  (See  Clin,  des  Hop.,  T.  II,  No.  28,  and  Arch.  Ocn, 
de  Med.,  T.  XVI,  p.  601.)  — CoMriLicii.] 


Sect.  II.J 


TRRATMKNT  ]!V  IIKEMETICALLY  SPJALING. 


509 


consummation  lias  not  been  attained.  Additional  and  impressive  illustrations  have  been 
furnished  of  the  well-known  facts  of  the  great  relief  of  dyspnoea  and  the  arrest  of 
hoemorrhage  that  sometimes,  though  far  from  invariably,  follow  the  immediate  closure  of 
chest  wounds.  Paring,  suture,  and  reunion  of  the  lips  of  deep  wounds  have  failed,  as  of 
old,  to  promote  cicatrization  of  the  torn  track  out  of  sight,  and  instances  have  been  fur- 
nished of  sewing  up  clothing  Avithin  the  thorax  and  of  tapping  through  the  liver  that  are 
serviceable  for  instruction  rather  than  imitation. 

The  foregoing  series  of  cases  of  penetrating  shot  wounds  of  the  chest,  treated  by  her- 
metically sealing,  probably  includes  all  that  recovered  ; because,  if  omitted  on  the  official 
records,  such  examples  Avould  probably  have  found  publicity  through  the  medical  jiress. 
But  many  fatal  cases  are  uncpiestionably  unmentioned.  The  fear  of  duplication  has  deterred 
the  writer  from  citing  those  fatal  cases  in  which  the  names  of  the  patient  or  of  the 
observer  were  wanting,  or  the  result  left  undetermined. 

In  the  Appendix  to  Part  I of  this  History  (p.  200),  will  be  found  an  interesting  dis- 
cussion, by  Hr.  J.  S.  Billings,  of  this  mode  of  treatment,  and  of  the  opinions  regarding  it, 
entertained  by  the  medical  officers  of  the  Army  of  the  Potomac.  Adopted  by  surgeons  of 
the  3i  division  of  the  Second  Corps,  it  was  “ regarded  with  disfavor  by  the  majority  of  the 
medical  officers  of  this  Army.”  At  Gettysburg,  Dr.  Billings,  in  charge  of  the  hospital  of 
the  2d  division  of  the  Fifth  Corps,  had  under  observation  “ six  cases,  in  which  the  hermeti- 
cally sealing  process  had  been  practiced  by  Dr.  Howard.  * An  assistant  surgeon  was 
left  by' Dr.  Howard  to  take  charge  of  the  cases,  and  carry  out  his  peculiar  mode  of  treat- 
ment, and  a written  order  was  given  by  Dr.  Letterman  that  these  cases  should  not  be  inter- 
fered with.  All  of  these  men  died  Avithin  eighteen  days.  On  tAVO  of  them  I had  autopsies 
made,  Avhich  revealed  empyema  and  pleuro-pneumonia.  In  one  case  a fragment  of  a 
Avoollen  shirt  lay  in  the  cavity  of  the  chest.”  Dr.  Billings  recpiested  Assistant  Surgeon  C. 
Smart,  medical  inspector  of  the  Second  Corps,  to  report  on  the  results  of  this  mode  of 
treatment  in  the  command  to  Avhich  he  Avas  attached.  After  expressing  his  chagrin  that 
his  iiiAmstigation  Iiad  resulted  in  little  of  real  importance,  owing  to  insurmountable  obsta- 
cles presented  by  the  imperfection  of  the  records,  and  the  absence  on  duty  or  on  sick  leaAm 
of  many  of  the  surgeons  of  the  three  hospitals  of  the  Second  Corps,  Dr.  Smart  continues : 

“In  the  hospital  of  the  1st  division,  I hav'e  obtained  positive  information  of  tbe  existence  of 
only  three  cases  of  chest  Avouuds  hermetically'  sealed  •,  although  1 am  fully  satisfied  that  more  than 
tliis  number  were  so  treated.  Even  in  these  cases  1 have  been  unable  to  obtain  the  names  of  the 
patients,  or  a statement  of  their  condition  before  operation.  That  three  cases,  howev'er,  of  i)ene- 
trating  wounds  of  the  chest  were  sealed  is  certain ; and  it  is  equally  so  that  this  operation  was 
followed  by  immediate  and  very  marked  improvement  in  the  condition  of  the  patients ; and  that 
they  did  well  so  long  as  they  remained  in  the  field  hospital.  What  has  become  of  them  since  then 
is  unknown.  The  cases  operated  upon  in  this  hospital  Avere  certainly  not  selected  on  account  of 
presenting  A'ery  favorable  chances  of  recovery  under  ordinary  treatment;  the  medical  officers  here 
being  inclined  to  view  the  operation  with  an  unfavoiableeye;  although  they  bring  forward  no  facts 
to  piove  aught  against  it,  on  the  contrary  their  experience  pointing  only  to  the  relief  supervening 
upon  the  completion  of  the  sealing  process,  and  hence  patients  that  seemed  to  promise  Avell  were 
sedulously  protected  by  the  medical  officers  in  charge  of  them  from  any  operative  interference. 
])r.  Howard  was  thus  leduced  to  the  necessity  of  selecting  his  cases  for  operation  from  those 
presenting  such  serious  symptoms  as  to  cause  them  to  be  set  down  as  probably  fatal,  however 
treated.  Yet  in  these  cases  sealing  was  followed  by  marked  improvement  in  the  condition  of  the 
patients,  who  did  well  during  the  short  time  they  remained  under  observation. 


510 


AVOUNDS  AND  INJURIKS  OF  THE  CIIKST. 


[ciiAT.  y, 


“In  the  hospital  of  the  2(1  division,  the  operation  has  been  eondemned  without  trial.  One 
case,  I learn,  was  operated  upon,  according  to  Doctor  Uoward’s  method,  by  Surgeon  Henry  A. 
Martin,  U.  S.  V.  Itelief  was  afforded,  and  two  days  afterward  the  patient  Avas  sent  to  City  Point. 
No  particulars  are  given.  In  the  3d  division,*  the  oi)eration  has  been  practiced  to  some  consider- 
able extent,  not  so  much  by  Dr.  Howard  personally,  as  by  the  medical  officers  of  the  division,  who 
tirst  learned  the  practice  after  Gettysburg,  and  have  since  then  adopted  it,  in  some  measure.  Not 
having  any  record  of  the  cases,  they  cannot  speak  of  the  ultimate  issue  of  hermetically  sealing. 
Yet,  that  cases  treated  thus  are  not  neees.sarily  fatal  is  evidenced  by  the  case  of  an  oftieer  (name 
not  given)  who,  but  a few  days  ago,  exhibited  to  Surgeon  J.  Jamison,  8Gth  jS'ew  York  Volunteers, 
the  cicatrices  of  the  sealing  performed  by  him  at  a previous  period.  Without  reference  to  the 
issue  in  death  or  recovery,  this  oiieration  is  praciticed  in  order  to  yield  the  relief  from  dyspnoea 
which  is  invariably,  in  the  experience  of  these  surgeons,  its  immediate  result.  On  the  records, 
only  two  cases  of  penetrating  wounds  of  the  chest  are  mentioned  as  having  been  sealed.  The 
reason  given  for  this  omission  is  that  patients  subjected  to  this  mode  of  treatment  are  seldom 
brought  to  the  operating  table,  and  hence  do  not  come  under  the  observation  of  the  recorders. 
Surgeon  J.  W.  Lyman,  57th  Pennsylvania  Volunteers,  has  lately"  sealed  up  two  cases— the  names 
he  does  not  recall : 

“Case  1st. — Ball  entering  internal  to  the  nipple  on  the  left  side,  passed  out  in  the  neighhorhood  of  the  inferior  angle  oi 
the  scapula  of  the  same  side.  The  evidences  of  perforation  of  the  lung  were  satisfactory.  Blood  w.as  expectorated  and  air  issued 
from  both  anterior  and  posterior  apertures.  As  the  dyspnoea  was  very  distressing,  it  was  resolved  to  seal,  which  was  effected  in 
the  usual  manner:  The  edges  were  first  j)ared  and  then  held  firmly  together  by  means  of  two  or  three  sutures;  a pledget  of  lint 
was  kept  in  position  over  the  united  lips  of  the  wound  by  one  or  two  strips  of  isinglass  plaster,  and  the  whole  coated  over  with 
collodion. 

“ Case  2d.— Ball  entered  on  the  outer  side  of  the  left  shoulder,  passed  behind  the  head  of  the  humerus,  and,  traversing  the 
upper  and  back  part  of  the  axillary  space,  entered  the  chest.  The  aj)erturo  of  exit  was  near  the  inferior  angle  of  the  sea))ula  of 
the  opposite  side.  The  difficulty  of  breathing  was  extreme.  The  whole  of  the  chest  was  emphysematous.  Coagulated  blood 
was  coughed  up  and  air  issued  from  the  wound  in  the  right  side.  This  wound  having  been  sealed  up  by  three  sutures,  air  was 
discovered  moving  through  the  wound  in  the  shoulder.  The  p.atient  objected  to  having  this  one  sealed,  as  he  found,  by  pressing 
with  his  outspread  hands  upon  his  chest,  he  caused  the  air  contained  in  the  cellular  tissue  to  issue  from  it,  and  so  relieved,  in 
some  measure,  his  oppressed  breathing.  The  opening,  however,  was  closed  uj)  by  two  stitches  after  the  air  in  the  areolar  tissue 
had  been  evacuated.  In  both  cases  the  patients  were  relieved,  and  were  doing  W'ell  when  sent  shortly  afterward  to  the  rear. 

“In  tlie  latter  case  the  propriety  of  closing  ni)  the  wound  in  the  shoulder  might  readily  be 
questioned;  but  I would  be  going  beyond  the  scope  of  this  report  were  I to  attempt  its  discussion. 
tSurgeon  J.  Jamison,  80th  New  York  Volunteers,  has  sealed  up,  during  this  caiujiaign,  at  least  eight 
cases.  His  last  operation  was  on  June  23d,  on  the  person  of  a man,  Lewis  Burgess,  belonging  to 
his  own  regiment.  He  was  called  in  haste  to  see  this  man  on  account  of  distressing  difficulty  of 
breathing.  The  operation  afforded  so  much  relief  that  after  it  the  ])atient,  who  previously  had 
been  all  anxiety,  laughed  and  joked  with  his  comrades.t  A case,  where  nature  adopted  Dr. 
Howard’s  principle  with  modified  practice,  may  be  mentioned.  Dr.  \V.  S.  Cooiier,  125th  New  York 
Volunteers,  relates  that  while  the  wagons  ordered  to  carry  wounded  to  the  rear  were  being  loaded 
up,  a man  belonging  to  his  regiment,  whom  he  had  previously  seen  and  recorded  as  being  shot 
through  the  lung,  complained  to  him  that  the  officers  loading  up  the  wagons  would  not  permit  him 
to  ride,  saying  that  he  was  able  to  walk.  The  wound  in  the  chest  was  sealed  up  by  a hard  cake  of 
dried  clots.  The  man,  he  has  since  learned,  is  convalescent.  This  was  a decided  case  of  injury  to 
the  lung,  for  the  man  coughed  up  small  clots,  and  these,  by  the  way,  formed  his  passport  into  the 
wagon.  Concerning  mortality  after  this  operation,  I can  say  but  little.  No  medical  officer  in  this  corps 
has  seen  a case  of  hermetically  sealed  chest  wound  dead.  Yet  it  is  possible  that  some  of  the  cases 
in  the  3d  division  might  have  died  without  attracting  attention;  no  particular  care  was  evinced 
in  watching  the  cases.  In  the  1st  division,  however,  it  a death  had  occurred,  I am  certain  it  would 
have  been  seized  iqion  as  proof  sufficient  to  condemn  the  operation.  From  the  registers  of  the  2d 
and  3d  divisions,  I have  transcribed  the  names  of  one  hundred  and  fifty  cases  of  penetrating  wounds 
not  hermetically  sealed  ; of  this  number,  forty-nine  died  while  in  the  Field  Division  Hospital.  In 

* The  chief  medical  officers  of  tlie  three  divisions  were : 1st  division,  Surgeon  D.  N.  Houston,  2d  Delaware  Volunteers  j 2d  division,  Surgeon  J. 
r.  Dyer,  IDth  Massachusetts  Volunteers;  3d  division,  Surgeon  Orpheus  Evarts,  2Cth  Indiana  Volunteers. — Ed. 

t He  died  on  June  29th.  Sec  page  50(5, — Ed. 


Sect.  II.] 


TREATMENT  BY  HERMETICALLY  SEALING. 


511 


this  report  fourteen  cases*  (not  selected  by  reason  of  their  presenting  fair  chances  of  a favoral)le 
issue)  treated  by  sealing  are  recorded  as  having  been  sent  to  the  rear  doing  Avell.  It  is  possible 
that  the  palliation  of  the  immediate  symptoms  may  have  something  to  do  with  this.  However, 
more  extended  observation  is  required  before  any  satisfactory  conclusion  can  be  arrived  at  upon 
tliis  subject.  In  concluding,  it  may  be  needless  to  mention  that  the  experience  of  those  oflicer.s,  in 
the  corps,  who  have  jiracticed  the  operation  has  as  yet  been  too  limited  to  enable  them  to  form 
any  idea  based  upon  facts  concerning  the  nature  of  those  cases  to  which  this  operation  is  more 
particularly'  applicable.”  * * * 

111  the  Army  of  the  James,  a strong  prejudice  was  manifested  against  Dr.  Howard’s 
plan  of  treatment,  especially  by  the  surgeons  at  the  base  and  field  hospitals  at  Broadway 
Landing  and  Point  of  Procks.  Surgeon  Pladley  B.  Fowler,  12th  New  Hampshire  Volun- 
teers, in  his  monthly  report  of  the  base  hospital  for  July,  1864,  says  : 

* * * “ During  the  month  ten  cases  of  gunshot  wounds  of  the  lung  died  here.  Of 

ten  cases  treated  by  Dr.  Howard,  of  Washington,  by  the  method  of  hermetically'  sealing  the  wounds 
in  the  chest  and  tapping  to  relieve  effused  fluid,  nine  died  and  one  was  sent  to  general  hos[)ital, 
the  wound  of  exit  freely  discharging  pus  at  the  time  he  was  put  on  the  transport.  The  pathological 
results  of  two  of  his  cases  are  reported  ; the  other  eight  were  examined  by  Dr.  Howard,  but  results 
not  made  known  to  us.” 

Of  the  cases  here  referred  to,  but  two  have  been  positively  identified,  the  case  of 
AVilliams,  printed  on  page  504,  and  tint  of  Private  G.  A¥.  Byerson,  9th  Maine  Volunteers. 'j' 
The  first  was  and  the  second  was  not  an  instance  of  hermetically  sealing.  Dr.  Fowler’s 
report  gives  the  following  additional  names  of  patients  with  gunshot  penetrating  wounds 
of  the  chest  who  died  in  the  hospital  under  his  charge  about  the  period  referred  to  from 
gunshot  wounds  of  the  chest,  viz  : 

Private  Lewis  King,  Co.  I,  9Gth  New  York  Volunteers,  died  July  2d,  1884. 

Private  Albert  Attwood,  Co.  K,  4tk  New  Hampshire  Volunteers,  died  July  2d,  1864. 

Private  Martin  Kelley,  Co.  I,  188th  Pennsylvania  Volunteers,  died  July  3d,  1864. 

Private  Albert  Vickery,  Co.  11,  8th  Maine  Volunteers,  died  July  4th,  1864. 

Private  Louis  Byron,  Co.  K,  169th  New  Y'ork  Volunteers,  died  July  4th,  1864. 

Private  Jesse  Harvey,  Co.  G,  7Cth  Pennsylvania  Volunteers,  died  July  8th,  1834. 

Private  James  Peabody,  Co.  I,  9th  Maine  Volunteers,  died  July  8th,  1864. 

These  names  probably  refer  to  the  cases  mentioned  by  Dr.  Fowler  as  illustrations  of 
the  disadvantageous  results  of  Dr.  Howard’s  treatment.  The  more  successful  case,  of 
empyema,  sent  to  the  hospital  at  Fort  Monroe  cannot  be  identified  from  the  hospital 
records. 

Assistant  Surgeon  G.  Derby,  U.  S.  V.,  medical  inspector  of  the  Department  of  Vir- 
ginia and  North  Carolina,  made,  on  July  7th,  1864,  a report  to  Surgeon  0.  McCormick,  U. 
S.  A.,  the  medical  director  of  the  department,  relative  to  some  of  tliese  cases.  Copies  of 
the  report  were  furnished  to  the  Acting  Surgeon  General  and  to  Surgeon  G.  Suckley,  medi- 
cal director  of  the  Eighteenth  Corps,  who  had  supervision  of  the  field  and  base  hospitals 
of  the  Army  of  the  James.  The  report,  divested  of  the  endorsements  and  other  official 
formulae,  was  as  follows  : 

“Oil  the  4tli  instant,  I inspected  the  base  hospital  of  the  Eighteenth  Army  Corps  and  found 
four  cwses  of  gunshot  wound  of  the  thorax,  all  of  which  were  under  the  immediate  cliarge  of 
Assistant  Surgeon  Benjamin  Howard,  U.  S.  A.,  who,  although  not  connected  with  the  hospital  or 

*In  the  scries  of  cases  that  I have  reported  by  name,  there  are  fourteen  of  the  three  division  hospitals  of  the  Second  Corps,  including  nine  fatal 
cases. — Ed. 

t An  account  of  the  autopsy  in  this  case,  in  which  the  abdominal  cavity  was  chiefly  implicated,  was  published  by  Surgeon  C.  II.  Carpenter,  14!?fli 
New  York  Volunteers,  in  the  Boston  Med.  and  Surg.  Jour.,  Vo).  LXXI,  p.  Hi.?.  It  will  be  noticed  farther  on  among  the  wounds  involving  botli  chest  and 
ubdomeii. 


512 


WoliNDS  AM)  lAMUltlKS  OK  Till'’,  OlII'^ST. 


I ClIA]’.  V, 


corps,  liad  special  autliority  from  Washington,  as  I was  informed,  to  direct  the  treatment  of  all 
similar  cases  which  miglit  be  ree.eived.  The  essential  points  of  his  treatment  consisted  in  hermet- 
ically closing  the  wounds,  and  subsequently  making,  with  the  trocar,  new  openings  for  the  exit  of 
accumulated  Iluid.  On  visiting  the  hospital  again  to-day,  1 learned  that  the  cases  1 had  seen  three 
days  lu'cviously  had  all  died.  I found  three  other  similar  cases  which  had  been  subjected  to  the 
same  treatment.  Two  of  them  were  moribund.  I also  learned  that  in  two  instances,  puncture  of 
the  walls  of  the  thorax  had  been  made  by  the  trocar  without  the  evacuation  of  fluid.  I found  Dr. 
Howard,  and  said  to  him  that,  as  medical  inspector  of  the  department,  1 felt  at  liberty  to  ask  for 
his  authority  to  do  what  he  had  done  and  was  still  doing.  His  reply  was  that  Dr.  Suckley,  medical 
director  of  the  Plighteenth  Cori)s,  had  verbally  authorized  him  to  look  after  these  cases.  One 
oflicial  paper  was  shown  me  dated  July  29th,  1803,  and  signed  by  Surgeon  J.  R.  Smith.  It  author- 
ized Assistant  Surgeon  Howard,  after  the  next  battle,  to  take  charge  of  cases  of  wounds  of  the 
thorax  and  abdomen.  Dr.  Howard,  howevau’,  disclaimed  any  direct  official  authority  for  his  present 
proceedings.” 

Tills  report  was  referred  to  Medical  Director  T.  A.  MeParlin,  of  tlie  Army  of  the 
Potomac,  who  forwarded  in  reply  the  following  report  hy  Assistant  Surgeon  Howard: 

* * * “I  have  the  honor  to  acknowledge  the  receipt  of  a communication  by  G. 

Derby,  Assistant  Surgeon,  H.  S.  V.,  reporting  certain  alleged  proceedings  of  mine  in  the  base  hospital 
of  the  Eighteenth  Corps,  with  endorsements  from  the  Surgeon  General’s  Oftice  and  from  yourself. 
■With  reference  to  the  endorsement  from  the  Surgeon  General's  Office,  I beg  most  respectfully  to 
state  that  I have  never  at  any  time  or  place  ‘ assumed  charge  of  patients  who  have  gunshot  wounds 
of  the  thorax,’  nor  havm  I represented  that  1 possessed  special  authority  from  Washington  or  any 
other  source  to  direct  the  treatment  of  them  or  any  other  class  of  cases.  The  report  of  G.  Derby, 
Assistant  Surgeon,  U.  S.  V.,  is  a gross  misrepresentation,  equally  ungenerous  and  unjust,  as  will 
appear  from  the  following  statement  of  facts:  On  June  30th,  1804,  by  invitation  of  my  friend 
Surgeon  Suckley,  U.  S.  V.,  medical  director  Eighteenth  Corps,  1 accom[)anied  him  on  a visit  to  his 
held  and  base  hospital.  During  the  course  of  a conversation  on  the  treatment  of  certain  gunshot 
wounds  of  the  chest  by  hermetically  sealing,  the  doctor  rei)lied,  ‘ You  have  a good  thing  there, 
doctor.  Those  cases  are  almost  sure  to  die  anyhow,  and  if  there  is  anything  which  imomises  to  be 
beueticial  in  their  treatment,  in  any  degree  whatever,  it  ought  to  be  tried.  If  1 can  do  anything 
to  hell)  you  in  your  investigations,  I will  be  very  glad  to  do  it,  &c.’  I replied  that  if  the  Eighteenth 
Corps  became  engaged  while  the  Army  of  the  Potomac  was  quiet,  if  I had  time,  I would  run  down 
to  take  notes  at  least,  even  though  I did  not  operate  or  treat  any  cases,  &c.,  &c.  During  our  visit, 
the  doctor  introduced  me  to  the  surgeons  in  charge  of  the  Held  and  base  hospitals,  respectively, 
and  directed  them  to  afford  me  eA  cry  facility  in  their  power  to  enable  me  to  treat  or  take  notes  of 
cases  as  I might  desire,  so  long  as  it  did  not  conflict  with  the  general  arrangements.  The  same 
evening,  the  Eighteenth  Corps  became  separately  engaged,  and  on  the  day  following,  toward  night, 
I tound  in  the  held  hospital  several  chest  wounds.  I operated  on  one  case.  Private  Williams,  1st 
Connecticut  Heavy  Artillery,  which  promised  very  unfa\mrably ; also  commenced  to  operate  on 
Private  Kelly,  G9th  Kew  York  Volunteers;  but,  as  he  appeared  unable  to'endure  the  position,  I 
desisted.  There  were  other  cases,  but,  as  it  was  growing  dark,  I left,  requesting  the  surgeon  in 
charge  to  send  my  patient  on  to  the  base  hospital  as  soon  as  he  could,  together  with  the  other 
chest  wounds.  They  were  not  forwarded  when  I called  the  following  day,  as  I had  anticipated, 
but  came  several  hours  afterward.  On  account  of  the  time  which  had  elapsed  since  the  reception 
of  the  wounds,  I gave  up  the  idea  of  hermetically  sealing  any  other  case,  though  otherwise  it 
might  appear  ever  so  favorable.  On  looking  about  the  hospital,  I found  several  chest  cases,  some 
of  which  were  evidently  mortal,  Avhich  I found  the  ward  surgeons  were  \ ery  anxious  to  get -rid  of. 
I saw  Dr.  PoAvler,  surgeon  in  charge,  and  stated  to  him  distinctly  that  1 had  one  patient.  Private 
Williams,  and  one  only,  for  whom  I was  responsible, — gaA^e  my  reasons  for  objecting  to  the  same 
plan  of  treatment  in  any  other  of  the  cases;  but,  as  I should  be  visiting  the  hospital  frequently, 
requested  that  all  the  cases  might  be  placed  in  the  same  ward  with  my  patient,  my  desire  not 
being  so  much  to  operate  or  carry  out  one  special  plan  of  treatment,  as  to  obscr\'e  closely  the 
largest  possible  number  of  cases.  Eight  cases  Avere  placed  together  with  my  patient  in  the  same 


Sf.ct.  II.] 


TREATMENT  BY  HERMETICALLY  SEALING. 


513 


ward  under  the  immediate  charge  of  Dr.  Tennant.  Before  breakfa.st  on  the.  next,  morning,  I had 
completed  the  mortems  of  three  of  the.se  cases  ; one  was  the  case  I had  (Commenced  to  operate 
upon,  as  referred  to,  the  others  I had  simply  taken  notes  of.  I visited  the  remainder  daily  until 
the  7th  instant,  once  with  Dr.  Suckley,  who  thought  my  patient  was  doing  tinely  under  the  circum- 
stances. ,On  each  visit  I took  notes  of  the  other  cases,  and  made  suggestions  as  to  their  treatment, 
or  modified  it.  I was  unable  to  visit  the  hospital  again  until  the  10th  instant,  when,  calling  on 
Di’.  Suckley,  I learned  he  had  just  left  General  Butler’s  headquarters,  where  he  was  informed,  by 
Assistant  Surgeon  Derby,  that  ‘ all  ’ my  cases  were  dead,  and  that  he  should  have  the  fact  reported 
to  the  Surgeon  General,  &c.  I immediately  went  to  the  hospital  and  was  informed  on  my  first 
inquiry  of  the  first  surgeon  I met,  ‘ All  your  cases  are  dead.’  1 replied,  ‘ I had  but  one,  who,  from 
the  first,  I apprehended  would  live  but  a short  time, — that  I was  sorry  the  others  had  all  died;  but 
had  feared  such  might  bo  the  result.’  I requested  to  see  Dr.  Tennant  [Assistant  Surgeon  Charles 
J.  Tennant,  21st  Connecticut  Volunteers],  the  ward  surgeon  in  charge,  but  found  he  had  been 
ordered  away  on  duty.  I was  referred  to  another  surgeon  who  had  succeeded  him,  and  from  him 
I learned  that  they  were  ‘ nearly  all  dead.’  I then  visited  the  ward  with  him  and  the  surgeon  who 
had  stated  to  me  ten  minutes  before  that  they  were  all  dead,  when  I found  three  living!  two  of 
them  being  more  complicated  than  any  others.  I had  taken  special  interest  in  them,  and  had 
modified  their  treatment  more  than  that  of  all  the  others  put  together.  In  one,  the  liver  was 
implicated.  1 had  on  one  occasion  removed  about  a pint  and  a half  of  fiuid  from  the  right  pleural 
cavity,  strongly  tinged  with  bile,  and  subsequently  about  a pint  of  the  same  nature.  In  the  other 
there  was  extensive  pulmonary  hernia,  which  I had  fixed  so  as  to  secure  a permanent  plug  with 
adhesions  around  the  orifice,  and  also  exhausted  the  pleural  cavity  of  air.  This,  I suppose,  is  the 
case  Assistant  Surgeon  Derby  reports,  in  which  the  trochar  was  used  without,  as  he  had  ‘ learned,’ 
the  removal  of  any  fluid.  Of  the  cases,  nine  in  all,  my  patient  lived  till  the  eighth  day  ; three  of 
the  others  died  on  July  2d  and  3d ; two  others,  I suppose,  died  during  my  absence,  and  three  were 
living  on  July  10th,  18C4.  Bermetically  sealing  was  practiced  in  no  case  except  that  of  my  patient. 
Private  Williams,  in  whom  both  lungs  were  extensively  involved — the  ball  having  entered  and 
passed  through  the  left  scapula,  below  its  spine,  passing  out  about  two  inches  below  the  middle  of 
the  right  clavicle.  I met  Assistant  Surgeon  Derby,  U.  S.  V.,  at  the  base  hospital  on  the  3d  and 
7th  instant;  on  neither  of  these  occasions  were  any  explanations  elicited  from  me,  which  I deemed 
unnecessary  under  the  circumstances.  My  presence  at  the  hospital  and  everything  connected  with 
the  whole  affair  was  simply  an  unofficial  matter  betw'een  Dr.  Suckley  and  myself,  to  whom  I 
should  have  simply  referred  Assistant  Surgeon  Derby,  U.  S.  V.,  for  information.  It  happened, 
how'ever,  that,  on  July  7th,  I had  in  my  pocket  the  communication  he  refers  to  from  the  Surgeon 
General’s  Office,  so  I showed  it  to  him,  at  the  same  time  stating  that  it  had  no  relation  whatever 
to  my  present  conduct,  which  was  entirely  without  anj"  written  order  or  authority.  I have  on 
other  occasions  frequently  consulted  with  and  operated  for  brother  medical  officers  in  other 
commands  than  my  own  with  the  same  mutual  courtesy  as  is  observed  in  private  practice,  which, 
so  far  as  I know-,  is  not  forbidden  by  humane  considerations,  professional  etiquette,  nor  by  official 
order.  I am  personally  responsible  for  my  professional  conduct  and  shall  be  happy  to  submit  my 
original  notes  of  cases,  or  in  any  way  contribute  to  its  investigation.  I think  it  must  be  evident, 
however,  from  a view'  of  the /acts  herein  stated,  not  as  I have  ‘ learned’  them,  but  as  I Icnow  them, 
that  my  conduct  in  the  case  has  been  in  perfect  accordance  with  propriety  and  good  discipline.” 

The  subject  appears  to  have  dropped  here.  Fighting  was  going  on  daily,  and  tlic 
attention  of  the  higher  medical  autliorities  was  occupied  l)y  very  wciglitv^  affairs.  The 
report  was  dated  July  18th,  1864.  Few  cases  in  which  the  treatment  in  question  was 
practiced  are  recorded  subsequently.  In  March,  1865,  liotvevcr.  Surgeon  George  Derby,  U. 
S.  V.,  with  a view  to  efface  an  impression  that  this  was  an  approved  method  of  treatment, 
printed  a communication  in  the  Boston  Medical  and  Surejical  Journal,  containing  the 
following  emphatic  language: 

“111  July,  18G4,  it  came  in  my  way  to  see  six  ca.ses  at  one  time  treated  in  this  manner  at  the 
field  hospital  of  the  Eighteenth  Army  Gorps  before  Petersburg.  All  six  proiiqitly  perished.  The 
G.T 


514 


WOUNDS  AND  INJURIES  OF  THE  CHEST, 


[Chap.  V, 


verdict  of  army  surgeons,  who  have  tried  this  method,  I thiidv  is  unanimous.  Can  we  not  then  be 
done  with  it— banish  it  from  onr  books  of  military  surgery,  and  let  it  rest  with  the  multitude  of 
exjdoded  theories  which  have  preceded  it  ? A writer  in  the  London  Lancet,  some  time  ago,  clearly 
showed  that  it  was  uuphilosophical.  Experience  has  proved  it  fatal.”* 

Hernia  of  the  Lung. — Writers  on  military  surgery  have  regarded  this  as  the  rarest 
of  the  complications  of  wounds  and  injuries  of  the  chest, an  opinion  confirmed  by  the 
experience  of  late  wars.  Authors  make  two  species  of  traumatic  pneumocele,  viz;  wound 
of  the  chest  with  protrusion  of  the  lung,  and  consecutive  pneumocele  or  pneumatocele,  or 
hernia  of  the  lung  properly  so  called,  in  which  the  protruding  portion  of  the  viscus  is 
enveloped  by  a covering  of  integument  and  thickened  pleura,  or  cicatrical  or  other 
adventitious  tissues.  Of  the  seven  examples  of  hernia  of  the  lung  noted  among  the 
twenty  thousand  cases  of  chest  wounds  returned,  five  at  least  were  of  the  primary  variety. 
It  is  usually  stated  by  systematic  writers  that  these  protrusions  most  frequently  occur 
anteriorly  and  in  the  neighborhood  of  the  nipple,  doubtless  because  most  of  the  recorded 
cases  occurred  after  incised  or  punctured  wounds,  and  hence  at  the  part  of  the  thorax  most 
exposed  to  stabs.  In  the  cases  here  adduced,  all  resulting  from  gunshot,  the  injury  was 
inflicted  low  down  in  the  chest;  in  five  instances,  at  or  below  the  ninth  rib;  in  two,  below 
the  nipple.  Hence,  several  of  the  cases  were  accompanied  by  wounds  of  the  belly,  and 
escape  of  portions  of  the  abdominal  viscera  as  well  as  the  lung.  It  is  greatly  to  be 
regretted  that  the  observations  are  so  imperfect  as  to  throw  little  light  upon  this  obscure 
subject.  The  exact  period  at  which  the  protrusions  occurred  and  the  behaviour  of  the 
tumor  in  inspiration  and  expiration  pass  unnoticed,  and  the  want  of  details  respecting  the 
extent  and  direction  of  the  .wounds  detract  from  the  value  of  the  observations,  which,  had 
they  been  minutely  and  carefully  described,  would  have  sufficed  to  decide  several  contested 
points.  But  the  vicissitudes  of  the  battle  field  are  not  favorable  to  accurate  clinical  records, 
and,  meagre  as  they  are,  these  histories  must  be  accepted  with  gratitude  because  of  their 
rarity.  The  first  case  relates  to  a man  who  was  captured  and  taken  to  Richmond  imme- 
diately after  the  reception  of  his  injury: 

Case. — Private  W.  A.  PerriD,  Co.  C,  lOCtli  New  York  Volunteers,  aged  29  years,  received  a gunshot  wound  of  the  left 
thorax,  by  a couoidal  ball,  at  the  W^ilderness,  Virginia,  May  Cth,  1864.  He  was  taken  prisoner  and  remained  in  the  enemy’s 
hands  until  August  14th,  when  he  was  paroled  and  conveyed,  by  the  steamer  New  York,  to  Annapolis,  Maryland,  entering  the  First 

* Consult  IIOWAED,  B.,  Treatment  of  Gunshot  and  Penetrating  Wounds  of  the  Chest  and  Abdomen  bg  Hermetically  Sealing,  American  Medical 
Times,  Vol.  VII,  p.  156,  October,  1863;  Longmore,  T.,  Remarks  on  the  recently  proposed  American  plan  of  treating  Gunshot  Wounds  of  the  Chest  by 
^'Hermetically  Sealing,"  London  Lancet,  p.  5,  Vol.  I,  1864  ; HOWARD,  B.,  A Review  of  some  Remarks  of  Professor  Longmore  on  the  Treatment  of  Gunshot 
Wounds  of  the  Chest  by  Hermetically  Sealing.  Am.  Jour.  Med.  Sci.,  N.  S.,  Vol.  XLVIII,  p.  .515;  DERBY,  G.,  Surgeon,  U.  S.  V.,  Gunshot  Wounds  of  the 
Thorax ; is  the  Treatment  by  Hermetically  Sealing  them  justifiable,  Boston  Medical  and  Surgical  Jounial,  Vol.  LXXII,  March,  1865 ; Otis,  G.  A.,  Circular 
No.  6,  War  Department,  Surgeon  General's  Office,  Washington,  1865,  4to,  p.  22 ; Brearey.  W.  F.,  Some  Cases  of  Penetrating  Wounds  of  the  Chest, 
treated  by  Hermetically  Closing,  Michigan  Univ.  Med.  Jour.,  October,  1871,  p.  466;  BUOWN,  P.  F.,  Gunshot  Wound  of  Chest  Treated  by  Hermetically 
Sealing,  Confed.  Stat.  Med.  and  Surg.  Jour.,  Oct.,  1864,  p.  163;  CIIISOLM,  J.  J.,  Conversion  of  Gunshot  Wounds  into  Incised  Wounds  as  a Means  of 
Speedy  Cure,  Confed.  Stat.  Med.  and  Surg.  Jour.,  p.  138,  Sept.,  1864  ; MICIIEL,  M.,  Healing  of  Gunshot  Wounds  by  First  Intention,  ibid.,  July,  1864, 
p.  99  ; IIecKEU,  a.  R.,  Boylston  Prize  Essay  on  Gunshot  Wouyids,  in  Boston  Med.  and  Surg.  Jour.  Vol.  LXXII,  p.  97,  1865 ; HAMILTON,  F.  H.,  A Trea- 
tise on  Military  Surgery  and  Hygiene,  New  York,  1865,  p.  281 ; Billings,  J.  S.,  Report  on  the  Treatment  of  Diseases  and  Injuries  in  the  Army  of  the 
Potomac  during  1864,  Appendix  to  Part  I,  Med.  and  Surg.  History  of  the  War  of  the  Rebellion,  p.  200 ; Brinton,  D.  G.,  Report  of  the  Operations  of  the 
Medical  Staff  of  the  Eleventh  Corps  at  the  Battle  of  Chattanooga,  ibid.,  p.  293. 

tlMAi'TiiEW  {op.  ciL,  Vol.  II,  p.  326),  the  acevurate  historian  of  British  Surgery  in  the  Crimea,  states  that  “no  case  of  hernia  of  the  lung  is 
reported.”  M.  LEGOUEST  {op.  cit.,  2™«  6d.,  p.  361)  speaks  of  this  as  “ la  plus  rare  dcs  complications  dcs  plaies  penUrantes  de  lapoitrine."  Mr.  Blenkins 
(8th  cd.  of  S.  Cooper's  Diet.,  Vol.  I,  p.  828)  describes  it  as  “one  of  the  rare  complications  of  penetrating  wounds  of  the  chest.*’  Hennen  speaks 
of  having  occasionally  met  with  herniary  protrusions  of  the  lungs  caused  by  guns,  caissons,  etc.,  running  over  men.  “ They  have  been  attended  by 
no  peculiar  inconvenience,  but  have  suppurated  freely,  and  have  been  punctured  like  cases  of  common  abscess.”  Guthrie  {op.  cit.,  5th  ed.,  p.  499) 
saw  at  Brussels,  after  the  battle  of  Waterloo,  “ three  cases  which  were  not  interfered  with,  greatly  to  the  advantage  of  the  patients.  It  is  rare,  however,” 
he  continues,  “ to  sec  a i>rotrusion  of  the  lung  after  a gunshot  wound.”  At  Waterloo,  Samuel  Cooper  ” had  a patient  with  a protrusion  of  a piece  of  lung, 
four  or  five  inches  in  length.  The  part  was  much  bruised  and  could  not  be  easily  reduced.  I therefore  applied  a ligature  around  its  base  and  cut  it  off. 
Previously,  however,  I made  an  incision  in  it  to  ascertainMviiother  it  would  bleed  freely,  which,  being  the  case,  induced  mo  to  use  a ligature.  I was 
afterward  informed  by  my  friend  Mr.  Collier  that  the  man  died.  ” Dkmme  (MilHiir-Chirugische  SLudicn,  Wurzburg,  1864,  B.  II,  S.  152)  claims  to  Jiave 
seen  four  cases  in  the  North-Italiau  military  hospitals  in  1859. 


Med  ft  J-ury  Hist,  of  the  M'av  of  the  Kc'l)elli()ii.  I'iirl  I.Vol  II.  0p.pa9 


'T  Sinclair 8*  Soil. Chroiiio-lHh  . 


Sect.  II.] 


HERNIA  OF  THE  LUNG. 


615 


Division  Hospital.  On  Deccnilier  lie  was  transferred  to  Camp  Parole  Hospital,  wlieiiee  lie  was  discliarped  fiom  service 
February  Ctli,  18C5.  Pension  Examiner  13.  8.  Slid  man  report.s,  .Inne  2:’d,  18G5,  tliat  tlic  ball  earrieil  away  a jiortion  of  the 
eighth  and  ninth  libs,  left  side,  forwaid  of  their  angles,  resulting  in  hernia  nearly  the  size  of  a' small  tea-cup,  which  it  is  difficult 
to  keep  in  place  with  bandage  and  compress.  Disability  total  and  more  or  less  permanent.  He  was  still  a pensioner  in 
March,  1872. 

This  would  appear  to  have  been  an  example  of  consecutive  pneumocele,  the  lung- 
forcing  the  soft  parts  outward  as  their  support  was  withdrawn  hy  the  removal  of  splinters 
and  exfoliations  from  the  fractured  ribs.  The  report  of  the  regimental  surgeon,  Dr.  J.  N. 
Freeman,  and  the  records  of  the  Sixth  Corps  hospitals,  and  of  the  General  Hospital  Ho. 
21,  at  Richmond,  and  of  the  transport  steamer  Hew  York,  have  been  vainly  searched  for 
additional  information. 

The  next  is  a very  extraordinary  case.  The  appearance  of  the  protruded  lung  shortly 
after  the  accident,  and  of  the  tumor  after  cicatrization  was  complete,  are  illustrated  by  two 
plates  (Plate  XI  opposite,  and  Plate  XII,  opposite  page  516). 

Case. — Captain  Robert  S , Co.  A,  29th  New  York  Volunteers,  was  wounded  at  Chancellorsville  on  May  2d,  18()3. 

A round  musket  ball,  fired  from  a distance  of  about  one  hundred  and  fifty  yard.s,  entered  the  eighth  intercostal  space  of  the  left 
side,  at  a point  nine  and  one-half  inches  to  the  left  of  the  extremity  of  the  ensiform  cartilage,  and  fractured  the  ninth  i-ib. 
W-ithout  wounding  the  lung  apparently,  the  ball  passed  through  the  diaphragm,  and  entered  some  portion  of  the  alimentary 
canal.  Captain  S.  walked  a mile  and  a half  to  the  rear,  and  entered  a field  hospital.  On  examining  his  wound,  the  surgeons 
found  a protrusion  of  the  lung  of  the  size  of  a small  orange,  which  they  unavailingly  attempted  to  reduce.  The  wound  was 
enlarged,  and  still  it  was  impracticable  to  replace  the  protruded  lung.  On  May  3d,  the  field  hospital,  where  Captain  S.  lay,  was 
exposed  to  the  enemy’s  fire.  He  walked  half  a mile  further  to  the  real’,  and  was  there  placed  in  an  ambulance,  and  taken  across 
the  Rappahannock,  at  United  States  Ford,  to  one  of  the  base  hospitals.  Here  fruitless  efforts  were  again  made  to  reduce  the 
hernial  tumor,  after  which  a ligature  was  thrown  around  its  base  and  tightened.  A day  or  two  subsequently,  tlie  patient  jiassod 
into  the  hospital  of  the  2d  division  of  the  Eleventh  Corps,  into  the  hands  of  Surgeon  Robert  Tliomain,  29th  New  York 
Volunteers,  who  removed  the  ligature  from  the  base  of  the  tumor.  A small  portion  of  gangrenous  lung  separated  and  left  a 
clean  granulating  surface  beneath.  On  May  7th,  the  ball  was  voided  at  stool.  On  May  8th,  the  patient  was  visited  by 
Surgeon  John  H.  Brinton,  U.  S.  V.,  who  found  him  walking  about  the  ward,  smoking  a cigar.  There  was  an  entire  absence 
of  general  constitutional  symptoms ; no  cough,  no  dyspnoea,  no  abdominal  pain  ; the  bowels  were  regular  and  appetite  good. 
The  protruding  portion  of  the  lung  was  carnified ; there  was  a dulness  on  percussion,  and  absence  of  the  respiratory  murmur 
in  a zone  an  inch  and  a half  in  width  around  the  circumference  of  the  base  of  the  tumor.  Surgeon  Tliomain  stated  that  the 
hernia  had  been  gradually  diminishing  in  volume.  It  was,  at  this  date,  half  the  size  of  an  egg,  and  covered  with  florid 
gi’anulations.  On  May  10th,  a drawing  of  the  parts  was  executed  by  Mr.  Stanch,  artist  of  the  Army  Medical  Museuih. 
(See  Chromolithograph  No.  XI.)  On  June  2d,  Captain  S.  was  transferred  to  Washington.  There  was  an  elastic,  partly 
reducible  tumor,  over  which  was  an  oval  granulating  surface  an  inch  and  a half  by  three-fourths  of  an  inch.  Thu  vesicular 
murmur  was  perfect  throughout  the  lung,  except  in  the  immediate  vicinity  of  the  tumor.  Compression  of  the  tumor  was 
advised.  After  a furlough  of  sixty  days.  Captain  S.  was  again  examined.  The  wound  had  entirely  healed ; the  resjiiratory 
sounds  were  normal ; there  was  still  a slight  hernia  of  the  lung.  The  general  health  of  the  patient  was  excellent.  At  this  date 
a second  drawing  was  executed.  (See  Chromolithograph  No.  XII.)  Tlie  captain  w’as  discharged  from  service  on  June  20th, 
1863,  and  was  subsequently  pensioned.  On  May  19th,  1864,  Pension  Examiner  E.  Swift  I’cports  the  patient  to  bo  entirely 
incapacitated  from  the  wound,  which,  at  that  date,  was  considerably  tumefied.  He  rates  his  disability  total  and  temporary. 
September  19th,  1865:  The  tumor  is  reported  to  be  undiminishod  in  size  and  painless.  The  patient  can  take  ordinary,  leisurely 
exercise,  but  is  unable  to  run  up  and  down  stairs.  He  has  no  cough,  but  sufi'ers  somewhat  from  gastric  sjunptoms,  his  stomach 
being  easily  disturbed.  The  extra-thoracic  tumor  is  resonant  on  percussion.  The  air,  in  entei-ing,  produces  a crepitant  crack- 
ling sound;  the  expiratory  murmur  is  feeble.  March  14tli,  1867  : Two  months  ago,  the  tumor  suddenly  enlarged  after  straining 
efforts  at  lifting,  being  now  five  inches  in  its  long  and  four  and  a half  inches  in  its  transverse  diameter.  The  respiratory  sounds 
are  feeble.  There  is  often  nausea  after  eating,  and  great  pain,  referred  to  the  tumor.  Pressure  over  the  tumoi'  causes  a gurgling 
sound,  simulating  the  presence  of  air  within  the  tumor,  and  borborygamus  throughout  the  intestines.  The  patient  declares  his 
inability  to  eat  meat.  The  contents  of  the  tumor  are  not  reducible ; tr.action  on  it  and  its  contents  produce  nausea.  A portion 
of  the  stomach  has  undoubtedly  escaped  through  the  diaphragm,  and  through  the  opening  in  the  thoracic  walls.  A bandage, 
so  arranged  as  to  retain  the  tumor  within  its  present  limits,  and  ))revent  further  enlargement,  was  applied.  A letter  I'rom  the 
patient,  dated  January  23d,  1870,  leads  us  to  infer  that  this  bandage  has  fulfilled  its  indication.  On  January  31st,  1870,  the 
patient  was  reported  to  have,  in  addition  to  his  other  troubles,  a hernia  of  the  stomach,  which  viscus  p.assed  uj)  through  the 
diaphragm  and  thence  through  the  opening  in  the  rib,  so  that  the  tumor  on  the  left  side  contained  both  lung  and  stomach.  He 
wore  a compressing  bandage.  On  July  20th,  1872,  Dr.  Win.  11.  Romig,  of  Allentown,  Pennsylvania,  the  family  jihysician  of 
Ca[)tain  Stolpe,  writes:  “The  hernial  tumor  is  of  a doughy  consistence,  its  surface  smooth,  measures  in  its  longest  diameter  four 
and  a half  inches.  Stolpe  says,  it  appears  smaller  at  times;  it  cannot  be  reduced  by  taxis,  neither  can  any  communication  ho 
discovered  with  the  internal  organs.  Never  gives  pain,  but  dyspnoea  is  ])roduced  upon  hastening  his  ]iace  or  heavy  lifting ; 
cannot  lie  on  his  left  side  for  same  reason  ; cannot  expand  his  lung  fully,  that  is,  beyond  normal  use.  His  stomach  will  take 
food  often,  but  not  much  at  a time;  the  left  side  of  his  body  does  not  appear  so  strong  us  the  right.  Weighs  about  one  hundred 
and  sixty  iiounds,  and  enjoys  good  health.” 


516 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


In  the  next  case  nothing  can  he  learned  relative  to  the  isochronism  in  the  variations 
of  volume  of  the  tumor  with  the  two  acts  of  rcs})iration  ; 

Case. — Private  George  W.  Bowiiian,  Co.  K,  4tli  Now  York  Heavy  Artilleiy,  aged  17  years,  was  wounded  at  Spottsyl- 
vaiiia,  May  lOtli,  1S64,  by  a conoidal  ball,  wbicb  entered  four  inches  below'  the  left  axilla,  and  emerged  two  inclies  to  the  left  of 
the  spinal  column,  on  the  same  level.  He  was  admitted  to  Armory  Square  Hospital,  May  ll'Jd,  1864.  Hernia  of  a portion  of  the 
viscera  occurred  from  ))oint  of  entrance  and  was  ligated  by  Acting  Assistant  Surgeon  D.  W.  C.  Van  Slyck.  He  was  furloughed 
.July  1st,  readmitted  August  20th,  again  furloughed  November  23d,  and  readmitted  January  28tb,  1865.  On  February  2d,  1865, 
he  was  returned  to  duty,  and  mustered  out  September  26th,  1865.  Pension  Examiner  W.  C.  Wade,  Holly,  Michigan,  reports, 
November  12th,  1869  ; “ Gunshot  wound  through  ninth  rib  below  left  scapula,  ball  emerging  near  spine,  having  penetrated  the 
abdominal  cavity.  Pieces  of  bone  have  been  removed,  and  part  of  the  omentum  sloughed  away;  the  muscles  of  the  side  are 
weakened.  Disability  three-fourths.” 

The  next  is  the  only  case  of  the  series  in  which  it  is  expressly  stated  that  the  lung 
was  wounded.  The  integrity  of  the  displaced  portion  of  the  lung  had  been  regarded  as 
an  almost  constant  condition  in  traumatic  pneumocele,  the  cases  recorded  by  Roscius  and 
Angelo  being  the  only  exceptions.  In  this  case,  it  is  possible  that  the  edge  of  the  lobe,  the 
part  usually  protruding,  was  uninjured,  the  missile  perforating  the  deep  pulmonary  tissue: 

Case. — Private  James  Infant,  Co.  G,  5th  New  Hampshire  Volunteers,  aged  19  years,  was  wounded  at  Petersburg,  Ajiril 
2d,  1835,  by  a conoidal  musket  ball,  which  entered  just  below  the  left  nipple  and  emerged  to  the  left  of  the  si.xth  dorsal  vertebra, 
penetrating  the  left  lung.  He  was  admitted  to  the  field  hospital  of  the  2d  division.  Ninth  Corps,  and  thence  transferred  by  rail 
to  the  Second  Corps  Hospital,  at  City  Point,  sent  thence  by  hosjiital  steamer  to  Washington,  and  admitfed  to  Armory  Square 
Hospital  on  April  16th.  A portion  of  the  lung,  two  bj'  five  inches,  protruded  through  the  wound  of  entrance.  Death  occurred 
from  asjdiyxia  on  April  18th,  1865.  The  case  is  reported  by  Surgeon  D.  W.  Bliss,  U.  S.  V. 

The  next  very  interesting  case  affords  an  example  of  herniti  of  the  liver,  omentum, 
and  lung,  complications  which  have  received  little  notice,  probably  because  of  the  rarity 
of  recovery  from  such  lesions.  It  recalls  the  case  recorded  by  Sir  Thomas  Bell,  in 
Duncan’s  Commentaries  (Vol.  II,  p.  319,  1785),  of  a grenadier  of  the  35th  British  Infantry, 
whom  he  saw  at  the  military  hospital  at  Point  Levi,  at  the  surrender  of  Quebec  to 
General  W olfe : 

Case. — Private  B.  S.  Sheridan,  Co.  A,  9th  Massachusetts  Volunteers,  was  wounded  at  Malvern  Hill,  July  1st,  1862,  by 
a musket  ball,  which  entered  the  right  side  between  the  ninth  and  tenth  ribs,  and  passed  out  a little  to  the  right  of  the  xyphoid 
cartilage.  Soon  after  the  reception  of  the  injury,  a portion  of  the  lung  protruded  from  the  anterior  wound,  and  from  the  posterior 
wound  there  was  a constant  dripping  of  bite.  On  .July  4th,  Sheridan  walked  from  the  ambulance  station  to  James  River,  a 
distance  of  a mile  and  a half,  with  the  ho)>e  of  getting  on  hoard  of  a gunboat.  He  was  disappointed,  and  was  taken  prisoner 
and  conveyed  to  Richmond.  No  dressings  were  apj)lied  to  the  hernia  of  the  lung.  It  was  uncovered,  and  the  patient  occasion- 
ally washeil  it.  He  suffered  little  pain  or  dyspnoea,  and  there  was  an  amazing  absence  of  shock  or  prosti'ation.  On  July  25th, 
the  bile  had  ceased  to  dribble  from  the  jiosterior  wound,  and  the  hernia  of  the  lung  had  greatly  receded.  He  was  exchanged, 
and  on  July  29th  admitted  into  the  hosjtital  at  Chester,  and  placed  under  a tonic  treatment.  The  mass  of  flesh  was  found  to  be 
muscular  tissue,  and  was  itrotruding  to  the  length  of  two  inches,  and  was  about  the  thickness  of  the  middle  finger.  He  soon 
complained  of  severe  p;iin  in  the  region  of  the  diaphragm,  which  was  augmented  by  taking  a full  breath,  and  of  paroxysms  of 
coughing  attended  with  but  slight  expectoration.  The  cough  and  pain  in  the  region  of  the  diaphragm  gradually  disappetired 
under  treatment.  After  the  protrusion  had  been  sloughed  away,  the  wound  closed,  leaving  a tumor  beneath  the  skin,  in  the 
))o.sition  of  what  was  the  base  of  the  protrusion.  This  tumor  was  slightly  variable  in  size,  but  could  not  bo  reduced.  About 
tbe  middle  of  September,  a movable  substance  was  discovered,  which  appeared  to  be  a portion  of  ball  flattened  on  the  eleventh 
rib,  by  the  side  of  the  tumor ; it  was  determined  to  remove  this  substance,  and  at  the  same  time  ascertain  the  character  of  the 
tumor.  On  doing  this,  it  was  found  to  be  an  irreducible  hernia  of  the  omentum ; no  bad  symptoms  followed  the  operation.  It 
appears  that  the  ball,  after  striking  the  chest,  turned  downward,  ])assed  through  the  oblique  muscles,  carrying  with  it  a portion 
of  their  tissue,  and  was  then  deflected  upward  to  the  point  of  exit.  The  peritoneum  was  probably  wounded  near  the  point  of 
exit,  which  allowed  the  omentum  to  follow  in  the  track  of  the  ball,  and  during  the  time  required  to  slough  away  the  pendant 
mass,  it  became  agglutinated  in  its  new  position,  which  rendered  it  irreducible.  The  patient,  at  liis  own  reejnest,  was  returned 
to  duty  on  October  31st,  1862.  Pension  Examiner  J.  W.  Foye  reports,  under  date  of  Aju-il  6th,  1869,  that  the  '‘ball  entered 
the  right  chest  on  its  posterior  aspect  at  a point  corresponding  with  the  angles  of  the  ribs  and  through  the  last  intercostal  space ; 
passing  forward  it  fractured  the  twelfth  rib  near  its  costal  attachment,  and  escaped  anteriorly  four  inches  from  the  median  line 
of  the  body,  having  first  entered  the  abdominal  cavity  by  detaching  the  diaphragm,  to  a small  extent,  from  the  ensiforin  cartilage. 
Through  the  opening  thus  made,  a process  of  omentum  h.as  floated  upward  constituting  a form  of  costo-phrenic  hernia.  The 
injury  is  grave  but  not  equivalent  to  the  loss  of  a hand.”  Under  date  of  March  4th,  1872,  the  Pension  Examining  Board  at 
Boston,  Massachusetts,  state  : “There  is  now  a hernia  of  the  lung  two  inches  in  diameter  at  base  at  situ  of  wound  of  exit.  The 
inferior  half  of  the  lower  lobe  of  the  right  lung  has  undergone  partial  consolidation  from  interstitial  deposit,  submucous  cre])ita- 
tion,  dulness  on  percussion,  and  also  i)liysical  signs  in  hernial  tumor.  His  general  health  is  mucli  impaireil,  and  he  is  at  present 
incapable  of  any  manual  lat)or.  His  disability  has  increased.” 


Med.R  '''urg.  of  tlie  War  of  tlie  Hebellion,  I' ai  l T.  Vol  II 


Op.  page  5If). 


KJ  St  .'itK'li  |>juy*  'I*  Suirl.ur  H- Sou,  Cliroiiio-rilli 


PLATE  XII.  GUNSHOT  WOUND  OF  THORAX  AND  ABDOM  EN  . 


Skct.  11.] 


HERNIA  OF  THE  LUNG. 


517 


The  sixth  case  is  cited  liy  Dr.  B.  Howard  in  his  report  already  ])rint,cd  (p.  513),  l)ub 
in  such  vague  terms  that  it  is  impossible  to  identify  the  patient,  or  to  determine  whether 
the  tumor  was  ligated  or  excised  or  reduced  without  operation : 

Case. — A soldier  of  the  Eighteenth  Corps  I’eceived  a gunshot  wound  of  the  chest,  before  the  entrenchments  at  Petersburg, 
late  in  June  or  early  in  July,  1864.  He  was  conveyed  to  the  base  hosj)ital  at  Broadwaj"  Landing,  in  charge  of  Surgeon  11.  B. 
Fowler,  12th  New  Hampshire  Volunteers.  He  was  placed  in  an  hospital  tent  with  a patient,  Private  Williams,  who  was  under 
the  charge  of  Assistant  Surgeon  B.  Howard,  U.  S.  A.,  who  took  notes  of  this  and  some  of  the  other  cases  of  chest  wounds  in 
the  w.ard.  The  only  facts  reported  in  regard  to  this  are  as  follows  : “Tliere  was  extensive  pulmonary  hernia,  which  1 had  fixed 
so  as  to  secure  a permanent  plug,  with  adhesions  around  the  orifice,  and  also  exhausted  the  pleural  cavity  of  air.  This,  1 
suppose,  is  the  case  Assistant  Surgeon  Derby  reports,  in  which  the  trochar  was  used  without,  as  he  had  ‘learned,’  the  removal 
of  any  fluid.” 

The  seventh  case  is  also  wanting  in  essential  details.  It  is  published  by  Dr.  F.  II. 
Flamilton  [op.  cit.,  p.  295).  It  is  interesting  as  one  of  the  few  examples  of  traumatic 
pneurnocele  through  a small  orifice,  and  complicated  by  strangulation  : 

Case. — A young  soldier  of  the  Fourth  Corps,  name  not  ascertained,  was  wounded  at  the  engagement  at  Fair  Oaks,  May 
31st,  1862.  “Our  attention,”  says  Dr.  Hamilton,  “was  called  to  him  the  night  after  the  second  battle  by  one  of  the  surgeons. 
He  had  been  wounded  by  a ball  on  the  left  side  of  the  thorax,  a little  below  the  nipple.  The  ball  had  not  been  found.  He  was 
l^dng  upon  the  ground  in  a condition  of  considerable  prostration.  The  hernia  was  about  one  inch  in  diameter,  having  escaped 
from  an  aperture  which  was  very  much  smaller.  It  was  completely  strangulated,  being  quite  black,  and  insensible  to  the  touch. 
We  applied  to  the  neck  of  the  hernia  a strong  silk  ligature,  for  the  purpose  of  expediting  its  destruction,  and  then  made  fast  the 
ends  of  the  ligature  to  the  outer  surface  of  the  chest  by  adhesive  plasters,  to  prevent  the  escape  of  the  ligature  within  the  cavity, 
in  case  the  hernia  should  retire  after  it  had  sloughed.  We  saw  this  poor  fellow  the  next  morning  lying  in  the  same  place.  He 
had  taken  a little  nourishment,  such  as  we  had  to  give  him,  and  expressed  himself  as  being  comfortable,  although  he  had  lain 
without  shelter  two  nights,  and  during  each  night  he  had  been  drenched  witU  rain.  In  this  respect  he  suflered,  however,  only 
in  common  with  at  least  two  thousand  other  wounded  and  dying  men.  We  cannot  omit  this  additional  tribute  to  the  bravery  of 
these  noble  fellows.  During  all  this  time,  and  we  were  with  them  every  moment  both  night  and  day,  there  was  never  heal'd  one 
cry  of  impatience  or  one  murmur  of  complaint  beyond  that  which  was  extorted  by  the  agony  of  suifering.  When  the  wounded 
were  sent  to  White  House,  this  boy  was  sent  with  them,  and  we  have  never  seen  or  heard  from  him  since.” 

Three  of  the  seven  cases, ^ in  all  probability,  terminated  fatally.  Three  of  the  four 
survivors  wear  retentive  bandages  with  concave  pads.  One  has  ventral  hernia,  and  two 
diaphragmatic  hernia,  the  latter  verifying  Guthrie’s  prediction  [op.  cit.  p.  506)  that  wounds 
of  the  diaphragm  will  never  be  found  to  heal,  but  will  remain  open  for  the  transmission 
and  possible  incarceration  of  the  abdominal  viscera  into  the  chest.  The  probability  of  the 
incarceration  and  possibility  of  strangulation,  and  consequent  necessity  for  the  operoTion 
described  by  Guthrie,  has  doubtless  been  explained  to  these  pensioners,  with  warnings  to 
avoid  muscular  exertions  and  stooping  postures.  In  two  of  the  successful  and  one  of  the 
fatal  cases,  ligations  were  placed  about  the  base  of  the  pulmonary  protrusions.  In  none 
of  the  cases  was  the  wound  enlarged  or  the  intercostal  space  wedged  open  to  facilitate 
the  reduction  of  the  hernia.  A more  particular  account  of  the  means  adopted  in  the  sixth 
case,  in  order  to  occlude  the  wound  with  the  lung  as  a plug,  and  to  exhaust  the  pleural 
cavity  of  air,  would  be  interesting. 

J.  CloqueF  explains  the  mechanism  of  protrusions  of  the  lung  through  a wound  as 
follows : The  expiratory  muscles  contracting  simultaneously  and  suddeidy  on  the  reception 
of  a blow,  and  the  glottis  closing,  the  air,  unable  to  escape  by  the  trachea,  fills  the 
pulmonary  cells,  and  the  elasticity  of  the  air  forces  the  lung  against  the  thoracic  parietes 
and  a portion  tends  to  escape  at  the  weakest  point.  NdlatoiF  accepts  this  explanation, 
but  Malgaigne^  proposes  a different  hypothesis,  believing  that  in  a sudden  forcil)lG 

* Cloquet,  Nouveau  Journal  dc  MHecine,  1819,  T.  VI,  p.  328.  * 

^XliLATON,  Pathologie  Chirurgicale,  T.  Ill,  p.  411. 

^MalOAIGNE,  Traite  d' anatomic  chirurgicale,  1859,  T.  IF,  p.  209. 

■•There  was  au  eighth  case,  inadvertently  omitted  here,  complicated  with  a fatal  abdominal  wound,  it  is  detailed  as  CASE  474,  on  page  135  of  the 
Second  Surgical  Volume. 


518 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


expiration  with  the  glottis  partially  closed  the  air  in  the  sound  lung  will  pass  into  the 
bronchi  of  the  injured  side,  forcing  the  lung  outward  if  there  is  a wound  in  the  parietes. 
Chelins^  and  M.  Morel-Lavallde'  accept  neither  of  these  explanations.  The  latter  has 
written  an  exhaustive  memoir  on  the  subject,  which  may  be  studied  with  great  profit, 
lie  has  collected  nearly  all  the  recorded  instances  prior  to  the  publication  of  his  paper. 
They  number  but  thirty,^  and  only  three  of  these,  reported  by  Richerand,  Cloquet,  and  S. 
Cooper,  resulted  from  gunshot  wounds. 

If  Guthrie’s  three  cases,  of  which  the  particulars  are  wanting,  occurred  after  gunshot,^ 
and  the  four  cases  referred  to  by  Demme,  be  added,  and  Baudens’s  case  in  Algiers,  and  the 
seven  examples  cited  in  this  subsection,  the  number  of  recorded  instances  of  pneumocele 
after  gunshot  injury  still  remains  less  than  a score.®  Fischer,  in  his  recent  admirable  work 
on  the  surgical  experiences  of  the  Franco-German  war,  observes  that  he  could  learn  of  no 
example  of  this  accident  among  the  wounds  of  the  chest  observed  in  the  Saxon  and 
Prussian  armies.  There  are  but  two  affections  with  which  hernia  of  the  lung  is  liable  to 
be  confounded,  viz:  intercostal  epiplocele,  with  which  it  may  also  be  complicated,  as  in 
two  of  the  cases  here  reported,  and  a pulmonary  abscess  or  vomica  approaching  the 
surface.  Careful  inspection  with  auscultation  and  percussion  should  serve  to  establish  the 
differential  diagnosis  ; but  mistakes  have  been  committed,  as  in  Ptuysch’s  case. 

There  is  on  record  but  a single  instance  of  successful  reduction  of  a traumatic  pneumo- 
cele without  previous  ligation,  the  case  of  Angelo.®  A good  recovery  ensued,  though  the  lung 
tissue  was  wounded.  Authors  generally  advise  gentle  taxis,  and  some  recommend  the 
enlargement  of  the  wound  to  return  the  tumor ; but  there  is  no  evidence  of  the  expediency 
of  this  measure.  Excision  or  ligation  were  employed  in  most  of  the  cases,  and  no  bad 


* CHELIUS,  A SysUm  of  ‘Surgery^  American  reprint  of  SontlFs  translation,  Yol.  I,  p.  497. 

^Morel-LavalleE,  Jlernics  du  poumon  (Mem.  de  la  Soc.  de  Cliir.,  1847,  T.  I,  p.  75). 

3 IlOLANDUS,  of  Parma  {Chirurgia,  T.  Ill,  Cap.  25,  Venet.  1449),  was  the  first  author  to  report  a case  of  traumatic  pneumocele.  The  tumor  was 
excised,  the  pedicle  left  in  the  wound,  and  the  patient  recovered.  IIOSCIUS  next  ohscn’cd  a case,  in  IGOG,  remarkable  as  following  a sword-thrust 
between  the  fifth  and  sixth  ribs,  deeply  wounding  the  lung ; excision ; recovery  (Fabricius  Ilildanus,  Opera,  Obs.  22,  p.  107).  G.  liOl'SEAU  {Observa- 
tions mcdicinales  et  cliirurgicales,  }>.  25,  Bordeaux,  1G17)  relates  an  example,  the  result  of  a pike-stab  between  the  third  and  fourth  ribs — reduction 
after  excision.  IlHODiUS,  of  Padua  {Ohservationum  mcdicinalium,  Centurits  III,  8 vo.,  Padoue,  1G57),  cites  a case  caused  by  a large  sword  wound  in 
the  side,  with  recovery  after  excision.  A canula  was  left  in  the  orifice.  When  this  was  discontinued  the  wound  closed.  NICHOLAS  TULriL’S,  of 
Amsterdam  {Ohservat.  Mcdiccc^  T.  Ill,  p.  124,  3 cd.  1G72),  describi’d  a large  hernia  of  the  lung  weighing  three  ounces,  which  he  ligated  and  excised 
five  days  after  the  patient  had  been  stabbed  in  the  chest.  The  protrusion  did  not  appear  till  the  third  day  after  the  wound  was  inflicted.  RUYSCH 
{Ohs.  anatomico-chirurgicarum  Cent.,  Obs.  53,  p.  70,  Amstelodami,  1691)  records  a traumatic  pneumocele  mistaken  for  an  epiplocele  and  successfully 
ligated.  BELL,  of  Cork,  describes  (Duncan’s  Medical  Commentaries,  1785,  Vol.  II,  p.  349)  a large  pulmonary  hernia  protruded  through  a stab  in  the 
right  side,  between  the  ninth  and  tenth  ribs.  Strangulation  ensued  and  gangrene ; but  the  patient  ultimately  recovered.  Sabatier  {Medicine  Operatoire, 
T.  I.  p.  20G,  2d  cd.,  1810)  mentions  a ease  fullo^ving  a bayonet  thrust.  Consult  also  on  this  subject:  BOYER,  Traite  des  maladies  chirurgicales,  5™®  6d., 
T.  V.,  p.  619;  HenXEX,  Principles  of  Military  Surgery,  3d  ed.  p.  376;  GODIL,  Du  mecanisme  de  la  respiration;  quelques  mots  sur  les  de. 

poitrine,  les  causes  de  Vemphyseme  et  sur  celles  des  qmeumoceles,  These  de  Paris,  1858,  No.  10 ; Jarjavay,  De  Vinjluence  des  efforts  dans  les  maladies 
chirurgicales,  Paris,  1847;  llICHET,  A.,  Traite  pratique  d'anatomie  medico-chirurgicale,  Paris,  1857;  Vergne,  Ilernie  du  poumon,  These  de 
Paris,  106;  Grateloup,  Journal  de  Vandermonde,  T.  53,  p.  41G;  TllYLLAYE,  Traite  des,  bandages  et  appareils,  3“®  4d.,  Paris.  1815;  IxiCllERAND, 
Nosographie  et  Therapeutique  chirurgicales,  T.  Ill,  p.  300  ; IllCHTER,  Chirurgisch  Dibliotcl-,  B.  Ill,  S.  138;  Mercier,  Journal  general  de  Medicenc,  T. 
34,  p.  378 ; BOERIIAAVE,  in  De  Haex,  Institutiones  qmthologicse,  T.  I,  Par.  712,  p.  333 ; PLATER,  Observationes,  p.  9G;  BERTHE,  Journal  de  Sedillot,  T. 
XVII,  p.  61 ; Larrey,  H.-,  DuUetin  de  la  SocieU  de  Chirurgie,  T.  VI,  p.  521 ; and  CASPAR'S  \Vochenschrift  for  case  of  Scharf,  1845,  No.  9 ; Baudens, 
Clinique  des  plaies  d'armes  a feu,  Paris,  1836,  p.  247 ; VELPEAU,  Comptes  Rendus  de  I'Acad.  dcs  Sci.,  1844  ; IIUGUIER,  Mem.  de  la  Soc.  de  Chir.,  T.  I, 
p.  194 ; Fischer,  II.,  Kriegschirugische  Erfahrungen,  Th.  I,  S.  124,  Erlangen,  1872 ; LARREY,  D.  J-,  Mem.  de  Chir.  Mil.,  T.  Ill,  p.  91. 

have  searched  in  vain  through  Guthrie's  work  on  gunshot  wounds,  his  monographs  and  lectures,  for  some  additional  information  to  that  in  the 
Commentaries  regarding  tlie  three  cases  of  pneumocele  he  saw  at  Brussels.  Thomson  alludes  to  one  of  them  in  his  Observations  after  Waterloo,  p.  92, 

®No  allusion  has  been  made  to  the  Congenital  and  Spontaneous  varieties  of  hernia  of  the  lung,  on  which  CruveilhIER  {Anat.  Path.,  Liv.  XXT,  p.  1), 
Cloquet  {Nouv.  Jour,  de  Med..  T.  VI,  p.  309),  and  H.  11.  SMITH  {Principles  and  Practice  of  Surgery,  1863,  Vol.  I,  p.  499)  have  treated,  as  these  are 
foreign  to  the  present  subject.  Professor  Smith  has  oliserved  two  cases  of  spontaneous  pneumocele,  remarkable  for  their  bulk  and  facility  of  reduction. 
He  states  very  positively  that  their  volume  enlarged  on  inspiration.  A very  interesting  case  of  hernia  of  the  lung,  following  an  incised  wound  of  the  left 
chest,  is  reported  by  Dr.  T.  B.  Hale,  of  JMinersville,  Pennsylvania,  in  the  Philadelphia  Medical  Examiner,  February,  1855,  p.  7.5.  A segment  of  lung, 
six  by  two  and  a half  inches,  was  removed.  There  was  neither  cough  nor  dyspnoea.  A rapid  recovery  ensued.  The  specimen  is  preserved.  The 
protrusion  is  alleged  to  have  expanded  during  inspiration.  Th«  same  allegation  is  made  in  regard  to  the  behavior  of  a protrusion  of  the  lung  in  a case  of 
wound  of  the  liver  and  diaphragm,  which  will  be  reported  farther  on.  We  must  believe  that  these  statements  of  the  augmentation  of  the  tumor  being 
synchronous  with  inspiration  were  all  founded  on  faults  of  memory  or  errors  of  observation.  Indeed  in  Dr.  Hale’s  case  the  protrusion  only  appeared  in 
coughing. 

‘’Angelo,  Gazetta  medica  di  Milano,  February,  1844. 


Sect.  II.] 


HEMORRHAGE. 


519 


results  appear  to  have  followed  these  operations.  Non-intervention  is  probably  the  safer 
precept.  After  a while  the  protrusion  contracts  adhesions  with  the  walls  of  the  thorax  and 
occludes  the  opening.^ 

Hemorrhage. — Notwithstanding  the  remarkable  manner  in  which  the  large  vessels 
often  escape  injury  from  missiles  entering  or  traversing  the  thorax,  eluding  them  by 
resiliency  or  sometimes  deflecting  them  in  their  passage,  bleeding  is  the  most  common  and 
the  most  fatal  of  the  complications  of  gunshot  wounds  of  the  chest.  It  may  arise  from 
lesions  of  the  larger  arteries  supplying  the  parietes,^  from  wounds  of  the  primary  carotids 
and  subclavian;  of  the  venous  and  arterial  brachio-cephalic  trunks;  of  the  aorta  and 
superior  vena  cava  and  azygos  vein;  of  the  pulmonary  vessels;  of  the  internal  mammary 
and  intercostal  artery;  and  also  from  laceration  of  the  pulmonary  parenchyma  and  from 
wounds  of  the  heart.  Many  of  these  injuries  are  either  instantaneously  mortal,  or  the 
partial  or  temporary  recoveries  are  regarded  as  surgical  curiosities.  Those  that  are  in 
some  degree  amenable  to  treatment  are  therefore  invested  with  the  greater  interest,  and 
demand  all  the  surgeon’s  solicitude  and  skill.  The  experience  acquired  in  the  late  war  has 
added  to  our  knowledge  of  some  of  the  rarer  forms  of  these  lesions,  and  served  to  indicate 
and  corroborate  what  apparently  are  the  sounder  of  the  conflicting  views  as  to  their  treatment. 

Wounds  of  the  Aorta  and  Cavas. — No  instance  has  been  found  upon  the  returns  of  a 
wound  of  the -arch  or  thoracic  portion  of  the  aorta  if  any  such  cases  occurred,  the  patients 
did  not  survive  long  enough  to  receive  hospital  treatment.  This  curious  exemption  from 
injury  cannot  depend  exclusively  upon  the  resiliency  of  the  arterial  coats,  for  the  Army 
]\Iedical  Museum  contains  two  specimens^  of  gunshot  injuries  of  the  abdominal  aorta,  in 
one  of  which  the  trunk  is  fairly  perforated  by  a pistol  ball.  Since  the  war.  Acting  Assistant 
Surgeon  W.  J.  Piper,’’  has  reported  an  accidental  pistol-ball  perforation  of  the  arch  of  the 
aorta.  The  wounded  soldier  lived  long  enough  to  be  carried  across  the  parade  to  the  post 
hospital  at  Baton  Rouge.  The  specimen  was  not  received  at  the  Museum.  Surgeon  J.  A. 
Lidell,'* *  U.  S.  V.,  has  recorded  a case  in  which  he  made  an  autopsy  upon  a man  shot  by  a 
pistol  ball,  which  entered  at  the  junction  of  the  cartilage  of  the  third  rib  and  the  sternum, 
grazed  the  left  lung,  and  perforated  the  aorta  just  without  the  semilunar  valves.  The 
pericardium  was  filled  with  coagulated  blood,  and  there  was  copious  extravasation  in  the 
pleural  cavities.  The  course  of  the  ball  was  altered  somewhat  by  grazing  the  lung.  It 
was  deflected  slightly  to  the  right.  Death  was  instantaneous.  Dr.  J.  B.  White’  mentions 
a case  of  bayonet  stab  causing  a small  puncture  in  the  aorta  a few  lines  without  tlie 
pericardium.  The  profuse  hsemorrhage  was  promptly  fatal. 

^Surgeon  A.  B.  Crosby,  U.  S.  V.,  records  to  Part  I,  p.  11)  a serious  case  of  intennediary  lia'inorrhagc  (tenth  day)  from  a gunshot 

wound  involving  the  external  mammary  {ihoracica  longa).  Acting  Assistant  Surgeon  II.  M.  Dean  gives  a fatal  ease  of  secondary  haemorrhage  from 
the  left  subscapiilar.  The  specimen,  presen-ed  as  a wet  preparation,  is  numbered  1.635  of  the  Surgical  Section.  The  artery  sloughed  twentj'-tive  days 

after  the  pas.-^age  of  a musket  ball  through  the  axilla,  l^rivate  F.  M.  D , Co.  D,  35th  North  Carolina  llcgimcnt,  aged  27  years.  Wounded  at 

I^ctcrsburg,  June  Ifith,  18G4.  Bleeding  arrested  by  pressure  and  I^Ionscl’s  salt,  July  10th;  fatal  rccun-ent  ha-morrhage  on  July  12th,  IStM.  Examples 
of  ligations  of  the  long  thoracic  and  of  branches  of  the  circumflex  arteries  are  given  in  Section  III  of  this  Chapter. 

*It  is  well  known  that  the  annals  of  surgery  contain  a few  such  examples.  Guattani  {Auctorum  I.atinorum  de  Ancurismatihns  CoUcefio, 
Boma,  1745)  records  the  case  of  a man  who  survivi’d  for  eight  years  an  incised  wound  of  the  arch.  Pkllictax  describes  {Clinique  Chi rurgicalc,  Paris, 
1810,  T.  Ill,  p.  211)  the  case  of  a man  who  lived  two  months  after  a puncture  of  the  aorta  near  its  origin  by  a foil.  IliciL  (Henke's  ZdUchrift^  1837,  B. 
11,  S.  459)  details  a ease  in  which  a patient  lived  twelve  months  after  receiving  a stab  in  the  ascending  aorta.  Gkken,  T.  Itl.,  of  Macon,  Georgia, 
juiblishes  (jSo?d/<era  Jfed.  awd  1855)  an  account  he  had  from  Dr.  J.  B.  Wiley,  “a  competent  and  reliable  observer,” of  an  autop.sy  (-f  a 

man  stabbed  a month  prcviouslj*,  by  a narrow  blade,  near  the  origin  of  the  aorta  in-front.  In  the  Journal  da  M^dicinc^  T.  XIAT,  p.  435,  is  a similar 
history,  of  a man  who  siu^Tved  six  days.  LicitOUfiE  has  inserted  in  Saviard’s  Observations  Chirurgicales,  which  he  edited,  a similar  case,  the  jiatient 
living  eleven  days.  Cases  of  rupture  of  the  aorta  from  external  violence  have  been  recorded  by  DIouoagnt  {Da  Sedibus  ct  Causis,  tf-c.,  Patavii,  17G5, 
Ep.  LIII),  LaujiencI.N  {Arch.  Gen.  de  Med.,  T.  VI,  p.  301),  ,St.  Eeoeu  {Montpelier  Thkses,  MS.,  quoted  by  Berurd),  and  a specimen  of  this  lesion  is 
preserved  in  the  JIuscum  of  St.  Bartholomew's  Ilosintal.  — ED.  ^ Specs,  910  and  4C85,  Sect.  J,  A.  M.'M. 

* Surgical  Memoir  on  the  Wounds  of  the  Blood  Vessels,  New  York,  1870,  Case  XLIX. 

® Circular  No.  3,  S.  G.  O.,  1871,  A Hrport  on  Surgical  Cases,  etc.,  pp.  35  and  99. 


520 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CiiAr.  V, 


5’lie  following  is  one  of  the  few  examples  of  gunshot  wound  of  the  descending  cava: 

Case. — Tlio  body  of  Privuto  John  M.  Frey,  Co.  D,  1st  Maryland  Potomac  Homo  Brigade,  was  brought  to  the  hospital 
at  Frederick,  Maryland,  May  21st,  1864,  for  hni-ial.  He  was  said  to  have  been  shot  by  a cavalryman  in  the  town  in  self-defence, 
Frey  having  assaulted  him,  demanded  his  monej',  and  shot  at  him  twice,  whereupon  the  cavalryman  fired  upon  him.  A gi-eat 
stream  of  blood  is  said  to  have  gushed  from  his  mouth  as  he  fell  forward  dead.  Necropsy;  The  hall,  supposed  to  have  been 
from  a pistol,  entered  three-quarters  of  an  inch  to  the  right  of  the  middle  line  in  front,  at  the  edge  of  the  sternum,  between  the 
first  and  second  ribs,  between  the  pleural  sacs,  in  the  mediastinal  space,  pierced  the  vena  cava  descendens,  one  inch  above  the 
base  of  the  heart,  passed  thence  through  the  right  side  of  the  right  bronchus,  severing  three  rings  immediately  opposite  the  point 
of  bifurcation  of  tlie  trachea,  and  thus  opening  a direct  communication  from  the  vena  cava  into  the  trachea  (giving  ready  exit  to 
a large  stream  of  l)lood),  thence  backward  and  a little  downward,  perforating  the  right  pleural  cavity,  and  emerged  between  tlie 
seventh  and  eighth  ribs,  grazing  the  lower  border  of  the  seventh,  one-quarter  of  an  inch  from  the  spinal  column.  The  lung  was 
not  wounded.  The  loss  of  blood  was  the  cause  of  death,  which  was  nearly  instantaneous.  There  was  a little  clotted  blood  in 
the  areolar  tissue  beneath  the  sternum.  Acting  Assistant  Surgeon  John  11.  Bartholf  reports  the  case. 


Acting  Assistant  Surgeon 


instance  of  tliis  lesion. 


J.  B.  White  ^ lias  reported,  since  the  war,  a remarkahlo 
A musket  ball  passed  through  the  stock  of  the  musket  of  the 
deceased,  entered  the  second  right  intercostal  space,  divided 
the  superior  cava,  traversed  the  chest  diagonally  beneath  the 
aorta,  emerged  through  the  third  left  intercostal  space,  shat- 
tered the  left  humerus,  and  was  found  in  a battered  state, 
thirteen  feet  from- where  the  wounded  man  fell.  There  was 
scarcely  any  luemorrhage  externally.  The  left  pleural  cavity 
contained  a large  amount  of  serum,  with  jelly-like  clots.  Tlio 
hsemorrhage  seemed  due  exclusively  to  the  division  of  the 
o->Q  TT  * * , 1 ..*•  descending;  cava.  The  patient  survived  long  enough  to  be 

Fig.  239. — Heart,  great  vessels,  and  portion  O i o o 

■55(i7?SectnWMlTL  Carried  from  his  post  to  the  hospital  close  at  hand. 


In  the  same  report  (p.  146)  Assistant  Surgeon  S.  M.  Horton,  U.  8.  A.,  relates  the  case 
of  a soldier  of  the  Eighteenth  Infantry,  with  an  arrow  wound  of  the  descending  vena  cava. 
Tlie  steel  point  of  the  weapon,  entering  at  the  junction  of  the  sternum  and  the  first  right 
rib,  penetrated  three  inches  downward  and  inward,  cutting  the  margin  of  the  upper  lobe  of 
the  right  lung  and  inflicting  a wound  an  eighth  of  an  inch  in  length  in  the  superior  cava, 
just  without  the  pericardial  sac.  Althouglp  scalped  and  suffering  from  other  wounds,  the 
unfortunate  man  survived  over  forty  hours.  Large  masses  of  coagula  were  found  in  the 
thoracic  cavity. 


Wounds  of  the  Innominata. — Two  examples  of  gunshot  injury  of  this  trunk  may  be 
inserted  here,  and  another,  of  a conoidal  musket  liall  embedded  between  the  innominata 
and  the  descending  cava  within  the  pericardium,  will  be  recorded  with  wounds  of  that 
membrane : 


Case. — Private  Frederick  Smith,  Co.  A.  134tli  New  York  Volunteers,  aged  20  3’ears,  was  wounded  at  the  battle  of 
Gettysburg,  I’ennsylvauia,  July  1st,  1833,  by  a i-ifle  ball,  which  entered  above  the  right  clavicle,  passed  under  the  sternum,  and 
emerged  between  the  fourth  and  fifth  ribs.  He  was  treated  at  the  Eleventh  Coiqrs  Hospital,  at  Gettysbui'g.  On  July  22d, 
hanuorrhage  took  place  from  the  arteria  innominata,  for  which  compression  was  applied.  Death  followed  on  July  25th,  1863. 
The  case  is  reported  by  Surgeon  James  A.  Armstrong,  75th  Pennsylvania  Volunteers. 

Case. — Private  W^illiam  A.  J , Co.  E,  7th  West  Virginia  Volunteers,  aged  26  years,  was  wounded  in  the  engage- 

ment on  the  Weldon  Railroad,  October  27th,  1864,  by  a conoidal  musket  ball,  which  entered  at  the  right  upper  angle  of  the 
sternum,  passed  under  the  clavicle,  and  lodged  in  the  thorax.  The  wound  was  plugged  with  lint,  and  the  wounded  man  was 
conveyed  to  City  Point,  and  thence,  on  an  hospital  steamer,  to  Washington,  where  he  was  received  at  Emory  Hospital.  On 
October  30th,  he  was  kejit  quiet,  with  a simple  dressing  to  the  wound.  . On  the  31st,  he  was  placed  under  the  influence  of 
chhu'ofonn,  and.an  exploration  was  made  for  the  ball,  which  led  to  a profuse  haemori'hage.  Plugging  the  wound  was  the  only 


* Circular  No.  3,  S.  G.  O.,  IriTl,  A Report  on  Surpical  Cases,  etc.,  p.  34. 


Sect.  II.] 


WOUNDS  OF  THE  GKEAT  BLOOD-VESSELS. 


521 


alternative.  Afterwai-ds  a compress  and  bandages  were  applied.  On  November  1st,  the  patient  suffered  greatly  from  dyspmra 
caused  by  liEEmotborax.  The  blood  effused  in  the  mediastinum  appeared  to  compress  the  trachea,  lie  died  on  November  2d, 
1864,  five  days  after  the  reception  of  the  wound.  The  autopsy  was  made  by  Surgeon  N.  IL  Moseley,  U.  S.  Y.,  in  charge  of  the 
hospital.  The  ball  was  found  resting  against  the  innominata,  having  ruptured  its  coats  and  produced  a diffused  aneurism.  The 
opening  in  the  innominata  is  oval,  nearly  half  an  inch  long,  and  is  situated  on  the  front  part  of  the  vessel,  a little  way  below  the 
bifurcation  into  carotid  and  subclavian.  The  specimen  was  contributed  to  tbe  Army  Medical  Museum  b}^  Surgeon  Bloseley,  and 
is  No.  3410  of  the  Surgical  series.  The  clinical  notes  were  furnished  by  the  ward  surgeon.  Dr.  C.  B.  I»IcQuesten. 

Wounds  of  the  Subclavian  Artery  and  Vein. — Wounds  of  these  great  blood-vessels 
occasionally  come  under  the  surgeon’s  treatment.  It  is  quite  time  that  the  dictum  of 
Jourdan’’'  that  surgery  is  powerless  in  lesions  of  arteries  within  the  cranial,  thoracic,  and 
abdominal  cavities  should  he  expunged  from  the  text-books.  At  least  five  cases  occurred 
during  the  late  war,  of  wounds  of  the  subclavian  in  which  surgical  intervention  was 
justifiable,  and  in  one  of  these,  the  left  subclavian  was  successfully  tied  by  a Confederate 
surgeon,  for  a wound  of  the  vessel  where  it  passes  across  the  first  rib.  Though  such  lesions 
are  immediately  mortal  in  the  majority  of  cases,  there  are  instances  in  which  the  bleeding 
is  delayed  or  arrested,  the  laceration  of  the  artery  being  obstructed  by  a spicula  of  bone, 
or  by  the  missile  or  a fragment  of  clothing  or  other  foreign  substance.  In  such  cases, 
audacity  is  the  part  of  prudence; 


Case — Private  Jolm  J.  T- 


-,  Co.  A,  122(1  New  York  Volunteers,  was  admitted  to  tbe  field  bospital  of  tbe  Sixth  Corps, 


Sej)tember  20th,  1864,  with  a gunshot  wound  of  the  right  side  of  the  neck,  received  the  day  previous  at  Winchester,  Virginia. 
Wdieu  admitted,  he  was  very  ^veak  from  haemorrhage  from  wound  and  hacmopt3'sis.  The  wound  was  plugged  and  water  dressings 
applied;  anod^mes  and  nutritious  diet  administered.  The  hatmorrhage  and  hmmopU'sis  continued;  the  right  side  of  the  chest 
became  enlarged  and  the  breath  fetid.  Death  resulted  October  5th,  1864.  Necropsy:  A minie  ball  entered  the  inferior  triangle 
of  the  neck,  right  side,  fracturing  the  first  rib  obliquely  at  its  middle  portion,  dei)ressing  the  st(irnal  portion  into  the  apex  of  the 
right  lung;  the  dorsal  fragment  ]n’ojected  upward  with  a sharp  pointed  extremity,  which  perforated  the  subclavian  arteiw  in  the 
second  part  of  its  course.  The  hall  then  emerged  above  the  spine  of  the  scajnda. 

The  mediastinum  and  the  light  pleural  cavity  were  filled  with  blood.  The  right 
intercostal  spaces  bulged  outward.  The  heart  was  forced  over  to  the  left.  The 

right  lung  was  collapsed.  There  were 
traces  of  periosteal  inflammation  on  the 
anterior  surfaces  of  both  portions  of  tlio 
rib.  The  appearances  of  the  artery,  well 
represented  in  Fig.  241,  indicated  that 
the  laceration  had  been  produced  either 
at  the  time  of  impact  of  the  missile,  or  by 
some  sudden  movement  of  the  shoulder, 
rather  than  by  gradual  attrition.  The  rib 
is  drawn  half  size  in  Fig.  240.  The  speci- 
mens were  presented  by  Acting  Assistant 
Surgeon  W.  Leon  Hammond. 


Fig.  240. — Oblique  gunshot  fracture  of  right 
first  rib.  Spec.  GOTO,  Scot.  I,  A.  M.  M. 


Fig.  241.— Fcrforiition  of  right  subclavian  by 
the  shai'i)  point  of  a fractured  lirst  rib.  Spec.  0377, 
.Sect.  I,  A.  JM.  M. 


This  patient  survived  the  lesion  of  the  artery  sixteen  days.  That  the  difficulties  to 
be  encountered  in  an  attempt  to  ligate  the  subclavian  under  such  circumstances  as  these 
arc  very  great,  is  illustrated  by  the  following  case;  that  they  are  not  absolutely  insur- 
mountable, especially  if  the  left  subclavian  is  the  seat  of  injury,  is  shown  by  two  cases 
recorded  in  the  next  Section : 


Ca.se. — Private  Levi  Reglea,  Co.  D,  16th  Pennsylvania  Cavalry,  agiul  2.5  j’cars,  by  occupation  a farmer,  was  admitted  to 
S.atterlce  Hospital,  Philadelphia,  from  field  hospital.  City  Point,  on  August  16,  1864,  with  a shot  fracture  of  the  clavicle,  first  rib, 
and  scapula.  The  ball  entered  the  right  chest  one  inch  from  the  sternum,  and  immediately  over  the  clavicle,  jiasslng  through 
and  .splintering-it  badly,  slightly  fracturing  the  fir.st  rib,  thence  through  the  right  scapula,  and  lodged  beneath  the  infra-sidnatus 
muscles,  one  inch  below  the  middle  of  its  spine,  where  it  could  be  distinctly  felt.  When  admitted,  his  general  heidth  was 
excellent — although  anmmic  from  the  loss  of  the  blood  which  occurred  immediately  .after  the  injury — and  the  wound  ajiparently 


* Dictionaire  de.i  Sciences  MediedJes,  T.  II,  p.  317.  “ Ea  cbinirgie  cst  impuissante  contre  les  IC’sions  d(;s  artires  placfics  dans  I'intcricur  dn  cidnc, 
de  la  poitrino  ct  du  bas-ventre.  Ces  lesions  sent  cssentiellement  inortelles,  i cause  de  ITifimorragie  elfrayantc  qui  s'ensuit,  et  qui  no  tarde  pas,  i fipuisor 
ies  forces  du  inalade ; car  les  blessiircs  dcs  arteres,  loin  do  s'obliterer  d’elles-ineines,  teudent  toujours  i s'agrandir  pur  Telfort  lat6ral  du  sang,  et  par  le 
dcchiremcut  des  fibres  de  la  tunique  musculeuse.” 

CG 


522 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[ClIAP.  V, 


doing  well;  both  the  power  of  motion  and  sense  of  touch  were  wanting  in  the  arm  of  the  wounded  side,  thus  indicating  that 
there  was  serious  injury  to  the  brachial  i)lexus,  which  was  further  confirmed  by  frequent  complaint  of  sharp,  shooting  pains 
extending  down  the  arm  and  forearm  to  the  finger  ends.  It  was  also  noticed  that  the  pulse  was  entirely  wanting  at  the  wrist, 
nor  could  there  he  any  pulsation  of  the  brachial  artery,  indicating  that  there  was  some  serious  injury  or  obstruction  to  the  subclavian 
artery.  Ordered  water  dressings,  tonics,  and  a good  nutritious  diet.  On  September  1st,  several  spiculaj  of  bone  were  removed 
from  the  wound,  wliich  continued  to  do  well  up  to  half-past  seven  o’clock  P.  M.  on  September  7th,  at  which  time  there  was  a 
j)rofuse  hmmorrhage  from  the  subclavian  artery,  by  which  the  patient  lost  fifteen  or  twenty  ounces  of  blood  in  a few  seconds. 
Upon  arriving  at  the  bedside,  the  hmmorrhage  was  found  perfectly  controlled  by  the  nurse,  to  whom  I had  given  explicit  instruc- 
tions as  to  the  manner  of  making  compression,  in  case  haemorrhage  occurred.  A consultation  was  immediately  called,  and  it  was 
decided  to  make  digital  compression  until  morning.  Accordingly,  the  acting  medical  cadets  were  detailed  to  perform  this  duty ; 
relieving  each  other  hourly.  The  patient  rested  comparatively  well  during  the  night;  in  making  the  changes  there  was  no  blood 
lost;  stimulants  were  freely  administered.  At  fifteen  minutes  before  twelve  in  the  morning,  a consultation  was  again  held,  when 
it  was  decided  to  ligate  the  subclavian  artery  in  the  second  third.  Acting  Assistant  Surgeon  Walter  E.  Atlee,  U.  S.  A.,  consulting 
])hysician,  operating.  An  incision  was  made,  bfit,  owing  to  the  condition  of  the  parts,  the  artery  could  not  be  found.  During 
tbe  operation  all  comjtression  was  removed,  but  there  was  not  the  least  haemorrhage.  After  the  operation  the  patient’s  body  was 
cold;  the  skin  moist,  with  a cold,  clammy  perspiration ; the  tongue  clean  and  smooth,  and  of  a leaden  hue;  the  nails  bluish; 
pulse  112,  and  very  weak;  the  patient  being  apparently  in  a moribund  condition.  The  cadets  were  again  detailed  to  administer 
stimulants  and  to  watch,  and,  in  case  of  haemorrhage,  to  make  compression.  Observations  by  Acting  Assistant  Surgeon  M.  J.  Grier, 
who  administered  an  anaesthetic  consisting  of  four  fluid  ounces  of  sulphuric  ether  and  two  of  chloroform  : “Pulse,  at  commence- 
ment of  aetherizatiou,  112,  irritable,  quick,  and  feeble,  rapidly  rising  to  130,  and  becoming  quick,  thready,  and  almost  imperceptible 
under  the  application  of  the  anaesthetic;  but  upon  the  removal  of  which  returned  to  its  former  condition.  Sometimes,  when  the 
administration  was  prolonged,  it  reached  the  frequency  of  160 — always  falling  below  115  in  a few  seconds  after  the  admission 
of  the  atmosphere.  He  was  very  susceptible  to  its  influence,  and  was  very  easily  controlled  by  the  occasional  application  of  the 
sponge.  Toward  the  close  of  the  operation,  it  was  deemed  advisable  to  administer  brandy,  under  which  the  pulse  changed  from 
115  to  about  100,  gaining  in  strength  and  volume.”  One  hour  after  the  operation,  there  was  considerable  reaction;  the  pulse  98, 
general  expression  better,  and  the  body  much  warmer.  Later  in  the  afternoon  the  pulse  fell  to  95,  gaining  in  volume  and  strength 
under  the  influence  of  the  stimulants.  At  a quarter  past  five  in  the  afternoon,  the  hasmorrhage  recurred,  the  patient  losing  about  the 
same  amount  as  at  first — in  a few  seconds — before  proper  compression  could  be  made.  The  second  haemorrhage  left  him  exceed- 
ingly weak,  the  pulse  scarcely  perceptible,  the  countenance  blanched,  the  extremities  cold,  beaded  perspiration  standing  on  the 
face;  very  restless;  thirst  urgent;  the  mind  clear  until  five  o’clock  on  the  morning  of  the  9th,  from  which  time  he  began  to  sink 
rapidly,  without  any  fiirther  loss  of  blood,  and  died  at  eight  o’clock.  Autopsy  elicited  the  following  facts : The  clavicle  was 
j)erforated  and  badly  fractured;  the  first  rib  slightly  fractured  just  outside  of  its  tubercle;  the  scapula  perforated  one  inch  below 
the  middle  of  its  spine;  the  subclavian  artery  lacerated  by  the  passage  of  the  ball  as  it  crossed  the  first  rib,  and  quite  a number 
of  spiculae  of  bone  were  driven  into  it,  plugging  it  up  entirely  for  nearly  two  inches;  the  injured  part  was  in  a sloughing  condition, 
and  the  inflammation  even  extending  to  within  the  innominata,  thus  rendering  it  evident  that  the  ligation  of  the  subclavian  in  its 
second  third  would  have  been  fruitless.  The  condition  of  the  artery  and  surrounding  parts  accounted  for  the  failure  to  find  the 
artery,  as  well  as  the  absence  of  pulsation.  It  was  also  found  that  the  brachial  plexus  was  injured,  which  accounted  for  the  loss 
of  power  and  the  pain  extending  down  the  arm  and  forearm.  All  the  other  organs  were  normal  in  structure  and  perfectly  healthy. 
The  case  is  reported  by  Acting  Assistant  Surgeon  A.  A.  Smith. 

In  the  next  case,  the  patient  survived  the  injury  for  two  days.  It  was  believed  that 
the  subclavian  vein  was  injured.  The  lesion  was  on  the  right  side,  and  it  was  apprehended 
that  any  attempt  to  remove  the  plug  of  lint  with  which  the  perforation  was  tamponned 
would  be  instantly  fatal,  and  that  the  wound  approached  the  innominata  so  closely  that 
the  possibility  of  placing  a ligature  on  that  trunk  alone  admitted  of  discussion : 

Case. — An  unknown  soldier  was  wounded  at  Antietam,  September  17th,  1862,  by  a conoidal  musket  ball,  at  short  range. 
The  missile  entered  at  the  junction  of  the  inner  third  with  outer  two-thirds  of  the  right  collar-bone,  made  a clean  perforation  in 
the  anterior  wall  of  the  bone,  and  largely  splintered  the  posterior  portion,  and  emerged  above  the  right  scapula.  The  wounded 
man  was  carried  to  the  field  hospital  at  Keedysville.  On  admission,  he  was  speechless,  and  in  a fainting  condition  from  loss 
of  blood.  The  track  of  the  wound  was  plugged  with  lint  saturated  with  the  solution  of  the  persulphate  of  iron.  The 

usual  restoratives  were  cautiously  administered,  and  the 
strictest  quiet  enjoined.  On  September  19th,  1862,  a 
deluging  haemorrhage  occurred,  and  the  patient  almost 
immediately  expired.  It  was  found  that  a spicula  of  the 
clavicle  had  transfixed  the  left  subclavian.  The  artery 
was  not  preserved.  The  clavicle,  represented  in  Fig.  242, 

fig.  249.-Longitmlinalfr™shot  fracture  of  the  right  clawcle.  Posterior  view.  - presented  to  the  Museum  by  Assistant  Surgeon  S.  A. 
Reduced  one-lialf.  Upcc.  liiT,  Sect.  I,  A.  M.  M.  Storrow,  U.  S.  A. 

The  case  by  Dr.  O’Keefe,  recorded  on  p.  479,  of  recovery  after  alleged  “undoubted 
severing  of  the  left  subclavian,’’  will  be  regarded  by  few  as  incontestable.  The  absence 
of  pulsation  in  the  brachial  is  explicable  by  inferring  embolism  of  the  axillary. 


Si^CT.  II.]  WOUNDS  OF  THE  BLOOD-VESSELS.  523 

Wounds  of  the  Internal  Mammaiy  Artery.— BallingalP  tells  us  that  lia?nioiThage 
from  this  vessel  “ is  exceedingly  difficult  to  detect  or  to  control,”  and  that  he  has  “seen 
more  than  one  instance  of  fatal  bleeding  from  this  source.”  Guthrie,^  whose  opinions  on 
every  subject  connected  with  the  surgery  of  the  arteries  are  justly  received  with  the  most 
respectful  attention,  is  very  facetious  at  the  expense  of  the  “theoretical  surgeons”  who 
have  occupied  themselves  with  inventions  for  suppressing  this  form  of  bleeding,  which,  it 
is  consolatory  to  know,  is  very  rare, — the  master  informing  us  in  the  next  sentence  that 
he  has  never  seen  a distinct  case  of  it.  It  will  be  safer  to  follov/  the  advice  of  those  who 
have  had  to  contend  with  such  lesions,  and  to  seek  for  such  information  on  the  subject  as 
further  experience  may  afford.  Only  five  or  six  cases  are  found  on  the  records,  in  which 
wounds  of  the  internal  mammary  were  distinctly  recognized.  Three  of  these  were  treated 
by  compression  and  styptics  and  two  by  ligation.  But  there  are  many  other  recorded 
instances  of  wounds  near  the  edge  of  the  sternum,  with  hsemorrhage  yet  without  hsemop- 
tysis,  in  some  of  which  the  existence  of  this  lesion  may  fairly  be  suspected.  As  it  was 
fatal  in  the  five  cases  in  which  it  was  detected,  it  merits  serious  attention  : 

Case. — Private  John  B , Co.  D,  51st  Illinois  Volunteers,  aged  ‘20  years,  was  wounded  at  Dalla.s,  Georgia,  June 

3d,  1864,  the  ball  entering  ov'er  the  left  side  of  sternum,  near  the  junction  of  the  second  rib,  and  emerging  above  the  clavicle, 
fracturing  the  sternum  and  clavicle.  He  was  promptly  conveyed  to  the  hospital  of  the  2d  division,  Fourth  Corps,  and, 
on  June  20th,  was  transferred  to  Hospital  No.  8,  Nashville.  When  admitted  he  was  very  feeble;  pulse  small  and  rapid; 
cough  very  severe;  pneumonia  of  both  lungs.  Expectorants  and  opiates  were  given,  and  the  patient  improved  until  July  8th, 
when  colliquative  diarrhoea  and  sweats  set  in,  followed,  on  the  10th,  by  severe  and  profuse  haemorrhage  from  the  external  wound. 
The  jiatient  was  much  reduced  by  i)rofuse  suppuration  and  pleuro-pneumonia  when  the  haemorrhage  occurred,  and  was  considered 
so  near  death  that  it  was  dangerous  to  give  anaesthetics  or  attempt  an  operation.  The  opening  from  which  the  blood  escaped 
was  plugged  with  lint  soaked  with  solution  of  persulphate  of  iron.  The 
haemorrhage  was  controlled,  hut  the  patient  sank  and  died  in  twelve 
hours.  Necropsy:  Lungs  greatly  engorged.  The  sternum  was  fractured 
transversely  at  junction  of  middle  with  upjier  third.  The  synchondro- 
sternal  articulations  of  first  and  second  ribs  were  torn  asunder;  sterno- 
clavicular articulations  disarticulated;  sternal  end  of  clavicle  fractured. 

The  fractured  end  of  the  sternum  was  crushed  and  jammed  into  the 
anterior  mediastinum.  The  arch  of  the  aorta,  arteria  innominata,  right 
subclavian  and  carotid,  and  also  the  left,  were  all  in  situ,  without  perfora- 
tion; hut  the  internal  mammary  was  found  in  the  mutilated  muscular 
ll.-^sue  with  its  mouth  gaping;  the  hasmorrhage  evidently  occurred  from 
the  last  mentioned  vessel.  The  specimen  of  fracture  of  the  clavicle  and 
sternum  was  preserved  and  is  represented  in  the  cut.  Fig.  243,  as  sent 
to  the  Museum.  The  middle  portion  of  the  clavicle  was  excised,  probably 

X)ost  mortem,  as  there  is  no  record  of  any  operation  during  life,  but,  on  Spec.  3760,  Sect.  I,  A.  M.  M. 
the  contrary,  a statement  that  it  was  thought  inexpedient  to  undertake 

one.  Necrosis  had  begun  to  invade  the  inferior  portion  of  the  fragment  of  the  sternum,  which  had  been  crushed  into  the  anterior 
mediastinum.  The  specimen  of  the  wounded  artery  was,  unfortunately,  not  saved.  The  osseous  preparation  was  presented  by 
Acting  Assistant  Surgeon  E.  T.  Higgins. 

Case. — Private  Ephraim  Guyer,  Co.  D,  151st  Pennsylvania  Volunteers,  aged  26  years,  was  wounded  at  Gettysburg,  July 
1st,  1863,  by  a conoidal  musket  ball,  which  fractured  the  humerus  .and  passed  along  the  clavicle  and  lodged  behind  the  edge  of 
the  sternum,  upon  the  internal  m.amm<ary  artery.  He  was  treated  in  the  field  hospital  until  the  18th,  when  he  was  conveyed  to 
the  hosj)ital  at  York,  Pennsylvania,  where  he  entered  on  August  23d.  There  was  sloughing  of  the  internal  mammary  artc'ry 
which  g.ave  rise  to  intermediary  hiemorrhage  to  the  amount  of  thirty  ounces.  Cold  applications  .and  compresses  were  ajiplied. 
The  case  terminated  fatally  on  August  24lh,  1863.  Surgeon  H.  Palmer,  U.  S.  V.,  reports  the  case. 

The  following  case  probably  relates  to  a lesion  of  the  internal  mammary,  as  that  is 
the  only  branch  of  the  subclavian  in  the  immediate  vicinity  of  the  wound  described ; 

Ca.se. — Private  Colby  Shrader,  Co.  I,  17th  Kentucky  Volunteers,  was  wounded  at  the  battle  of  Shiloh,  April  7th,  186‘2, 
by  a musket  ball,  which  passed  through  the  right  arm  into  the  thorax,  lodging  on  the  pleura.  He  was  treat<‘d  at  the  general 
hospit.al  at  Mound  City,  Illinois.  On  April  17th,  haemorrhage  set  in  from  a branch  of  the  subclavian  artery.  I’rofessor  S.  1>. 
Gross  tried  to  ligate  the  bleeding  vessel,  but  failed.  The  [)atient  died  on  the  following  day.  The  post-mortem  examination 
revealed  a cul  de  sar,  within  the  pleura  filled  with  blood.  The  case  is  reported  by  Surgeon  E.  C.  Fraiddin,  U.  S.  V.,  and  Surgeon 
H.  Wardner,  U.  S.  V. 


Fig.  243. — Necrosed  fragment  of  the  storimm  and  portion 
of  left  clavicle  after  gunshot  fracture.  Kcduccd  to  ouc-third. 


* BallixgalL,  Outlines  of  Military  Surgery,  5th  ed.,  London,  1805,  p.  330. 


Guthiue,  Commentaries,  ttc.,  already  cited,  p.  517. 


524 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CiiAr.  V, 


The  next  ease  was  communicatefl  by  Surgeon  AV.  Clendenin,  U.  S.  V.,  to  Dr.  John 
A.  Liclell,  <ond  is  published  by  the  latter  in  his  valuable  memoir  on  wounds  of  the  blood- 
vessels d 

Case. — “ , Co.  A,  45tli  Illinois  Volunteers,  was  wounded  at  the  battle  of  Mission  Eidge.  The  ball  struck 

tbe  edge  of  tlie  sternum  obliquely  near  its  junction  with  the  cartilage  of  the  fourth  rib,  and  emerged  from  the  side  of  the  thorax 
between  the  third  and  fourth  ribs,  a little  more  than  three  inches  external  to  the  orifice  of  entrance  (on  the  left  side).  The  wound 
extended  through  the  parietes  of  the  chest  without  injuring  the  lutig  or  pericardium.  For  two  or  three  minutes  the  haemorrhage 
was  somewhat  jirofuse,  but  it  ceased  spontaneously;  the  degree  of  shock  w'as  severe.  After  the  haemorrhage  had  ceased,  the 
man  was  transferred,  in  an  ambulance,  to  hospital  at  Chattanooga.  For  ten  days  the  case  progressed  favorably  (the  wound  looked 
well,  but  it  was  thought  that  the  patient  was  scorbutic),  with  every  prospect  of  recovery ; but  while  the  patient  was  in  the  .act  of 
drinking  water,  coughing  was  excited,  and  haemorrhage  supervened.  Efforts  were  made  by  the  attending  surgeons  to  arrest  the 
bleeding,  by  means  of  stypties,  compression,  etc.,  but  without  success.  No  attempt  was  made  to  place  a ligature  tipon  the  vessel. 
The  patient  died  from  exhaustion  on  the  night  of  the  twelfth  day  after  he  was  wounded.  There  were  no  positive  evidences  of 
internal  hasmorrhage.  Post-mortem  examination  made  twelve  hours  after  death.  A small  piece  of  bone  had  been  gouged  out  of 
the  edge  of  the  sternum;  no  fracture  of  sternum  or  ribs;  j)leura  costalis  cut  through  to  the  extent  of  nearly  one  inch;  internal 
mammary  artery  severed;  pleura  puhnonalis  and  lung  uninjured.  The  pleural  cavity  contained  a clot  of  Hood  weighing  eighteen 
ounces.  Is  it  not  highly  probable  that  ligature  of  the  internal  mammary  artery  would  have  saved  the  life  of  the  patient,  as  a 
ligature  of  that  vessel  was  practicable,  and  the  attending  circumst.ances  favorable?”* * 

Dr.  Liclell,  who  has  studied  the  subject  of  traumatic  hsemorrhage  with  great  care,  and 
whose  observations  on  what  he  aptly  designates  as  “battle-field  haemorrhage”  I have  fre- 
quent occasion  to  cite,  makes  the  following  comments  on  this  case : 

“I  believe  that  tbe  question  raised  above  by  Dr.  Cleudenin,  should  be  answered  affirmatively. 
And  why,  let  me  ask,  was  the  vessel  not  searched  for  and  tied  when  the  secondary  haemorrhage 
occurred,  in  this  case?  The  reply  to  this  inquiry  is  contained  in  the  report  of  the  case,  and  is 
clothed  in  these  words:  ‘Efforts  were  made  by  the  attending  surgeons  to  arrest  the  bleeding  by 
means  of  styptics,  compression,  etc.,  but  without  success.’  The  truth  of  the  matter  is  that 
inefficient  means  were  employed  for  the  purpose  of  arresting  the  haemorrhage  in  this  case,  and  the 
means  that  might  have  proved  effectual  in  controlling  it  were  utterly  neglected.  The  ouly  effect 
which  appears  to  have  been  produced  by  the  use  of  styptics  and  i)ressure,  was  to  cause  the  blood 
to  flow  internally  instead  of  externally,  and  thus  to  accumulate  iu  the  pleural  cavity.  At  the  same 
time  the  secondary  haemorrhage  must  have  been  i^rofuse,  for  it  made  its  appearance  on  the  tenth 
day,  the  patient  died  on  the  night  of  the  twelfth,  and,  on  making  an  autopsy,  a coagulum  weighing 
eighteen  ounces  was  found  iu  the  pleural  cavity.  It  would  have  been  well  for  this  patient  if  such 
agents  for  the  relief  of  secondary  haemorrhage,  arterial  in  character,  as  styptics  and  pressure  had 
never  been  heard  of,  for  then  the  attending  surgeons  would  have  been  compelled  to  search  for  aud 
tie  the  bleeding  vessel,  and  thus  his  life  would,  iu  all  prob.ability,  have  been  saved.  It  seems  to  mo 
passing  strange,  that  the  relation  iu  which  the  em])loymeut  of  styptics  aud  compression  stands  to 
the  em[)loymeut  of  the  ligature  for  the  arrest  of  secondary  haemorrhage,  arterial  in  character, 
especially  if  it  be  profuse,  should  ever  be  overlooked  by  the  surgeon.  The  reader  must  pardon  me 
for  stating  iu  this  place  what  I believe  that  relation  to  be,  namely,  the  former  should  never  be 
employed  for  the  arrest  of  jirofuse  secondary  arterial  haemorrhage,  unless  the  ligature  has  failed  to 
control  the  bleeding,  or,  from  some  inherent  reason,  cannot  be  applied  with  safety  to  the  patient. 
Styptics  and  pressure  should  be  used  for  the  arrest  of  that  form  of  haemorrhage,  not  from  choice, 
but  as  remedies  of  expediency  aud  of  last  resort.  A single  remark  should  be  made  with  regard  to 
the  jirimary  haemorrhage  which  occurred  in  the  foregoing  case.  Although  it  was  rather  profuse, 
for  two  or  three  minutes,  it  ceases  spontaneously,  because  the  vessel  from  which  it  came  (the  internal 
mammary  artery)  had  been  completely  divided  by  the  projectile,  and  thus  was  iu  a condition  to 
permit  occlusion  of  the  bleeding  orifice  to  spontaneously  occur.” 

* Lidell,  J.  a.,  On  the  irow/icZs  of  Blood-vessels,  2'raumatic  Ufvrtiorrhage,  Traumatic  Aneurism,  Traumatic  Gangrene.  Surgical  Memoirs  of  the 
War  of  the  Rebellion,  collected  and  published  by  the  United  States  Sanitaiy  Commission,  New  York,  1870. 

* There  is  probably  an  error  in  the  military  description  in  this  case.  The  45th  Illinois  regiment,  attached  to  the  Seventeenth  Corps,  was  at  Vicks- 
burg at  the  date  refeiTcd  to,  and  no  corre.sponding  case  appears  on  its  hospital  record.  lAcutenaut  Jacob  Elliott,  Co.  A,  4x’d  Illinois  Volunteers,  was  admitted 
on  November  25tli,  1803,  at  Chattanooga,  with  a gunshot  wound  of  the  chest,  and  died  on  Uecenibcr  6th,  1803,  with  symptoms  similar  to  those  described. 
The  cases  are  probably  identical.  Surgeon  W.  CLENDENIN,  U.  S.  V.,  was  Acting  Medical  Inspector  of  the  Department  of  the  Cumberland  at  the  lime, 
and  appears'to  have  taken  notes  industriously  for  his  own  use.  The  hospital  records  are  very  imiierfect. 


Skct.  II.] 


WOUNDS  OF  THE  BLOOD-VESSELS. 


525 


]\r.  Toiirdes  lias  written  an  excellent  mxjnograpli^  on  tliis  suliject.  He  sliows  from 
tire  cases  be  lias  collected  that  the  lesion  occurs  with  equal  frequency  on  either  side,  that 
the  prognosis  is  always  exti'cmely  grave,  that  more  than  half  of  the  cases  are  accompanied 
by  section  of  the  costal  cartilages;  and  that  this  section  always  occurs  when  the  vessel  is 
wounded  below  the  fourth  rib,  the  last  observation  applying  particularly  to  incised  wounds. 
There  may  be  external  hiEmorrhage  and  internally  into  the  anterior  mediastinum,  into  the 
pleural  cavity  and  into  the  pericardium.  The  diagnosis  may  be  very  difficult,  for  the 
signs  of  intrathoracic  extravasation  are  often  equivocal.  Nclaton"  observes  that  if  the 
hsemorrhage  is  suspended  at  the  time  of  examination,  anatomical  considerations  may  affiord 
presumptive  evidence,  and  that  every  deep  wound  near  the  margin  of  the  sternum  from 
the  first  to  the  seventh  rib  should  be  viewed  with  suspicion.  External  arterial  hiemorrhago 
decides  the  point;  but  this  sign  is  often  absent.  The  diagnosis  may  be  complicated  by 
bleeding  from  wounded  lung,  and  the  internal  hsemorrhage  then  affords  no  decisive  sign, 
the  position  of  the  wound  alone  suggesting  the  presumption  that  the  internal  mammary 
artery  is  interested.  The  vessel  is  often  of  sufficient  calibre  to  furnish  blood  very  freely, 
and  death  may  result  either  from  the  profusion  of  the  bleeding  or  from  asphyxia  from 
hsemothorax.  Larrey  advised  to  close  the  wound  and  leave  the  care  of  the  bleeding  to 
nature;  but  there  are  serious  objections  to  this  plan,  which  Larrey  employed  indiscriminately 
for  all  chest  wounds  with  internal  bleeding.^ 

For  example,  if  the  blood  passes  into  the  pericardium,  the  heart’s  movement  is  impeded, 
and  soon  arrested;  if  it  enters  the  pleural  cavity  or  mediastinum,  there  is  room  for 
haemorrhage  which  must  be  mortal,  and  if  the  patient  escapes  these  primary  accidents  he 
is  exposed  to  those  of  putrid  decomposition  of  the  extravasated  blood.  Hence,  we  should 
prefer,  with  Velpeau,  Marjolin,  Gross,  and  Lidell,  to  tie  the  vessel,  though  this  is  an 
operation  of  extreme  and  sometimes  almost  insurmountable  difficulty,  a point  which  will  be 
considered  in  the  next  Section. 

Wounds  of  the  Intercostal  Arteries. — Gibson'* *  remarks  that  “ hsemorrhage  from  this 
source  is  neither  so  profuse  nor  so  dangerous  as  has  been  commonly  imagined,”  a sentence 
containing  two  erroneous  propositions;  for,  as  will  be  presently  shown,  a lacerated  intercostal 
may  ^^our  four  pounds  of  blood  into  the  pleural  cavity,  and  eleven  out  of  fifteen  cases 
reported  during  the  war,  or  73.4  per  cent.,  had  a fatal  result.  Didactic  authors  generally 
make  light  of  this  accident,^  alluding  justly  to  its  extreme  rarity,  usually  cpioting  Boyer’s 
hackneyed  witticism  of  the  contrivances  for  arresting  the  bleeding  being  more  numerous 
than  the  authenticated  examples  of  the  lesion,  and  often  concluding  by  the  suggestion  of 
some  ingenious  method  by  the  author.  Baudens,®  however,  admits  that  wounds  involv- 
ing the  intercostal  arteries  are  interesting,  and,  agreeing  with  him  that,  though  rare, 
they  are  important,  I shall  here  enumerate  the  cases  that  were  reported  during  the 

^ Tourdes,  Des  hlessures  de  Vartlre.  mammaire  interne  sous  la  point  de  vue  medicodegal,  Paris,  1849,  p.  41. 

®N^:L-\T0X,  Clemens  de  Pathologie  chirurgicale,  T.  Ill,  Paris,  1854,  p.  450. 

It  esthien  preferable, " \\e  says,  d' abandonner  Vhemorrhagie  produite  par  Vinter  cosiale  ouparla  mammaire  interne,  aux  seuls  efforts  dc  la 
nature;  on  ferme  laplaie,  le  sang  s'accumule  dans  le  thorax,  et  lepoumon  n'itant  x^lus  eomprimt  par  Vair,  sc  dilate  de  nouveau  et  annule  le  vide  de  la 
caviieP  LakreY  (D.  J.)  Clinique  chi rurgicale,  T.  IV,  Paris,  1832,  p.  101. 

* OiBSOX,  W.,  Institutes  and  Practice  of  Surgery,  7th  ed.,  Philadelphia,  184  5,  Vol.  J,  p.  112. 

®Boyer,  Traite  dis  mat.  chir.,  6d.,  T.  V,  p.  (ilO;  DuruYTliEX,  Lemons  oraJes,  etc.,  T.  VI,  p.  355  ; Vir>AE,  Traiit  de  Path.  Ert.,  5'*"^6d.,  T.  TV, 
p.  Ofi ; Xlir.ATON,  Kidmens  de  Path,  chir.,  T.  Ill,  p.  4.52 ; EkiCHSEX,  Science  and  Art  o f Surgery,  Vol.  I,  p.  438,  ohscrv'os  that  “ the  intercostal  arteries 
usually  seem  to  escape ; or  at  least,  if  wounded,  they  do  not  bleed  in  a troublesome  manner;”  LegOUEKT  (Chirurgie  d'Armee,  2'«*‘  6d.,  p.  347),  regards 
most  of  the  cases  of  wounds  of  the  intercostal  arteries  cited  by  authors  as  fm  t contestable ; but  admits  that  the  twenty-eight  cases  collected  by  Martin 
{Des  Lesions  dcs  arleres  intercostales,  I’aris,  18.55)  leave  little  room  for  criticism. 

®Baudens,  Clinique  des  plaies  d'armes  d feu,  p.  213. 


526 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


war*  that  were  treated  Ly  compression,  and  cite,  in  the  next  Section,  those  in  which  ligation 
was  performed,  and  will  there  refer  to  some  of  the  ingenious  modes  of  arresting  the 
lisemorrhage  that  have  occasioned  so  many  sneers. 

Case. — Private  Oscar  A.  Barnes,  Co.  F,  20tli  New  York  Cavalry,  was  wounded,  on  March  5th,  1864,  while  sitting  in  his 
tent  in  camp  at  Northwest  Landing,  Virginia,  by  the  accidental  discharge  of  a Colt’s  revolver  in  the  hand  of  a comrade.  The 
ball  entered  between  the  third  and  fourth  ribs,  above  and  to  the  left  of  the  left  nipple,  ])assed  through  the  superior  lobe  of  the 
left  lung,  making  its  exit  near  the  inner  border  of  the  scapula,  at  the  origin  of  its  spine,  fracturing  the  bone  at  this  point  and 
lodging  under  the  integuments.  Within  thirty  minutes  alter  the  accident  the  ball  was  extracted,  together  with  several  small 
j)ieces  of  bone,  through  an  incision  made  through  the  integuments.  Ha'moptj’sis  and  profuse  hatmorrhage  from  the  intercostal 
artery  having  set  in,  the  wound  was  plugged  with  lint  and  cold-water  dressings  were  applied.  The  patient  was  placed  on  the 
wounded  side  and  perfect  rest  was  enjoined.  Opiates  were  freely  administered.  Expectorants  were  given  to  assist  in  relieving 
the  lungs.  As  soon  as  suppuration  appeared,  the  dressings  were  changed,  and  warm  cataplasms  were  applied.  The  patient 
continued  to  expectorate  bloody  sputa  for  five  days  after  the  rece])tion  of  the  injury,  after  which  he  steadily  improved.  By  the 
end  of  the  month  he  had  so  far  recovered  as  to  be  able  to  walk  about.  On  July  31st,  in  the  following  year,  he  was  mustered 
out  of  service.  In  April,  18G7,  the  man  was  examined  by  Dr.  George  JI.  Cook,  pension  examining  surgeon  at  Syracuse,  New 
York,  who  reports  him  suflering  from  expectoration  and  frequent  formation  of  abscess  of  the  lung;  also  from  lameness,  resulting 
from  a gunshot  fracture  of  the  metatarsal  bone  of  the  left  foot,  the  disability  being  rated  one-fourth  for  tlio  latter  wound  and 
three-fourths  for  that  of  the  lung.  This  pensioner  was  on  the  rolls  in  March,  1872.  The  case  is  reported  by  Assistant  Surgeon 
M.  W.  WTlson,  118th  New  York  Volunteers. 

Case. — Private  George  Goodwin,  Co.  H,  100th  New  York  Volunteers,  aged  19  years,  received  a gunshot  wound  of  the  right 
lung  during  the  attack  on  Fort  Darling,  May  16th,  1864.  He  was  treated  for  a few  days  at  the  field  hospital  of  the  Tenth  Army 
Corps,  and  subsequently  at  the  Broad  and  Cherry  Streets  Hospital,  Philadelphia.  On  June  23d,  a hmmorrhage  occurred  from 
the  intercostal  artery.  From  six  to  ten  ounces  of  blood  were  lost,  when  the  haemorrhage  was  checked  by  the  application  of 
jiersulphate  of  iron,  aided  by  a compress.  There  was  no  recurrence  afterward.  On  the  following  day,  the  jiatient  had  an  attack 
of  rubeola.  He  soon  convalesced  and  improved  steadily,  and  was  soon  able  to  leave  for  his  homo  on  furlough.  On  August  26th, 
1864,  he  was  returned  to  his  command  entirely  lecovered.  He  is  not  a pensioner.  Surgeon  John  Neill,  U.  S.  V.,  reports  the  case. 

In  tlie  two  following  fatal  cases  of  liaemorrhage  from  the  intercostal  arteries,  the  patients 
were  apparently  exhausted  by  bleeding  prior  to  their  admission  to  hospital: 

Case. — Private  Anson  A.  Barrett,  Co.  E,  12th  U.  S.  Infantry,  was  wounded  at  the  battle  of  Cedar  Mountain,  August  9th, 

1862,  by  a musket  ball,  which  entered  three  inches  to  the  left  of  the  sternum,  at  the  inferior  margin  of  the  first  rib,  and  emerged 
near  the  sixth  dorsal  vertebra,  severing  in  its  course  an  intercostal  and  one  of  the  larger  bronchitd  arteries.  He  was  conveyed 
by  rail  to  the  Third  Division  Hospital,  at  Alexandria,  where  he  died  from  the  efi’ects  of  hasmorrhage,  on  August  17th,  1862. 

Case. — Private  Charles  Hale,  Co.  F,  22d  Massachusetts  Volunteers,  was  wounded  at  the  battle  of  Rappahannock  Station, 
November  7th,  1863,  by  a fragment  of  a shell,  which  produced  a severe  fracture  of  the  right  side  of  the  chest  and  rupture  of  an 
intercostal  artery.  Two  days  after  the  reception  of  the  injury,  the  wounded  man  reached  the  Finley  Hospital,  where  the  bleeding 
was  imperfectly  controlled  by  compresses  and  styptics.  The  jtatient  died  on  the  following  day  from  the  effects  of  hemorrhage. 
Surgeon  B.  B.  Breed,  U.  S.  V.,  reports  the  case. 

Ill  the  next  three  cases  the  arterial  lesions  were  verified  at  the  autopsies.  Two  of 
them  were  complicated  by  hamiotJiorax. 

Case.— Priv.ate  Edward  Fanning,  Co.  M,  1st  Missouri  Cavalry,  was  accidentally  shot  through  the  thorax  at  Cape 
Girardeau,  Missouri,  on  December  19th,  1863.  He  was  conveyed  to  the  post  hospital,  where  he  lingered  until  December  30th, 

1863.  The  post  mortem  examination  disclosed  that  the  missile,  a conoidal  pistol  ball,  had  entered  above  the  right  nipple,  passed 
through  the  sternum  and  upw'ard,  splintering  the  third  rib,  left  side,  and  wounding  the  intercostal  artery,  thence  going  into  the 
left  shoulder,  fracturing  the  head  of  the  humerus  and  lodging  in  the  glenoid  cavity.  The  thoracic  cavity  was  found  to  contain 
two  quarts  of  yellowish  blood.  The  lungs  were  congested  and  the  left  pleura  was  inflamed  and  softened.  Reported  by  Acting 
Assistant  Surgeon  Patiick  Gilroy. 

Ca.se. — Private  Joseph  Kreider,  Co.  E,  45th  Pennsylvania  Volunteers,  received,  at  Campbell  Station,  East  Tennessee, 
November  16th,  1863,  a penetrating  wound  of  the  thorax  by  a conoidal  ball.  On  the  same  day,  ho  was  admitted  to  Asylum 
Hospital,  Knoxville,  where  he  died  on  December  1st,  1883.  Post  mortem  showed  that  the  ball  entered  between  the  third  and 
fourth  ribs,  three  inches  from  the  median  line,  fracturing  fourth  and  fifth  ribs,  right  side,  wounding  intercostal  artery, 
and  emerged  between  seventh  and  eighth  ribs,  five  inches  below  axilla,  same  side ; there  was  extensive  inllammation  of  upper 
and  middle  lobe  of  right  lung ; lower  lobe  collapsed ; cavity  between  pleura  puhnonalis  and  jtleura  costalis  filled  with  blood  from 
a secondary  hmmorrhage,  which  had  been  both  internid  and  external.  The  case  is  reported  by  Surgeon  C.  W.  McMillen,  1st 
Tennessee  Mounted  Infantry,  by  whom  the  autopsy  was  made. 

*Iii  the  tenth  edition  of  liis  favorite  Vadu  Mccuni  (p.  484),  Dr.  Druitt,  after  advertin'^  to  Mr.  Lawson's  statement  that  “the  intercostal  artery  was 
not  once  secured  in  the  Crimean  campaign,”  cites  Circular  No.  G,  S.  G.  ().,  1805,  as  authority  for  the  assertion:  “ the  same  was  the  case  iii  the  American 
war.”  On  page  71  of  tliat  report  two  oases  <»f  ligation  (.f  the  intcrcxistal  are  r('foiTed  to. 


Sect.  II.] 


WOUNDS  OF  THE  BLOOD-VESSELS. 


527 


C.v.sK. — Lieutfiiaiit  .Toliii  S.  Ddbinson,  Adjutant  7tli  Illinois  Volunteei's,  was  woundpd  at  the  l)attl(M)f  Allatoona  Bass, 
Georgia,  Oetober  utli,  1S64,  hy  a eonoidal  musket  ball,  which  entered  near  the  inferior  angle  of  the  left  scapula  and  emerged 
antenorlv,  fracturing  the  sixth  rib,  ])enetrating  the  left  lung,  and  tearing  an  intercostal  artery.  Copious  bleeding  from  the  ante- 
rior oj)ening,  together  with  expectoration  of  blood,  followed  the  injury.  The  limmorrhage  was  checked  by  the  application  of 
persidphate  of  iron.  After  this,  tincture  of  veratruin  viride  was  administered  for  about  two  weeks.  The  jiatient  remained  at 
the  field  hospital  of  the  4th  division.  Fifteenth  Corps,  for  over  four  weeks,  being  greatly  debilitated  and  in  bad  health  at  first, 
t)ut  mending  sufficiently  to  bear  transportation  to  a general  hospital  on  November  3d.  On  the  following  day,  he  reached  Ilosjjital 
No.  1 at  Chattanooga,  Tennessee,  where  he  died  on  January  4th,  1865.  Surgeon  T.  R.  Zearing,  57th  Illinois  Volunteers,  l eports 
the  wound,  and  Surgeon  J.  II.  Phillips,  U.  S.  V.,  the  termination  of  the  case. 

In  the  seven  foregoing  instances,  hEemorrhage  was  primary  in  four,  intermediary  in 
one,  and  secondary  in  one,  and  resulted  from  wounds  hy  musket  balls  in  four  cases,  from 
pistol  balls  in  two,  and  from  a shell  fragment  in  one.  The  injuries  were  inflicted  on  the 
right  side  in  four  and  on  the  left  in  three  cases,  and  were  associated  in  four  cases  at  least 
hy  perforation  of  the  lung.  Nearly  all  of  the  wounds  were  in  the  space  hounded  hy  the 
third  to  the  sixth  ribs,  inclusively.  Compresses  and  styptics  were  the  only  local  measures 
employed.  This  subject  will  be  continued  in  the  next  Section.  Bleeding  from  laceration 
of  the  pulmonary  tissue  will  be  considered  in  connection  with  hsemothorax,  empyema, 
etc.,  in  the  observation  at  the  close  of  the  Chapter.* 

Other  Lesions  of  Blood-Vessels. — Specimen  1640,  of  the  Army  Medical  Museum,  is 
an  example  of  the  rare  lesion  of  a rupture  of  the  left  subclavian  pem.j* 

C.\SE. — Valentine  K , commissary  detachment,  was  caught  between  the  buffers  of  two  railway  cars,  July  26th. 

The  humerus,  clavicle,  and  scapula  were  fractured,  the  neighboring  soft  parts  wore  pulpificd,  though  the  skin  was  unbroken. 
The  left  arm  became  sphacelous,  and  the  patient  died  July  2od,  1863.  The  subclavian  artery  was  obliterated,  where  it  leaves 
the  first  rib.  The  subclavian  vein- was  torn  and  had  supplied  the  blood  which  distended  the  soft  ])arts.  Assistant  Surgeon  W^. 
Thomson,  U.  S.  A.,  presented  the  specimen  and  memorandum. 

Specimen  2721,  shows  a bayonet  wound  of  tlie  riglit  subclavian,  near  the  innom- 
iiiata,  opening  two-thirds  of  the  cylinder  of  the  artery.  It  is  from  a soldier  killed  at  Fort 
WaGiner. 

O 

Aneurism. — False  diffused  and  consecutive  aneurisms  were  among  the  secondary  con- 
ditions rarely  observed  after  gunshot  wounds  of  the  thorax. J The  following  is  an  exain})le, 
and  a few  others  will  be  cited  in  the  next  Section : 

Case.. — Private  J.  H.  Carpenterj  Co.  C,  4th  Virginia  Cavalry,  aged  28  years,  \vas  wounded  on  May  12tli,  18G4,  hy  a 
niinid  ball,  which  entered  one  and  a half  inches  below  the  inner  third  of  right  clavicle,  making  exit  one  inch  from  and  parallel 
to  posterior  border  of  right  axilla.  On  May  15th,  he  was  admitted  to  Chimborazo  Hospital,  liichmond,  Virginia.  The  patient  spat 
blood  at  the  reception  of  the  wound  and  for  several  days  afterw’^ards  ; and  on  May  20th,  hseinorrhage  occurred  from  a branch  of 

* Consult  Harder,  Diss.  dc  hsemorrhagia  arterim  intcrcostalis  sistenda,  Berolmi,  1823;  Assalint,  Manuale  dC  Chirurgia,  Milano,  1812.  p.  57; 
EavatON,  Pratique  inoderne  de  la  chirurgie,  Paris,  1785,  Vol.  II,  p.  130;  ClIEiauS,  Vber  die  Verlctzung  dev  Art.  intercostalis  in  Ileiclelberger  klinisebe 
Anualen,  B.  I,  T.  IV ; Gaxt,  Science  and  Practice  of  Surgery^  p.  884 ; VELPEAU,  Nouv.  £,le.  de  Med.  Op.,  T.  II,  p.  2G5;  IIAIIRISON,  Surgical  Anatomy 
of  the  Arteries,  4th  ed.,  Dublin,  1839 ; Fraser,  P.  A.,  Treatise  on  Penetrating  Wounds  of  the  Chest,  Loudon,  1859,  p.  Ill ; SaxsOX,  Des  heniorrhagics 
traumatiques,  Paris,  1836,  p.  252. 

tNo  example  of  gunshot  wound  of  the  subclavian  vein  is  reported  as  having  come  under  treatment,  unless  the  case  mentioned  on  pa^^  522  be 
regarded  as  such.  The  case  reported  by  ]\Ir.  Blenkins  (Fraser,  op.  cit.,  p.  13),  where  a ball  passed  between  tbe  right  subclavian  artery  and  vein, 
wounding  the  latter,  and  causing  fatal  phlebitis,  remains  the  solitary  recorded  instance.  But,  as  Mr.  Fraser  observes,  the  exemption  is  ideal  rather  than 
real,  for  probably  a large  proportion  of  those  killed  on  the  field  of  battle  die  from  tom  blood-vessels. 

J Traumatic  affections  of  the  great  blood -vessels  of  the  chest  arc  usually  passed  over  cursorily  by  systematic  authors,  and  our  information  concerning 
these  is  scattered  through  theses,  monographs,  journals,  and  collections  of  cases.  Leuouest  {op.  cit.,  p.  3.33)  quotes  a unique  instance  of  recovery  from 
a punctured  wouud  of  the  aorta,  obser\'ed  by  Dr.  Neil  of  Bamberg,  in  1812  (Henke's  Zeitschrift  fur  Arzn.,  Ileft  II,  1837,  1839,  and  Arch.  gen.  dc 
mid.,  2"®  s^rie,  1838,  T.  II,  p.  109),  the  cicatrix  being  verified  a year  subsequently  at  the  autojisy  after  death  from  pneumonia.  DiCMMK  {op.  cit., 
p.  37)  saw  a young  Austrian  at  the  hospital  of  St.  Francis,  at  Milan,  perish  from  secondary  haemonhage  four  weeks  after  the  reception  of  a gunshot 
injury  of  the  pectoral  portion  of  the  descending  aorta.  Blandix  {Anutomie  topographique,  2d  6d.,  1834,  p.  287)  observed  at  the  Beaujon  liospital  a 
young  man  who  survived  a short  time  a pistol  wound  of  the  azyges  vein,  near  its  tenninal  curve.  BRESCHET  {Jtepertoire  giniral  d’ anatomic  et  de 
physiologic  pathologique  et  dc  clinique,  T.  IV,  p.  196)  records  an  autopsy  of  a youth  of  twenty-five  years,  who  received  in  a duel  Ji  punctured 
wound  of  the  azygos  vein  in  the  curve  it  describes  before  emptying  into  tbe  cava  near  the  right  side  of  the  body  of  the  fifth  dorsal  vertebne  ; tlic  patient 
suivived  three  days.  TlM.ELS,  of  Colbcrg  {Responsis  mcdicis  et  diaeteiicis,  1668,  C.  XVI,  quoted  by  Bonctus,  Scpulchrctum,  Vol.  Ill,  p.  3."9)  records 
t)ic  case  of  a nobleman,  stabbed  through  the  right  axilla,  between  the  lliird  and  fourth  rib.s,  the  blade  wouiuling  the  i>ulmonary  artery.  Frotliy  bleed 
fiowod  externally  and  there  were  frequent  syncope.s ; but  the  wounded  man  lived  tlirce  days.  Specimen  3388,  of  the  Surgical  .Section  </f  the  Army 
Medical  3Iuseum,  alfordsa  rare  instance  (jf  coinjiression  of  the  left  ujqHT  pulmonary  vein  by  a coiundal  ball  imbedded  in  tbe  adjacent  lung  substance. 
The  patient  died  on  the  twelfth  day  from  secondary  haemorrhage.  .Sec  IIexnex  {1.  c.  3d  ed.  p.  97)  for  a case  of  rupture  of  tlic  azygos. 


528 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CiiAr.  V, 


tliu  axilliiry  artery,  but  was  controlled  by  a solution  of  persul))bate  of  iron.  He  improved  until  .June  Ctb,  wben  considerable 
fever  .supervened,  with  great  pain  in  the  right  side  and  cough  ; no  ex])ectoration ; ten  grains  of  calomel  and  two  grains  of  opium 
were  administered  at  once;  the  next  day  he  was  much  improved,  with  no  pain  and  less  fever;  anodynes  were  given  nightly, 
and  he  continued  to  improve  until  the  18th  w hen  the  wound  had  healed.  It  was  then  discovered  that  traumatic  aneurism  of  the 
axillary  artery  had  formed ; the  pulsating  tremor  was  distinctly  felt  and  easily  recognized.  The  patient  remained  in  hospital 
until  a satisfactory  diagnosis  could  he  made.  He  was  furloughed  on  June  27th,  1864.  The  case  is  reported  by  Dr.  Dickie, 
1’.  A.  C.  S.,  in  a case-hook  of  the  Chimborazo  Hospital. 

Wciinds  of  the  Pericardium  and  Heart. — Some  of  the  cases  reported  are  interesting 
in  a medico-legal  point  of  view,  others  as  illustrating  the  difficulties  of  diagnosis  in  this 
class  of  injuries,  and  others  again  as  objects  of  curiosity  or  extreme  instances  of  what 
nature  can  bear. 

Wounds  of  the  Pericardium. — A number  of  examples  of  gunshot  wounds  of  the 
pericardium  were  recorded,  in  which  the  patients  survived  several  weeks,  and  the 
symptoms  were  noted  with  more  or  less  exactitude,  and  the  nature  of  the  lesions  were 
verified  by  'post-mortem  examination.  Cases  of  recovery  are  also  noted,  in  which,  if  the 
evidence  of  this  injury  is  not  irrefragable,  the  reporters  appear  to  have  formed  the  diagnosis 
with  tolerable  precision.  Some  observations  of  secondary  pericardial  disease  excited  by 
gunshot  injury  have  already  been  cited  (pp.  488,  492)  and  others  will  be  adduced.  The 
cases  tend  to  confirm  the  conclusion  of  FischeiC — derived  from  an  analysis  of  fifty-one 
cases,  with  twenty-two  recoveries, — that  wounds  of  this  membrane,  unless  gravely  compli- 
cated, are  less  dangerous  than  has  been  generally  supposed ; 

Case. — Private  Henry  C.  Vaughn,  Co.  K,  3il  Iowa  Cavalry,  aged  28  years,  was  wounded,  during  General  Pleasonton's 
campaign  in  Missouri,. October  23d,  1884,  by  a conoidal  hall,  which  entered  the  ninth  rib,  just  under  the  left  nipple,  and  emerged 
about  eight  or  nine  inches  posterior  to  the  point  of  entrance,  wounding  the  pericardium  in  its  course.  The  lib  was  very  much 
s}iliutercd  at  the  ])oiut  of  entrance.  He  was  taken  to  the  post  hospital  at  Independence,  Missouri,  where  simjde  dressings  were 
ajijilied.  On  October  25th,  he  was  transferred  to  the  hospital  at  Kansas  City,  Missouri.  Extensive  pleuritis  and  the  decomposed 
lliiids  made  the  case  a very  severe  one,  but  the  patient  bore  his  extreme  sufferings  with  great  fortitude.  Death  resulted  on 
November  5th,  1864.  The  case  is  reported  by  George  H.  Hood,  Acting  Assistant  Surgeon. 

Case. — Private  James  Ackerman,  Co.  I,  81st  Pennsylvania  Volunteers,  aged  18  years,  was  wounded  at  Gaines’s  Mill, 
Virgini.a,  June  27th,  1862,  and  admitted  to  Hygeia  Hospital,  Old  Point  Comfort,  June  30th,  with  gunsliot  comminuted  fracture 
of  both  bones  of  the  forearm  near  the  elbow-joint ; the  ball,  a miuie,  having  passed  through,  and  then  entering  the  chest,  between 
tbe  fifth  and  sixth  ribs,  at  the  junction  of  the  cartilage  with  rib.  The  ball  could  not  be  found,  although  search  was  made  with  a 
female  catheter.  The  track  of  the  wound  was  very  obliquely  through  the  intercostal  muscles  toward  the  apex  of  the  heart. 
Tliere  ^vas  duluess  of  the  anterior  part  of  the  left  chest,  and  he  suffered  some  pain  and  dyspnoea.  There  was  no  cough  nor 
expectoration.  The  patient  seemed  well  and  comfortable  during  the  day,  but  at  night  was  alwtiys  delirious,  frequently  screaming 
out  that  “ the  rebels  W’ere  after  him.”  The  arm  was  placed  in  an  angular  tin  splint,  and  dressed  with  cold  water  until  the 
inflammation  subsided  and  suppuration  became  free.  He  died  July  12th,  1862.  At  the  necropsy,  the  ball  was  found  to  have 
jtassed  along  the  diaphragm  from  the  place  of  entrance  and  entered  the  pericardium  at  its  apex,  and  was  found  lying  loosely  in 
that  sac,  together  with  considerable  serum  and  flakes  of  lymph.  The  surface  of  the  heart  was  tilso  covered  with  lymph,  but  its 
coverings  were  not  wounded.  The  track  of.  the  wound  had  healed,  as  well  as  the  wound  in  the  pericardium  ; in  fact,  it  was 
difficult  to  detect  the  spot  which  marked  its  entrance.  The  lungs  and  liver  were  healthy.  The  arm  did  not  exhibit  any 
evidences  of  repair.  The  case  is  reported  by  Surgeon  R.  B.  Bontecou,  U.  S.  V. 

Case. — Private  Ambrose  Burgess,  Co.  E,  16th  Maine  Volunteers,  was  wounded  at  Fredericksburg,  Virginia,  December 
13th,  1862,  by  a conoidal  musket  ball,  which  fractured  the  fourth  rib  and  penetrated  the  lung;  the  missile  entered  the  left  side 
about  the  angle  of  the  seventh  rib,  taking  an  upward  direction,  and  emerging  at  the  nipple,  between  the  third  and  fourth  ribs. 
He  was  received  into  the  First  Corps  hospital,  and,  on  December  23d,  admitted  to  Harewood  Hosj)ital,  Washington.  When 
received  lie  was  exceedingly  weak  ; the  w'ound  was  dressed,  and  brandy  and  milk  punch  freely  administered ; he  continued, 
however,  to  sink,  and  died  December  2Cth,  1862.  Necropsy  showed  that  the  ball  in  its  course  luid  opened  the  pericardium  and 
penetrated  the  lower  lobe  of  the  lung.  The  case  is  reported  by  Surgeon  Thomas  Antisell,  U.  S.  V. 

In  the  next  case  it  is  to  Le  regretted  tliat  the  opportunity  of  making  an  autopsy  was 
neglected : 

Ca.se. — Private  John  A.  Clark,  Co.  I,  3d  Maine  Volunteers,  was  admitted  to  Judiciary  Siptare  Hospital,  Washington, 
.July  loth,  1863,  with  a gunshot  wound  of  left  lung,  received  at  Chancellorsville,  Virginia,  May  2d,  1863.  He  was  dischargi^d 
the  service  on  February  12tb,  1864.  There  was  confirmed  tuberculosis ; predisposition  existing  before  enlistment ; the  exciting 
cause,  probably,  being  the  wound ; also  slightly  impaired  use  of  arm.  The  case  is  reported  by  Assistant  Surgeon  Alexander 


G.,  Die  Wunde.n  des  Herzens  iind  d^s  JJerzbcutcls,  in  Archiv  fiir  Klinische  Chirargie,  B.  IX,  p.  571. 


Skct.  II.] 


WOUNDS  OF  THE  PERICARDIUM. 


529 


Ingram,  U.  S.  A.  Pension  Examiner  James  15.  Bell,  Augusta,  Maine,  reports,  March  22(1,  1864  : Ball  entered  one  incdi  above 
the  left  nipple  slightly  to  the  inside,  passed  directly  through  the  chest  at  right  angles  with  the  walls ; probably  wounded  the 
pericardium,  and  passed  within  h.alf  an  inch  of  the  heart.  The  disability  now  results  from  hffiinoptysis,  debility  and  pain,  and 
may  be  permanent.”  December  18th.  1866,  he  reports:  “Died  from  ha'inorrh.age  of  the  lungs  from  the  seat  (jf  the  wound  on 
June  6th,  1866.” 

In  the  first  of  the  three  succeeding  cases  of  recovery,  the  diagnosis  of  wound  of  the 
pericardium  is  more  positively  made  than  in  the  other  two  : 

Case. — Private  Anthony  H.  Rabell,  Co.  I,  83d  Pennsylvania  Volunteers,  aged  27  years,  was  wounded  at  Spottsylvania, 
Virginia,  May  8th,  1864,  by  a conoidal  ball,  which  entered  left  chest  four  inches  below  axilla,  fractured  fourth  and  filth  ribs, 
j)assed  through  the  pericardium,  and  was  removed  from  middle  portion  of  sternum.  He  was  taken  to  Fifth  Corps  hospital,  and, 
on  May  14th,  admitted  to  Harewood  Hospital,  Washington.  Supporting  treatment,  with  rest  and  quiet,  tvas  adopted.  He  was 
furloughed  on  July  12th,  and  returned  to  hospital  September  18th;  was  again  furloughed  October  30th,  and  readmitted 
November  25th,  1834.  February  4th,  1865,  the  wound  had  entirely  healed ; he  complained  of  a difficulty  in  lying  down,  and 
required  his  shoulders  to  be  raised  in  order  to  obtain  rest ; this  was  probably  caused  by  adhesions  that  had  taken  place.  He 
was  discharged  the  service  June  6th,  1865.  The  case  is  rej)orted  by  Surgeon  R.  B.  Bontecou,  U.  S.  V.  Pension  Examiner 
George  S.  Gale,  New  York  City,  reports,  January  1st,  1869,  that  the  ball  entered  three  inches  below  and  back  of  left  nipple, 
passed  up  and  forward  to  sternum,  injuring  the  bone,  and  causing  pleuritis  and  consequent  adhesions ; there  was  shortness  of 
breathing  on  severe  exercise ; the  muscular  adhesions  along  the  track  of  the  ball,  particularly,  cripple  the  action  of  left  arm  by 
rendering  the  pectoral  muscles  nearly  powerless. 

Case. — Captain  William  McConihe,  Co.  F,  2d  New  York  Volunteers,  was  wounded  at  Chancellorsville,  Virginia,  May 
2d,  1863,  by  a conoidal  ball,  which  entered  the  left  chest  between  the  fifth  and  sixth  ribs  near  the  sternum,  and  lodged.  He  was 
conveyed  to  the  field  hospital  of  the  1st  division.  Second  Corps,  where  simple  dressings  were  applied  to  the  wound.  He  was 
subsequently  treated  in  private  quarters  in  Washington;  was  furloughed  on  the  11th,  and  discharged  from  service  May  26th, 
1863.  Pension  Examiner  W.  W.  Potter  reports,  August  7th,  1866  : “ The  pulse  is  irregular,  frequent,  and  feeble.  The  peculiar 
action  of  the  heart  and  the  condition  of  the  circulation  lead  to  the  belief  that  the  structure  of  the  pericardium,  or  the  heart 
itself,  was  injured  by  the  ball.  Disability  total  and  permanent.”  ^ 

Case. — Private  Calvin  F.  Jones,  Co.  H,  36th  Illinois  Volunteers,  was  admitted  to  Ho.spital  No.  1,  Murfreesboro’,  Ten- 
nessee, January  8th,  1863,  with  a gunshot  penetrating  wound  of  the  chest,  received  at  Murfreesboro’,  December  31st,  1862.  He 
was  returned  to  duty  February  19th,  1863,  and  discharged  from  service  April  9th,  1863.  Surgeon  F.  W.  Lytle,  36th  Illinois 
Volunteers,  who  reports  the  case,  states,  on  the  certificate  of  disability,  that  Jones  was  w'ounded  through  the  left  side  of  the 
chest,  involving  the  ti.ssue  of  the  left  lung,  and  probably  of  the  heart  or  its  coverings,  giving  rise  to  palpitation  whenever  he 
takes  any  exercise. 

Case. — Private  William  L , Co.  B,  6th  Ohio  Cavalry,  aged  18  years,  was  wounded  in  a skirmish  on  the  Rapidann 

River,  Virginia,  September  8th,  1363 ; one  ball  entered  the  left  side  of  the  thorax  on  a level  with  the  fourth  rib,  posterior  to  the 
junction  of  the  cartilage  with  the  bone,  and  emerged  eight  and  one-half  inches  posterior  to  the  wound  of  entrance,  and  three 
ribs  lower  down,  fracturing  the  seventh  rib  anterior  to  its  angle.  The  second  ball  entered  on  a level  with  the  tenth  rib,  passed 
from  behind  forward,  and  fractured  the  ninth  rib  about  one  inch  jiusterior  to  the  junction  of  the  cartilage  with  the  bone.  He  was 
conveyed  to  Washington,  and  admitted,  on  the  12th,  to  Lincoln  Hospital.  On  admission,  he  was  very  pale  and  anminic  and 
suftered  greatly  from  his  wounds ; no  emphysema  of  surrounding  integument.  Respiration  40  per  minute,  short  and  labored. 
Cough  harassing,  though  no  sputa  was  brought  up.  No  difference  in  measurement  existed  between  the  two  sides  of  the  chest; 
pulse,  108;  sleeps  poorly  ; orthopna-a  prominent.  September  17th:  It  was  observed  that,  in  addition  to  the  empyema  which  was 
present  on  the  left  side,  a violent  pleurisy  had  attacked  the  right.  The  combined  sources  of  depression  rapidly  exhausted  the 
remaining  vital  power  of  the  patient.  On  the  20th,  several  spiculm  of  bone  were  removed  from  the  wound  of  exit.  The 
coughing  would  occasionally  cause  large  quantities  of  purulent  mattc'r  to  be  discharged  from  the  wound.  The  person  and 
surroundings  of  the  patient  became  offensive  in  the  extreme,  rendering  him  a pitiable  object.  On  the  25th,  pericarditis  was 
detected.  At  this  time,  he  presented  the  following  symptoms  : orthopnoea  ; sits  up  in  bed  with  head-frame  behind  him  ; respira- 
tion 45  per  minute  and  laborious;  face  expressive  of  great  exhaustion,  pallid ; nostrils  dilated  strongly  at  every  inspiration ; 
wild  expression  of  eyes,  pupils  contracted.  Pulse  variable,  generally  ra])id,  compressible,  and  soft.  No  fever  or  delirium. 
Death  resulted  on  October  6th,  1863.  Necropst':  Right  lung  displaced  ; almost  the  entire  space  of  anterior  part  of  the  thorax 
occupied  by  distended  pericardium  ; left  lobe  of  liver  united  to  omentum  by  a recent  exudation  of  lymph  ; thirty  ounces  of  fluid 
in  right  pleural  cavity,  twenty  ounces  of  pus  in  left.  Right  lung  covered  from  apex  to  base  with  a layer  of  yellowish  lymj)h, 
and  in  many  places  erected  into  trabeculm  uniting  lung  to  pleura  costalis;  lobes  agglutinated  together  and  to  the  diaphragm; 
posterior  portion  of  lung  engorged  with  blood;  left  lung  semi-solidified  and  filled  with  minute  abscesses.  Upper  j>art  of  pleura 
covered  with  layer  of  lymph,  lower  part  thickened  and  discolored  by  pus.  Abscess  in  first  lobe  completely  circumscribing 
.second  lobe;  the  pericardium  contains  thirty  ounces  of  a clear  colored  mahog.any  serum,  and,  together  with  the  heart,  was  covered 
with  a thick  layer  of  yellowish  lymph.  The  liver  was  somewhat  softened.  Acini  somewhat  indistinct.  Spec.  No.  1722,  Sect. 
I,  A.  M.  M.,  shows  a wet  preparation  of  the  sixth,  seventh,  and  eighth  rihs.  The  specimen  shows  firm  ])leuritic  adhesions. 
Specimen  No.  2243  of  the  same  section  shows  a wet  preparation  of  the  heart  and  pericardium.  Both  of  the  serous  sinfaces  are 
shaggy  with  ))rofuse  deposits  of  lymph,  which,  in  the  recent  state  were  pinkish  in  color.  Toward  the  posterior  surface  the  two 
sides  of  the  pericardium  are  united.  Both  specimens  were  contributed,  with  a history  of  the  case,  by  Assistant  Surgeon 
H.  Allen,  U.  S.  A. 

G7 


530 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[ClIAP.  V, 


Wounds  of  the  Heart. — It  is  well  known  that  wounds  of  the  heart  are  no  longer  con- 
sidered, as  in  ancient  times,'-'  absolutely  and  invariably  mortal ; but  we  are  still  ignorant  of 
the  degree  of  injury  the  organ  may  sustain  without  destruction  of  life,  and  can  only  con- 
jecture the  causes  of  delay  in  the  termination  of  some  rare  cases  presenting  lesions  that  are 
generally  instantly  fatal.  The  diagnosis  is  very  obscure.  Hsemorrhage,  syncope,  pain, 
dyspnoea,  proscordial  anxiety,  pallor,  husky  voice,  thready  pulse,  excessive  thirst,  emesis, 
hiccough,  cold  sweats,  palpitation,  a systolic  bellows  murmur  or  other  abnormal  sounds, 
many  or  all  of  these  may  attend  a wound  in  the  cardific  region  without  establishing  more 
than  a presumption  that  the  heart  itself  is  wounded.  A peculiar  friction  sound  has  been 
suggested  as  pathognomonic  of  traumatic  pericarditis;  but  few  surgeons  can  have  occasion 
to  familiarize  the  ear  with  this  semeiological  refinement.  In  the  cases  that  survive  for  any 
length  of  time,  the  prognosis  will,  of  course,  be  very  guarded,  and  the  treatment,  after 
closing  the  wound,  will  be  limited  to  absolute  bodily  rest,  and  the  employment  of  those 
measures  tending  to  moderate  the  heart’s  action,  unless  the  dyspnoea  induced  by  distention 
of  the  pericardial  sac  should  justify  the  withdrawal  of  the  extravasation  by  paracentesis. f 
A perusal  of  the  conflicting  views  of  writers  respecting  the  relative  danger  of  injuries  of 
the  different  cavities  of  the  heart,  and  even  in  regard  to  the  gravity  of  superficial 
wounds,  and  their  frequently  indefinite  descriptions  of  the  remote  structural  changes  ob- 
served, admonish  us  that  further  careful  clinical  and  pathological  observations  are  requisite 
to  elucidate  these  points.  Though  many  of  the  cases  that  appear  on  the  surgical  records 
of  the  war  are  not  of  this  character,  yet  no  apology  need  be  made  for  presenting  all  the 
facts  that  have  been  ascertained  on  this  difficult  and  interesting  subject.  Four  instances  of 
gunshot  wounds  of  the  heart  that  were  not  immediately  fatal  appear  on  the  records.  In 
the  first,  the  patient  survived  for  fourteen  days  a wound  of  the  right  auricle  by  a round 
musket  ball : 


Case. — Private  Jacob  Lanning,  Co.  A,  51st  Pennsylvania  Volunteers,  aged  45  years,  was  wounded  at  South  Mills,  North 
Carolina,  April  18th,  1862 ; the  missile  entered  through  the  lower  jaw,  carried  away  the  symphysis,  passed  down  the  left  side  of 
the  neck,  and  lodged  in  the  thorax.  He  was  taken  prisoner  and  remained  in  the  enemy’s  hands  until  the  24th,  when  he  was 
released  at  Norfolk  and  conveyed  to  Hygeia  Hospital,  Old  Point  Comfort.  The  tongue  was  destroyed  to  a considerable  extent, 
and  that  portion  of  the  jaw  occupied  by  the  incisors  was  comminuted  and  distributed  along  the  course  of  the  ball.  An  incision 
was  made  in  the  lower  part  of  the  neck  to  give  exit  to  the  pus,  and  through  this  opening  the  finger  could  be  passed  down  into 
tbe  chest.  The  case  appearing  hopeless  from  the  first,  little  was  done  except  to  sustain  and  stimulate.  The  patient  persisted  in 
sitting  up  and  would  occasionally  attempt  to  make  up  his  bed  and  walk  about  the  room  when  not  restrained.  He  died  suddenly. 
May  2d,  1862,  fourteen  days  after  the  reception  of  the  injury.  At  the  necropsy,  the  ball  was  found  to  have  descended  over  the 
aorta,  down  the  mediastinum,  penetrated  the  muscular  tissue  of  the  right  auricle,  and  was  suspended  in  the  endocardial  cavity. 
Evidence  of  pleuritis  and  pericarditis  were  apparent  after,  though  not  before,  death.  The  case  is  reported  by  Surgeon  E.  B. 
Bontecou,  U.  S.  V. 


* Hn’POCllATES : Aphorism  XVIII,  Sect.  G;  Celsus  (Lib.  V,  cap.  26) : “Servari  non  potest  cui  cor  percussum  est,’’  and,  farther  on  ; “ Corde 
percusso.  matura  mors  sequitur."  Galen’s  prognosis  is  hardly  less  gloomy  (Z)e  locis affect.,  Lib.  V,  cap.  2) : “ Protinus  liominem  mori  necesse  est,"  and 
"Igitur,  si  ad  ventrem  cordis  vulnus  aliquatido  penetraverit,  protinus  magno  cum  sanguinis  fluore  moriuntur,  id  que  precipue,  si  sinistrie partis  venter 
fuerit  vulneratus.” 

t Several  authors  have  made  collections  of  cases  of  wounds  of  the  heart.  The  latest  and  most  complete  perhaps  is  by  Dr.  GeOEG  FisCHER,  of 
Hannover,  who,  in  an  article  in  von  Langcnbcck’s  Archiv  fur  KUnische  Chirurgie,  15.  IX,  IL  II,  S.  571,  Berlin,  1868,  enumerates  four  hundred  and 
fifty-two  cases,  of  which  forty-four,  with  ten  recoveries,  were  punctured  wounds ; two  hundred  and  sixty,  with  forty-three  recoveries,  were  punctured 
incised  wounds;  seventy -two,  with  twelve  recoveries,  were  gmishot  wounds;  seventy-six,  with  ten  recoveries,  were  contusions  and  traumatic  ruptures. 
M.  J.LSIAIN  (Plaits  du  cceur.  These  de  coucours  pour  I'agregation,  Baris,  1857,  8vo.  p.  100)  has  analyzed  one  hundred  and  twenty-one  eases.  Dr, 
Purple  (New  York  Journal  of  Medicine,  1855,  N.  S.  Vol.  XIV,  No.  Ill,  p.  411),  with  his  Statistical  Observations  of  Wounds  of  the  Heart,  has  compiled 
a table  of  forty-two  authenticated  eases  of  wounds  of  the  heart  that  were  not  immediately  fatal,  twelve  being  injm-ies  from  gunshot.  OLLIVIER  (d’ Angers) 
records  (Diet,  de  Med.,  1834,  T.  VIII)  fifty-four  cases  of  wounds  of  the  heart,  and  SaxsON  (Plaits  du  occur,  Thdsc,  1827,  p.  16)  enumerates  the  more 
important  cases  cited  by  his  predecessors.  Dupuytren  (Leqons  orales,  2™'  fed.)  refers  to  fourteen  cases,  four  of  which  came  under  his  own  ohseivation. 
Fournier  gives  several  examples  in  his  Cas  Pares  (Diet,  de  Sci.  Med.,  T.  IV).  Ciiastanet  (Journal  de  Midecine  Uilitaire,  Baris,  1783,  T.  II,  p.  377) 
has  collected  many  cases  from  Bonetus,  Morgagni,  and  others,  and  recorded  fivm  highly  interesting  observations  of  his  own.  I have  grouped  together 
(Otis,  A Peport  of  Surgical  Cases,  etc.,  1871,  p.  33)  twenty-one  cases  of  wounds  of  the  heart  observed  in  the  Army  of  the  United  States  from  1865  to  1870, 
eighteen  being  gunshot,  ^wo  incised,  and  one  a punctured  wound  from  an  arrow. 


Skct.  II.]  WOUNDS  OF  THE  HEART.  531 

The  next  case  refers  to  a patient  who  lived  an  hour  and  a quarter  after  a perforation 
of  the  right  auricle  and  left  ventricle  by  a conical  pistol  ball : 

CaSk. — Private  Charles  T , 1st  Maryland  Potomac  Home  Brigade,  aged  25  years,  received  a pistol-shot  wound  of 

the  left  side  in  an  affray  with  the  provost  guard  at  Frederick,  Maryland,  February  14th,  1862,  at  about  11  P.  M.  The  jx'rson 

discharging  the  pistol  was  standing  within  a few  feet  of  T , who  had  his  left  side  turned  toward  him.  The  bullet  entered 

just  over  the  fouith  rib,  on  a line  with  the  anterior  fold  of  the  axilla.  The  patient  immediately  became  much  prostrated  and 
speedily  unconscious,  with  much  jactitation  and  labored  respiration,  but  no  ha3mo])tysis  or  emphysema  was  observed.  He  was 
first  seen  about  11.30  p.  M.  On  auscultation  and  percussion  the  action  of  the  heart  w!is  weak  and  tumultuous,  and  the  left  side 
of  the  chest  exhibited  marked  duluess,  indicating  effusion  of  blood  into  tlie  pleural  cavity.  He  died  at  12. 15  a.  M.  The  necropsy, 
twelve  hours  afterward,  revealed  a fracture  of  the  fourth  rib,  a wound  of  the  lower  and  anterior  portion  of  the  upper  lobe  of  the 
left  lung,  which  track  was  found  continuous  with  one  passing  through  the  left  ventricle  of  the  heart  about  its  centre,  and  emerging 
at  tlie  riglit  auricle;  thence  it  passed  through  the  outer  and  upper  portion  of  the  middle  lobe  of  the  right  lung,  and  terminated  by 
a small  puncture  of  the  pleura  costalis  over  the  fifth  rib.  The  bullet  was  found  in  the  right  pleural  cavity,  which,  like  the  left, 
contained  about  fourteen  ounces  of  effused  blood.  The  pericardium  also  contained  about  four  ounces  of  blood.  Surrounding  the 
track  of  the  wound  in  the  pulmonary  tissue,  was  a mass  of  coagulum,  which  explained  the  absence  of  haemoptysis  and  emphysema. 
The  bullet  was  the  ordinary  conical  one  used  in  revolving  pistols.  A w'et  preparation  of  the  heart  is  Spec.  No.  837,  Sect.  I,  A. 
M.  M.,  and  was  contributed,  with  a history  of  the  case,  by  Assistant  Surgeon  K.  F.  Weii-,  U.  S.  A.  Circular  No.  G,  1865,  states 
erroneously  that  the  patient  “survived  twelve  hours.”  He  died  near  twelve,  midnight. 

The  third  is  an  example  of  perforation  of  the  left  auricle  and  left  ventricle  by  a 
pistol  ball.  The  patient  lived  forty-six  hours  after  the  reception  of  the  injury,  although 
the  case  was  complicated  by  wounds  of  the  abdomen  and  axilla : 

Case. — Private  Lewis  Wright,  Co.  C,  4th  Regiment,  Veteran  Reserve  Corps,  aged  28  years,  was  wounded  at  Quincy, 
Illinois,  September  8th,  1864;  he  was  assaulted  by  an  intoxicated  citizen,  who  fired  several  shots  at  him,  three  of  which  took  effect; 
one,  an  inch  above  the  crest  of  the  ilium,  in  the  middle  line  of  the  left  side ; another  through  the  anterior  boundary  of  the  axillary 
space,  and  the  third  on  the  right  side  of  the  back,  about  two  inches  exterior  to  the  inferior  angle  of  the  scapula.  The  patient 
when  brought  to  the  hospital  was  cold  and  almost  pulseless,  though  conscious.  He  complained  of  a general  sense  of  indescribable 
suffering  and  unquenchable  J;hirst ; very  little  hsemorrhage  had  taken  place.  The  situation  of  the  balls  could  not  be  ascertained. 
Anodynes,  diffusible  stimulants,  friction,  and  artificial  heat  were  resorted  to,  but  any  means  to  bring  on  reaction  proved  unavailing. 
The  patient  lived  just  forty-six  hours  after  the  reception  of  the  wounds.  At  the  post  mortem  examination  of  the  body  it  was 
found  that  the  first  ball  had  entered  above  the  crest  of  the  ilium,  passed  directly  into  the  cavity  of  the  abdomen  and  into  the 
intestines.  The  second  simply  passed  through  the  anterior  boundary  of  the  axilla  from  below  upward.  The  third  entered  the 
chest  at  the  point  specified,  fractured  the  posterior  third  of  the  eighth  rib,  entei’ed  the  right  lung  about  its  middle,  passed  through 
it  and  into  the  left  auricle  of  the  heart,  thence  through  the  auriculo-ventricular  opening  to  the  left  ventricle,  making  its  exit  about 
the  middle  of  the  lateral  aspect  of  the  organ,  thence  through  the  pericardium,  and  could  be  traced  no  farther.  The  balls  entering 
the  body  were  small,  which  made  the  track  difficult  to  trace  through  the  different  tissues,  so  much  so  that  with  the  utmost  care 
and  perseverance  no  ball  was  found.  A pint  or  a pint  and  a half  of  blood  was  found  in  the  right  chest.  Acting  Assistant 
Surgeon  J.  T.  Wilson  reports  the  case. 

In  the  fourth  case,  the  testimony  of  the  existence  of  a cicatrix  of  a musket-ball 
wound  of  the  right  auricle,  and  of  softening  and  rupture  of  the  muscular  tissue,  two  and 
a half  years  after  recovery  from  the  injury,  is  very  positive  ; 

Case. — Private  John  Reynolds,  Co.  D,  1st  Michigan  Sharp-shooters,  aged  42  years,  received  a gunshot  wound  of  the  left 
breast  and  shoulder  at  Spottsylvania,  Virginia,  May  12th,  1864.  He  was  conveyed  to  the  field  hospital,  where  simple  dressings 
were  applied  to  the  wound.  On  May  25th,  he  was  transferred  to  the  1st  division  hospital,  Alexandria;  on  February  25th,  1865, 
to  Fairfax  Seminary  Hospital,  Virginia;  on  April  4th,  to  St.  Mary’s  Hospital,  Detroit,  Michigan,  and  on  May  26th  to  Harper 
Hospital,  Detroit,  whence  he  was  discharged  from  service  July  14th,  1865.  He  died  at  Mattawan,  Van  Buren  County,  Michigan, 
November  22d,  1866.  Apost  mortem  examination  was  made  by  Drs.  David  Brown  and  Nathan  M.  Smith.  The  ball  entered  the 
body  between  the  fourth  and  fifth  libs  on  the  left  side,  passed  upward  and  backward  and  emerged  between  the  clavicle  and 
scapula  of  the  same  side,  wounding  in  its  passage  the  anterior  surface  of  the  auricle  of  the  heart,  producing  the  appearance  of  a 
cicatnx  on  said  auricle,  organic  lesion  resulting  therefrom,  and  subsequently  decay  and  rupture  of  the  auricle,  causing  almost 
instantaneous  death.  All  the  vital  organs  except  the  heart  were  healthy. 

Without  the  slightest  disposition  to  impugn  the  accuracy  of  the  conclusions  of  Dr. 
Brown  and  Dr.  Smith  regarding  the  morbid  conditions  observed  at  the  necropsy,  I may 
be  permitted  to  ask  if  the  paucity  of  details  concerning  the  wound  does  not  warrant  a 
certain  skepticism  as  to  the  relation  sought  to  be  established  between  it  and  the  appear- 
ances noted  at  the  autopsy.  It  is  known  that  the  milk  spots  (Tiiaculce  albidce)  of 
Rokitanski  have  been  mistaken  for  cicatrices. 


532 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


That  death  is  apparently  absolutely  instantaneous  after  some  wounds  of  the  heart  is 
generally  conceded,  yet  the  absence  of  all  automatic  muscular  movements  is  uncommon. 
Diemerhroeck  describes  [Anat.  Corp.  hum.,  Lib.  VI,  c.  I)  a man  receiving  a sword  thrust 
in  the  chest,  and  falling  dead  instantly  : Quasi  fuimme  ictus  concidit  moxque  extmctus  est, 
and  in  many  cases  of  military  executions  death  is  pronounced  to  be  instantaneous  ; but 
the  extinction  of  vitality,  resulting  from  the  sudden  gush  of  blood,  rarely  resembles  that 
caused  by  the  lightning  stroke,  the  sideration  of  chloroform,  woorara,  or  prussic  acid,  or  by 
a wound  of  the  medulla  oblongata.  Mr.  Poland  correctly  observes  {loe.  cit.,  p.  608)  that 
“the  popular  notion  of  persons  springing  up  in  the  air,  when  shot  through  the  heart,  is  not 
verified  by  facts.”  There  is  a hurried  exclamation  or  a convulsive  gasping  not  infrequently, 
and  the  phenomena  usually  attendant  on  sudden  syncope  or  collapse,  are,  according  to  Herr 
Fischer’s  statistics,  those  that  commonly  predominate.  The  two  following  abstracts,  the 
first  by  a distinguished  writer  on  military  surgery,  the  second  a tragi-comic  account  of  the 
homicide  of  an  officer  fleeing  from  his  friends,  graphically  depict  sudden  deaths  from  heart 
wounds 

Case. — Private  Edward  Barrett,  Co.  F,  32d  New  York  Volunteers,  was  shot  by  a sentinel  at  Camp  Newton,  Virginia, 
January  30th,  1862.  Medical  Inspector  Frank  H.  Hamilton,  U.  S.  A.,  in  a report  of  the  case  in  the  American  Medical  Times,  Vol. 
VIII,  p.  193,  says;  “Assisted  by  Surgeons  Little,  Brown,  Totten,  and  others,  I made  an  autopsy  on  the  same  day.  The  ball  had 
entered  on  the  left  side  of  his  chest  about  four  inches  below  the  inferior  angle  of  the  scapula,  striking  and  breaking  the  lower 
margin  of  the  eiglith  rib  and  carrying  some  small  fragments  into  the  track  of  the  wound.  The  wound  of  entrance  was  rather 
smaller  than  an  ordinary  musket  ball,  oval,  its  edges  slightly  inverted  and  surrounded  with  a reddened  areola,  caused  by  the 
integument  being  sliglitly  abraded  or  deprived  of  its  cuticle  Ity  the  pressure  of  the  ball  before  it  penetrated  the  tissues.  From 
this  point  the  track  of  the  ball  passed  through  the  free  margin  of  the  upper  lobe  of  the  left  lung,  making  a contused,  but  not 
lacerated,  cylindric.al  channel,  which  channel  was  surrounded  through  its  whole  length  by  an  ecchymosis  of  .about  one  inch  in 
diameter.  The  ball  then  penetrated  both  ventricles  and  the  right  auricle,  and  through  the  upper  Iqbe  of  the  right  lung,  escaping 
in  the  right  axilla.  The  track  through  the  right  lung  presented  the  same  appearance  as  that  through  the  left;  and  the  wound  of 
exit  was  larger  by  one-half  than  the  wound  of  entrance,  somewhat  oval  also,  the  edges  not  everted,  but  looking  discolored,  as  if 
they  were  blackened  by  )iowder.  This  discoloration  was  found  to  be  due  to  a slight  extravasation  of  blood  into  the  tissues  under 
the  skin.  The  heart  was  firmly  contracted  and  contained  no  blood  in  any  of  its  cavities ; but  the  pericardium  contained  about 
eight  ounces,  and  the  two  pleural  cavities  much  more.  The  lungs  were  completely  collapsed.  The  wounds  in  the  several  cavities 
of  the  heart  were  not  in  any  instances  more  than  three  lines  in  diameter,  and  appeared  like  slits,  as  if  made  by  a pointed  instru- 
ment. After  this  man  was  shot,  he  uttered  one  exclamation  and  fell  apparently  dead.” 

Case. — “Lieutenant  Dennis  H.  J , Co.  I,  55th  Massachusetts  Volunteers,  was  accidentally  shot  through  the  heart  by 

a fellow-officer  at  Yellow  Bluff,  Florida,  March  23d,  1834,  while  they  were  attempting  to  escape  from  an  apprehended  attack  by 
the  rebels.  In  the  hand  of  the  latter  officer  was  a Smith  and  Wesson  revolver  cocked,  which  was  discharged  as  they  both  slip])ed 

and  fell  together  at  the  edge  of  the  water  into  which  they  were  trying  to  drag  their  boat.  J instantly  fell  back  into  the 

water,  only  exclaiming  twice  “ save  me!  save  me!”  evidently  under  the  impression  that  the  shot  came  from  the  enemy ; his  face 
also  expressing  rather  terror  at  the  repoi't  than  bodily  pain  from  the  wound.  For  an  instant  he  convulsively  grasped  the  rope, 
but  soon  let  go,  and  with  one  gurgling  respiration  both  heart  and  lungs  appeared  to  have  ceased  to  act  within  half  a minute.  The 
supjiosed  rebels  proving  to  be  a pai'ty  of  engineer  soldiers  from  this  post,  the  non-recognition  having  been  mutual,  the  body  was 
recovered  and  brought  to  the  post  hospital ; no  further  sign  of  life  was  manifested,  except  a sort  of  groan  when  the  body  was 
raised,  about  five  minutes  after  the  accident,  which  may  well  be  supposed  to  have  been  the  result  of  the  sudden  displacement 
of  the  large  quantity  of  fluid  in  the  cavities  rather  than  of  any  conscious  volunt.ary  action.  The  accident  occurred  at  five  o’clock 
P.  M.  Necropsy:  liigor  mortis  slight.  Surface  of  body  very  pale  and  rather  cool.  The  single  external  wound  was  veiy  small 
and  situated  tw’o  inches  below  and  a little  inward  from  the  left  nipple.  There  had  been  no  external  haemorrhage,  but  on  op(>ning 
the  chest  more  than  three  quarts  of  blood  were  found  in  this  cavity  and  that  of  the  pericardium,  the  lung  being  compressed 
against  the  anterior  parietes.  From  its  entrance  between  the  fifth  and  sixth  ribs,  the  ball  had  passed  almost  directly  backward, 
inclining  obliquely  toward  the  middle  line,  perforating  the  pericardium  and  the  heart  near  its  apex,  so  as  to  leave  two  openings 
in  the  pericardium  and  left  ventricle,  and  had  buried  itself,  base  foremost,  in  the  body  of  the  eleventh  dorsal  vertebr.a,  but 
without  entering  the  spinal  canal.  The  wound  of  entrance  of  the  heart  was  one  inch  above  the  apex  of  the  organ  and  close  to 
the  interventricular  septum ; that  of  exit  was  one  inch  and  three-quarters  above  the  apex  and  three-quarters  of  an  inch  from  the 
septum.  The  former  was  small  and  one-fourth  of  an  inch  in  diameter  throughout;  the  latter  was  one-fourth  of  an  inch  in 

* For  (lescri])tions  of  sudden  deaths  from  wounds  of  the  lieart,  consult  IlELWio  ( Observationes  mcdico-physicee,  4to,  Augsburg,  1800,  Ohs.  08)  ; 
PlilOU  (Mimoires  sur  les  plaics pinelraulcs  cU  la  2>oitrine,  in  Mem.  de  I'Acad.  roy.  de  Med.,  Paris,  1833,  T.  II,  p.  420) — an  armorer  falls  dead  without 
uttering  a word,  the  heart  traversed  lengthwise  by  two  pistol  balls;  TiMAlUS  {Casus  nted.  jirax.,  Leipzig,  1077,  Lib.  VI.  Obs.  38),  subitoque  concidens, 
ilUco  mortuus  est;  OLLiviEii  (1.  c.,  p.  240),  three  cases  of  stabs  of  the  left  ventricle ; heart  contracted  and  empty.  It  is  probable  that  the  rapidity  of 
death  is  due  not  to  the  profuse  bleeding,  as  Sexac  (Traite  de  la  structure  du  caeur,  Paris,  1749,  T.  II,  p.  371)  supposed,  but  to  the  obstacle  to  the 
cii-culation  caused  by  distension  of  the  pericardium  as  Morgagxi  (1.  c.,  ep.  07)  explains. 


Sect.  II.] 


WOUNDS  OF  THE  HEABT. 


533 


diameter  at  its  inner  extremity,  but  greatly  increased  in  calil)re  from  within  outward  so  as  to  be  of  a conical  shape,  with  edges 
somewhat  torn.  Tlie  columni®  carnea;  on  the  septinn  were  barely  grazed  in  one  spot,  whence  it  may  he  inferred  that  the  ventricle 
was  dilated  when  struck  by  the  hall.  The  contrast  between  the  two  wounds  suggests  the  idea  that  the  invei-sion  of  the  halt  may 
have  been  caused  by  the  contraction  of  the  po.sterior  w'all  of  the  ventricle  at  the  moment  of  perforation.  Both  the  ventricles  were 
empty.”  Spec.  2039,  Sect.  I,  A.  M.  i\I.,  is  a wet  preparation  of  the  lower  part  of  the  heart;  the  missile  is  attached.  It  was 
contributed,  with  a history  of  the  case,  by  Assistant  Surgeon  Burt  G.  Wilder,  55th  Massachusetts  Volunteers. 

Cardiac  Diseases  resulting  from  Wounds. — A number  of  cases  are  found  on  the  hospital 
records  of  functional  or  organic  diseases  of  the  heart,  confidently  referred  to  the  remote  effects 
of  gunshot  injuries  of  its  envelope  or  the  tissues  in  the  immediate  vicinity.  Some  of  these 
cases  are  carelessly  alluded  to  by  clerks  or  pension  examiners  as  recoveries  after  wounds  of 
the  heart.  The  following  are  examples  of  this  group  of  cases : 

Case. — Sergeant  Herrick  Hodges,  Co.  I,  17th  Michigan  Volunteers,  was  wounded  at  Antietam,  ^Maryland,  September 
17th,  18(32;  the  hall  entered  the  left  chest,  passed  through  the  seventh  rib,  and  lodged  in  the  lung;  he  also  received  a wound 
through  the  calf  of  the  left  leg.  He  was  treated  in  the  field  until  October  3d,  when  he  was  transferred  to  Frederick,  Maryland, 
in  the  hospitals  of  which  place  he  remained  until  January  27th,  1863,  when  he  was  returned  to  duty.  He  was  discharged  from 
service  at  post  hospital,  Detroit,  Michigan,  June  1st,  1863.  Pension  Examiner  H.  O.  Hitchcock  reports,  under  date  of  February 
12th,  1864,  that  the  hall  still  remains  in  the  chest,  causing  great  functional  disturbance  of  the  lieart,  pain,  and  ])rostration. 
Disability  total. 

Case. — -Lieutenant  J.  II.  Allen,  Co.  G,  15th  Virginia  Infantry,  received  a gunshot  wound  of  the  left  lung,  implicating  the 
pericardium,  at  Antietam,  ilaryland,  September  17th,  1862.  He  was  subsequently  retired  from  service  on  account  of  endocarditis, 
resulting  in  structural  change  or  organic  disease  of  the  heart,  which  rendered  him  perfectly  unfit  for  field  service.  Tlie  case  comes 
from  a medical  certificate  for  retirement,  signed  by  the  members  of  a Confedeiate  Examining  Board. 

Case. — Private  Alexander  Smith,  Co.  I,  100th  New  York  Volunteers,  aged  37  years,  is  reiiorted  by  Surgeon  M.  S. 
Kittinger,  100th  New  York  Volunteers,  as  having  been  discharged  from  service  September  9th,  1862,  on  account  of  a gunshot 
wound  through  the  right  lung.  Pension  Examiner  H.  N.  Loomis  reports,  October  19th,  1866 : “ The  hall  entered  about  three 
inches  to  the  left  of  the  spine  and  about  the  same  distance  below  the  apex  of  the  scapula,  passed  between  the  ribs  and  through 
the  left  lung  and  escaped  one  and  a half  inches  below  the  left  nipple.  The  wounds  are  healed  externally.  He  has  constant 
cough,  with  expectoration  of  muco-purulent  matter,  which,  in  the  mornings,  is  mixed  with  blood.  He  has  distinctly  marked 
hypertrophy  of  the  heart.  The  throbbing  of  his  heai't  can  he  seen  across  the  room.  Pulse  92  and  irregular.  He  is  emaciated 
and  weak,  and  has  laborious  breathing,  accompanied  with  pain  and  a distressing  sense  of  suffocation  when  lie  exercises.  The 
cough  and  expectoration  undouhtedlj'  proceed  from  the  unhealed  wound  of  the  lung.  There  is  no  doubt  that  the  disease  of  the 
heart  originates  from  the  passage  of  the  ball  so  nearly  in  contact  as  to  produce  oi'ganic  change,  first  from  the  shock  and  then  from 
subsequent  inflammation.”  Smith  died  August  10th,  1869,  of  “hypertrophy  and  valvular  disease  of  the  heart,  resulting  from  the 
wound.”  His  attending  physician  has  attended  him  for  sixteen  years  and  says-  he  was  a healthy  man.  His  reasons  for  disputing 
the  examiners  statement  are  not  given. 

Case. — Private  Jacob  Bang,  Co.  D,  76th  Pennsylvania  Volunteers,  aged  23  years,  was  wounded  in  the  left  breast  by  a 
conoidal  ball,  at  Petersburg,  Virginia,  July  30th,  1864.  Being  at  once  conveyed  to  the  field  hospital,  simple  dressings  were 
applied  to  the  wound.  On  August  2d,  he  was  transferred  to  the  hospital  at  Fort  Monroe;  on  the  7th,  to  De  Camp  Hospital,  New 
York  Harbor,  and  on  September  13th,  to  Satterlee  Hospital,  Philadelphia,  whence  he  was  returned  to  dutj^  October  19th,  1864. 
On  October  24th,  he  entered  Augur  Hospital,  Virginia,  and  was  discharged  from  service  January  1st,  1865.  Pension  Examiner 
H.  S.  Huber  reports,  February  2d,  1871 : “The  ball  entered  the  chest  one  inch  above  the  nipple,  passed  directly  through  the  left 
lung,  and  emerged  just  below  the  lower  angle  of  the  scapula.  Slight  dulness  on  percussion  and  feeble  respiratory  murmur  in  the 
vicinity  of  the  cicatrix.  Disability  total  and  permanent.”  It  is  added  that  the  heart  was  injured. 

Ca.se. — Private  John  W.  Hopper,  Co.  B,  79th  Indiana  Volunteers,  was  admitted  to  Hospital  No.  1,  Louisville,  Kentucky, 
February  28th,  1863,  with  a gunshot  penetrating  wound  of  the  chest,  received  at  Murfreesboro’,  Tennessee,  December  31st,  1802. 
He  was  discharged  from  service  March  29th,  1833.  Pension  Examiner  Wilson  Lockhart  reports.  May  15th,  1863 ; “ The  ball 
entered  the  posterior  portion  of  the  left  lung  and  lodged  somewhere  in  the  region  of  the  heart,  afl'ecting  its  circulation  in  such  a 
manner  as  to  induce  a general  dropsical  condition.  Pain  and  dulness  at  seat  of  injury.  Disability  total  and  permanent.” 

Formerly  punctured  and  incised  wounds  of  the  lieart  were  met  with  most  frequently,"'' 
but,  at  the  present  day,  injuries  from  fire-arms  are  much  more  common.  Of  twenty  cases 

*The  earlier  recorded  examples  of  temporary  surviTal  of  wounds  of  the  heart  are  mtiinly  instances  of  stahs  by  swords  or  daggers.  l*arc  was  one 
of  the  first  {in  Lib.  Vllf,  c.  32)  to  refute  the  prevalent  doctrine  that  wounds  of  the  heart  were  instantaneously  mortal,  adducing  the  example  he 
saw  at  Thurin,  of  a duellist,  who,  after  receiving  a sword  thrust  in  the  heart  large  enouglt  to  admit  the  finger,  pursued  his  (.ppe-nent,  thrusting  at  lum 
several  times,  for  two  hundred  paces,  and  then  fell  dead.  Among  the  more  interesting  cases  of  wounds  by  the  sword  or  knilc  arc  those  rcconled  by 
I’Eltcv  (SaxsOX,  obs.  19),  where  the  patient  lived  nine  hours  after  the  right  auricle  was  freely  laid  open  ; — by  Lilly  {Zodiactis  vu’.fUco-gaUicus^  ( ienevui, 
Aprilis,  1080,  obs.  X),  whose  patient  lived  five  days  after  a swonl  wound  of  the  riglit  auricle.  Dr.  Hillings  lias  recently  acquired  a copy  of  this  very 
rare  work,  the  first  medical  journal  ever  published,  for  the  Surgeon  (ieneral's  Library.  IJilly's  case  is  cited  in  the  Sejmlchrctnni  of  Ilonctus,  'i'.  Hi. 
ji.  37(),  and  by  Dllivier  (?.  c.,  i>.  2.rJ) ; by  LnilOUGK  (in  his  edition  of  Saviard  s Uacucil  d' obse.rvalions  'dc  Chin/rgic,  1792,  obs.  1 13),  of  a soldier  W’ho 
resumed  his  avocations  on  the  ninth  day  after  receiving  a stab  in  the  right  auricle,  and  died  suddenly  on  the  eleventh  day  at  a cabaret.  Ollivier  reganls 
wounds  of  the  right  ventricle  as  not  imly  the  most  common  but  the  least  promptly  fatal.  For  incised  or  punctured  wounds  of  this  cavity,  see  the  cases 


534 


WOUWDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


observed  in  tlie  Army  in  the  five  years  succeeding  the  war,  eigliteen  were  from  gunshot,  and 
two  from  stabs  by  knives.  One  of  the  latter  furnished  the  Museum  with  a remarkable 
example  of  solution  of  continuity  of  bone  by  incision,  as  well  as  one  of  the  heart  with  a 
gash  in  the  right  auricle. 

The  specimens  of  incised  wound  of  the  heart  referred  to  and  illustrated  by  the  accom- 
panying wood-cuts  (Figs.  244  and  245)  were  taken  from  a man  killed  in  an 
affray  at  Fort  Dodge,  Kansas,  June  2d,  1867.  He  had  inflicted,  with  a large 
sheath-knife,  several  stabs  upon  his  antagonist,  when  the  latter,  seizing  his 
wrist,  turned  the  point  of  the  knife  toward  him,  and 
suddenly  drove  the  blade  with  great  force  into  his  chest, 
the  handle  still  being  grasped  in  his  own  hand.  He  fell 
at  once,  gasping  for  breath,  his  face  deadly  pale,  and 
expired  in  about  eight  minutes.  Assistant  Surgeon 
C.  S.  De  Graw,  U.  S.  A.,  made  an  autopsy  on  the  fol- 
lowing morning.  After  cleanly  dividing  the  sternum, 
the  blade  had  traversed  the  mediastinum  and  freely 
opened  the  right  auricle.  The  cavities  of  the  heart 

. , , Fic:.245. — Siernum, 

were  empty,  the  sac  ot  the  pericardium  and  the  ?i>owing  an  nwique 

i incision  through  gla- 

mediastinum  were  filled  with  blood.^  geeFi.  a^mAi. 


Fig.  244. — Heart,  with  an  in- 
cised wound  of  the  right  auricle. 
Spec.  4870,  Sect.  I,  A.  M.  M. 


The  collection  of  the  Army  Medical  Museum  includes  seven  specimens  of  gunshot 
wounds  of  the  heart, — five  from  pistol  balls'  and  two  from  conoidal  musket  balls,^ — a 
specimen  of  incised  and  one  of  punctured  wound,^and  two  specimens  of  cardiac  disease 
resulting  secondarily  from  gunshot  injury.^ 

The  duration  of  life  after  wound  of  the  heart  is  not  proportionate  to  the  extent  of  the 
wound.® 


of  Panatioli  {latralogismorum  seu  medicinaUum  ohservationes  pentacostx  quinque,  Roma,  1652,  Pent.  V,  obs.  45),  life  prolonged  for  four  days;  and  a 
similar  case  is  reported  by  JOUERT  (Arch.  gen.  de  Mcd.^  1830,  p.  200);  those  of  BARTHOLIN  {Hist.  anat.  et  med.  rar.  Cent.  I,  Hist.  77)  ; Garmann 
{Ephem.  nat.  Cur.,  obs.  114,  p.  228);  BOTKR  (in  Fourcroy’s  Mtdecine  ecclaxree  par  les  set.  phys.,  T.  II,  p.  92),  are  examples  of  incised  wounds  of  the  right 
ventricle,  in  which  the  patients  sinvived  five  days.  DURAndr  reports  (Memoire  sur  Vahus  de  V ensevelissement  des  marts.  Strasbourg,  1780)  a case  in 
which  a patient  suiA'ived  a sword  thrust  of  the  right  ventricle  fifteen  days,  and  N.  MULLER,  according  to  Tulpius  {Ohs.  med.,  Lib.  c.  13),  saw  a similar 
case.  MORANI)  {Opuscules  de  Chirurgie,  Sec.  Partie,  1772,  p.  184)  presented  the  heart  of  a soldier  to  the  Academy  of  Sciences,  in  1835,  exhibiting,  in 
the  right  ventricle,  a sword  cut  which  caused  no  gnive  symptoms  until  the  fourth  day;  the  patient  died  on  the  ninth.  Diemerbroeck’S  {Anat.  Carp, 
Bum.,  L.  VI)  jiatient  walked  sixty  paces  and  lived  ten  days  after  a similar  wound.  Valsalva’s  (in  Morgagni’s  cases.  Opera  Omnia,  T.  II,  Epist.  53, 
art.  4,  Patavii,  1765)  patient,  wounded  in  the  same  manner,  died  on  eighth  day;  AUGE’s  on  the  ninth  (Marrigues,  Bemarques  sxir  lesplaies  du  cceur,  Anc. 
.Tour,  de  Med.,  T.  XLVIII,  p.  244) ; those  of  Rov  (Bonetus,  1.  c.,  T.  Ill,  p.  357)  and  Fantoxi  {Giornale  di-lcttcrale  d' Italia,  T.  XXI,  p.  148),  not  until  the 
twenty-third  day.  Of  sword  wounds  of  the  left  ventricle,  not  immediately  fatal,  COURTIAL  {Kouv.  ohs.  anat.  sur  les  os,  170.5,  p.  138)  cites  a case  in  which 
the  patient  walked  five  hundred  paces  and  lived  five  hours;  Frisi  {II  Filiatro  Sel^ezio,  1834,  p.  37),  one  of  death  on  the  tenth  day;  Faxtoni  (?.  c.,  p.  145), 
one  of  a soldier  who  lived  seventeen  days. 

' See  Circular  No.  3,  S.  G.  O.,  1871,  A Report  of  Surgical  Cases  treated  in  the  Army  of  the  United  States  from  1865  to  1871,  p.  91. 

2 Army  I\Iedical  ^Museum,  Sect.  I,  Spec.  837,  pistol-ball  perforation  of  left  ventricle  and  right  auricle, — suiA'ived  one  hour  and  a quarter;  see 
details  in  text.  No.  2639,  a similar  specimen,  antero-postcrior  perforation  of  left  ventricle  near  septum, — instant  death ; cited  in  text,  also  in  lioston  Med. 
and  Surg.  Jour.,  Vol.  LX  XI,  p.  292.  No.  5688,  laceration  of  right  ventricle  by  a ball  from  a Navy  revolver, — death  instantaneous.  No.  5929,  oblique 
perforation  of  anterior  wall  of  left  ventricle  by  a small  Derringer  ball;  cavity  not  open  {see  Circular  No.  3,  S.  G.  O.,  1871,  p.  33) ; suicide, — lived  twenty- 
seven  minutes.  No.  5949,  pistol-shot  through  right  ventricle, — siUAuved  fifteen  minutes. 

3 Army  IMedic.al  Museum,  Sect.  I,  Spec.  1052,  gunshot  perforation  of  left  ventricle  {Cat.  of  Surg.  Sect.,  p.  453).  No.  5648,  gunshot  laceration  of 
right  ventricle  and  auricle  (Circular  No.  3,  p.  36), — death  instantaneous. 

^Army  IMedical  Museum,  Sect.  I,  Spec.  4870;  cited  in  text.  No.  5958,  stab  near  apex  in  right  ventricle  by  a jack-knife, — ^ran  thirty  yards  and 
sunTved  twelve  minutes. 

® Army  IMedical  I^Iuseum,  Sect.  I,  Spec.  504 ; musket  ball  imbedded  between  innominata  artery  and  descending  cava,  provoking  pericarditis  ( Cat. 
Surg.  Sect.  A.  M.  1\I.,  p.  453).  This  is  the  case  referred  to  in  connection  with  wounds  of  the  innominata  on  p.  520.  Further  than  that  it  was  presented 
by  Siirgeon  D.  W.  Bliss,  IJ.  S.  V.,  and  that  it  was  removed  from  a patient  who  died  in  1862  in  Armory  Square  Hospital,  with  a gunshot  wound  of  the 
chest,  no  information  concerning  the  specimen  or  the  clinical  facts  connected  with  it  can  be  obtained.  No.  2243,  shaggy  deposits  of  lymph  upon  heart  and 
pericardium  following  gunshot  wound  {Ibid.,  p.  454). 

®This  was  illustiatcd  in  Dr.  Carvallo’s  patient  {Spec.  5929,  mentioned  in  foot-note  2),  also  by  the  well-known  case  of  Tour  d’ Auvergne,  first  gren- 
adier.of  France,  who  died  immediately  from  a superficial  lance  w’ound  of  the  anterior  wall  of  the  left  ventricle,  received  at  Neustadt,  July,  1798.  Also 
by  the  case  of  the  Sardinian  prince,  whose  wife  thrust  a gold  needle  into  his  right  ventricle,  causing  instant  death.  (SUE,  Aj^er^u  general  de  la  mid.  leg. 
In  Recueil  period,  de  la  Soc.  de  Med.  de  Paris,  T.  VHI,  p.  31,  and  the  case  of  the  Due  de  Berri,  recorded  and  treated  by  Dupuytren.  I have  not  space  to 
treat  of  the  effect  of  the  direction  of  tlie  wound  on  the  duration  of  life,  or  the  relative  frequency  of  wounds  of  the  several  cavities,  or  lodgment  of  foreign 
bodies  in  Uie  heart,  or  of  rupture  of  that  organ. 


Sect.  II.] 


WOUNDS  OF  THE  MEDIASTINUM. 


535 


Shot  Wounds  of  the  Mediastinuni.—lt  is  certain  that  even  large  foreign  bodies  may 
penetrate  or  pass  through  the  mediastina,  without  injuring  either  lung  or  implicating  any 
of  the  important  organs  contained  in  the  mediastinal  spaces.  An  interesting  instance  has 
been  adduced  (p.  486),  and  illustrated  by  Plate  X,  where  the  anterior  mediastinum  was 
very  freely  opened  by  a canister  shot,  and  its  contents  exposed  to  view  without  sustaining 
serious  injury,  and  the  patient  rapidly  recovered,  and  now,  after  ten  years,  maintains  a 
cheerfulness  of  temper  as  admirable  as  the  fortitude  with  which  he  bore  the  suffering  at 
first  attendant  on  his  wound.  Other  less  surprising  examples  are  noticed  among  the  gun- 
shot fractures  of  - the  sternum.  The  following  is  an  additional  case  : 

Case. — Sergeant  Janies  G.  Powers,  Co.  C,  57th  Massacliusetts  Volunteers,  was  wounded  at  Petersburg,  Virginia,  July 
30th,  1864,  by  a conoidal  ball,  which  fractured  the  fifth  and  sixth  ribs,  and  carried  away  a portion  of  the  sternum.  He  also 
received  a fracture  of  the  middle  third  of  the  humerus.  He  was  carried  to  the  field  hospital  of  the  1st  division,  Ninth  Corps, 
where  Surgeon  W.  V.  White,  57th  Massachusetts  Volunteers,  administered  chlorofoim  and  ether  and  amputated  the  left  arm  at 
the  junction  of  the  middle  and  upper  thirds  by  circular  operation.  He  died  August  IGth,  1864.  This  case  is  supposed  to  be 
the  one  alluded  to  by  Assistant  Surgeon  George  M.  McGill,  U.  S.  A.,  medical  inspector,  in  a letter  to  Surgeon  T.  A.  MeParlin, 
U.  S.  A.  (then  medical  director  of  the  Army  of  the  Potomac),  dated  August  13th,  1864,  in  which  he  says : “Among  the  surgical 
cases  there  is  one  in  hospital  now  of  capital  interest.  The  meso-sternum  has  been  broken  in  two  by  a ball  which  lacerated  the 
soft  parts  over  it.  The  broken  pieces  of  bone  have  been  removed ; the  soft  parts  are  gone  (by  sloughing  and  retraction  after 
incision),  so  that  an  observer  looks  upon  the  heart  invested  with  pericardium,  and  distinguishes  plainly  the  diastole  and  systole 
of  the  auricles;  at  the  same  time  the  apex  impulse  can  be  felt.  The  wound  is  a human  vivisection.”  The  identification  of  this 
case  was  correct.  Surgeon  Horace  Ludington,  100th  Pennsylvania,  contributed,  May  31st,  1875,  a full  account  of  the  case,  which 
will  be  published  in  the  Third  Surgical  Volume.  It  is  accompanied  by  a very  interesting  specimen.  No.  6528,  A.  M.  M. 

Abscess  and  sloughing  of  the  loose  areolar  tissue  which  fill  its  interstices,  attend  some 
of  the  wounds  penetrating  the  mediastinum  : 

Case. — Private  William  Eobertson,  Co.  H,  71st  Pennsylvania  Volunteers,  aged  21  years,  received  at  Antietam,  Maryland, 
September  17th,  1862,  a gunshot  wound  in  the  anterior  mediastinum.  He  was  admitted  to  Master  Street  Hospital,  Philadelphia, 
on  September  29th.  The  treatment  consisted  of  nutritious  diet  and  opiates  at  first;  but,  in  November,  the  pain  in  the  muscles 
became  severe;  yet  yielded  almost  entirely  to  the  use  of  expectorants  ; ulceration  of  the  skin  and  sloughing  of  the  cellular  tissue 
finally  complicated  the  case,  and  the  patient  died  from  exhaustion  on  November  ,17th,  1862.  The  case  is  reported  by  Surgeon 
Paul  B.  Goddard,  U.  S.  V. 

Wounds  of  the  Thoracic  Duct. — Xo  instance  is  found  in  the  surgical  records  of  the 
war,  of  a wound  of  the  thoracic  duct,  verified  by  autopsy,  nor  was  there  any  example 
among  the  injuries  of  the  chest  of  a case  presenting  symptoms  that  aroused  the  suspicion 
that  this  rare  lesion*  might  be  the  main  feature  of  the  complications.  Dr.  Fraser  observes 
[ep.  cit.,  p.  101)  that  in  the  British  army  in  the  Crimea,  “ certain  cases,  where  neither  the 
lungs  nor  large  vessels  were  wounded,  but  rapid  and  fatal  sinking  occurred,  may  be 
explained  by  the  supposition  that  the  thoracic  duct  had  been  injured.”  But  the  surgical 
historians  of  the  Crimean  war,  Matthew  and  M.  Chenu,  do  not  specify  such  cases. 

Wounds  of  the  (Esophagus. — Wounds  of  the  cervical  portion  of  this  canal  have 
been  considered  on  p.  408.  They  are  usually  associated  with  wounds  of  the  windpipe. 

* “ Tenement  rarcs,”  says  M.  LKGOUEST  {op.  cit.,  6d.  p.  330),  “ qu'on  n‘en  possede  pasd'exemple  authentique : il  est  juste  dcrccunnaitrc  qu'clles 
peuvent  passer  inaperejues,  au  milieu  du  d^sordre  des  parties  voisines  qui  doit  necessairement  les  accompagner.”  IIennen  {op,  cit.,  3d  ed.  p.  404) 
remarks : “ Of  lesions  of  the  Thoracic  Duct,  I shall  not  insult  m}’’  readers  by  treating ; the  uncomplicated  injury^  is  barely  possible ; but  ai*t  can  do 
nothing  toward  its  cure.”  I cannot  conceive  that  it  is  disrespectful  to  the  reader  to  advert  to  the  sources  of  our  limited  information  on  the  subject ; but 
there  may  be  some  obscure  reason,  since  Larrey  and  Guthrie  and  Baudens  passed  it  over  in  silence.  I’rofessor  S.  D.  GnOSS  {op.  cit.,  Vol  II,  p.  450)  tells 
us  that  Blumenbach  refers  to  an  instance.  I cannot  find  the  reference  in  J.  BitiKDnicn  Bi.UMEN'BACII's  Medicinische  Bihliothek,  Gottingen,  1783,  in 
which  the  author  confines  himself  to  anatomical  details  obseiv'ed  by  >Subaticr,  llewson,  and  l^ccquct.  BONEIUS,  hotvever  {Sepulchretuin,  Vol.  Ill,  p. 
360),  cites  from  Bartholinus  several  examples  of  wounds  of  the  chylifei’ous  duct,  characterized  by  the  escape  of  a copious  white  liquid,  copiosus  albicans 
humor.  ClIELIUS  {op.  cit.,  Vol.  I,  p.  501)  remarks  that  injuries  of  the  thoracic  duct  may  be  connected  with  penetrating  wounds  of  the  chest ; but  “ as 
in  these  cases  there  must  always  bo  injury  of  the  most  highly  important  parts,  the  mortal  result  is  usually  not  to  be  prevented.”  DEMME  mentions 
{Studien,  18G4,  p.  114)  that  in  the  Italian  War  of  1850  he  could  learn  of  no  instance  of  wound  of  the  lymphatic  duct.  Buesciiet,  in  his  article  Dcchire- 
ments,  in  the  Dictionary  in  GO  volumes,  T.  VIll,  p.  140,  has  collected  from  Morgagni  {op.  cit.,  cpis.  XVI,  § 7),  Soemmering  (De  morh.  vasorum  absorbent 
tium  corp.  hum.  p.  52),  Willis  {Pharm.  ration.),  Lossius,  Monro,  Licutand,  and  others,  many  instances  of  spontaneous  laceration  of  the  tlioracic  duct,  but 
regards  the  case  recorded  by  Guiffart  as  alone  well  authenticated.  All  the  authors  refer  to  the  extravasation  of  a lactescent  liquid  in  tire  cavities  of 
the  chest  and  abdomen  as  the  principal  sign  of  this  lesion,  and  generally  pronounce  it  speedily  mortal,  great  emaciation  super\'cning.  if  death  is  delayed. 


536 


WOUNDS  AND  INJURIES  OF  THE  CHEST, 


[Chap.  V, 


Wounds  of  tlie  thoracic  portion  must  he  very  rare,  as  only  a solitary  instance  appears 
on  the  reports  of  the  war  : 

Case. — Privute  Jolin  Henry  Jones,  Co.  E,  15tli  New  Jersey  Volunteers,  was  wounded  at  Spottsylvania,  May  10th,  18C4, 
by  a colloidal  hall,  which  entered  the  right  arm  posteriorly,  passed  forward  and  upward,  comminuting  and  carrying  away  one 
and  a half  inches  of  the  spine  of  the  scapula,  passed  under  the  clavicle,  opening  the  thoracic  cavity  behind  the  carotid  vessels, 
fracturing  the  transverse  processes  of  fourth  and  fifth  cervical  vertebra;,  and  lodged  against  the  oesophagus.  He  was  admitted 
to  Lincoln  Hospital,  at  Washington,  on  May  16th,  and  died  May  20th,  1864.  Post  mortem  examination  revealed  the  course  of 
the  ball  as  described.  The  apex  of  the  right  lung  was  covered  with  lymph  ; there  was  ecchymosed  blood  in  the  walls  of  the 
chest,  and  fluid  blood  in  its  cavities.  The  walls  of  the  gullet  were  lacerated  but  not  perforated ; the  spinal  cord  was  congested, 
but  no  clot  found  in  the  canal ; the  kidneys  and  liver  were  congested  and  the  gall  bladder  was  distended.  The  case  is  reported 
by  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A. 

In  this  case,  no  symptoms  peculiar  to  the  wound  of  the  oesophagus  are  recorded. 
Boyer  [1.  c.,  T.  V,  p.  606)  gives  a full  account  of  these  injuries,  with  an  interesting  case 
of  recovery  after  bayonet  wound. 

Wounds  of  the  Nerves. — Baudens,  whose  practical  observations  it  is  always  a pleasure 
to  consult,  declares  that  wounds  of  the  phrenic  nerve  are  not  very  rare,^  and  that  they  are 
indicated  by  pain  in  the  diajjhragm,  by  gastralgia,  and  generally  by  vomiting.  These 
symptoms  commonly  subside  in  ten  days  or  a fortnight,  but  are  reechoed  by  more  persist- 
ent pains  in  the  shoulder  and  arm,  sometimes  associated  with  paralysis,  of  which  Baudens 
cites  a good  instance.  Baudens  also  gives  a good  case  of  a gunshot  wound  lacerating  the 
oesophagus  and  eighth  pair  of  nerves,  which  proved  fatal  in  twelve  hours.  The  stomach 
was  half  filled  with  undigested  food.  There  was  no  extravasation  except  of  blood,  for 
there  had  been  no  vomiting  and  no  ingestion  of  food  or  drink.  This  observation  corrobo- 
rates the  physiological  views  which  ascribe  to  the  division  of  the  eighth  pair  low  down  the 
arrest  of  gastric  secretion  and  of  thirst  and  vomiting,  the  communication  between  the  brain 
and  viscera  being  destroyed.  I have  been  unable  to  find  in  the  records  any  cases  that 
throw  light  on  the  effects  of  injuries  of  large  nerves  within  the  thorax.  A priori,  it  may 
be  inferred  that  various  derangements  in  the  functions  of  haematosis,  digestion  and  respira- 
tion would  be  observed  ; but  the  complicated  nature  of  these  injuries  appears  to  forbid  any 
precise  analysis.  Dr.  S.  W.  Mitchell,  in  a recent  instructive  monograph,^  narrates  the 
case  of  Private  Warner,  18th  Pennsylvania  Volunteers,  who  received  a gunshot  injury  to 
the  anterior  thoracic  nerve  probably,  causing  paralysis  of  the  great  pectoral  muscle,  and 
extension  of  disease  to  the  brachial  plexus.  I find  no  special  case  of  wound  of  the  par 
vagum  or  other  thoracic  nerve  noted  in  the  returns. 

MAunds  of  the  Diaphragm.— The  records  contain  references  to  one  hundred  and 
twenty  cases  of  wounds  of  the  diaphragm  that  came  under  treatment.  Some  of  them  have 
been  described^  with  the  wounds  of  the  thoracic  viscera  with  which  they  were  associated, 
and  others  will  come  under  notice  with  wounds  of  the  abdominal  viscera.  Hence,  it 
will  be  more  convenient  to  continue  this  subject  further  on,  where  it  will  be  abundantly 
shown  that  wounds  of  the  diaphragm,  though  not  invariably  mortal,  as  the  ancients  be- 
lieved, rarely  heal,  and  leave  always  a liability  to  hernial  protrusion.^ 

‘Baudens,  Clinique  des plates  d'armes  d feu^  Paris,  1836,  p.  249. 

^Mitchell,  S.  W.,  Injuries  of  the  Nerves  and  their  Consequences,  Philadelphia,  1872,  p.  212. 

® See  ante,  cases  of  PEiiuiN,  p.  514,  Stolpk,  p.  515,  Bowman,  p.  .516,  Sheridan,  p.  516.  These  four  are  examples  of  diaphragroatic  hernia.  For 
bayonet  wound  of  the  diaphragm,  see  case  of  IlAY,  p.  467.  For  examples  of  recovery  after  gunshot  wounds  of  the  diaidiragm,  see  cases  of  Iloric,  p.  480, 
Collins,  p.  491.  See  also  ease  of  Ackerman,  p.  528. 

^ Consult,  on  this  subject,  OUTIIRIE  ( Commentaries,  1.  c.,  p.  499),  BAUDENS  {1.  c.,  p,  301),  Friderict,  Dc  diaphr.  ex  vulnere  lucso,  Diss.  Jenao,  1671  j 
Schenk,  Dc  diajthragmatis  nat.  et  morhis,  Diss.  Jenae,  1671 ; Nelaton,  ^Icm.  depath,  chirurgicale,  T.  HI,  p.  463;  LEGOUEST  (/.  c.,  p.  363) ; ETIMUL* 
LEU,  Diss.  de  vulnerihus  diaphragmatis,  Lipsiae,  1730;  PERCY,  Diet,  de  Sci.  Med.,  T.  IX,  p.  214 ; CLOQUET,  Diet,  de  Med.,  T.  X,  p.  259 ; Devergie,, 
Medicine  legale,  S™*  6d.,  1852,  T.  II,  p.  35;  Desault,  Jour,  de  Chir.,  T.  Ill,  p.  9 ; Mertens,  Vulnus  pectoris  complic.  cum  vulnere  diaphragmatis 
Strassburg,  1758  ; CavaliER,  Observations  sur  qnelques  lesions  da  diaphragm,  These  dc  Paris,  No.  362. 


Sect.  III.] 


OPEEATIONS. 


537 


Section  III. 


OPERATIONS  ON  THE  CHEST. 


The  ligations  of  the  great  arterial  trunks  and  of  some  of  their  branches,  the  excisions 
of  portions  of  the  bony  case,  the  extractions  of  splinters,  missiles,  and  other  foreign  bodies, 
and  the  cases  of  thoracentesis  will  be  considered  in  this  section. 

Ligations. — The  cases  in  which  it  was  found  necessary,  during  the  war,  to  apply 
ligatures  to  arteries  of  the  chest,  were  sufficiently  numerous,  especially  when  viewed  in 
connection  with  the  examples  of  wounds  of  those  vessels  recorded  in  the  preceding  section, 
to  constitute  a valuable  contribution  to  our  information  on  this  branch  of  surgery.  No 
example  of  ligation  of  the  primary  carotid  within  the  chest,  for  wound  or  aneurism, 
appears  on  the  returns,  and  in  the  few  cases  of  lesion  of  the  innominata  that  came  under 
treatment,  it  was  not  deemed  feasible  to  place  double  ligatures  on  the  vessel. 

Ligations  of  the  Innominata. — In  the  seventeen  cases  ^ in  which  this  vessel  has  been 
tied,  the  operation  was  performed  for  traumatic  cause  in  only  a single  instance, — when 
Hutin,  after  tying  the  subclavian,  after  Anel’s  method,  for  punctured  wound  of  the  axillary, 
on  the  appearance  of  intermediary  haemorrhage,  placed  a ligature  on  the  brachio-cephalic. 
The  patient  survived  the  operation  twelve  hours.  Success  could  not  have  been  reasonably 
anticipated,  as  the  conduct  of  the  case  was  wrong  in  principle.  In  the  solitary  success  among 
the  operations  for  aneurism,  the  carotid  and  the  vertebral  were  also  tied,  and  recurrent 
haemorrhage  was  controlled.  In  cases  of  punctured  or  gunshot  wounds  of  the  distal  portion 
of  the  innominata,  in  which  the  bleeding  has  been  temporarily  controlled  by  compression, — 
such  cases  are  recorded  on  page  520  and  one  in  Dr.  Blackman’s  practice,  in  which  bleeding 
from  a small  puncture  was  restrained  by  digital  compression  for  nearly  a week, — I conceive 
that  the  correct  operation  theoretically  would  be  to  place  a ligature  around  the  middle  of 
the  brachio-cephalic,  to  tie  the  carotid  and  subclavian  as  near  the  bifurcation  as  practica- 
ble, and  then  to  amputate  the  arm  at  the  shoulder.  In  view  of  the  discouraging  statistics 
of  ligations  of  the  innominata  for  disease,  such  a proposal  may  be  regarded  as  preposterous, 
but  it  must  be  remembered  that  we  have  experience  of  only  one  ligation  of  the  innominata 
for  traumatic  cause,  and  that  performed  under  hopeless  circumstance;^  that  Mott  and  his 
successors,  who  failed  in  their  operations  on  the  brachio-cephalic,  were  not  shaken  in  their 
convictions  that  the  measure  would  ultimately  be  established  as  a means  of  preserving 

^The  operators,  dates  of  operation,  and  duration  of  sui^Tval  were : l^Iott,  in  1818,  26  days;  Graefe,  in  1822,  67  days  ; Norman,  in  1824,  GO  hours ; 
Arendt,  in  1330,  8 days ; Bland,  in  1832,  8 days ; Hall,  in  1833,  3 days , Dupnytren’s  Parisian  colleague,  in  1834,  — days ; Lizars,  in  1837,  21  days ; Hutin, 
in  1842,  12  hours;  Cooper,  in  1859,  9 days;  Cooper,  in  1860,  34  days;  Pirogoff,  about  the  same  time  [Grundzuye  (hr  AUgemeinen  Krieyschiruryie, 
Leipzig,  1864,  p.  459],  24  hours;  Gore,  in  18(1-,  17  days;  Smyth,  in  1864,  recovery.  In  four  cases  the  artery  was  exposed  but  not  ligated  because  of  the 
diseased  condition  of  its  coats,  namely;  by  Porter,  in  1831  (Dublin  Jour.,  1832,  Vol.);  by  Key,  in  1832,  deatli  on  the  23d  day  (ClilSP,  On  Diseases  of 
the  Blood-vessels,  p.  206);  by  A.  Post,  and  by  Hoffman.  TIic  brachio-cephalic  artery  is  said  to  have  been  tied  twice  by  Bujalsky  (Tahuhe  anatomico- 
chirurgicse  ligandarum  arteriarum  majorum  erponentes,  St.  Petersburg,  Elephant  Folio,  32  pp.  14  pi.)  I cannot  refer  to  the  magnificent  work  of  the 
latter  in  which  the  cases  are  said  to  be  recorded.  Its  companion,  Operationes  lithotomiie  exponentes,  is  in  the  Office  libraiy'. 

presume  no  one  will  question,  at  this  date,  that  Hutin  should  have  attempted  to  place  doable  ligatures  at  the  scat  of  puncture  in  the  axillary^ 
and,  failing  in  this,  to  have  amputated  the  arm. 

(J8 


538 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Cmvp.  V, 


life,  and  that  the  solitary  success  achieved  by  Smyth  was  attained  by  the  removal  of  the 
sources  of  recurrent  hoemorrhage.  The  operation  suggested  would  not  be  more  formidable, 
so  far  as  the  apprehension  of  shock  is  concerned,  than  the  ablation  of  the  arm  with  the 
scapula,  or  with  the  clavicle,  operations  that  have  been  successfully  accomplished  for  tumors 
of  those  bones.  In  a lean  patient,  if  the  bleeding  could  be  staunched  long  enough  to  pass 
a ligature  about  the  brachio-cephalic,  the  remaining  steps  of  the  operation  would  present 
no  very  serious  difficulties.  As,  in  a wound  of  the  distal  portion  of  the  innominata,  the 
probability  that  the  application  of  a single  ligature  near  the  cardiac  extremity  would  be 
futile  amounts  almost  to  a certainty,  I believe  that  the  measure  suggested  offers  the  sole 
forlorn  alternative  from  the  otherwise  inevitable  doom. 

Ligations  of  the  Subclavian. — There  were  five  recoveries  among  the  twenty-five 
ligations  of  the  subclavian.  These  five  cases  will  be  reported  in  the  order  of  the  length  of 
interval  between  the  dates  of  injury  and  of  the  ligation.  The  operations  were  performed 
on  account  of  primary  hsemorrhage  in  one  instance,  twice  for  intermediary  haemorrhage 
from  the  axillary  or  one  of  its  principal  branches,  once  for  false  diffused  aneurism  and  once 
for  false  consecutive  aneurism.  Three  of  the  operations  were  on  the  left  and  two  on  the 
right  side.  Partial  paralysis  of  the  corresponding  arm  remained  in  three  cases.  In  all  five, 
the  vessel  was  tied  above  the  clavicle,  near  the  acromial  margin  of  the  anterior  scalenus. 
The  patients  were  from  twenty  to  twenty-eight  years  of  age : 

Case  1. — Corj)oral  G.  M.  Caughtian,  Co.  K,  13th  South  Carolina  Regiment,  aged  25  years,  was  wounded  July  3d,  1863, 
the  hall  passing  through  the  upper  part  of  the  chest,  wounding  the  lung  and  the  subclavian  artery  where  it  passes  between  the 
clavicle  and  the  first  rib.  The  subclavian  was  ligated  on  the  inner  side  of  the  clavicle.  The  oper.ation  was  successful;  the 
patient  was  furloughed,  with  the  wounds  entirely  healed,  but  with  the  left  arm  paralyzed,  one  of  the  nerves  of  the  brachial 
plexus  having  probably  been  included  in  the  ligature.  The  case  is  reported  by  Surgeon  H.  L.  Thomas,  P.  A.  C.  S.' 

Case  2. — Corporal  D.avis  J.  Palmer,  Co.  C,  8th  Iowa  Volunteers,  aged  20  years,  received  a gunshot  wound  of  left  axilla 
at  Shiloh,  Tennessee,  April  7th,  1882,  the  ball  entering  two  inches  below  the  clavicle,  traversing  pectoralis  major  muscle  and 
lodging  near  scapula,  after  wounding  the  axillary  artery ; hemorrhage  occurred  on  April  8th.  He  was  admitted  to  Floating 
Hospital  Empress,  on  April  14th,  and  on  the  same  d.ay  a tumor  three  inches  in  diameter,  pulsating  with  an  aneurismal  thrill, 
bleeding  when  pressure  on  subclavian  was  removed,  was  ligated.  An  incision  from  the  clavicular  origin  of  the  sterno-cleido- 
mastoid  to  near  the  border  of  the  trapezius  was  made,  the  border  of  the  scalenus  anticus  was  found,  and  the  left  subclavian  w'as 
ligated,  with  the  gre.ater  portion  of  its  sheath,  chloroform  having  been  administered.  The  condition  of  patient  at  time  of  operation 
was  anaemic.  Bottles  of  hot  water  were  applied  to  relie.ve  the  excessive  numbness  of  the  left  arm,  and  nourishing  diet  was  given. 
He  w'as  transferred  to  general  hospital  at  Kex)kuk,  Iowa,  April  20th,  1882.  The  ligature  came  away  on  May  20th,  thirty-six  days 
after  the  operation,  and  he  was  furloughed  on  M.ay  29th,  1882.  He  was  discharged  the  service  on  September  6th,  1862.  He  was, 
on  June  16th,  1863,  mustered  in  as  captain,  Co.  A,  25th  Iowa  Volunteers,  and  mustered  out  as  lieutenant-colonel  on  June  6th, 
1865.  The  case  is  reported  by  the  operator.  Surgeon  Thomas  F.  Azpell,  U.  S.  V.  Examining  Surgeon  William  McClelland, 
Washington,  Iow.a,  reports,  M<ay  21st,  1867  : “ Ball  entered  near  collar  bone,  and  was  afterwards  cut  nut  at  the  lower  edge  of 
the  shoulder  blade.  The  muscles  of  the  shoulder  .and  arm  are  greatly  absorbed,  and,  in  consequence,  the  arm  is  very  w’eak.  He 
is  one-half  incapacitated  from  performing  m.anu.al  labor.  Disability  one-half  and  temporary.  Still  a pensioner  in  1872. 

Case  3. — Private  John  T.  Endij,  Co.  F,  5th  North  Carolina  Regiment,  aged  23  years,  was  wounded  July  2d,  1863;  the 
ball  entered  one  and  a half  inches  below  the  left  scapula,  ranged  forward,  and  lodged.  There  was  great  tumefaction  and  effusion 
about  the  shoulder,  while  the  wound  under  the  deltoid  region  was  filled  with  clots  of  blood.  Haemorrhage  supervened  on 
the  morning  of  the  16th,  but  was  controlled  by  pressure  and  styptics ; it  occurred  .again  the  evening  of  the  same  d.ay  and  was 
controlled  in  like  manner.  On  the  morning  of  the  17th,  veiy"  profuse  haemorrhage  took  place,  which  could  only  be  controlled  by 
pressure  over  the  subclavian  artery.  An  exploration  of  the  wound  failed  to  discover  the  bleeding  vessel,  and  it  was  determined 
to  ligate  the  subclavian  in  its  third  division.  The  operation  was  ))erfonned  without  any  untow.ard  accident,  but,  while  the 
haemorrhage  was  lessened,  the  flow  of  blood  could  not  be  entirely  arrested  in  the  wound,  even  with  the  assistance  of  styptics  ; 
it  was,  therefore,  decided  to  ligate  also  the  supra-scapular  .artery,  which  had  been  e.xposed  in  the  operation  ; this  being  done  the 
hmmorrhage  immediately  ceased.  The  patient  was  put  to  bed  with  the  arm  warmly  wadded,  and  at  night  there  was  sufficient 
temperature  in  the  parts  below  the  seat  of  ligature.  The  ligature  from  the  supra-scapular  came  aw.ay  on  the  tenth  day  and  that 
from  the  subclavian  on  the  thirteenth  day.  The  patient  got  well  without  any  bad  symptom,  and  was  furloughed  August  31st, 
1863.  The  ball  was  not  discovered.  Surgeon  H.  L.  Thomas,  P.  A.  C.  S.,  reports  the  case.'^ 


* Tlioius,  II.  L.,  Co-nf (.derate.  Slates  Medical  and  Surgical  Journal,  Vol.  I,  p.  185. 
'‘Ibid.,  p.  183.  It  would  be  of  interest  to  have  the  names  of  the  operators. 


Sect.  III.] 


LIGATIONS  OF  THE  SUBCLAVIAN. 


539 


Case  4. — Private  Charles  Wiggins,  Co.  G,  9tli  New  York  Heavy  Artillery,  aged  21  years,  ^vas  wounded  at  Petersburg, 
March  25th,  1855,  by  a mini6  ball,  which  entered  one  and  a half  inches  below  the  clavicle,  and  emerged  near  the  upper  third  of 
the  axillary  border  of  the  scapula.  He  was  admitted  to  Finley  Hospital,  at  Washington,  March  29th.  Intermediary  hsemorrhage 
from  the  axillary  occurred;  and,  on  May  7th,  the  outer  third  of  the  right  subclavian  artery  was  ligated.  lie  progressed  favorably, 
and  was  discharged  from  service  on  August  3d,  1865.  The  case  is  reported  by  Surgeon  G.  L.  Pancoast,  U.  S.  V.  Pension 
Examining  Surgeon  ^M.  D.  Benedict  reports,  August  2d,  1865 : musket  ball  through  right  shoulder  and  axilla,  resulting  in  partial 
paralysis  of  corresponding  arm  and  hand ; limb  is  entirely  disabled  at  present;  will  probably  improve.  Disability  total.  Duration 
two  years.”  In  1872,  this  pensioner’s  name  was  still  borne  on  the  rolls. 

Case  5. — Sergeant  James  Hickey,  Co.  M,  1st  New  York  Veteran  Cavalry,  aged  28  years,  w'as  wounded  at  Piedmont, 
Virginia,  J une  5th,  1864.  Ball  entered  an  inch  below  the  centre  of  the  right  clavicle  and  passed  directly  through.  On  September 
17th,  he  was  admitted  to  Camp  Parole  Hospital,  Annapolis,  Maryland.  There  was  aneurism  of  the  axillary,  subclavicular  portion ; 
bruit  distinct;  rough  feeling  to  the  touch.  On  September  19th,  ligation  of  subclavian  artery  in  its  third  portion  was  performed; 
chloroform  and  ether  were  administered;  the  condition  of  the  patient  was  very  good.  On  October  5th,  the  wound  had  nearly 
healed;  the  ligature  had  not  come  away;  the  arm  and  hand  were  cooler  than  natural;  the  aneurism  was  as  distinct  as  before  the 
operation ; no  pulse  could  be  detected  in  the  brachial,  radial,  or  ulnar.  He  was  transferred  to  Rulison  Hospital,  February  19th, 
1865,  whence  he  w'as  discharged  from  service  on  May  30th,  1865.  The  case  is  reported  by  the  operator.  Surgeon  F.  H.  Gross, 
U.  S.  V.  Pension  Examiner  T.  B.  Reed,  of  Philadelphia,  May  21st,  1867,  reports:  “No  use  or  power  of  right  arm.  Circulation 
very  feeble,  and  atrophied  muscular  condition.  Man  is  disabled  from  all  labor  by  the  aneurism  alone.  General  health  impaired. 
Is  liable  to  rupture  and  death  by  any  exertion.”  In  1872,  this  pensioner’s  name  was  still  on  the  rolls. 

Ligations  of  the  subclavian  in  its  third  portion,  for  wounds  of  the  axillary  or  the 
extreme  distal  portion  of  the  subclavian,  or  for  injuries  of  the  vessels  resulting  in  ulceration 
or  gangrene  and  intermediary  or  secondary  haemorrhage,  such  ligations,  as  applications  of 
the  methods  of  Hunter  or  Anel  (for  the  vessel  was  often  tied  very  near  the  bleeding  point) 
to  wounded  arteries,  were  quite  often  and  very  unsuccessfully  employed.  In  the  five 
following  cases,  the  right  subclavian  was  secured: 

Case  6. — Private  Harrison  McMichael,  Co.  A,  57th  Indiana  Volunteers,  aged  19  years,  received  a gunshot  wound  of  the 
right  side  of  the  chest,  at  Franklin,  Tennessee,  November  30th,  1864,  the  ball  passing  beneath  the  clavicle  and  injuring  the  coats 
of  the  axillary  artery.  He  was  admitted  to  hospital  at  Nashville,  December  1st,  1864.  The  artery  soon  sloughed  off  at  the 
junction  of  the  axillary  with  the  subclavian,  causing  hmmorrhage  and  threatening  immediate  death.  On  December  11th,  chloro- 
form was  administered  and  the  subclavian  artery  was  ligated.  He  was  treated  with  stimulants,  but  died  from  secondary  hmmor- 
rhage  December  16th,  1864.  The  case  is  reported  by  the  operator.  Surgeon  S.  E.  Fuller,  U.  S.  V. 

Case  7. — Private  Thomas  J.  Conterman,  Co.  G,  48th  New  York  Volunteers,  aged  21  years,  was  wounded  at  Fort  Darling, 
Virginia,  May  9th,  1864,  by  a minid  ball,  which  entered  the  right  axilla,  two  and  one-half  inches  above  lower  border  of  pcctoralis 
major,  and  emerged  two  inches  above  posterior  fold  of  axilla.  He  was  admitted  to  St.  Joseph’s  Hospital,  New  York  City,  on 
May  23d,  and  on  May  31st,  the  right  subclavian  artery  was  ligated  at  outer  third.  At  the  time  of  operation  the  parts  wereswollen, 
sloughy,  and  painful,  but  sound  at  seat  of  ligation,  patient  feeble  from  loss  of  blood;  pulse,  130;  skin  hot.  Haiinorrhage 
recurred  three  times;  the  patient  did 
not  improve  in  any  respect.  On  June 
2d,  chloroform  was  administered  and  a 
branch  of  axillary  plexus  of  veins  was 
ligated  by  division  of  pectoralis  major. 

He  died  J une  2d,  1884,  three  hours  after 
the  second  operation  and  fifty  hours  after 
ligation  of  subclavian  artery,  from  exhaus- 
tion. On  autopsy,  the  subscapular  artery 
was  found  to  have  sloughed  three-fourths 
of  an  inch  from  origin ; the  axillary  vein 
and  an  adjacent  vein  also.  A wet  prepa- 
ration of  the  right  subclavian  artery  is 
represented  in  the  wood-cut  (Fig.  246). 

It  was  contributed,  with  a history  of  the 
case,  by  the  operator.  Acting  Assistant 
Surgeon  George  F.  Shrady. 

Case  8. — Private  Edwin  Pfluger,  Co.  H,  2d  Pennsylvania  Heavy  Artillery,  aged  28  years,  was  wounded  before  Petersburg, 
June  27th,  1864,  by  a conoidal  ball,  which  entered  the  right  shoulder  posteriorly  and  perforated  the  scapula  just  below  the  s))ine. 
He  was  admitted  to  the  hospital  at  Fort  Monroe  on  July  4th.  On  July  14th,  intermediary  hamiorrhage,  to  the  amount  of  thiee 
pints,  occurred.  Assistant  Surgeon  Edward  Curtis,  U.  S.  A.,  ligated  the  axillary  artery  in  its  continuity,  not  far  below  the  clavicle; 
hatmorrhage  recurred  on  the  24th;  and,  on  the  2.5th,  Dr.  Curtis  ligated  the  subclavian  artery  in  the  third  part  of  its  course. 
Hmmorrhage  recurred  on  the  27th,  from  the  distal  end  of  the  a.xillary  arteiy,  but  it  was  arrested  by  plugging  the  wound.  The 
case  terminated  fatally  on  August  10th,  1864. 


Fig.  24fi. — A posterior  view  of  the  innominata,  right  common  carotid,  and  subolav  ian,  witli  a ligature 
on  its  outer  portion,  of  the  axillary  and  some  of  its  branehcs.  There  are  anomalies  in  the  origin  of 
tlio  vertebral  and  thyroid  axis  and  the  axillary  divides  into  brachial  and  ulnar.  The  s^ibscapular  has 
sloughed.  Spec.  4:1:11,  Sect.  I,  A.  M.  M. 


540 


WOUNDS  AND  INJURIES  OP  THE  CHEST. 


[ClIAl>.  V, 


Case  <J.— Private  J.  IP.  Kiny,  Co.  C,  ‘29th  North  Carolina  Regiment,  was  wounded  at  Chickamaug.a,  Georgia,  September 
19th,  1883,  the  ball  jiassing  through  the  right  shoulder  joint,  fracturing  and  detaching  tlie  head  of  the  humerus.  ^ The  missile 
entered  near  the  coracoid  iiroccss  and  passed  out  over  the  spine  of  the  scapula.  The  accident  was  followed  by  a high  degree  of 
swelling  and  inllammation,  extending  from  the  seat  of  injury  down  the  torearm;  suppuration  copious  and  oflensive,  with  high 
irritativ”e  fever.  On  October  10th,  there  was  hatmorrhage  from  the  anterior  wound,  which  was  arrested  by  pressure;  on  the  11th, 
the  hmmorrhage  recurred  copiously  from  both  wounds,  and  the  subclavi.an  was  ligated  in  its  external  third.  There  was  no  further 
hamiorrhage,  but  gangrene  attacked  the  wound  of  operation  on  the  20th,  and  the  patient  died  the  next  day.  T he  case  is  leported 
by  Dr.  11.  L.  Thomas. 


Case  10. — Sergeant  Henry  B , Co.  D,  12th  New  Hampshire  Volunteers,  aged  21  years,  was  admitted  to  Emory 

Hospital,  W.ashington,  June  11th,  1884,  with  a gunshot  wound  of  the  right  shoulder,  received  at  Cold  Harbor  on  the  3d.  Aconoidal 
ball  entered  below  the  clavicle  and  passed  out  at  the  anterior  aspect  of  the  arm,  about  three  inches  below  the  shoulder  joint.  He 
also  received  a flesh  wound  of  the  upper  third  of  the  right  thigh.  The  patient  had  a hmmorrhagic  diathesis,  which  his  father 
stated  was  hereditary  in  the  family— for  example,  a simple  cut  of  the  finger  would  cause  haemorrhage  to  such  an  amount  as  to 
endanger  life.  Under  these  circumstances,  and  upon  consultation,  it  w.as  decided  after  his  first  attack  of  haemorrhage  to  ligate  the 
subclavian.  The  operation  was  successfully  performed  on  June  17th,  by  Surgeon  N.  R.  Moseley,  U.  S.  V.  Strong  hopes  were 
entertained  of  the  patient’s  recovery;  but,  unfortunately,  in  addition  to  his  peculiar  diathesis,  he  had  a severe  cough,  which  it 

seemed  almost  impossible  to  relieve  or  arrest  temporai-ily . On  the  morning 


Fig.  247. — A posterior  view  of  the  distal  end  of  tlie  anonjmaa, 
tbc  criffin  of  the  common  carotid,  and  the  rig’ht  subclavian 
divided  by  a lifrature  in  its  third  portion.  The  subclavian 
had  been  divided  long’itudinally  behind  to  display  the  small 
fibrinous  clot.  Spec.  2812,  Sect.  I,  A.  M.  M. 


of  the  29th,  while  in  conversation,  the  artery  gave  way,  and  death  w-is 
almost  instantaneous  from  haemorrhage.  The  adjacent  wood-cut  represents 
the  specimen,  which  was  prepared  and  presented,  with  the  notes  of  the 
case,  by  Surgeon  N.  R.  Moseley,  the  operator.  It  consists  of  a portion 
of  the  innominata  and  of  the  subclavian  and 
carotid,  and  is  figured  in  the  wood-cut  (Fig. 

247.)  There  were  slight  fibrinous  exudations 
on  either  side  of  the  point  at  which  the  ligature 
cut  through.  The  commencement  of  the  vertebral 
.and  superior  intei’costal  are  shown,  and  the  thyroid 
axis  and  transversus  colli. 


In  the  three  following  cases  the  left  suhclavian  was  tied: 

Case  11. — Piivate  Dexter  W.  I — 


-,  Co.  B,  Cth  Connecticut  Volunteers,  aged  35  years, 
was  admitted  to  hospital  at  New  Haven,  Connecticut,  June  13th,  1864,  with  a gunshot  wound  extending 
Under  spine  of  left  scapula,  forward  and  inward  toward  cavity  of  the  chest,  received  at  Bermuda 
Hundred,  Virginia,  May  ‘20th,  1884.  There  was  g.angrene  in  the  wound  the  size  of  an  orange,  extending 
deeply  into  the  tissues ; secondary  haemorrhage  occurred  from  branches  of  the  axillary  artery.  On 
June  18th,  the  subclavian  artery  was  ligated,  in  the  outer  third.  On  June  20th,  there  were  chills, 
followed  by  all  the  symptoms  of  i)y£emia.  He  was  treated  by  tbe  administration  of  morphia  and 
whiskey,  and  bromine  w.as  applied  to  gangrenous  p.arts.  He  died  on  June  24th,  1864.  The  wood- 
cut  (Fig.  248)  represents  a wet  preparation  of  a section  of  the  left  subclavian.  The  clot  is  well 
shown.  Contributed,  with  a history  of  the  case,  by  Acting  Assistant  Surgeon  T.  B.  Townsend. 


FIG.  248.— Coagulum  in 
left  subclavian  six  days  after 
ligation.  Spec.  408t),  Sect.  I, 
A.  M.  M. 


Case  12. — Private  J.  H.  Henderson,  Co.  F,  57th  Pennsylvania  Volunteers,  was  wounded  <at  Fair  Oaks,  Virginia,  May  31st, 
1862,  by  musket  ball,  which  entered  the  left,  arm  in  front  of  the  insertion  of  the  deltoid  and  passed  out  .at  the  posterior  border  of 
the  axilla.  He  was  admitted  to  Judlci.ary  S<]U.are  Hospital,  Washington,  on  June  4th.  The  humerus  was  uninjured;  .arm  much 
ecchymosed.  June  19th,  there  was  copious  hmraorrhage  from  the  anterior  wound.  On  June  ‘23d,  the  left  subclavian  artery  was 
ligated,  in  the  outer  third.  At  the  time  of  operation  there  was  great  prostration  from  the  haemorrhage.  No  unfavorable  symptoms 
till  .Tune  2Gth;  then  great  mental  excitement,  jiatient  asserting  he  was  dying;  was  partially  quieted  by  anodynes  ; no  chills.  He 
died  from  pyaemia  .Tune  ‘2711),  1882.  The  case  is  n-ported  by  Acting  Assistant  Surgeon  Francis  11.  Brown. 

Ca.se  13. — Private  John  Hites,  Co.  C,  7th  Iowa  Volunteers,  aged  19  years,  received  a gunshot  wound  of  the  left  axilla  at 
Corinth,  Mississippi,  October  3d,  1882.  He  was  admitted  to  the  City  Hosjiital,  St.  Louis,  on  October  15th,  where,  on  October  22d, 
intermediary  haemorrhage  occurred  and  the  subclavian  artery  was  ligated,  in  tbe  third  portion  of  its  course.  Haemorrhage 
recurred  on  October  ‘29th,  and  the  patient  died  October  31st,  1862.  The  case  is  reported  by  the  operator.  Surgeon  John  T. 
Hodgen,  U.  S.  V. 


Ill  the  two  following  cases  the  artery  was  secured,  according  to  the  now  little  employed 
method,  below  the  clavicle,  at  the  extreme  distal  portion  of  its  course : 

Case  14. — Private  Benjamin  Brannan,  Co.  B,  61st  New  York  Volunteers,  aged  22  years,  received,  at  Spottsylvania,  May 
8th,  1864,  a gunshot  wound  of  the  right  shoulder  and  arm.  He  was  admitted  into  the  Campbell  Hosjntal,  Washington,  on  May 
13th.  Secondary  haemorrhage  to  the  amount  of  forty  ounces  occurred  on  May  29th,  and  Surgeon  A.  F.  Sheldon,  U.  S.  V.,  ligated 
the  subclavian  arteiy  in  its  continuity  beneath  the  clavicle.  The  patient  did  well  until  June  15th,  when  the  ligature  came  away 
and  slight  haemorrhage  occurred,  which  was  arrested  by  compression,  but  recurred,  and  he  died  on  the  19th.  The  case  is 
reported  by  the  operator. 


Sect.  III.] 


LIGATIONS  OF  THE  SUBCLAVIAN. 


541 


Case  15. — Color  Sergeant  Smith  E.  Dow,  4th  New  York  Volunteers,  aged  28  years,  was  wounded  at  Petersburg,  Virginia, 
October  27th,  1864,  by  a ball,  which  entered  near  inferior  clavicular  margin,  passing  inward,  downward,  and  backward,  divided 
into  two  parts,  and  emerged  near  superior  angle  of  right  scapula.  He  was  admitted  to  the  Fairfax  Seminary  Hospital,  Virginia, 
November  2d,  1864;  there  was  e.xtensive  sloughing  and  suppurating,  and  on  November  5th  the  right  subclavian  artery  was 
ligated  below  clavicle,  lie  was  feverish  and  Aveak  from  loss  of  blood.  Patient  did  well  for  ten  daj’s  after  the  operation,  when  he 
was  allowed  to  sit  up.  Ligatures  removed  ; ])rofuse  hscmorrhage,  four  ounces;  compression  made.  Eleventh  day,  hoemorrhage 
of  four  ounces ; decided  to  ligate.  Parts  indurated ; on  pulsation  artery  could  not  be  seen  at  its  normal  position  ; compression 
continued.  IL;  died  November  18th,  1884,  from  recurring  haemorrhage,  the  artery  having  divided  at  point  of  ligation.  Necropsy : 
Parts  of  the  wound  indurated  ; almost  impossible  to  trace  the  course  of  arteries  and  veins  ; bony  deposit  below  clavicle,  impli- 
cating arteries  and  veins;  subclavian  artery  divided  at  point  of  ligation;  ends  contracted  two  inches;  ujiper  end  drawn  inward 
from  its  normal  position  two  inches.  The  case  is  reported  by  the  operator,  Assistant  Surgeon  Harrison  Allen,  U.  S.  A. 

Traumatic  Aneurism. — The  following  case  of  gunshot  wound  of  the  axilla  was 
complicated  by  traumatic  diffused  aneurism,  on  account  of  which  ligation  of  the  subclavian 
was  performed  at  a period  of  two  hundred  and  sixty  days  from  the  date  of  reception  of  the 
injury.  The  distinguished  operator  vainly  endeavored  to  carry  out  the  correct  rule  of 
practice  by  ligating  the  axillary ; 

Case  16. — Coi-poral  Thomas  Ward,  Co.  C,  2d  Pennsylvania  Reserve  Corps,  received  a wound  of  the  left  axilla  by  a conoidal 
ball,  at  Mechanicsville,  V^irginia,  June  25th,  1832.  He  was  admitted  to  hospital  at  Washington,  July  4th,  1862,  and  transferred 
to  Philadelphia,  September  2d.  He  was  admitted  to  Christian  Street  Hospital  on  September  3d  ; on  admission,  both  orifices  of 
wound  were  healed.  February  1st,  1863,  swelling  commenced  in  axilla.  March  1st,  there  was  some  fluctuation  in  tumor;  no 
bruit  or  thrill;  an  exploring  needle  revealed  only  extravasated  blood;  integuments  discolored.  March  14th,  profuse  arterial 
bleeding.  On  March  15tb,  the  left  subclavian  artery  was  ligated,  in  its  outer  third,  and  an  unsuccessful  attempt  was  made  to 
ligate  the  axillary,  and  a large  quantity  of  extravasated  blood  was  turned  out  of  the  axilla.  At  the  time  of  operation  there  was 
excessive  pain  in  the  arm,  ascribed  to  lesion  of  the  brachial  plexus;  hypodermic  injections  of  morphia  had  no  eft'ect,  and  cold- 
water  dressings  gave  more  relief  tlian  anything  else ; there  was  extreme  prostration  from  ha3raorrhage.  Reaction  never  fairly 
set  in,  and  he  died  on  ISIarch  17th,  1863.  The  operation  was  performed  by  Dr.  S.  D.  Gross,  Professor  of  Surgery  in  JeS'erson 
Medical  College.  The  case  is  reported  by  Acting  Assistant  Surgeon  John  J.  Reese. 

In  the  following  cases  of  circumscribed  aneurism,  resulting  from  gunsliot  injury,  the 
subclavian  wms  tied  unsuccessfully  on  the  thirty-eigbtli  and  the  fifty-eighth  days  from  the 
reception  of  the  original  wound: 

Case  17. — Corporal  IVilliam  Broderick,  Co.  C,  199th  Pennsylvania  Volunteers,  aged  39  years,  was  admitted  into  Hampton 
Hospital,  Fort  Monroe,  on  April  5th,  1865,  with  a gunshot  wound  of  the  left  shoulder,  received  A))ril  2d,  1865.  Ball  entered 
just  below  clavicle,  outer  side,  passing  through  the  thorax  and  emerging  at  the  inferior  portion  of  the  scapula.  Secondary 
htemorrhage  occurred  several  times  ; the  aneurism  was  three  inches  in  diameter.  On  May  30th,  the  left  subclavian  artery  was 
ligated  in  the  external  third.  The  aneurism  decreased  very  rapidly  after  the  operation,  and  on  June  8th,  only  a slight  fidness 
was  observed  in  the  place  of  the  aneurism  ; the  w'ound  united,  except  an  inch  at  the  external  end  of  the  incision.  On  the  ninth 
day  profuse  haemorrhage  occurred,  filling  the  original  sac  and  the  tissues  in  front  of  the  shoulder.  He  died  from  exhaustion  June 
11th,  1835.  Post  mortem  showed  ligature  yet  on  the  artery,  and  a clot  in  the  vessel  on  either  side  of  ligation,  not  very  firm  nor 
adherent  to  inside  of  artery;  one  inch  of  axillary  artery  gone;  no  fibrinous  deposit  in  the  aneurismal  sac;  blood  clot  soft.  The 
case  is  reitorted  by  Assistant  Surgeon  E.  McClellan,  U.  S.  A. 

Case  18. — “Private  J.  B.  Click,  Co.  G,  5th  Virginia  Cavalry,  was  wounded  November  8th,  1863,  at  Brandy  Station,  by  a 
minie  ball,  which  entered  the  anterior  fold  of  the  right  axilla,  about  its  middle,  ranged  through  the  axillary  s)iace,  and  was 
removed  by  counter  incision  between  the  spinal  column  and  the  vertebral  border  of  the  scapula.  ■ When  admitted  into  the 
hospital,  November  9th,  the  day  after  the  reception  of  the  wound,  there  w'as  no  indication  of  any  more  serious  injury  than  is 
usual  in  flesh  wounds.  All  of  his  symptoms  were  favorable,  and  he  rested  easy  till  the  fifth  day,  when  he  complaliu'd  of  very 
severe  pain,  extending  from  the  shoulder  to  the  tips  of  the  fingers.  This  was  accompanied  by  sleeplessness,  a costive  state 
of  the  bowels,  and  great  w'eakuess.  He  continued  suffering  more  or  less  in  this  way  till  December  3d.  A small,  hard,  and 
circumscribed  tumor  was  then  detected  for  the  first  time  under  the  tendon  of  the  pectoralis  major.  This  tumor  increased  rapidly 
in  volume.  On  the  6th  of  December,  fiuctuation  and  also  pulsation  became  evident,  and,  on  auscultation,  a double  sound  similar 
to  the  bellows  murmur  of  the  heart.  No  thrill  was  perceptible  either  in  the  tumor  or  the  radial  artery.  The  symi)toms  wc're 
still  too  obscure  to  determine  accurately  its  character,  and  opinion  was  very  much  divided.  Some  maintained  strenuously  that 
it  was  an  abscess,  from  the  very  feeble  pulsation  and  entire  absence  of  all  thrill,  and  also  from  the  fact  that  pressure  upon  the 
subclavian  over  the  first  rib  failed  to  diminish  the  size  of  a tumor.  Others  were  disposed  to  regard  it  as  an  arterio-venous 
aneurism^  and  others  again  asserted  that  it  was  an  extravasation  of  blood,  produced  by  ulceration  of  the  coats  of  a vein.  On 
the  9th  of  December,  all  pulsation  in  the  tumor  and  in  the  brachial  and  radial  arteries  ceased  suddenly.  The  bellows  murmur  also 
ceased.  This  was  evidently  due  to  great  pressure  upon  tlie  axillary  artery  by  the  greatly  increased  size  of  the  tumor.  An 
exploring  needle  was  now  introduced,  and  a few  drops  of  gruinous  blood  escaped,  but  no  trace  of  pus  could  be  detected.  The 
diagnosis  being  still  doubtful,  he  was  suffered  to  remain  until  the  15th.  A trocar  was  then  introduced,  when,  as  before,  dark 
blood  only  escaped.  It  was  then  determined  to  ligate  the  subclavian.  The  operation  was  performed  on  the  Kith,  by  Assistant 


542 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Surgeon  J.  C.  Baylor,  the  artery  being  tied  in  the  third  part  of  its  course.  After  the  application  of  the  ligature,  a consultation 
was  held  as  to  the  propriety  of  opening  the  sac,  which,  by  the  great  pressure  it  exerted  over  the  axillary  plexus  of  nerves,  was 
rapidly  exhausting  the  patient.  It  was  decided  to  lay  it  open  by  a free  incision.  This  was  accordingly  done,  and  an  immense 
clot  exposed.  On  passing  the  finger  into  the  clot,  the  artery  spouted,  and  profuse  hoemorrhage  ensued  that  threatened  a speedy 
termination  to  life.  The  clot  was  quickly  turned  out  and  several  attempts  made  to  secure  the  bleeding  vessel,  hut  they  proved 
ineffectual,  and  as  a last  resort  the  tampon  was  used.  The  haemorrhage  was  thus  arrested,  but  the  patient  was  left  in  an 
exceedingly  feeble  and  prostrated  condition.  Stimulants  were  freely  administered,  but  he  sank  rapidly,  and  died  in  eighteen 
hours  after  the  operation.  An  autopsy  held  the  next  day  revealed  a lesion  of  the  axillary  artery  just  below  the  origin  of  the 
subscapular.  The  ligature  was  found  firmly  fastened  around  the  subclavian,  the  inner  and  middle  coats  of  which  were  divided. 
But,  as  a week  had  elapsed  since  all  pulsation  had  ceased  in  the  tumor  and  in  the  arteries  below  it  before  the  operation  was 
performed,  time  had  been  given  for  the  establishment  of  anastomotic  communication,  and  hence  the  htemorrhage.  Surgeon 
P.  F.  Browne,  P.  A.  C.  S.,  reports  the  case.‘ 

Case  19. — “Private  K.  P.  KaJwa,  Co.  B,  Jeff  Davis  Legion,  aged  29  years,  very  large  and  muscular,  while  acting  as 
scout  near  the  Peaks  of  Otter,  on  June  14tb,  1864,  was  shot  with  a minie  ball  through  the  left  axilla;  hsemorrhage  represented 
as  very  profuse,  notwithstanding  which  he  rode  eight  miles,  closely  pursued  for  three  miles.  He  spent  several  days  in  a private 
house,  and  was  admitted  to  Campbell’s  Hospital  on  June  19th.  The  ball  had  passed  through  the  tendons  of  the  pectoralis  major 
and  latissimus  dorsi,  severing  the  axillary  artery,  apparently  in  its  lower  third ; the  haemorrhage  had  ceased  spontaneously  on 
the  first  day  and  had  not  recurred;  pulse  impercejttible ; very  great  swelling  and  hardness  in  the  axilla,  extending  to  the  elbow, 
with  great  discoloration  from  ecchymosis  ; severe  pain  from  shoulder  to  hand,  with  a sense  of  numbness,  hut  not  complete  loss  of 
sensation;  the  capillary  circulation  hut  little  impaired,  and  temperature  normal;  when  he  sat  up  the  veins  of  the  forearm  became 
much  distended;  wounds  healthy  and  healing;  pulse  in  the  right  arm  feeble  and  freq^uent — above  100;  appetite  feeble;  he 
slept  but  little,  and  then  from  the  influence  of  opium.  He  continued  in  the  same  state,  with  little  variation,  for  three  weeks ; 
sometimes  we  thought  that  we  could  feel  a faint  pulsation  in  the  radial  artery,  hut  it  was  so  slight  as  to  be  doubtful.  Early  in 
July,  while  the  general  swelling  of  the  arm  diminished,  the  tumor  in  the  axilla  was  obviously  enlarging  and  extending  under  the 
pectoral  muscle,  when,  by  the  8th,  it  became  very  prominent  and  as  large  as  the  fist.  On  the  night  of  the  10th,  a free  arterial 
haemorrhage  took  place  from  the  posterior  wound ; after  the  loss  of  about  a pint  of  blood,  it  was  arrested  by  pressure,  for  an 
hour,  upon  the  subclavian  above  the  clavicle,  and  did  not  return;  his  pulse  very  feeble,  and  above  120;  he. was  very  much 
alarmed  about  his  condition,  indeed  he  had  been  unusually  low-spirited  from  the  first.  On  the  11th,  for  the  first  time,  a distinct 
pulsation  was  felt  in  the  tumor,  both  iu  the  axilla  and  over  the  pectoral  muscle;  there  w'as  no  perceptible  thrill  or  bruit;  from 
this  time  the  tumor  steadily  increased  in  size,  and  the  pulsation  daily  became  stronger;  there  was  also  increase  of  the  pain  and 
numbness  in  the  limb ; constant  fever  and  sleeplessness,  and  loss  of  appetite.  It  was  decided,  in  consultation,  to  tie  the 
subclavian  above  the  clavicle,  as  affording  him  the  best  chance  of  recovery,  although  his  general  condition  was  not  favorable  for 
an  operation.  Accordingly  on  the  23d  of  tluly,  assisted  by  Surgeon  Blackford  and  the  rest  of  the  surgical  staff  of  this  post.  I 
ligated  the  artery  where  it  passes  over  the  first  rib.  The  operation  was  rendered  somewhat  difficult  by  the  unusual  number  of 
superficial  arteries  that  required  to  be  tied,  and  by  the  elevation  of  the  clavicle  from  the  tumor  in  the  a.xilla.  The  pulsation  in  the 
tumor  immediately  ceased  and  did  not  return;  the  swelling  became  less  tense,  but  the  pain  continued,  and  the  fever  increased; 
the  capillary  circulation  in  the  limb  continued  good,  and  its  temperature  appeared  to  be  little,  if  at  all,  diminished  (we  had  no 
thermometer  to  test  it  accurately),  for  a few  days  he  seemed  to  be  doing  well,  but  on  the  2Gth,  the  incision  presented  an 
unhealthy  appearance,  with  a slight  erysipelatous  blush  and  some  swelling  below  the  clavicle.  By  the  28th,  the  shoulder  and 
breast  became  enormously  swollen,  so  as  completely  to  conceal  the  aneurismal  tumor.  On  the  next  day  there  was  extensive 
erysipelas  on  the  outside  and  back  of  shoulder,  which  spread  rapidly  over  the  breast  and  down  the  arm  to  the  elbow ; the 
incision  .suppurating  and  unhealthy.  On  the  same  day  he  was  seized  with  a severe  pleuritic  pain  on  the  left  side,  and  great 
difficulty  of  breathing,  but  without  cough  ; the  respiratory  motion  was  confined  so  exclusively  to  the  right  side,  that  the  left 
seemed  paralyzed,  and  was  obviously  several  inches  smaller  than  the  right  side,  although  auscultation  showed  the  presence  of 
effusion  in  the  left  thorax;  bowels  torpid  and  tympanitic;  pulse  150,  and  very  feeble.  July  30th;  No  improvement  in  his 
condition,  although  the  pain  iu  the  side  had  nearly  ceased.  July  31st:  Prostration  extreme;  respiration  more  difficult ; died 
soon  after  midnight.  Autopsy  : Axillary  ai’tery  and  vein  both  severed  by  the  ball  in  their  lower  third  ; the  axilla  filled  with  a 
large  clot,  extending  to  within  three  inches  of  the  elbow  and  considerably  beneath  the  pectoralis  major.  The  coagulum  was 
moderately  firm,  and  contained  in  a thin  adventitious  sac  of  cellular  tissue,  hut  without  any  fibrinous  deposit.  The  median  nerve 
had  e.scaped  division,  but  was  very  much  discolored,  as  were  also  the  other  nerves  in  the  axilla.  The  artery,  where  ligated,  had 
united,  hut  not  very  firmly  ; no  clot  had  formed  withiu  it,  owing  probably  to  the  fact  that  the  posterior  scapular  artery,  instead 
of  being  a branch  from  the  transversalis  colli,  arose  directly  from  the  subclavian,. between  the  scaleni,  and  about  two-thirds  of 
an  inch  above  the  point  of  ligation;  this  would,  probably,  have  led  to  secondary  haemorrhage  after  the  separation  of  the  ligature. 
There  was  a large  serous  effusion  in  the  left  side  of  the  thorax,  with  a deposit  of  a thick  layer  of  fibrin  over  a large  surface  of 
the  lung ; phnuiic  nerve  healthy.  There  was  also  slight  deposit  in  the  pericardium,  and  some  effusion.  The  only  treatment 
that  was  admissible  after  the  operation  was  morphine,  stimulants,  and  tiuct.  mur.  ferri.  It  would,  probably,  have  been  better 
to  have  tied  the  subclavian  soon  after  his  admissio  i,  when  his  general  health  was  less  impaired.  But  would  the  rules  of  surgery 
have  justified  the  ligation  of  a large  artery  when  there  was  no  haemorrhage  and  no  pulsation  in  the  tumor?  The  axillary 
swelling  and  absence  of  pulse  at  the  wrist  afforded  strong  presumptive  evidence  that  the  artery  was  divided,  but  we  could  not  be 
sure  that  the  absence  of  pulse  was  not  owing  to  the  pressure  of  the  tumor,  which  might  have  arisen  from  the  division  of  a branch 
of  the  a.xillary,  and  if  so  we  might  reasonably  hope  that  iu  time  it  would  be  absorbed  and  the  circulation  restored.  It  was  not 
until  the  tumor  began  to  increase  in  size,  with  distinct  pulsation,  that  we  felt  satisfied  that  an  operation  was  indispensable,  and 
our  choice  then  lay  between  disarticulation  and  ligature  of  the  subclavian — the  ligature  of  the  axillary  in  the  midst  of  such 


' BiiOWNE,  P.  F.,  Confederate  States  Medical  and  Surgical  Journal,  Vol.  I,  p.  23,  18G4. 


Sect.  III.] 


LIGATIONS  OF  THE  SUBCLAVIAN. 


543 


swelling  and  altered  relation  of  parts  was  out  of  tlie  question.  We  decided  upon  the  ligation  of  the  artery  as  beuig  sanctioned 
bv  the  highest  authority;  the  more  especially  as  his  constitutional  condition  almost  forbade  the  hope  of  successful  amputation. 
I would  suggest  that,  in  a similar  case,  where  the  posterior  scapular  arose  directly  from  the  subclavian,  it  would  be  proper  to  tie 
it,  as  well  as  the  main  artery;  in  this  case  it  could  have  been  done  without  difficulty,  as  it  could  be  jdainly  seen  and  felt  where  it 
crossed  the  cervical  plexus.  The  other  branches  of  the  transversus  colli  and  the  supra-scapular  would  prob.ably  be  sufficient  to 
supply  the  anastomosing  circulation.  The  immediate  cause  of  death  in  this  case  was  pleuritis,  which  has  been  observed  to  be 
far  the  most  frequent  cause  of  death  after  ligation  of  the  subclavian.  The  erysi[)elas,  to  which  there  has  latterly  been  some 
tendency  in  this  neighborhood,  no  doubt  also  contributed  to  the  fatal  termination.”  Surgeon  Win.  Selden,  P.  A.  C.  S.,  reported 
the  case.^ 

The  next  case  refers  to  a ligation  of  the  left  subclavian,  by  Surgeon  John  A.  Lidell, 
U.  S.  V.,  for  circumscribed  traumatic  aneurism  following  the  division  of  the  axillary  by  a 
carbine  ball.  The  complete  report  is  given  in  tbe  author’s  own  language 

Case  20. — “Captain  John  F.  Jordan,  Co.  B,  13th  Virginia  Cavalry,  aged  31  years,  and  of  sound  constitution,  was  admitted 
to  Stanton  United  States  Army  General  Hospital,  June  23d,  1833.  He  had  been  wounded  on  June  2l8t,  in  action  near 
Middleburgh,  Virginia,  by  a shot  from  a carbine.  The  bullet,  which,  by  the  way,  was  conical  in  shape,  penetrated  the  pectoralis 
major  muscle  of  the  left  side,  at  a point  on  a level  with  the  axillary  artery,  and  about  one  and  a half  inches  from  the  margin  of 
the  armpit,  passed  directly  backward  beneath  the  shoulder,  wounding  the  axillary  artery,  together  with  the  brachial  plexus  of 
nerves,  and  escaped  behind.  Patient  said  he  lost  a great  deal  of  blood  immediately  after  the  wound  was  inflicted,  so  much 
indeed  that  he  fainted,  when  the  lijemorrhage  ceased  of  itself,  and  did  not  return.  On  admission  to  hospital,  his  left  arm  exhibited 
some  sw'elling,  oedematous  in  character,  and  its  inner  side  was  ecchymosed  nearly  down  to  the  elbow-joint.  It  was  also 
paralyzed,  the  loss  of  both  sensibility  and  mobility  being  complete.  There  was  no  radial  pulse  in  that  arm,  and  pulsation  could 
not  be  detected  in  the  brachial  or  any  other  artery  thereof.  From  this  we  inferred  that  the  axillary  artery  had  been  severed  by 
the  bullet.  The  temperature  of  the  limb  was  not  below  the  normal  standard ; on  the  contrary,  we  thought  it  to  be  somewhat 
warmer  than  the  limb  of  the  opposite  side.  There  was  nothing  remarkable  in  the  appearance  of  the  wound.  The  patient’s 
general  condition  was  good.  He  did  not  look  as  if  he  had  suffered  from  luEmori-hage.  His  bowels  were  constijiated;  ordered  a 
saline  purge,  together  with  a spare  diet,  and,  with  a view  to  lessen  the  tendency  to  secondary  limmorrhage,  he  was  directed  to 
remain  quiet  in  bed,  to  exert  himself  as  little  as  possible,  and  to  have  ice  applied  constantly  over  the  injured  artery.  He  was 
also  directed  to  take  morphine  at  night  if  necessary  to  procure  rest.  Under  this  treatment  the  patient  progressed  without  an 
unfavorable  symptom;  the  wound  cleaned  itself  and  closed  up  in  a satisfactory  manner,  and  we  congratulated  the  patient  in  that 
he  was  likely  to  get  well  without  suffering  the  terrible  secondary  hsomorrhage,  which  frequently  attends  gunshot  wounds  of  tlie 
axillary  artery.  The  limb  continued  to  be  completely  paralyzed  as  to  motion,  but  sensation  had  gradually  been  restored  to  tbe 
fingers,  hand,  and  forearm.  On  the  morning  of  the  12th  of  July,  we  noticed  the  appearance  of  a small,  rounded,  circumscribed 
swelling  of  the  size  of  an  egg,  at  the  seat  of  injury  to  the  artery.  The  scar  of  the  anterior  orifice  of  the  gunshot  wound  was 
exactly  on  the  summit  of  the  convexity  of  the  swelling,  as  the  patient  lay  in  bed.  The  tumor  was  tense  in  feel,  and  pulsated 
distinctly  and  synchronously  with  the  heart.  There  was,  howev’er,  an  entire  absence  of  the  aneurismal  thrill  and  aneurismal 
bruit.  By  compressing  the  subclavian  artery  against  the  first  rib,  the  tumor  became  soft,  much  less  in  size,  and  ceased  to  ]mlsate. 
On  withdrawing  compression  the  tumor  speedily  filled  up,  became  tense,  and  pulsated  again.  Patient  stated  that  during  the 
preceding  night  he  felt  something  “give  way”  in  his  loft  armpit,  while  attempting  to  change  the  position  of  this  arm  by  the  aid 
of  the  right  hand.  During  the  day  the  aneurism  increased  rapidly  in  size,  and  in  the  evening  was  fully  twice  as  large  as  when 
first  noticed  in  the  morning.  July  13th,  the  aneurism  continued  to  increase  steadily  in  size,  and  in  the  evening  was  about  half 
as  large  as  the  clenched  fist.  July  14th,  the  aneuristn  had  grown  but  little  since  previous  day;  it  was  still  rounded,  distinctly 
circumscribed,  and  somewhat  oval  in  shape.  By  compressing  the  subclavian,  it  ceased  to  pulsate,  became  soft  and  much 
shrunken,  but  the  prior  condition  of  things  was  restored  speedily  on  withdrawing  compression ; as  on  a previous  occasion,  there  was 
still  no  thrill  or  bruit.  Diagnosis : Circumscribed  traumatic  aneurism  of  the  axillary  artery.  From  the  entire  absence  of  jmlsation 
in  all  the  arteries  beyond  the  aneurism,  which  existed  even  at  the  time  of  admission  to  hospital,  and  the  comi)lete  want  of  thrill 
and  bruit  in  the  aneurism  itself’  we  believed  that  the  aneurism  had  been  developed  from  the  j)roximal  end  of  the  severed  artery, 
and  that  opinion  was  strengthened  by  the  fact  that  the  swelling  had  not  expanded  outward  and  downward  into  the  armpit,  where 
there  was  but  little  in  the  anatomical  structure  of  the  parts  to  obstruct  its  growth,  any  more  rapidly  than  it  had  done  in  another 
direction,  where  it  was  covered  over  and  bound  down  by  the  pectoral  muscles.  The  swelling  had  expanded  so  equally  in  all 
directions,  that  the  scar  of  the  anterior  wound  still  remained  exactly  over  the  centre  of  the  tumor,  as  when  we  first  saw  it.  The 
aneurism  was  so  distinctly  circumscribed  that,  although  its  origin  was  traumatic,  it  was  deemed  advisable  to  attempt  a cure  of 
it  by  the  Hunterian  method.  As  there  was  not  sufficient  space  to  secure  the  artery  below  the  clavicle  without  opening  the  sac, 
I proceeded  to  tie  the  left  subclavian  artery  external  to  the  scalenus,  on  the  afternoon  of  that  day  (July  14th).  The  patient  being 
under  sulphuric  ether,  that  operation  was  performed  without  difficulty  by  the  ordinary  method.  On  tightening  the  ligature  the 
tumor  ceased  to  pulsate,  shrunk  a good  deal,  and  became  soft.  The  left  arm  was  directed  to  be  wrajjped  in  cotton  wool,  and  to 
be  kept  warm  by  the  further  aid  of  bottles  of  warm  water,  to  be  renewed  from  time  to  time  as  occasion  might  require.  A full 
dose  of  morphia  was  prescribed.  He  was  enjoined  to  preserve  the  recumbent  posture,  and  to  avoid  exertion  of  every  kind.  A 
milk  diet  was  allowed.  July  15th,  patient  had  a comfortable  night;  tem])erature  of  arm  not  diminished;  discontinued  the  warm 
water.  July  IGth,  patient  doing  well  in  every  respect;  arm  warm;  color  thereof  good;  discontinued  the  cotton  wool.  July 
17th,  bowels  being  confined,  he  took  an  ounce  of  sulphate  of  magnesia.  July  19th,  aneurismal  sac  opened  sj)ontaneously  last 

•Seldex.  W.,  Confederate  States  Medical  and  Surgical  Journal,  Vol.  I,  No.  U,  p.  134,  September,  18G4. 

^Lidell,  On  the  Wounds  of  Blood-vessels,  Traumatic  Uiemorrhage,  Traumatic  Aneurism,  and  Traumatic  Gangrene.  In  Surgical  Memoirs  of  tbe 
4yar  of  the  Rebellion,  Vol.  I,  p.  101,  New  York,  1870. 


544 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


night  tliroiigh  the  anterior  scar  of  the  gunsliot  wound,  and  discharged  two  or  three  ounces  of  very  dark-colored  blood,  mixed 
with  ])ns.  Suppuration  of  the  sac  had  been  threatened  ever  since  the  day  after  the  operation.  He  was  allowed  a full  diet.  July 
20th,  a moderate  discharge  of  old  blood  and  pu.s,  accompanied  with  a gradual  diminution  in  the  size  of  the  aneurism,  and  but  a 
moderate  degree  of  inflammation  of  the  sac  continued  on  this  and  several  days  following,  the  patient’s  general  condition  being 
unexceptionable  all  tlie  while.  July  27th,  the  aneurismal  swelling  had  entirely  disappeared  ; suppuration  of  the  s.ac,  moderate 
in  <iuantity,  still  continued,  the  pus  being  of  a good  quality.  August  1st,  the  I’ujature  separated  ami  was  removed  to-day,  without 
the  occurrence  of  heemorrhaye  or  any  other  difficulty;  discharge  from  sac  good  in  quality  and  steadily  diminishing  in  quantity ; 
discovered  some  excoriation  at  the  inner  side  of  the  left  elbow,  occasioned  probably  by  pressure,  the  patient  having  followed  very 
closely  the  injunction  to  keep  as  still  as  possible  in  the  recumbent  posture;  directed  a stimulating  plaster  to  be  applied,  and  the 
pressure  to  be  removed  to  other  situations  by  arranging  pillows.  August  5th,  discharge  from  sac  had  subsided  to  a small 
quantity  of  healthy  pus,  and  the  orifice  was  manifestly  contracting.  We  hoped  that  adhesion  of  the  sac  was  taking  ])lace. 
I’atient’s  condition  seemed  to  be  favorable  in  every  respect,  except  that  he  had  been  losing  flesh  rapidly  for  several  days  without 
obvious  cause.  For  want  of  any  other  reason,  we  attributed  it  to  the  extreme  heat  of  the  weather,  the  temperature  both  day 
and  night  having  been  unprecedented  ever  since  July  25th,  the  mercury  at  midday  ranging  from  90°  to  100°  in  the  shade,  and 
seldom  falling  below  80°  at  night.  August  Cth;  a profuse  ilow  of  blood  from  the  sac  came  on  this  morning  without  ■warning; 
the  loss  of  blood  being  so  rapid  as  to  threaten  speedy  death.  The  officer  of  the  day  was  close  at  hand,  and  stopped  the  bleeding 
by  injecting  about  one  ounce  of  liquor  ferri  persulphatis  into  the  bottom  of  the  sac,  through  a female  catheter,  introduced  for  the 
purpose.  The  haemorrhage  ceased  immediately.  We  had  been  emboldened  to  use  the  persulphate  of  iron  freely  in  this  way, 
because  we  had  a few  weeks  before  (June  22d)  stopped  a troublesome  secondary  flow,  in  alarming  quantity,  of  arterial  blood 
from  the  cavity  of  a large  abscess,  associated  with  gunshot  fracture  of  the  right  thigh,  by  injecting  about  two  drachms  of  liquor 
ferri  persulphatis  through  a catheter,  carried  into  the  neighborhood  of  the  supposed  source  of  the  haemorrhage,  a branch  of  the 
jirofunda  artery,  and  no  unpleasant  effect  of  any  kind  followed  it.  Again,  about  the  same  time,  we  had  been  troubled  to  manage 
a case  of  general  oozing  of  blood  from  the  cut  surface  of  a thigh,  amputated  secondarily  for  gunshot  injury.  After  trying 
exposure  to  the  air,  ice-water,  and  even  ice,  without  effect,  we  stopped  this  bleeding  immediately  by  covering  the  end  of  the 
stump  with  pledgets  of  lint  soaked  in  liquor  ferri  persulphatis.  Aside  from  pretty  severe  pain,  which  soon  subsided,  no  unpleasant 
consequence  of  any  kind  followed.  We  did  not  discover  any  evidence  of  even  the  feeblest  action  as  an  escharotic,  and  indeed 
have  since  thought  that  the  case  progressed  better  than  other  amputations  of  the  same  class.  In  consequence  of  the  secondary 
ha;morrhage  and  the  efforts  to  repress  it,  the  aneurismal  sac  became  filled  up  again  to  the  original  size.  August  10th,  another 
severe  haemorrhage  occurred  from  the  same  orifice;  it  was  readily  stopped  by  again  injecting  persulphate  of  iron  in  solution. 
August  11th : profuse  haemorrhage  occurred  to-day  through  the  opening  of  the  posterior  oi’ifice  made  by  the  bullet,  after  it  had  been 
healed  for  more  than  a month.  This  bleeding  was  also  suppressed  immediately  by  injecting  liquor  ferri  persulphatis  through  a 
catheter.  After  this  there  was  no  more  haemorrhage.  During  the  next  few  d.ays  he  seethed  to  rally  from  the  depression  produced 
by  these  repeated  losses  of  blood.  He  was  ordered  to  have  wine,  and  anything  in  the  line  of  supporting  treatment  that  he 
would  take.  August  18th:  the  aneurismal  sac  has  again  suppurated,  and  there  is  a profuse  discharge  of  dark-colored  and  very 
offensive  pus.  August  25th:  patient  failing  rapidly ; suppuration  very  profuse  and  extremely  offensive  in  character.  August  29th, 
he  died,  worn  out  with  the  suppuration  and  the  haemorrhages,  forty-six  days  after  the  operation,  and  twenty-eight  days  after  the 

ligature  came  away.  Autopsy  eighteen  hours  after  death : 
Emaciation  extreme;  rigor  mortis  moderate;  a large 
elongated  cavity,  with  ragged  dark-colored  walls, 
occupies  the  original  seat  of  the  aneurism,  and  extends 
beyond  it  outward  into  the  axilla;  the  axill.ary  artery  is 
found  to  have  been  severed  obliquely  by  the  bullet  about 
one  and  one-half  inches  abov'e  its  termination  in  the 
brachial;  the  divided  extremities  are  separated  widely 
apart  (to  the  extent  of  about  three  inches);  the  distal 
end  appears  to  have  been  pushed  away  from  the  prox- 
imal end,  either  by  the  original  aneurism,  or  the  subse- 
quent hemorrhages  and  suppuration;  the  proximal  end 
is  obli(pie  and  closed,  while  the  bruised  and  lacerated 
portion  of  it  appears  about  to  be  cast  off  by  the  ulcer- 
ative process,  as  a distinct  line  of  demarcation  has  been 
formed;  the  distal  end  is  oblique  and  unclosed,  but  the 
calibre  of  the  artery  is  contracted  down  to  about  a line  in  diameter,  and  it  is  blocked  up  by  a coagulum  three-eighths  of  an  inch 
long;  the  branches  of  the  axillary  given  off  above  the  point  of  injury,  especially  the  superior  thoracic  and  the  acromial  thoracic, 
are  much  enlarged ; the  axillary  vein  is  greatly  diminished  in  size  about  the  track  of  the  bullet,  but  it  is  still  pervious ; the  brachial 
plexus  of  nerves  was  also  wounded  by  the  bullet,  all  the  trunks  being  cut  off  except  that  of  the  musculo-spiral  and  cii'cumflex 
nerves.  The  proximal  extremities  of  the  divided  trunks  were  somewhat  bulbous.  At  the  seat  of  the  operation  tlie  wound,  which 
at  one  time  was  nearly  closed,  is  now  open  quite  down  to  the  artery  at  the  jxiint  of  ligation,  the  new  gi’anulations  having  been 
reabsoibed  to  that  extent,  but  the  artery  for  a distance  on  each  side  thereof  is  surrounded  by  a dense  mass  of  new  connective 
tissue,  so  tliick  and  dense  as  to  make  it  a little  difficult  to  get  at  and  remove  the  specimen  without  injury.  On  the  proximal  side 
of  the  ligature  the  vessel  is  blocked  up  to  a dist.ance  of  about  live-eighths  of  an  inch;  on  the  other  side  of  the  ligature  it  is  blocked 
up  to  the  extent  of  about  two-eighths  of  an  inch.  In  the  cavity  of  the  thorax  we  find  old  jfleuritic  adhesions  on  both  sides,  and 
old  tuberculous  cicatrices  at  the  apex  of  each  lung;  but  both  lungs  are  now  entirely  free  from  tuberculous  deposits:  abdomen  not 
opened.”  The  specimen,  represented  in  the  above  wood-cut  (Fig.  249),  and  also  specimen  3243,  showing  the  brachial  plexus, 
were  contributed  by  the  operator. 


Fig.  249. — Drawing  of  the  arterial  preparation  from  Dr.  Lidell's  case  of  ligation 
of  the  loft  subcl.avi.in.  ^ipec.  1(184,  Sect.  I,  A.  M.  Jf. 


Sect.  III.] 


ligatio:n's  ok  the  subcj.avi an. 


545 


Case  21. — Sergeant  Henry  Grotlienn,  Co.  K,  5tli  United  States  Cavalry,  aged  28  years,  was  admitted  into  the  McClellan 
Hospital,  Philadelphia,  June  23d,  1863,  from  Lincoln  Hospital,  Washington,  with  an  aneurism  of  the  right  axillary  artery,  the 
result  of  a gunshot  wound  received  at  Beverly  Ford,  Virginia,  June  9th,  1863.  The  ball  had  passed  in  on  the  anterior  part  of 
the  arm,  near  the  shoulder-joint,  and  was  cut  out  at  Lincoln  Hospital  an  inch  below  the  inferior  angle  of  the  scapula.  In  a 
report  of  the  case  in  the  American  Journal  of  Medical  Sciences,  Vol.  XLVII,  p.  128,  N.  S.,  Acting  Assistant  Surgeon  Isaac 
Norris  says:  “When  I took  charge  of  the  ward,  on  July  26th,  the  patient  was  absent.  He  returned  on  the  28th,  and  after 
making  a careful  examination  of  the  arm,  the  true  nature  of  the  disease  became  manifest,  as  the  pulsation  of  the  tumor — at  that 
tim'5  about  the  size  of  a large  horse-chestnut — was  very  apparent,  and,  upon  auscultation,  the  aneurismal  thrill  could  be  distinctly 
heard,  corresponding  with  the  contraction  of  the  left  ventricle  of  the  heart.  My  predecessor  had  had  made  an  apparatus 
composed  of  a compress  of  lead  with  screws  so  arranged  that  by  tightening  them  any  amount  of  i)ressure  desired  coidd  be 
placed  upon  the  part.  The  apparatus  was  adjusted,  but  after  a trial  of  some  thirty  hours,  it  was  abandoned  on  account  of  the 
jiain  it  gave  the  patient,  and  a padded  bandage  was  substituted,  in  the  faint  hope  that  it  might  be  of  use.  This  was  worn  for 
nearly  ten  days,  hut  it  was  finally  left  off,  and  the  treatment  was  reiluced  to  keeping  the  arm,  as  nearly  as  possible,  at  perfect 
I’est.  On  the  16th  of  August  last,  the-aneurism  became  much  larger,  and  from  the  pressure  upon  the  axillary  plexus  of  nerves, 
caused  him  great  pain.  The  following  evening  it  was  decided  to  operate  and  tie  the  subclavian,  despite  the  hazard  attending  it. 
The  aneurism  broke,  unfortunately,  early  the  next  morning,  before  the  operation  could  be  performed,  and  the  patient  lost  from 
thirty  to  forty  ouTices  of  blood.  The  haemorrhage!  finally  ceased  of  its  own  accord,  but  he  was  so  weakened  and  exhausted  fi’om 
the  great  loss  he  had  sustained,  that  it  was  the  opinion  of  the  medical  staff  of  the  hospital,  upon  consultation,  that,  if  anything 
was  attemjited  then,  he  would  die  under  the  operation,  and  that  his  life  might  be  prolonged  for  a few  hours  more  by  keejiing  up 
digital  compression  upon  the  artery.  This  was  accordingly  done,  and  the  assistants  appointed  relieved  each  other  every  hour 
or  two,  until  the  arrival  of  Surgeon  R.  H.  Coolidge,  medical  inspector  of  the  Army,  on  a chance  visit  to  the  hospital,  who  at  once 
besaine  interested  in  the  case,  and  thought  the  sidiclavian  should  be  tied  without'  delay  ; the  temporary  absence  of  Dr.  Taylor, 
the  surgeon  in  charge,  being  the  objection  to  its  performance.  As  the  patient  seemed  to  be  rallying  each  hour.  Dr.  Coolidge 
decided  to  return  to  the  hospital  in  the  afternoon,  and  operate,  if  no  objection  then  existed.  Upon  his  return,  the  hffimorrhage 
again  having  commenced,  he  proceeded  to  ligate  the  subclavian  in  the  third  part  of  its  course.  I here  give  the  account  of  the 
operation  as  furnished  by  the  Doctor  : ‘ The  patient  came  easily  under  the  influence  of  the  chloroform,  and  the  operation  was 
performed  carefully  and  deliberately.  The  loss  of  blood  amounted  to  a few  drops  only,  htemorrhage  from  the  aneurism  having 
been  completely  ai-rested  by  a torni(iuet.  Chloroform  was  not  adminisistered  after  the  operation  began.  The  artery,  on  being 
exposed,  was  found  closer  to  the  brachial  plexus  than  usual,  and  it  was  also  quite  deeply  seated,  the  patient  being  a large  mus- 
cular man.  An  armed  artery  needle  having  been  passed  beneath  the  vessel  from  below  upward  and  outward  and  withdrawn, 
it  was  fouml  by  the  operator,  and  his  assistants  also,  that  the  inferior  cord  of  the  brachial  jilexus  was  included  in  the  ligature,  a 
result  attributed  in  part  to  the  want  of  sufficient  curve  in  the  needle.  Another  one,  having  a more  abrupt  curve,  being  armed 
and  passed  beneath  the  artery,  it  was  elevated  by  the  first  ligature,  and  cai'O  taken  to  exclude  the  nerve  above  mentioned.  The 
firet  ligatiu-e  was  then  withdrawn,  and  several  of  the  medical  officers  present,  having  examined  the  parts,  and  satisfied  themselves 
that  nothing  but  the  artery  was  embraced  in  the  ligature,  the  knot  was  tied,  the  lips  of  the  incision  drawn  together,  and  the 
patient  placed  in  bed.’  Everything  seemed  to  do  well  until  about  eight  o’clock  P.  M.,  when  the  patient  complained  of  consider- 
able pain  in  the  region  of  the  wound.  Morphia  was  given  to  him  freely,  and  repeated  the  following  houi-,  but  without  the  effect 
of  quieting  him.  The  patient,  from  that  time,  grew  ra])idly  worse,  suffering  with  great  dyspnoea,  and  at  midnight  expired,  six 
hours  after  the  operation.  The  post-mortem  revealed  the  unexpected  fact  that  a nerve  of  considerable  size,  lying  immediately 
posterior  to  the  artery,  had  been  included  in  the  ligature  despite  the  care  that  had  been  taken  to  prevent  it.  It  is  to  be  regretted 
that  this  nerve  was 
not  traced  to  its  ori- 
gin and  termination ; 
all  that  can  now  be 
said,  is  that  it  was 
followed  as  a single 
cord  down  to  and 
upon  the  posterior 
wall  of  the  aneurism. 

It  was  certainly  nei- 
ther of  ^le  two  cords 
of  the  hrachial  plex- 
us, and  its  situation 
was,  beyond  doubt, 
abnormal,  as  the 
nerve  included  in  the 
ligature  was  directly 
opposite  the  knot,  and 

could  not  be  seen  when  the  artery  was  placed  in  its  proper  position.  It  is  scarcely  necessary  to  add  that  no  writer  on  anatomy  has 
described  such  a nerve,  nor  has  any  dissection  on  record  shown  the  existence  of  one,  previous  to  this.  At  the  time  the  ligature 
was  tied,  the  patient  was  but  slightly  under  the  influence  of  chloroform,  and  no  pain  was  manifested  until  several  hours  after- 
wards. The  preparation  is  an  exceedingly  instructive  one,  the  aneurismal  sac  being  very  large,  and  the  course  of  the  artery 
well  shown.  The  infiltration  of  blood  also  into  the  surrounding  cellular  tissue  was  very  great.”  The  specimen,  consisting  of  the 
aneurismal  sac  and  the  subclavian,  with  a ligature  on  the  third  portion,  is  represented  in  the  accompanying  wood-cut  (UlG.  260). 
It  was  contributed,  with  the  notes  of  the  case,  as  subsequently  published,  by  Acting  Assistant  Surgeon  Isaac  Norris,  jr. 

C9 


FIG.  250.— Traumatic  aneurism  of  the  right  axillary,  with  ligation  of  the  suholavian.  Spec.  2(109,  Sect.  I,  A.  M.  M. 


546 


WOUNDS  AND  INJUKIES  OF  THE  CHEST. 


[Chap.  V, 


Some  surgeons  clescrilje  tlie  ligation  of  the  subclavian  behind  or  between  the  scaleni 
as  a distinct  operation.  The  vessel  appears  to  have  been  secured  on  the  left  side,  in  this 
portion  of  its  course  in  the  two  following  cases.  They  are  both  illustrations  of  Anel’s 
method  unsuccessfully  applied  to  wounded  arteries.  The  first  was  for  intermediary 
hcemorrhage  on  the  eighth  day;  the  second  for  secondary  hemorrhage  on  the  eighty-ninth 
day,  the  result  of  gangrene: 


Case  22. — Corporal  George  M.  Kleclmer,  Co.  D,  93cl  Illinois  Volunteers,  aged  23  years,  received  at  Allatoona,  Georgia, 
on  October  5th,  1864,  a gunshot  wound  of  the  left  arm ; the  ball  entering  at  insertion  of  deltoid  muscle,  lodged  between  the  clavicle 
and  first  rib,  over  the  tubercle  of  the  rib.  He  was  admitted  to  the  general  hospital  at  Rome,  Georgia,  October  8th,  1864,  and, 
on  October  13th,  the  subclavian  artery  was  ligated  behind  the  scalenus  anticus  and  the  ball  removed ; chloroform  and  ether 
were  administered.  At  the  time  of  operation,  there  was  excessive  infiltration  of  serum  in  all  the  parts  involved  in  the  operation, 
and  profuse  secondary  hsemori'hage,  with  extreme  prostration  therefrom.  Stimulants  were  freely  administered,  hut  he  died  six 
hours  after  the  operation.  The  case  is  reported  by  the  operator.  Surgeon  J.  H.  Grove,  U.  S.  V. 

Case  23. — Sergeant  IF.  H.  Jlolshowes,  3d  South  Carolina  Battery,  was  wounded  at  Franklin,  Tennessee,  November  30th, 
1864,  by  a conoidal  ball,  which  entered  about  an  inch  below  the  left  clavicle  and  lodged  in  the  substance  of  the  lung.  He  was 
treated  in  the  field  until  December  26th,  when  he  was  transferred  to  No.  1 hospital,  Nashville.  About  February  23d,  1865,  a large 
gangrenous  ulcer  formed,  which  spread  rapidly,  involving  the  tissues  from  the  inner  third  of  the  clavicle  to  the  axilla,  exposing 
the  blood-vessels  and  nerves.  The  subclavian  artery  sloughed  in  its  distal  third  on  February  27th  ; about  twelve  ounces  of  blood 
were  lost.  The  patient  was  much  reduced.  Surgeon  B.  B.  Breed,  U.  S.  V.,  administered  chloroform  and  ligated  the  left  sub- 
clavian artery  between  the  scaleni  through  an  incision  above  the  clavicle.  Tonics,  stimulants,  and  a nutritious  diet  were  given 
and  disinfectant  dressings  were  applied.  The  gangrene  was  arrested  with  difficulty.  The  patient  did  well  until  the  eighth  day 
after  the  operation,  when  he  was  attacked  with  severe  rigors,  which  occurred  at  irregular  intervals  until  March  11th,  1865,  when 
death  resulted  from  pymmia.  The  necropsy  showed  a firm  clot  in  artery.  Multiple  abscesses  existed  throughout  both  lungs. 
Thrombi  in  the  subclavian. 


Two  cases  of  ligation  of  the  right  subclavian  on  the  tracheal  side  of  the  scaleni  are 
recorded.  In  the  first  of  these  formidable  operations,  the  patient  survived  the  operation 
only  half  an  hour: 

Case  24. — William  S , a scout  for  General  Milroy,  was  admitted  into  Cumljerland  Hospital,  Nashville,  December  1st, 

1864,  having  been  wounded  while  on  a scouting  c.xpedition  on  or  about  November  15th  ; while  taking  supper  at  a fiirm-house  he 
was  fired  at  through  the  window,  the  ball  striking  about  the  external  third  of  the  right  clavicle,  fractured  it,  passed  obliquely 
inward  and  backward,  and  emerged  on  the  back  near  the  cervical  vertebrae.  The  pleural  cavity  was  opened  by  the  ball,  and 
whenever  he  changed  his  position  a quantity  of  fluid,  having  the  appearance  of  blood  mixed  with  serum,  would  flow  out. 
Compresses  were  kept  on  the  wound,  and  whenever  they  were  taken  off  there  would  be  a discharge  of  the  bloody  fluid.  The 
quantity  lost  at  different  times  was  great,  and  the  patient’s  strength  failed  rapidly.  On  the  evening  of  December  14th,  a severe 
hasmorrhage  occurred  from  the  subclavian  artery,  which  was  controlled  for  some  time  by  pressure.  The  necessity  of  suigical 
interference  was  urgent,  as  the  patient  had  already  lost  a large  amount  of  blood.  Assistant  Surgeon  S.  C.  Ayres,  U.  S.  V., 
immediately  operated.  A triangular  flap  was  made  by  cutting  parallel  with  the  upper  border  of  the  clavicle  and  along  the  inner 
border  of  the  sterno-mastoid — the  two  incisions  meeting  at  the  sterno-clavicular  articulation.  The  sternal  and  part  of  the 
clavicular  insertion  of  the  sterno-mastoid,  as  well  as  the  sternal  attachments  of  the  sterno-hyoid  and  sterno-thyroid  muscles,  were 
divided  and  turned  backward  with  the  ends  of  the  fingers  and  the  cellular  tissue  carefully  divided  with  a grooved  director.  The 
par  vagum  was  recognized  and  di'awn  inward,  and  the  internal  jugular  vein  outward.  The  artery  was  found  lying  quite  deep  below 
the  clavicle;  with  some  difficulty  the  aneurism  needle  was  passed  around  the  artery  from  below  upward  and  the  ligature  drawn. 
Hsemorrhage  ceased  from  this  moment,  but  it  was  evident  that  the  patient  was  sinking  rapidly.  He  died  in  about  half  an  hour. 
If  the  haemorrhage  had  not  occurred  he  could  not  in  all  probability  have  lived  many  days.  Autopsy  twelve  hours  after  death  : 

Body  much  emaciated.  The  ball  had  fractured  the  outer  third  of  the 
clavicle  and  the  first  rib.  It  had  opened  the  pleur.al  cavity  in  its 
course  and  had  fractured  the  spinous  processes  of  the  seventh  and 
eighth  cervical  vertebrae,  and  had  made  its  exit  on  the  left  side  of  the 
spinal  column.  The  hmmorrhage  from  the  subclavian  was  occasioned 
by  a sharp  spieula  of  bone  which  had  caused  ulcer.ation  of  the  coats  of 
the  artery.  The  right  pleural  cavity  contained  a large  quantity  of 
bloody  serum,  such  as  was  discharged  from  the  wound  previous  to 
death,  .and  the  lung  was  found  completely  hepatized.  It  is  probable 
that  a vein  was  ruptured  by  the  ball  iu  its  course,  and  that  the  bloody 
fluid  disch.arged  from  the  pleural  c.avity  before  the  arterial  heemor- 
rhage  occurred  was  a mixture  of  venous  blood  and  scrum ; but,  from 
the  disorganized  condition  of  the  tissues,  it  was  impossible  to  tell 
which  branch  had  been  severed.  The  wood-cut  (FiG.  251)  show's 
the  innominata,  right  carotid,  and  subclavian  arteries,  with  a ligature 
in  situ  on  the  subclavian  three-fourths  of  an  inch  from  its  origin.  It 
was  contributed,  with  a history  of  the  case,  by  the  operator. 


Sect.  III.] 


LIGATIONS  OF  THE  SUBCLAVIAN. 


547 


Case  25. — Private  Adam  Grimm,  Co.  D,  7th  Connecticut  Volunteers,  aged  21  years,  was  wounded  before  Petersburg, 
Virginia,  June  Dili,  1864,  by  a rifle  ball,  wliich  fractured  the  acromion  end  of  the  right  clavicle,  passed  beneath  the  scapula  and 
out  below  the  lower  border.  On  the  llth,  he  was  admitted  to  Hampton  Hospital  at  Fort  Monroe,  and  some  fragments  of  bone 
were  removed.  The  wound  looked  healthy  and  continued  discharging  laudable  pus  and  granulating  until  June  28th,  at  11  A.  M., 
when  secondary  haemorrhage  occurred  and  the  patient  lost  about  six  ounces  of  arterial'blood,  before  the  bleeding  could  be  arrested 
by  pressure.  On  the  29th,  haemorrhage  again  occurred,  more  severely,  than  before,  losing  from  fourteen  to  sixteen  ounces  of 
blood.  The  cavity  of  the  wound  was  by  this  time  much  enlarged.  The  haemorrhage  was  again  apparently  checked  by  plugging 
the  wound  with  lint  saturated  with  perchloride  of  iron,  but  in  two  hours  the  whole  of  the  tissues  between  the  wound  and  the  neck 
were  engorged  with  blood,  the  swelling  rapidly  increasing,  and  thus  showing  that  he  was  still  bleeding.  After  consultation  it 
was  decided  to  stimulate  freely  and  give  narcotics  to  relieve  pain,  and  let  him  remain  till  morning.  June  30th,  11  A.  M.,  being  in 
about  the  same  condition — the  tongue  dry  and  glazed,  pulse  120  and  very  weak,  and  with  the  engorgement  gradually  increasing — 
the  subclavian  was  ligated  successfully  in  the  first  part  of  its  course.  Coagula  were  then  removed  from  the  cavity  of  the  wound, 
and  it  was  syringed  with  ice  water,  no  bleeding  being  apparent.  Immediately  after  the  operation  he  rallied ; the  tongue  became 
moist;  pulse  at  left  wrist  110;  at  right  wrist  none.  The  temperature  of  both  arms  was  the  same  and  continued  so  throughout. 
July  1st,  10  P.  JI.,  left  pulse  110,  right  barely  perceptible.  Patient  in  good  spirits;  takes  nourislunent  freely,  but  complains  of 
pain  in  swallowing.  10  P.  M.,  left  pulse  112,  right  same  as  in  the  morning.  A sedative  was  administered.  July  2d,  left  pulse 
110,  right  increasing  a little  in  strength.  The  patient  improved  somewhat  until  the  7th,  at  which  time  the  left  pulse  was  90  and 
the  right  still  increasing  in  strength.  He  complained  of  pain  in  the  region  of  the  heart,  but  no  abnormal  sounds  were  heard. 
July  8th,  left  pulse  120  ; tongue  dry  and  glazed  ; at  9 P.  M.,  he  had  a rigor.  July  9th,  7 A.  M.,  a slight  hsemorrhage  occurred 
from  the  point  where  the  artery  was  Hgated ; the  wound  was  plugged  and  pressure  employed ; at  10  a.  m.,  the  hsemorrhage 
recurred  more  severely  than  before.  From  this  time  until  evening  there  were  repeated  haemorrhages ; the  patient  gradually 
sank  and  died  at  8 P.  Ji.,  remaining  sensible  to  the  last.  Necropsy : Both  the  supra-scapular  and  posterior  scapular  arteries 
were  found  to  be  in  a sloughing  condition,  which  was  apparently  the  cause  of  the  last  hsemorrhages.  The  subclavian  was  ligated 
about  half  an  inch  from  its  origin.  The  ligature  had  come  away  and  the  coats  of  the  artery  were  ulcerated  through.  On  the 
cardiac  side  a slight  clot  had  formed,  but  on  the  distal  side  the  clot  was  larger,  firmer,  and  more  perfectly  organized.  The  case 
is  reported  by  Dr.  Alexander  E.  Becker,*  of  Providence.  Rhode  Island,  from  notes  by  Acting  Assistant  Surgeon  C.  H.  Bullen. 

In  the  twenty-five  foregoing  cases,  the  ligations  were  on  the  right  side  in  thirteen,  in 
twelve  on  the  left.  The  patients  were  from  nineteen  to  thirty-nine  years  of  age,  the 
average  being  twenty-five  years.  The  interval  between  the  reception  of  the  injury  to  the 
date  of  ligation  varied  from  one  to  two  hundred  and  sixty  days.  The  average  was  about 
twenty  days  in  twenty-three  cases,  the  two  cases  of  traumatic  aneurism  in  which  the 
operation  was  done  at  a late  date  being  abstracted.  The  operations  were  all  for  the  results 
of  gunshot  injuries;  in  one  case  for  primary  hsemorrhage,  and  in  two  for  intermediary 
hsemorrhage  from  the  third  portion  of  the  subclavian;  in  eleven  for  intermediary  hsemor- 
rhago  from  the  axillary  or  its  branches;  in  two  cases,  for  secondary  haemorrhage  from 
ulceration  of  the  axillary,  and  in  nine  cases  for  false  aneurism  of  the  axillary.  The 
intervals  between  the  operation  and  the  fatal  termination  in  five  of  the  unsuccessful  cases 
w’ere  less  than  one  day;  in  one  of  the  fifteen  remaining  cases,  death  took  place  on  the 
third  day;  in  six,  from  the  fifth  to  the  eighth;  in  one,  on  the  tenth;  in  five,  from  the 
twelfth  to  the  fifteenth;  in  one,  on  the  twentieth,  and  in  one  on  the  forty-sixth  day. 
Twelve  patients  died  from  recurring  hsemorrhage  from  the  distal  side  of  the  ligated  point; 
three  died  from  pysemia,  and  three  from  .exhaustion  from  the  preceding  hsemorrhages;  one 
from  gangrene,  and  one  from  pleuritis.  The  assertion  of  Surgeon  Selden  that  the  latter  is 
the  most  frequent  cause  of  death  in  ligation  of  the  subclavian,  is  not  supported  by  these 
facts.  The  percentage  of  mortality  is  80  per  cent.,  or,  including  only  the  twenty-one  cases 
of  ligation  outside  of  the  scaleni,  76  per  cent.*)* 

* Becker,  On  Gunshot  Wounds,  Fiske  I'and  Prize  Essay,  1864,  p.  10. 

t In  Dr.  George  W.  Norris's  table  {Am.  Jour.  Med.  Set.,  N.  S.,  Vol.  X,  p.  13,  July,  1845),  compiled  with  the  conscientious  care  that  characterizes  all  of 
his  statistical  contributions  to  surgery,  sixty-nine  cases  of  ligation  of  the  subclavian  for  all  causes  are  recorded,  of  which  thirty-three,  or  47.8  per  cent.,  were 
fatal.  Dr.  Wilhelm  Koch’s  exhaustive  paper  ( Ueher  UnUrbindungen  und  Anturismen  dcr  Arlcria  suhclavia,  Arch.  f.  d.  kl.  Chir.,  B.  X,  H.  1,  S.  1915,  280, 
Berlin,  1869)  tabulates  two  hundred  and  twelve  cases,  and  classifies  them  according  to  the  indications  for  operation.  Of  seventy -tlirce  ligations  for  injury, 
forty-eight,  or  C5;7  per  cent.,  were  fatal.  Professor  Willard  Parker's  statistics  {Transactions  Am.  Med.  Assoc.,  Vol.  XVIII,  p.  246)  give  one  hundred  and 
ninety-six  ligations  of  the  subclavian,  with  a mortality  of  54.5  per  cent.  Of  seventy  of  these  operations  performed  for  other  causes  than  aneurism,  the 
mortality  was  C8.5.  At  page  422,  a case  of  ligation  (if  the  left  subclavian  in  the  third  portion  for  gunshot  wound  of  the  neck  is  recorded,  and  another  on  p. 
456,  in  Wounds  and  Injuries  of  the  Spine,  and  in  treating  of  Wound.i  of  the  Upper  Extremities,  in  the  second  volume,  I shall  enumerate  twenty-six  additional 
cases,  a total  of  fifty-three  cases,  with  forty-two  deaths,  a mortality  rate  of  79.2,  or  nearly  that  reported  in  (Mrcular  No.  6,  S.  (1.  O.,  ISfif),  p.  78,  from  an 
analysis  of  thirty-five  cases.  Dr.  Billroth,  in  his  Chirurgischc  Jtriefe,  1870,  S.  124,  gives  a most  vivid  and  interesting  account  of  five  ligations  of  the 
subclavian  in  which  he  operated  or  assisted  at  Weissenburg  and  Mamilieim.  One  patient  was  probably  saved. 


548 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Ligations  of  the  Internal  Mammary  Artery. — In  referring,  on  page  523,  to  wounds  of 
tliis  vessel,  four  examples  were  cited  in  wliicli  pressure  and  styptics  failed  to  control  the 
bleeding.  In  the  two  following  cases  the  ligature  was  equally  ineffectual: 

Case. — Private  Ambrose  Campbell,  Co.  A,  2d  New  York  Heavy  Artillery,  aged  21  years,  was  wounded  near  Petersburg, 
June  29th,  18C4,  by  a conoidal  ball,  which  entered  the  left  side  near  the  junction  of  the  osseous  with  the  cartilaginous  portion 
of  the  second  rib,  and  emerged  near  the  sterno-costal  articulation  of  the  second  rib  on  the  opposite  side  of  the  chest,  tearing 
away  in  its  course  the  cartilage  of  the  rib  on  the, left  side,  jiroducing  an  extensive  comminuted  fracture  of  the  sternum  and  sepa- 
rating the  cartilaginous  attachment  of  the  second  ilb  on  the  right  side  of  the  chest.  The  cavity  of  the  left  pleura  was  laid  open 
to  the  extent  of  two  inches,  and  the  corresponding  lung  wounded  by  a sjncula  of  bone  driven  inward  from  the  sternum  at  the 
time  of  injury.  He  W'as  at  once  conveyed  to  the  hospital  of  the  1st  division.  Ninth  Corp.s,  and  thence  transferred,  on  July  3d, 
and  admitted  into  Carver  Hospital,  Washington,  on  July  oth.  On  admission,  patient  manifested  symptoms  of  pleuro-pneumonia, 
accompanied  with  low  muttering  delirium  with  a tendency  to  sleep,  with  somewhat  lucid  intervals.  There  was  involuntary  dis- 
charge of  urine  ever  after  admission,  as  also  of  faces,  with  some  two  or  three  exceptions.  Pulse  not  more  frequent  than  in 
health,  full,  yet  more  hard;  skin  har.sh  and  dry,  yet  not  much  above  the  natural  temperature ; respiration  oppressed,  but  not 
labored.  Tbe  cavity  of  left  jileura  was  filled  with  a dark-brown  fluid,  which  was  occasionally  removed  by  gently  jdacing  the 
patient  in  a ])rone  jiosition,  allowing  the  fluid  fo  escape  through  the  orifice  of  fhe  wound,  but  for  four  or  five  days  prior  to  death 
it  was  partially  removed  by  the  use  of  a syringe.  In  the  latter  stage  of  the  disease,  fully  four  ounces  of  serum  were  effused  into 
the  cavity  daily.  These  s3'm])toms  continued  with  little  variation  until  July  13th,  when  profuse  hajmorrhage  occurred,  j)robably 
from  the  internal  mammary,  which  was  ligated  by  Surgeon  O.  A.  Judson,  U,  S.  V. ; there  was  not  less  than  twelve  ounces  of 
blood  lost,  and  the  patient  sank  more  rapidly,  and  died  on  July  19th,  1864.  Autopsy  showed  the  following:  Condition  of  right 
lung,  normal ; left  lung  hi  situ,  firndy  bound  down  to  wall  of  chest  by  recent  adbesion  ; a lacerated  wound  of  upper  surface  of 
upper  lobe  about  two  inches  in  extent,  which  was  gangrenous;  lower  anterior  portion  of  upper  lobe  gangrenous;  this  lobe  was 
congested  elsewhere,  except  at  apex ; lower  lobe  in  a state  of  red  hepatization ; liver  enlarged,  pale,  and  of  a nutmeg  appear- 
ance; spleen  enlarged,  did  not  present  its  usual  granular  appearance.  During  life,  the  pulsations  of  the  aorta  and  heart  were 
exjiosed  whenever  the  effused  fluid  was  removed.  The  treatment  of  fhe  case  consisted,  in  the  earlier  stages,  of  moderate  doses 
of  (luinine,  with  punch,  castor  oil,  and  cough  mixture;  in  latter  stages,  diffusible  stimulants  and  nourishing  diet.  Specimen  No. 
2925,  Sect.  I,  Army  Medical  Museum,  consists  of  the  seventh  cervical  tind  first  three  dorsal  vertebrae,  with  the  corresponding 
ribs  and  part  of  tbe  sternum.  The  second  left  rib  was  struck  at  its  costal  extremity  by  a bullet,  which,  passing  transversely, 
tore  away  the  cartilage,  comminuted  the  sternum,  and  separated  the  cartilaginous  attachment  of  the  second  right  rib;  the  sternum 
is  extensively  necrosed,  especially  on  its  internal  surface,  the  second  portion  of  which  shows  traces  of  periosteal  disturbance. 
The  specimen  and  histoiy  were  contributed  by  the  operator. 

As  is  well  known,  ligation  of  the  internal  mammary  is  esteemed  of  easy  performance 
in  the  first  three  intercostal  spaces,  difiicult  in  the  fourth,  very  difficult  in  the  fifth,  almost 
impracticable  in  the  sixtli  (Goyrand).  I do  not  know  that  it  has  occurred  to  any  one  to 
adopt,  in  securing  the  internal  mammary  near  the  xiphoid  appendix,  Gerard’s  method  for 
tying  the  intercostal,  until  the  following  operation  was  practiced  by  Surgeon  R.  B.  Bontecou, 
U.  S.  V.  One  would  suppose  that  the  mammary,  at  the  fifth  intercostal  space,  would  be 
too  distant  from  the  ensiform  cartilage,  to  permit  a mediate  ligature  of  this  sort  to  be  placed 
effectually.  The  ligature  did  not  control  the  bleeding  in  Dr.  Bontecou’s  case: 

Case. — Privafe  John  Gnlliii,  Co.  F,  65th  New  York  Volunteers,  aged  30  years,  was  wounded  at  Spottsylvania,  Virginia, 
May  8th,  1864,  by  a conoidal  ball,  which  entered  the  chest  on  the  left  side  between  the  sixth  and  seventh  ribs,  five  inches  below 
the  nipple,  and  emerged  between  tlie  fifth  and  sixth  ribs  on  the  right-side,  four  inches  below  the  nipple,  passing  under  the  ensi- 
form cartilage,  wounding  the  internal  mammary  artery,  and  opening  the  right  chest  cavity  and  lower  lobe  of  the  lung  on  that 
side.  He  was  conveyed  to  the  hospital  of  the  1st  division.  Sixth  Corps,  and  on  the  14th  was  transferred  to  Harewood  Hospital, 
WTxshington.  On  admission,  the  parts  were  in  a very  bad  condition.  The  patient  was  anaemic  and  feeble  from  haemorrhage. 
On  the  19th,  Surgeon  K.  B.  Bontecou,  U.  S.  V.,  administered  sulphuric  ether,  enlarged  the  wound  of  entrance,  and  passed  a 
piece  of  bandage  through  and  tied  it  over  the  ensiform  cartilage,  ligating  the  internal  mammary  artery.  Simple  dressings  and 
cold  ap])lication8  were  a]iplied,  and  sui)i)orting  treatment  administered.  The  patient  gradually  sank,  and  died  May  24th,  1864, 
from  recurring  hasmorrhage  and  pneumonia  of  the  right  lung.  The  case  is  reported  by  the  operator. 

We  are  indebted  ttj  Goyrand  for  the  best  method  of  proceeding  in  ligtdion  of  the 
internal  mammary.^  “An  incision  two  inches  in  lengtli  is  to  be  made  near  the  edge  of 
the  sternum  obliquely  from  above  downward  and  from  without  inward,  forming  with  the 

was  first  published  in  the  Lancette  Fran^aise,  September  3Uth,  1834,  and  is  quoted  by  Guthrie  {Ccynimaxtaries,  p.  518)  and  others.  It  is 
gratifying  to  know  that  his  nephew,  Dr.  Siebert,  has  lately  published,  in  a collected  form,  the  scattered  memoirs  of  the  surgeon  of  Aix,  who  attained,  in 
his  provincial  sphere,  a celebrity  scarcely  second  to  that  of  any  of  the  pupils  of  Dupuytren.  In  this  volume,  {Clinique  Chirurgicale,  du  Docteur 
GovhaM)  (d’Aix),  Paris,  1870,  8vo.,  pp.  588,)  tlio  modest  author  states  (p.  323)  that  he  conceived  and  practiced  this  opcratu.n  on  the  cadaver  ton  years 
before  he  printed  an  account  of  the  manual  procedure,  and  he  details  a highly  interesting  account  of  a sabre  wound  of  the  iiiterual  mammary. 


SIOCT.  III.] 


LIGATIONS  OF  THE  INTEKNAL  MAMMARY. 


549 


axis  of  the  body  an  angle  of  forty-five  degrees.  The  middle  part  of  this  incision  should  be 
three  or  four  line&  distant  from  the  margin  of  the  sternum,  and  in  the  centre  of  the  sternal 
extremity  of  the  intercostal  space.  Dividing  successively  the  skin,  the  cellulo-adipose 
subcutaneous  tissue,  and  the  great  pectoral  muscle,  the  intercostal  space  is  exposed.  An 
incision  is  then  to  be  made  in  the  same  direction  and  over  the  entire  width  of  the  space  of 
the  aponeurotic  layer  wliicli  continues  the  external  intercostal  muscle  and  the  superficial 
fasciculi  of  the  internal  intercostal.  Witli  a grooved  director,  the  fibres  of  the  latter 
muscle  are  to  be  separated  and  torn  through,  and  the  artery  and  its  two  venai  comites  are 
laid  bare  at  three  lines  from  the  edge  of  the  sternum,  which  separates  these  fibres  from 
the  pleura.  Then,  nothing  is  easiei  than  to  isolate  the  artery  and  to  slide  beneath  it  the 
curved  end  of  a grooved  director  or  other  suitable  instrument  for  passing  the* *thread.”  By 
following  these  directions  strictly,  the  operator  can  scarcely  miss  the  artery  on  the  injected 
dead  subject,  and  the  operation  is  not  difficult  in  the  upper  intercostal  spaces  on  the  living 
subject,  except  in  those  cases  of  gunshot  fractures  of  the  sternum,  cartilages,  and  adjacent 
structures,  in  which  the  relations  of  the  parts  are  disturbed.  A¥hen  there  is  an  open  wound 
and  the  adjacent  soft  tissues  are  swollen  and  infiltrated,  and  the  vessel  lacerated  and 
displaced,  the  operation  becomes  very  difficult.  Then  it  is  best  to  have  recourse  to  the 
plan  of  DesaulB  and  Zang^  and  to  place  over  the  wound  a fine  compress,  four  or  five  inches 
square,  to  press  the  centre  of  this  through  the  wound,  and  to  stuff  the  glove-finger  or  sac 
thus  formed  with  lint;  the  angles  of  the  compress  are  then  put  together,  and  the  pad  or 
ball  of  lint  is  drawn  gently  outward,  and  made  to  compress  the  wounded  vessel  against  the 
sternum.  To  keep  the  pad  in  place,  the  compress  may  be  tied  like  a purse,  and  the  ligature 
secured  around  a roller  or  other  convenient  cylinder.  Ndlaton^  advises  tliat  an  air-compressor 
in  the  shape  of  a bag  of  rubber  or  gold-beaters’  skin  be  introduced  and  insufflated  within 
the  chest. 

Ligation  of  the  Suprascapular  Artery. — An  instance  in  which  this  vessel  was  success- 
fully tied,  on  account  of  intermediary  haemorrhage  following  a gunshot  wound  of  the  neck, 
is  recorded  on  page  422.  In  the  following  case,  the  same  sound  practice  of  exposing  the 
bleeding  vessel  and  placing  a ligature  above  and  below  the  wound,  was,  if  the  brief  notes 
are  correctly  interpreted,  again  adopted  and  rewarded  by  a successful  issue: 


Casi:. — Private  Solomon  Sickles,  Co.  H,  14th  New  .Jersey  Volunteers,  aged  27  years,  was  wounded  at  Monocacy,  Mary- 
latnl,  .JulyDtli,  1834,  by  a conoidal  ball,  which  penetrated  the  lung  and  fractured  the  scapula.  lie  was  received  at  General 
Hospital,  Frederick,  Maryland,  on  the  next  day,  and  thence  transferred  to  .Jarvis  Hospital,  Baltimore,  where  he  was  admitted 
on  July2oth.  On  August  1st,  intermediary  haemorrhage  occuiTed,  prob.ably  from  a diffused  traumatic  aneurism,  .and  si.xteen 
ounces  of  blood  was  lost;  both  ends  of  the  posterior  and  superior  scapuhar  arteries  were  then  ligated.  There  w.as  no  recurrence 
of  the  haemorrhage  and  the  patient  was  doing  well  when  transferred  to  Philadelphia,  September  11th,  1864.  He  was  admitted 
to  General  Hospital,  Beverly,  New  Jersey,  September  13th,  1834,  and  thence  transferred  to  Whitehall  Hospital,  Bristol,  Pennsyl- 
vania, where  he  was  admitted  April  5th,  1865.  He  was  discharged  the  service  July  6th,  1865.  The  case  is  reported  hy 
Assistant  Surgeon  De  Witt  C.  Peters,  U.  S.  A.  Examining  Surgeon  .James  B.  Coleman,  Trenton,  New  Jersey,  reports,  October 
26th,  1868  : “Musket  ball  entered  the  left  side  about  two  inches  from  the  sternum,  broke  the  upper  surface  of  the  clavicle,  passed 
through  the  lower  part  of  the  neck,  and  came  out  through  the  upper  edge  of  the  scapula,  carrying  away  more  than  an  inch  of 
the  bone  down  to  its  spine ; many  fragments  of  bone  were  discharged  from  the  wounds,  fi'ont  and  back.  . The  shoulder  is  much 
emaciated,  weak,  and  m>iscles  much  contracted  in  their  movements;  the  arm  cannot  be  thrown  from  the  side  at  a greater  angle 
than  ten  degrees.  The  disqualification  for  manual  labor  is  entire  and  permanent  in  that  degree.” 


■Desault,  Journal  de  Chirurgie,  Paris,  1771. 

^Zano,  C.  15.,  Darslellung  blutiger  heilkunstlerischer  Operationen,  Wien,  182:3,  Theil  I,  S.  2:5:5. 

*X6L.vrox,  £le7n.  de  Path.  Chir.,  T.  Ill,  p.  4.>2.  The  instniracnts  of  this  description  desi/jned  fi  r tlie  treatment  of  ci)istaxi3  or  the  dilatation  of  the 
uterine  canal  are  fragile  and  unreliable.  The  materials  for  Desault  s tampon  are  always  at  hand,  and  the  compress  can  bo  made  strong  and  safe.  If  tho 
attempt  to  ligate  the  vessel  fails,  this  is  tlie  best  resource.  The  hazard  of  exciting  inllummation  in  the  iiloiira  and  lung  is  less  to  be  dreaded  tlian  tlio 
danger  of  hsemothorax.  It  is  approved  by  Velpeau  {op.  cit.,  T.  II,  p.  2(17). 


550 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Ligations  of  the  Intercostal  Artery. — Seven  cases  of  gunsliot  wounds  of  this  vessel 
have  been  reported,  on  page  526,  et  seq.  In  the  eight  following  cases  of  the  same  nature, 
attempts  were  made  to  control  the  bleeding  by  ligature;  but  six  of  the  eight  cases  resulted 
fatally.  In  the  first,  the  old  method  of  Gdrard,^  of  including  the  rib,  nerve,  and  veins  in 
the  ligature  was  adopted: 

Case. — Private  Smith  Scofield,  Co.  D,  Gth  Connecticut  Volunteers,  aged  21  years,  was  wounded  at  Drury’s  Bluff, 
Virginia,  May  14th,  1864,  by  a round  ball,  which  enttneil  the  right  side  of  the  chest,  just  posterior  to  the  angle  of  the  ninth  rib, 
passed  anteriorly,  fractured  the  ninth  and  tenth  ribs,  and  emerged  about  three  inches  anterior  to  angle  of  tenth  rib.  He  was 
treated  in  the  field,  and,  on  the  19th,  sent  to  the  hospital  at  I’oint  Lookout,  Maryland.  On  May  27th,  profuse  haemorrhage  from 
both  wounds  occurred,  which  was  only  controlled  by  cutting  down  and  joining  the  wounds  of  entrance  and  exit  in  the  track  of 
the  ball,  and  ligating  the  tenth  intercostal  artery  bypassing  a ligature  around  both  vessel  and  rib.  The  operation  was  performed 
by  Assistant  Surgeon  William  H.  Gardner,  U.  S.  A.  Cold-water  dressings  were  ajiplied.  The  haemorrhage  did  not  recur.  The 
patient  was  transfe'rred,  on  September  3d,  1864,  to  Connecticut  for  muster  out  of  service.  Examining  Surgeon  G.  B.  Upham,  of 
Yonkers,  New  York.  July  8th,  1867,  reports  ; “ The  wound  of  side  consists  in  having  portions  of  three  ribs  removed  by  a musket 
ball,  leaving  the  right  side  much  impaired  so  far  as  the  action  of  the  lung  is  concerned.  The  injury  to  the  arm  consists  in  having 
the  upper  portion  of  the  right  arm  impaired  from  the  effects  of  the  same  wound  in  the  right  side.  The  two  wounds  incapacitate 
the  applicant  one-half  and  ))ermanently.” 

One  great  objection  to  tlie  use  of  styptics  in  tliis  class  of  wounds  is  the  clanger  of  their 
falling  into  the  pleural  cavity,  and  the  emphtyment  of  powdered  substances  would  be 
especially  exposed  to  this  hazard.  Probably  the  opening  into  the  chest  was  obstructed,  in 
Dr.  Duer’s  case,  by  coagula  or  sloughs.  At  all  events,  the  result  was  successful: 

Case. — Private  Reuben  Morris,  Co.  K,  142d  Pennsylvania  Volunteers,  aged  2.5  years,  received  a gunshot  wound  of  the 
left  side,  between  the  tenth  and  eleventh  ribs,  at  Fredericksburg,  Virginia,  December  12th,  1862.  He  was  treated  in  the  field 
ami  was  transferred  to  Finley  Hospital,  Washington,  on  the  24th,  and  to  Convalescent  Hospital,  Philadelphia,  on  January 
11th,  1863.  On  January  20th,  secondary  hmmorrhage  occurred  from  the  intercostal  artery  to  the  amount  of  four  ounces.  Acting 
Assistant  Surgeon  Edward  L.  Duer,  tied  the  artery  at  one  extremity  in  the  wound ; the  hatmorrhage  did  not  recur.  After  the 
ligation  the  wound  was  filled  with  subnitrate  of  bismuth  and  a compress  applied.  This  dressing  was  allowed  to  remain  seventy- 
two  hours,  when  the  slough  came  away  with  the  dressing  and  the  sore  presented  a perfectly  healthy  appearance.  He  \vas 
discharged  from  service  June  13th,  1833.  The  case  is  rejxjrted  by  Assistant  Surgeon  V.  B.  Hubbard,  U.  S.  A.  Examining 
Surgeon  Charles  Mace,  of  Scranton,  Luzerne  County,  Pennsylvania,  reported,  June  22d,  1863:  “Morris  was  wounded  through 
his  left  side,  fracturing  two  ribs.  Disability  one-half.”  He  was  last  paid  on  March  3d,  1872. 

In  the  next  case,  the  attempt  to  tie  the  vessel  was  unsuccessful,  tbougli  undertaken  by 
an  experienced  medical  officer.  Surgeon  T.  Antisell,  U.  S.  V.: 

Case. — Private  Alfred  McClay,  Co.  E,  ll4th  Pennsylvania  Volunteers,  aged  17  years,  was  wounded  at  Fredericksburg, 
Virginia,  December  13th,  1862,  by  a conoidal  ball,  which  entered  the  right  side  at  the  costal  cartilage,  and  emerged  at  the  angle 
of  the  ninth  rib,  fracturing  the  lil)  between  the  point  of  entrance  and  exit.  He  was  treated  in  the  field,  and,  on  December  17th, 
was  sent  to  Harew'ood  Hos])ital.  When  admitted,  he  suffered  from  traumatic  pneumonia,  which  was  treated  by  venesection  and 
the  administration  of  morphia  and  antimony.  He  recovered  sufficiently  to  be  able  to  move  about  the  ward.  The  wound  healed 
kindly.  On  January  llth,  a profuse  htemorrhage  occurred  from  the  wound,  probably  from  intercostal  artery,  which  continued 
in  spite  of  compression.  An  unsuccessful  attempt  was  made  to  ligate  the  artery.  The  htcmorrhage  was  finally  suppressed, 
after  an  alarming  loss  of  blood,  by  tight  bandaging  and  styptics.  The  stoppage  of  tlie  haBinorrhage  was  immediately  followed 
by  pain  on  both  sides,  cough,  and  expectoration.  Pyatmia  set  in,  and  death  occurred  on  January  24th,  1863.  Necropsy : No 
opening  had  been  made  into  the  cavities,  either  by  the  missile  or  ulceration.  Eight  abscesses,  from  the  size  of  a pea  to  that  of 
an  orange,  were  found  in  the  lower  lobe  of  the  left  lung,  which  was  also  in  a ver}'  congested  condition. 

Case. — Private  J.  B.  Bruce,  Co.  C,  31st  Alabama  Regiment,  aged  17  years,  was  wounded  in  the  chest  by  a minio  ball 
and  taken  prisoner  at  the  battle  of  Shiloh,  April  6th,  1862.  Assistant  Surgeon  B.  Howard,  U.  S.  A.,  in  a report  of  the  case 
published  in  The  American  Medical  Times,  Vol.  VI,  page  52,  says:  “ My  attention  was  specially  called  to  his  case  the  second 
day  out  from  Pittsburg  Lauding  by  my  friend  Dr.  Busli,  sr.,  of  Lexington,  Kentucky,  because,  of  the  many  cases  of  wounds  of 
the  chest  on  board  the  transport,  this  was  one  of  the  very  few  in  which  the  ball  had  lodged.  The  patient  had  a rather  favorable 
appearance,  and  the  wound  looked  well,  with  no  tendency  to  hatmorrhage.  April  17th,  patient  was  admitted  to  General 
Hospital,  Louisville,  Kentucky,  with  gunshot  wound  of  the  chest,  fracturing  the  ninth  rib  about  three  inches  to  the  left  of  the 
spinal  column.  The  usual  symptoms  of  gunshot  wound  of  the  lung  which  were  present  gradually  disappeared ; the  hectic  which 
ensued  had  ceased,  and  the  patient,  though  very  weak,  was  convalescing  with  remarkable  rapidity ; medication  had  been  discon- 
tinued, the  only  remaining  treatment  consisting  in  the  use  of  simple  dressing  and  bandage  to  the  healing  wound.  April  29th : 
Galling  accidentally  at  the  hospital  at  about  one  o’clock  P.  M.,  1 was  informed  an  orderly  had  been  dispatched  to  request  me  to  visit 
the  patient  immediately.  Secondary  hasmorrhage  had  suddeidy  occurred,  the  bed  was  already  saturated  with  blood,  and  the  patient 
almost  in  a state  of  syncope.  A medical  officer  had  been  trying  in  vain  to  stop  the  bleeding  for  about  half  an  hour,  and  when  I 


‘(ff:uAUI),  in  Dionis,  Cours  d' Operations  de,  Ctiirurpie,  e<l.  La  Faye,  Paris.  1771,  p.  IMl. 


SiX'T.  III.] 


LIGATIONS  OF  THE  INTERCOSTAL. 


551 


entered  was  controlling  it  by  pressure  on  the  wound.  I slightly  enlarged  the  wound,  and  discovering  with  my  little  finger  a 
good  many  small  fragments  of  comminuted  hone,  carefully  removed  some  of  them  with  dressing  forceps.  Meanwhile,  the  arterial 
jet  was  becoming  stronger  and  the  patient  momentarily  weaker.  There  was  evidently  no  time  to  be  lost.  Pressure  at  the 
wound  was  quickly  supplied  and  steadily  kept  up.  Stimulus  w'as  administered,  and  tin*  patient  being  jdaced  ui)on  the  tahk^  was 
put  under  chloroform.  An  incision  was  then  made  on  the  proximal  side  of  the  wound  about  an  inch  and  a half  in  length, 
beginning  about  half  an  inch  to  the  right  of  the  margin  of  the  wound  and  extending  along  the  middle  of  the  posterior  surface  of 
the  ninth  rib,  the  middle  of  the  incision  being  about  an  inch  and  a quarter  from  the  wound  in  order  that  spicula  of  bone  might 
not  interfere  with  the  subsequent  steps  of  the  operation.  Having  laid  bare  that  part  of  the  rib  and  carefully  defined  its  superior 
margin,  I took  the  blunt-pointed  strongly-curved  needle  belonging  to  the  chain  saw,  armed  it  with  a well-waxed  ligature,  and 
introduced  it,  passing  it  immediately  over  the  superior  margin  of  the  rib  at  the  middle  of  the  incision.  The  lips  of  the  incised 
wound  were  well  retracted,  so  that  the  eye  of  the  needle  could  be  sufficiently  depressed  to  maintain  the  contact  of  its  blunt  point 
with  the  inner  surface  of  the  rib  until  it  emerged  at  its  inferior  margin  opposite  the  point  of  entrance.  The  ligature  was  then 
tied,  including  both  the  rib  and  ai'tery.  The  bleeding  stopped  instantly.  In  order  to  make  the  success  secure,  I repeated  the 
operation  in  the  same  manner  at  the  distal  side  of  the  gunshot  wound.  The  soft  parts  were  then  brought  together  and  secured 
by  sutures  and  adhesive  straps.  The  patient  rallied  from  the  effects  of  the  chloroform,  conversed  rationally,  but  sank  from 
exhaustion  and  died  about  three  o’clock  P.  M.  The  autopsy  relieved  me  of  the  chief  objection  which  appeared  to  present  itself 
to  the  operation,  for  after  careful  examination  it  was  found  that  in  the  case  of  both  ligatures  the  pleura  costalis  was  not  pierced. 
When  the  usual  means  had  failed,  a tedious  attempt  was  made  in  a case  that  came  under  my  observation  to  secure  the  bleeding 
ends  of  the  artery,  but  without  success.  In  such  a proceeding  there  must  be  great  danger  either  of  creating  an  opening,  or  of 
enlarging  one  already  made  into  the  cavity  of  the  chest.  The  operation  with  the  needle  as  described  above,  has  the  following 
advantages  where  ordinary  means  have  failed : The  bleeding  is  stopped  from  the  first  moment  of  seeing  the  patient,  as  it  can 
always  be  controlled  by  pressure  at  the  wound  until  the  operation  is  completed.  Pneumothorax  need  not  be  apprehended,  as  the 
pleural  cavity  is  not  penetrated,  and  even  though  it  were,  the  operation  being  subcutaneous,  would  not  be  likely  to  cause  it.  A 
silver-wire  ligature,  which  it  would  be  better  to  use,  would  not  produce  pleuritis  of  a serious  character  even  though  the  pleura 
were  pierced;  the  ligature  could  be  twisted  as  tightly  as  necessary  without  danger  of  breaking  and  be  withdrawn  at  pleasure. 
From  the  relation  of  the  artery  to  the  rib,  more  certain  success  might  be  anticipated  from  this  operation  anterior  to  the  angle  of 
the  rib.  In  the  case  given  above,  after  all  other  means  had  been  tried  in  vain,  the  success  of  the  operation  was  instant  and 
complete,  and  but  for  the  previous  loss  of  blood  would  probably  have  saved  the  life  of  the  patient.” 

Case. — Private  Patrick  F.  W , Co.  A,  33d  Ohio  Volunteers,  received  a penetrating  gunshot  wound  of  the  chest  at 

Chickamauga,  Georgia,  September  20th,  18C3;  the  missile  entered  four  inches  below  the  right  axilla,  passed  backward,  and 
emerged  at  the  lower  angle  of  the  scapula.  He  was  taken  prisoner  and  remained  in  the  hands  of  the  enemy  until  September 
30th,  when  he  was  paroled  and  sent  to  the  hospital  at  Chattanooga,  Tennessee.  Haemorrhage  occurred  several  times  during  the 

night  of  October  4th;  an  examination  on  the  next  day  showed  the  skin  to  bo 
swollen  with  an  accumulation  of  blood;  the  patient  w’as  exceedingly  feeble  and 
almost  deadly  pale.  Surgeon  I.  Moses,  U.  S.  V.,  administered  ether,  dilated  the 
wound,  turned  out  all  the  clots,  and,  after  some  difficulty,  succeeded  in  ligating  the 
intercostal  artery.  Some  spicula;  were  removed,  but  it  was  not  deemed  safe  to 
continue  the  use  of  the  ana;sthetic  longer  and  the  patient  was  aroused.  No  further 
haemorrhage  occurred  and  he  promised  admirably,  but  about  the  end  of  the  month 
he  began  to  fail,  and  died  of  empyema  of  the  same  side.  Necropsy;  The  lung 
had  been  wounded  and  adhered  closely  to  the  edges  of  the  wound.  The  hnver 
part  of  the  pleura  contained  dark  unhealthy  i)us,  while  the  upper  part  was  filled 
with  an  infiammatory  secretion.  The  pathological  specimen  showing  the  lower 
third  of  the  right  scapula  and  the  adjoining  portions  of  the  seventh,  eighth,  ninth, 
and  tenth  ribs,  is  represented  in  the  wood-cut  (Fig.  252).  The  extremity  of  the 
scapula  is  carried  away,  the  tenth  rib  comminuted,  and  the  ninth  contused.  The 

^ ^ . „ . . . fractured  extremities  are  necrosed.  The  thoracic  surfaces  show  free  deposits  of 

Fig.  252. — Portions  of  ng;ht  scapula  and  nbs,  snow-  . .ii.,,. 

ini^  gunshot  fractures  of  exit.  A^iec.  2124,  Sect.  I,  A.  osseous  matter,  which  agglutinate  them.  It  was  contributed,  with  a history  of 

the  case,  by  the  operator. 

Case. — Private  James  Mahew,  Co.  D,  100th  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  North  Anna  River, 
Virginia,  May  24th,  1864,  by  a conoidal  musket  ball,  which  entered  the  left  side  and  fractured  the  twelfth  rib.  He  was  received 
into  the  field  hospital  of  the  1st  division.  Ninth  Corps.  Spicula;  of  bone  were  reqioved  and  an  intercostal  artery  was  ligated. 
Death  sujiervened  two  days  after  the  reception  of  the  injury.  The  case  is  reported  by  Surgeon  M,  K.  Hogan,  U,  S.  V. 

Case. — Private  J.  H.  Butterfield,  Co.  F,  3d  Vermont  Volunteers,  aged  26  years,  was  w'ounded  at  Lee’s  Mills,  Virginia, 
April  16th,  1862;  the  ball  entered  the  integuments  at  the  seventh  rib,  a little  posterior  to  the  nipple,  and  emerged  six  inches 
posteriorly,  fracturing  in  its  course  the  eighth  and  ninth  ribs.  He  was  treated  in  the  field  until  the  20th,  when  he  was  transferred 
to  Hygeia  Hospital,  Old  Point  Comfort,  Virginia.  When  admitted  the  patient  was  suffering  from  chills,  followed  by  jirofuse 
perspiration.  April  2.5th,  considerable  htemorrhage  occurred  from  the  intercostal  artery.  Surgeon  R.  B.  Bontecou,  U.  S.  V., 
operated  by  uniting  the  wounds  of  entrance  and  exit  by  incision,  and  cutting  off  the  fractured  ends  of  the  ribs  with  the  bone 
forceps,  leaving  the  periosteum  and  vessel  untouched.  The  intercostal  artery  was  picked  up  by  the  tenaculum  and  ligated.  The 
pleural  cavity  did  not  seem  to  have  been  opened  by  the  ball,  but  the  motion  of  the  cut  end  of  the  tib  wore  an  opening  and  also 
divided  the  artery,  and  hsemonhage  again  occuned.  Two  da3's  after,  the  vessel  was  again  tied  and  the  rib  cut  off  still  further. 
Only  supporting  treatment  was  used,  together  with  quipine.  The  patient  continued  to  sink,  and  died  May  4th,  1862,  froip 
exhaustion. 


552 


WOUNDS  AND  INJUPJES  OF  TIIR  CTTEST. 


[Chap.  V, 


Case. — Private  Thomas  Adams,  Co.  C,  7th  Wisconsin  Yolnnteers,  aged  18  years,  was  wounded  at  the  batth;  of 
Sjaittsylvania,  Virginia,  May  lOtli,  1864,  hy  a conoidal  musket  hall,  which  passed  througli  tlie  left  arm  and  lodged  in  the  lung.  He 
reached  Alexandria,  Virginia,  several  days  after  being  wounded,  and  was  admitted  to  the  5id  division  hospital.  Haemorrhage 
occurred  from  an  intercostal  artery  on  May  18th,  and  again  on  the  following  day.  For  this  compression  was  resorted  to,  and 
an  unsuccessful  attempt  at  ligation  was  made  by  Surgeon  T.  Push  Spencer,  U.  S.  V.,  at  the  entrance  wound  in  the  chest,  about 
three  inches  in  front  of  the  angle  of  the  sixth  rib.  The  fifth  intercostal  space  was  found  very  narrow  at  this  point,  the  wound 
in  the  pleura  very  deep,  and  the  obstacles  to  tying  the  vessel  were  insurmountable.  Compression  by  jdugging  the  wound  and 
closing  the  orifice  as  nearly  as  practicable.  Sixteen  ounces  of  blooel  were  lost  on  the  occasion  of  the  third  bleeding.  Death 
resulted  on  May  19th,  1864.  At  the  autopsy,  the  left  pleural  cavity  was  found  to  contain  much  blood.  The  ball  was  lodged  in 
the  lower  lobe  of  the  lung  of  that  side. 

Of  these  eight  cases  of  ojiemtions  on  the  intercostal,  three  were  for  secondary  and  four 
for  intermediary  haemorrhage,  and  one  for  primary  bleeding  after  gunshot  wounds.  Six 
cases  were  fatal ; one  from  pyaemia,  one  from  empyema,  one  failed  to  react,  and  three  had 
recurrent  haemorrhage.  The  operations  had  scarcely  more  satisfactory  results  than  the  cases 
treated  by  compression.  Desault’s  excellent  means  of  compression  by  the  compress  stuffed 
with  lint  does  not  appear  to  liave  been  employed  in  any  of  the  fifteen  cases.  It  merits  a 
trial  whenever  a ligature  cannot  be  made  satisfactorily,  and  without  tying  in  the  rib.  If 
the  pleura  and  lung  are  intact,  the  risk  of  wounding  these  organs  is  avoided,  and  if  they 
are  already  wounded,  it  is  the  least  irritating  dressing  that  can  be  employed.  There  is  no 
danger  of  losing  the  little  pad  within  the  pleural  cavity,  as  has  happened  in  plugging  the 
wound  with  sponge  or  charpie;  and  it  can  be  further  said  in  favor  of  this  method  that  it 
has  proved  successful  in  a considerable  number  of  cases  (Begin,  Velpeau,  Jamain)  in 
controlling  the  haemorrhage  without  exciting  inflammation  in  the  lung  or  pleura.  The 
authorities  cited  in  the  foot-note  discuss  many  other  plans  of  dealing  with  this  troublesome 
form  of  haemorrhage.  Some  of  them  are  dangerous,  others  trivial,  and  others  again  more 
ingenious  than  useful. 

* GEitAitD  (note  by  La  Faye  in  his  edition  of  the  Cours  d’Operations  of  DIONIS,  1740,  p.  425)  first  proposed  to  control  bleeding  from  the  intercostal 
artery  hy  passing  a ligature  around  the  rib  and  interposing  a pledget  of  lint  between  the  ligature  and  the  inner  surface  of  the  rib.  He  inserted  the  thread 
at  the  wound  with  a sharp  curved  needle  and  brought  it  out  through  the  intercostal  space  above.  GOULAIIP,  of  Montpelier  {Mem,  de.  I'Acad.  dcs  Sciences^ 
1740),  and  Gauengeot  ( Traite  dcs  Ojicrations  de  Chirurgie,  I’ezcnas,  1777,  T.  II,  p.  430),  endeavored  to  avoid  a second  wound,  by  employing  a blunt 
needle,  with  the  eye  near  the  extremity,  and  a very  abrupt  curve,  and,  by  keeping  close  to  the  rib,  to  bring  the  thread  out  at  the  first  opening.  LebeU  (in 
PlknCK,  Samlung  von  Bcdbacht ungen,  I>.  II.  S.  210)  passed  a riband  by  a flat  flexible  probe  througli  a new  opening  made  in  the  intercostal  space  above. 
Steidele  {Ahhandlung  von  den  BIu{/tilssen,  Wien,  1776,  S.  77)  proposed  to  substitute  a silver  probe  cur\’ed  in  S,  and  BoriCiiEit  {Audi  cine  Compressions- 
meihodef.  d.  Arteria  intercostalis,  in  dessen  Ahhandlung  v.  d.  Krankheitcn  der  Knochen,  Leipsig,  1795,  S.  233)  proposed  a bent  bulbous  steel  probe  with 
an  eyelet.  Reich  (VELPEAU,  Nouv.  £lem.  de  Med.,  Op.  T.  II.  p.  265)  advised  that  both  ends  cf  the  ligature  should  be  passed  through  a piece  of  gum 
catheter  before  knotting.  If,  with  the  aid  of  these  suggestions,  the  operator  succeeds  in  ligating  the  intercostal  with  the  rib,  he  may  contemplate  with 
Sabatier  {De  la  Mcdecinc  Operatoirc,  6d.  dc  Sanson  et  Begin,  1812,  Tk  II)  the  dangers  of  iiuncturing  the  pleura,  of  necrosis  from  denudation  of  the  rib,  and 
of  the  pledget  or  tent  falling  into  the  pleural  cavity.  The  plans  for  tying  the  artery  above,  or  the  artery,  vein,  and  nerve  together  are  also  numerous. 
Reybard  {Mem.  &ur  le  Traifement  des  Plaits  Penetrantes  de  la  Poitrine,  Paris,  1827,  p.  SCO)  and  Nevermann  {Ueber  das  heste  Verfahren,  cim 
Hsemorrhagie  der  Art,  intercostalis  nach  Verwundungen  zu  stillen,  in  Berliner  IMed.  Centralzeitung,  Ang.  6,  1836)  propose  to  use  sttiphyloraphic  or  other 
jointed  needles  to  pass  the  thread;  Grossiiedi  ( V.  Graefe  nnd  V.  Walthcr's  Jour.)  recommends  Arendt’s  aneurism  needle,  which  Chelius  {Ueber  das 
Verletzung  der  arteria  intercostalis  in  gerichtlich  Medicinischer  Ilinsicht  in  Heidelb.  Klin.  Annalen  B.  Ill,  H.  2)  condemns.  B.  Bell  {A  System  of 
Surgery,  7th  ed.,  1804,  Vol.  1,  p.  258)  insists  that  in  thin  people,  it  is  always  practicable  to  expose  the  vessel  and  to  take  it  up  with  a sharply  curved 
tenaculum.  This  failing,  he  would  resort  to  I^eber’s  plan.  Assalini  {Manuals  di  Ckirurgia,  p.  57)  advises  that  the  artery  be  cut  across  and  allowed  to 
retract,  and  ThedEN  ( Willd.  vernwundete  Arteria  intercostalis  ganz  durchschneideii  und  zurilcl'schieben ; dessen  neue  Bemerk.  und  Erfabr.  Th.  I,  Berlin, 
1782,  S.  59)  contends  that  bleeding  may  always  be  stanched  by  ccrnplcting  the  division  of  the  artery,  turning  back  its  posterior  extremitj’-,  and  plugging 
the  wound.  GutiIRIE  {Commentaries,  L c.  p.  519)  met  with  no  difliculty  in  using  torsion  in  one  case,  and  the  ordinary  ligature  in  another.  BILGUKU 
(Pract.  Anweizung  fiir  Fcldwunddrzte,  Berlin,  1783,  S.118)  and  lllCHTER  {Chirurgischc  Bibliothch,  Gottingen,  B.  IV.  S.  C95)  applauded  the  plan  of  tying 
a stout  thread  about  the  middle  of  a tent,  introducing  the  latter  horizontally  through  the  wound,  which  is  enlarged  if  necessary,  then  placing  the  tent 
vertically  and  drawing  upon  the  chord,  thus  compressing  the  artery,  and  the  edges  of  the  two  adjacent  ribs  as  well,  as  Velpeau  remarks.  Lotieri,  of 
Turin  {Ilistoire  de  V Academic  royalc  dc  Chirurgie,  p.  XCV,  appended  to  the  second  volume  of  the  Memoirs  of  the  Academy,  4"^,  Paris,  1753),  invented  a 
steel  plate,  with  a pad  and  perforations  at  the  ends  for  passing  a riband,  and  proposed  to  introduce  this  instrument  within  the  chest  to  make  direct  compression 
on  the  artery.  Quesxay  (in  Sabatier.  1.  c.,  p.  84)  substituted  an  ivory  whist-marker,  with  a dossil  of  lint  for  a pad,  and  perforations  for  a tape  to. keep  the 
instrument  in  place.  BELLOQ  {Mem.  dc  CAcad.  de  Chir.  T.  II,  p.  121,  Plate  IV)  found  all  their  plans  defective  and  invented  a complicated  tourniquet  or 
vice  with  steel  convex  disks,  between  which  the  rib  and  its  vessels  were  to  be  compressed.  The  employment  of  these  machines  involved  the  necessity  of 
a very  large  wound  in  the  chest.  Digital  compression  by  relays  of  assistants  has  found  its  advocates  (according  to  VELPEAU,  1.  c.,  p.  2GG).  LOEFELER 
{Blutsiillung  aus  d.  Arteria  intercostalis,  in  Blumcnbach's  IMed.  Bibliothek,  B.  Ill,  S.  511,  Gottingen,  1794)  teaches  that  the  intercostal  space  should  be 
opened  and  the  artery  tied  posteriorly  to  the  wound,  leaving  the  latter  open  for  the  discharge  of  blood  and  secretions.  I^rofessor  GROSS,  {Op.  cit.,  5th  ed., 
Vol.  ir,  p.  444)  proposes  to  drill  a small  aperture  into  the  rib,  immediately  above  the  artery,  and  to  pass  a silver  wire  around  its  bleeding  orifice.  CHET.irs 
{South's  Translation,  Am.  ed.,  1.  c.,  T.  J,  p.  492)  well  observes  that  bleeding  from  the  interccstal  arterj''  is  often  obsei^’ed  by  the  military  surgeon  in 
connection  with  laceralifin  of  the  lung,  and  that  most  <.f  the  methods  above  mentioned  increase  the  bleeding  from  that  organ.  AVhen  the  intercostal  artery 
is  wounded  between  the  sternum  and  angles  of  the  ribs,  where  the  majority,  perhaps,  of  wounds  of  the  chest  occur,  the  vessel  does  not  always  bleed  freely; 
hut  posteriorly  a wound  almost  iiivariably  causes  profuse  bl(‘(Mling.  ami  liore  the  vessel  is  secure<l  with  much  diflleul'.y  on  account  of  its  depth. 


Sr.cT.  III.] 


LIGATIONS  OF  TITK  AXTLLALY. 


55B 


Ligations  of  the  Asillary  Artery. — Besides  the  largo  numljOT  of  ligations  of  llic 
axillary  after  wounds  of  the  arm,  which  will  be  detailed  hereafter,  there  were  thirteen 
cases  in  which  this  vessel  was  tied  for  haemorrhage  attending  gunshot  wounds  of  the  chest. 
The  result  was  unsuccessful  in  every  instance.  The  patients  were  from  eighteen  to  twenty- 
five  years  of  age,  the  average  being  twenty-one.  The  operation  was  on  the  right  side  in 
five,  on  the  left  in  eight  instances.  It  was  performed  for  early  bleeding,  from  wounds  of 
the  axillary  or  brachial  in  three  cases;  in  ten,  for  intermediary  haemorrhage,  occurring  from 
the  tenth  to  the  eighteenth  day  after  the  reception  of  the  injury.  Three  of  the  patients 
died  on  the  day  of  the  operation,  the  others  from  the  third  to  the  thirteenth  day.  In  the 
first  case  the  operation  was  performed  for  primary  bleeding  from  the  brachial : 

Case  1. — Private  James  Leddie,  Co.  E,  llStli  New  York  Volunteers,  was  wounded  at  Petersburg,  Virginia,  .June  30tb, 
1SG4,  by  a musket  ball,  wliicli  entered  the  upper  third  of  the  left  arm,  passed  behind  the  bone,  wounding  the  brachial  artery,  and 
emerged  two  inches  below  the  middle  of  the  clavicle.  He  was  conveyed  to  the  hospital  of  the  1st  division.  Eighteenth  Corjis, 
where  the  left  axillary  artery  was  ligated  in  the  axilla  on  account  of  persistent  hasmorrhage  on  July  1st.  Patient  pale,  arm  cold, 
foiearm  almost  pulseless.  Sen.sation  .absent  from  hand  and  part  of  forearm.  Death  resulted  on  July  2d,  1834.  The  case  was 
reported  by  the  operator.  Surgeon  T.  II.  Squire,  80th  New  York  Volunteers. 


Case  2. — Private  Michael  Foley,  Co.  K,  11th  Illinois  Cavalry,  aged  20  years,  a robust  and  healthy  man,  was  wounded 
near  Vicksburg,  Missi.ssippi,  March  3d,  1834 ; the  ball  struck  near  the  margin  of  the  pectoral,  passed  backward,  inward,  and 
upward,  and  lodged  in  the  muscles  of  the  back,  between  the  scapula  and  spinal  column;  the  axillary  artery  was  severed  in  its 
lower  third.  He  fainted  from  loss  of  blood,  when  wounded.  On  the  fth,  he  w.as  conveyed  to  Hospital  No.  2,  Vicksburg.  When 
admitted,  there  was  .some  fever;  pulse  90,  full  .and  moderately  strong.  Skin,  secretions,  and  appetite  in  tolerably  good  condition. 
The  wound  was  painful,  but  he  had  slept  some,  was  cheerful,  and  did  not  suppose  himself  dangerously  wounded.  The  arm  was 
considerably  swollen;  extensive  ecchymosis  of  arm  and  chest;  no  hmmorrhage;  wound  healthy ; suppuration  commencing.  No 
pulsation  below  the  wound;  arm,  forearm,  and  hand  warm.  Collateral  circulation  good.  Assistant  Surgeon  W.  B.  Trull, 
U.  S.  V.,  administered  chloroform,  enlarged  the  wound,  and  ligated  the  ])roximal  end  of  the  axillary  artery  in  the  wound  three- 
fourths  of  an  inch  above  the  injuiy.  Very  little  hmmorrhage  occurred.  The  p.atient  reacted  finely.  On  the  7th,  the  ball  was 
cut  down  upon  and  removed.  He  did  well  until  the  Sth,  when  the  ligature  separated,  and  intermediary  hannorrhage  came  on  to 
the  amount  of  thirty-two  ounces.  The  arm  was  considerably  swollen  but  the  wound  was  not  unhealthy.  The  patient  was  feeble, 
pale,  and  anxious;  pulse  rapid  and  weak.  Chloroform  was  again  administered,  and  the  artery  religated  half  an  inch  higher  uj) 
in  the  wound.  He  gradually  sank,  and  died  on  March  10th,  1864.  from  exhaustion,  the  .axillary  artery  having  sloughed  after  the 
first  ligation.  The  post-mortem  examination  revealed  nothing  additional  except  the  precise  points  of  the  ligations  of  the  artery. 
The  second  ligation  was  one-third  of  an  inch  above  the  external  circumflex  artery.  The  case  is  reported  by  Surgeon  Edward  L. 
Hill,  20th  Ohio  Volunteers. 

Case  3. — Corporal  Alfred  Hollingshead,  Co.  H,  12th  Kentucky  Volunteers,  was  wounded  at  Marietta,  Georgia,  June  21st, 
1834,  by  a pistol  ball,  which  entered  at  the  upper  third  of  the  right  arm,  passed  inward  to  the  chest,  and  emerged  at  the  third 
dorsal  vertebra.  He  was  taken  to  the  field  hospital  of  the  Twenty-third  Corps.  On  June  23d,  paralysis  of  motion  and  sensation 
in  the  arm  ensued.  Surgeon  Edward  Shippen,  U.  S.  V.,  enlarged  the  wound  and  ligated  the  axillary  artery  ; the  brachial  artery 
w.as  .also  ligated  below  the  wound.  Mortification  supervened  in  the  course  of  forty-eight  hours,  and  death  resulted  on  June  26th, 
18C4.  The  case  is  reported  by  Surgeon  A.  M.  Wilder,  U.  S.  V. 


Case  4. — Private  William  Hall,  Co.  H,  15th  United  States  Infantry,  aged  19  years,  while  lying 
in  his  tent  at  Mobile,  Alabama,  January  11th,  1866,  was  wounded  by  the  accidental  discharge  of  a musket 
in  the  hands  of  a comrade.  The  ball  entered  the  right  side  just  below  the  c.artilages  of  the  false  ribs, 
fracturing  in  its  passage  the  eighth  rib;  it  then  emerged,  and  entering  the  axilla,  traversed  the  arm,  and 
passed  out  posteilorly  at  the  top  of  the  shoulder.  The  humerus  was  not  injured.  He  was  taken  to  the 
post  hospital  at  Mobile.  Before  admission  he  was  said  to  h.ave  lost  a bucketful  of  blood.  When  admitted 
ho  was  in  a state  of  syncope,  was  unable  to  speak,  and  almost  pulseless.  The  extremities  were  cold. 
Powerful  stimulants  were  immediately  administered.  Very  slight  haimorrhage  occurred  from  either  wound. 
He  continued  to  improve  steadily  until  the  morning  of  the  20th,  when  he  was  attacked  with  profuse 
limmonliage,  which  came  from  the  neighborhood  of  the  axillary  artery.  He  lost  ahout  fifteen  ounces  of 
blood.  The  usual  compression  was  applied  and  the  haimorrhage  ceased.  On  the  morning  of  the  21st,  a 
second  hsemorrhage  occurred,  by  which  he  lost  about  twenty  ounces  of  blood.  On  the  22d,  the  prostration 
was  so  extreme  and  the  prospects  of  controlling  the  continued  oozing  so  remote,  that  a consultation  was 
held,  and  it  was  determined  to  put  him  under  the  influence  of  chloroform  and  tie  the  artery.  A very 
small  quantity  of  the  vapor  sufficed,  and  after  a great  deal  of  difficulty,  owing  to  the  gre.at  swelling  and 
purulent  matter  in  the  wound,  the  artery  was  tied  with  a single  ligature  by  Acting  Assistant  Surgeon 
1\.  W.  Coale.  During  the  operation  several  pieces  of  cloth  were  extracted,  and  also  two  pieces  of  sub.stance 
which  had  the  appearance  of  portions  of  an  artery  and  which  suhsequently  prov(>d  to  be  such.  On  the 
extraction  of  the  cloth,  haemorrhage  per  saltum  commenced,  which,  however,  was  easily  controlhal  by 
pressure  on  the  subclavian  above  the  clavicle  by  means  of  a door-key.  The  patient  only  survived  the 

70 


Fig.  2r;3. — Portion  of 
riglit  axillary  artcr^', 
its  coats  ulcerated 
throngli,  after  ^ainshot 
contusion. 

Sect.  I,  A.  M.  M. 


554 


WOUNDS  AND  IN.JUETES  OF  THE  CHEST. 


[ClIAP.  V, 


operation  a few  niiimtes.  Necropsy  : A largo  semi-circular  portion  of  the  axillary  artery,  correspoiidiiig  to  about  half  the  calibre 
of  the  vessel,  was  clearly  cut  out  by  the  ball,  about  au  inch  below  where  it  is  called  the  subclavian.  The  bone  and  brachial 
plexus  were  uninjured.  The  lower  dissection  showed  the  fractured  rib,  with  suppurating  soft  parts,  corresponding  to  the  course 
of  the  ball.  The  most  important  fact  connected  with  the  case  was  the  great  length  of  time  before  intermediary  lueiuorrhage 
took  ])lace — nine  days.  There  is  no  doubt  th.at  the  cloth  was  driven  into  the  iirtery,  and,  possibly,  by  some  movement  of  the 
patient  afterward,  or  from  suppuration  of  surrounding  tissues,  this  and  the  coagula  were  dislodged.  Almost  invariably  such 
a wound  iu  an  artery  of  this  calibre  would  cause  death  in  less  th.an  five  minutes.  The  w'ood-cut  (FiG.  253)  on  the  preceding 
page  represents  a preparation  of  the  axillary  artery.  It  was  contributed,  with  a history  of  the  case,  by  Assistant  Surgeon  H. 
J.  Phillips,  U.  S.  A. 

Case  5. — Private  John  W.  Hills,  Co.  A,  145th  Pennsylvania  Volunteers,  aged  24  years,  was  wounded  at  Fredericksburg, 
Virginia,  December  13th,  1862 ; the  ball  entered  the  integuments  at  the  middle  third,  external  edge  of  the  scapula,  passed  through 
the  axilla,  and  lodged  in  front,  just  below  the  insertion  of  the  pectoralis  minor.  He  was  carried  to  the  field  hospital,  where  the 
ball  was  removed  a few  hours  after  the  reception  of  the  injury.  Simple  dressings  were  applied.  On  the  17th,  he  was  transferred 
to  Harewood  Hospital,  Washington.  The  case  progressed  well  until  the  23d,  when  haemorrhage  to  the  amount  of  about  six 
ounces  occurred  from  the  posterior  wound.  The  wound  was  enlarged  and  the  bleeding  vessel  searched  for,  but  it  could  not  be 
found,  although  it  was  supposed  to  be  the  suprascajiular  artery,  as  pressure  below  the  clavicle  arrested  the  haemori'hage.  The 
edge  of  the  scapula  was  denuded  and  rough  for  .about  one  inch.  The  axillary  artery  was  ligated  immediately  after  its  emergence 
from  beneath  the  clavicle  and  the  incision  brought  together  by  adhesive  strips.  December  24th : Some  febrile  disturbance.  A 
diaphoretic  was  administered,  and  milk  diet  ordered.  25th:  Nervous  delirium ; stimulants,  with  morphia,  beef  tea  and  chicken 
diet.  26th:  The  delirium  has  subsided.  On  the  27th,  he  refused  to  take  the  stimulants  and  morphia,  and  the  delirium  returned. 
It  was  with  the  greatest  difficulty  that  nourishment  could  bo  administered  to  him,  as  he  closed  his  teeth  and  rejected  everything. 
He  continued  in  this  condition  until  the  29th,  when  a capillary  haemorrhage  occurred  to  the  amount  of  about  one  ounce  from  the 
posterior  wound.  Compress  and  bandage  were  applied,  which  entirely  arrested  it.  He  would  occasionally  take  a spoonful  of 
milk  punch  with  a small  quantity  of  morphia  in  it.  Death  resulted  on  the  night  of  December  29th,  1862.  The  ligatures  h.ad 
not  come  away.  The  wound  of  incision  had  suppurated  freely  but  there  was  no  attempt  at  union.  Surgeon  Thomas  Antisell, 
U.  S.  V.,  reports  the  case. 

Case  6. — Serge.ant  John  Mackey,  Co.  I,  50th  Pennsylv.ania  Volunteers,  aged  23  years,  was  admitted  to  Mount  Pleasant 
Hospital,  Washington,  May  29th,  1864,  with  a gunshot  wound  received  at  Cold  Harbor,  Virginia,  on  the  25th.  The  ball  entered 
.at  the  anterior  aspect  of  left  arm  and  made  its  exit  at  posterior  and  inferior  border  of  scapula;  the  a.xillary  artery  was  divided 
about  where  it  becomes  the  brachial.  June  5th : Arm  and  forearm  immensely  swollen  from  erysipelas  and  extravasation,  and  in 
a sloughing  condition.  The  patient  was  nearly  exhausted  from  excessive  haemorrhage  from  the  axillary  artery.  Acting  Assistant 
Surgeon  H.  Craft  attempted  to  ligaV;  the  axillary  artery.  An  incision  of  three  inches  was  made  along  the  border  of  the  dorsal 
muscles,  and  the  .artery  exposed.  While  in  the  .act  of  taking  it  up  the  patient  died.  The  case  is  reported  by  Assistant  Surgeon 
C.  A.  McCall,  U.  S.  A. 

Case  7. — Private  John  Moser,  Co.  B,  51st  Illinois  Volunteers,  aged  18  years,  was  wounded  at  Franklin,  Tennessee, 
November  30th,  1864.  A conoidal  ball  entered  over  the  anterior  border  of  the  right  scapula,  fractured  the  bone,  passed  downward, 
and  emerged  at  lower  angle  of  scapula.  He  was  admitted  on  the  next  day  to  Hospital  No.  3.  Nashville.  Tonics  and  nourishing 
diet  were  administered.  On  December  12th,  intermediary  haemorrhage  occurred  ti’om  enlarged  vessels  of  the  collateral  circulation ; 
pressure  was  applied  and  the  bleeding  arrested  until  the  14th,  when  it  again  occui-red.  A ligature  was  now  successfully  applied 
to  the  axillary  artery  under  the  border  of  the  pectoralis  minor  muscle.  This  arrested  the  bleeding  until  the  19th,  when  profuse 
haemorrhage  occurred  from  the  incision.  The  wound  was  plugged.with  lint  saturated  with  tincture  of  iron  and  pressure  was 
applied.  The  haemorrhage  did  not  recur,  but  the  patient  failed  to  recuperate,  and  died  December  21st,  1884,  from  exhaustion. 
The  case  is  reported  by  Surgeon  J.  R.  Ludlow,  U.  S.  V. 

Ca.se  8. — Private  Asahel  A , Co.  F,  25th  Massachusetts  Vtdunteers,  aged  25  years,  was  wounded  at  Cold  Harbor, 

Virginia,  June  3d,  1864;  a conoid.al  ball  entered  the  left  .axilla  and  lodged  at  the  posterior  border  of  the  scapula.  He  was  taken 

to  the  field  hospital  of  the  2d  division.  Eighteenth  Corps,  where  tlie  ball  was  removed  and  simple  dressings  were  applied.  On 

June  11th,  he  was  transferred  to  Lincoln  Hospital,  Washington.  On  the  15th,  intermediary  haemorrhage  to  the  amount  of  about 

twenty  ounces  occurred,  probably  from  some  branch  of  the  axillary  artery.  The  wound  was  dilated  .and  a small  artery,  probably 

one  cut  in  dilating  the  wound,  ligated.  The  wound  was  filled  with  lint  saturated  in  a solution  of  persulphate  of  iron,  and  a 

compress  applied.  The  .axillary  artery  could  be  distinctly  felt  with  the  finger,  pulsating  in  the  wound.  Pulse  regul.ar,  but  weak; 

patient  looked  pale.  Anodynes  and  stimul.ants  were  administered.  On  the  next  day  hmmorrhage  again  occurred,  which  yielded 

to  strong  pressure  on  the  compress.  June  17th,  10  A.  M. : Patient  very  pale,  amemic,  and  suffering  from  much  pain  in  the  arms 

.and  shoulder.  The  compress  and  plugging  were  removed,  when  the  blood  gushed  out  .alarmingly.  The  wound  was  freely 

dilated  and  the  axillary  artery  ligated.  The  haemorrhage  stopped  and  at  the  same  time  the  heart  ceased  to  beat.  The  necropsy 

showed  the  axillary  largely  opened  .about  the  middle  of  its 

course,  on  the  side  next  to  the  track  of  the  ball.  There  had 

evidently  been  sloughing  through  nearly  the  whole  calibre  ol 

the  artery.  The  adjacent  wood-cut  (Fig.  254)  represents  a 

preparation  of  the  left  axillary  artery,  with  a large  and  deep 

ulceration,  involving  nearly  half  of  the  cylinder  of  the  vessel, 

about  an  inch  above  the  origin  of  the  subscapularis.  It  was 

T.,..  c^rA  -n  c 1 a.  . 1 ■ , ...  contributed,  with  a history  of  the  case,  by  Acting  Assistant 

Fig.  254. — Portion  of  a left  axillarj-  artery,  showing  an  ulceration  after  ’ •'  > J o 

ligation.  .Spec.  257(),  .Sect.  I,  A.  M.  M.  Surgeon  W.  L.  Herriman. 


Sect.  III.] 


LIGATIONS  OF  THE  AXILLAEY. 


555 


('.\SE9. — Private  James  T.  Sliephord,  Co.  A.  18th  Massachusetts  Volunteers,  aged  18  year.s,  of  a naturally  strong  and 
vigorous  constitution,  was  wounded  at  Gettysburg,  Pennsylvania,  July  2d,  183d;  the  ball  entered  at  the  inner  edge  of  the  dcd- 
toid  of  the  left  side,  at  the  curve  of  the  armjiit.  passed  through  the  axillary  space,  and  emerged  three  inches  below  on  the  outer 
side  of  the  arm  ; a great  (piantity  of  blood  was  lost  at  the  time  of  the  injury.  lie  was  treated  in  the  field  until  the  8th,  when  he 
was  transferiH'd  to  S.'itterlee  Hospital,  Philadelphia.  The  patient  was  kept  as  fjuiet  as  possible,  and  cold  water  aii](li(M  to  the 
wound.  On  the  14th,  arterial  hajmorrhage  took  place,  when  about  a pint  of  blood  was  lost.  The  wound  was  immediately  cut 
down  upon,  and  the  bleeding  vessel,  supposed  to  bo  the  axillary  artery,  was  tied.  On  the  19th,  hasmorrhage  to  the  amount  of 
about  eighteen  ounces  occurred  ; the  wound  was  again  opened  and  the  vessel  secured  higher  up.  On  the  23d,  hfemorrhago  re- 
curred again,  and  the  vessel  was  ligated  still  higher  up.  It  was  only  after  the  third  ligation  that  the  pulsation  at  the  wrist  was 
stopped;  during  the  intervals  of  the  haemorrhage  he  was  kejit  up  with  beef  tea,  brandy,  milk,  etc.  After  the  third  hemorrhage 
he  was  excessively  exhausted,  and  it  seemed  as  if  he  would  hardly  rally.  A fourth  haemorrhage,  on  July  24th,  caused  deatli. 
The  case  is  reported  hy  Acting  Assistant  Surgeon  T.  G.  Morton. 

Case  10. — Private  David  Walsh,  Co.  D,  lOGth  New  York  Volunteers,  aged  23  years,  was  admitted  to  Filbert  Street  Hos- 
pital, October  24th,  18G4,  with  a gunshot  wound  of  the  left  shoulder,  received  at  Cedar  Creek,  Virginia,  on  the  19th.  November 
3d : Vessels  and  tissues  much  matted  together.  The  patient’s  constitutional  condition,  which  was  good  primarily,  was  greatly 
i-educed  by  haemorrhage.  Acting  Assistant  Surgeon  Edward  L.  Duer  administered  chloroform  and  ethei-,  and  ligated  the  left 
axillary  artery  immediately  under  the  clavicle,  in  the  triangle  formed  by  the  pectoralis  minor  muscle,  thorax,  and  clavicle.  Un- 
der the  free  use  of  cream,  butter,  and  wines  the  progress  of  the  case  was  very  encouraging,  but  haemorrhage  recurred  on  No- 
vember loth;  death  resulted  on  the  .same  day.  Surgeon  Thomas  B.  Eeed,  U.  S.  V.,  reports  the  case. 

Case  11. — Private  Charles  Tighe,  Co.  F,  both  Massachusetts  Volunteers,  aged  18  years,  received  a gunshot  wound  of  the 
left  chest  and  arm  at  Petersburg,  Virginia,  June  16th,  1834.  The  ball  entered  at  the  middle  of  the  pectoralis  major  of  right  side, 
passed  through  the  left  axilla,  and  emerged  at  the  upper  third  of  the  arm,  outer  aspect,  wounding  the  axillary  artery.  He  was 
at  once  admitted  to  the  hospital  of  the  1st  division,  Nintli  Corps,  where  simple  dressings  were  applied  to  the  wound.  On  the 
19th,  ho  was  transferred  to  Harewood  Hospital,  Washington.  On  July  1st,  intermediary  hmmorrliage  to  the  amount  of  twelve 
ounces  occurred,  and  on  the  next  day  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  ligated  the  axillary  artery.  The  htemorrhage  did  not 
recur,  but  the  patient  died  July  4th,  1864,  from  exhaustion.  The  case  is  reported  by  the  operator. 

Case  12. — Private  William  E.  Downing,  Co.  1, 16th  Pennsylvania  Cavalry,  aged  19  years,  was  wounded  at  Hanover,  Vir- 
ginia, on  May  28th,  1864,  by  a conoidal  ball,  which  passed  through  the  left  axillary  space.  Flo  was  conveyed  to  the  field  hospital 
of  the  '^d  division.  Cavalry  Corps,  where  the  wound  was  dressed.  On  June  4th,  he  was  transferred  to  De  Camp  Hospital.  New 
York  Harbor.  On  the  l-.ith,  intermediary  haemorrhage  to  the  amount  of  twenty  ounces  occurred  from  the  axillaiy  artery.  On 
the  15th,  the  patient  was  jnit  under  the  influence  of  chloroform  and  the  axillary  artery  was  ligated  above  and  below  the  wound. 
The  vein  was  found  injured,  and  was  also  ligated.  The  haemorrhage  did  not  recur.  Death  ensued  on  June  28th,  1834. 
Assistant  Surgeon  Warren  Webster,  U.  S.  A.,  reports  the  ca.se.  There  was  no  evidence  at  the  post  mort'-m,  examination  of  the 
phlebitis  or  of  pyaemia. 

Case  13. — Private  E.  C.  Melley,  Co.  K,  2d  West  Y'irgiuia  Jilounted  Infantry,  was  wounded  at  Droop  Mountain,  Virginia, 
November  Gth,  1833,  by  a musket  ball,  which  entered  one  and  one-fourth  inches  below  the  junction  of  the  inner  and  middle  thirds 
of  the  clavicle,  passed  downward  and  backward,  and  made  its  exit  about  midway  of  the  inferior  costa  of  the  scajmla,  one-half 
an  inch  from  its  edge.  He  was  conveyed  to  Beverly,  and  admitted,  on  the  12th,  to  the  post  hospital.  Simple  dressings  were 
applied  to  the  wound.  On  the  18th,  he  was  transferred  to  Grafton,  a distance  of  forty-six  miles.  When  admitted,  an  enormous 
tumor  of  coagulum  occupied  the  a.xilla,  burrowing  under  and  between  the  pectoral  muscles  as  well  as  the  scapula  and  latissinius 
dorsi,  filling  up  the  space  below  the  clavicle,  and  rendering  all  the  tissues  tense.  The  superficial  veins  were  enlarged.  The 
patient  had  lost  considerable  blood  while  being  removed  from  Beverly.  He  i)assed  the  night  tolerably  well.  Pulse  quite  full  at 
both  wrists.  The  hmmorrhage  proceeded  from  the  anterior  orifice;  the  posterior  one  was  closed  and  nearly  healed.  On  Novem- 
ber 19th,  Surgeon  S.  N.  Sherman,  U.  S.  V.,  administered  chloroform  and  ligated  the  axillary  artery  over  the  second  rib.  An 
incision  was  made  along  the  junction  of  the  sternal  and  clavicular  portion  of  the  pectoral  muscle,  and  the  clot  turned  out,  when 
a sudden  and  tremendous  gush  of  blood  took  place,  wdiich  was  promptly  arrested  by  compression  above  the  clavicle.  The  clav- 
icular portion  of  the  muscle  was  partly  divided  at  right  angles  to  the  first  incision.  The  depth  of  the  wound  was  considerable, 
rendered  so  by  the  swollen  condition  of  the  parts ; the  tissues  were  greatly  disorganized.  Pulsation  of  the  artery  was  arrest(>d 
by  compression  above  the  clavicle.  In  searching  for  the  art('ry  the  subclavian  vein  was  opened,  the  entrance  of  air  caused  syn- 
cope, and  death  ensued  in  from  seven  to  ten  minutes.  The  necropsy  revealed  the  axillary  artery  almost  entirely  divided  about 
one  inch  before  it  becomes  the  brachial.  The  case  is  reported  by  the  operator. 

Of  the  thirteen  foregoing  operations  for  ligation  of  the  axillary,  there  were  four  of  what 
is  called  diffused  aneurism  ; which,  as  Professor  Gross  remarks,  is  not  an  aneurism  at  all. 
Yet  in  these  cases  the  compression  exercised  by  the  effused  blood  and,  in  two  of  them  at 
least,  injury  of  the  brachial  plexus  and  axillary  vein,  had  so  seriously  interrupted  the 
circulation  of  the  arm,  that  it  is  highly  probable  that  amputation  at  the  shoulder-joint,  or 
the  “ old  operation,”  might  have  given  less  disastrous  results,  or  at  least  would  have  been 
more  correct  practice.  Of  Case  3,  Surgeon  0.  S.  Frink  remarks  : 

“ The  patient  was  not  in  a favorable  condition.  The  arm  was  cold,  and  jferfectly  paralyzed;  at 
onetime  there  was  a slight  movement  of  the  fingers  possible,  but  this  was  soon  gone,  and  although 


556 


WOUNDS  AND  IN.IUKIES  OF  THE  CHE^ST. 


[Chap.  V, 


there  was  no  diroet  injury  of  the  axillary  plexns,  sensation  and  motion  were  not  restored  after  the 
artery  was  ligated,  owing  to  the  fact,  as  I think,  of  the  collateral  circulation  being  impeded  by  the 
pressure  of  the  aneurism,  prior  to  the  operation,  and  there  not  being  sufficient  vigor  in  the  system 
to  restore  it  afterward.’’ — {Medical  Director  H.  S.  Hewit’s  Report,  p.  81.) 

In  one  of  these  four  cases,  the  promptly  fatal  issue  was  referred  to  entrance  of  air  into 
the  subclavian  vein.  In  one,  gangrene  appeared,  and  two  were  fatal  from  anaemic 
exhaustion  before  mortification  set  in.  Of  the  nine  remaining  cases,  six,  in  which  single 
ligatures  had  been  placed  on  the  cardiac  side  of  the  wound,  died  of  recurrent  distal 
haemorrhage;*  two  were  so  , exhausted  that  they  died  during  the  operation;  while  Dr. 
Webster’s  patient  (Case  12)  lived  till  the  thirteenth  day,  and  appears  to  have  succumbed 
to  the  prostration  consequent  on  the  bleeding  prior  to  the  operation.  In  this  case  and 
Dr.  Shippen’s  (Case  3)  alone  of  the  thirteen,  was  the  artery  tied  below  as  well  as  above 
the  wound.  In  ten  of  the  thirteen  cases,  the  missile  injured  the  axillary  artery  ; in  three, 
bleeding  was  thought  to  proceed  from  the  thoracic,  scapular,  or  circumflex  branches.  That 
pressure  below  the  clavicle  should  arrest  hsemorrhage  from  the  suprascapular  (Case  5) 
was  singular,  to  say  the  least,  and  led  to  practice,  which,  unless  the  bleeding  in  Case  7 
came  from  another  branch  of  the  subclavian,  the  posterior  scapula,  is  believed  to  be 
unparalleled.  Though  one  or  two  of  the  operations  may  be  regarded  almost  as  ligations 
of  the  subclavian  toward  the  end  of  its  third  portion,  the  error  of  tying  that  vessel  above 
the  clavicle  for  wound  of  the  axillary  [see  Guthrie,  Lect.  XII,  p.  200)  was  not  committed 
in  any  of  the  cases  of  this  lamentable  series. 

Ligations  of  Branches  of  the  Axillary. — In  wounds  of  the  chest  complicated  by 

bleeding  in  the  axilla,  after  the  main  trunk,  the  subscapular  was  the  vessel  most  com- 

monly injured.  But  no  instance  appears  of  ligation  of  this  trunk 
in  the  continuity  for  wounds  or  for  wounds  of  its  branches,  though 
it  was  not  infrequently  tied  in  operations  for  amputation.  The 
Museum  affords  a specimen,  represented  in  the  wood-cut  (Fig.  255), 
of  a gunshot  wound  of  this  vessel,  resulting  in  sloughing  and  fatal 
secondary  hgemorrhage  : 

Case. — Private  F.  M.  Drale,  Co.  D,  35th  North  Carolina  Regiment,  aged  27  years,  was 
struck  by  a musket  ball,  at  Petersburg,  June  16th,  1864,  three  inches  below  the  left  clavicle. 
The  missile  made  its  exit  at  the  posterior  border  of  the  left  axilla.  He  was  made  a prisoner,  and 

sent  to  Lincoln  Hospital  on  June  25th.  He  had  full  extra  diet  and  simple  dressings,  and  nothing 
of  importance  occurred  until  July  10th,  when  there  was  profuse  arterial  bleeding  from  the  exit 
orifice,  stanched  by  plugging  the  track  of  the  ball  with  pledgets  of  charpie  dipped  in  solution  of 
persulphate  of  iron,  and  applying  compresses  tightly  bandaged  in  the  armpit.  Bleeding 
recurred,  and  the  patient  died  on  July  12th,  1864.  The  post-mortem  dissection  revealed  a 
phagedenic  condition  of  the  posterior  part  of  the  wound,  and  the  subscapular  artery  was  com- 
pletely sloughed  through  at  its  origin.  The  specimen  was  contributed  by  Acting  Assistant 
Surgeon  II.  M.  Dean ; the  notes  of  the  case  by  Acting  Assistant  Surgeon  Thaddeus  L.  Leavitt. 

Case. — Private  Daniel  Hughes,  Co.  Iv,  13th  New  York  Artillery,  aged  23  years,  was  admitted  to  the  Foster  Hospital, 
New  Berne,  North  Carolina,  with  an  incised  and  punctured  wound  of  the  left  side  and  hip,  inflicted  with  a knife  at  New  Berne 
on  the  same  day.  On  admission,  there  was  hmmorrhage  from  the  thoracica  longa  artery.  The  patient’s  condition  was  good. 
Assistant  Surgeon  E.  F.  Hendricks,  15th  Connecticut  Volunteers,  ligated  the  bleeding  vessel ; simple  dressings  were  applied. 
He  recovered  and  was  returned  to  duty  September  27th,  1864.  The  case  is  reported  by  the  operator. 

Case. — Private  Zeba  S.  Lyon,  Co.  I,  17th  Vermont  Volunteers,  aged  20  years,  was  wounded  at  Petersburg,  Virginia, 
April  2d,  1865,  by  a conoidal  ball,  which  fractured  the  middle  and  anterior  border  of  the  right  scapula  and  the  fourth  rib,  passed 
into  the  lower  lobe  of  the  right  lung,  and  lodged.  He  was  taken  to  the  field  hospital  of  the  Ninth  Corps,  and,  on  April  0th,  was 
transferred  to  Slough  Hospital,  Alexandria.  Light  cold-water  dressings  and  stimulants  were  used  until  April  14th,  when 

Theodor  Bilrotli  would,  perhap.s,  contest  the  distal  origin  of  the  fatal  haemorrhages  in  some  of  these  cases.  .See  the  fifteenth  letter  of  his 
recent  Chirurgisdte  Bnefc.  liut  I think  the  prcpariitions  in  the  Museum  would  convince  him  of  the  frequency  of  bleedin/j  of  this  nature. 


sloughing  off  of  the  subscapular 
at  its  origin.  Spec.  2833,  Sect.  I, 
A.  M.  M. 


f r.cT.  III.] 


EXCISIONS  OF  THE  CLAVICLE. 


557 


liaeniorrliage  occurred  from  a small  branch  of  the  circumflex  artery,  which  was  ligated  at  the  time.  Oil  the  Kith,  hamiorrhage 
recurred  from  a deeper  branch.  Several  minor  branches  of  the  circumflex  artery  were  cut  down  upon  and  ligated  by  Surgeon 
Edwin  Bentley,  U.  S.  V.  The  patient  lost  in  all  about  twenty  ounces  of  blood.  Nourishment  and  stimulants  were  administered. 
Death  resulted  on  April  21st,  1835.  The  necropsy  revealed  the  course  of  the  ball.  The  lower  lobe  of  the  right  lung  had  under- 
gone decomposition  ; the  upper  lobe  was  congested. 

Doubtless  many  branches  of  the  thoracic  and  scapular  arteries  were  occasionally  tied 
to  arrest  primary  or  secondary  bleeding  from  wounds,  or  else  in  the  course  of  operations; 
but  special  references  to  such  instances  do  not  appear  on  the  reports. 

This  review  of  the  results  of  ligations  in  the  trunk,  after  gunshot  wounds,  is  very 
discouraging,  and  it  can  hardly  be  denied  that  the  excessive  mortality  was,  in  a measure, 
due  to  departures  from  accepted  rules  of  practice.  But  the  difficulties  in  dealing  with 
gunshot  wounds  of  the  clavicular  and  axillary  regions  are  so  great,  as  often  to  defy  the 
best  planned  and  most  skilfully  executed  surgical  interference;  and  those  whose  experience 
of  traumatic  lesions  of  the  subclavian  and  axillary  regions  is  largest,  are  least  hasty  in 
criticising  failures  in  their  management.* 

Excisions. — Though  excisions  of  the  bones  of  the  trunk,  and  possibly  those  of  the 
joints,  have  been  known  and  practiced  from  early  times,  from  the  time  of  Galen  indeed, 
it  is  little  more  than  a century  since  they  have  been  reintroduced  and  practised  according 
to  fixed  rules  as  belonging  to  the  established  resources  of  surgery.  Until  the  publication 
of  Park’s  two  letters,  in  Jeffray’s  translation  of  Moreau,  in  1806,  and  Syme’s  work,  in 
1831,  the  English  language  possessed  no  book  on  excisions,  and  yet,  in  1803,  the  Moreaus 
had  excised  nearly  all  of  the  larger  joints. 

Excisions  of  the  Clavicle. — Extirpation  of  the  collar-bone  on  account  of  necrosis,  or 
for  malignant  growths,  may  be  regarded  as  an  established  operation  of  recent  date.*|* 
Though  rarely  required  in  gunshot  fractures  of  the  clavicle,  in  very  extensive  comminutions 
the  complete  excision  of  the  bone  may  possibly  be  expedient.  It  was  twice,  at  least, 
resorted  to  during  the  war ; on  both  occasions  with  a fatal  result.  The  first  case  is 
accredited  to  a Confederate  surgeon,  whose  name  is  not  given,  at  the  battle  of  Spottsyl- 
vania.  The  memorandum  of  the  operation  appears  on  the  monthly  report,  for  May,  1864, 
of  Surgeon  J.  L.  Cabell,  the  professor  of  surgery  at  the  University  of  Virginia : 

Case  1. — Private  Henry  Miller,  Co.  I,  5th  Virginia  Eegiment,  was  admitted  to  the  Confederate  hospital  at  Charlottesville, 
Virginia,  May  8th,  1864,  with  a gunshot  wound  of  the  chest  and  fracture  of  the  clavicle.  The  clavicle  had  been  excised  on 
the  field,  on  the  6th.  He  died  on  May  17th,  1834.  The  case  is  reported  by  Surgeon  J.  L.  Cabell,  P.  A.  C.  _S. 

* For  a fatal  case  of  ligation  of  the  left  subclavian  in  the  second  portion,  for  gunshot  wound  of  the  axillary,  see  Military  Surgery  and  Operations 
following  the  Battle  of  lUvas^  Nicaragua,  April,  18.56,  by  I.  MOSES,  M.  D.,  late  Surg6on  General  of  the  Nicaraguan  Army.  Ilosides  the  authors  already 
cited,  consult,  on  this  subject:  NO'IT,  J.  C.,  Ligature  of  Subclavian  Artery  for  the  cure  of  Axillary  Aneurism  caused  by  Gunshot  wouml,  Am.  Jour. 
Med.  Sci.,  p.  Ill,  Vol.  II,  1841 ; Sir  Willi.vm  FeroussOX’s  remarks  in  the  last  edition  of  his  System  of  Practical  Surgery,  London,  1870,  and  in  the  later 
volumes  of  the  lancet ; Mr.  J.  E.  Erichsen’s  ohsci^-ations  in  the  fifth  edition  of  his  Science  and  Art  of  Surgery,  London,  1869,  Vol.  II,  p.  8(i ; Mr.  J.  Spence’s 
Lectures  on  Surgery,  Edinburgh,  1871 ; Sir  James  Y.  Simpson's  Acupressure,  Edinburgh,  1864  ; Professor  Gross’s  learned  critical  and  historical  comments 
in  the  fifth  edition  of  his  System  of  Surgery,  lOiiladelphia,  187i,  Vol.  I,  p.  804,  Vol.  II,  p.  4.50;  Dr.  J.  Ashliurst's  excellent  summary  of  tlie  present  state 
of  our  information  in  his  nevr  Principles  and  Practice  of  Surgery,  Philadelphia,  1871,  p.  547;  BILUOTII,  Vhirurgische  Briefe,  U.  S.  V.,  Berlin,  1872,  S. 
113;  George  Fischer,  in  Dr.  von  Pitha's  Uandbuch. 

t Professor  Gross  informs  us  {System  of  Surgery,  Vol.  II,  p.  1077)  that  llemmcr  extirpated  the  clavicle  for  osteosarcoma  as  far  back  as  1732.  Dr.  O. 
lleyfelder  {Lehrhuch  der  Resectionem,  Wien,  18C3,  S.  300)  has  collected  nine  cases  of  total,  and  eighteen  of  partial  excision  of  the  bone,  and  ascribes  the 
priority  in  practicing  total  excision  to  Jleyer,  who  operated,  in  1823  {Encyc.  Worterbuch  de  Med.  TFiss.,  B.  29),  successfully  on  a man  of  34  years,  witli 
caries;  hut  he  ascribes  a partial  resection  of  the  diaphysis  to  ('assebohm,  in  1719  {Act.  Med.  Berol.,  B.  I).  In  1813,  Dr.  Charles  lUcCreary,  of  Kentucky, 
excised  tlic  right  collar  bone,  of  a boy  of  14  year.s,  for  scrofulous  caries.  The  boy  survived  many  years,  with  an  excellent  use  of  the  C/Orresponding 
limb.  The  specimen  is  in  Professor  Gr.iss's  private  collection.  Drs.  Wedderhurn,  of  New  Orleans,  in  1852;  Blackman,  in  IS.IG,  and  Finpia,  of  Richmond, 
in  1860,  had  like  success  in  similar  cases.  Moll,  in  1828;  J.  (k  Warren,  in  1832,  and  Dr.  E.  S.  (jooper,  in  18.57;  Dr.  Curtis,  of  Chicago,  about  the  same 
year,  and  Dr.  Eve,  of  Xashvillc,  in  1870,  performed  the  operation  for  malignant  tumors.  Mott's  ease  alone  was  successful.  For  the  removal  of  tumors, 
the  operation  is  of  course  far  more  difficult  than  in  caries;  Mott  applied  over  forty  ligatures  in  the  course  of  his  operation,  which  lasted  nearly  four 
hours. 


558 


WOUNTJS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Of  the  next  operation  of  this  nature,  more  particulars  are  furnished.  The  operator 
was  Dr.  James  0.  Palmer,  now  Surgeon  General,  U.  S.  N.  : 

Case  ‘2. — Peter  Pitts,  a landsman  of  the  United  States  Ship  Hartford,  aged  19  years,  received  a penetrating  wound  of  the 
chest  in  action  at  Mobile  Ray,  August  5th,  1834.  In  a communication  to  the  American  Journal  of  Medical  Sciences  for  April, 
1835,  Passed  Assistant  Surgeon  J.  K.  Tryon,  U.  S.  N.,  says  : “ The  patient  was  supposed  to  have  been  wounded  by  a fragment  of 
shell,  which  entered  midway  between  the  articulations  of  the  clavicle  of  the  right  side,  splintered  the  hone  to  both  sternal  and  acro- 
mial e.Ktreraities,  fractured  the  first  two  ribs  near  sterno-costal  articulation,  passed  through  the  apex  of  the  right  lung,  and  made  its 
exit  through  the  scapula  just  beneath  the  spine  of  that  bone.  The  wound  of  entrance  was  oval,  edges  jagged  and  inverted,  with 
the  fractured  extremities  of  the  clavicle  pressing  downward  and  inward  upon  the  blood-vessels  and  nerves  in  that  region.  The 
wound  of  exit  was  nearly  circular,  edges  lacerated  and  everted,  with  .spiculae  of  bone  from  the  clavicle  and  scapula  protruding. 
Si.x  hours  after  the  injury,  the  patient  (being  tjuieted  from  time  to  time  by  the  inhalation  of  chloroform)  was  brought  under  the 
attention  of  the  surgeons  of  the  Hartford.  After  careful  examination,  finding  no  portion  of  the  clavicle  could  be  preserved.  Dr. 
James  C.  Palmer,  surgeon  of  the  fleet,  removed  the  entire  hone.  During  the  dissection,  the  attachments  of  the  sterno-cleido- 
mastoid  and  trapezius  to  the  clavicle  were  removed ; the  external  jugular  was  the  only  vessel  tied.  The  edges  of  the  wound 
were  brought  carefully  together  by  the  interrupted  suture  and  water  dressings  applied;  the  spiculm  of  bone  were  removed  from 
the  wound  of  exit  and  dressed  in  the  same  manner.  The  patient  bore  transportation  exceedingly  well,  and,  on  the  afternoon  of 
August  Cth,  when  admitted  into  the  Naval  Hospital  at  Pensacola,  symptoms  were  quite  favorable.  August  8th  ; Many  additional 
pieces  of  bone  were  removed  from  the  wound  of  exit  and  sutures  taken  from  the  incision  made  by  the  operation.  On  account  of 
the  severe  injury  to  the  lung,  pneumonia  soon  supervened,  and  very  little  hope  of  recovery  was  entertained  by  reason  of  the 
severity  of  the  attack.  However,  on  the  19th,  the  patient  was  fully  convalescent  from  the  pneumonia  ; wounds  looked  favorable, 
suppurated  freely,  and  healthy  granulations  were  observed  throughout  the  wound  of  exsection,  with  sternal  point  nearly  closed. 
The  patient  continued  to  improve  till  the  22d  instant,  when  he  became  anxious  and  restless ; bed-sores  were  soon  developed, 
and,  by  gravitation  of  pus  at  the  wound  of  exit,  abscesses  formed  beneath  the  scapula,  which  exposed  the  entire  lower  border. 
This  wound  gradually  assumed  an  unhealthy  action  ; patient  became  emaciated,  and  died  of  exhaustion  at  twenty  minutes  after 
seven  o'clock  l’.  JI.,  August  20th,  1834,  twenty-five  days  after  the  injury  and  operation.  At  the  time  of  his  death  the  wound  of 
excision  had  entirely  healed  near  the  sternal  end,  and  was  filling  up  rapidly  by  healthy  granulations  near  its  outer  extremity. 
With  this  evidence  of  repair  we  can  safely  state  the  perfect  success  of  the  operation,  and  but  for  the  severe  wound  of  the  scapula 
the  probable  recovery  of  the  patient.  Treatment  throughout : Tonics,  stimulants  and  anodynes,  and  during  the  difl'erent  stages 
of  pneumonia,  the  usual  course  was  pursued.”  At  the  necropsy,  on  examining  the  thorax,  about  one-fifth  of  the  upper  portion 
of  the  right  lung  was  found  to  have  been  destroyed,  probably  by  the  missile,  in  conjunction  with  the  subsequent  suppuration. 
Tliis  cavity  was  lined  with  a tough  memhrane  three  lines  in  thickness,  dividing  it  from  the  lower  portion  of  the  lung,  which  was 
found  to  be  perfectly  healthy.  Direct  communication  had  existed  between  the  anterior  and  posterior  wounds.  Surgeon  General 
J.  C.  Palmer  contributed,  December  2oth,  1872,  the  pathological  specimen  from  this  case.  Spec.  5213,  Surg.  Sect.  It  consists  of 
the  fractured  right  scapula,  upper  extremity  of  humerus,  and  first  and  second  ribs,  both  of  the  latter  fractured. 

Unless  complicated  by  serious  injury  of  tlie  lung,  nerves,  or  great  vessels,  it  would 
not  appear  that  the  operation  is  necessarily  a very  fatal  one.  Six  of  nine  cases  of  extirpa- 
tion of  the  clavicle  collected  by  Dr.  0.  Heyfelder  {op.  cit.  8.  300)  were  perfectly  successful, 
and  several  other  successful  operations  have  since  been  reported. 

Partial  excisions  of  this  bone  for  necrosis,  or  compound  fracture,  or  dislocation  are 
more  common.  Some  surgeons  (Dr.  E.  C.  Cooper,  Assistant  Surgeon  Ayres,  U.  S.  V.) 
practice  excision  of  the  sternal  portion  of  the  clavicle  to  facilitate  operations  on  the  brachio- 
cephalic or  the  first  portion  of  the  subclavian.  The  sternal  extremity  is  a favorite  seat  of 
syphilitic  caries,  which  may  require  gouging  or  partial  excision.  The  three  following  cases 
of  excision  of  the  outer  third,  inner  third,  and  middle  third  of  the  clavicle  were  fatal,  but 
were  complicated  by  gunshot  perforations  of  the  lung; 

Case  3. — Corporal  M.  C.  Pember,  Co.  D,  33d  Wisconsin  Volunteers,  aged  28  years,  was  wounded  at  the  battle  of  Spanish 
Fort,  Alabama,  April  3d,  1835,  by  a conoidal  musket  ball,  which  fractured  the  right  clavicle,  and  perforated  the  upper  lobe  of 
the  right  lung.  He  was  received  into  the  field  hospital  of  the  Sixteenth  Corps,  where  resection  of  the  outer  third  of  the  clavicle 
was  performed  by  Surgeon  Edwin  Powell,  72d  Illinois  Volunteers.  Several  days  afterward  the  wounded  man  was  transferred 
to  the  Marine  Hospital  at  New  Orleans,  where  he  died  on  April  12th,  1865. 

Case  4. — Private  Charles  Baker,  Co.  D,  31st  United  States  Colored  Troops,  aged  20  years,  was  wounded  at  Petersburg, 
Virginia,  July  30th,  1864,  by  a cf)noidal  ball,  which  entered  at  the  middle  of  the  right  scapula,  penetrated  the  right  lung,  and 
emerged,  fracturing  the  inner  third  of  the  clavicle.  He  was  treated  in  the  hospital  of  the  Ninth  Corps  until  August  17th,  when 
he  was  transferred  to  Satterlee  Hospital,  Philadelphia.  When  admitted,  the  outer  end  of  the  denuded  clavicle  was  protruding, 
and  the  patient  was  suffering  from  bed  sores,  which  became  worse.  Appliances  for  the  bed  sores  were  made.  On  September 
8th,  the  protruding  portion  of  the  clavicle  was  excised.  Simple  dressings  were  applied,  and  stimulants  and  tonics  administered. 
Sept(‘mber  25th  : System  becoming  exhausted  from  the  siqjpuration.  October  4th  : A pyaemic  chill  occurred.  Death  resulted  on 
October  6th,  1864,  from  pymmia.  The  case  is  reported  by  Surgeou  I.  I.  Hayes,  U.  S.  V. 


Sr.cT.  II].] 


EXCISIONS  OF  THE  CLAVICLE. 


559 


Case  5. — Corporal  Freeman  Scott,  Co.  L,  21st  Pennsvlvania  Cavalry,  aged  18  years,  was  wounded  at  Cldckalioniiny 
liivcr,  Virginia,  June  2d,  18!j4,  by  a colloidal  ball,  wbicb  struck  the  li‘ft  clavicle  about  its  middle,  producing  a comminuted 
fracture,  jiassed  downward  and  backward,  and  lodged  apjiarently  beneath  the  scapula.  He  was  admitted  to  Stanton  Hospital, 
■Washington,  on  June  4th.  The  wound  was  suppurating  jirol'usely  but  of  good  quality;  the  broken  ends  of  the  clavicle  over- 
lapping each  other;  they  were  denuded  of  periosteum  and  bathed  with  pus  ; they  were  surrounded  by  a cavity  filled  with  pus, 
which  extended  down  almost  to  the  artery,  and  there  was  great  danger  that  the  sharp  end  of  the  underlying  fragment  would  be 
driven  into  the  artery  by  an  unlucky  movement  of  the  elbow.  The  general  health  of  the  patient  was  favorable.  On  June  IJth, 
1864,  ether  was  administered,  the  wound  of  entrance  dilated  by  an  incision  on  the  front  of  the  clavicle,  and  two  inches  of  its  middle 
third  excised  with  a chain  saw  and  the  osteotome,  great  care  being  taken  that  the  subclavian  artery  should  receive  no  detriment. 
The  portion  resected  was  denuded  of  periosteum,  and  lying  in  a cavity  filled  with  pus.  Death  occurred  from  jdeuritis  on  June 

23d,  1864.  The  case  is  reported  by  the  operator.  Surgeon  John  A.  Lidell,  U.  S.  V. 

The  three  following  cases  had  a more  successful  issue  : 

Case  G. — Sergeant  J.  H , Co.  I,  9th  New  York  State  Militia,  was  admitted  to  the  hospital  at  Frederick,  Maryland, 

September  23d,  1862,  with  a gunshot  wound  of  the  shoulder,  received  at  Antietam  on  the  17th,  by  the  bursting  of  a shell.  On 

examination,  it  was  found  that  the  outer  half  of  the  clavicle  had  been  torn  away ; this,  with  a 

fracture  of  a portion  of  the  spine  of  the  scapula  and  of  the  acromion  process,  allowed  the  shoulder 
to  drop  down.  The  soft  parts  abov'e  the  joint  had  the  appearance  of  having  been  much  torn 
and  lacerated  and  were  in  a sloughy  condition.  Stimulating  dressings  were  applied,  and  in 
about.two  weeks  the  slough  separated,  leaving  a granulating  idcer  six  inches  in  length  and  four 
in  breadth.  Although  the  sloughing  had  been  quite  extensive,  the  joint  remained  uninjured. 

Doctor  Gurdon  Buck,  of  New  York,  while  inspecting  the  hospital,  had  seen  the  case,  and 
advised  an  operation,  which  he  performed  on  October  12th.  The  patient  was  etherized,  and 
the  outer  portion  of  the  clavicle  as  far  as  the  attachments  of  the  sterno-cleido-mastoid  muscle 
was  removed  by  chain-saw.  The  integuments  above  and  below  were  then  dissected  up  and 
brought  together  by  iron-wire  sutures.  The  forearm  was  bent  at  a i-ight  angle  with  the  arm, 
which  was  raised  to  a level  with  the  shoulder,  and  put  in  position  by  Smith’s  anterior  splint. 

The  case  progressed  very  favorably ; on  December  12th,  a tubular  sequestrum,  about  two  and 
one-balf  inches  in  length,  was  removed;  on  the  16th,  another  small  piece  of  bone  came  away. 

On  January  16th,  1883,  the  patient’s  general  condition  was  good.  An  examination  with  a 
probe  revealed  some  small  fragments  of  bone,  which  had  prevented  the  complete  cicatrization  of 
the  wound.  He  was  discharged  from  service  on  Jlarch  13th,  1883,  at  which  time  there  -vyas 
paralysis  of  the  arm.  The  acromial  and  outer  cylindrical  portions  of  the  necrosed  clavicle  were 
forwarded,  with  a history  of  the  case,  by  Assistant  Surgeon  R.  F.  'VYeir,  U.  S.  A.,  and  are 
represented  by  the  wood-cut  (Fig.  256).  Pension  Examiner  W.  M.  Chamberlain  reports, 

March  20th,  1863:  “There  is  no  power  in  the  arm,  and  the  wound  is  not  fairly  closed.  '*a! 

Disability  mostly  permanent.”  M.  M. 

Case  7. — Lieutenant  Colonel  H.  N.  Whitbeck,  65th  Ohio  Volunteers,  aged  37  years,  was  wounded  at  Kenesaw,  Georgia, 
June  27th,  1864;  the  missile  fractured  the  left  clavicle  in  its  middle  third,  and  lodged  in  the  cavity  of  the  thorax.  He  was  taken 
to  the  hospital  of  the  2d  division.  Fourth  Corps,  where  simple  dressings  were  applied  to  the  wound.  On  July  2d,  he  was  trans- 
ferred to  Officers’  Hospital,  Nashville,  Tennessee.  The  wound  was  inflamed  and  discharging  thin  sanious  pus ; granulations 
exuberant;  patient  feverish  and  restless;  pulse  110.  On  June  15th,  Acting  Assistant  Surgeon  J.  A.  Hall  excised  two  and  one- 
half  inches  of  the  middle  third  of  the  clavicle  thiough  an  incision  three  inches  long.  He  was  furloughed  on  August  1st,  and 
was  afterward  placed  on  court-martial  duty  at  Nashville,  until  finally  discharged  from  service  on  August  16th,  1865.  I’ension 
Examiner  A.  D.  Blein  reported,  December  2d,  1835:  “ Ball  entered  left  lung  ; not  yet  extracted.  Wound  not  healed.  Another 
ball  passed  through  arms,  entering  the  side  of  the  body,  passing  out  on  the  other  side  superficially.  Disability  total  but  tempo- 
rary.” Lieutenant  Colonel  Whitbeck  visited  the  Army  Medical  Museum,  January  13tb,  1870,  at  which  date  he  stated  the 
wound  had  not  permanently  healed.  It  had  re-opened  four  times  during  the  previous  year.  He  enjoyed  com])aratively  good 
health.  He  was  a pensioner  in  March,  1872. 

Case  8. — Private  J.  H.  N , Co.  B,  10th  Ohio  Volunteers,  aged  25  years,  a robust  German,  was  wounded  at  Perry- 

ville,  Kentucky,  October  8th,  1862,  by  a minie  ball,  which  jiassed  through  the  left  shoulder  and  shattered  the  acromial  half  of 
the  clavicle.  He  also  received  a gunshot  wouml  of  the  left  hand.  He  was  taken  to  the  field  hospital,  where  the  ring  finger  was 
amputated  at  the  metacarpo-phalangeal  joint.  On  October  14th,  he  was  transferred  to  No.  1 Hospital,  New  Albany.  On  the 
17th,  the  acromial  half  of  the  bone  was  removed  at  the  articulation,  through  a straight  incision,  by  Acting  Assistant  Surgeon  A.  S. 
Greene,  who  contributed  the  specimen,  represented  of  natural 
size  in  the  adjacent  wood-cut  (Fig.  257),  with  notes  of  the  case. 

Shreds  and  strips  of  periosteum  were  left  in  the  whole  course  of 
the  removed  hone,  and  the  wound  was  closed  hy  numerous 
stitches  of  iron  wire.  No  adhesive  strips  were  applied.  He  was 
discharged  from  service  on  January  6th,  1863,  at  which  time 
perfect  new  bone  had  formed  throughout  the  wound.  The 
shoulder  drooped  forward  a little,  but  the  motion  was  good.  This 
pensioner  was  paid  to  June,  1867,  and  Pension  E.xaminer  AV. 

Owen  reports  his  disability  total  and  pjermanent.  The  specimen 
was  forwarded  by  Surgeon  W.  Varian,  U.  S.  V. 


Fig.  2.57. — Shattorcil  acromial  Imlf  of  loft  clavicle,  excised  for  fjim- 
shot  fracture.  *S/?cc.  372,  Sect.  1,  A.  M.  M. 


560 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CuAr.  V, 


In  some  of  the  gunshot  fractures  of  the  clavicle  described  on  pages  483  and  522, 
splinters  of  bone  were  removed.  In  the  following  interesting  case,  the  fractured  ends  of 
the  bone  were  removed : 

Case  9. — Sergeant  J.  M.  Woodell,  Co.  I,  63d  Massachusetts  Volunteers,  aged  45  years,  was  wounded  at  Port  Hudson, 
Louisiana,  May  27th,  1853;  tlie  missile  entered  near  the  sternal  end  of  the  right  clavicle,  passed  backward  and  outward,  com- 
nunuted  the  clavicle  and  neck  of  the  scapula,  the  scroniion  and  coracoid  processes  of  which  it  fractured,  and  escaped  through 
the  scapula,  just  below  the  spine.  It  also  fractured  the  first  and  second  ribs  at  their  middle,  wounded  the  subclavian  artery  and 
vein,  and  injured  the  brachial  plexus.  The  jiatient  was  conveyed  to  New  Orleans,  and  admitted,  on  the  29th,  to  the  University 
hosj)ital.  The  loose  fragments  of  bone  were  removed,  the  fractured  ends  of  the  clavicle  rounded  oft',  and  cold-water  dressings 
apjdied.  Death  resulted  on  June  7th,  1863.  While  in  hosj)ital,  and  for  several  hours  after  death,  the  right  side  of  the  chest  and 
right  arm  were  several  degi'ees  warmer  than  the  corresponding  parts  of  the  left  side.  The  necropsy  revealed  the  injury  done  by 
the  hall.  The  subclavian  artery  was  not  opened,  though  the  inner  coats  were  much  lacerated,  where  the  artery  passed  over  the 
first  rib,  so  much  so  that  the  vessel  was  torn  in  removing  it.  The  subclavian  vein  was  torn,  and  an  imperfect  coagulum  filled 
up  its  cavity.  The  outer  cord  of  the  brachial  jdexus  was  torn  across.  Specimen  No.  1304,  Sect.  I,  A.  M.  M.,  shows  the  clavicle, 
scapula,  and  first  and  second  ribs  of  the  right  side.  It  was  contributed,  with  a history  of  the  case,  by  Assistant  Surgeon  P.  S. 
Conner,  U.  S.  A. 

Tlie  subject  of  the  following  fatal  case  of  partial  excision  had  undergone  also  an 
amputation  at  the  wrist: 

Case  10. — Corporal  IF.  II.  Hushj,  Co.  I,  3d  South  Carolina  Regiment,  while  in  the  act  of  firing,  November  18th,  18C3, 
was  wounded  by  a hall  from  au  Enfield  rifle,  which  struck  the  left  hand,  injuring  it  severely,  and,  after  passing  through  many 
folds  of  blanket,  struck  the  riyht  clavicle  about  two  inches  from  the  sternal  articulation,  fracturing  and  comminuting  the  bone  for 
the  space  of  about  two  inches,  and  sjditting  the  sternal  end  to  within  a half  inch  of  the  articulation  ; it  then  passed  through  the 
upper  part  of  the  humerus,  entering  at  and  breaking  the  inferior  edges  of  the  cartilaginous  surface  of  the  head  of  the  bone,  and 
coming  out  near  the  upper  part  of  the  attachment  of  the  teres  major  and  latissimus  dorsi.  On  the  next  day  the  left  hand  was 
amputated  about  an  inch  above  the  wrist.  In  a report  of  the  case  the  Confederate  States  Medical  and  Surgical  Journal,  Vol.  I, 
page  159,  Assistant  Surgeon  E.  L.  Johnson,  P.  A.  C.  S.,  says:  “The  case  came  under  my  charge  on  the  4th  of  December,  at 
which  time  nothing  was  known  of  the  position  of  the  ball.  The  surgeon  who  first  examined  the  case  was  necessarily  ignorant  of 
the  fact  that  the  humerus  was  injured,  for  it  was  not  broken  in  two,  but  shot  through,  which  caused,  however,  some  .splintering. 
December  5th  : Wrist  (stump)  doing  \vell  ; right  arm  very  much  swollen,  probably  on  account  of  an  abscess  in  the  anterior  part 
of  the  shoulder,  which  ])resses  on  the  veins.  December  16th  : Ligatures  came  away  from  the  stump.  December  19th  : Ordered 
whiskey,  eggs,  milk,  and  other  'nourishing  diet,  which  have  just  been  obtained  for  the  first  time.  December  24th  : The  discharge 
of  pus  is  now  from  one  to  two  gills  per  day.  It  escaped  by  overflowing  of  the  wound  at  the  clavicle,  the  quantity  being  much 
augmented  by  pressure  on  the  anterior  part  of  the  shoulder,  over  the  abscess.  December  25th  ; Dr.  Spinks,  of  Humi)hrey's 
brigade,  and  Dr.  North,  of  Anderson’.s,  were  consulted  to-day,  and  it  was  agreed  : 1st.  To  ])ut  the  i)atient  under  the  influence  of 
chloi'oform,  in  order  to  make  a thorough  examination.  2d  : To  remove  the  ball,  if  its  position  could  be  ascertained.  3d.  If  the 
shoulder-joint  has  not  been  injured,  or  any  other  serious  injury  been  done  by  the  ball  in  its  progress,  to  remove  all  necrosed 
portions  of  the  clavicle.  December  23th  : Through  the  kindness  of  one  of  the  Federal  surgeons  at  Knoxville,  I procured  a good 
and  complete  set  of  resecting  instruments.  December  27th:  The  following  operation  was  made  to-day.  Assistant  Surgeons 
Spinks,  Dygott,  and  Gotten,  and  Dr.  Allen,  being  present : The  patient  having  been  aiifesthetized,  was  placed  upon  the  table, 
and  a large  gum  catheter  was  introduced  into  the  wound  and  passed  outward  along  the  sinus  to  the  anterior  part  of  the  shoulder, 
where  there  was  a collection  of  [tus,  and  where  the  ball  was  supposed  to  be.  Nothing  more  was  gained  by  this  step  than  a 
knowledge  of  the  exact  position  of  the  abscess.  The  arm  was  then  moved  about  to  ascertain  whether  or  not  the  humerus  was 
fractured ; and  as  there  was  no  crepitus,  uo  displacement,  and  no  impairment  of  the  movements  of  the  joint,  it  was  decided  that 
the  humerus  and  shoulder-joint  were  intact.  An  incision  about  two  inches  long  was  then  made  at  the  anterior  edge  of  the  deltoid 
muscle,  and  j^arallel  with  it,  reaching  from  opposite  the  head  of  the  humerus  to  below  the  neck.  After  cutting  nearly  an  inch 
deej)  through  the  swollen  tissue,  the  knife  entered  the  abscess.  The  finger  was  then  introduced,  and  a large  abscess  was  found 
with  one  sinus  leading  to  the  wound  at  the  clavicle,  and  one  leading  around  under  the  skin  and  fascia  to  another  abscess,  which 
lay  in  the  posterior  part  of  the  shoulder.  The  first  or  anterior  abscess  contained  pus  and  a few  small  spiculae  of  bone.  The 
second  or  posterior  contained  dark,  filfliy  pus,  and  the  ball,  which  was  extracted.  The  clavicle  was  then  resected.  The  existing 
orifice  was  enlarged  by  incisions — one  extending  neai’ly  to  the  articulation  of  the  left  clavicle  and  sternum,  the  other  extending  over 
the  distal  fragment  for  about  two  inches.  The  sternal  end  was  then  disarticulated  and  removed  by  dissection.  All  spiculajwefe 
then  carefully  removed  from  the  wound.  These  spicuhe  were  generally  furnished  on  one  surface  with  i)eriosteum,  by  which 
they  grew  to  the  tissues.  Their  other  surfaces  being  free,  and  acting  as  foreign  bodies,  were  surrounded  by  pus.  There  was 
one  point,  howev'er,  at  the  bottom  of  the  wound,  about  one  inch  and  a half  long,  which  was  firm  and  immovable  and  covered 
with  healthy  gi'anulations.  Tliis  was  supposed  (at  the  time)  to  be  a poi  tion  of  the  clavicle  from  the  posterior  surfiice  that  had 
never  been  displaced,  and  as  there  was  no  collection  of  jjus  under  or  around  it  it  was  not  removed.  A chain  saw  was  then 
passed  under  the  distal  fragment  an  inch  from  the  broken  end,  the  bone  sawn  in  two,  and  the  fragment  removed  by  dissection. 
Though  no  veins  or  arteries  of  any  size  were  cut,  he  lost  over  half  a pint  of  blood,  the  tissues  being  very  vascular.  A few  .sutures 
were  taken  ; wet  lint  was  a))plied;  the  patient  was  put  to  bed,  and  mor))hine  and  whiskey  were  administered.  December  28th  : 
Rested  well  last  night ; very  pale  and  languid  to-day  ; without  appetite  and  with  some  diarrhoea  ; a counter  opening  was  made 
into  the  abscess  from  which  the  ball  hud  been  extracted;  prescribed  one  grain  of  oj)ium,  ordered  eggs,  whiskey,  «fcc.  December 
29th  : Has  a little  more  color  in  his  cheeks  to-day  than  he  had  yesterday ; eat  s(iuirrel  stew  with  great  relish  ; bowels  bett^u- ; 


Sect.  III.] 


EXCISIOKS  OF  THE  CLAVICLl':. 


5G1 


prescribed  tr.  catechu,  gave  whiskey,  eggs,  milk,  »fcc. ; the  opeiiiugs  in  the  shoulder  are  discharging  freely  to-day,  the  discharge 
from  the  wound  being  much  diminished.  The  swelling  of  the  arm  is  so  much  reduced  as  to  slacken  the  bandages,  the  first  of 
which  were  apjdied  on  the  5th  instant,  and  which  had  been  re-applied  every  two  or  three  days  since.  The  arm  reduced  about 
one-third.  December  30th  and  31st:  Doing  well.  January  1st,  1864:  Doing  well;  appetite  good;  wound  and  incisions 
granulating;  discharge  from  the  wound  much  diminished,  there  not  being  enough  to  overflow  the  wound  in  twelve  hours;  the 
discharge  from  the  anterior  incision  (in  which  a tent  isTcept),  which  is  now  the  outlet  from  the  abscess  in  the  shoulder,  is  less 
than  the  discharge  was  from  the  wound  before  the  operation.  January  7th:  Healthy  granulations  over  the  end  of  the  bone,  and, 
indeed,  everywhere  about  the  wound;  discharge,  which  is  from  the  shoulder,  very  slight.  January  8th:  In  the  afternoon, 
some  diarrhoea;  presci'ibed  tr.  opii,  tr.  catechu  in  equal  paifs,  twenty  drops  after  each  operation  on  bowels.  January  14th: 
Whiskey  supplies  have  been  out  since  the  7th  ; diarrhoea  has  been  constant ; prescribed  tannin,  catechu,  opium,  &c.,  with  no 
effect;  losing  flesh  and  getting  weaker.  January  21st:  Diarrhoea  constant;  patient  very  weak;  procured  whiskey  to-day. 
January  26th  : During  past  six  days  have  had  good  supply  of  stimulants ; patient  very  weak ; diarrhma  continuas  ; will  probably 
not  live  till  to-morrow.  January  27th  : Died  at  one  o’clock  i».  M.  T\\q  post-mortem  examination  revealed  the  course  of  the  ball. 
On  making  an  incision  from*  the  wound,  which  had  healed  to  a considerable  extent,  to  the  incision  on  the  front  part  of  the 
shoulder,  and  from  there  around  to  the  posterior  incision,  I found  the  track  of  a large  abscess.  This  also  extended  downward 
in  front,  and  parallel  with  the  pectoralis  minor.  At  the  bottom  of  this  branch  abscess  there  was  a spicula  of  bone  half  an  inch 
long.  The  ball  had  passed  through  the  head  of  the  humerus,  but  had  not  broken  it  in  two.  It  did  not  pass,  therefore,  in  front 
of  the  shoulder,  through  the  sinus  by  which  it  was  extracted.  WTierever  any  periosteum  was  left,  bone  was  forming  rapidly. 
The  hard,  firm  place  in  the  bottom  of  the  wound,  supposed  during  the  operation  to  be  a spicula  from  the  posterior  part  of  the 
clavicle,  proved  to  be  entirely  new  bony  formation.  The  .abscesses  around  the  head  of  the  humerus  were  large,  and  had  burrowed 
back  into  the  shoulder  to  some  extent.” 


The  eleventh  and  last  of  this  series  of  operations  on  the  clavicle  was  practiced  for 
necrosis  following  a simple  fracture  of  that  bone  ; 


Case  11. — Private  John  Q , Co.  E,  9th  New  York  Cavalry,  sustained  a comminuted  fracture  of  the  right  clavicle, 

by  his  horse  being  shot  during  a charge  into  Winchester,  Virginia,  June  8th,  1862,  and  falling  upon  him.  He  was  conveyed  to 
Washington  and  admitted  to  Finley  Hospital,  where  he  was  found  to  be  suffering  from  gener.al  emphysema,  the  result,  probably, 
of  a wound  of  the  apex  of  the  pleura  from  some  of  the  fr.agments  of  the  broken  bone.  He  was  treated  for  this  difliculty  for  a 
considerable  time  and  lin.ally  entirely  recovered.  Several  spiculse  of  bone  were  removed  through  an  incision  from  under  the 
skin  in  the  situation  of  the  sternal  extremity  of  the  clavicle.  On  October  21st,  1863,  he  was  admitted  to  St.  Joseph’s  Hospital, 
Central  Park,  New  York.  The  wound  over  the  sternal  aspect  was  still  open  and  presented  the  pouting  and  indolent  appearance 
indicative  of  dead  bone  at  its  bottom.  A probe  being  passed  into  this  opening  disclosed  bare  bone,  which  was  still  firm  in  its 
attachments  and  which  was  decided  to  be  a portion  of  the  head  of  the  clavicle.  His  condition  was  good  and  it  was  thought 
best  to  wait  until  the  sequestrum  should  detach  itself  before  any  attempt  at  removal  should  be  made.  January  14th,  1864,  an 
abscess  formed  over  the  outer  third  of  the  clavicle  which  was  opened  and  showed  the  existence  of  dead  bone  at  that  point  also. 
Simple  applications  were  made  to  both  wounds.  February  10th:  The  sternal  extremity  of  the  clavicle  commenced  to  protrude 
itself  through  the  inner  opening  and  was  found  to  be  connected  with  and  evidently  to  form  a solid  piece  with  that  portion  of 
sequestrum  felt  through  the  outer  opening.  It  w.as  thought  that  the  whole  of  that  portion  of  the  bone  between  these  two  points 
was  dead.  There  was  a considerable  amount  of  thickening  around  it  caused  by  the  deposit  of  involucrum.  The  wound  dis- 
charged slightly.  June  1st:  The  bone  was  now  freely  movable  in  its  bed  and  its  sternal  end  pointed  out  of  the  wound  for  a 
distance  of  three-fourths  of  an  inch.  Aside  from  a pain  in  the  right  side  of  the  chest  and  in  the  right  shoulder,  with  .an  incon- 
venience in  the  motion  of  the  parts,  the  patient  sufl'ered  very  little  and  enjoyed  a good  api)etite.  On  June  21st,  1864,  Acting 
Assistant  Surgeon  J.  K.  Merritt  removed  the  sequestrum  by  slightly  enlai’ging  the  intern.al  opening.  The  parts  fi-om  which  this 
portion  of  bone  was  removed  soon  became  firmly  braced  by  a new  bridge  of  osseous  tissue,  formed  l)y  the  involucrum,  and 
really  constituted  a new  clavicle.  The  motions  of  the  arm,  though  somewhat  restrained,  were  nevertheless  good,  all  the  support 
to  the  shoulder  necessary  for  the  subsequent  good  use  of  the  limb  being  left  good.  The  case  progressed  well  until  July  16th, 
when  the  wounds  covered  themselves  with  an  ashy  slough  and  hospital  g.angrene  fairly  declared  itself.  On  the  10th,  a thick 
.angiy-looking  slough  covered  both  wounds;  the  edges  of  the  openings  were  tumid  and  inflamed.  The  surfaces  of  the  ulcers 
were  touched  with  bromine,  but  the  sloughs  were  so  thick  that  the  remedy  failed  to  have  the  desired  effect.  On  the  14th,  the 
sloughs  were  removed  and  bromine  applied  directly  to  the  part.  By  the  10th,  the  gangi-ene  had  extended  itself  into  the  tr.ack 
which  communicated  between  the  two  wounds.  The  p.atient  complained  of  a gre.at  deal  of  pain  and  soreness.  Bromine  was 
introduced  into  the  track  of  the  wound,  but  owing  to  the  presence  of  the  slough  and  the  difliculty  of  removing  it,  the  remedy 


could  not  be  brought  in  direct  conhact  with  the  surfaces  underneath.  The  parts  were  repeatedly  touched  with  bromine  and 
bathed  with  a wash  made  of  the  same.  Under  this  treatment  they  assumed  a healthy  aspect  .and  the  patient  commenced  to  do 
well.  By  September  10th,  the  p.arts  had  entirely  healed ; there  was  a marked  enl.argement  from  deposit  of  new  bone  at  the  seat 
of  exfoliation.  The  soldier  was  discharged  from  service  October  1st,  1864 ; the  arm  was  useful  and  nearly  all  the  normal 
movements  could  be  made  with  it.  The  sequestrum  is  repre.sented  in  the 
adjoining  wood-cut  (Fig.  258).  It  is  partially  tubular  and  is  about 
three  inches  in  length.  The  sternal  articular  surface  is  destroyed  .as  well 

as  all  the  cancellous  structure  in  the  longitudinal  diameter  of  the  bone.  . I 

It  is  evident,  too,  that  the  acromial  end  of  the  clavicle  did  not  become 
necrosed,  and  the  deficiencies  of  the  compact  tissue  of  the  head  portion 
of  the  bone  may  be  accounted  for  by  the  removal  of  the  several  small  „ 

. 1' 10.2.58. — 1 ubolar  seqoe.sfrum  from  necrosis  of  nght  clavi- 

fragments  at  the  hospital  at  VVashmgton.  The  excavation  on  the  anterior  cle.  Spec.  4332,  Sect.  I,  A.  M.  M. 


71 


662 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


face  of  tlie  hone  was  proliahlv  caused  by  flie  removal  of  two  or  three  detached  fragments  at  that  time.  If  there  were  any  small 
fragTiients  toward  the  sternal  end,  as  doubtless  there  were,  they  must  have  been  firmly  attached  to  the  periosteum  and  become 
incorporated  with  the  involucrum,  and  helped  to  form  tlie  firm  bridge  of  bone  which  exists  over  the  subclavian  vessels.  The 
specimen  was  contributed,  with  a history  of  the  case,  by  Acting  Assistant  Surgeon  G.  F.  Shrady. 

Excisions  of  Portions  of  the  Scapula. — The  comjfarative  frequency  of  fracture  of  the 
shouhler-hlade  in  gunshot  wounds  of  tlie  chest  has  been  referred  to  on  page  484  of  this 
Chapter,  and  examples  are  there  cited  of  the  removal  of  loose  splinters  of  hone,  as  part  of 
the  ordinary  dressing  of  such  injuries.  Sometimes,  it  is  necessary  to  excise  undetached 
portions  of  bone,  to  facilitate  the  extraction  of  jirojectiles,  fragments  of  clothing,  or  equip- 
ments, or  other  foreign  bodies.  When  great  comminution  has  been  produced,  it  may  be 
advisable  to  excise  considerable  portions  of  the  bone.  When  necrosis  involves  the  larger 
jiart  of  the  scapula,  it  should  be  extirpated.  The  last  assertion  is  justified  by  the  argument 
of  ])r.  Stephen  Rogers,  whose  admirable  paper’*'  on  the  subject  conclusively  establishes  the 
apparent  paradox  that  it  is  safer,  in  cases  of  malignant  disease,  to  excise  the  whole  than  a 
part  of  this  Ijone.  Excision  of  the  entire  scapula  has  thus  far  been  practiced  in  military 
surgery  only  in  connection  with  ablation  of  the  arm;  in  other  words,  as  an  amputation  above 
the  shoulder.  It  was  thus  successfully  performed  by  Gumming,  in  1808,  in  the  case  of  a 
man  with  gunshot  comminution  of  the  liumerus  and  scapula,  and  a similar  operation,  for  the 
same  cause,  was  successfully  practiced  by  Gaetani  Bey,  in  1838,  on  a boy  of  14  years. 

The  removal  of  the  entire  scapula  and  preserving  the  arm  is  an  advance  of  modern 
surgery whicli  must  undoubtedly  be  acknowledged  as  a legitimate  resource  in  military 
practice  in  cases  of  extensive  necrosis  following  gunshot  fracture.  So  far,  I believe,  there  is 
no  recorded  instance  of  its  employment;  although  Dr.  Neudorfer,  of  the  Austrian  army,  in 
1862,  successfully  removed  the  greater  part  of  the  scapula,  in  a case  of  necrosis  caused  by 
gunshot  comminution.  In  our  late  war,  the  several  partial  excisions  enumerated  in  the 
following  series  were  practiced,  and  others  that  will  be  found  detailed  at  page  492,  et  seq., 
of  the  Second  Surgical  Volume. 

Case  1. — Private  F.  E.  B , Co.  F,  5tli  Connecticut  Volunteers,  aged  51  years, 

was  wounded  at  Cbaneellorsville,  Virginia,  May  3d,  1863,  by  a conoidal  ball,  wbicli  struck 
the  infra-spinatus  fossa  of  the  left  scapula  about  niidw.ay  between  its  inferior  angle  and 
the  .spine,  passed  forward,  splintered  the  bone  extensively,  and  finally  lodged  in  tlie  glenoid 
cavity  without  injuring  the  humerus.  He  was  treated  in  the  field  liospital  of  the  1st 
division.  Twelfth  Corps,  until  the  Cth,  when  he  was  sent  to  Lincoln  Hospital,  W'ashington. 
An  operation,  for  the  removal  of  the  ball,  discovered  a large  number  of  shattered  fragments 
lying  near  the  joint,  which  w'ere  dissected  out  from  their  ligamentous  attachment  and 
withdr.awn.  The  lower  portion  of  the  scapula  being  now  entirely  separated  from  the 
ujiper,  and,  not  knowing  to  what  extent  the  inferior  portion  of  the  bone  had  been  splintered, 
it  was  determined  to  remove  it  rather  than  risk  the  effects  of  the  prolonged  discharge  from 
the  remnant.  Chloroform  was  administered,  and  the  operation  performed  by  Surgeon  H. 
Bryant,  U.  S.  V.  The  sjiine  and  supra-spinous  fossa  were  jireserved.  The  smooth  head 
of  the  humerus  was  visible  through  the  wound.  The  patient  did  remarkably  well.  No 
bad  symptoms  supervened,  and  he  gradually  regained  his  strength.  The  incision  made 
for  the  removal  of  the  bone  filled  up  without  sinuses  or  discharge  of  exfoliations.  On 
August  20th,  he  was  furloughed  for  sixty  days.  Upon  returning,  the  wound  had  entirely 

* ROOEHS,  S.,  Case  nf  Excision  of  the  Entire  S:apula,  to  which  is  added  a Ilistory  of  the  Operations  involving  a Kcmoral  of  all  or  a Considerable 
Part  of  this  Bone;  with  the  view  nf  establishing  the  surgical  Character  and  Prognosis  of  this  Class  of  Operations.  In  Am.  Jour,  of  tlie  Med.  Sci., 
N.  S.,  Vul.  LVI,  p.  359,  ]8(>8.  [.See  also  Dr.  S.  Rooniis's  p-aper  in  the  A’cio  York  Med.  Jour..  18()9,  Vol.  VIII,  p.  433.] 

[“Entirely  a modern  aeliievement  in  surgery,"  said  .Sir  W’illiam  Fcrgu.sson  (Lectures  on  the  Progress  nf  Surgery,  London,  18G7,  Lecture  2,  p.  47), 
and  awarded  the  credit  of  first  practicing  if  to  .Syme.  It  was  first  performed  by  15.  von  Langenheck,  in  1855,  for  osteocophaloma.  in  a boy  of  12  years  ; 
next  by  .Syme,  for  a “sanguineous  cyst  of  the  bone,"  in  a woman  of  70  years  ; third,  by  Dr.  J.  F.  Ileyfelder,  in  18.57,  for  caries  in  an  adult,  who  died  on 
the  eighth  day  of  pyiemia  (Deutsche  Klinik,  1857);  by  Mr.  Jones,  of  Jersey,  in  18.58,  (Med.  T.  <£■  <?.,  December,  1858)  for  caries  in  a girl  of  15  years, 
who  had  a most  useful  arm  six  years  afterward ; by  Dr.  Hammer,  in  IShO  (.St.  Louis  Med.  Reiiorter),  for  csteo  cancer,  in  a girl  of  18  years;  by  Syme, 
in  18fi0,  for  osteo-cancer ; by  Frofessor  Schuh,  in  1860,  for  osteo-cancer  in  a child  of  8 years;  by  M.  Michaux,  in  1864,  for  encephaloma ; by  Dr.  S. 
llogcrs,  in  1867,  for  osteo-canocr  (1.  c..  ji.  389).  Eight  of  the  nine  patients  recovered,  and  the  m.njority  retained  useful  arms.  I am  indebted  to  the 
masterly  paper  by  Dr.  Rogers,  above  referred  fo,  for  these  references,  and  for  most  of  the  information  on  which  the  comments  on  this  series  of  cases  is 


Fig.  259. — Rortion  of  left  scapula  suc- 
cessfully removed  after  it  gunshot  injury. 
Sjter.  1U90,  .Sect,  I,  A.  M.  M. 


Sect.  III.] 


EXCISIONS  OF  THE  SCAPULA. 


563 


healed.  The  use  of  the  fore-ami  and  hand  ivere  perfect,  (hough  the  motion  of  the  arm,  as  tvas  .anticipated,  was  impaired  by  the 
loss  of  support  of  the  head  in  the  glenoid  cavity.  It  had  fallen  back  slightly  from  its  natural  position.  The  arm,  from  weakness, 
was  still  worn  in  a sling.  The  patient  was  enabled  to  eat,  tie  his  cravat,  brush  his  hair,  button  his  clothes,  etc.,  with  the  affected 

member,  .and  its  strength  and  usefulness  were  daily  increasing.  On  January  14th,  1864,  B was  transferred  to  Connecticut, 

and  finally  discharged  from  service  in  March,  1864.  The  pathological  specimen  was  contributed,  with  this  history  of  the  case,  by 
the  operator.  It  is  figured  in  the  preceding  cut  (Fig.  259).  This  man  is  a pensioner.  On  May  27th,  1867,  Pension  Examiner 
E.  Strickland  reports  that  the  arm  is  utterly  useless  and  painful,  and  rates  the  pensioneFs  dis.ability  as  tot.al  and  prob.ably  permanent. 
[Dr.  S.  B.  Ward  has  inforaied  the  office  that  Assistant  Surgeon  H.  Allen,  U.  S.  A.,  performed  this  operation,  a fact  that  Dr. 
Allen  has  personally  confirmed.  ] 


The  result  in  this  case  would  probably  have  been  even  more  favorable,  if,  after  the 
removal  of  the  head  of  the  bone,  the  spine,  acromion,  coracoid,  and  superior  border  had 
also  been  extracted  and  the  extirpation  made  complete,  for  the  pension  examiner’s  report 
appears  to  indicate  that  the  mutilated  remnants  of  bone  give  trouble. 

In  a successful  case  of  decapitation  of  the  head  of  the  humerus,  noticed  as  Case  1493, 
in  Chapter  IX  of  the  Second  Surgical  Volume,  Surgeon  0.  A.  Judson,  U.  S.  V.,  excised  a 
portion  of  the  coracoid  process,  the  movements  of  the  arm 
remaining  very  well  preserved.  Dr.  Judson  also  operated 
in  the  following  case,  removing  large  fragments  of  the  infra- 
spinous  fossa  to  extract  an  impacted  ball : 

Case  2. — Private  J.  B- 


Co.  H,  7fh  Massachusetts  Volunteers,  aged  34 
ye.ars,  having  been  wounded  at  Chancellorsville,  on  May  3d,  was  sent  to  Washington, 
and  admitted  to  Carver  Hospital  on  May  9th,  1863.  A bullet  had  entered  the  left 
shoulder  just  below  the  coracoid  process  of  the  scapula,  lodging  near  its  neck  in  the 
substance  of  the  infr.a-spinatus  muscle.  The  patient’s  condition,  upon  admission  to 
hospital,  being  good,  he  was  allowed  a full  diet.  On  May  14th,  intermittent  fever 
complicated  the  case,  for  which  suitable  remedies  were  prescribed.  The  bullet  was 
removed  fi’om  the  wound,  through  an  incision,  on  May  21st,  the  patient  being  chloro- 
fonned.  The  scapula  was  much  shattered,  and  the  incision  being  enlarged,  fr.agments 
of  bone  were  also  removed.  Intermittent  fever  and  secondary  haemorrhage  ensued; 
the  patient  sank  rapidly,  and  died  on  May  25th.  The  specimen,  figured  in  the 
adjoining  wood-cut  (FiG.  260),  was  contributed  to  the  Army  Medical  Museum,  with 
a memorandum  of  the  case,  by  the  operator.  Surgeon  0.  A.  Judson,  U.  S.  V. 


Fig.  260. — Fractured  scapula,  with  a split  ball 
attached.  Spec.  1211,  Sect.  I,  A.  M.  M. 


The  following  operation  was  practiced  also  under  the  direction  of  Dr.  Judson,  to  wliose 
lot  fell  an  unusually  large  number  of  injuries  of  this  description.  See  ante,  Figs.  220  and 
224,  pages  483  and  485: 

Case. — Private  George  R.  M , Co.  E,  84th  Pennsylvania  Volunteers,  aged  29  years,  was  wounded  at  the  Wilder- 

ness, Virginia,  May  6th,  1864,  by  a conoidal  ball,  which  entered  at  the  superior  angle  of  the  scapula,  passed  backward,  producing 
a compound  comminuted  fracture  of  the  spine  of  the  left  scapula  and  remained  in  the  wound.  He  was  treated  in  the  field  until 
the  14th,  when  he  was  transfeired  to  Carver  Hospital,  Washington.  When  admitted,  his  constitutional  condition  was  excellent 
and  the  injured  parts  were  in  good  condition;  there  was  not  much  swelling  but  considerable  pain.  On  May  17th,  Acting 
A.ssistant  Surgeon  William  E.  Clark  administered  chloroform  and  excised  the  fractured  spine  of  the  scapula  through  a straight 

incision  immediately  over  it.  He  also  removed  the  ball.  The  wound 
was  then  filled  with  charpie,  and  cold-water 
di-essings  applied.  The  patient  reacted  well 
from  tlie  shock  of  the  operation  and  continued 
to  improve,  the  wound  granulating  rapidly  and 
secreting  a quantity  of  laudable  pus.  On  Juno 
17th,  1864,  he  was  furloughed,  and,  on  Sep- 
tember 10th,  admitted  to  Satterlee  Hospital,  I'E’-  262.— Conoidal  ball 
Fig.  261.— Portion  of  spine  of  loft  .scapula  fractured  by  a m -i  i i i • i i t removed  from  the  injured 

conoidal  ball.  Spe/:.  2294,  .Sect.  I,  A.  JI.  JI.  Philadelphia,  whence  he  was  translerred  to  the  spine. 


based.  The  merit  of  priority  in  proposing  to  remove  the  scapula  and  save  the  arm  belongs  to  Liston  (1819).  The  names  of  American  surgeons  are 
honorably  connected  with  this  advance  in  surgerj-.  In  18.50,  Professor  Gross  successfully  removed  tlie  scapula  entire,  with  tlic  exception  of  the  glenoid 
cavity  and  end  of  the  acromion,  preserving  the  arm ; in  1860,  Dr.  AValter,  of  Pittsburg,  removed  all  of  tho  scapula  except  tlie  neck,  glenoid  cavity,  and 
acromion,  in  a boy  of  17  }-ears,  with  caries,  preserving  a useful  arm  (Am.  Jour,  of  Med.  .Sci.,  18(il) ; in  1837,  Mussey  excised  tlie  scapula  for  an  enormous 
ostco-sarcoma,  in  a man  whose  arm  had  been  amputated  six  years  before ; tlie  patient  was  well  fifteen  years  after  the  second  operation.  McLellan,  1838, 
removed  the  scapula,  arm,  and  portion  of  clavicle  successfully,  in  a boy  of  17  years,  witli  osteocephaioma ; Gilbert,  in  1846,  successfully  performed  another 
of  these  amjiutations  above  the  shoulder,  .and  so  did  Dr.  Gordon  Buck,  in  1864,  in  a man  wlio  Iiad  previously  lost  tlie  iirin,  for  osteo-caiicer.  Dr.  .Sehuiiiiert, 
of  Xevv  Orlciins,  operated  successfull}',  in  1868,  for  osteochondroma.  Dr.  llaiiiiiicr  operated  a second  time,  in  1869,  unsuccessfully. 


564 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Voteran  Reserve  Corps,  January  l/tli,  1865.  Discliarged  from  service  nii  Sepfember  14tb,  1865.  Tlie  wood-cuts  (Figs.  261  and 
262)  on  the  preceding  jnige  show  the  acromion  and  upper  third  of  the  spine  of  the  left  sca]mhi,  and  the  missile  causing  the  fracture. 
It  was  contributed,  with  a history  of  the  case,  by  Surgeon  O.  A.  Judson,  U.  S.  V.  Pension  Examiner  John  McCulloch  reports, 
May  11th,  1866,  that  “the  ball  entered  and  passed  over  and  rather  back  of  the  head  of  the  left  humerus,  shattering  the  scapula, 
and  was  extracted  about  one-third  from  the  lower  point  of  scai)ula.  Arm  can  be  raised  nearly  level — carried  forward  pretty 
well,  but  not  back.  Scapula  hollow,  arm  weak.  Disability  three-fourths,  probably  not  wholly  curable.” 

Ill  the  next  case,  the  operation  was  practiced  for  disease  not  resulting  from  gunshot 
injury,  hut  attriljuted  to  periostitus  induced  by  the  pressure  of  the  knapsack.  The  report 
does  not  state  whetlier  a syphilitic  or  strumous  taint  existed,  but  the  coincident  periostitis 
of  the  tibia,  a bone  not  subjected  to  pressure  from  accoutrements,  establishes  a presumption 

Case. — Private  Morris  0 , Co.  D,  8th  United  States  Infantry,  aged  20  years, 

was  treated  in  the  early  part  of  1862,  for  intermittent  fever.  He  subsequently  sufferwl 
with  fever  jjaroxysms.  About  July  1st,  he  was  sent  to  Fort  McHenry.  While  there,  an 
abscess  formed  below  the  tuberosity  of  the  tibia,  and  one  on  the  toj)  of  his  right  shoulder 
said  to  have  been  caused  by  the  pressure  of  his  knapsack  and  accoutrements.  The 
abscess  on  the  shoulder  began  to  discharge  on  July  6th.  On  August  13th,  he  was  admitted 
to  Camden  Street  Hospital,  Baltimore,  suffering  from  typhoid  fever.  On  August  15th,  a 
portion  of  the  right  acromion  process  of  the  scapula  was  excised,  and,  on  the  22d,  the 
spine  and  the  balance  of  the  acromion  process  were  removed  by  Assistant  Surgeon  R. 
Bartholow,  U.  S.  A.,  on  account  of  ulceration  following  an  abscess.  He  was  discharged 
from  service  on  November  1st,  1862,  and  applied  for  a pension;  the  pension  surgeon,  after 
two  examinations,  decided  that  his  disability  was  one-half  and  likely  to  continue  through 
life,  but  the  application  -was  rejected  for  non-compliance  with  the  regulations  of  the  Pension 
Bureau.  The  adjacent  wood-cut  (FiG.  263)  shows  parts  of  the  necrosed  fragments,  one 
and  one-half  inches  in  length.  The  specimen  was  contributed  by  Assistant  Surgeon  R. 
Bartholow,  U.  S.  A.,  with  the  above  history  of  the  case. 

In  tlie  case  of  Private  J.  P , 14t]i  Indiana  Volunteers,  narrated  on  page  475, 

the  necrosed  scapula  and  upper  extremity  of  the  humerus  being 
represented  by  Fig.  211,  Acting  Assistant  Surgeon  W.  AV.  Keen,  jr., 
excised  the  spine  of  the  bone,  a month  before  the  fatal  termination  of 
the  case  from  extension  of  disease  to  the  shoulder-joint  and  pleural 
cavity.  IPe  removed  at  the  same  time  a portion  of  the  ball  that 

corresponding  with  the  post  mortem  specimen  figured  on  page  475. 

The  accompanying  wood-cut  (Fig.  265)  represents  the  specimen  from  the  first  case, 
detailed  on  page  475,  of  gunshot  fracture,  with  removal  of  detached  fragments  of  the 

scapula,  and  resection  of  the  sharp  fractured  ends  of  the 
clavicle.  .Though  not  an  instance  of  formal  excision,  it 
is  interesting  for  comparison  in  this  connection. 

No  instance  was  reported  of  trephining  the  scapula, 
an  operation  advised  in  some  surgical  treatises  for  the 
removal  of  dead  bone  or  of  foreign  bodies.  M.  Dubrueil* 
relates  a case  in  which  he  resorted  to  this  expedient 
during  the  late  Franco-Grerman  war.  The  cutting  bone- 
pliers  and  osteotomes  in  use  are  much  better  adapted 
than  the  trephine  for  such  partial  excisions  as  are 
required  on  the  scajiula. 

* I)unRUi:ii>,  Gazette  des  Uopitaux,  Paris,  Pevr.  4, 1871.  Velpeau  cites  MarescliaFs  case  of  trephioing  the  scapula,  iu  the  Mem.  dc  VAcad.  de  Chir., 
T.  II,  Ilistoire  de  I’Acad,  p.  lx.  , 


Pig.  265. — Right  scapula,  portion  of  clavicle,  and 
head  of  humerus,  showing  results  of  gunshot  fracture. 
Spec.  720,  Sect.  I,  A.  M.  JM. 


inflicted  the  injury.  The  specimen  (Fig.  264)  is  represented  of  a size 


Fig.  264. — Spine  of  the  right 
scapula,  excised  for  necrosis  after 
ooinminution  by  a conoidal  musket 
ball,  a portion  of  which  is  attached. 
S2)ec.7\)4,  Sect.  I,  A.  M.  M. 


of  such  a condition; 


Fig.  263. — Necrosed  portions  of  the  right 
acromion  and  spine  of  the  scapula.  Size 
of  nature.  Spec.  415,  Sect.  1,  A.  M.  M. 


Sect.  III.] 


EXCISIONS  OF  THE  SCAPULA. 


565 


In  the  Army  of  the  Loire,  at  the  engagements  about  Orleans,  in  October,  Hovemher, 
and  December,  1871,  M.  A.  ChipaulL  removed  large  portions  of  the  scapula  in  three  cases 
of  gunshot  comminution,  as  follows  : 


Ca.se  1. — Gleizal.  aged  23  years,  27th  marching  regiment,  was  wounded,  December  2d,  1870,  at  I’oiirpry,  near  Artenay 
and  admitted,  December  lOtli,  to  the  ambulance  at  the  Visitation.  A musket  ball  had  shattered  the  sub-spinal  blade  of  the  right 
scapula.  Ou  January  2Cth,  1871,  M.  Chipault  removed  about  half  of  the  bone  below  the  spine,  carefully  ])reserving  the 
periosteum.  The  patient  was  discharged,  nearly  well,  April  2d,  1871. 

Case  2. — Weber,  aged  35  years,  40th  marching  regiment,  received  a gunshot  comminution  of  the  right  scapula  at 
Neuvilliers,  December  2d,  1870,  the  ball  entering  at  the  acromion  and  making  its  exit  at  the  posterior  angle  of  the  spine. 
Admitted  to  the  Visitation,  December  18th,  whei’e,  on  Februai’y  11th,  1871,  the  spine  and  acromion  were  excised.  There  was 
rapid  reproduction  of  bone,  tbe  operation  having  been  sub  periosteal,  as  described,  and  the  upper  extremity  regained  its  functions 
except  ;U)duction  of  the  arm.  On  May  11th,  the  patient  was  discharged  from  liospital. 

Case  3. — Klein,  aged  22  years,  33d  marching  regiment,  was  wounded  at  Ormes,  October  11th,  1870,  by  a ball,  which 
comminuted  the  su])ra  and  infra-sj)inous  portions. and  spine  of  the  right  scapula.  He  entered  the  Orphan  Asylum  Hospital  .Inly 
1st.  1871.  There  was  extensive  necrosis,  for  which  M.  Chipault  excised  nearly  the  entire  scajuda,  the  glenoid  cavity,  coracoid, 
and  acromion  being  left.  The  patient  recovered  and  preserved  some  use  of  the  upper  extremity. 

Dr.  Chipault  illustrates  these  cases  by  six  chromo-lithographs,  representing  th,e 
appearance  of  the  patients  after  partial  recovery,  and  the  pathological  preparations  of  the 
comminuted  scapulae.  M.  Chipault  also  publishes  a case  communicated  to  him,  by  Dr. 
Charpignon,  which  may  be  abridged  as  follows  : 

Case  4. — Gerin,  7th  battalion.  Foreign  Legion,  at  Orleans,  October  11th,  1870,  had  his  right  scapula  comminuted  by  a 
ball,  which  struck  between  the  clavicle  and  first  right  rib,  and  passed  out  through  the  shoulder-blade.  On  October  23d,  the 
wound  wuis  enlarged,  and  several  necrosed  fragments  of  the  scapula  were  extracted.  Some  of  them  were  so  adherent  that  it  was 
necessary  to  divide  the  muscular  attachments.  The  patient  recovered,  and,  in  December,  was  sent  to  serve  in  Africa.  He  pr(!- 
served  tbe  use  of  his  arm  completely. 

Velpeair  describes  a patient  on  whom  he  practiced  quite  an  extensive  excision  of  the 
acromial  portion  of  the  scapula,  for  a comminution  by  grapeshot,  in  Paris,  in  July,  1830. 
j\I.  LegouesD  also  mentions  a case  in  which  a ball,  grooving  the  external  border  of  the 
scapula,  lodged  under  the  glenoid  cavity,  so  that  he  was  “ compelled  to  resect  largely  to 
remove  the  projectile.” 

From  the  Crimean  AVar,  but  one  instance  of  partial  excision  for  fracture  of  the  scapula 
is  noticed  in  Matthew’s  statistical  return  {pp.  cit.,  p.  372).  The  case  is  fully  described  in 
a paper  on  excisions,  read  at  the  twelfth  ordinary  meeting  of  the  Crimean  Medical 
Society  [Med.  Itvics  and  Gazette,  September,  1856),  March  20th,  1856,  by  Surgeon 
Thornton,  of  the  9th  regiment,  the  operator  in  the  case.  Dr.  Watson ■*  states  that  “when 
attached  to  the  surgical  hospital  above  Balaclava,  I had  the  opportunity  of  seeing  several 
cases  of  fracture  of  the  scapula  from  grapeshot.  I recollect  one  case  in  particular,  where 
the  ball  was  lodged  beneath  the  scapula,  from  which  position  it  was  extracted  by  incision 
about  a month  aftei’  the  infliction  of  the  injury.  In  this  instance  the  whole  of  the  bone  was 
extensively  comminuted,  its  processes  alone  remaining  intact.  In  spite  of  this  extent  of 
injury,  the  fragments  in  great  part  retained  their  vitality,  and,  although  the  discharge  was 
for  a time  both  copious  and  exhausting,  the  part  consolidated,  and  the  patient  recovered 
with  the  loss  of  scarcely  any  bone.  I have  also  seen  the  head  of  the  humerus,  the  coracoid 

* M.  CinPAULT,  A. — Fractures  par  Arrays  a Feu  Expectation^  Resection  sous-p6riostee  ^cidement.  Amputation.  Iloyal  8°,  Paris,  1872, 

^VELI’BAU,  Med.  Op6rat.  (already  cited),  T.  11,  p.  571. 

^LegoUEST,  TraiU  dc  Chirurgie  d' Arm^^  2cme  §d.,  p.  325.  The  specimen  is  presented  at  the  Museum  of  Val  de-Grdcc.  See  op.  cit.  Ficf.  45. 

‘^Edinburgh  Medical  dfrurnal^  Vol.  XV,  p.  124,  1809.  This  writer  prints  a history  of  an  amputalimi  of  the  scapula  ami  “adopts,”  as  lie  terms  it, 
I>r.  Stephen*  Kogeus’h  table,  dislocating  it  into  subdivisions.  As  he  “ rearranges  ” it,  tlie  priority  of  excising  tlie  entire  scapula  ami  iircserving  the  arm 
would  appear  to  belong  to  an  Kdinburgh  surgeon,  Syme  (1850),  instead  of  to  Laxgendeck  (1655).  The  legitimate  fruit  of  Dr.  llOGEUS’s  industry  is 
be  preferred  to  Dr.  Watson’s  adoption. 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


5()6 

process,  and  glenoid  surface  so  injured  by  a conical  ball  as  to  recpiire  excision  of  lire  bead 
of  the  humerus  and  the  extraction  of  the  primary  fragments  of  the  scapula.” 

Sir  William  Fergusson  says,^  “I  can  scarcely  imagine  any  case  of  compound  fracture 
of  the  scapula  where  removal  of  the  whole  of  that  bone  would  be  justihable  as  a primary 
proceeding.”  Dr.  P.  H.  Watson  says,  “ To  this  remark,  I most  cordially  adhibit  my 
concurring  testimony.”  Undoubtedly,  a combination  of  circumstances  that  would  render 
a primary  excision  or  amputation  of  the  scapula  for  gunshot  comminution  advisable  can 
seldom  arise ; yet,  without  a very  vivid  imagination,  one  may  conceive  of  conditions, 
resulting  from  lacerations  by  large  projectiles,  which  would  render  primary  interference  by 
extirpating  the  scapula  and  preserving  the  arm,  or  by  amputation  above  the  shoulder,  not 
only  justifiable  but  imperative.  As  a general  rule,  after  removing  detached  fragments,  the 
military  surgeon  will  await  what  nature  will  accomplish  in  consolidating  the  fraotured 
bone,  and  will  reserve  excision,  as  an  intermediary  or  secondary  measure,  in  cases  of 
extended  necrosis." 

Excision  or  Removal  of  Portions  of  the  Ribs.— This  is  a very  old  operation  ; but  its 
applications  in  military  surgery  are  not  very  numerous  or  important.  The  smoothing  off 
very  sharp  pointed  ends  of  ribs  fractured  by  balls,  and  extraction  of  loose  fragments, 
constitute  the  only  admissible  primary  interference.  When  necrosis  supervenes,  more 
extended  operations  are  required.  The  cases  of  Grallagher  and  Butterfield,  printed  on  pages 
506  and  551,  describe  the  ordinary  partial  excisions  resorted  to  in  the  ribs.  Some  details 
are  given  in  the  following  series  of  cases ; 

Cask  1. — Private  J.  H.  Havvortb,  Co.  D,  G9tlt  New  York  Volunteers,  was  wounded  at  Antietam,  Maryland,  September 
17tb,  1862,  by  a conoidal  ball,  wbicb  entered  on  tbe  twelfth  rib,  right  side,  two  inches  anterior  to  its  angle,  and  emerged  on 
the  same  rib,  posteriorly,  six  inches  from  tbe  first  wound.  He  was  admitted,  on  tbe  24tb,  to  tbe  hospital  at  Frederick,  where,  on 
December  2d,  Surgeon  H.  S.  Hewit,  U.  S.  V.,  excised  tbe  posterior  portion  of  tbe  tenth  rib  on  the  right  side.  He  recovered,  and 
was  discharged  from  service  on  January  1st,  1863,  His  name  does  not  appear  on  tbe  pension  rolls. 

Case  2. — Sergeant  Edward  R.  Barker,  Co.  G,  148tb  New  J.’ork  Volunteers,  aged  33  years,  was  wounded  in  tbe  left  breast 
by  a conoidal  ball,  at  Fair  Oaks,  Virginia,  October  27tb,  1864.  He  was  admitted,  on  the  29th,  to  Hampton  Hospital,  Fort  Mon- 
roe, where,  on  January  11th,  1865,  a portion  of  rib  was  excised.  He  was  furloughed  on  March  16th,  1865;  reported  to  hospital 
at  Rochester,  New  York.  On  July  11th,  1865,  he  was  transferred  to  Ira  Harris  Hospital,  Albany,  New  York,  whence  he  was 
discharged  from  service  on  July  29th,  1865.  Examining  Surgeon  Jolin  B.  Chapin,  of  Canandaigua,  New  York,  October  16th, 
1866,  reports : “Ball  entered  left  breast  betw’een  the  nipple  and  median  line,  striking  the  ribs,  and  emerging  below,  say,  opposite 
the  stomach.  The  course  of  the  ball  after  striking  the  ribs  was  downward.  Four  or  five  ribs  were  fractured.  The  disability 
consists  of  an  extensive  cicatrix,  involving  the  intercostal  muscles  and  the  origin  of  the  pectoralis  major  muscle,  preventing  the 
use  of  the  arm  in  a backward  direction  and  interfering  with  respiration.  The  applicant  states  that  he  is  also  suffering  from  gun- 
shot wound  in  the  calf  of  the  leg,  received  June  3d,  1864,  at  Cold  Harbor,  Virginia.  Leg  lame;  foot  swells  so  that  he  can  only 
wear  a boot  part  of  the  time.” 

Case  3. — Private  Peter  C.  Farnsworth,  Co.  F,  31st  Maine  Volunteers,  aged  17  years,  received  a shell  w’ound  of  the  right  side 
of  the  chest  at  Petersburg,  Virginia,  June  17th,  1864  ; the  eighth  rib  was  fractured  at  its  centre,  and  the  seventh  and  ninth  ribs 
denuded  on  the  same  line.  He  was  at  once  conveyed  to  the  2d  division  hospital  of  the  Ninth  Corps,  where  simple  dressings  were 
applied.  On  June  20th,  he  w'as  transferred  to  Mount  Pleasant  Hospital,  Washington.  When  admitted,  the  patient’s  general 
health  was  good.  There  was  slight  inflammatory  action  in  the  integuments  immediately  about  the  wound.  The  fractured  ends 
of  the  rib  did  not  interfere  with  the  action  of  the  pleura.  June  24th;  Inflammation  subdued,  but  no  efforts  at  granulations ; 
stimulant  injections  and  resin  cerate  dressings.  On  June  30th,  physic.d  signs  of  pneumonia  made  their  appearance,  localized 
about  the  seat  of  injury.  July  4th,  pneumonia  resolved.  Wounds  and  adjacent  tissues  in  a sloughing  condition.  Secondary 
haemorrhage  occurred  from  the  intercostal  artery,  which  couUl  not  be  secured  on  account  of  the  mass  of  slough.  The  wound  was 
thoroughly  injected  with  tincture  of  njuriate  of  iron  and  plugged  with  lint  saturated  with  the  same.  The  slough  still  advancing, 
the  patient  was  etherized  on  July  8th,  and  the  wound  was  thoroughly  cauterized  with  nitric  acid;  a yeast  and  charcoal  poultice 
was  then  applied.  The  remainder  of  the  slough  came  away  on  July  12th;  hmmorrhage  recurred,  and,  the  artery  eluding  search, 


* Feiigusson,  a System  of  Practical  Surgery,  5tU  ed.,  1870,  p.  302. 

^Consult  further;  Gross,  S.  D.,  Western  Journal  of  Med.  and  Surg.,  od  series,  Vol.  XI,  p.  419.  1853;  Blackman,  G.  C.,  Am.  Jour,  of  the  Med. 
Sci.,  N.  S.  Vol.  XXXVI,  p.  578;  LOGAN,  Richmond  and  Louisville  Medical  Journal,  August,  1872,  p.  131 ; the  same.  Southern  Journal  of  Med.  Sci., 
October,  1867.  Dr.  F.  H.  Hamilton  (Prin.  and  Pract.  of  Surgery,  p.  395)  refers  to  an  excision  of  the  scapula  for  necrosis  after  gunshot  injury,  reported 
by  liim  in  tlie  N.  Y.  Med.  Journal.  ,Tanuarj%  1869.  That  number  is  missing  in  tlie  otherwise  complete  file  in  tliis  (Itlice. 


Sect.  III.] 


EXCISIONS  OF  PORTIONS  OF  THE  RIBS. 


567 


tlie  treatment  of  tlie  4tli  was  succe.«sfiilly  resorted  to.  The  outer  ends  of  tlie  fractured  rib  were  found  to  liavi;  caused  irritation  by 
their  friction  motion  on  the  pleura;  and,  on  the  Ihtli.  Acting  Assistant  Sui-geon  F.  S.  Barbarin  administered  an  ana3Sthctic  and 
removed  the  diseased  portions  of  the  fractured  ends  of  the  eiglith  rib  ; all  the  diseased  portions  of  the  seventh  and  ninth  ribs 
looking  toward  the  eighth  rib  were  removed  by  the  nippers  and  smoothed  with  a lenticidar.  But  little  blood  was  lost,  and  the 
)iatient  reacted  promptly.  After  the  excision,  the  condition  of  the  patient  impi'oved  in  regard  to  breathing  and  a])])etite.  He  did 
well  until  July  2Gth,  when  by  some  sudden  movement,  while  walking  in  the  hall  of  the  hosjiital  with  the  assistance  of  crutches, 
he  fiactured  the  ninth  rib.  Jul3-2()th;  Treatment  continued;  quite  comfortable,  but  irritable.  August  8th:  In  a very  feeble 
condition.  Suttering  acute  pain  over  the  whole  abdomen,  with  frequent  discharges  from  his  bowels.  Pulse  120.  He  gradually 
became  weaker,  and  died  August  13th,  18(i4.  At  tin;  necropsy  the  upper  and  middh;  portions  of  the  right  lung  were  found  to 
he  partly  adherent  to  the  costal  j)leura  by  thin  fibrous  bands.  Assistant  Surgeon  C.  A.  McCall,  U.  S.  A.,  reported  the  case. 

Case  4. — Corporal  Ellsby  McCoy,  Co.  D,  20th  Maine  Volunteers,  aged  19  years,  was  wounded  at  Poplar  Grove  Cluuvh, 
Virginia,  September  30th,  1864,  by  a conoidal  ball,  which  entennl  the  chest  on  the  left  side,  fractured  the  fourth  rib,  and,  glancing, 
lodged  in  the  axilla  on  the  same  side.  He  was  taken  to  the  field  hospital  of  the  Fifth  Corps,  and,  on  October  7th,  was  trans- 
ferred to  Lincoln  Hospital,  Washington.  On  October  20th,  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A.,  administered  chloroform 
and  extracted  the  ball  through  an  incision  made  along  the  border  of  the  latissimus  dorsi  muscle;  the  end  of  the  fractured  rib 
was  also  resected.  The  patient  was  discharged  from  service  March  23d,  1865.  He  is  not  a jiensioner. 

Case  5. — Private  Daniel  Fisher,  Co.  C,  27th  Pennsylvania  Volunteers,  aged  22  years,  was  wounded  at  Gettysburg,  July 
1st,  1863,  by  a conoidal  ball,  which  entered  the  lumbar  region  three  inches  to  the  left  of  the  spine, 

])assed  superhcially  upward  and  outward  for  about  six  inches,  and  lodged  in  the  walls  of  the  chest, 
lie  was  at  once  conveyed  to  the  field  hospital,  where  the  ball  was  removed,  with  a piece  of  the  rib,  on 
July  4th.  He  subsequently  fell  into  the  hands  of  the  enemy,  was  paroled  in  a few  days,  and,  on  the 
11th,  entered  Turners  Lane  Hospital,  I’hiladelphia.  Water  dressings  were  applied  to  the  wound.  He 
improved  rapidly,  and  was  returned  to  duty  August  12th,  1863.  The  missile,  oblicpiely  liattened  on 
one  side  of  the  body  as  if  from  contact  with  a stone,  was  contributed  to  the  Army  Medical  Museum,  pjg  ogg  _]\iysi;et  h,,ii 
with  a history  of  the  case,  by  Assistant  Surgeon  C.  II.  Alden,  U.  S.  A.,  and  is  represented  by  the  ttattened  by  impact  wiib 
adjoining  wood-cut  (T IG.  266).  A.  M.  M. 

Ca.se  6. — Private  Andrew  J.  T , Co.  F,  7lh  Indiana  Volunteers,  aged  18  years,  received  a gumshot  wound  of  the  right 

arm  and  right  side,  fracturing  the  ninth  rib,  at  Petersburg,  Virginia,  July  28th,  1864.  He  was  taken  to  the  field  hospital  of  the 
Fifth  Corps,  where  splints  were  applied  to  the  arm.  On  August  1st,  the  arm  was  amputated  at  the  junction  of  the  middle  and  the 
iqiper  thirds  by  Acting  Assistant  Surgeon  C.  II.  Van  Tagen.  He  was  transfeiTcd  to  Lovell  Hospital,  Portsmouth  Grove,  Rhode 
Island,  August  7th.  When  admitted  he  was  suffering  considerable  pain  ; appetite  poor.  On  August  12th,  Acting  Assistant 
Surgeon  E.  Seyifarth  administered  an  anaesthetic  and  removed  a portion  of  the  ninth  rib  through  an  incision  three  indies  long. 
Simjile  dressings  were  applied.  The  patient  did  well  until  September  10th,  when  he  began  to  fail,  and,  in  spite  of  stimulants, 
died  from  exhaustion,  with  empyema,  September  24th,  1864,  The  sjiecimen  of  the  amjuitated  arm  is  No.  4725,  Sect.  1,  A.  M.  M., 
and  was  contributed  by  the  ojierator. 

Peculiar  Shot  Fractures  of  ilie  Fibs. — Here  there  is  tin  ()|)|)ortunitv  to  advert  to  some 
other  varieties  of  fractures  of  the  ribs  than  those  described  on  i»ao;es  -188,  490,'-'  and  521. 
The  history  of  the  case  that  furnished  the  curious 
perforation  of  the  rib  represented  in  the  cut  (Fig. 

267)  is  printed  on  page  446  (Bugler  B ),  with 

wounds  of  the  spine,  the  ball  having  also  perforated 
the  body  of  the  vertebra.  The  missile  has  executed 
the  first  step  in  one  of  the  proposed  methods  for 
ligation  of  the  intercostal  artery.  Tlie  following 
case  exemplifies  the  rare  occurrence  of  a “willow- 
fracture”  produced  by  a musket  ball; 

Case. — Private  William  T , Co.  C,  33d  North  Carolina  Regiment,  aged  21  years,  was  wounded  at  Fredericksbuig, 

Virginia,  May  3d,  1863,  by  a conoidal  ball,  which  entered  the  right  side  at  the  eighth  intercostal  space.  He  lay  on  the  held 
during  the  night  in  a rain  storm  and  on  the  next  day  was  conveyed  to  the  field  hospital,  where  he  was  treated  until  the  8th, 
when  he  was  transferred  to  Lincoln  Hospital,  Washington.  When  admitted,  his  breathing  was  very  laborious  ; imlse  rai)id, 
(juick,  and  non-compressible ; expression  of  the  fiice  anxious;  sputa  frothy  and  firmly  adherent  to  the  eu]) ; breathing  carried  on 
principally  by  the  left  lung.  He  said  the  saliva  had  been  tinged  with  blood.  Sedatives  and  expectorants  were  administered. 
May  19th:  Patient  suffers  from  cough,  causing  intense  pain  in  side.  He  continued  to  fail,  and  died  klay  21st,  1863.  At  the 
necroj)sy  the  right  lung  was  found  to  be  compressed,  collap.stul,  and  pushed  forward ; parenchyma  i)ale  red ; small  bronchial 
tube  prominent.  The  posterior  surface  was  covered  with  a thick  layer  of  recent  yellowish  lynq)h  ; the  anterior  suifaco  was  of 
a pale  greyish  blue  color  and  free  from  lymph.  As  viewed  in  situ  the  lung  extended  from  the  first  to  the  sixth  rib,  jirojecting 

* See  ante.  Figs.  224,  228,  229,  231,  2:)3,  23.">,  23ti,  240. 


Fig.  267. — External  and  internal  views  of  tlie  anterior  thinl 
of  the  eleventh  right  rib,  perforated  by  a carbine  ball.  Spec.. 
3291,  Sect.  1,  A.M.  M. 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  \ 


068 


jiHlcriorly  ncaily  to  tlip  nn'diaii  line.  Tlie  portion  not  visible  was  firmly  bound  to  tlie  ribs  and  anterioi-  poi'tion  of  tbe  diajiliraom 
by  adhesions.  The  lung  was  sejiarated  from  the  costal  pleura  by  a large  quantity  of  purulent  matter  measuring  twenty-four 
ounces.  The  diaphragmatic  and  costal  surfaces  were  covei-ed  with  a thick  layer  of  lymph  similar  to  that  observed  in  the  lung.  The 

ball  had  entered  the  body  on  the  right  side,  in  the  eighth  inter- 
costal space,  passed  slightly  downward  and  inward,  fracturing 
the  ninth  rih  a little  anteriorly  to  its  angle,  passed  through  the 
diaphragm  and  upper  posterior  part  of  the  right  lobe  of  the  liver, 
reentered  the  pleural  cavity,  having  made  a wide  ragged  track, 
and  was  .found  l.ving  on  the 
diaphragm.  The  tr.ack  of  the 
ball  was  lined  with  lymph. 

The  missile  would  ajipear  to 
have  struck  the  rib  sidewise, 
and  being  much  flattened  (FlG. 

269),  after  partially  fracturing 
the  rib  to  liave  been  deflected 
into  the  ninth  intercostal  space. 

The  peculiar  fracture  of  the  rib  is  shown  in  the  wood-cut  (Fig.  268).  The  bone  and  missile  are  mounted  together  in  the  Museum 
specimen,  which  rvas  contributed,  with  notes  of  the  case,  by  Assistant  Surgeon  Harrison  Allen,  U.  S.  A. 


Fig.  268. — Extenial  and  internal  views  of  a section  of  the  rigid  ninth 
rib,  with  a gunsliot  willow’-fracture.  Spec.  1141,  Sect.  I,  A.  JI.  M. 


Fig.  269. — Sliisket  ball  flattened 
bv  Uderal  impact  on  a rib.  Spec. 
till.  Sect.  I,  A.  M.  M. 


Tliougli  Specimen  3823,  of  willow  fracture  of  the  left  fourth  rib,  hy  a glancing  shot, 
referred  to  on  page  490,  was  from  a slender  man,  who  gave  his  age  as  twenty-eight  years, 

yet  we  should  anticipate  that  such 
lesions  would  occur  commonly  in 
very  young  subjects.  A more  com- 
mon form  of  gunshot  fracture  is  rep- 
resented in  the  adjacent  wood-cut 
(Fig.  270)  from  a specimen  taken 
from  a man  of  46  years,  wounded  by 
a small  fragment  from  a shell,  at  the 
battle  of  Mission  Ridge. 

In  the  following  remarkalde  case,  the  patient  succumbed  from  dysentery,  and  it  was 
possible  to  observe  the  morbid  alterations  at  the  seat  of  fracture  more  than  eight  months 
after  the  injury  was  inflicted : 

Case. — Private  Thomas  P.  C.  C , Co.  A,  9th  Mississippi  Regiment,  aged  19  years,  was  wounded  near  Petersburg, 

Virginia,  Nrivember  5th,  1864,  bj’  a conoidal  ball,  wdiich  entered  the  posterior  portion  of  the  left  thorax,  passed  between  the 
tenth  and  eleventh  ribs,  fracturing  the  latter,  as  well  as  the  transverse  process  of  the  eleventh  dorsal  vertebra.  He  was  treated 
in  a Confederate  hospital  at  Eidimond,  and,  on  May  6th,  1865,  was  admitted  into  the  hosjiital  at  Point  Lookout,  Maryland.  On 
July  24th,  he  was  transferred  to  Armory  Square  Hosjfltal,  Washington,  and,  on  August  17th,  to  Douglas  Hospital.  The  patient 
stated  that  on  the  reception  of  the  in.jui'y  he  had  a free ‘hsemorrhage  from  the  wound,  spat  blood,  and  had  great  difficulty  of 
breathing,  but  that  he  was  doing  well  until  about  the  middle  of  June,  when  he  was  attacked  with  diarrhoea.  On  his  admission 
to  Douglas  Hospital  he  was  terribly  emaciated — almost  a living  skeleton.  On  the  18th,  the  ball,  which  had  lodged  behind  the 
tenth  rib  about  one  and  a half  inches  from  the  wound  of  entrance,  was  removed  by  Assistant  Surgeon  William  F.  Norris,  U.  S.  A. 
In  spite  of  the  free  administration  of  beef  tea  and  stimulants,  with  astringents  and  injections  qf  nitrate  of  silver  for  his  dysentery, 
the  patient  sank  rapidly,  and  died  August  20th,  1865.  An  autopsy  was  made  thirteen  hours  after  death.  There  were  strong 
pleuritic  adhesions  between  both  lungs  and  the  walls  of  the  thorax.  The  lungs  were  healthy  except  the  lower  lobe  of  the  left 
lung,  which  was  collapsed  and  firmly  adherent  to  the  w'alls  of  tin?  chest  near  the  seat  of  injury,  in  such  a manner  as  to  form  a 

cavity  of  considerable  dimensions  between  the  wall  of  the  chest  and 
the  lung  substance.  The  liver  and  kidneys  were  fatty,  the  spleen 
healthy,  the  intestines  shrunken  and  pallid,  but  everywhere  healthy 
exce])!  the  descending  colon  and  rectum,  where  the  solitary  glands 
were  much  enlarged  and  had  ulcerated.  They  presented  the  appear- 
ance of  small  cysts,  the  size  of  q pea,  with  minute  circular  openings 
at  the  summit,  and  contained  a transparent  gelatinous  mass.  The 
pathological  specimen  is  represented  in  the  accompanying  wood-cut 
(Fig.  271).  The  wound  of  entnuice  in  the  fractured  rib  is  well 
rounded,  and  the  two  are  firmly  agglutinated  by  osseous  deposit. 
The  preparation  was  contributed,  with  a history  of  the  case,  by  the 
ojierator.  Assistant  Surgeon  W.  F.  Norris,  U.  S.  A. 


Fig.  271. — Posterior  halves  of  tenth  and  eleventh  left  ribs,  showing 
a consolid.ated  fraoture  by  a conoidal  ball,  which  is  attached.  Spec. 
1561,  Sect.  I,  A.  M.  M. 


Fig.  270.— Anterior  two-tliirds  of  the  foiirtli  and  fiftli  ribs  comminuted  by  a shell 
fragment.  Spec.  2185,  Sect.  I,  A.  JI.  HI. 


Sect.  HI.] 


EXCISION  OR  REMOVAL  OF  PORTIONS  OE  THE  RIBS. 


509 


C.VSE. — Sergeant  James  K , Co.  A,  35tli  Indiana  Volunteers,  was  struck,  Novenilx'r  2otli,  1863,  by  a fragment  of  sliell 

in  the  left  chest,  the  missile  penetrating  the  thorax.  He  was  taken  to  one  of  tlie  field  hospitals  of  the  Fourth  Corps,  where  some 
fragments  of  bone  wen?  extracted  and  the  ragged  wound  dressed  simply,  and  the  ribs  confined  by  a broad  chest  bandage.  There 
was  much  dyspnoea  and  anxiety,  but  little  haemorrhage.  The  missile  had  lodged  in  the  thorax.  On  December  1st,  the  patient 
was  sent  by  rail  to  Nashville,  and  entered  Hospital  No.  1 on  December  3d.  His  pidse  was  feeble,  surface  pale,  tongue  coated  and 
dry.  There  was  an  offensive  sero-purulent  discharge  from  the  wound,  and  a dry,  hacking  cough.  He  had  pneumonia.  He  was 
treated  by  small  doses  of  morphia,  with  iron  and  quinine,  and  milk  j)unch.  On  the  11th,  he  had  chills,  and,  on  the  succeeding 
days,  rigors,  with  excessive  reaction.  He  died  from  exhaustion  on  December  16th,  1863.  There  was  a copious  thin  ])urulent 
•exudation  within  the  left  pleural  cavity.  The  missile  lay  in  the  costo-diaphragmatic  angle.  Acting  Assistant  Surgeon  W.  H. 
Matlock  forwarded  the  specimen,  and  the  memorandum  of  the  history  was  transmitted  by  Surgeon  Caleb  W.  Horner,  U.  S.  V. 


Not  uncommonly  a ball  striking  a rib  at  short  range  would  drive  before  it  such  con- 
siderable fragments  of  the  bone  as  would  constitute  two  or  more  inches  of  its  shaft.  Such 

injuries  were  rarely  attended  Ijy  bleeding  from  the  torn  arteries,  but  often  by  free 

haemorrhage  from  the  lacerated  pulmonary  tissue. 
The  adjacent  wood-cut  (Fig.  272)  represents  a 
specimen  from  such  a case,  in  which  the  sharji, 

FKaSTO-Seotion  of  ninth  rib.  from  which  more  than  J^^Sgecl  extreillitieS  of  the  I’ib  luul  llOt  bceil  rOUlldecl 

two  inches  of  the  bodyof  th3  bone  were  driven  into  the  left  /w-ff  1 .-ry 
lung  by  a conoidal  musket  ball.  <Spec.  2423,  Sect.  I,  A.  M.  M.  L)Uli(3  lOICBpb. 


Case. — Private  H.  C.  H , Co.  B,  1st  Maine  Heavy  Artillery,  aged  21  years,  was  wounded  May  6th,  1864,  at  the  battle 

of  the  Wilderness,  by  a conoidal  musket  ball,  which  perforated  cavities  of  the  thorax  and  abdomen,  and  lodged  in  the  left  kidney. 
The  patient  was  sent  to  Washington,  and  died  in  Lincoln  Hospital,  June  3d,  1864.  The  large  fragments  from  the  rib  were  found 
imbedded  in  the  lower  lobe  of  the  left  lung,  which  was  in  a state  of  grey  hepatization.  Assistant  Surgeon  J.  C.  McKee,  U.  S.  A., 
contributed  the  specimen. 


In  the  following  case,  a ball  imbedded  itself  in  the  seventh  rib,  comminuting  the 


posterior  wall,  but  not  penetrating  the  costal 
pleura,  or  the  periosteum  of  the  inner  surface 
of  the  rib.  The  patient  survived  the  injury 
two  months.  The  fragments  of  the  posterior 
wall  are  consolidated,  chiefly  by  cartilaginous 
formations : 


Fig.  273. — Anterior  lialf  of  the  right  seventh  rib,  showing  a cavity 
near  the  chondral  extremitv,  where  a round  musket  ball  was  imbedded. 
Spec.  877,  Sect.  1,  A.  M.  M'. 


Case. — Private  John  D.  Y , Co.  H,  4th  Pennsylvania  Reserves,  aged  20  years,  received  at  Mechanicsville,  Virginia, 

June  23th,  1862,  three  wounds  from  ball  and  buckshot;  one  of  the  right  elbow;  another,  a superficial  one,  of  the  skin,  about 
two  inches  below  the  right  nipple,  and  a third,  about  four  inches  lower,  the  hall  lodging  in  the  anterior  extremity  of  the  seventh 
rib.  His  wounds  were  dressed  on  the  field,  and  he  was  then  placed  in  an  ambulance  train,  which  joined  in  the  change  of  bas(> 
to  the  James  River.  From  Harrison’s  Landing,  he  was  sent,  in  a hospital  tran.sport,  to  Philadelphia,  and  was  admitted  to 
Satterlee  Hospital,  on  July  31st,  1862.  He  lingered  until  August  25th,  1862.  An  autopsy  was  made  by  Professor  Joseph 
Leidy,  who  contributed  the  specimen  represented  by  the  adjacent  wood-cut  (Fig.  273)  and  the  following  notes  of  the  pathological 
appearances:  “The  light  lung  appeared  to  be  sound  in  the  upper  lobe,  but  was  collapsed  and  condensed  in  the  lower  ones. 
There  were  also  extensive  pleuritic  adhesions ; and  the  pulmonary  pleura  of  the  lower  part  of  the  lung  was  much  thickened. 
The  pleural  cavity  was  distended  with  an  accumulation  of  pus  and  serum.  The  heart  and  left  lung  were  normal.  The  liver 
was  much  enlarged  and  presented  some  fatty  degenwation.  The  stomach,  intestines,  and  spleen  were  .sound.  The  kidneys  were 
large  and  presented  some  appearance  of  fatty  degeneration  of  the  cortical  substance,  which,  however,  was  not  confirmed  by 
microscopic  examination.” 


Beside  the  cases  that  have  been  cited  of  excision  of  portions  of  ribs,  or  removal  of 
splinters,  or  extraction  of  necrosed  fragments,  five  cases  are  found  on  the  reports,  noted 
too  briefly  to  admit  of  precise  determination  of  their  nature.  They  may  be  included  in 
the  following : 

Memorandum. — 1.  Sergeant  S.  L.  Bowden,  Co.  B,  South  Carolina  Palmetto  Sharpshooters.  October  7th,  1864.  Excision 
of  rib.  Confederate  hospital,  Jackson,  Mississippi.  {Confederate  Register, 49.) 

2.  Private  Anthony  Briggs,  Texas  Cavalry.  Fragment  of  shell  fractured  two  ribs,  right  side,  below  axilla.  April  2l8t, 
1863.  Sloughing,  exposure  of  pleural  sac.  Excision  of  one  and  a half  inches  of  rib  and  a small  segment  of  next  rib,  exposing 
the  pleura  pulmonalis  for  an  irregular  space  of  about  one  and  a half  inches  square.  Recovery.  (Field  note-book.) 

3.  Private  B D , 40ih  Illinois  'IMlunteers.  Gunshot  fracture  of  seventh  rib.  Chlorofonn  administered  and 

rib  resected.  Patient  recovered.  (Field  register.) 

72 


570 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


4.  I’riv.ito  J.  Snmicr,  Co.  I,  Stli  Ponnsylvania  Cavalry.  Gunshot  woniid  fracturing  tenth  and  eleventh  rihs,  and  penetrating 
liver.  Diinviddie,  JIarch  31st,  1865.  Excision  of  portion  of  injured  rib.  Discharged  September  2d.  1865.  (Casualty  list.) 

5.  Ihivate  Michael  Donnegan,  Co.  D,  17th  New  York  Volunteers,  aged  25  years.  Savage’s  Station,  June  29th,  1862. 
Excision  of  portion  of  tenth  rih.  Nearly  well  September  9th,  1862. 

Dr.  J.  A.  Reagan,  of  North  Carolina,  has  published  [Am.  Jour,  of  the  Med.  Sciences, 
N.  S.  Vol.  LIV,  p.  564,  October,  1867)  an  account  of  a successful  excision  of  necrosed 
portions  of  the  right  fifth  and  sixth  ribs  in  a soldier  shot  through  the  chest  in  August,  1863. 
The  ball  had  entered  to  the  right  of  the  spine,  split  upon  the  fifth  rib ; one  piece  emerging 
from  the  fifth  intercostal  space,  while  the  other  fragment  lodged  under  the  sixth  rib.  In 
July,  1865,  Dr.  Reagan,  excised  the  necrosed  portions  of  bone,  extracted  the  ball,  and 
evacuated  a pleural  abscess  containing  three  pints  of  pus.  The  patient  recovered  rapidly, 
and,  twenty-five  months  after  the  operation,  was  in  robust  health., 

The  indications  for  excisions  of  the  rib  have  been  formulated  by  M.  Demarquay  as 
follows:  First,  when  a foreign  body  is  impacted  in  a rib;  secondly,  in  some  forms  of  frac- 
ture of  the  rib;  thirdly,  in  cases  of  caries  and  necrosis;  fourthly,  in  cases  of  cancer  or 
tumors.^  The  first  indication  would  present  itself  when  arrow-heads  are  impacted  in  the 
ribs ; ^ or  the  points  of  knives  or  swords  are  broken  off  in  the  shafts  of  ribs ; or  when  a 
pistol  or  musket  ball  is  imbedded  and  cannot  be  extracted  by  forceps  or  screw.  Thus, 
Malle, ^ in  1843,  removed  a broken  knife-blade,  impacted  in  the  right  fifth  rib,  including  the 
foreign  body,  with  a portion  of  the  rib,  in  the  crown  of  a trephine. 

In  compound  comminuted  fractures,  the  circumstances  of  each  case  must  determine 
the  necessity  and  extent  of  surgical  interference.  It  will  be  always  proper  to  remove 
detached  fragments  of  bone,  even  if  driven  into  the  lung  tissue,  and  it  may  be  necessary 
to  saw  off  the  splintered  ends  of  the  ribs.  Yet  when  points  of  the  inner  lamina,  still 
covered  by  periosteum,  are  bent  inward,  it  may  be  safer  to  replace  them  by  traction  with  a 
lenticular,  hoping  for  consolidation,  and  preferring  always  that  mode  of  dressing  involving 
the  least  hazard  of  injuring  the  pleura;  which  will  sometimes  incur  greater  risk  from  the 
presence  of  the  fractured  ends,  and  in  other  cases  from  the  operation  for  their  removal.^ 

In  cases  of  caries  and  necrosis,  there  is  less  difficulty  in  deciding  when  an  operation  is 
opportune  and  far  greater  facility  in  its  performance;  for  the  pleura  in  these  cases  is  usually 
thickened  and  separated  from  the  rib.^  The  operations  for  tumors  may  present  formidable 
difficulties;  but  need  not  be  considered  here.® 

‘ SI.  Demauquay  { Gaz.  Mid.  de  Paris^  T.  XXIV,  p.  30,  ISfiO).  I cite  M.  Demarquay  as  the  latest  author  who  has  treated  the  subject  systemat- 
ically. Dr.  F.  II.  Hamilton  (Princijdes  and  Practice  of  Surgery y 1872,  p.  266)  proposes  another  indication  : “To  exsect  a portion  of  the  rib  in  order  to 
reach  and  secure  the  bleeding  vessel”  in  some  cases  of  hemorrhage  from  the  intercostal  artery,  which  is,  I think,  inadmissible. 

^See  Rejiort  of  Surgical  Cases,  c^c.,  Circular  No.  3,  8.  G.  O.,  1871,  p.  160,  for  illustrations  of  this  form  of  injury,  and  specimens  4735,  4736,  and 
4823  of  the  Army  Medical  Museum. 

3 Malle  (Traite  d' Anatomic  Chirurgicale  et  de  Midccine  OptratoirCy  Paris,  1855,  p.  660).  M.  Malle  bbseiwes  justly  that  Heine’s  osteotome  is  a 
preferable  instrument  for  such  operations,  but  tins  is  a yory  expensive  instrument,  rarely  made  except  for  the  armamentaria  of  public  institutions. 
Medical  olficers  should  know  that  there  is  one,  which  they  are  at  liberty  to  use,  in  the  collection  of  instruments  at  this  Office. 

'^Duverney  {Traite  dcs  Maladies  des  Os),  BOTTCIIER  {Answahl  d.  Chir.  VerhandeSy  Berlin,  179.5),  Goulard  {(Euvres  de  ChirurgiCy  Pizenas,  1766), 
Callisen  (Systema.  Chirurg.  Hod.  UajnitSy  1788)  writes  on  this  class  of  cases.  KOUX  reports  a case  in  the  Examinateur  Medicaly  Vol.  I,  p.  122.  A 
full  collection  of  cases  is  made  by  JjEGER,  Ilandwdrterhuch  der  gesammten  Chirurgie,  Leipsig,  1839,  Art.  Resectio  ossiuMj  B.  V.,  S.  424. 

®Dr.  WII.LIAM  A.  McDowell,  of  Fincastle,  Virginia,  was  one  of  the  first  in  this  countrj^  to  excise  considerable  portions  of  necrosed  ribs.  He 
describes  in  his  Dissertation  on  the  Pathology  of  the  Bones  {Am.  Med.  Recordery  Vol.  XIII,  p.  119),  the  extraordinaiy  operation  he  successfully  performed 
June  25th,  1827,  fur  the  removal  of  the  greater  part  of  the  right  sixth  and  seventh  ribs.  At  that  time  the  operation  by  PiCllERAND  (the  account  is 
translated  in  the  Medical  Repository y New  York,  1818,  Vol,  PV,  p.  401),  and  that  of  ClTTADlNl  (Annali  univ.  di  Medicinay  Milano,  Marzo,  1826;  but 
published  in  the  Journal  comple.mentaires  of  the  great  dictionary  in  sixty  volumes,  in  1820)  w*ere  about  the  only  instances  of  this  operation  mentioned  in 
the  current  siu'gical  literature.  Cittadini  removed  only  the  sternal  extremity  of  the  first  rib,  necrosed  in  consequence  of  the  impaction  of  a stiletto  point. 
He  divided  the  cartilage  with  a probe-pointed  knife,  and  the  rib  by  cutting  forceps. 

6 Consult  Professor  S.  D.  Gross’s  System  of  Surgery y 5th  ed.,  Vol.  II,  p.  1080.  M.  DEMARQUAY,  Article  CoteSy  in  the  Nouveau  Dictiemnaire  de 
Midicine  ct  de  Chirurgie  PratiqueSy  P.aris,  1869,  T.  IX,  p.  589,  and  the  amplification  of  this  article  in  a dissertation  entitled  Resection  des  cotes  in  the 
Gazette  Medicate  de  Paris,  36me  S6rie,  T.  XXIV,  pp.  29,  56;  Percy’s  Article  Resections,  in  the  Diet,  des  Sci.  Med.,  T.  XLVII,  p.  5.50;  IliVERIUS, 
Ohservationes  Medicarum  Cehturise  Quatuor,  Ijugduui,  1763,  p.  129;  Communicated  obseiwation  by  A.  D.  OziA  AimaR,  a most  celebrated  surgeon  of 
Gratianopolis  (Grenoble),  Obs.  Ill,  relating  to  Dominus  de  Bessin,  a contusion  with  extensive  caries  of  the  ribs,  that  had  been  treated  by  the  actual 
cautery,  until  an  openiTig  into  the  thorax  w'us  produced  that  would  admit  the  hand.  Aimar  removed  four  fingers’  breadths  from  the  carious  ribs,  and 


Sect.  III.] 


EXCISIONS  OK  THE  STEKNUM. 


571 


Excisions  of  Portions  of  the  Sternum.— Trephining  of  the  inanuln-ium  and  gladiolus, 
which  should  he  legitimately  classed  with  excisions,  has  been  recommended  in  cases  of 
necrosis,  and  compound  fracture  of  the  bone,  and  to  facilitate  ligation  of  the  internal 
mammary,  and  the  extraction  of  foreign  bodies  from  the  anterior  mediastinum.  De  la 
hlartinibre  laid  down  rules  for  trepanning  the  sternum  [Mem.  de  I Acad,  de  Chir.,  1819, 
T.  IV,  p.  488);  but  Percy  tells  us  [Chirurg.  d' Armee,  p.  123)  that  Purman  was  the  first 
wlio  performed  the  operation,  and  remarks  naively  that  when  a ball  is  lodged  in  the 
duplicature  of  the  mediastinum,  “ce  seroit  effectivement  I’unique  ressource  dans  cette 
conjoncture.  Mais  il  faudroit  auparavant  etre  bien  sur  qu’elle  y fut,  et  on  sait  combien 
a cet  figard  les  signes  sont  decevans.”  A number  of  examples  have  been  given  of  gunshot 
fractures  of  the  sternum,  laying  open  the  mediastinal  cavity  so  that  the  pulsations  of  the 
aorta  and  the  heart  were  exposed.  Conspicuous  among  these  is  the  fortunate  case  of 
Private  Betts  (Plate  X,  opp.  ji.  486).  Dr.  Judson’s  case  of  ligation  of  the  internal 
mammary  (p.  548)  after  gunshot  fracture  of  the  manubrium  and  second  rib,  illustrated  by 
the  interesting  specimen,  Xo.  2925,  of  the  Surgical  Series  of  the  Museum ; and  the  case 
observed  by  Dr.  McGill  (Powers,  p.  535),  in  which  the  movements  of  the  heart  could  be 
seen  and  felt  through  a perforation  of  the  gladiolus,  will  also  be  remembered  by  the  reader, 
and  will  recall  the  case  described  by  Galen,'* *"  and  that  of  the  son  of  the  Viscount  of 
hlontgomery,  which  afforded  the  immortal  Harvey  the  occasion  to  demonstrate  to  His 
Serene  Majesty  Charles  H the  movements  and  the  insensibility  of  the  heart. f 

obtained  a sound  cicatrix.  Demarquay  says  that  Cercuus^  in  the  sixteenth  century,  was  regarded  as  the  author  of  the  operation  of  resection  of  carious 
ribs.  I do  not  find  this  name  among  the  authors  of  the  sixteentli  century.  Androuet  Cerccati  (1576)  wrote  on  architecture,  and  J.  A.  Ccrceau,  the  only 
(>ther  c-f  the  name  known  to  bibliophiles,  was  a French  Jesuit,  who,  in  the  next  century,  wrote  verses  "of  mediocre  quality,”  according  to  Voltaire. 
I3ut  M.  A.  Severinus  advocated  the  excision  of  carious  ribs,  in  the  sixth  book  of  his  Synopseos  Oiirurgisc,  Amsterdam,  1664,  p.  135,  and  cites  Galen, 
Colsus.  and  Paul  of  iEgina,  without  misleading  Champion,  who,  in  1815.  published  a thesis  entitled  liiscctions  de.s  os  cariis  dans  \mr  continuiete.  (from 
which  lil.  Demarquay  complains  that  writers  have  quoted  without  acknowledgment),  and  duly  cites  Galen  {Methodus  medendi,  1,  v.  ch.  8),  Celsus  {de 
Re  Med.  1.  viii,  c.  2)  and  Soranus,  of  Ephesus,  in  the  twelfth  chapter  of  the  collection  made  in  the  eleventh  centuiy  by  Kicetas,  of  Constantinople. 
Ikiul  of  Higina  (See  Syd.  ed.  translation’,  Vol.  II,  p.  453),  after  iireser^'ing  the  dregs  of  the  Arabs  in  the  honey  of  his  Saronic  Greek,  has  fared  as  badly 
as  Champion  at  the  hands  of  the  plagiarists.  Other  observations  of  excisions  of  portions  of  necrosed  ribs  may  be  found  in  A.  SCIIENKIUS,  De  Vuhi. 
thorac.,  Ohs.  niedicinalium,  Frankfurti,  lt)G5,  L.  II,  p.  297;  LeVacheu,  in  the  Mercure  de  France,  April,  1858.  IlICllEUAND’S  famous  case  is  printed  in 
the  Bulletin  de  la  Faculte,  T.  VI.  ROUX  wrote  on  the  subject  in  1802,  in  his  treatise  De  la  Resect,  on  dn  Rctrancli.  des  os  malades.  Moreau  describes 
examples  in  his  two  essays,  1803  and  1815.  See  also  CriTADixi,  De  la  resect,  des  cotes  (in  Arch.  G6n.  de  M4d.,  1828,  T.  XVIII,  p.  71)  ; Clot  Bey,  for 
two  cases  {Jour.  Hcb.  1825)  ; Blandin,  Kecrosc  d'un  cote  (Gaz.  des  Hop.,  1840,  p.  373) ; FiORi,  Resection  de  la  totaliU  d'une  cote  (Gaz.  des  Hop,  1842, 
p.  518,  £r(un  Annali  univ.  di  Milano) ; IIeyeeldeu  {op.  cit.,  Bceckel's  cd.  p.  236) ; Largiii  {Operazioni  sotto-perinstee  e sotto-capsulari,  Torino,  1855. 
Professor  Gross  refers  to  a remarkable  excision  of  the  necrosed  shafts  of  the  sixth  and  seventh  ribs,  which  he  performed  at  the  Jefferson  College  clinic, 
in  1857 ; and  cites  the  extraordinary*  exploits  by  Suif  {Bernardus  Suevns?  in  Haller)  and  Dr.  ^lilton  Antony,  of  Georgia  (it  is  illustrated  by  a plate  in 
the  Phil.  Jour,  of  Med.  and  Phys.  Sci.,  Vol.  VI,  p.  108),  and  the  formidable  operations  by  John  C.  Warren,  George  INIcClellan,  and  William  Gibson. 
Warren's  two  cases  are  printed  in  the  Boston  Med.  and  Sarg.  Jour..  Vol.  XVI,  p.  201,  18:i7:  George  5IcClellan’s  case  was  published  in  the  Western 
Jour,  of  Med.  and  Phys.  Sci.,  Vol.  IV,  p.  479,  1831,  and  Dr.  J.  II.  B.  McClellan  related  its  later  history  in  the  Med.  Examiner,  N.  S,  Vol.  VI,  p.  75,  1850. 

* Galen  gives  the  Uistoria  pueri  p)ersanati  cui  os  pectoris  excisum  erat,  in  his  work  de  Anatomicis  Administrationihus.  It  may  be  found  in  the 
Latin  version  commented  by  Vesalius,  Liber  VI,  Cap.  13,  in  the  Opera  omnia,  Tomus  I,  of  tlie  Basil  edition  of  15G2,  as  follows : " Quoniain  vero  semel 
curati  pueri  mentionem  feci,  nihil  mali  fuerit  omnia,  quo  ipsi  euencnit,  perceusere.  Xam  propter  historic  utilitatem,  etiam  si  ad  prmsens  opus  nihil 
attineat,  no  abs  re  fuerit  ea  commemorfe.  Ictus  puer  ille  in  pectoris  osse  in  palaestra  neglectus  primum  est,  deinde  parum  probe  curatus  post  menses 
quatuor  pus  in  parte  percussa  apparuit  hoc  auferre  cogitans  medicus  puerum  incidit,  an,  ut  putabat,  subito  ad  cicatricem  vulnus  prerduxit  postea  rursus 
infiammatio  oborta  est,  mox  quoque  absccssus  iterum  sectus  puer  est,  nec  amplius  cicatrix  obduci  potuit.  Quapropter  herus  ipsius  pluribus  mcdicis 
convocatis,  inter  quos  ego  quoque  eram,  deliberare  .super  curatione  pueri  iussit.  Cum  autem  sideratio  quam  Greci  c^a.Ke\T)  appellant,  pectoris  ossis 
affectus  videretur  omnibus,  appareret  ante  <S:  cordis  d sinistra  ipsius  parte  motus  memo  affectum  os  excidere  audebat : quipjie  arbitrabantur  thoracis 
perforationem  necessario  futuram.  Ego  autem  citra  vocatam  proprie  d mcdicis  perforationem  adhibita,  jiollicitus  sum  me  cxcisurum,  de  absolutavero 
curatione  nihil  promisi:  cum  incertum  esset,  num  aliquid  ex  iis  qum  pectoris  ossi  subjacent,  fuerit  alfectu,  (fc  quatenus  affectu,  itaque  regione  detecta 
amplius  nihil  in  pectoris  osse  lesum  apparuit,  atque  quod  ab  initio  statim  videbamus;  quare  etiam  magis  ad  manus  operationem  venire  sum  ausus:  cum 
iam  fines,  quibus  arteriae,  &.  venae  subhairescunt  utrinque  illa?si  occurrisseut.  Cum  vero  afiectum  os  ab  eo  iiolissimu  loco  exidissem,  in  quo  talis 
pericardii  vertex  ad  nascitur  cumque  nudum  cor  appareret  (quippe  involucru  ipsius  computruerat),  ob  hoc  quide  haud  bonam  statim  spem  de  puero 
habebam,  attamen  in  totu  brevi  teporis  spacio  persanatus  est,  (luod  non  accidisset  si  nemo  affectum  os  abscindere  ausus  fuisset,  nemo  aut  tentasset  nisi  iu 
administrationihus  anaticomicis  pr^exercitatus.  Alius  quidam  e(;dem  teinjx  re  putrificum  vitium  ex  humorum  dccubitu  in  brachio  subsecans,  insignein 
arteriam  particularum  inembri  ignorantia  divisit:  subtioque  ob  sanguinis  pnifluviuin  conturbatus  est,  &.  cum  vix  laijneo  ipsam  posset  intcrcipere  (erat 
enim  profundior)  repente  quide  ex  sanguinis  fluorc  periculnm  repulit,  sed  aliaratione  hominern  jiigulavit,  gangracna  videlicet  propter  laqucum  occupate 
anteriam  maxime,  &.  primu  deinde  omnia  ipsi  circundata.  Hmc  igitur  ex  multis  pauca  obiter  dicta  sunt,  qum  cordatis  lectoribus  prtesentis  commentarii 
utilitatem  indicant.” 

tThe  account  is  printed  as  though  lost  or  estrayed,  as  La  l^IartiniOre  obser^'es,  at  page  208,  Ex.  LII  of  the  Exercitationes  de  Generations 
Animalium,  Lugduni,  ed.  Nov.,  apud  Kcrkhem,  1737.  The  following  is  the  translation  of  Willis  (Syd.  Soc.,  cd.  1847,  p..382) : "A  young  nobleman, 
eldest  son  of  the  Viscount  Montgomery*,  when  a child,  had  a severe  fall,  attended  with  fracture  of  the  ribs  of  the  left  side.  The  consequence  of  this  was  a 
suppurating  abscess,  which  went  on  discliarging  abundantly  for  a long  time,  from  an  immense  gap  in  his  side  ; this  I had  from  himself  and  other  cnuliblo 
persons  who  wore  witnesse**.  Between  the  J8th  and  19th  years  of  his  age,  this  young  ^nibleman,  having  traveled  through  France  and  Italy,  o«une  to 


572 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Ojierations  on  tliG  stcnunn  iluring  tlie  war  appear  to  have  been  limited  to  tlie  removal 
of  broken  fragments  at  the  primary  dressing  of  gunshot  fractures  involving  this  part,  and 
the  extraction  of  small  necrosed  pieces.  Fractures,  on  account  of  the  spongy  texture  of  the 
bone,  and  the  support  it  receives  from  its  fascia  propria,  were  usually  unattended 

witli  much  comminution.  A number  of  examples  have  been  cited  of  the  more  important 
cases  that  came  under  treatment.'^'  The  two  following  abstracts  refer  to  interesting 
specimens  in  the  Museum  : 

Case. — Private  John  M , Co.  F,  34th  New  York  Volunteers,  received  a perforating  gunshot  wound  of  the  chest  at  Fair 

Oaks,  Virginia,  May  31,  1862.  The  missile  entered  at  the  junction  of  the  third  and  fourth  ribs  with  the  costal  cartilage  on  the 
left  side,  and  escaped  at  a corresponding  spot  on  the  right  side.  He  was  admitted,  on  June  4th,  to  the  Balfour  Hospital  at 
I’ortsmouth,  Virginia.  There  was  hmnioptysis,  cough,  and  spasmodic  paiu,  with  dyspnoea  upon  any  emotion.  He  died  June 
28,  1862.  At  the  necropsy,  the  posterior  periosteum  was  found  to  he  uninjured,  although  the  sternum  was  fi-actured.  A slight 
adhesion  was  found  on  the  right  side.  The  pathological  preparation  from  this  case  is  specimen  No.  4938,  Sect.  I,  A.  M.  M., 
consisting  of  two  portions  of  the  sternum,  and  exhibiting  a fracture  of  the  gladiolus.  It  was  contributed,  with  notes,  by  Assistant 
Surgeon  William  Thomson,  U.  S.  A. 

Case. — Private  John  McC , Co.  B,  56th  New  York  Volunteers,  aged  26  years,  was  admitted  to  the  Balfour  Hospital 

at  Portsmouth,  Virginia,  June  4,  1862,  with  a gunshot  perforating  wound  of  the  chest  received  at  Fair  Oaks  on  May  31st.  The 
ball  entered  the  posterior  fold  of  the  left  axilla  and  escajted  at  the  junction  of  the  right  third  rib  with  the  sternum.  The  patient 
had  the  usual  symptoms  of  traumatic  pleuro-pneumonia.  He  died  June  25,  1862.  At  the  necropsy,  it  was  discovered  that  scarcely 
a vestige  of  the  left  lung  remained.  The  left  ])leural  cavity  contained  pus.  An  ecchymosis  was  found  upon  the  arch  of  aorta. 
Specimen  No.  4934,  Sect.  I,  A.  M.  M.,  is  the  upper  half  of  the  sternum  and  exhibits  a gunshot  fracture  of  the  second  piece  of  the 
gladiolus  most  conspicuous  on  the  posterior  or  inner  surface.  The  articulation  between  the  manubrium  and  first  piece  of  the 
gladiolus  is  obliterated  by  ossification.  The  fracture  is  attended  by  disjunction  of  the  second  and  third  pieces;  the  third  suture 
still  exists.  The  preparation  was  contributed  with  a memorandum  by  Assistant  Surgeon  William  Thomson,  U.  S.  A.,  who 
remarks  that  the  interest  of  the  case  resides  mainly  in  the  long  continuance  of  life  (three  weeks),  with  such  an  injury. 

The  mortality  of  gunshot  fractures  of  the  sternum,  that  came  under  treatment,  was 
not  very  great-  Of  fifty-one  cases,  only  eighteen,  or  35.3  per  cent.,  terminated  fatally. 
This  coincides  with  the  conclusions  of  Dr.  Oscar  Heyfelder  (op.  cit.,  p.  241),  who  has 
collected  seventeen  instances  of  partial  excision  of  the  sternum,  with  only  one  fatal  result  ;■]* * 

London,  liaving  at  this  time  a very  large  open  cavity  in  his  side,  through  which  the  lungs,  as  it  was  believed,  could  both  be  seen  and  touched.  When 
this  circumstance  was  told  as  something  miraculous  to  His  Serene  Majesty  King  Charles,  he  straightway  sent  me  to  wait  on  the  young  man,  that  I might 
ascertain  the  true  state  of  the  case.  And  what  did  I find?  A young  man,  well  grown,  of  good  complexion,  and  apparently  possessed  of  an  excellent 
constitution,  so  that  I thought  the  whole  story  must  be  a fable.  Having  saluted  him  according  to  custom,  however,  and  inlbnned  him  of  the  king’s 
expressed  desire  that  I should  wait  upon  him,  he  immediately  showed  me  everything,  and  laid  open  his  left  side  for  my  inspection,  by  removing 
a plate  which  he  wore  there  by  way  of  defence  against  accidental  blows  and  other  external  injuries.  I found  a large  open  space  in  the  chest,  into 
which  I could  readily  introduce  three  of  my  fingers  and  my  thumb;  which  done,  1 straightway  perceived  a certain  protuberant  fleshy  part,  affected 
with  an  alternating  extrusive  and  intrusive  movement ; this  part  I touched  gently.  Amazed  with  the  novelty’  of  such  a state,  I examined  everything 
again  and  again,  and,  when  1 had  satisfied  myself,  I saw  that  it  was  a case  of  old  and  extensive  ulcer,  bey’ond  the  reach  of  art,  but  brought  by  a miracle 
to  a kind  of  cure,  the  interior  being  invested  with  a membrane  and  the  edges  protected  with  a tough  skin.  But  the  fleshy’-  part  (which  1 at  first  sight  took 
lor  a mass  of  granulations,  and  others  hud  always  regarded  as  a portion  of  the  lung) — from  its  pulsating  motions  and  the  rhy’thm  they’  obser\*ed  with  the 
pulse  when  the  fingers  of  one  of  my'  hands  were  apx>lied  to  it,  those  of  the  other  to  the  artery  at  the  wrist,  as  well  as  from  their  discordance  with  the 
respiratory  movements — I saw  was  no  portion  of  the  lung  that  I was  handling,  but  the  apex  of  the  heart ! covered  over  with  a layer  of  fungous  flesh  by'- 
way  of  external  defence,  as  commonly  happens  in  old  foul  ulcers.  The  servant  of  this  y'oung  man  was  in  the  habit  daily  of  cleansing  the  cavity  from  its 
accumulated  sordes  by  means  of  injection  of  tepid  w’ater ; after  which  the  plate  was  applied,  and,  with  this  in  its  place,  the  young  man  felt  adequate  to  any 
exercise  or  expedition,  and  in  short  he  led  a pleasant  life  in  jicrfect  safety’.  Instead  of  a verbal  answer,  therefore,  I carried  the  y’oung  man  himself  to  the 
king,  that  his  majesty’  might  with  his  own  cy’cs  behold  this  wonderful  case:  that,  in  a man  alive  and  well,  he  might,  without  detriment  to  the  individual, 
obser\’e  the  movement  of  the  heart,  and  with  his  proper  hand  even  touch  the  ventricles  as  they  contracted.  And  his  most  excellent  majesty’,  as  well  as 
my-self,  acknowdedged  that  the  heart  was  without  the  sense  o^  touch ; for  the  y’outh  never  knew  when  we  touched  his  heart,  except  by  the  sight  or 
the  sensation  he  had  through  the  external  integument.  We  also  particularly  observed  the  movements  of  the  heart,  viz:  that  in  the  diastole  it  was 
retracted  and  withdrawn,  whilst  in  the  systole  it  emerged  and  protruded,  and  the  sy’stole  of  the  heart  took  place  at  the  moment  the  diastolp  or  pulse  in  the 
wrist  was  perceived  ; to  conclude,  the  heart  struck  the  walls  of  the  chest,  and  became  prominent  at  the  time  it  bounded  upward  and  underwent  contraction 
on  itself.” 

* See  pages  486,  487,  488.  504,  523,  526,  535,  548. 

tSI.  HirrOLi'Tic  Larkey,  in  his  lectures  on  surgery  at  Val-de-Grace,  ascribes  the  frequent  occurrence  of  necrosis  of  the  sternum  to  the  pressure  of 
the  soldier's  cross-belts.  Such  an  efl'ect  has  not  been  obsen’cd  frequently  in  the  United  States  service.  M.  Linoli  has  resected  the  xiphoid  appendage 
{Annali  univ.  di  medicina  di  Milano,  1851)  fur  obstinate  vomiting.  It  has  been  affirmed  by  Percy’  that  the  xiphoid  cartilage  will  sometimes  recede  before 
a ball  and  then  spring  back  barring  the  opening,  as  observed  by  Guillemeau  {(Euvres  de  Chirurgie,  Rouen,  1649)  in  the  case  of  M.  do  Mal6corne.  If 
the  sternum  is  very  soft,  it  will  not  bear  readily  the  pressure  of  the  trephine  or  osteotome,  and  it  will  be  necessary  to  resort  to  the  chisel  or  gouge,  as 
Boyer  did,  or  the  chain  saw,  as  employ’ed  by  Dr.  J.  F.  IlEYFELDER.  MOREAU,  Blandin,  J.EGER,  and  KUCIILER  removed  diseased  costal  cartilages  in 
their  operations  for  partial  excisions  of  the  sternum.  See  JiEGER,  Handivortcrhuch  der  gesammten  Chirurgie,  B.  V,  8.  425,  Leipsig,  1839 ; SKlELDEUUr, 
0)1  the  Operation  of  Trepanning  the  Sternum,  translated  from  the  Transactions  of  the  Roy’al  Society  of  Copenhagen,  1813,  in  Am.  Med.  Repository. 
N.  S..  1820,  Vol.  V,  p.  273 ; Fergusson,  Syst.  of  Pract.  Surgery,  5th  ed.,  1870,  p.  620 ; HOPTOX,  Operation  of  the  Trephine  for  the  Remeycal  of  a Portion 
of  Carious  Sternum,  Am.  Jour.  Med.  Sci.,  Vol.  V,  p.  45,  1829 ; and  among  older  authors,  COLOSSIUS,  De  perforatione  ossis  pectoralis,  Tubingen,  1775; 
Bu'1T('IIER,  Abhandlungcn  v.  d.  Krankhcit  d.  Knochen,  T.  I,  S.  Ill,  Dessau,  1781;  Brandes,  De  Pectoris  Paracentesi,  Ocettingen,  1792;  J.  \j.  Pei'IT, 
Traiie  dc  mal.  chir,,  already  cited,  1774,  T.  I,  p.  76. 


SiCCT.  III.] 


THORACENTESIS, 


573 


Thoracentesis. — This  operation  was  occasionally  resorted  to  during  tlie  war  to  relieve 
the  effects  of  effusions  resulting  from  acute  and  chronic  pleurisy;  and,  more  frecpiently, 
on  accjimt  of  effusions  consequent  on  traumatic  pleuro-pueumonia,  or  the  lo^ment  of 
foreign  bodies  within  the  chest.  The  instances  that  are  not  classified  under  other  headings 
will  be  enumerated  here. 

In  the  eight  following  cases,  paracentesis  of  the  thorax  was  practiced  on  account  of 
hydrothorax  or  empyema  unconnected  with  any  wound  of  the  chest: 

Case  1. — Private  John  Vaughan,  Co.  B,  3(1  battalion,  12th  United  States  Infantry,  aged  22  years,  was  admitted  to  the  Post 
Ilos^iital,  Washington,  May  30th,  18C6,  suffering  from  chronic  pleurisy  of  the  left  side,  with  extensive  effusion.  By  June  28th, 
the  effusion  extended  over  an  inch  above  the  left  nipple.  Good  nourishing  food,  mercurial  inunction,  and  mild  diuretics  had 
produced  no  diminution  of  the  abdominal  ffuid.  The  patient’s  appetite  was  good ; he  slept  soundly,  and  was  able  to  walk  about, 
and  felt  but  little  inconvenience.  Assistant  Surgeon  William  Thomson^  U.  S.  A.,  performed  paracentesis  thoracis  with  a silver 
trocar  above  the  ninth  rib,  near  the  inferior  angle  of  the  scapula,  through  valvular  opening.  Twenty-one  ounces  of  albuminous 
serum  were  removed,  after  which  the  wound  was  hermetically  closed.  The  operation  was  repeated  .Tuly  16th,  August  7th,  and 
Sejitember  22d,  giving  but  transitory  relief.  lie  was  returned  to  duty  October  16th,  1866.  Not  a pensioner. 

Case  2. — Private  Martin  Carbit,  Co.  B,  18th  United  States  Infantry,  aged  23  years,  was  admitted  to  hospital  at  Camp 
Dennison,  June  24th,  1864,  suffering  from  empyema  of  left  side.  The  symptoms  present  were  an  entire  absence  of  tbe  respiratory 
munmir  of  the  affected  side,  with  bronchial  respiration,  and  protrusion  of  the  intercostal  spaces;  fixedness  of  the  thoracic  parietes; 
tenderness  on  pressure  of  the  intercostal  spaces;  dullness  on  percussion,  and  increased  circumference  of  the  side,  relative  to  the 
noimal  circumference  of  the  other.  There  was  also  a small  opening  between  the  second  and  third  costal  cartilages  at  their  junction 
with  the  sternum.  On  August  26th,  the  patient  was  very  weak  and  life  was  fast  ebbing  away.  His  appetite  was  poor,  and  he 
suffered  from  diarrhoea,  fever,  and  great  dyspnoea.  Acting  Assistant  Surgeon  A.  Buckingham  introduced  a canula  between  the 
sixth  and  seventh  ribs;  about  one  (ptart  of  thick  pus  of  a very  offensive  odor  flowed  away.  The  operation  was  repeated  on 
August  26th  and  30th,  and  on  September  1st,  3d,  and  5th,  the  same  ciuantity  being  drawn  off  each  time,  the  pus  becoming  thinner. 
Stimulants  and  toiucs,  with  good,  nour-ishing  diet,  were  administered.  The  side  collapsed  considerably,  and  the  patient’s  strength 
improved  rapidly.  He  was  discharged  from  service  September  6th,  1864.  Not  a j)ensioner. 

Case  3. — Private  John  H.  Miller,  Co.  L,  17th  Illinois  Cavaliy,  aged  20  years,  was  admitted  to  Marine  Hospital,  Chicago, 
Illinois,  April  4th,  1864,  with  incipient  phthisis  and  pleurisy,  with  effusion.  Great  dyspnma  and  cyanosis  occui’i  ed.  On  June 
29th,  Acting  Assistant  Surgeon  Ralph  N.  Isham  performed  thoracocentesis.  July  4th,  jjatient  walking  about.  Discharged  from 
service  July  28th,  1864.  Not  a pensioner. 

In  the  two  following  cases,  metastatic  abscesses  and  empyema  appear  to  have  resulted 
as  pyaemic  complications  after  excision  or  amputation  for  gunshot  injuries  of  the  extremity. 
There  was  no  primary  injury  of  the  chest  in  either  case: 

Case  4. — Private  Robert  Bivens,  Co.  E,  115th  Illinois  Volunteers,  aged  20  years,  was  wounded  at  Chickamauga,  Georgia, 
September  20th,  1863,  by  a musket  ball,  which  passed  directlj'  through  the  right  elbow-joint.  On  September  26th,  Surgeon 
William  Varian,  U.  S.  V.,  administered  chloroform  and  excised  a portion  of  the  right  ulna  and  the  inner  condyle  of  the  humerus. 
Simple  dressings  were  applied,  and  tonics  and  stimulants,  with  nourishing  diet,  were  administered.  In  February,  1864,  inflam- 
mation of  the  lungs  supervened,  with  formation  of  abscesses,  for  which  paracentesis  thoracis  was  peiformed  by  Dr.  kloore,  of 
Decatur,  Illinois.  The  patient  was  discharged  from  service  iSIarch  23d,  1865,  on  surgeon’s  certificate  of  disability.  Examining 
Surgeon  Ira  B.  Curtis,  Decatur,  Illinois,  August  14th,  1866,  reports  : “ Gamshot  wound  through  arm  near  elbow-joint.  There 
has  been  resection  at  the  joint.  .Joint  was  perfectly  anchj-losed,  and  the  wound  still  discharging  at  both  orifices.  Flextil  .at 
right  angle.  Limb  much  emaciated  and  useless.  General  health  poor,  result  of  said  wound,  owing  to  the  constant  drain  on  the 
constitution.  He  was  still  a pensioner  in  March,  1872.” 

Ca.se  5. — Private  Seth  T.  Reynolds,  Co.  G,  4th  Indiana  Cavalry,  aged  22  year.s,  w’as  admitted  to  Ilosjtital  No.  1,  Nashville, 
Septendier  3d,  1864,  with  a gunshot  fracture  of  the  three  middle  toes  of  tlA  right  foot  and  the  metatarsal  bone  of  tbe  little  toe  of 
the  left  foot,  received,  accident, ally,  at  Nashville  on  the  same  day.  Acting  Assistant  Surgeon  M.  L.  Herr  administered  chloroform 
and  removed  the  three  toes  of  the  right  foot  near  the  metatar.sal  ])halangeal  articulation,  and  also  excised  the  fifth  metatarsal  bone 
of  the  left  foot.  On  November  1st,  1864,  Dr.  Herr  performed  paracentesis  thoracis  of  the  left  side  of  the  chest  between  thesi.xth 
and  seventh  ribs,  one-fourth  the  dist.ance  from  the  spinal  column  to  the  sternum.  Twenty  ounces  of  pus  were  removed.  The 
jtatient  improved  rapidly  under  the  administration  of  tonics,  stimulants,  and  nutritious  diet,  and,  on  December  21st,  w.as  transferred 
to  Crittenden  Hospital,  Louisville;  on  June  lOtb,  1865,  to  Brown  Hospital,  whence  he  was  returned  to  duty,  probally  to  be 
mustered  out,  June  14th,  1865.  Surgeon  B.  B.  Breed,  U.  S.  V.,  imports  the  case. 

Three  of  the  eight  cases,  in  which  tapping  was  resorted  to  on  account  of  tlie.  results  of 
idiopathic  pleurisy,  terminated  fatally: 

Case  6. — Private  .John  Robinson,  Co.  G,  112th  Pennsylviinia  Volunteers,  aged  20  years,  was  admitted  to  Colivalescent 
Hospital,  Philadelphia,  February  24th,  1864,  suffering  from  iileurisy  of  the  right  side,  with  effusion.  By  March  12th,  the  right 


574 


AVOUNDS  AND  INJURIES  OF  THE  CHEST. 


[ClIAI-.  V, 


thorax  had  become  perfectl}’  Hat  on  pei’cussion.  No  respii-atory  murmur  could  be  heard.  The  sujierficial  veins  were  distended 
and  could  be  seen  crossing  over  the  surface.  The  intercostal  surfaces  were  also  distended.  Tbe  patient  was  in  a sinking  condition 
from  want  of  due  aeration  of  the  blood.  Pulse  i:?2;  respiration  48  per  minute.  Acting  Assistant  Surgeon  A.  U.  Hall  performed 
paracentesis  thoracis,  with  bistoury  and  trocar  between  the  sixth  and  seventh  ribs,  anteriorly,  at  the  angle  of  the  thorax. 
Twenty-four  ounces  of  clear  straw-colored  serum  were  evacuated,  wlien  the  flow  was  stopped,  as  the  patient  appeared  exhausted. 
The  dyspnoea  was  much  relieved,  but  the  patient  was  so  utterly  prostrated  that  ho  continued  to  sink.  The  treatment,  which  had 
at  lirst  been  especially  du-eeted  to  the  chest,  was  at  a later  period  changed  to  supporting  and  stimulating.  Death  resulted  March 
13th,  1864.  At  the  necropsy  the  right  chest  was  found  to  contain  twenty-four  ounces  of  bloody  serum.  The  right  lung  was 
compressed  against  the  spine.  The  whole  cavity  was  lined  with  thick,  false  membranes,  and  soft  bridles  of  the  same  traversed 
the  cavity  in  every  direction.  The  ujiper  lobe  was  consolidated.  The  left  lung  was  merely  hypostatically  congested — floating 
in  water.  The  wound  of  operation  in  the  parietes  of  the  right  chest  had  healed  over,  making  it  difficult  to  be  found  on  the  inside. 
The  heart  was  jierfectly  healthy. 

Case  7. — Private  William  O.  Martin,  Co.  E,  5th  Michigan  Cavalry,  aged  19  years,  was  admitted  to  Jarvis  Hospital, 
Baltimore,  March  3d,  1865,  suffering  from  pleurisy.  Effusion  and  empyema  supervened.  On  May  13th,  the  left  pleural  cavity 
was  filled  with  a sero-pundent  fluid,  displacing  the  heart  to  the  right  side.  Acting  Assistant  Surgeon  H.  McElderry  performed 
paracentesis  thoracis  between  the  eightli  and  ninth  ribs,  on  the  left  side;  about  two  gallons  of  fluid  were  evacuated.  Tonics  and 
stimulants  were  administered.  Death  resulted  May  27th,  1865. 

Case  8. — Private  Thomas  Tigner,  Co.  E,  193d  Ohio  Volunteers,  aged  17  years,  was  admitted  to  Jarvis  Hospital,  Baltimore, 
March  27th,  1865,  suffering  with  pleurisy  and  empyema.  By  May  29th,  1865,  the  right  pleural  cavity  was  distended  with  fluid, 
and  there  was  great  dyspnoea.  Acting  Assistant  Surgeon  E.  G.  Waters  performed  paracentesis  thoracis  between  the  eighth  and 
ninth  ribs,  on  the  right  side ; aboiii-  one  gallon  of  fluid  was  evacuated.  The  patient  died  June  22d,  1865. 

No  doubt  many  other  cases  are  noted  on  the  medical  reports,  the  subject  strictly 
pertaining  to  the  domain  of  internal  pathology,  and  being  mentioned  incidentally  only  on 
the  surgical  returns.'^’ 

In  the  nine  following  cases,  thoracentesis  was  performed  on  account  of  effusions 
following  the  perforation  of  the  chest  by  small  projectiles; 

Case  9. — Corporal  L.  G.  Klanhowcr,  Co.  K,  1st  Florida  Regiment,  was  wounded  at  Mission  Ridge,  Tennessee,  November 
25th,  1863,  by  a nm.sket  ball,  which  entered  above  the  spine  of  the  right  scapula,  passed  through  the  cavity  of  the  chest,  and 
emerged  one  inch  below  the  sterno-clavicular  arliculation  on  the  same  side.  He  was  taken  prisoner  and  conveyed  to  Hospital 
No.  2,  Chattanooga,  December  8th.  Anterior  wound  discharged  daily;  dullness  over  right  lung  in  its  whole  extent;  bulging  of 
chest  well  marked.  Percussion  over  left  lung  more  resonant  than  natural.  Upon  forcibly  distending  the  lung,  about  one  pint  of 
unhealthy  jms  was  discharged  from  the  anterior  wound.  Surgeon  A.  McMahon,  64th  Ohio  Volunteers,  perfoimed  thoracentesis 
at  the  lower  angle  of  the  scapula  and  upper  border  of  seventh  rib,  drawing  off  at  least  sixteen  ounces  of  sero-purulent  matter, 
extremely  fetid,  jjresenting  somewhat  the  appearance  of  dirty  soap-suds.  Wound  closed  with  scraped  lint.  Anterior  and 
posterior  wounds  closed  with  lint,  firmly  covered  with  adhesive  plaster.  The  patient  felt  relieved  after  the  operation ; the  difficulty 
of  breathing  was  not  so  great,  but  he  was  troubled  with  a short,  dry,  irritable  cough.  Stimulants  were  ordered  freely.  Death 
occurred  on  December  11th,  1863. 

Case  10. — Private  George  W.  Sawyer,  Co.  A,  Ist  Michigan  Sharp-shooters,  was  wounded  at  the  Wilderness,  Virginia,  May 
5th,  1864,  by  a conoidal  ball,  which  entered  a little  below  and  to  the  right  of  the  right  nipple,  passed  through  the  lung,  and  emerged 
just  to  the  right  of  the  spine;  the  same  ball  also  passed  through  the  right  arm.  On  June  14th,  he  was  admitted  to  the  Third 
Division  Hospital,  Alexandi-ia.  Pleuri.sy  and  empyema  supervened,  and  on  January  25th,  1865,  Assistant  Surgeon  W.  G.  Elliott, 
U.  S.  V.,  performed  paracentesis  thoracis.  Tonics,  stimulants,  and  nutritious  diet  were  administered.  The  case  progressed 
favorably,  aud,  on  June  25th,  the  patient  was  transferred  to  Harper  Hospital,  Detroit,  Michigan,  whence  he  was  discharged  from 
service  July  2l6t,  1865.  Pension  Examiner  J.  AV.  Falley  reports,  September  1st,  1865,  “the  wound  of  entrance  is  still  discharging. 
He  is  able  to  walk  about  the  house.”  Sawyer  died  July  .30th,  1866. 

Case  11. — Private  Owen  Morrison,  Co.  I,  1st  Ohio  Volunteers,  aged  22  years,  received  a gunshot  wound  of  the  neck  and 
right  shoulder  by  a conoidal  ball  at  Resaca,  Georgia,  May  14th,  1864.  He  was  treated  in  the  fielil,  and,  on  May  27th,  was 
transferred  to  Hospital  No.  1,  Nashville,  Tennessee.  By  June  17th,  the  jiatient  was  exhausted  by  coughing  and  labored respira- 
tioti,  and  the  suffocation  caused  by  a large  collection  of  fluid  in  the  chest.  The  intercostal  spaces  over  the  right  side  were 
obliterated,  and  the  left  lung  was  highly  inflamed.  Acting  Assistant  Surgeon  H.  C.  May  performed  paracentesis  thoracis  of  the 
right  side  of  the  chest,  between  the  sixth  and  seventh  i-ibs,  five  inches  from  the  sternum.  Ninety-three  ounces  of  sero-purulent 
fluid  were  drawn  off.  The  removal  of  the  fluid  gave  temporary  relief.  Air  reentered  the  collapsed  lung.  Tonics,  stimulants, 
aud  nutritious  diet  were  administered.  The  patient  died  June  17th,  1864.  from  exhaustion. 


* The  subject  of  thoracocentesis  in  the  effusions  of  acute  pleurisy  has  recently  (April,  1872)  been  discussed  at  the  Academy  of  Medicine  of  Paris, 
at  great  length.  Professor  BklllEH,  in  a memoir  in  which  he  claimed  tlmt  the  popularization  of  tracheotomy  in  croup  and  thoracentesis  in  pleurisy  were 
the  two  greatest  of  Trousseau's  great  titles  to  the  grateful  hom.age  of  the  profession,  supported  the  views  advocated  in  the  Clinique  Midicale  de  VJJdtel- 
Dieu,  by  sixteen  carefully  observed  cases,  which  he  thought  demonstrated  the  innocuitj'  of  “capillary  thoracocentesis”  with  an  aspirator  providing 
against  the  admission  of  air.  Many  of  the  academicians  joined  in  the  exhaustive  an<l  somewhat  acrimonious  debate  that  followed,  among  them  a few  that 
had  participated  in  the  similar  discussions  of  1835  aud  1805,  among  them  MM.  GuiiuiN,  .SilDlLLOT,  Eicuet,  CllASSAlGNAC,  IlOGEU,  aud  IlfcUAllD. 


Sect.  III.] 


TIIORACEKTESIS. 


575 

Case  12. — Captain  I’i'osjht  Palien,  Co.  C,  208tli  Pennsvlvania  Volunteer.'!,  aged  2G  year.s,  Avas  wounded  at  I’eterslairg, 
Mtircli  25tli,  1865,  by  a conoidal  ball,  wliicdi  entered  beneath  the  inferior  angle  of  the  left  scaptda,  passed  through  the  pleura,  and 
emersjed  at  the  anterior  superior  border  of  the  left  axillary  space.  lie  was  treated  in  the  field  hospital  of  the  Ninth  Corps,  until 
April  24th,  Avhen  he  was  transferred  to  Armory  Square  Hosjntal,  Washington.  When  admitted,  there  was  considerable  dyspna-a, 
with  excessive  pain,  which  was  increased  by  coughing.  At  each  forcible  expiration  the  air  was  expelled  from  the  wound  of  the 
back.  Stimulants  and  anodynes  were  given.  Whenever  the  patient  moved  he  complained  of  a gurgling  sensation.  On  percus- 
sion in  the  recumbent  and  upright  position,  it  was  decided  that  there  was  a large  quantity  of  pus  in  the  thoracic  cavity.  The 
cavity  was  opened  by  Assistant  Surgeon  Charles  A.  Leale,  U.  S.  V.,  and  twelve  ounces  of  pure  pus  Avithdrawn,  liy  means  of  a 
Flint's  evacuator.  Air  Avas  forced  from  the  thoracic  caA'ity  through  the  Avound  in  the  arm.  Morphine  given  to  allay  pain.  On 
June  2d,  hamiorrhage  occurred  from  the  cavity  near  the  axillary  space,  and  the  patient  died  on  the  same  day. 

Case  13. — Private  John  C.  Burk,  Co.  B,  hth  United  States  Cavalry,  aged  28  years,  Avas  Avounded  at  Manassas  Gap,  July 
21st,  1863,  by  a ball,  Avhich  entered  the  left  side  of  the  body  better  than  half  Avay  betAveen  sternum  and  side,  between  sixth  ami 
seventh  ribs,  ]iassing  backAvards  and  upAvards,  emerging  just  beloAV  the  outer  and  inferior  angle  of  the  left  scapula,  injuring  the 
left  lung.  There  Avas  considerable  hsemorrhage  at  time  of  injury.  He  Avas  admitted  into  Lincoln  Hospital,  Washington,  D.  C.,  on 
July  30th,  1863,  Avhen  vesicular  murmur  Avas  heard  over  upper  portion  of  lung;  dull  over  loAver;  but  over  region  of  wound,  loud 
(U-ackling ; air  rushing  in  and  out  during  respiration  ; pulse,  84 ; tongue  somewhat  flabby  and  furred ; boAvels,  costive ; no  passage 
for  nine  days.  On  August  21st,  after  consultation,  paracentesis  thoracis  Avas  performed  by  Assistant  Surgeon  H.  Allen,  U.  S.  A., 
between  the  sixth  and  seventh  ribs;  no  jtus  escaped.  Patient  improved  until  September  8th,  after  Avhich  he  grew  Averse,  suft'ering 
from  pain  in  chest,  ;md  failing  rapidly;  continually  calling  for  Avater,  hut  refusing  food  and  medicine.  He  died  on  September  11, 
1863.  Post  mortem  nineteen  hours  after  death;  rigidity  well  marked;  not  much  emaciated;  parts  in  situ ; right  lung  barely  visible ; 
left  lung  bound  anteriorly  to  costal  pleura,  a little  behind  the  junction  of  the  cartilages  in  the  ribs,  extending  from  the  clavicle  to 
the  fourth  rib.  Behind  and  beloAV  it,  Avas  a collection  of  pus  measuring  thirty-six  fluid  ounces  and  six  drachms.  The  pleura 
everywhere  Avas  covered  Avith  a thick  layer  of  lymph ; a small  sac  Avas  found  betAveen  the  internal  portion  of  the  lung  and  the 
pericardium,  filled  with  a straw  colored  limpid  serum.  Position  of  heart  someAvhat  deviated,  the  apex  being  in  the  median  line 
on  a level  with  the  fifth  rib,  the  left  side  of  the  heart  being  parallel  with  the  median  line,  the  right  side  being  throAvn  much 
beyond  it,  encroaching  considerably  on  the  right  thoracic  cavity.  The  left  lobe  of  the  liver  extended  three  inches  to  the  left  of 
the  median  line;  the  free  margin  of  the  right  lobe  extended  doAvn  Avithin  an  inch  of  the  umbilicus.  The  fundus  of  the  stomach 
Avas  seen  beneath  the  left  lobe.  Intestines,  normal;  a feAV  fibrinous  threads  Avere  present;  omentum  not  visible;  oesophagus  of 
dark  purple  color;  mucous  membrane  firm;  trachea  purplish;  contained  a small  quantity  of  viscid  mucus.  Bronchial  glands 
enlarged  and  blackened  1st  lobe  of  right  lung;  pigmentary  matter  abundant  externally,  parenchyma  of  a darkish  red  color,  jmler 
toAvard  the  surface;  permeated  everyAvhere  Avith  air,  and  a large  quantity  of  thin  frothy  matter  exuded  on  pressure.  On  the 
s(!Cond  lobe  Avas  a conspicuous  dejAressed  puckered  spot  on  its  anterior  surface,  which,  upon  examination  proved  to  be  calcareous 
deposit.  Third  lobe  intensely  congested,  being  of  a deep  dark  reddish  color ; veins  filled  Avith  clotted  blood,  and  the  same  character 
of  bronchial  secretion  as  seen  in  the  first  lobe.  Left  lung  much  collapsed,  being  a little  over  an  inch  in  thickness ; much 
compressed;  of  a dull  mahogany  color,  and  not  permeated  Avith  air,  except  the  anterior  median  portion.  Eight  lung  Aveighed 
nineteen  ounces ; left  lung  Aveighed  tAventy-tAvo  ounces.  Heart  measured  three  and  a quarter  inches  in  Avidth  and  four  inches  long ; 
right  auricle  contained  a small  quantity  of  venous  blood,  Avhich  Avas  entangled  in  soft  clots  in  the  meshes  of  the  tricuspid  valve, 
particularly  at  the  base,  and  a firm  fibrinous  clot  ran  through  the  auricle  into  the  ventricle,  thence  up  into  the  pulmonary  artery, 
the  valves  of  Avhich  Avere  healthy.  The  left  side  of  the  heart  contained  no  clot ; a small  quantity  of  blackish  fluid  Avas  seen  at  the 
base  of  the  venti-icle ; the  organ  Avas  perfectly  healthy,  and  Aveighed  ten  and  a half  ounces.  Pericardial  fluid,  tAventy-six  drachms, 
of  a turbid  yelloAvish  color,  turbid  Avith  lym])h.  Liver  measured  tAvelve  by  ten  inches,  and  four  and  a half  inches  thick;  Aveighed 
ninety-five  and  a half  ounces ; bile,  one  drachm;  of  a dark  sienna  broAvn  color,  very  viscid,  semi  opaque;  liver  perfectly  healthy. 
Spleen,  six  inches  long  by  three  and  a half  inches  Avide;  of  a darkish  mahogany  color  externally  and  internally ; Aveight,  twelve 
ounces.  Eight  kidney,  five  inches  long  by  three  Avide;  of  a dark  puri)le  color  throughout;  jAyramidal  bodie.s  of  a lighter  color 
than  the  cortical,  especially  at  their  apices.  Left  kidney,  five  and  a half  inches  long  by  tAvo  and  a half  Avide ; similar  in  appeai'ance 
to  the  opposite  kidney;  right  Aveighed  seven  and  three-quarter  ounces ; left,  eight  and  a quarter  ounces.  Pancreas  Aveighed  four 
and  a quarter  ounces,  ten  inches  huig  by  tAvo  and  a quarter  inches  across  head.  Brain,  membranes  healthy;  quantity  of  fluid  in 
the  ventricles  inappreciable;  organ,  firm  and  healthy ; Aveight,  forty-eight  ounces.  Intestines,  perfectly  healthy.  The  ball  entered 
in  the  back  tAVO  inches  beloAV  the  s])ine  of  the  scapula,  and  four  inches  from  the  vertehrte,  making  its  exit  eight  and  a half  inches 
b(doAV  the  coracoid  process  betAveen  the  seventh  and  eighth  ribs  of  the  left  side.  The  case  is  reported  by  the  operator.  Assistant 
Surgeon  H.  Allen,  U.  S.  A. 

The  following  case  of  perforation  of  both  lungs  by  a pistol  ball,  presented  the  compli- 
cations of  ha3mothorax,  empliysema,  and  tromatopnoea,  and  is  interesting  as  one  of  the 
few  instances,  if  not  the  only  one,  reported  during  the  war,  of  lumbar  ecchymosis  as  a 
si  Gin  of  chest  wounds 

O 

Case  14. — Corporal  Samuel  A.  C , Co.  E,  1st  United  States  Cavalry,  aged  20  years,  was  wounded  in  a cavalry 

charge  near  Culpeper,  Virginia,  August  1st,  1803;  the  missile,  a revolver  ball,  entered  the  back,  left  side,  about  two  and  a 

* There  has  been  a general  disbelief  among  the  military’  surgeons  with  whom  I have  conversed  or  coiTOSponded,  in  regard  to  the  diagnostic  value 
of  this  sign  of  wound  of  the  thorax,  and  having  never  observed  the  phenomenon  in  question,  I luive  shared  in  this  incredulity.  CllAUSSiKll  and  !^I.\bCAlGNK 
contested  the  possibility  of  the  transudation  of  lilood  tiirougli  the  pleura  during  life  ; but  admitted  the  existence  of  the  lumbar  oechymosis  (U^scribed  by 
Valentix.  and  ascribed  it  to  the  inGltration  of  blocKl  into  the  cellular  tissm?  tlinmgli  tlie  external  wound.  M.  JUCGOUEST,  in  the  last  editifiu  of  his 
VUtrurfjic  tV Armic,  page  ^'>2,  says : “ (!e  symptoine,  qnc  nous  avons  eu  roecasion  do  oonstuter,  est  sans  importance,  et  son  apparition,  toujours  tariUve, 
s’ujonte  rien  au  diagnostic  sutlissamment  6lucide  par  le  reunion  d un  certain  noiiibru  des  symptomes  (pic  nous  avons  exjius^s.”  1 had  concurred  in  the 


576 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


lialf  indu‘8  below  the  spine  of  the  scapula,  above  the  posterior  margin  of  tjie  arm-pit,  by  the  teres  muscles,  and  was  found 
beneath  the  skin  to  the  right  of  the  sternum,  beneath  the  fourth  and  fifth  ribs.  He  rode  about  a mile  and  then  fainted.  The 
haemorrhage  was  considerable  and  he  also  vomited  a little.  Cold  applications  were  applied  and  the  patient  was  conveyed  to 
Washington,  entering  Douglas  Hospital  on  the  next  day.  On  admission  there  was  extensive  emphysema  and  distressing 

dyspnoea,  the  patient  breathing  with  a peculiar  puff  of  the  mouth  at  every  expiration. 
He  complained  of  pain  in  the  left  hypochondriac  region,  in  the  vicinity  of  the  ball,  which 
was  immediately  extracted  by  a perpendicular  incision  an  inch  in  length.  The  wound, of 
incision  for  the  exit  of  the  ball  immediately  gave  rise  to  traumatic  dyspnoea  until  it  was 
closed  with  straps  of  isinglass  plaster  covered  with  collodion.  The  patient  stated  that  he 
had  considerable  limmoptysis,  perhaps  a cup  half  full,  immediately  after  having  been 
wounded.  Small  doses  of  antimony  and  calomel,  with  stimulants,  were  administered,  and 
an  anodyne  given  at  night.  August  3d:  Vomiting;  bowels  costive.  A grain  of  calomel 
was  given,  which  opened  the  bowels.  Dyspnoea  considerably  diminished,  but  still  annoy- 
ing; pain  in  left  hypochrondriac  region  during  cough  was  allayed  by  the  application  of  a 
mustard  poultice;  emphysema  the  same  as  on  the  day  before.  August  4th:  Appetite 
good;  patient  somewhat  more  comfortable.  On  the  5th,  the  anterior  wound  was  opened, 
which  seemed  to  ease  his  respiration  for  a short  time,  but  the  distress  in  breathing  soon 
I'eturned.  The  patient  recognized  the  extent  of  his  injury  and  had  no  hopes  of  recovery. 
August  6th:  The  patient  passed  a tolerably  good  night;  dyspnoea  increased  during  t;he 
course  of  the  day ; emphysema  in  lumbar  region ; a mild  cathartic  was  given ; the  cough 
became  more  troublesome  and  painful.  The  patient  vomited  a bilious  green  fluid,  and 
during  that  act  a '‘paracentesis  naturalis”  occurred  by  the  violent  explosion  of  the 
adhesive  plaster  from  the  anteilor  wound,  followed  by  the  discharge  of  a pint  and  a halt 
of  bloody  serum  and  hot  blood,  which  escaped  particularly  rapidly  at  each  expiration  and 
effort  to  cough.  This  escape  of  the  bloody  effusion  in  the  thoracic  cavity  relieved  him 
from  the  annoying  dyspnoea,  but  weakened  him  in  a great  degree.  Stimulants  were  adnnnistered  freely,  but  he  gradually  sank ; 
the  arterialization  of  the  blood  could  not  take  place;  the  blood  became  poisoned  by  carbonic  acid,  and  he  died  of  coma  at  11  o’clock 
P.  SI.,  August  9th,  1863.  A post-mortem  examination  was  made  ten  hours  after  death.  A strong,  well-built,  robust  cadaver; 
excellent  physique.  Stiffness  of  death  well  marked.  Emphysema  all  about  the  upper  portion  of  the  sternum  and  both  sides  of 
the  chest.  The  back  and  left  thigh  were  of  a mulberry  hue.  The  pistol  ball  had  perforated  the  inferior  edge  of  the  shoulder- 
hlade,  just  below  the  glenoid  cavity  and  the  infraspinatus  and  subscapularis  muscles.  It  went  into  the  left  thoracic  cavity,  between 
the  second  and  third  ribs,  and  penetrated  the  anterior  portion  of  the  upper  lobe  of  the  left  lung,  and,  extending  across  the  chest 
above  the  blood  vessels,  entered  the  lower  portion  of  the  upper  lobe  of  the  right  lung.  A perpendicular  incision  one  and  a half 
inches  obliquely  upward  from  the  right  nipple,  between  the  third  and  fourth  ribs,  an  inch  external  to  the  sternum,  represented  the 
wound  of  exit.  On  removing  the  isinglass  plaster  which  closed  this  wound,  a considerable  rush  of  air  escaped.  On  careful 
dissection  of  the  skin,  the  cervical,  pectoral,  and  abdominal  muscles  were  found  largely  infiltrated  with  blood,  and  there  were  clots 
of  coagulated  blood  between  the  cellular  tissues.  The  right  lung  was  completely  collapsed,  caused  by  one-half  gallon  of  blood  in 
the  pleural  sac;  nearly  the  same  condition  on  the  left  side.  Adhesion  of  both  lungs  to  costal  parietes  indicated  late  pleurisy  and 
the  cause  of  former  pain  in  that  region.  The  heart  and  its  appendages  were  normal.  Paracentesis  thoracis  was  performed 
between  the  eighth  and  ninth  ribs  on  the  right  side,  posteriorly,  without  injuring  the  lungs,  and  it  gave  exit  to  the  enormous 
quantity  of  extravasated  blood.  The  case  is  reported  by  Acting  Assistant  Surgeon  Carlos  Carvallo.  The  specimen,  numbered 
1680  in  the  surgical  series  of  the  IMuseum,  is  the  left  scapula,  grooved  just  below  the  glenoid  cavity.  A fissure  of  one  inch  and  a 
half,  not  connected  with  the  direct  wound  of  the  ball,  exists  in  the  lower  wing  of  the  bone.  The  preparation  and  the  notes  of  the 
case  were  forwarded  by  Assistant  Surgeon  Wm.  Thomson,  U.  S.  A. 


view  expressed  by  Dr.  Fraser,  at  page  87  of  his  often  cited  work,  and  supposed  that  this  sign  was  admitted  by  surgical  authorities  chiefly  through 
deference  for  the  great  name  of  Darrej-.  Dr.  Fraser  says:  “The  presence  of  the  ecchymosis  of  blood  in  the  loins  * * which  I never  witnessed, 
altliougli  it  is  dwelt  upon  as  certain  evidence  of  effusion  into  the  pleural  cavity,  by  Valentin  and  others,  * * * indeed,  if  it  were  not  for  the  distinct 
statement  made  by  Baron  Laivey,  at  page  240,  as  to  the  presence  of  this  peculiar  discoloration,  ‘ce  signe  est  I'nn  des  plus  pathognomoniques,'  I sliould 
consider  this  as  one  of  many  matters  of  romance,  unthinkingly  handed  down  by  one  writer  to  another.”  Larre}'  appears,  however,  to  dwell  more  upon 
the  (edematous  engorgement,  that  Valentin  also  regarded  as  characteristic,  than  upon  the  ecchyraotic  discoloration.  Here  is  the  passage  from  the 
Clinique.  Chirurgicale,  T.  II,  p.  240:  “Enfin  Ton  aper(;oit,  ainsi  que  I'indique  Valentin,  nn  engorgement  ceeUmateux  plus  ou  moins  6tendu,  avec  on 
sans  ecchymose,  derridre  I’hypocondre  correspondant  & repanchement,  et  ce  signe  est  Vun  des  plus  pathognomoniques.  II  se  produit  par  une  sorte 
d’infiltration  sdro-sanguine  qui  se  fait  du  foyer  de  I'dpanchement,  a travers  les  membranes  sdreuses,  les  muscles  intercostanx  et  dorsaux,  les  tissus  cellulaire 
et  dermoide.  Nous  avons  cemstamment  observe  ce  phenomene,  et  nous  avons  plusieurs  fois  snrpris  la  nature  dans  la  marche  de  sa  formation,  e’est-a-dire 
qu’d  rouverture  des  cadavres  des  personnes  mortes  de  ces  blessurcs  avec  dpanchement,  nous  avons  pn  suivre  I'infiltration  sanguine  depuis  sa  source 
jusque  sous  la  peau."  With  this  testimony,  the  subject  would  appear  to  demand  further  investigation.  I will  append  one  more  citation  from  Valentin's 
rather  rare  book  (Hecherches  critiques  sur  la  Chiritrgie  woderne.  Amsterdam,  1772,  p.  72j,  that  the  nature  of  the  signs  he  insisted  on  may  he  precisely 
understood:  “Ces  caracteres  ne  se  recontrent  point  dans  rdchiniose  qui  est  le  signe  de  repanchement  de  sang  dans  la  poitrine  : celle-ci  en  a d’antres  qui 
lui  sont  absolnment  propres;  dans  quelque  point  de  la  circonf6rence  de  la  poitrine  que  suit  la  plaie,  cette  Schimose  est  tonjours  situ6e  dans  le  meme  lieu, 
du  cot§  od  repanchement  existe : elle  se  forme  vers  I’angle  des  fausses  cotes : elle  prend  sa  direction  vers  le  carrd  des  lombes ; on  I’observe  souvent  d 
la  surface  de  ce  muscle : sa  couleur  est  la  meme  que  celle  des  taches  qui  paroissent  au  bas-ventre  peu  de  terns  apres  la  raort,  e’est  d dire,  d'un  violet 
tres  dclairci;  d'ailleurs  ce  signe  ne  se  manifeste  point  dans  le  premier  instant,  on  ne  I'appecoit  ordinairement  que  deux  jours  ou  environ  apr6s  I’accident; 
il  est  quelquefois  plus  longtems  sans  se  rendre  sensible.  On  con<;(tit  ais6ment  que  I’on  ne  pent  attribuer  cette  6chimose  qu’d  I’infiltration  du  sang 
6panch§  ; la  partie  la  plus  fluide  de  cette  li(iuenr,  apres  avoir  p^nfetre  la  plevre  dans  le  point  le  plus  diclive  de  la  poitrine,  dchappe  sans  peine  aux 
digitations  que  ferment  les  attaches  du  diai)hragme.”  “ Ce  n'est  pas  sdulement  dans  les  epanchemens  de  sang  cpie  I’on  pent  observer  cette  espece  de 
suintement  de  I'humeur  contenue  dans  le  poitrine;  il  a figalement  lieu  lorsqn'il  se  fait,  dans  cette  cavitd,  un  amas  d'eau  et  de  pus.  Quoiqu'il  n'entre 
pi.int  dans  uion  plan  de  trailer  iei  des  signes  de  ces  deux  especes  d'eiiauchemens,  cette  seconde  v§rite  vient  si  natnrellement  a I'appui  de  celle  (ine  j’ai 
deja  etablie,  elle  est  d'ailleurs  si  importaute  par  elle-meme,  que  je  n'ai  pas  cm  devoir  la  passer  sous  silence.” — COMI'ILEU. 


Sect.  III.] 


THORACENTESIS. 


577 


Case  15. — Private  Ellis  Hulzizer,  Co.  G»  36th  Illinois  Volunteers,  aged  18  years,  was  wounded  at  Dallas,  Georgia,  May 
30tli,  1864.  The  missile  entered  the  left  side,  in  front,  passed  through  the  pectoralis  major  muscle,  near  its  tendinous  jjortion, 
fractured  a rib,  perforated  the  thorax,  and  emerged  behind,  having  perforated  the  scapula.  He  was  at  once  conveyed  to  the 
hospital  of  the  2d  division.  Fourth  Corps,  where  simple  dressings  were  applied.  On  August  1st,  he  was  admitted  to  Hosj)ital 
No.  19,  Nashville.  The  patient  was  irritable  and  prostrate,  and  suffered  from  fever,  diarrhoea,  and  much  emaciation.  On  August 
15th,  the  wounds  of  entrance  and  exit  were  open,  but  being  so  high  in  the  thorax  there  was  a large  amount  of  pus  constantly 
accumulating  in  the  pleural  cavity,  and  it  was  deemed  expedient  to  make  an  opening  at  a lower  point  to  allow  ready  drainage. 
The  lung  was  completely  collapsed,  and  the  discharge  very  offensive.  Acting  Assistant  Surgeon  Charles  S.  Merrill  performed 
paracentesis  thoracis,  the  opening  being  made  between  the  sixth  and  seventh  ribs.  A tube  was  introduced  and  retained,  the 
pleural  cavity  being  cleansed,  daily,  with  tepid  watei',  followed  by  a weak  solution  of  chlorinated  soda  for  its  stimulating  and 
disinfectant  qualities.  Generous  diet,  with  a liberal  allowance  of  tonics  and  stimulants,  was  given,  with  vegetable  astringents  and 
opiates  for  diarrhocal  discharges.  Death  resulted  on  November  2d,  1864,  from  exhaustion. 

The  three  following  of  the  series  of  nine  shot  perforations  of  tlie  chest  are  reported  as 
instances  of  partial  recovery  : 

Case  16. — Captain  Noah  Bowman,  Co.  D,  142d  Pennsylvania  Volunteers,  aged  28  years,  was  wounded  at  Petensburg, 
Virginia,  April  1st,  1865,  by  a conoidal  ball,  which  entered  one-fourth  of  an  inch  to  the  left  of  the  ensiform  cartilage,  passed 
beneath  the  ribs,  through  the  right  lung,  and  emerged  at  eighth  rib,  below  axillary  space.  Ilmmoptysis  followed,  which  lasted 
for  several  hours.  He  was  treated  in  the  field  hospital  of  the  Fifth  Corps  until  April  29th,  when  he  was  transferred  to  Armory 
Square  Hospital,  Washington.  When  admitted,  the  patient  suflered  greatly  from  dyspnoea  ; characteristic  sputa  of  pneumonia; 
lower  lobe  of  right  lung  collapsed;  considerable  febrile  movement ; great  emaciation.  May  6th  : Upon  a careful  examination,  the 
succussion  sound  was  distinctly  heard ; the  line  noting  the  height  at  which  the  fluid  stood,  while  the  patient  was  in  an 
upright  position,  was  about  two  inches  above  the  right  nipple.  As  both  wounds  were  closed,  an  incision,  of  a valvular  nature, 
was  made  near  the  wound  at  eighth  rib,  and  a No.  7 gum-elastic  catheter  introduced  about  four  inches  into  the  cavity,  pointing 
downward,  when,  by  means  of  a Davidson’s  syringe,  sixty-eight  ounces  of  pus  and  serum,  having  an  exceedingly  ofl'ensive 
odor,  was  withdrawn.  The  catheter  was  then  removed  and  the  integument  held  firmiy  over  the  opening  by  the  atmospheric 
pressure,  thereby  preventing  any  ingress  of  air  from  without.  Very  little  pain  attended  the  operation,  and  the  patient  expressed 
himself  as  feeling  greatly  relieved.  lie  improved  rapidly  in  health,  and,  on  May  2Gth,  left  for  his  home  with  good  use  of  right 
lung  and  in  an  apparent  condition  for  a complete  and  speedy  I'ecovery.  He  was  discharged  from  service  on  June  1st,  1885. 
Pension  Examiner  Henry  Brubaker  reports,  November  10th,  1865,  that  there  is  constant  and  free  discharge  of  pus  from  the 
opening  iii  the  right  side  of  the  chest.  The  right  lung  is  almost  completely  consolidated.  He  is  entirely  unable  to  leave  his 
room.  Greatly  emaciated  and  debilitated.  Still  on  the  Pension  List  in  1872, — no  improvement  reported.  . 

Case  17. — Sergeant  Hiram  H.  Terwilliger,  Co.  E,  80th  New  York  Volunteers,  aged  29  years,  was  wounded  at  Bull  Run, 
Virginia,  August  30th,  1832,  by  a minie  ball,  which  struck  just  below  the  calf,  on  the  inner  side  of  the  left  leg,  and  split  upon  the 
bone,  one  part  passing  through  and  issuing  near  its  point  of  entrance;  the  other  lodging  on  the  outer  side  of  the  leg.  This 
wound  bled  freely  and  occasioned  considerable  pain,  but  he  kept  his  place,  till,  as  he  thinks,  about  a half  hour  later,  when  he 
was  struck  again  by  a round  bullet  on  the  left  side ; the  missile  passed  directly  through  the  cavity  of  the  chest,  grazing  the  lungs 
and  liver,  aiul  emerged  between  the  seventh  and  eighth  ribs  on  the  right  side.  It  then  entered  the  right  arm  and  fractured  the 
humerus  into  the  elbow  joint,  where  it  lodged  ; the  spiral  nerve  was  injured.  - The  first  stunning  sensation  of  the  wound  having 
passed,  he  left  the  field  and  walked  a distance  of  about  two  miles,  when,  exhausted  by  loss  of  blood,  he  fainted.  He  was  con- 
veyed to  Alexandria,  and  admitted,  on  September  1st,  to  Fairfax  Street  Hospital.  On  admission,  he  was  insensible!.  Strong 
stimulants  were  administered.  Acting  Assistant  Surgeon  Robertson  removed  the  half  of  the  ball  which  had  loilged  in  the  leg ; 
it  was  found  flattened  and  ragged-edged.  The  case  progressed  favorably  for  about  eight  weeks,  when  the  wound  of  the  chest 
closed.  This  was  followed  by  diarrhoea  and  feverishness,  which  symptoms  passed  off  in  a few  days.  His  appetite  and  Hesh 
returned,  and  lie  was  discharged  from  service  on  January  14th,  1833.  Soon  after  his  arrival  home,  a cough  set  in,  followed  by 
severe  pain  in  left  side,  disturbed  sleep,  impaired  appetite,  laborious  breathing,  swollen  limbs,  night  sweats,  and  profuse  expecto- 
ration. These  symptoms  becoming  more  and  more  aggravated,  and  evidence  of  pus  in  pleural  cavity  being  well  defined,  the 
operation  of  thoracentesis  was  performed  by  Dr.  Smith  Ely,  of  Newburgh,  New  York,  on  April  28th.  A trocar  was  plunged 
into  the  cavity  of  the  chest,  just  below  the  left  shoulder  blade,  and  an  India-rubber  tube  inserted  in  the  opening,  the  ends  of 
which  were  left  hanging  down  about  four  inches,  the  one  within  and  the  other  on  the  outside  of  the  chest.  The  operation  was 
painful  in  the  extreme,  but,  weak  and  emaciated  as  he  was,  he  endured  it  without  flinching.  No  ancesthetic  could  be  administered, 
owing  to  his  feeble  condition.  Through  the  syphon  formed  by  the  tube,  there  was  discharged,  during  the  ensuing  ten  days, 
about  seven  quarts  of  matter.  At  the  end  of  that  time,  the  tube  was  removed  and  the  opeiung  immediately  closed.  The  heart, 
which  had  been  pushed  around  to  the  right  side,  resumed  its  natural  position,  and  the  lungs  their  proper  functions.  The  cough 
ceased,  swelling  disappetired  from  his  limbs,  and  his  health  gradually  improved,  until  about  September  1st,  when  he  removed  to 
Alexandria,  Virginia,  and  went  into  business.  I’ension  Examiner  R.  Loughran  reports,  October  IGth,  1871 : Adhesion  of  i)leura 
and  difficulty  in  expansion  of  chest  and  respiration.  Almost  constant  pain  in  track  of  ball.  Digestion  greatly  im()aired,  and 
general  debility  of  the  entire  system.  Partial  anchylosis  of  elbow-joint.  Tibia  injured  and  soft  j)arts  consolidated  ; partial  loss  of 
motion  of  foot.* 

Case  18. — Private  Keefe,  14th  Uiuted  States  Infantry,  aged  21  years,  while  running  the  guard  at  Fort  Trumbull,  Connecti- 
cut, received  three  gunshot  wounds,  the  missiles  being  buckshot.  Two  of  the  latter  entered  his  legs,  inflicting  mere  flesh  wounds, 
while  a third  struck  a rib,  one  inch  beneath  the  angle  of  the  left  scapula,  and  coursed  around  the  chest,  and  to  the  left,  tin:  length 

* This  case  was  reported,  at  great  lengtti,  in  tlie  Proecedings  of  the  Ellenville  (Ulster  County,  New  Y(jrli)  Historical  Society,  .July  8th,  ISlit,  and 
16  copiwl  in  the  Medical  and  Surgical  Reporter,  Philadelphia,  18ti5,  Vol.  XII,  p.  137. 


578 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


of  a probe ; its  subsequent  direction  and  position  being  doubtful.  Tito  shock  to  the  system  was  marked  and  resulted  in  much 
depression.  A slight  cough  commenced  on  the  following  morning,  with  bloody  expectoration,  both  of  which  continued  for  three 
days  and  then  ceased.  This,  in  connection  with  a slight  emphj’sematous  condition  of  the  cellular  membrane,  in  the  neighborhood 
of  the  external  wound,  indicated  a probable  injury  of  the  lung.  Auscultation  and  percussion  failed  for  some  time  in  announcing 
pathological  changes,  and,  with  the  exception  of  a severe  periodical  cough,  coming  on  every  evening  and  lasting  half  an  hour, 
there  was  nothing  to  cause  suspicion  of  the  approach  of  pleurisy,  respiration  being  natural  and  the  patient  able  to  lie,  fi-om  the 
first,  on  either  side  and  in  a horizontal  position.  Rest,  rigid  diet,  and  mild  antiphlogistics,  with  morphia  for  the  paroxysmal 
cough,  were  alt  the  medication  which  he  received  at  the  outset.  Though  his  countenance  did  not  recover  its  accustomed  hue 
and  healtlifulness,  yet  his  appetite  being  good  from  the  first,  and  there  being  no  cough  and  but  little,  if  any  dyspnoea,  he  was 
sent  to  quarters.  Subsequently,  physical  examination  detected  a gradual  effusion  into  the  left  cavity  of  the  chest,  which  increased 
ultimately  until  the  heart  pulsated  three  inches  to  the  right  of  the  median  lino  of  the  sternum.  So  gradual  was  its  occurrence,  that 
the  opposite  lung  had  been  akle  perfectly  to  adapt  itself  to  its  increased  and  supplemental  duties,  and  decubitis  on  either  side, 
with  the  head  low,  was  perfectly  easy  and  without  cough.  The  treatment  consisted  in  large  blister,  frequently  repeated,  the  use 
of  squills,  digitalis,  and  calomel,  and,  subsequently,  hydragogue  cathartics  and  iodide  of  potassium.  Owing  to  unsusceptibility  of 
the  system  to  the  actioti  of  mercury,  its  specific  effects  could  not  be  produced  by  careful  medication,  and  hence  probably  a ground 
of  failure.  Although  there  was  no  imperative  symptom  demanding  an  ojieration,  yet,  as  the  presence  of  effusion  was  so  cleai  ly 
indicated  by  stethoscope  and  other  symptoms,  it  was  thought  advisable  to  operate,  which  was  done  substantially  after  the  manner 
of  Wyman  and  Bowditch,  using  a small  exploring  trocar,  but  in  connection  with  the  stomach-pump  furnished  army  surgeons,  in 
])lace  of  the  more  complicated  instrument  invented  especially  for  this  purpose.  The  resistance  being  considerable  and  the  trocar 
delicate,  it  could  not  be  forced  in  rapidly  for  fear  of  breaking,  and  the  pleura  was  evidently  pressed  before  the  needle,  and, 
although  ultimately  punctured,  yet,  from  some  cause,  the  orifice  in  the  canula  became  closed  after  about  six  ounces  of  bloody 
serum  had  been  discharged.  The  relief  was,  however,  marked  and  permanent ; respiration  was  deeper,  vocal  fremitus  increased 
in  extent,  the  heart  in  some  measure  receded  to  its  accustomed  position,  and  the  patient  became,  in  all  respects,  improved.  Diur- 
etics and  hydragogue  cathartics  had  an  increased  power,  and  within  a fortnight  after  the  operation  there  were  some  two  m-  three 
j)ints  of  serous  matter  discharged  apparently  by  fistulous  opening  into  the  bronchi.  He  constantly  improved  in  health,  and  at 
his  own  suggestion  was  returned  to  garrison  duty.  In  June,  18G3,  this  man’s  chest  was  carefully  examined,  and  the  lower  half 
of  the  left  lung  found  dull  on  percussion,  no  vocal  fremitus,  and  the  heart  pulsating  a little  to  the  right  of  the  sternum;  Not  a 
pensioner.  Acting  Assistant  Surgeon  Isaac  G.  Porter,  the  operator,  reported  the  case.*  This  man  accompanied  a detachment 
of  his  regiment  to  Madison  Barracks,  whence  he  deserted  on  September  18th,  1863. 

In  the  four  following  cases,  hydrothorax  or  empyema  followed  the  lodgment  of 
missiles  in  the  chest,  and  tapping  was  employed  as  a palliative  measure ; the  first  three 
ended  fatally,  the  last  was  a partial  recovery; 

Case  19. — Corporal  J.  Kelly,  Co.  B,  Gth  Wisconsin  Volunteers,  was  wounded  at  the  battle  of  Gettysburg,  Pennsylvania, 
July  3d,  1863,  by  a musket  ball,  which  entered  the  chest  and  lodged.  He  was  treated  at  the  hospital  of  the  first  division.  First 
Cori)s.  Paracentesis  thoracis  was  performed  by  Surgeon  A.  W.  Preston,  Gth  Wisconsin  Volunteers,  fifteen  days  after  the  recep- 
tion of  the  injury.  Death  followed  on  the  21st  day  of  July,  1863. 

Case  20. — Private  Philip  Carpenter,  Co.  I,  4th  Michigan  Volunteers,  aged  22  years,  received  a penetrating  wound  of  the 
chest  at  Cold  Harbor,  Virginia,  June  3d,  1884.  A conoidal  ball  entered  four  inches  below  the  outer  third  of  the  left  clavicle, 
over  the  third  rib.  He  was  taken  to  the  hospital  of  the  1st  division.  Fifth  Corps.  There  he  remained  until  the  12th,  when  he 
was  transferred  to  Douglas  Hospital,  Washington.  On  admission,  there  was  a large  effusion  into  the  left  thoracic  cavity,  extreme 
debility,  and  dyspnoea.  Assistant  Surgeon  William  Thomson,  U.  S.  A.,  performed  paracentesis  thoracis;  seventy-two  ounces  of 
bloody  serum  were  evacuated.  The  canula  was  allowed  to  remain,  and  during  the  night  there  was  a free  discharge.  He  spat 
dark  blood  at  first,  then  pneumonic  rusty  sputa.  Death  resulted  June  22d,  1864,  from  traumatic  pleuro  pneumonia.  At  the 
necropsy,  the  lungs  were  found  to  be  hepatized.  There  were  fifty  ounces  of  fluid  in  the  thoracic  cavity.  Evidences  of  pericarditis 
were  also  found. 

Case  21. — Private  Thomas  Kinney,  Co.  A,  17th  United  States  Infantry,  aged  36  years,  was  wounded  at  Petersburg, 
Virginia,  September  30th,  1864,  by  a ball  which  entered  under  the  inner  third  of  the  clavicle,  one  inch  from  the  margin  of  the 
sternum,  fractured  the  second  rib,  and  lodged  in  the  right  lung.  He  was  conveyed  to  the  hospital  of  the  Fifth  Corps,  and  on 
October  7th  was  transferred  to  Harewood  Hospital,  Washington.  When  admitted,  his  constitutional  condition  was  good.  On 
October  11th,  hoemothorax  was  diagnosed.  The  right  lung  was  compressed,  there  was  dullness  on  percussion,  an  absence  of 
the  respiratory  murmur,  and  dyspnoea.  Surgeon  R.  B.  Bontecou,  U.  S.  V.,  administered  ether  and  performed  paracentesis 
thoracis  on  the  right  side,  between  the  sixth  and  seventh  ribs,  in  the  linea  axillaris ; five  quarts  of  blood  and  serum  were 
removed.  The  patient  felt  much  relief  after  the  operation,  respiration  becoming  easy  and  audible  through  the  whole  of  the  right 
lung,  except  in  the  inferior  part  of  the  third  lobe.  The  wound  was  covered  with  oil-silk  to  prevent  the  admission  of  air,  and  a 
DoveFs  powder  was  given  eveiy  three  hours.  The  case  progressed  as  follows  ; October  12th,  pulse  120.  October  13th,  feels 
pretty  well ; pulse  90 ; respiration  audible  as  before.  The  wound  discharged  a bloody  serous  fluid.  At  6 p.  m.,  re.spiration 
was  difficult,  and  percussion  in  the  lower  parts  dull ; respiration  was  not  audible  on  the  posterior  side.  The  finger  was  introduced 
into  the  opening  and  a large  amount  of  bloody  serum  discharged ; the  patient  felt  somewhat  relieved.  October  14th,  weak ; 
pulse  110;  discharges  free  and  of  a putrid  smell ; crepitation.  Percussion  dull  in  lower  part  of  left  lung;  respiration  normal. 
Treatment,  supporting;  Dover’s  powder  of  ten  grains  every  three  hours.  The  patient  continued  to  sink,  and  died  October  20th, 

*POUTEI!,  I.  G. — Cases,  in  Jour,  of  the  Med.  Sciences,  N.  S.  Vol.  XI, VII,  p.  13.5. 


Sect.  III.] 


TIIOEAOENTESIS. 


579 


18G4,  from  exhaustion.  At  the  autopsy,  ten  hours  afterward,  both  auricles,  and  the  riglit  ventricle  of  the  heart,  were  found  to  he 
filled  with  fibrinous  coagula.  The  pericardium  contained  a small  quantity  of  scrum.  The  right  lung  was  collapsed  and  hepatized  ; 
the  bronchi  and  their  ramifications  were  filled  with  matter.  The  ball  entered  the  inner  margin  of  the  middle  lobe  of  the  right 
lung  and  emerged  on  the  exterior  surface  of  the  third  lobe,  slightly  fractured  the  eighth  rib,  and  was  found  lying  on  the  diaphragm. 
The  pleurae  were  covered  with  lymph,  and  a spicula  of  the  second  rib  was  found.  There  were  a few  small  tubercles  at  the  apex 
of  the  left  lung. 

Case  22. — Private  D , 40th  Illinois  Volunteers.  Gunshot  wound ; ball  entered  right  thorax  ; extensive  emphysema 

followed.  Paracentesis-thoracis  performed.  The  patient  recovered  sufficiently  to  be  discharged  from  hospital.  The  case  is 
reported  by  Surgeon  E.  Andrews,  1st  Illinois  Light  Artillery. 

In  two  cases,  in  which  paracentesis  of  the  thorax  was  unavailingly  performed, 
traumatic  pleurisy,  with  effusion,  followed  gunshot  wounds  of  the  chest  that  apparently  did 
not  penetrate  the  pleural  cavity: 

Case  23. — Sergeant  J.  B.  E , Co.  D,  30th  North  Carolina  Eegiment,  aged  19  years,  was  wounded  at  Kelly’s  Ford, 

Virginia,  November  7th,  1863.  The  ball  entered  fo\ir  inches  to  the  right  of  the  spinous  processes,  between  the  tenth  and  eleventh 
ribs,  and  emerged  between  the  eighth  and  ninth  ribs,  in  a line  with  the  middle  of  the  axilla.  The  eighth  and  ninth  ribs  were 
fractured  near  the  wound  of  exit.  The  track  of  the  ball  was  five  inches  long.  He  was  taken  prisoner  and  conveyed  to  Wash- 
ington, entering  Douglas  Hospital  on  the  9th.  The  wound  was  considered  a non-penetrating  one,  although  the  jjatient  stated 
that  he  had  coughed  some  florid,  frothy  blood,  and  had  suffered  from  dyspnoea.  His  expectoration  was  slightly  tinged  with  blood 
for  several  days  after  his  admission.  The  wound  discharged  freely,  and  became  very  tender  on  pressure.  A harassing  cough  and 
increasing  dyspnoea  indicated  the  presence  of  traumatic  pleuritis.  The  treatment  comprised  diuretics,  expectorants,  with  sedatives 
to  procure  sleep,  tonics  and  nutrients,  with  stimulants,  and  iodine  locally,  in  form  of  tincture,  over  the  chest,  as  a counter-irritant. 
Acting  Assistant  Surgeon  Carlos  Carvallo,  who  reports  the  case,  says:  “At  four  and  a half  o’clock  a.  m.  of  December  8th,  he 
awoke  suddenly  from  a dream,  very  much  frightened,  coughed  very  hard,  and  expectorated  freely  an  enormous  quantity  of 
remai'kably  thin,  mucous,  very  frothy  phlegm.  At  nine  o’clock  A.  M.,  I found  him  exceedingly  collapsed,  though  feeling  himself, 
subjectively,  very  well — he  thought  he  was  strong.  On  examining  his  chest,  I found  a great  deal  of  effusion  in  right  chest, 
whizzing  in  the  bronchial  tubes,  and  some  dyspnoea.  After  considtation,  paracentesis  thoracis  was  decided  uj)on,  and  Assistant 
Surgeon  William  Thomson,  IT.  S.  A.,  introduced  a trocar  into  the  posterior  lateral  angle  of  the  right  chest,  between  the  tenth  and 
eleventh  ribs,  which  was  followed  immediately  by  the  exit  of  thirty-eight  fluid  ounces  of  pus.  The  operation  was  unaccompanied 
by  pain  and  produced  almost  instantaneous  relief  from  the  dyspnoea.  The  whizzing  also  diminished  to  a great  degree.  Stimulants 
were  freely  administered.  In  the  afternoon,  the  patient  appeared  to  be  in  a moribund  state,  but  toward  night  he  rallied  considerably 
and  felt  comparatively  comfortable.  He  passed  a restless  night,  though  he  breathed  easier  than  before  the  operation.  At  seven 
and  a half  A.  M.,  he  said  he  felt  strong  and  hopeful,  but  he  died  at  quarter  to  ten  o’clock  A.  M.,  December  9th,  1863.”  Necropsy: 
Several  patches  of  ecchymosis  in  the  intercostal  muscles,  between  the  ninth  and  tenth  and  eleventh  and  twelfth  ribs.  Eight  lung 
collapsed  and  shrunk  up,  and  adherent  to  costal  parietes  of  pleura.  Left  luug  congested — otherwise  normal.  No  signs  of 
pneumonia.  The  pleural  leaf  which  covered  the  internal  surface  of  the  right  chest  was  exceedingly  thickened  and  presented  the 
appearance  of  leather.  The  pathological  specimen,  showing  the  anterior  portion  of  the  eighth  rib  on  the  right  side  fractured, 
with  splintering  of  the  internal  surface,  is  No.  1901  of  the  Surgical  Section,  Army  Medical  Museum.  A moderate  osseous  deposit 
has  occurred.  It  was  contributed  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A. 

Case  24. — Corporal  Israel  Spotts,  Co.  G,  200th  Pennsylvania  Volunteers,  aged  24  years,  received  a gunshot  non-penetra- 
ving  wound  of  the  chest  at  Petersburg,  Virginia,  March  2f  th,  1865.  He  was  conveyed  to  the  hospital  of  the  Ninth  Corps,  where 
haunoptysis  and  dyspnoea  supervened.  On  April  Cth,  he  was  transferred  to  Harew’ood  Hospital,  Washington.  Surgeon  E.  B. 
Bontecou,  U.  S.  V.,  reports  that  the  ball  entered  the  back  in  the  dorsal  region,  about  two  inches  below  the  spine  of  the  scapula, 
and  buried  itself  in  the  ti-apezius  muscle,  whence  it  was  extracted.  On  admission,  the  condition  of  the  injured  parts  and  consti- 
tutional state  of  the  patient  were  good.  He  did  very  well  for  a while,  the  wound  healing  kindly  ; but  toward  the  early  part  of 
the  mouth  of  May,  the  chest  became  enormously  distended  with  effusion.  There  was  a harassing  cough,  anxiety  of  countenance, 
oppressed  breathing,  and  symptoms  of  empyema.  An  operation  being  necessary  to  relieve  the  patient,  paracentesis  thoracis  was 
performed  by  Surgeon  Bontecou,  on  May  9th,  by  freely  opening  the  chest  at  the  right  posterior  and  lateral  aspect,  between  the 
eighth  and  ninth  ribs.  About  six  pints  of  sanious  pus  were  removed;  no  anmsthetic  was  used.  The  patient  felt  at  once  relieved 
and  did  remarkably  well  after  the  operation.  The  treatment  consisted  of  simple  dressings,  anodynes,  and  supporting  throughout. 
He  was  furloughed  and  sent  to  his  home  at  Hammondstown,  Pennsylvania.  Dr.  Stichley,  attending  physician,  states : “Saw 
soldier  after  he  reached  home;  found  him  suffering  from  empyema.  After  he  was  home  a few  days  an  operation  was  performed 
on  him,  removing  two  or  three  quarts  of  pus  from  his  chest.  Operation  had  to  be  performed  every  two  or  three  weeks.  The 
bullet  was  still  in  the  lung.  He  lived  in  this  condition  for  about  two  months.  Death  resulted  September  20th,  1865,  from  exhaustion 
produced  by  suppuration.” 

On  page  449,  a complicated  case  of  tapping  for  empyema  is  recorded;  another  case, 
attended  by  pneumothorax  and  empyema  and  treated  by  free  incision  into  the  thorax 
posteriorly  is  noted  on  page  493 ; an  instance  in  which  the  diaphragm  and  liver  were 
perforated  in  tapping  is  reported  on  page  504;  and  a case  in  wliich  fluid,  tinged  witli  bile, 
was  removed  from  the  pleural  cavity  by  paracentesis  is  referred  to  on  page  513.  Adding 


580 


WOUNDS  AND  INJUKIES  OF  THE  CHEST. 


[Chap.  V, 


these  to  the  twenty-four  foregoing  abstracts,  a total  of  twenty-eight  cases  of  thoracentesis 
is  presented,  with  nine  recoveries.  Abstracting  eight  cases  of  effusion  from  idiopathic 
pleurisy,  there  remain  twenty  instances  of  tapping  for  effusions  in  the  chest  following 
injuries,  with  only  four  recoveries,  a death  rate  of  80  per  cent.,  indicating  that  the  ordinary 
mortality  of  penetrating  gunshot  wounds  of  the  chest  is  not  materially  affected  by  the 
operation.  The  side  on  which  paracentesis  was  performed  is  indicated  in  twenty-five  of 
the  twenty-eight  cases,  and  was  on  the  right  in  fourteen,  and  on  the  left  in  eleven  cases. 
Whether  any  significance  should  be  attached  to  the  fact  that  in  twelve  of  the  seventeen 
determined  fatal  cases  the  operation  was  performed  on  the  right  side,  the  figures  are  too  few 
to  decide. 

Drainage  Tubes.^' — In  some  of  the  cases  of  empyema,  discharge  from  the  pleural  cavity 
was  facilitated  by  the  employment  of  drainage  tubes,  with  the  instruments  and  method  so 
much  insisted  on  by  M.  Chassaignac,  or  by  using  an  ordinary  gum  catheter  as  a syphon. 
An  ingenious  plan  of  keeping  apart  the  lips  of  sinuses,  which  it  was  desirable  to  have 
pervious,  was  in  common  use  at  Armory  Square  Hospital,  and  was  devised,  I believe,  by 
that  excellent  surgeon.  Dr.  G.  K.  Smith,  of  Brooklyn.  It  consisted  simply  of  a bent  watch- 
spring,  of  the  form  indicated  in  the  wood-cut  (Fig.  275),  with  sufficient 
elasticity  to  separate  the  walls  of  long  fistulous  tracks  in  the  soft 
parts.  In  suppuration  in  the  thick  muscles  of  the  thigh  or  calf  in 
compound  fractures,  this  simple  expedient  was  found  far  preferable  to 
any  form  of  tent  or  drainage  tube,  and  it  could  be  used  advantageously 
in  sinuses  on  the  anterior  aspect  of  the  chest  and  abdomen.  The 
utility,  in  cases  of  thoracic  fistulae  of  keeping  the  pleural  cavity  as  far 
as  possible,  free  from  decomposing  fluids,  was  universally  acknowledged. 
The  following  is  a case  in  which  a tube  was  inserted  daily.  Frequently 
they  were  left  in  place  permanently: 

Case. — Private  Gotlieb  Blesserij,  Co.  G,  SOth  Ohio  Volunteers,  aged  20  years,  was 
wounded  at  Mission  Eidge,  Tennessee,  November  25th,  1863,  by  a musket  ball,  which  entered 
just  below  the  left  clavicle  and  passed  out  posteriorly,  fracturing  the  inferior  angle  of  the  scapula. 

He  was  taken  to  the  hospital  of  the  3d  division.  Fifteenth  Corps,  where  he  was  treated  until 

December  22d,  when  he  was  transferred  to  the  general  hospital  at  Chattanooga.  At  the  time 

Fig.  275.— Watch-spring  dila-  of  admission  he  was  breathing  rapidly  and  with  great  difficulty.  On  a physical  examination 
tor  for  sinuses.  ,S/>cc.  2455. 

of  the  chest,  found  the  diaphragm  forced  down  and  bulging  of  the  left  intercostal  spaces;  the 
heart  to  the  right  side  of  the  sternum  and  general  dulness  over  the  left  side  of  the  thorax. 
Change  of  position  had  no  influence  over  the  sounds  elicited  by  percussion ; no  respiratory  murmur  could  be  discovered  on 

the  left  side ; that  of  the  right  was  increased  and  sibilant.  The  pul.se  was  frequent  and  weak.  Appetite  poor.  Wounds  of 

entrance  and  exit  discharging  small  quantities  of  reddish  pus.  On  the  second  day  after  his  admission  a small  tube  was  passed 
through  the  iiosterior  wound  into  the  pleural  cavity  and  about  twelve  ounces  of  pus  drawn  off.  After  this  the  tube  was  inserted 
daily,  and  largo  qu.antities  of  thin  foetid  pus  withdrawn.  After  the  fluids  were  removed,  tlie  left  side  of  the  thorax  became  much 
contracted  and  the  heart  resumed  its  normal  position.  Tonics,  stimulants,  and  anodynes  were  administei'ed.  The  patient 
gradually  sank,  and  died  ou  January  11th,  1864,  from  exhaustion.  Necropsy:  Fifth,  sixth,  seventh,  and  eighth  ribs  fractured. 
Fragments  of  bone  protruding  in  thoracic  cavity.  No  attempt  at  repair.  Base  of  heart  opposite  upper  border  of  third  rib ; 
apex  opposite  intercostal  space  of  fifth  and  sixth  ribs,  two  inches  from  median  line.  Pericardium  thickened  and  containing  one 
ounce  of  straw-colored  serum.  Left  lung  compressed  against  spinal  column,  and  occupying  a space  five  inches  in  length  and  one 
and  a half  in  width.  The  remainder  of  the  thoracic  cavity  was  occupied  by  an  abscess  emptied  of  its  pus  but  containing  twelve 
ounces  of  bloody  serum. 

* See  M.  IIOLON,  Du  traitement  de  Vempyime  purulent  par  le  drainage  chirurgicalc,  187G,  These  de  Paris,  141.  This  author  has  collected  many 
favorable  cases  from  the  practice  of  M.  Chassaignac,  and  Drs.  Goodfellow,  Banks,  Fincham,  and  other  English  practitioners.  See  also  M.  Chassaignac, 
Traiti  pratique  de  la  Suppuration  et  du  Drainage  chirurgicale,  Paris,  1859,  T.  II,  p.  34C ; also  Drs.  FULLEK,  H.  W.,  POWELL,  D.,  and  PLAYFAIR,  in 
British  Medical  Journal,  1872,  February  17th,  p.  183,  and  March  3Cth,  p.  339,  and  Dr.  Powell,  in  Clinical  Soc.  Transactions,  Vol.  HI,  p.  244  ; Dr. 
Maclagan  {Brit.  Med.  Jour.,  July  2Cth,  1872,  p.  63).  Mr.  DeMougan  {Med.  Chir.  Trans.,  1859,  Vol.  XIJI,  p.  231)  speaks  favorably  of  the  results  of 
drainage  in  empyema  at  the  Middlesex  Hospital.  Surgeon  D.  1’.  Smith,  U.  S.  V.,  advocated  the  treatment  at  the  beginning  of  the  war  {Am.  Med.  Times, 
•July  6th,  1861,  p.  13),  but  has  not  recorded  any  observations,  that  I can  find,  of  later  experience. 


Sect.  III.] 


THORACENTESIS. 


581 


Jncisiom,  Injections. — Rurgeons  Bontccou/  Ilainilton,®  IToward/'  Ellis/  and  otlioi’s, 
advised  or  had  recourse  to  free  incisions  into  the  jdenral  cavity  in  some  cases  of  traumatic 
empyema,  especially  those  complicated  by  the  presence  of  foreign  bodies  or  of  coagula  of 
blood.  Personally,  I am  convinced  that  this  is,  under  certain  restrictions,  sound  practice; 
but  I am  unable  to  adduce  any  instances  that  testify,  in  a striking  manner,  to  its  efficacy. 
The  cases  that  came  under  my  observation  were  benefitted,  I believe,  by  this  interference; 
but  they  were  not  cured;  and  nearly  all  of  those  referred  to  by  writers  on  this  particular 
point  were  of  such  a character  as  to  admit  only  of  palliative  measures."'^ 

The  utility  of  injecting  stimulating  fluids  into  the  pleural  cavity  after  jun’ulent 
effusions  had  been  evacuated  and  a permanent  drain  established,  was  advocated,  but  not 
acknowledged.  The  advantages  of  M.  Boinet’s  method”  were  not  realized.  Surgeon  F. 
H.  Hamilton^  advised,  in  cases  complicated  by  the  presence  of  foreign  bodies  in  the  cavity’ 
of  the  chest,  thorough  syringing,  “with  such  disinfectants  as  carbolic  acid,  chloride  of 
soda,  or  bromine;”  but  no  evidence  of  their  efficacy  is  produced.  Tepid  detergent  injec- 
tions, to  wash  away  foul  discharges,  and  occasionally  bits  of  clothing  or  of  exfoliated  bone, 
and  warm  milk  and  water,  as  recommended  by  Guthrie  [Comm.  1.  c.,  p.  429),  was  found  as 
unirritating  and  useful  as  anything.  The  advantage  of  the  suggestion  of  this  admirable 
teacher  to  have  the  opening,  in  these  cases,  as  low  as  possible,  was  appreciated;  though 
most  surgeons  did  not  venture  on  the  eleventh  intercostal  space  behind,  as  advised  by  him, 
the  tenth  intercostal  space  being  considered  as  low  a point  as  was  consistent  with  the  safety 
of  the  diaphragm. 

The  point  of  election  for  the  first  puncture,  though  in  a measure  determined  by  the 
seat  of  injury  and  the  nature  of  the  effusion,  appears  to  have  been  the  seventh  intercostal 
space,  one-third  of  the  distance  from  the  spinous  processes  of  the  vertebra  to  the  median 
line  of  the  sternum.  This  point  was  selected  in  nine  of  seventeen  cases  in  which  this 
particular  is  noted.  In  five,  the  puncture  was  made  between  the  eighth  and  ninth  ribs, 
and  once  in  the  fourth,  once  in  the  fifth,  and  once  in  the  tenth  intercostal  space.  The 
ordinary  trocar,  finnished  in  the  field  operating  cases,  was  usually  employed;  but,  in  a 
few  instances,  the  methods  and  apparatus  recommended  by  Drs.  Wyman  and  Bowditch,® 
and  by  Dr.  Flint  were  employed.” 

*Dr.  BONTECOU,  ante,  p.  493;  ^iiAiilLTON,  rrin.  and  Tract,  of  Sure/.,  p.  70:2;  ^Howakd  {/.  c.),  (i\T  3'.  Med.  Jour.,  Vol.  XIV.,  p.  511). 

®HirPOCiiATES,  according  to  Haller,  sanctions  paracentesis  of  the  chest  in  einpj’ema,  by  boring  through  a rib,  in  the  treatise  nepi  twv  cvtos  naOoiu. 
Leonides  taught  that  the  thorax  might  be  opened  between  the  fifth  and  sixth  ribs  to  remove  pus,  though  he,  or  I’aul  <jf  .^gina,  adds  that  tliis  will  not 
avoid  the  fatal  result.  LUSITANUS  (Curat.  Medic.  Ceni.,  Florence,  1551  ; Cent.  II,  and  Cent.  Ill)  cites  two  fatal  and  one  successful  example  of  this 
operation  in  empyema.  SsiETius  (Mis.  Med.  Lib,  XII.  Fraucof.  IGll)  gives  an  instance  of  successful  paracentesis  for  the  evacuation  of  putrid  pus  in  a 
case  of  wound  of  the  chest.  Chiflet  (Singulares  tarn  ex  curat,  quam  ex  cadav.  sect.  Obs.,  Paris,  ICll)  advises  thoracentesis  in  empyema.  llEEUS 
(Obs.  Medicse,  Leodii,  1622)  taught  that  the  thorax  should  be  perforated  between  the  fifth  and  sixth  ribs,  not  between  the  fourth  and  fifth,  for  fear  of 
wounding  the  diaphragm.  Bautholinus  (in  libello  de  jpulmonibus,  Hafniie,  IGGO)  dwelt  upon  the  danger  of  admitting  air  into  the  pleural  cavity,  and 
suggested  expedients  for  avoiding  it  in  paracentesis.  IM.  G.  PtJU>LA.NN,  a militarj’  surgeon  of  Breslau,  whom  Percy  accredits  ns  the  first  to  practice 
thoracentesis,  advocates  the  operation  in  his  Chirurgischer  Lorherkranz,  Oder  grosse  Wundartzneg  (Halberstadt,  1U85,  Frankfort,  1692,  Breslau  aiul 
Lcipsig,  1705),  and,  in  the  last  edition,  cites  a successful  case  of  thoracentesis,  for  traumatic  effusion  of  blood  and  pus.  After  him  Aliunus,  Veuduc, 
BnUNNEK,  Petit,  and  Valismeui,  refer  to  paracentesis  in  empyema,  with  approbation.  On  the  applications  of  the  oixTution  in  military  surgery,  some- 
thing may  be  found  in  Ravaton  (TVaiTc  des  Playes  des  Armes  a Feu,VQ.ns,\loO)‘,  Gauengeot  (TraiU  dcs  Op.  Paris,  1748);  llEiSTEil  (Instit.  Chir., 
Amsterdam,  (1739),  and  in  PEltCV  (loc.  cit.)-,  in  Laeuey  (Mem.  de  chir.  mil..  Paris,  1812,  T.  Ill,  p.  442) ; in  IIennen  (Mil.  Surg.,  3d  cd.,  1829,  p.  382);  and 
in  GutiihiE  (Comm.  p.  424). 

®M.  Boinet,  Traitement  des  epanchements  pleuretiques  imrulents  par  les  Injections  en  general  et  Ics  Injections  iod6es  en  particuliev,  in  Arch.  g6n. 
dc  Med.,  1853,  5e  S.^  T.  I,  pp.  277,  521.  ’Hamilton,  F.  H.,  The  Prineijiles  and  Practice  of  Surgery,  1872,  p.  112. 

®Bowditch,  H.  I.,  On  Pleuritic  Ejfusions  and  the  Neces.%ity  of  Paracentesis  for  their  liemoval.  Am.  Jour,  of  the  Med.  Sci.j  Vol.  XXIII,  p.  320. 

®RUST  (Theoretisch-praktisches  Uandbuch  der  Chirurgie,  Berlin,  1834,  p.  57)  advises  to  incise  midway  between  the  sternum  and  spine,  at  the  upper 
margin  of  the  last  rib,  to  avoid  the  main  branch  of  the  intercostal  artery,  but  unless  the  operator  is  well  satisfi<*d  that  the  diaphragm  is  miu’h  dcpresse<l, 
it  is  undoubtedly  imprudent  to  puncture  below  the  sixth  intercostal  space  anteriorly  or  at  tlursidc,  and  below  the  tenth  pi-stcriorl}'.  Dr.  Rust  gives  the 
following  list  for  the  points  of  puncture  selected  by  different  operators:  ninth  intercostal  left  and  eighth  on  right  side,  Hippocrates,  Vcsallus,  'I’ulpius, 
Plattner,  Ollenroth,  Lc Blanc,  Pclletan,  Sabatier,  Richcrand,  Larrcy;  fifth,  Paulus  iEgineta,  Fabrieius  Aiiuapcndentc,  Dionia,  Barbette;  eighth  inter- 
<K)Stal,  the  width  of  four  fingers  below  the  scapula,  fivp  or  six  inches  from  the  spine,  Garengcot,  Lc  Dran,  Nuck,  v.  Walther ; sixth  intercostal,  Sc  jltctus, 
Sharp,  Brumfield,  Gooch,  B.  Bell;  fourth,  Par6,  Severin,  (Jamper,  v.  Ammon;  tcntli,  Lusitanus,  Heister,  Desault,  Chopart;  Langpnbepk  advises  the 
width  of  fimr  fingers  from  tl»c  proees.sp.s  of  the  spine  and  the  same  distance  lielow  the  scapula. 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


.532 


Balls  and  Foreign  Bodies  Lodged. — It  has  already  been  shown  by  many  examples 
that  the  lodgment  of  projectiles  or  other  foreign  bodies  within  the  chest  does  not  necessarily 
involve  a fatal  result.  Aft5r  provoking  serious  .inflammatory  accidents  or  haemorrhages,  the 
presence  of  such  extraneous  substances  comes  to  be  tolerated,  and  they  remain  in  the  substance 
of  the  lung,  invested,  according  to  Ballingall  and  others,  in  an  adventitious  cyst  or  capsule, 
or  lie  loosely  in  the  pleural  cavity,  or  roll  about  upon  the  diaphragm,  or  are  imbedded 
harmlessly  in  the  muscular  tissue  of  the  thoracic  parieties.  More  commonly,  they  give  rise  to 
purulent  formations  and  hectic  fever ; but  even  under  these  circumstances  life  is  occasionally 
preserved  by  extraction  of  the  foreign  body,  or  by  its  spontaneous  expulsion,  either  through 
the  bronchial  tubes  or  through  fistulse  in  the  walls  of  the  chest.  Some  of  the  more  remarkable 
illustrations  reported  during  the  war  may  be  grouped  here. 

Cask  1. — Priv’ate  James  Apple,  Co.  I,  42d  Ohio  Volunteers,  was  wounded  at  Vicksburg,  Missis.sippi,  May  20th,  1863,  the 
ball  struck  the  top  button  of  his  blou.S((,  which  it  carried  with  it;  entered  the  right  lung  two  inches  below  the  clavicle,  close  to 
the  sternum,  ranged  obliiptely  downward,  and  lodged  behind  and  a little  below  the  axilla.  Surgeon  J.  C.  Kolb,  42d  Ohio 
Volunteers,  examined  the  wound  and  removed  the  ball  and  button  ; the  button  was  found  to  have  been  split  into  four  pieces;  a 
piece  of  blouse  about  two  inches  square  adhered  to  one  of  the  fragments.  The  patient  was  taken  to  the  hospital  of  the  Thirteenth 
Coiqis,  where  he  remained  until  June  4th,  when  he  was  transferred,  per  hospital  steamer  R.  C.  Wood,  to  Memphis,  entering  the 
Union  Hospital  on  the  8th.  On  July  Ifth,  1863,  he  was  transferred  to  Convalescent  Camp;  he 
was  finally  discharged  from  service  on  December  2d,  1864.  Pension  Examiner  R.  Wirth,  reports 
that  there  is  consolidation  of  the  upp(  r lobe  of  the  right  lung,  causing  difficulty  of  breathing; 
shoulder  joint  partially  anchylosed.  Pension  Examiner  Albei  t Wilson  reports,  September  20th, 
1867,  that  the  pensioner  has  recovered  all  the  functions  of  the  parts  involved.  Disability  none. 
Under  date  of  May  15th,  1871,  Pension  Examiner  J.  H.  Maxwell  reports  that  there  is  considerable 
dulness  on  percussion,  and  some  difficulty  of  breathing.  Disability  two-thirds  and  indefinite. 
The  wood-cut  (I'To.  276)  shows  the  missile,  a conoidal  ball,  and  two  of  the  fragments  of  the 
brass  button,  which  were  contributed  by  Mi'.  W^.  D.  MeJilton. 

Cask  2. — Private  Christopher  Holmes,  Co.  H,  7th  Connecticut  Volunteers,  aged  25  years,  was  wounded  at  Fort  Fisher, 
North  Carolina,  January  15th,  1885,  by  a conoidal  ball,  which  intcred  one  and  a half  inches  below  the  middle  of  the  right 
clavicle,  jiassed  through  the  superior  border  of  the  right  lung,  and  emerged  at  posterior  axillary  border.  Ho  was  carried  to  tlie 
liehl  hospital  where  simple  dressings  were  applied  to  the  wound.  On  January  20th,  he  was  put  on  board  the  Hospital  Steamer 
Spaulding  and  conveyed  to  New  York,  entering  McDougall  Hospital  on  the  25th.  He  was  discharged  from  service  on  May  4th, 
1865.  Pension  Examiner  R.  M.  C.  Lord  reports,  on  September  22d,  1836,  that  Holmes  is  a pensioner,  his 
disability  being  rated  three-fourths  and  probably  permanent.  In  a letter  to  this  Office,  dated  New  Loudon, 
Connecticut,  January  ICth,  1872,  Dr.  A.  W.  Nelson  reports:  “ ‘ Blood  came  out  of  his  mouth.’  The  b.all 
carried  in  his  coat  button.  The  eye  and  inner  part  were  removed— the  outer  thin  shell  was  too  deep  for 
safe  extraction.  He  made  a good  recovery  ; now  has  fair  health  and  good  weight.  The  right  lung  is  a 
little  sensitive  to  dust.  etc.  Has  never  had  a sinus  or  any  troublesome  symptom  from  his  wound  or  the 
button.  Last  September  it  had  approached  the  surface.  For  six  weeks  it  has  given  him  some  pain,  and 
yesterday  I removed  it  by  iiu  incision  through  the  skin  and  areola  tissue  one  and  a half  inches  above 
the  nipple.  Holmes  carried  this  fragment  for  seven  years  without  suppuration.  From  its  appearance  and 
the  tenderness  of  the  surface,  I doubt  not,  in  a few  weeks  or  months,  the  piece  had  come  out  without 
surgical  aid.  This  little  body  seemed  to  be  encysted.”  It  was  contributed  to  the  Army  Medical  Museum  by 
the  operator,  and  is  represented  in  the  adjacent  wood-cut  (Fig.  277). 

Ca.sr  3. — First  Liu'.itenant  William  P.  Wright,  1st  New  York  ludejiendent  Battery,  aged  28  years,  was  wounded  at 
Gettysburg,  Pennsylvania,  July  3d,  1863,  by  a conoidal  ball,  which  entered  the  thorax  two  and  a half  inches  from  the  nipjde  of 
riglit  side,  on  a line  between  it  and  the  acromion  i)rocess,  and  emerged  five  inches  from  the  spine,  two  inches  from  the  inferior 
angle  of  the  scai)ula,  in  a line  with  the  apex  of  the  shoulder.  He  was  received  into  the  Si.xth  Army  Corps  hos))ital  soon  after 
he  was  wounded.  There  was  considerable  haamorrhage,  resulting  in  an  unusual  amount  of  prostration,  especially  after  the 
r<‘moval  of  pieces  of  clothing,  of  which  there  were  several ; he  was  placed  in  a recumbent  position,  opium  and  cold  drinks  admin- 
istered, and  the  wounds  dressed.  On  August  5th,  he  was  admitted  to  Camp  Letterman  Hospital,  Gettysburg,  where  he  remained 
under  treatment  until  end  of  August,  when,  having  sufficiently  recovered,  he  was  allowed  to  go  to  his  home.  At  this  time  he 
was  able  to  walk  some  distai  ce  without  difficulty.  Several  pieces  of  bone  were  discharged  from  the  posterior  opening  during 
the  next  six  weeks,  when  it  he.aled ; the  anterior  wound  continued  to  discharge  two  or  three  weeks  longer,  bringing  away  small 
])ieces  of  clothing  and  some  horse  hairs  from  the  stiffening  of  his  coat.  He  was  able  to  walk  at  this  time  with  little  fatigue;  but 
for  several  months  could  not  sleep  in  a horizontal  position.  He  was  finally  discharged  the  service  June  Gth,  1864.  March  14th, 
1836,  he  was  perfectly  well,  and  could  bear  gymnastic  exercise.  The  right  chest  is  one-half  inch  less  in  circumference  than  the 
left.  Tlie  case  is  reported  by  Surgeon  L.  \V.  Oakley,  2il  New  Jersey  Volunteers.  Not  a pensioner. 

* Tills  specimen  was  rcclaiined  by  the  pensioner  October  ettfi,  187J ; amt  the  number  S'JGS  Is  now  assigned  to  another  specimen. 


Fig.  277. — Button 
removed  from  cliest 
after  seven  years. 
Spec,  ai.lli,  Sect.  I, 
A.  M.  Xt. 


Fig.  270. — Ball  and  piece  of 
button  extracted  from  the  right 
lung.  Spec.  5yG8,  .Sect.  I,  A.  M.  M.* 


Sect.  III.] 


BALLS  AND  LOREIGN  BODIES  LODGED. 


583 


It.  is  not  uncommon  for  a ball,  after  penetrating  tlio  thorax  and  passing  il\rougli  tlie 
lung,  to  be  reflected  from  the  pleural  surface  of  the  opposite  costal  wall,  and  to  fall  upoi;. 
the  diaphragm,  and  find  its  way  into  the  posterior  costo-diaphragmatic  angle,  as  in  the 
following  case  of  luBmothorax  ; 

Case  4. — Private  Erastus  Roberts,  Co.  H,  12tli  Illinois  Cavalry,  aged  18  years,  was  wounded  at  Rappabannock  Station, 
Virginia,  October  12tb,  18G3,  by  a conoidal  ball,  wbicb  entered  near  fourth  rib,  between  right  scapula  and  spinal  column,  and 
penetrated  the  chest.  He  was  admitted  to  Emory  Hospital,  Washington,  on  the  next  day.  There  was  severe  i)ain  in  the  right 
lung  and  gi’eat  dyspnoea;  absence  of  respiratory  murmur  in  right  side.  The  treatment  consisted  of  dressings,  bandage  around 
thorax,  and  opiates.  He  died  October  15th,  18C3.  Autopsy  showed  rib  fractured  at  place  of  wound ; cavity  of  light  chest  full 
of  blood;  right  lung  collapsed  but  not  wounded;  the  ball  was  found  in  the  right  thoracic  cavity.  Spec.  No.  449C,  Sect.  I,  A.  M. 
M.,  is  an  elongated  conoidal  ball,  notched  at  the  apex  and  longitudinally  grooved  on  one  side  of  the  body,  and  was  contributed, 
with  a history  of  the  case,  by  Acting  Assistant  Surgeon  A.  M.  Plant. 

It  is  very  common  for  the  ball  to  possess  sufficient  momentum  to  carry  it  through  the 
thorax  and  yet  be  detained  by  the  elasticity  of  the  skin,  beneath  the  soft  parts  on  the  side 
of  exit.  In  such  cases  the  ball  is  usually  cut  out  on  the  field  ; but  is  sometimes  suffered 
to  remain  until  the  patient’s  arrival  at  a permanent  hospital,  as  in  the  following  cases ; 


Case  5. — Private  Carlos  E.  Lawrence,  Co.  E,  57th  North  Carolina  Regiment,  aged  34  years,  was  wounded  at  Rappahannock 
Station,  November  7th,  18G3,  by  a conoidal  ball,  which  entered  one  inch  to  the  right  of  the  sj)inous  process  of  the  sixth  dorsal 
vertebra,  passed  forward  and  lodged  one  inch  inside  of  the  right  nipple.  On  the  9th,  he  was  admitted 
to  Armory  Square  Hospital.  The  patient,  whose  constitution  was  not  naturally  strong,  was  extremely 
debilitated  and  much  enfeebled  from  the  effects  of  the  wound,  which  was  much  swollen  and  highly 
inflamed.  On  the  10th,  the  ball  was  excised  by  Acting  Assistant  Surgeon  D.  W.  C.  Van  Slyck.  The 
patient’s  system  failed  to  respond  to  the  most  thorough  and  stiniulating  treatment,  and  he  continued  to 
sink,  and  died  on  November  IGth,  18G3,  from  asthenia.  The  missile,  somewhat  roughened  near  the  apex, 
was  forwarded  to  the  Arm}'  Itledical  Museum,  with  a minute  of  the  case,  by  Surgeon  D.  W.  Bliss,  U.  S.  V., 
and  is  represented  in  the  wood-cut  adjoining  (Fig.  278). 


Fig,  278. — Ball  removed 
after  traversing  the  ehest. 
Spec.  563,  Sect.  I,  A.  M.  M. 


The  next  abstract  illustrates  not  only  this  feature,  but  tlie  rapid  development  of 
bydrotliorax  wbicb  sometimes  follows  penetration  of  tbe  lung  by  a musket  ball  : 

Case  G. — Sergeant  Thomas  Clark,  Co.  I,  1st  United  States  Cavalry,  was  struck  by  a carbine  ball  in  tbe  cavalry  fight  near 
Brandy  Station,  Virginia,  August  1st,  1863.  On  the  next  day  he  was  admitted  to  Douglas  Hospital,  Washington.  When 
admitted,  the  bullet  was  discovered  beneath  the  integument,  below  the  inferior  angle  of  the  left  scapula,  whence  it  was  removed 
by  Acting  Assistant  Surgeon  J.  E.  Smith.  The  wound  of  entrance  was  found  anteriorly  over  the  third  lib,  which  had  been 
fractured.  This  case  was  diagnosed  as  a penetrating  wound  of  the  left  thoracic 
cavity,  involving  the  upper  lobe  of  the  lung.  There  had  been  hemoptysis  and 
dyspnoea,  and  there  was  when  admitted  great  prostration.  The  clinical  history  of 
the  case,  is  very  imperfect.  On  tbe  7th,  the  patient  was  found  almost  in  articulo 
mortis,  and  fully  comprehended  the  situation ; but  after  a consultation  it  was  concluded 
that  no  operation  at  that  period  would  be  of  avail.  The  effusion  had  almost  filled 
the  left  side,  and  was  causing  dyspnoea  and  profound  depression,  and  at  11  a.  m. 
death  took  place.  . Previous  to  the  autopsy,  a trocar  was  introduced  below  the 
angle  of  the  scapula,  between  the  eleventh  and  twelfth  ribs,  and  evacuated  half  a 
gallon  of  bloody  serum.  On  examining  the  lungs,  the  track  of  the  bullet  was  found 
lined  with  spiculm  of  bone  from  the  comminutetl  rib.  There  was  local  pneumonia 
of  the  upper  lobe,  with  the  usual  evidence  of  pleuritis ; copious  effusion  of  scrum,  and 
extensive  exudations  of  lymph.  No  other  h'sions  w(*re  discovered,  and  death  occurred 
from  the  traumatic  pleuritis  and  its  consequent  effusion.  The  accompanying  wood- 
cut  (Fig.  279)  gives  some  idea  of  the  coui-se  of  the  ball.  It  was  drawn  from  a wet 
preparation  forwarded  to  the  Museum  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A., 
then  in  charge  of  Douglas  Hospital. 


Fig.  279. — Preparation  of  portion  of  tbo  npp<  r 
lobe  of  the  left  lung,  showing  the  traek  of  a 
conoidal  musket  ball,  which  is  attached.  Spec. 
1678,  Sect.  I,  A.  M.  M. 


In  the  next  case  the  apparent  direction  of  the  ball  would  suggest  that  both  pleund 
cavities  were  opened  ; but  it  is  probable  that  its  track  on  the  right  side  lay  without  the 
thorax  ; 


Case  7. — Private  Chauncey  Pinney,  Co.  D,  154th  New  York  Volunteers,  aged  25  years,  was  wounded  at  Gettysburg, 
Pennsylvania,  July  Ist,  1863,  by  a conoidal  ball,  which  entered  the  left  side,  fractured  the  sev’enth  rib  about  its  middle,  traversed 
the  cavity  of  the  chest,  and  lodged  in  the  right  side,  three  inches  external  to  the  apgle  of  fhe  sixth  rib.  He  ivas  treated  in  the 


584 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


fk  ld  hospital  until  August  6th,  when  he  ^vas  transferred  to  the  hospital  at  Camp  Letternian.  The  patient  had  suffered  little  from 
the  effects  of  the  injury.  Tin;  hall  was  ('xcised  and  the  wound  was  dressed  with  simide  cerate  and  tightly  supported  by  adhesive 
))laster.  Tonics  were  administered,  with  an  o])iato  occasionally,  and  at  night.  From  the  wound  of  entrance  there  was  a 
])rotrusion  of  about  an  inch  in  size,  which  was  at  first  believed  to  he  a hernia  of  the  lung,  but  subsequently  proved  to  be  tissue 
which  yielded  to  caustic.  Suffered  from  dyspnoea  and  slight  cough;  right  leg  very  sore  and  lame  from  rheumatism.  August 
13th,  general  health  improving.  Sejitember  1st,  wound  presented  a healthy  granulating  surface,  with  slight  suppuration.  Ho 
continued  to  imiirove,  and,  on  October  1st,  was  transferred  to  Broad  Street  Hospital,  Philadelphia;  on  January  22d,  1864,  to  Mower 
Hospital,  whence  he  was  returned  to  duty  February  IGth,  1864.  On  November  1st,  1864,  he  entered  Hospital  No.  8,  Nashville, 
and  was  again  returned  to  duty  January  1st,  1865.  On  April  29th,  1865,  he  was  admitted  to  the  hosjutal  at  Elmira,  New  York, 
and  was  linally  discharged  from  service  July  7th,  1865.  Acting  Assistant  Surgeon  A.  B.  Stouelake  reports  the  case.  Pension 
Examiner  Ira  Shedd  n ports,  under  date  of  May  2,  1867  : “A  conoidal  ball  entered  the  left  side  of  the  chest,  between  the  tenth 
mid  ileventh  ribs,  and  emerged  on  the  opposite  side  about  two  inches  anterior  to  the  spinal  column,  fracturing  in  its  passage  one 
of  the  vertebra;,  and  injuring  the  left  lobe  of  the  lung  and  spinal  cord  or  nerves.  Has  neuralgia  of  right  leg;  is  permanently 
lame,  often  having  severe  pain ; pain  in  hack  and  loins,  with  dysury  and  partial  retention  of  urine,  the  result  of  spinal  irritation ; 
strabismus,  and  loss  of  sight  merging  to  amaurosis,  evidently  increasing  in  severity,  resulting  from  the  original  spinal  injury; 
fatigue,  and  often  producing  dyspnoea  and  great  prostration.  Disability  total  and  jiermanent  in  present  degree.”  He  was  still  a 
])ensioner  in  March,  1872. 

The  exact  site  of  lodgment  is  almost  always  obscure,  and  sometimes  is  not  in  the 
cavity  in  which  the  indiscreet  tyro  would  persist  in  groping  for  it  with  his  probes,  as  in 

the  case  of  Corporal  William  N , related  at  page  451,  in  which  the  missile  (Fig.  204) 

penetrating  the  chest  above  the  right  clavicle,  passed  downward,  and,  impinging  on  one 
of  the  dorsal  vertebrte  was  deflected,  and  traversed  the  mediastinum  and  lower  lobe  of 
the  left  lung,  and  diaphragm,  and  lodged  under  the  greater  curvature  of  the  stomach. 
The  case  of  Captain  Stolpe,  related  on  page  515,  and  illustrated  by  Plates  XI  and  XII, 
and  also  the  following  case  are  in  point.  In  the  latter  instances,  the  balls  were  voided  at 
stool ; 


Case  8. — Priv 
25tli,  was  adiuittcd 
cartilaginous  portion 


Pig.  280. — Conoidal 
ball,  much  disfigured 
and  containing  several 
bony  spicula;  imbedded. 
Spec.  1500,  .Scet.  I,  A. 
W.  M. 


ate  Thomas  B.  Belt,  Co.  C,  155th  Peunsylvaiiia  Volunteers,  having  been  wounded  at  Petersburg  on  IMarch 
to  Armory  S([uaro  Hospital,  Washington,  on  April  24th,  1865.  A bullet  had  entered  through  the 
of  the  seventh  rib,  passed  into  the  region  of  the  transverse  colon,  and  lodged.  On  admission,  the  patient 
suffered  from  traumatic  fever,  severe  pain  in  tlie  region  of  the  wound,  extending  over  the  abdomen, 
hiccough  and  vomiting — the  vomited  matter  consisting  of  small  particles  of  greenish  matter.  There  was 
difficult  respiration  and  anorexia;  the  surface  was  covered  with  a cold,  clammy  perspiration,  and  there 
was  great  difficulty  in  making  water.  The  treatment  in  this  case  consisted  of  a demulcent  and  anodyne 
decoction,  of  which  a wine-glassful  was  taken  four  or  five  times  daily ; the  free  use  of  cracked  ice,  and 
a very  limited  diet  of  beef-tea,  not  exceeding  six  ounces  daily.  On  April  29th,  the  patient  being  seized 
with  severe  pain  in  the  bowels,  passed  the  ball  while  defecating.  Immediate  relief  followed,  and  on  May 
1st,  1865,  the  patient  was  doing  well.  He  was  discharged  the  service  on  September  22d,  1865.  The  missile 
was  contributed  to  the  Army  Medical  Museum,  with  the  foregoing  account,  by  Acting  Assist.ant  Surgeon 
C.  H.  Bowen.  It  is  shown  in  the  adjoining  wood-cut  (Fig.  260).  Belt  is  not  a pensioner. 


Case  9. — Private  William  Welsh,  Co.  F,  51st  Ohio  Volunteers,  received  a gunshot  wound  of  the  thorax,  at  Murfreesboro’, 
Tennessee,  December  31st,  1862.  He  was  taken  to  the  hospital  of  the  3d  division.  Fourteenth  Corps,  and  simple  dressings  applied 
to  the  wound.  On  January  10th,  he  was  transferred  to  Hospital  No.  19,  Nashville,  whence  he  was  conveyed,  on  January  30th, 
per  hospital  boat  Emerald,  to  Covington,  Kentucky,  entering  Seminary  Hospital.  He  died  on  February  14lh,  1863.  At  the 
necropsy,  a buckshot  W'as  found  to  have  entered  the  right  breast,  between  the  fifth  and  sixth  ribs,  fracturing  the  sixth,  passed 
through  the  parietes  into  the  cavity  in  a direction  downward  and  toward  the  spine,  wounding  the  pleura,  passed  through  the 
diaphragm,  and  diagonally  through  the  right  lobe  of  the  liver,  close  uj)on  the  superior  extremity  of  the  right  kidney,  but  doing 
no  material  damage  to  that  organ,  and  lodged  in  the  body  of  the  first  lumbar  vertebra,  about  three  lines  from  the  spinal  can.al. 
In  the  cavity  of  the  chest  on  the  right  side,  between  the  pleura-costalis  and  pleura-[)uhnonalis,  adhesions  were  strong  throughout, 
and  when  separated  there  were  appearances  of  pus  on  the  surface  of  the  lung.  The  lung  itself  exhibited  signs  of  inflammation 
in  its  whole  extent,  and  was  collapsed  to  .about  half  the  size  of  the  left  lung.  No  evidence  appeared  that  this  lung  had  been 
wounded,  although  it  is  possible  that  it  did  not  wholly  escape  injury.  Heart  and  left  lung  normal.  There  was  not  much  fluid  in 
the  pleural  cavity,  but  the  fold  of  the  pleura  passing  over  the  diaphragm  had  a large  coagulum  intervening  between  it  and  the 
diaphragm,  Abdominal  viscera  all  healthy,  except  the  liver,  which  was  much  congested,  with  signs  of  inflammation  along  the 
track  of  the  ball.  The  case  is  reported  hy  Surgeon  J.  T.  Carpenter,  U.  S.  V. 


In  the  next  case,  fragments  of  clothing  were  expectorated  four  months  after  the  recep- 
tion of  the  wound  ; 


Case  10. — Lieutenant-Colonel  John  B.  Callis,  7th  Wisconsin  Volunteers,  aged  35  years,  was  wounded  at  Gettysburg, 
July  1st,  1883,  by  a ball,  which  entered  the  right  side,  immediately  over  the  tenth  rib,  midw.ay  between  the  sternum  -and  spinal 


Sect.  III.] 


BALLS  AND  FOREIGN  BODIES  LODGED. 


585 


column,  fractured  the  rib,  passed  downward  and  haclcward,  and  lodged.  He  was  admitted  to  the  hospital  of  the  1st  division. 
First  Corps.  It  appears  that  he  was  subsequently  admitted  to  a private  house  at  Gettysburg,  on  August  2d.  lie  had,  for  some 
time,  fever,  with  jaundice  ; never  had  bloody  expectoration,  though  sometimes  considerable  cough.  There  was  no  discharge  ot 
bile  from  the  wound.  On  August  12th,  the  patient  was  gradually  improving  ; the  wound  had  healed ; tenderness  nearly  absent ; 
liver  still  hard  and  slightly  enlarged ; base  of  right  lung  dull  on  percussion  ; appetite  good,  and  general  health  much  improved. 
The  treatment  consisted  of  counter  irritation  over  the  liver  and  lungs;  the  administration  of  tonics  and  anodynes,  with  stimu- 
lants, and  a full  diet.  The  patient  was  transferred  on  September  2d,  1833.  He  was  admitted  to  hospital  at  Annapolis  on 
November  8th,  1863.  Writing  from  that  city,  under  date  of  November  19th,  1833,  the  patient  furnishes  the  following  additional 
particulars:  After  having  been  wounded,  he  suffered  intense  pain  in  the  region  of  the  liver,  the  right  lung  and  shoulder,  and 
expectorated  blood.  His  right  leg  and  arm  were  partially  paralyzed,  and  in  sixteen  or  twenty  hours  he  was  much  jaundiced. 
On  September  1st,  he  started  for  his  home  in  Wisconsin,  still  unable  to  helj)  himself.  Arriving  at  Altoona,  Pennsylvania,  an 
•abscess  that  had  formed  in  the  liver,  broke  into  the  lung,  and  its  contents  were  expectorated,  the  wound  being  closed  externally. 
A surgeon  informed  him  that  the  matter  ho  was  then  raising  consisted  of  pure  bile.  This  discharge  continued  until  he  arrived  at 
Chicago,  when  the  passage  seemed  to  close  up.  At  Boscobel,  Wisconsin,  where  he  lay  over  ten  days,  the  discharge  reappeared, 
and  he  raised  about  a quart  of  yellow  or  greenish  matter,  tinged  with  blood,  and  very  bitter.  On  October  5th,  he  walked  alone 
for  the  first  time,  after  which,  imjn'ovemeut  took  place.  He  occasionally  raised  ])us  from  the  lungs,  and,  on  November  IGth,  in 
a parox3-sm  of  coughing,  two  jiieces  of  woolen  cloth  were  ejected.  (See  wood-cut,  FiG.  281.)  At  date  of 
writing,  he  suffers  extremelj-  from  soreness  in  the  region  of  the  liver  and  right  lung,  and  right  shoulder ; 
thinks  the  ball  lies  at  the  back  of  the  lower  lobe  of  the  right  lung,  where  he  experiences  a heavy,  tearing 
pain.  The  injured  lung  is  hepatized  and  very  tender ; the  right  arm  and  leg  still  have  a numb  sens.ation. 

Acting  Assistant  Surgeon  J.  H.  Longnecker  writes  from  Annapolis,  under  date  of  November  20th,  “the 
patient  is  doing  well,  with  every  prospect  of  being  able  to  return  to  duty  shortly’,”  and  again  on  the.2Gth  of 
the  same  month  “ there  has  been  no  ejection  of  bile  since  he  is  here.”  The  patient  was  discharged  the 
service  on  December  28th,  181)3,  for  phy-sical  disability,  and  yvas  pensioned,  his  disability  being  rated  total 
and  permanent.  On  June  20th,  1864,  he  was  appointed  Major  in  the  Veteran  Reserve  Corps,  yvhen  his 
pension  yvas  dropped.  He  was  promoted  to  Lieutenant  Colonel  on  Ftbruaiy  11th,  1865;  was  discharged 
on  May  4th,  1868,  and  again  pensioned.  A communication  from  Pension  Examiner  C.  F.  Fulley,  dated  August  30th.  1870, 
reports  the  patient  subject  to  hajinorrhage  from  the  lungs,  and  to  partial  paralysis  of  the  loyver  extremities.  The  lower  portion 
of  the  right  lung  is  consolidated  and  adherent  to  the  pleura;  the  patient  is  weak  and  emaciated.  His  disability  is  rated  total. 
In  JIarch,  1872,  he  was  still  a pensioner. 


Fig.  28]. — Tyvo 
pieces  of  yvoolon  cloth 
ejected  from  t li  o 
lungs.  Sjiec.  3990, 
Sect.  I,  A.  JI.  M. 


In  two  of  the  three  following  cases,  it  is  alleged  that  balls  were  extracted  from  the 
substance  of  the  lung;  and  in  the  third,  from  a lodgement  within  the  pleural  cavity  upon 
the  apex  of  the  left  lung.  The  latter  case  should  be  compared  with  that  of  Cottrell,  on 
page  424.  It  is  to  be  regretted  that  so  few  details  are  given  of  the  removals  of  the  missiles 
from  the  pulmonary  parenchyma: 

Case  11. — Private  W.  S.  Jenne,  Co.  B,  6th  Vermont  Volunteers,  aged  20  years,  was  yvounded  at  Fredericksburg,  May  4th, 
1863,  by  a spent  minie  ball,  yvliich  struck  him  yvhile  lying  down,  just  behind  the  right  clavicle,  a little  to  the  outside  of  the 
middle,  passed  directly  downyvard  into  the  apex  of  the  lung,  and  lodged  at  a depth  of  one  and  a half  inches.  It  yvas  exti-acted 
from  the  entrance  yvound  about  a yveek  afteryvard.  He  yvas  left  on  the  Held  in  the  enemy’s  hands  until  May  12th,  yvhen  ho  yvas 
paroled  and  taken  to  Potomac  Creek  Hospital,  whei-e  he  remained  until  it  yvas  broken  up,  about  the  middle  of  June,  yvhen  he 
was  transferred  to  Annapolis,  Maryland.  On  December  29th,  he  voluntarily  returned  to  his  regiment ; the  yvound  had  neai-ly 
healed,  but  still  discharged  slightly’.  He  continued  on  duty  with  his  regiment  until  its  muster  out  in  the  summer  of  1865. 
October  5th,  1835:  The  yvound  occasionally  breaks  out  and  discharges  for  a short  time.  His  breathing  is  somewhat  shorter  after 
exertion  than  formerly,  but  his  health  is  otheryvise  good.  Pension  Examiner  E.  P.  Watkins  reports  that  the  clavicle  is  injured 
to  such  an  extent  as  to  disable  him  someyvh.at.  He  yvas  pensioned,  his  disability  being  rated  total,  and  doubtful  as  to  permanency. 
Was  last  paid  March  4th,  1872. 

Case  12. — Sergeant  Andrew  McRae,  5th  Maine  Battery,  aged  30  years,  received  a gunshot  penetr.ating  wound  of  the  chest 
at  Chancellorsville,  Virginia,  Maj’  3d,  1863.  The  missile  entered  two  inches  beloyv  the  right  clavicle  and  penetrated  the  right 
lung.  He  yvas  treated  in  the  field  until  the  9th,  yvhen  he  entered  Carver  Hospital,  Washington,  whence  he  was  discharged  from 
service  Februaiy  18th,  1864.  Pension  Examiner  T.  B.  Smith  reports,  under  date  of  February  19th,  1864  : “The  ball  eutert'il 
tlie  right  side  of  the  chest,  betyveen  the  second  and  third  ribs,  one  inch  from  the  sternum,  perforated  the  lung,  and  yvas  extracted 
through  the  yvound  of  entrance.  The. lung  is  still  unsound,  health  bad,  cough,  &-C.  Disability  total  for  two  ^vears.”  I’ensioii 
E.xaininer  W.  D.  Steyvarf  reported,  September  20th,  1867,  that  the  scar  yvas  small  and  looked  healthy.  General  health  good ; 
disability  none.  On  February  26th,  1872,  Pension  Examiner  J.  O.  Stanton  reexamined  McRae  and  stated  that  there  was  “some 
dullness  on  percussion  over  upper  portion  of  right  lung,  yvith  diminished  respiration;  he  has  a hard  dry  cough.  The  action  of 
the  heart  is  much  increased.  There  are  evidently  pleuritic  adhesions  in  the  region  of  the  yvound,  and  he  has,  in  ny  opinion, 
chronic  bronchitis;  all  caused,  no  doubt,  by  the  yvound.  Disability  three-fourths,  and  uncertain.” 

Case  13. — Private  Seth  Cooper,  Co.  M,  2d  Massachusetts  Cavalry,  aged  23  years,  yvas  yvounded  at  Vienna,  Virginia, 
December  21st,  1833,  by  a conoidal  ball,  yvhich  entered  at  a point  one-half  inch  in  front  of  and  above  the  left  ear.  Ho  yvas  taki'u 
to  the  field  hospital,  yvhere  the  yvound  yvas  examined  and  search  made  for  the  ball.  A probe  could  be  passed  through  the  point 
of  entrance  to  the  condyle  of  the  occijiital  bone,  yvhich  obstructed  and  changed  the  course  of  the  ball,  it  being  impossible  to  trace 
it  further.  Perfect  quiet  and  rest  yvere  enjoined,  yvith  tlic  e.xpectution  th.’it  tin?  ball  yvould  become  enej’sted.  ThriM!  yveeks  lat(‘r 

74 


586 


WOUNDS  AND  INJUKTES  OF  THE  GUEST. 


rciiAP.  V, 


inflaniiuation  sot  in  anil  rittors  coniinoncod,  and  tlio  pationt's  life  demanded  that  the  ball  .should  he  found  and  removed.  A probe 
was  aimin  introdneed  to  the  eondvle  of  the  cceijntal  bone,  a free  incision  made  down  to  the  end  of  tlie  probe,  the  linger  passed 
downward  to  and  under  the  clavicle,  when  the  ball  was  found  resting  upon  the  apex  of  the  lung  and  was  removed.  The  wound 
liealed  by  granulations,  and  recovery  ensued,  with  paralysis  of  the  facial  muscles  of  the  injured  side.  On  June  11th,  1864,  he 
was  transferred  to  Cam|)bell  Hospital,  Washington;  on  July  2d,  to  Cony  Hospital,  Augusta,  Maine,  and,  on  July  14th,  to  the 
hospital  at  Keadville,  Massachusetts,  whence  he  was  returned  to  duty  Novemher  9th,  1864.  He  was  discharged  from  service 
April  4th,  1865.  Pension  Examiner  George  W.  Farrar,  under  date  of  July  26th,  1867,  says,  that  the  right  side  of  the  face  is 
jiaralvzed  and  that  the  pensioner  suft'ers  from  severe  attacks  of  neuralgia.  His  health  is  seriously  impaired.  Disability  one-half 
and  permanent. 


His  name  was  still  borne  on  the  Pension  List  on  June  4th,  1872. 


A soldier’s  culpable  negligence  in  failing  to  remove  the  tompion 
before  firing,  resulted  sometimes  in  the  bursting  of  the  piece;  sometimes 
in  the  projection  of  the  tompion  with  sufficient  force  to  penetrate,  within 
short  range,  a man’s  body;  almost  always,  unfortunately,  in  more  injury 
to  others  than  to  himself.  The  following  is  one  of  these  cases,  in  which 
the  stopper  was  lodged  in  the  lung,  and  the  damage  done  to  the  ribs  and 
internal  viscera  are  illustrated  by  specimens  in  the  Museum ; ^ 


Fig.  282. — The  metallic 
portion  of  a tompion  re- 
moved from  the  lower 
lobe  of  the  rig-ht  lung. 
Spec.  6 1 6, i),  Sec.  1,  A . M . M . 


Case  14. — Private  G. 

M , Co.  C,  13tli  New 

Jersey  Volunteers,  was  shot 


at  Bolivar  Heights,  Maryland, 
September  17th,  1862,  by  a 
soldier  in  the  rear  rank,  who  neglected  to  remove  his 
tompion.  The  missile  penetrated  the  chest  from  the 
back  and  fractured  the  eleventh  rib.  The  wounded 
man  was  carried  to  the.  hospital  of  the  1st  division  of 
the  Eighth  Corps.  His  breathing  was  oppressed 
almost  to  suffocation;  his  pulse  weak  and  fluttering; 
the  blood  oozed  from  the  jiosterior  wound  in  a florid 
track,  but  not  profusely;  there  was  frothy  limmo- 


Fio.  283. — Pesteriiir  view  rf  Bectiors  of  the  right  tenth,  eleventh  and  twelfth  ribs 
the  eleventh  comminuted  by  a tompion.  Spec.  filT,  .Sect.  I,  A.  M.  M. 


ptysis  with  frequent  painful  eflbrts  at  eoughing.  A broad  chest  bandage,  decubitus  on 
the  right  side,  and  an  opi.ate,  made  his  eondition  more  tolerable  toward  night,  and,  on  the- 
following  day,  he  was  placed  in  a ho.spital  railway  car  and  sent  to  Baltimore,  a distance  of 
eighty  miles,  and  thence,  a hundred  miles  farther,  hy  rail,  to  Philadelphia.  On  the  26th, 
he  was  admitted  to  South  Street  Hospital,  Philadelphia,  in  a state  of  great  prostration, 
with  the  symptoms  of  traumatic  pleuro-pneumonia  and  hepatitis.  There  was  extreme 
irritability  of  stomach,  frequent  cough  and  dyspnoea.  The  lower  right  chest  was  flat 
on  percussion ; there  was  a sanious  purulent  discharge  from  the  wound.  The  patient 
died  on  October  15th,  1862.  At  the  autopsy,  the  evidences  of  extensive  inflammation  of 
the  right  pleur.al  cavity  and  of  peritoneal  inflammation  in  the  vicinity  of  the  liver,  were 
very  apparent.  Spec.  No.  616,  Sect.  I,  A.  M.  M.,  shows  the  lower  lobe  of  the  right  lung 
and  part  of  the  liver,  with  a portion  of  the  diaphragm  intervening,  to  which  both  viscera 
are  firmly  adherent.  The  lung  was  wounded  by  the  metallic  portion  of  the  tompion,  which 
was  imbedded  in  it.  The  preparation  is  imperfectly  represented  in  the  accompanying 
wood-cut  (Fig.  284),  reduced  to  one-fourth  size,  from  a drawing  of  the  dissection  made 
at  the  Museum.  In  the  inferior  portion  the  button  of  the  tompion,  represented  of  natural 
size  in  Fig.  282,  is  seen  impacted  in  the  lung  tissue,  which  is  in  a state  of  grey  hepatiza- 
tion. The  cut  orifices  of  Large  bronchial  tubes  and  arterial  and  venous  truidts  appear  in 
the  left  upjier  [lortion  ; and,  to  the  right,  an  attempt  is  made  to  delineate  the  thickened 
|)leura  and  dia])hragm,  to  which  the  lung  adhered  firmly,  and  the  convex  surface  of  the 
liver,  which  partly  adhered  to  the  diaphragm.  Spec.  No.  617,  of  the  same  section, 
represented  in  Fig.  283,  shows  portions  of  the  last  three  ribs  of  the  right  side,  with  the 
eleventh  completely  fractured.  The  fragments  are  partially  united  by  new  bone,  which 
entangles  some  necrosed  portions.  Both  preparations  were  contributed,  with  a history  of 
the  case  after  the  patient’s  admission  to  South  Street  Hospital,  by  Acting  Assistant  Surgeon  H.  Hart.  The  other  notes  are  taken 
from  the  field  reports. 

The  following  is  one  of  the  best  illustrations  that  the  Museum  possesses  of  the  method 
that  Nature  sometimes  pursues  in  order  to  render  a foreign  body  unirritating,  by  encysting 
it.  A conoidal  ball  had  lodged  in  the  lower  lobe  of  the  left  lung.  Its  passage  through 


Fig.  284. — Section  of  the  lower  lobe  of  the 
right  Inngi  with  the  button  and  wire  of  a 
t iiulHfclded  in  it,  a portion  of  the 

•diaidiragni  and  <if  the  liver  appear  at  the 
uplier  right  liaiKi  of  the  preparation.  Spec. 
*616,  Sect.  I,  A.  M.  M. 


* Dr.  Uobinson  {Diary  of  the  Crimean  War,  pagtf  gives  a curious  instance  of  wound  by  a tompion.  See  also  Spec.  246,  Sect.  I,  A.  M.  M. 


Sect.  III.] 


BALLS  AND  FOREIGN  BODIES  LODGED. 


587 


an  intercostal  space  and  tlirongli  the  lung  substance  had  been  attended  l)y  the  least  possible 
amount  of  laceration  and  bleeding;  yet  it  had  struck  and  fractured  the  sternum,  and,  when 
reflected,  had  injured  the  pericardium  sufficiently  to  light  up  inflammation.  Alost  of  the 
track  healed  kindly ; the  constitutional  symptoms  were  slight  at  first,  and  were  due  to  the 
pericardial  rather  than  the  pulmonary  lesion.  The  ball  rested  a quarter  of  an  inch  beneath 
the  pleura.  T]ie  track  leading  to  it  was  cicatrized.  A well-marked  zone,  with  a radius  of 
about  one  inch,  surrounded  the  ball.  On  the  immediate  confines  of  this  zone,  the  lung 
tissue  was  normal  in  appearance,  and,  under  the  microscope,  the  only  alteration  noticeable 
was  slight  enlargement  of  the  Capillary  net-work  about  the  air-cells.  Within  the  line, 
clearly  defined  in  the  specimen  hardened  in  alcohol,  the  tissues  had  undergone  cheesy 
metamorphosis,  the  progressive  stages  being  met  in  approaching  the  ball,  in  the  immediate 
vicinity  of  which  were  chalky  deposits: 

Case  15. — Corporal  W.  S , Co.  H,  lol&t  New  York  Volunteers,  aged  2G  years,  was  admitted  to  the  3d  division 

hospital,  Alexandria,  December  4th,  18G3,  with  a gunshot  penetrating  wound  of  the  left  chest,  received  at  Locust  Grove 
Virginia,  November  27th.  A conoidal  ball  entered  two  inches  below  the  coracoid  process,  passed  inward  and  downward  and 
lodged  in  the  posterior  portion  of  the  lower  lobe  of  the  left  lung.  When  admitted,  there  was  slight  constitutional  disturbance, 
diminished  respiration  of  apex  of  left  lung,  slight  cough,  and  white  frothy  expectorations.  Sedatives,  anodynes,  and  stimulants 
were  administered,  with  nourishing  diet.  On  the  next  day,  the  patient  was  able  to  walk 
about  the  ward  and  seemed  quite  comfortable.  Nothing  occurred  to  attract  particular 
attention  until  January  3d,  when  the  expectoration  was  noticed  to  be  very  offensive; 
respiration  .scarcely  perceptible  in  the  left  lung;  pulse  very  weak.  January  8th,  18G4, 
breathing  labored,  complete  duluess  of  left  side  extending  to  right  of  sternum.  He  grad- 
ually sank,  and  died  on  January  10th,  18G4.  Necropsy:  Left  pleural  cavity  filled  with 
serum;  lung  compressed  in  small  space.  Pericardium  was  much  distended  with  fluid, 
amounting  to  twelve  ounces,  and  the  second  rib  comminuted.  The  ball  had  struck  the 
sternum  at  the  articulation  of  the  second  rib,  which  was  denuded  and  rough.  The  whole 
surface  of  the  pericardium  was  covered  with  coagulated  lymph  having  the  appearance  of 
tripe.  The  ball  was  found  in  the  posterior  portion  of  the  lower  lobe  of  the  right  lung  ; 
the  liver  was  enlarged  and  soft.  A preparation  of  a portion  of  the  left  lung,  with  the 
missile  lodged  just  beneath  its  surface,  is  represented  in  the  wood-cut  (Fig.  285).  The 
lung  has  been  laid  open  to  display  the  lodgment  of  the  ball.  Even  the  rings  on  the  base 
of  the  projectile  are  imprinted  on  the  cheesy  tissue.  The  specimen  was  contributed,  with 
a history  of  the  case,  by  Acting  Assistant  Surgeon  W.  G.  Elliott. 

Some  other  remarkable  examples  of  observations  made  j)ost-mortem  of  the  lodgment 
of  foreign  bodies  will  be  inserted  here: 

Case  1G. — Private  John  M.  IMosher,  Co.  I,  1st  Maine  Cavalry,  was  wounded  at  Brandy  Station,  Virginia,  October  12th, 
1863,  by  an  elongated  rifle  ball,  which  struck  near  the  costal  cartilage  of  the  fifth  rib,  coursed  inward  and  to  the  right,  and, 
passing  over  the  xiphoid  appendage,  perforated  the  diaphragm,  entered  the  liver  immediately  to  the  right  of  the  suspensory 
ligament,  passed  outward  and  slightly  upward  and  emerged  on  the  posterior  surface  of  the  greater  lobe  to  rest  beneath  the 
diaphragm.  He  was  taken  to  the  field  hospital,  where  he  remained  for  several  days,  when  he  was  sent  to  Washington  and 
admitted  to  Lincoln  Hospital  on  the  ISlth.  Death  resulted  on  October  20th,  18G3,  from  pericarditis  and  j)leurisy.  The  necropsy 
revealed  the  course  of  the  ball.  The  right  lung  was  not  visible,  its  site  being  occiqjied  by  a puffy  mass  of  emphysematous 
cellular  tLssue  in  a state  of  inflammation  ; toward  the  median  line  this  infiltration  was  covered  by  a thick  layer  of  exudation  of  a 
dark  purplish  red  color.  The  pericardium  was  covered  externally  with  a layer  of  lymph 
of  a recent  formation.  There  was  about  one  half  jiint  of  dark  and  serous  fluid  in  each 
lileural  cavity.  On  section  of  the  first  and  second  lobes  they  were  found  congested, 
especially  at  the  apex  of  the  first.  Bronchial  irritation  was  shown  by  the  excess  of  the 
frothy  secretion  in  this  part.  Immediately  to  the  right  of  the  suspensory  ligament  a ragged 
roundish  opening  was  seen;  five  and  a half  inches  to  the  right,  and,  on  a line  with  this, 
another  opening  was  observed  of  the  same  general  appearance  as  the  first.  At  this  point, 
the  liver  was  firmly  adherent  bo  the  diaphragm  by  inflammatory  products,  as,  indeed,  was 
the  greater  part  of  the  right  lobe,  but  the  latter  were  much  older  adhesions  than  those 
around  the  wound.  At  this  opening,  a brass  button  was  found  with  a portion  of  clothing 
attached.  The  missile,  disfigured  a very  little,  with  an  ordinary  military  coat  button 
inverted,  together  with  the  cloth  to  which  it  was  sewn,  is  represented  by  the  wood-cut 
(Fig.  280).  It  was  contributed,  with  notes  of  the  case,  by  Assistant  Surgeon  H.  Allen, 

U.  S.  A.,  from  Lincoln  Hospital. 


Eio.  28G. — Elongated  rifle  bail,  soino- 
wliat  disfigured,  with  an  ordinary  military 
button  inverted,  and  the  olotli  to  wliii  li 
itwassewn.  ,Spcc. 4151,  .Sect.  I,  A.M.M. 


Fig.  285. — Conoidal  ball  encysted  near 
the  free  edge  of  the  lower  lobe  of  the 
left  lung.  The  segment  of  the  lobe  is 
laid  open  to  show  the  lodgment  t.f  tlie 
missile.  Spec.  2014,  Sect.  I,  A.  M.  JI. 


588 


WOUNDS  AND  INJURIES  OF  TlIE  CHEST. 


[Chap.  V, 


Cask  17. — Pi  ivato  Alhnan  M.  P , Co.  C,  J4tli  Virginia  Reginirnt,  aged  3.5  years,  w.as  wounded  at  Ilatelier’.s  Rnii, 

October  27tli,  IStM,  and  made  .a  )nisoner.  He  was  taken  to  the  field  bospital  of  the  1st  division  of  tlie  St'cond  Corps,  wbeni 
Surgeon  William  Vosbnrg,  111th  New  York  Volunteers,  noted  tlie  case  (one  of  i)enetrati?ig  wound  of  the  chest)  and  apjdied  the 
necessary  dressings,  and  administered  restoratives,  and,  when  the  patient  had  rallied  from  the  shock  of  the  injury,  sent  him  in 
an  .■unbalance  to  the  rear,  whence  he  was  conveyed  on  a hospital  steamer  to  Washington;  where  he  was  admitted  to  Columbian 

Hospital,  Washington,  October  30th,  1804,  with  a “gunshot  penetrating  wound  of  the 
chest,  received  at  Petersburg,  Virginia,  on  the  27lh.  A mini6  ball  entered  the  triangle  of 
the  neck,  passed  downward  into  the  chest,  fractured  the  first  lib  and  partially  the  clavicle, 
and  slightly  injured  the  apex  of  the  left  lung.”  Acting  Assistant  Surgeon  .C.  E.  Lloyd, 
in  charge  of  the  ward,  treated  the  case  mainly  on  the  expectant  plan,  with  careful  nursing, 
and  palliative  remedies  to  meet  symptoms.  The  ball  was  out  of  reach,  and  Surgeon  T. 
R.  Crosby,  U.  S.  V.,  in  charge  of  the  hosj)ital,  decided  that  an  attempt  to  extract  it  was 
unwarrantable,  as  was  clearly  proved  in  the  setpiel.  The  patient  suffered  greatly  from 
oppressed  breathing  and  the  usual  complications  of  traumatic  pleuro-pneumonia,  especially 
from  freipient  painful  cough.  Concentrated  sustaining  nourishment  was  given,  but  the 
patient  steadily  grew  worse,  and  death  resulted  on  November  lltb,  18G4,  from  inter- 
mediary hsemorrbage.  The  necropsy  showed  rigor  mortis  great.  Old  pleuritic  and 
diaphragrnatic  adhesions  existed  on  the  left  side  of  the  chest.  There  were  about  four 
ounces  of  clotted  blood  on  the  walls  of  the  chest  near  the  wound.  The  upper  lobe  of 
the  left  lung  was  atrophied  and  almost  gangrenous  in  appearance.  The  adjoining  wood- 
cut  (Fig.  287)  shows  a wet  preparation  of  the  ui)per  half  of  the  left  lung,  with  a conoidal 
ball  embedded  in  its  substance,  partially  blocking  up  the  left  pulmonary  vein.  It  was 
contributed,  with  a memor.andum  of  the  case,  by  Acting  Assistant  Surgeon  J.  Fischer. 
After  the  speedmen  had  been  hardened  in  .alcohol,  upon  tr.acing  the  track  of  the 
wound  from  its  enti'.ance  in  the  ))leura  at  the  posterior  p.art  of  the  upper  lobe  of  the 
left  lung,  near  the  apex,  downward  and  forward  to  the  root  of  the  lung,  the  larger 
of  the  two  missiles  figured  in  the  wood-cut  (Fig.  288)  was  found  lying  against  the 
conunon  trunk  formed  by  the  junction,  in  this  case,  of  the  two  left  pulmonary  veins. 

There  was  a small  jagged  opening  in  the  vein,  whether  produced  mechanically 
after  death,  or  by  ulceration,  could  not  be  determined.  The  track  of  the  wound  was 
filled  with  coagula.  Near  by  the  larger  missile,  lying  against  the  fibrous  cord  con- 
stituted by  the  remains  of  the  ductus  arteriosus,  was  found  a smaller  misshapen 
fragment.ary  projectile,  apparently  a jiortion  of  a carbine  ball.  It  was  difficult  to  account  for  its  presence,  which  had  not  been 
remarked  in  the  examination  of  the  specimen  in  its  recent  state.  It  had  app.arently  entered  through  the  same  track  as  the  larger 
missile,  a track  that  was  large  and  much  lacerated.  It  is  hardly  possible  that  it  could  have  been  introduced  post-mortem  to  freight 
tbe  |>reparation,  which  submerged  in  .alcohol  by  its  own  density.  It  was  not  a fragment  of  the  larger  ball,  which,  though  battered 
and  flattened  by  imjiact  on  tbe  first  rib,  was  entire  and  weighed  540  grains.  Its  presence  in  the  already  perplexing  specimen 
was  very  puzzling. 


FiG.t287. — Ball  ludgcd  against  pulmonary 
vein.  Spec.  *d388.  Sect.  1,  A.  M.  M. 


Fig.  288. — Ball  and  fragment  of  ball  removed 
from  Spex.  3888. 


Fig.  2811. — Thickened  and  adherent  pericardium 
and  portiiai  of  left  lung,  ivith  imbedded  ball.  Spec. 
IITIKI,  Soot.  I,  M.  M. 


Case  18. — Priv.ate  Alexander  J , Co.  K,  C2d  Ohio  Volunteers,  aged 

33  years,  was  wounded  at  Deep  Bottom,  Virginia,  August  IGth,  18G4,  by  a mini6 
ball,  which  penetrated  the  right  side  of  the  thorax  near  the  sternum.  He  was 
t.aken  to  the  field  hospital  station  of  the  1st  division  of  the  Tenth  Corps,  where 
the  wound  was  dressed  and  a chest  bandage  applied;  and  restoratives  given.  He 
was  very  faint  and  the  breathing  was  labored.  He  was  sent  to  City  Point,  and 
placed  on  the  hospital  transport  Connecticut,  in  charge  of  Surgeon  T.  B.  Flood, 
U.  S.  V.,  and  conveyed  to  Philadelphia.  On  the  21st,  he  was  admitted  to  the 
hosjiital  .at  Beverly,  New  Jersey.  Cold-water  dressings  were  applied  to  the 
wound.  He  died  December  21st,  18C4,  from  empyema  of  the  left  side.  At  the 
necropsy  the  ball  was  found  to  have  entered  just  above  the  sterno  clavicular 
articulation  of  the  right-  side,  passed  downward  and  to  the  left,  fractured  the 
sternal  end  of  the  left  clavicle,  and,  entering  the  chest,  imbedded  itself  in  the  left 
lung,  where  it  was  found.  The  left  pleur.al  cavity  contained  about  two  quarts  of 
pus,  which  compressed  the  lung  so  as  to  cause  solidificatioli  of  that  organ.  The 
pericardium  was  firmly  adherent  to  the  heart,  and  the  liver  and  spleen  were  some- 
wh.at  enlarged.  The  other  organs  were  in  a healthy  condition.  The  adjacent 
wood-cut  (Fig.  289)  shows  a wet  prep.aiation  of  the  heart  and  left  lung,  with 
the  model  of  a conoidal  bullet  in  situ.  Assistant  Surgeon  Woodhull  remarks  that 
“tbe  specimen  shows  that  neither  speedy  death  nor  pneumonia  is  a necessary 
consequence  of  gunshot  wound  of  the  lung,”*  but  the  evidences  of  pulmonary  as 
well  as  cardiac  inllammation  are  unmistakable,  though  the  fatal  issue  was  so 
long  delayed.  The  preparation  was  contributed,  with  a history  of  the  case,  by 
Assisfant  Surgeon  C.  Wagner,  U.  S.  A. 


* CnUdngue  of  the  Surgical  Section  of  the  Army  Medical  Museum,  1808,  p.  480.  As  leaden  bullets  in  wet  preparations  rapidly  oxidize  anil  discolor 
the  aleobol.  I commonly  replace  them  with  a cast  painted  witli  dark  insoluble  varnish,  and  preserve  the  missile  outside  tbe  jar. — CUKA'I'OK. 


Sect.  III.] 


BALLS  AND  FOREIGN  BODIES  LODGED. 


589 


Case  19. — Private  J.  J.  P , Co.  B,  5th  Wisconsin  Volunteers,  aged  24  years,  was  wounded  at  Cliancellorsville, 

May  3d,  1863,  by  a conoidal  ball,  which  entered  between  the  sixth  and  seventh  ribs,  an  inch  outward  of  the  inaminillary  line, 
grazing  and  fracturing  the  seventh  rib.  He  was  treated  in  the  field  hospital,  and,  on  May  8th,  was  transferred  to  Douglas 
Hospital,  Washington.  When  admitted,  the  patient  was  suflTering  from  very  severe  dyspnoea,  accomjianied  by  an  incessant, 
painful,  and  annoying  cough ; respiration  was  very  frequent,  forced,  and  superficial.  He  stated  that  he  had  spat  blood  after  the 
injury,  but  not  the  least  tinge  of  blood  was  observable  in  the  thick  frothy  mucous  expectoration.  An  abundant  effusion  in  the  left 
thoracic  cavity  easily  accounted  for  the  dyspnoea.  Purgatives,  diaphoretics,  and  stimulants  were  administered  and  counter- 
irritants  applied  over  the  left  side  of  the  chest,  with  water  dressings  to  the  wound.  He  died  May  10th,  1833.  At  ihe post-mortem 
examination,  sixteen  hours  after  death,  old  adhesions  were  found  in  the  right  lung  and  fresh  ones  in 
the  left.  The  effusion  of  sero-sanguinolent  fluid  in  the  left  cavity  was  the  immediate  cause  of  death. 

Paracentesis  thoracis  wmuld  have  proved  of  but  little  avail,  as  the  diaphragm  was  perforated  and  the 
spleen  and  left  kidney  badly  bruised  and  injured.  The  ball  lodged  parallel  to  the  transverse  process 
of  the  fourth  lumbar  vertebra,  near  the  spine.  The  case  was  exceedingly  interesting,  because  the 
patient  had  manifested  no  abdominal  symptoms,  had  no  blood  in  his  urine,  and  voided  it  freely  and 
without  pain  in  spite  of  the  extensive  injury  to  the  left  kidney.  The  case  is  reported  by  Acting  Assist- 
ant Surgeon  Carlos  Carvallo.  The  missile,  with  the  merest  contusion  of  the  rings  at  one  point,  was 
forwarded  to  the  Army  Medical  Museum  by  Assistant  Surgeon  W.  Thomson,  U.  S.  A.,  and  is  repre- 
sented in  the  adjoining  wood-cut  (Fig.  290). 

Case  20. — Private  J.  A.  S , Co.  C,  145th  Pennsylvania  Volunteers,  aged  19  years,  was 

wounded  at  Gettysburg,  Pennsylvania,  July  2d,  1863,  by  a conoidal  ball,  which  perforated  the  left  scapula 
just  below  the  spine,  and  passing  forward  to  the  right,  splintered  the  sternal  end  of  the  first  rib.  He  was 
conveyed  to  the  hospital  of  the  1st  division.  Second  Corps,  and,  on  July  9th,  admitted  to  McKim’s  Mansion 
Hospital,  Baltimore,  where  he  died  on  the  same  day.  At  the  autopsy  the  ball  was  found  compressed  upon 
itself  in  the  anterior  mediastinum,  opposite  the  first  intercostal  space.  The  apex  of  the  left  lung  was 
daf  lKill'rei^-red*^frora'  engorged  and  the  left  pleura  contained  about  two  quarts  of  sero-sanguinous  fluid.  Miliary  cysts  filled 

the  mediastinum  after  with  pus  were  seen  at  the  apex  of  the  right  lung.  The  specimen  is  represented  in  the  adjoining  wood-cut 

grains.  SpecMti,  Sect.  (FiG.  291).  The  history  was  contributed  by  Acting  Assistant  Surgeon  R.  H.  Sterling. 

I,  A.  M.  JI.  ' ' 

Case  21. — An  unknown  soldier,  wounded  at  the  battle  of  Gettysburg,  was  brought  into  one  of  the 
field  hospitals,  in  an  insensible  state,  with  a wound  under  the  malar  bone.  The  ball  had  taken  a down- 
ward course  through  the  neck  into  the  thoracic  cavity,  and  could  not  be  traced.  Pulmonary  symptoms 
arose,  and  the  patient  lingered  till  August  7th,  when  he  died,  and,  at  the  autopsy,  the  missile,  a misshapen 
conoidal,  with  bony  spiculse  imbedded  in  it,  was  found  in  the  posterior  mediastinum,  behind  the  arch  of 
the  aorta.  The  projectile  is  represented  by  the  wood-cut  (Fig.  292).  It  was  contributed  to  the  Museum 
by  the  curator.  Surgeon  J.  H.  Brinton,  U.  S.  V. 


Fig.  290. — Ball  weighing’ 
510  grains  slightly  contused 
after  passing  through  the 
thorax.  Spec.  293,  Sect.  I, 
A.  M.  M. 


To  the  eight  foregoing  abstracts  of  cases  of  foreign  bodies  removed 
from  the  cavity  of  the  chest  after  death,  should  be  added  some  examples 
of  the  extraction  of  the  missiles  during  life. 

In  the  five  following  cases,  projectiles  were  excised  from  the  thoracic 
parietes ; in  one  instance,  after  being  encysted  for  fourteen  months  : 


Case  22. — Private  Hugh  Meehan,  Co.  A,  63d  New  York  Volunteers,  was  wounded  at  Gettysburg,  July 
2d,  1863,  by  a ball  which  entered  the  right  side,  between  the  second  and  third  libs,  passed  around  to  the 
inner  border  of  the  scapula  and  lodged,  injuring  the  edge  of  the  bone  to  some  extent.  He  was  sent  from  the 
field  hospital  of  the  1st  division.  Second  Corps,  to  Patterson  Park  Hospital,  Baltimore,  where  the  ball  was 
extracted  on  July  31st,  1863,  through  a counter  incision.  The  wound  healed  kindly,  and  Meehan  was 
returned  to  duty  December  11,  1863.  The  operator.  Acting  Assistant  Surgeon  A.  T.  Pick,  presented  the 
missile,  represented  in  the  wood-cut  (Fig.  293),  to  the  Museum. 


Fig.  292. — Misshapen 
conoidal  ball  lodged  hi 
mediastinum  after  tr.av- 
ersing  neck.  Spec.  143!*, 
Sect.  I,  A.  M.  M. 


Fig.  293.— Bali 
studded  with  par- 
ticles of  bone  from 
scapida.  Weiglit, 
483  gr.iins.  Spec. 
1422,  Sect.  I,  A. 
M.  M. 


Fig.  294. — Conoidal  ball 
laterally  flattened,  with 
the  apex  blunted  by  im- 
pact on  the  scapula.  Spec. 
3174,  Sect.  I,  A.  M.  M. 


Case  23. — Private  Joseph  Fouracre,  Co.  B,  1st  Delaware  Volunteers,  was  wounded  at  Antietain, 
September  17th,  1832,  by  a ball,  which  struck  the  scapula  and  buried  itself  in  the  muscles.  Itsjxisition 
was  detected,  and  it  was  extracted  on  September  24th,  the  date  of  the  patient’s 
admission  to  McKim’s  Hospital,  Baltimore.  There  were  some  exfoliations  from 
the  scapula,  and  the  wound  healed  tardily,  but  ultim.ately  cicatrized  firmly, 
and  the  patient  was  returned  to  duty  on  June  16th,  1863.  The  projectile,  repre- 
sented by  the  wood-cut  (Fig.  294),  was  sent  to  the  Museum  by  the  operator. 

Surgeon  Lavington  Quick,  U.  S.  V. 


Case  24. — Assistant  Surgeon  .1.  B.  Brinton,  U.  S.  A.,  contributed  the  specimen  figured  in  the  accom- 
panying wood-cut  (Fig.  295)  to  the  Museum,  without  further  information  than  that  it  was  cut  out  from  the 
supra-scapular  fossa,  where  it  lay  partly  impacted  in  the  spine  of  the  scapula,  in  the  c.ase  of  a soldier  of  the 
Army  of  the  Potomac,  wounded  before  Petersburg.  This  wound  healed  witliout  ill  conseiiuences. 


Fig.  295. — Conoidiil 
ball  roughened  by 
impact  with  ppino  of 
scapula.  Spec. 

Tcct.  I,  A.  M.  M. 


590 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Eiglity-eight  abstracts  of  cases  attended  by  the  lodgment  of  balls  or  other  foreign 
bodies  will  be  found  recorded  between  page  473  and  page  582,  or  the  beginning  of  this 
subsection.  In  over  one-tbird  of  the  cases,  or  tbirty-tliree,  the  foreign  bodies  were 
extracted,  either  immediately  or  within  twenty  days  in  eleven  cases,  and  at  periods  ranging 
from  one  to  twenty-two  months  in  the  remainder.  Twenty  of  these  thirty-three  patients 
recovered.  In  seven  of  the  twenty,  the  missiles  had  probably  not  penetrated  beyond  the 
thoracic  walls  ; seven  were  examples  of  perforation  of  the  chest  and  the  removal  of  the  ball 
from  lodgment  beneath  the  integument  or  scapula ; in  one,  the  famous  case  of  Betts  (Plate 
X),  the  projectile  was  removed  from  the  mediastinum,  and  the  five  remaining  cases,  of 
Kuhn,  Knowles,  Tomlinson,  Branson,  and  Rabell,  were  believed  to  be  examples  of  wounds 
of  the  lung  tissue. 

Case  25. — Private  H.  Millineth,  Co.  E,  9th  New  York  Zouaves,  was  wounded  at  Roanoke  Island, 
February  8tl),  1862,  by  a round  musket  ball,  which  entered  beneath  the  anterior  convexity  of  the  clavicle  and 
buried  itself  in  the  soft  tissues.  The  wound  healed  without  trouble,  the  ball  becoming  encysted.  Millineth 
entered  Armory  Square  Hospital,  at  Washington,  a year  afterward,  with  typhoid  fever.  When  convalescent, 
the  ball  was  detected  in  the  supra  scapular  fossa,  and  was  excised,  April  28th,  1863.  The  man  was  discharged, 
well,  May  4th,  1863,  on  the  expiration  of  his  term  of  service.  Surgeon  D.  W.  Bliss,  U.  S.  V.,  presented  the 
specimen,  figured  in  the  wood-cut  (Fig.  296). 

Case  26. — Private  Julius  Wilt,  Co.  A,  45th  New  York  Volunteers,  aged  22  years,  was  wounded  at  Gettysburg,  July  1st, 
1863,  by  a conoiflal  ball,  which  entered  to  the  right  of  the  second  lumbar  vertebra,  passed  between  the  skin  and  cellular  tissue,  and 
lodged  two  inches  to  the  right  of  the  umbilicus.  He  was  taken  to  the  4th  division  hospital,  where,  on  the  12th,  the  missile  was 

cut  out.  He  had  also  a ragged  wound  below  the  right  nipple,  which  appeared  to  implicate 
only  the  soft  textures.  The  treatment  consisted  of  tonics,  with  simple  dressings  to  the 
wound.  The  wound  of  the  back  soon  cicatrized ; that  of  the  chest  continued  to  dis- 
charge. The  patient  became  weak  and  prostrate,  but  improved  under  the  administration  of 
stimulants  and  tonics.  On  November  7th  he  was  transferred  to  Newton  University  Hos- 
pital, Baltimore,  at  which  time  the  wound  of  exit  had  not  healed.  On  March  2d,  1864, 
Surgeon  C.  W.  Jones,  U.  S.  V.,  made  an  incision  one  and  a half  inches  in  length  in  the 
side  and  removed  a piece  of  shell  one  and  three-fourths  by  one  and  one-fourth  inches,  and 
which  weighed  one  and  one-fourth  ounces.  The  presence  of  this  missile  had  not  been  sus- 
pected for  a long  time.  The  wound  soon  afterward  healed,  and  he  was  transferred  to  De 
Camp  Hospital,  New  York  Harbor,  whence  he  was  returned  to  duty  on  September  27th, 
1864.  The  fragment  of  shell  was  contributed  to  the  Museum,  with  the  above  notes,  by  the 
operator,  and  is  represented  of  the  natural  size  in  the  adjoining  wood-cut  (Fig.  297). 

Of  the  twenty-six  abstracts  included  in  this  subsection  thirteen  relate  to  the  extrac- 
tion of  missiles  or  foreign  bodies  during  life.  One  other  example  may  be  cited  in  detail, 
and  the  other  cases  of  this  description  that  appear  on  the  returns  must  be  considered 
numerically. 

Case  27. — Private  Francis  Cook,  Co.  K,  2d  Michigan  Volunteers,  was  wounded  at  Bailey’s  Cross  Roads,  Virginia,  Septem- 
ber 4lh,  1861,  by  a conoidal  ball,  which  penetrated  the  lungs.  Surgeon  William  O’Meagher,  37th  New  York  Volunteers,  in  a 
report  of  the  case  in  Am.  Med.  Times,  Vol.  IV,  p.  6,  says : “While  on  picket  duty  near  the  Cross  Roads,  he  received  from  the 
enemy’s  picket  a gunshot  wound  through  the  lungs,  and  when  discovered  by  his  comrades,  who  had  hastened  to  the  spot,  was  found 
faint  from  profuse  haemorrhage,  and  lying  on  the  wounded  side.  By  them  he  was  conveyed  in  a blanket  to  the  main  body 
stationed  at  the  Cross  Roads,  the  distance  being  about  a mile,  and  on  their  arrival  I saw  him  immediately.  On  examination,  his 
clothes  behind  were  found  saturated  with  blood,  while  several  large  clots  were  removed  from  the  immediate  vicinity  of  the  wound. 
As  he  was  extremely  prostrated,  some  stimulants  were  gradually  administered  until  reaction  took  place,  and,  in  the  meantime,  I 
was  searching  for  the  exit  of  the  bullet,  which  had  entered  the  left  side  posteriorly,  fracturing  the  tenth  rib  and  making  a large 
irregular  wound.  On  introducing  my  finger  for  about  two  inches  for  the  purpose  of  exploring  and  removing  foreign  substances, 
I felt  the  lung  tissue,  and  found  the  wound  itself  partially  filled  with  coagula  and  extending  toward  the  opposite  side  in  a 
transverse  direction ; emphysema  appeared  to  some  extent  in  the  vicinity.  I did  not  attempt  a further  exploiation,  especially  as 
the  wound,  as  far  as  I could  discern,  appeared  free  from  foreign  substances  and  partially  closed.  Shredded  lint  was  then  applied 
to  the  wound,  and  the  patient  gently  turned  over  on  the  wounded  side.  On  searching  for  the  exit  of  the  ball,  the  only  indication 
of  its  presence  was  a patch  of  emphysema  on  the  opposite  side,  somewhat  higher  up  than  the  aperture,  but  the  biill  itself  could 
not  be  felt,  so  I resolved  to  wait  awhile  in  order  to  allow  the  patient  to  recover  somewhat,  hoping  that,  in  the  meantime,  the 
respiratory  eftbrts,  increased  by  a pretty  tight  bandage,  would  force  the  ball  outward  and  thus  render  it  |>alpable.  Accordingly, 


Fig.  297. — Fragment  of  sliell  removed 
from  the  right  side,  eight  months  after 
injury.  Sjjcc.  4503,  Sect.  I,  A.  JI.  M. 


FIG.  296 


Sect.  III.] 


BALLS  AND  FOREIGN  BODIES  LODGED. 


591 


ill  aliout  four  hours,  he  began  to  experience  severe  pain  in  this  part,  and  on  removing  the  bandage,  at  the  same  time  directing 
liim  to  take  a full  hreath,  -which  he  did  with  ease  and  evident  relief,  I was  exceedingly  gratified  to  find  the  ball  pi’esenting  itself 
in  the  sixth  intercostal  space.  On  cutting  down  I found  it  firmly  imbedded  in  tbe  costal  pleura,  and  after  a little  delay, 
occasioned  by  a desire  not  to  make  a large  opening,  removed  it  with  a common  forceps,  and  immediately  closed  the  wound  with 
interrupted  sutures.  The  bandage  was  again  applied,  and  a full  anodyne  administered,  after  which  he  slept  well  for  two  hours 
and  felt  very  much  relieved.  The  missile,  contrary  to  my  first  anticipations,  turned  out  to  be  a small  triangular-shaped  rifie- 
bullet,  irregular  and  rough  at  the  edges,  as  if  it  were  so  designed  to  produce  greater  mischief.  Ho  continued  very  comfortable  for 
two  days,  taking  light  nourishment  and  appearing  quite  cheerful  and  intelligent,  occasionally  only  being  attacked  with  dyspnma, 
which,  however,  was  never  sufficient  to  cause  any  apprehension.  Obedient  to  directions,  he  lay  perfectly  still,  without  talking, 
except  in  answer  to  a.necessary  question  as  to  his  condition.  His  bed  was  a canvas  field-stretcher,  with  poles  inserted  into  the 
folded  canvas,  which  was  also  attached  to  the  end  pieces  by  buttons  and  cords.  The  iron  framework  at  the  ends  raised  it  from 
the  ground  sufficiently  to  afford  a safe,  easy,  and  efficacious  means  of  transportation,  far  supei'ior,  in  my  opinion,  to  any  other 
thus  far  presented,  and  certainly  better  than  field  ambulances  over  rough  roads.  On  this  he  was  conveyed,  on  the  third  day,  a 
distance  of  perhaps  ten  miles,  to  the  general  hospital  in  Alexandria,  where  he  died  on  the  fifth  day.  I am  indebted  to  Dr.  H. 
Laurence  Sheldon,  the  surgeon  in  charge,  for  the  following  record  of  the  autopsy : ‘Left  side  of  chest  filled  with  bloody  serum; 
lung  compressed,  and  a space  between  anterior  parietes  and  surface  of  lung  filled  with  air.  Lymph  covered  the  visceral  and 
parietal  pluras,  and  clots  of  blood  were  on  the  most  dependent  portion  of  the  cavity.  The  ball  struck  the  tenth  rib,  fracturing  it 
three  inches  from  its  articulation  with  vertebrae,  passed  through  the  lower  lohe  of  left  lung,  where  there  was  intense  inflammation 
in  its  track,  with  numerous  spiculae  of  bone  carried  two  inches  into  substance  of  lung  from  the  fractured  rib,  thence  through  body 
of  tenth  vertebra,  through  diaphragm  and  upper  suiface  of  liver,  a distance  of  two  inches;  again  through  diaphragm,  and  was 
removed  externally  between  sixth  and  seventh  ribs.  There  was  a patch  of  pneumonia  on  the  right  lower  lobe.  Half  a gallon 
of  serum  and  blood  was  taken  from  both  pleural  cavities.’  I should  have  mentioned  as  rather  remarkable,  that  for  three  days, 
though  he  had  considerable  dyspnma,  and  pain  referred  to  in  both  jilaces,  he  had  neither  cough  nor  expectoration  until  the  fourth 
day,  leading  some  to  suppose  that  both  lungs  were  not  seriously  wounded,  as  I had  at  first  reported,  the  h.all  rather  making  a 
circuit  outside  the  lung.  But  I think  it  almost  impossible  that  the  right  lower  lobe  could  escape  when  the  ball  passed  twice 
through  the  diaphragm  and  upper  surface  of  the  liver,  being  finally  removed  from  the  sixtA  intercostal  space;  besides,  ‘there 
was  a patch  of  pneumonia  on  the  right  lower  lobe,  and  half  a gallon  of  serum  taken  from  both  pleural  cavities.’” 

Besides  the  forty-seven  cases  of  extractions  of  balls  or  foreign  bodies  from  the  thoracic 
walls  or  cavity  that  have  been  cited  with  some  details,  were  two  hundred  and  sixty-nine, 
of  which  only  the  results  can  be  noted.  In  the  aggregate  of  three  hundred  and  sixteen 
operations,  a fatal  termination  ensued  in  one  hundred  and  eight  cases  ; in  one  hundred 
and  nineteen  cases,  the  patients  were  discharged  with  various  degrees  of  disability,  and 
eighty-one  recovered  sufficiently  to  resume  duty,  at  least  temporarily.  Forty-one  of  the 
recoveries  are  found  among  cases  in  which  the  projectile  was  lodged  beneath  the  soft 
parts,  without  having  injured  the  contents  of  the  chest.  The  remaining  two  hundred  and 
seventy-five  were  attended  either  by  fr.icture  of  the  ribs,  or  presumed  injury  of  the  contents 
of  the  thorax.  Of  these  patients,  one  hundred  and  eight  are  known  to  have  died  ; in 
eight  cases,  the  result  is  unknown ; and  there  remain  one  hundred  and  fifty-nine  examples, 
or  more  than  one-half,  of  reported  recoveries.  As  the  names  of  the  majority  are  found  on 
the  pension  roll,  there  can  be  little  doubt  of  the  fact  of  recovery ; but  there  is  every  reason 
to  believe  that  the  gravity  of  the  injury  was  overestimated,  and  that  many  cases  returned 
as  penetrating  wounds  of  the  chest,  in  reality  were  wounds  of  the  parietes  only. 

That  there  were  a certain  number  of  recoveries  after  extraction  of  balls  from  the 
pulmonary  parenchyma  cannot  be  denied,  but  there  is  a lamentable  deficiency  in  details 
in  the  reports  of  this  most  important  class  of  injuries.*  It  must  be  very  rarely  that  any 
attempt  should  be  made  to  discover  and  extract  balls  lost  and  lodged  in  the  tissue  of  the 
lung.  It  is  safer  to  abandon  such  to  the  care  of  nature.  LeDran  points  out  a rare 
exception  to  this  precept,  which  presents  itself,  by  a happy  chance,  when  from  a former 
pleurisy  the  wounded  lobe  is  firmly  adherent  to  the  walls  of  the  chest.  In  all  other  cases, 
Percy  and  Desport  and  Bagieu,  who  cannot  be  accused  of  timidity,  advise  against  attempts 

*Larrey,  D.  J.,  JHe/Ti.  de  Ckir,  Mil.,  Paris,  1817,  T.  IV,  p.  261;  LOIlMlCYER,  Die  Schusswunden  und  Hire  Jieliandluvg,  Gottingen,  1859,  p.  124; 
Rust,  J.  N.,  Ucmdbuch  der  Chirurgie,  Berlin,  1856,  Band  17,  S.  622;  BauDICXS,  Clinique  des  plaies  des  d'armes  d fev^  I^aris,  1856,  p.  242;  Fabrictus 
Hild^lnus,  Ohservat tones  CAirwr^icfl?,  Cent  I,  Obs.  46;  .Stromkyer,  J/aximcn  der  Krie.gshcHkunst,  Hannover,  1861,  p.  452;  TllOMABSIN  M , i?isscr- 
tation  sur  Vexlracti&n  des  corps  etrangers  des  plaies,  et  specialemeul  de  ccllcs  faites  par  armes  d feu,  Strasb.,  1788. 


592 


WOUNDS  AND  INJUKIES  OF  THE  CHEST. 


[Cjiap.  V, 


at  extraction.  M.  Demme,  on  the  other  hand  [Militdr-chirurgische  Stiidien,  Zweite  Abth., 
S.  138,  AViirzhurg,  1864),  says:  “Entirely  unfounded  is  the  fear  of  a careful  examination 
for  the  seat  of  lodgment  of  the  projectile.  A systematic  search  should  be  made  in  the 
direction  of  the  wound,  which  should  be  ascertained  by  the  finger  or  the  probe.”  Dr. 
Pirogoff^  [Orundzuge  der  allgemeinen  KriegscMrurgie,  Leipzig,  1864,  p.  534)  severely 
criticises  these  precepts  of  Dr.  Demme.  Professor  Gross  {A  System  of  Surgery,  5th  ed., 
Vol.  II,  p.  446)  teaches  that  “any  foreign  substance  that  may  be  present  should  be 
promptly  removed,  provided  it  is  easily  accessible ; for  the  rule  here,  as  in  all  other 
visceral  cavities,  is  to  refrain  from  officious  interference.”  No  one  will  question  the 
propriety  of  extracting  accessible  foreign  bodies ; but  there  will  be  differences  of  opinion 
as  to  what  constitutes  officious  interference.  It  is,  perhaps,  impossible  to  formulate  the 
general  rule  more  precisely  than  is  done  in  the  language  of  this  learned  author ; but  the 
whole  question  at  issue  is  involved  in  the  interpretation  of  the  rule.  I cannot  subscribe 
to  the  next  sentence:  “Nothing,  in  such  a condition,  can  more  clearly  betray  the  ignorance 
of  the  surgeon  than  the  introduction  of  the  probe  into  the  chest ; a careful  exploration  of 
the  outer  wound  is  always  admissible,  especially  when  suspicion  exists  that  a rib  has  been 
fractured,  or  that  a ball  has  lodged  in  one  of  the  intercostal  spaces.”  Dr.  Demme,  Dr. 
Cooper,  and  M.  Legouest,  are  assuredly  neither  ignorant  nor  inexperienced,  and  the  case 
of  Dr.  Ellis  (Lewis,  p.  494)  alone  proves  the  propriety  of  undertaking,  under  some 
circumstances,  very  serious  operations  for  the  removal  of  foreign  bodies  from  the  lung. 
The  dogmatic  teaching  of  Dupuytren,^  has  probably  exerted  much  influence  upon  modern 
practice  in  this  connection.  He  said:  “Une  blessure  de  poitrine  par  armes  a feu  qui 
traverse  le  poumon  ne  doit  jamais  etre  sondde,  e’est  la  plus  grave  hdrdsie  que  I’on  puisse 
commettre  en  chirurgie,  et  I’instrument  dit  sonde  de  poitrine,  que  I’on  trouve  dans  les 
trousses  des  chirurgiens,  devrait  bien  etre  banni,  au  moins  pour  cos  sortes  de  Ifisions.”  To 
this,  M.  Legouest  replies,  at  page  357,  of  the  last  edition  of  his  Traite  de  Chirurgie 
d'Armee:  “Les  faits  sent  en  complet  disaccord  avec  ce  prdcepte  : le  seul  inconvenient 
auquel  on  s’expose  en  sondant  une  plaie  de  poitrine  par  coup  de  feu  que  Ton  suppose 
renfermer  un  corps  dtranger,  est  de  ne  pas  trouver  ce  que  Ton  cherche.  En  effet,  ou  bien 
le  poumon  fibre  d’adhdrences  s’est  rdtraetd  vers  sa  racine  et  dchappe  I’instrument  explo- 
rateur  qui  parcourt  sans  obstacle  la  cavitd  pleurale;  ou  bien  le  poumon  est  adherent  k la 
plevre  costale  et  sa  blessure  reste  en  rapport  avec  la  plaie  extfirieure.  Dans  ce  dernier 
cas,  une  sonde  de  poitrine  ou  une  sonde  de  gros  calibre  de  gomme  dlastique  pent  etre 
introduite  dans  le  trajet  escharififi  de  la  plaie  du  poumon,  sans  courir  le  risque  de  causer 
une  irritation  plus  vive  que  la  presence  de  la  balle,  d’esquilles,  de  vetements  ou  d’autres 
corps  entrainds  par  le  projectile.  Si  Ton  dtait  assez  heureux  pour  rencontrer  le  corps 
dtranger  dans  le  poumon,  il  faudrait,  comme  le  conseille  Ledran,  dilater  suffisamment  la 
plaie  extdrieur  pour  aller  le  saisir  avec  des  pinces  et  I’extraire  sans  obstacle.”  The  general 
opinion  among  military  surgeons  in  the  war  of  the  Rebellion  appeared  to  be  that  it  was 
always  well  to  complete  the  diagnosis,  for  nothing  can  be  better  than  the  entire  truth  ; 


^He  also  adverts  {1.  c.  S.  549)  to  the  remarkable  operation  by  Dr.  COOPER,  of  San  Francisco:  “Of  desperate  operations  successfully  performed 
for  injuries  of  the  chest,  few  arc  worthy  of  imitation.  Nearly  all  concern  the  removal  of  forei^  bodies  from  the  cavity  of  the  c-hest.  A few  of  these 
adventurous  operations  resulted  successfully.  One  of  the  most  desperate  cemes  to  us  again  from  America.  It  is  a case  related  by  Dr.  E.  S.  COOPER  (of 
San  Francisco),  in  1857.”  See  COOPER,  E.  S.,  Ilcport  of  an  operation  for  Removing  a foreign  hody  from  beneath  the  Ecart.  (rublishcd  by  the  San 
F rancisco  IMedico-Chirurgical  Association  as  an  additional  paper  to  its  Transactions  for  the  year  1857.)  Dr.  W.  F.  Atlee  (.\iu.  J.tuir.  (ff  Jlcd.  Sci.,  N.  S., 
Vol.  XXXV.,  p.  229)  remarks  of  this  operation  that  “it  is  extraordinary  cvcn.for  California,  that  land  of  enormities  of  every  description.” 

^ Dl’PUYTREN,  oraUs  de  clinique  chirurgicale,  T.  VI,  p.  382. 


Sect.  III.] 


BALLS  AND  FOREIGN  BODIES  LODGED. 


693 


but  when  tlie  means  of  arriving  at  it  might  do  more  harm  than  the  knowledge  of  it  could 
do  good,  it  was  the  part  of  wisdom  to  know  when  to  be  willing  to  remain  in  doubt.  The 
authors  of  the  Confederate  Manual^  declare  that  “if  the  presence  of  a ball  within  the 
cavity  be  ascertained,  efforts  should  be  made  for  its  removal.  But  any  attempt  to 
determine  where  the  ball  has  lodged  should  be  made  very  cautiously,  as  more  harm  may 
result  from  the  interference  than  from  the  lodgment  of  the  foreign  body.”  Examples 
have  been  cited  (p.  481,  et  seq.)  of  the  fatal  consequences  of  the  rash  and  unwarrantable 
explorations  that  the  authors  that  have  been  quoted  and  others  reprehend ; but  surely 
there  is  a wide  interval  between  such  meddling  and  the  judicious  use  of  the  probe  and 
forceps  in  cases  in  which  there  are  just  grounds  for  suspecting  the  presence  of  a foreign 
body,  and  the  sagacious  practitioner  will  neither  discard  the  probe  absolutely  nor  use  it 
habitually.  It  is  almost  needless  to  repeat  that  all  good  surgeons  agree  that  the  finger  is 
the  best  probe  whenever  available. 

The  surgeon  will  remember  that  a ball  striking  the  chest  may  lodge  in  the  soft  parts 
near  the  point  of  impact,^  or  be  deflected  to  distant  parts, ^ or  it  may  be  impacted  in  a rib,^ 
or  wedged  in  an  intercostal  space,^  or  lodged  in  the  sternunE  or  spine,'’'  or  against  the 
clavicle®  or  scapula;®  or  it  may  fracture  the  rib  and  push  the  costal  pleura  before  it  and 
not  penetrate  the  cavity;^®  or,  penetrating  the  cavity,  it  may  lodge  either  in  the  walls  or  in 
the  contained  viscera  or  in  the  cavity,  or  pass  out  of  the  cavity  and  make  a wound  of  exit, 
or  else  lodge  under  the  skin,  scapula,  or  soft  parts  near  its  emergence  from  the  thorax. 
Perhaps  it  would  be  best  to  restrict  the  term  perforating  gunshot  wounds  of  the  chest  to 
the  cases  comprehended  in  the  two  latter  subdivisions.  The  ball  may  perforate  the  chest 
through  intercostal  spaces  without  fracture,  or  there  may  be  fracture  at  the  point  of  impact 
and  not  at  the  point  of  egress,  or  the  reverse;  or  the  ball  may  traverse  the  mediastina  or 
both  sides  of  the  thorax,  or  enter  the  chest  by  pushing  aside  the  cartilages  ; or,  lastly,  it 
may  penetrate  through  the  neck  or  diaphragm,  as  has  often  occurred  since  the  use  of  arms 
of  long  range  has  frequently  justified  the  adoption  of  the  prone  position  under  fire.  The 
ball  may  carry  with  it  various  extraneous  matters,  or  portions  of  the  bony  case  it  has 
encountered  in  entering.  Examples  of  nearly  all  of  these  various  forms  of  injury  have 
been  enumerated  and  others  will  be  found  in  Table  XXII. 


I avail  of  the  remaining  space  to  intro- 
duce illustrations  of  foiu"  other  specimens, 
the  histories  of  which  are  briefly  as  follows: 
Fig.  298  represents  a missile  which  struck 
Corporal  S.  M.  Elder,  Co.  K,  10th  Pennsyl- 
vania Reserves,  at  Fredericksburg,  Decem- 
ber 13th,  1862,  in  the  third  right  intercostal 
space,  and  was  extracted,  January  19th, 
1863,  by  Surgeon  O.  A.  Judson,  U.  S.  V., 
near  the  lower  angle  of  the  scapula.  Elder 
recovered  and  was  pensioned.  Fig.  299  rep- 
resents a post-mortem  specimen  found  in  the 

body  of  Lieut.  H.  II.  W , Co.  D,  0th 

Maine,  wounded  at  Rappahannock  Station, 
November  7th,  1863,  the  ball  fracturing  the 
stcnium  and  first  rib  and  entering  the  apex 
of  the  lung.  The  case  terminated  fatally  in 
six  days.  Fig.  300  represents  a heavy  ball 
extracted  December  21st,  1862,  from  near 
the  spine  of  the  left  scapula,  by  Assistant 
Surgeon  W.  A.  Conover,  U.  S.  V.,  having 
entered  December  13th,  1862,  in  the  third  left 
intercostal  space  anteriorly  in  the  case  of 
Private  J.  Porret,  Co.  B,  105th  Pennsyl- 
vania, wounded  at  Fredericksburg,  who  sub- 
sequently recovered  and  was  discharged. 


Fig.  298. — A conoidal 
ball  of  unusual  slender- 
ness. The  two  lower 
thirds  arc  compressed 
on  one  side  and  bear 
markings  as  if  of  the 
texture  of  coarse  cloth. 
Spec.  4657,  Sect.  I,  A. 
M.  M. 


Fig.  299. — An  elongated 
rifle  ball  somewhat  blunted 
and  flattened  upon  one  side 
in  which  small  fragments 
of  bone  are  imbedded,  with 
one  and  a half  inches  of 
brass  wire  hooked  in  the 
apex. — Spec.  2651,  Sect.  I, 
A.  M.  M. 


Fig.  300.  — Ball 
weighing  840  grains, 
with  the  body  flat- 
tened obliquely  and 
two  short  lateral 
grooves  near  the  apex. 
Spec.  4399,  Sect.  1,  A. 
M.  M. 


Fig.  301. — Ball  split  in 
traversing  tlie  chest.  Weight 
684  grains.  Spec.  573,  Sect. 
I,  A.  M.  M. 


Fig.  301  represents  a prqiectiie  that  passed  through  the  chest  of  a soldier  at  Gettysburg,  and  then  lodged  deeply  in  the  soft  parts  of  the  man  behind  him, 
whence  it  was  extracted  by  Acting  Assistant  Surgeon  B.  B.  Miles. 


•A  Manual  of  Military  Surgery,  prepared  for  the  use  of  the  Confederate  .States  Army,  by  order  of  the  .Surgeon  General,  Richmond,  1863,  p.  60. 
^See  page  473.  ^Besides  the  examples  given,  see  IIExnen  (h  c.,  p.  392),  Gutiiuie  (I.  c.,  p.  464).  ‘•Page  .569.  ®Page568.  “Page  474.  ’Chapter 
IV,  p.  460.  “Page  475.  “Page  476.  '“See  a remarkable  case  related  by  D.  J.  Laiirey  (Jour.  G6n.  do  Mfid.,  T.,  LXXII). 


594 


WOUNDS  AND  INJUEIES  OE  THE  CHEST. 


[Chap.  V, 


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Sect.  III.] 


SPECIMENS  OF  FOREIGN  BODIES  EXTRACTED 


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596 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CiiAr.  V, 


Several  examples  of  balls  or  other  foreign  bodies  remaining  within  the  cavity  of  the 
chest  for  seven  or  eight  years,  have  been  related.  Sufficient  time  has  not  elapsed  since  the 
war  to  afford  jrarallel  instances  to  those  recorded  by  Larrey  and  Hennen  and  Guthrie,  and 
those  readers  whose  appetite  for  the  marvellous  is  not  appeased  by  the  two  following  abstracts 
must  be  referred  to  the  works  of  those  authors  and  of  others  cited  in  the  foot-note 

Case. — Henry  Miltenberger,  Co.  K,  12th  Ohio  Cavalry,  aged  20  years,  was  injured,  June  9th,  1864,  at  Mount  Sterling, 
Kentucky.  In  a report  in  the  Medical  and  Surgical  Eeporter,  Vol.  XVI,  ji.  404,  Dr.  A.  Geiger  of  Dayton,  Ohio,  says:  “He  was 
struck,  at  Saltville,  V.u.,  April  7th,  1834,  by  a minie  ball  in  the  left  side;  the  ball  entered  at  the  lower  margin  of  the  seventh  rib  on 
a line  parallel  with  the  axilla.  He  bled  severely  at  the  time,  but  refused  to  be  carried  to  the  hospital,  and  remained  with  his 
comrades  in  camp,  and  after  five  days  started  on  horseback  with  General  Stoneman’s  brigade  into  Georgia,  South  Carolina,  etc., 
and  continued  with  his  regiment  until  the  close  of  the  war.  He  states  that  after  the  healing  of  the  wound  externally  he  did  not 
experience  much  inconvenience,  except  occasional  shortness  of  breath  and  inability  to  perform  active  exercise,  such  as  fast 
walking,  running,  etc.  After  being  discharged  from  the  army,  he  returned  home  and  engaged  in  work  at  his  trade,  that  of  a 
carpenter,  and  continued  to  enjoy  tolerable  good  health,  until,  some  time  in  September,  1866,  he  contracted,  by  exposure,  a severe 
cold,  since  which  time  he  has  had  some  cough  and  frequent  expectoration  of  blood.  Also,  at  times,  complete  aphonia,  with 
sense  of  sulibcation.  One  of  these  attacks  was  so  severe  as  to  produce  spasms  and  insensibility,  which  continued  for  several 
hours.  Oftentimes,  during  a severe  fit  of  coughing,  accompanied  sometimes  by  vomiting,  he  would  feel  the  presence  of  a hard 
body  in  the  wind  pii)e,  which  he  could  almost  at  the  time  cough  up.  On  the  26th  day  of  March,  1867,  after  having  been  at 
work  during  the  forenoon,  he  felt  so  unwell  at  noon  that  he  returned  home,  and,  in  a short  time  afterward,  was  taken  with  a 
severe  fit  of  coughing  and  soon  expectorated  a minie  ball,  weighing  three-fourths  of  an  ounce  and  the  one’ that,  nearly  thfee 
years  previous,  had  entered  the  left  side.  The  ball  was  covered  entire  with  a tough  mucous  coat,  and  the  small  cavity  at  the 
base  was  filled  with  pus.  Considerable  hminorrhage  followed  the  expectoration  of  the  ball,  but  the  relief  he  experienced  was  so 
great  that  he  rejoiced  to  be  rid  of  his  unpleasant  companion  that  for  so  long  a time  had  been  the  occasion  of  so  much  discomfort. 
He  still  continues  to  expectorate  small  quantities  of  blood  and  bloody  mucus,  but  he  considers  himself  so  much  better  that  he  is 
engaged  in  working  at  his  trade,  and  he  is  of  the  opinion  now  that  all  will  soon  be  right  with  him.  It  might  be  idle  to  speculate 
as  to  where  this  ball  has  been  during  this  long  period,  and  the  course  it  may  have  traveled  to  find  its  way  into  the  bronchi,  and 
then  to  the  trachea,  or  it  may  at  first  have  lodged  in  the  bronchia;  but  it  is  a remarkable  instance  of  the  ‘vis  medicatrix  naturw,’ 
in  an  otherwise  healthy  young  man,  and  of  the  surprising  efforts  nature  will  sometimes  make  to  rid  herself  of  an  incumbrance 
that  would  interfere  with  the  normal  action  of  her  functions.”  In  his  declaration  for  pension  Miltenberger  states  that  a ball 
entered  his  right  lung  and  lodged,  and  was  coughed  up  in  February,  1866.  Said  wound  has  caused  disease  of  the  lung  with 
constant  pain,  and  at  night  he  cannot  sleep  on  account  of  almost  constant  coughing.  In  a second  declaration  he  states  that  he 
was  treated  in  the  hospital  at  Lexington,  Kentucky,  for  two  months;  was  home  on  furlough  for  thirty  days;  was  afterwards 
treated  in  hospital  at  Camp  Dennison,  Ohio,  where  he  remained  until  March,  1865,  when  he  was  returned  to  his  regiment  for 
light  duty.  Pension  Examiner  C.  McDermont,  Surgeon  Nation,al  Military  Asylum,  Dayton,  Ohio,  under  date  of  January  26th, 
1871,  states  that  the  applicant  came  under  his  charge  in  the  winter  of  1866-7,  at  Dayton.  'When  called  to  see  him  he  was 
sufl'ering  from  intense  dyspnoea  and  had  to  be  constantly  prop])ed  up  in  bed.  The  symptoms  were  those  of  pneumonia.  During 
the  treatment,  he  expectorated  a ball  in  connection  with  bloody  mucus  and  pus,  and  soon  afterward  recovered  so  that  in  the 
following  summer  he  was  engaged  working  at  his  trade.  He  occasionally  called  to  see  him  about  his  lung,  which  he  stated  was, 
at  times,  so  painful  as  to  prevent  his  working.  He  was  not  present  when  Miltenberger  threw  up  the  ball,  but  saw  him  a few 
hours  afterward,  and  all  the  circumstances  of  the  case,  especially  the  marked  relief  which  the  discharge  of  the  ball  brought,  after 
about  four  days  of  intense  sufl'ering  from  dyspnoea,  compelled  him  to  believe  that  the  attack  was  due  to  the  presence  of  the  ball 
in  the  lung.  The  application  for  pension  is  still  pending.  The  official  reports  in  this  case  are  briefly  as  follows : That  the 
applic.ant  was  injured  at  Mount  Sterling,  Kentucky,  June  9th,  1864,  “by  the  falling  of  a horse,”  signed  by  Surgeon  George  W. 
Brooks,  12th  Ohio  Cavalry;  that  he  was  admitted  to  general  hospital  at  Lexington,  Kentucky,  June  12th,  1864,  with 
“contusion  of  muscles  of  the  back, — kick  of  a horse,  received  at  Blount  Sterling, — returned  to  duty  June  23d,  1864,”  signed  by 
Acting  Assistant  Surgeon  Robert  Peter;  “admitted  to  regimental  hospital,  July  19th,  1864,  with  diarrhoea;  sent  to  general 
hospital,  July  24th,  1864,”  signed  by  Surgeon  G.  'W.  Brooks;  admitted  to  Lexington  general  hospital  with  “inguinal  hernia  in 
right  iliac  region,  by  a kick  from  a horse;  furloughed  September  18th,  readmitted  October  16th,  transferred  October  17th, 
reported  at  Camp  Dennison,  Ohio,  October  23th,  1864,”  signed  by  Acting  Assistant  Surgeon  Robert  Peter;  “admitted  to  Camp 
Dennison,  October  26th,  1864,  with  inguinal  hernia;  furloughed  for  twenty  days,  February  22d,  1835;  readmitted  March  18th, 

* Delius,  of  Erlangen  {Amxnitates  Mediae  circa  casus  viedico-practicos  haud  vulgares,  Lipsia!.  1747,  Vol.  V,  p.  If)!),  speaks  of  a soldier  coughing 
up  a ball  long  after  the  reception  of  the  injury.  ItEViiiLLfi-PAlllsE.  Deux  observations  sur  des  corps  etrangers  qui  ont  sejourvi  dans  la  poitrinc  d,  la 
suite  des  plates  penetrantes  de  cette  partie;  in  Arch.  Gin.  de  Med.,  Mai,  1825,  T.  VlII,  p.  539,  relates  that  a Captain  of  the  115th  of  the  line  received 
in  October,  1813,  on  the  bank  of  the  Bidassoa,  a gunshot  wound  of  the  right  side,  the  ball  traversing  the  chest,  entering  through  the  shoulder-blade  and 
emerging  at  the  cartilage  of  the  fourth  rib  near  the  sternum.  He  expectorated,  twelve  days  afterwards,  a piece  of  blue  cloth  and  a small  sequestntm. 
A year  subsequently,  he  e.vpectorated  a larger  sequestrum,  and  then  recovered  his  health  completely  and  resumed  his  militarj'  duties.  lie  aftenvards 
married  and  begot  two  children.  In  1825,  he  enjoyed  good  health.  Baron  Percy  (/.  c.  p.  125)  tells  of  his  friend  M.  the  Marquis  of  Bavilly,  who  enjoyed 
good  health,  though  shot  in  the  chest  ten  years  before,  and  having  expectorated  many  patches,  and  even  pieces  of  tow  used  as  wadding.  Professor 
Gross  (Practical  Treatise  on  Foreign  Bodies  in  the  Airqiassages,  1854,  p.  58)  recalls  the  instance  recorded  by  Farricius  IIildaxus  (op.  om.,  p.  41,  ie82, 
already  cited  in  note  to  p.  591),  that  of  TULI’IUS  (Ohservat.  Medic.  Lib.  II,  obs.  15,  Amsterdam,  10.52),  and  that  of  Pigray  (Epitome  des  Priceptes  de 
midecine  et  chirurgie,  llouen,  1042),  of  necrosed  fragments  of  bone  and  pieces  of  tents  coughed  up  three,  four,  and  six  months  after  injury.  In  his  Sgstem, 
5th  cd.,  Vol.  II,  p.  400,  Professor  GROSS  cites  other  cases,  and  among  tlicm,  two  ‘‘of  the  spontaneous  expulsion  of  bullets  in  the  act  of  coughing.”  Dr. 
F.  II.  Hamilton  (Prin.  and  J^ract.  of  Surg.,  1872,  p.  11‘2),  misleads  his  readers  by  referring  fjr  the  above  ease  to  the  New  York  Medical  Kccord,  Jan.  15, 
1807,  which  contains  no  allusion  to  it. 


Sect.  III.] 


BALLS  AND  FOREIGN  BODIES  LODGED. 


597 


iiiid  rotuniod  to  duty  March  21st,  18(3.",”  signed  liy  Surgeon  C.  JIcDcnnont,  IT.  S.  V.  Tliis  is  all  the  ('vldcncc*  iircsented  hy  Iho 
otlicial  tiles  of  the  Sui'geon  General's  Oilice;  hut,  in  his  second  aiiplication,  tiled  at  the  Ih'iision  Jtureau,  Miltenbergiu- adds  tin' 
following  testimony  : “Wallace  K.  Hughes,  jM.  D.,  Berlin  Centre,  Mahoning  County,  Ohio,  under  oath,  declares  that  he  was  the 
surgeon  of  the  12th  Ohio  Cavahy,  and  that  he  treated  Miltenberger  while  in  the  service  aforesaid.  He  attended  Miltenberger 
during  the  time  between  June  9th,  18G4,  and  June  11th,  18G4,  and  March,  1865,  to  November,  1865.  At  the  battle  of  Mount 
Sterling,  Kentucky,  June  9th,  1864,  at  about  nine  o’clock  A.  JI.,  Miltenberger  was  wounded  by  a minic  ball  in  the  left  lung,  the 
ball  lodging.  He  was  sent  to  hospitals  and  did  not  again  return  until  in  IMarch,  1865,  and  I treated  him  from  March,  1865,  to 
muster-out  of  regiment,  November  14th,  1865,  for  said  wound.  Ball  I'emained  in  his  lung  up  to  date  of  his  di.seharge  and  had 
produced  phthisis  pulmonalis.”  The  official  arm}’  register  of  the  Volunteer  force  of  the  United  States  Army,  jtublished  by  the 
Adjutant  General,  Washington,  August  31st,  1865,  states,  Bart  V,  p.  19,  that  Surgeon  G.  W.  Brooks,  12th  Ohio  Cavalry, 
resigned  August  7th,  1865,  and  that  Assistant  Surgeon  Wallace  K.  Hughes,  12th  Ohio  Volunteers,  was  promoted  Surgeon, 
September  2t/th,  1865.  The  affidavit  of  Dr.  Hughes  is  not  in  accord  with  the  certificates  of  Drs.  Brooks,  Peters,  and  McDerniont, 
or  the  report  of  Dr.  Geiger.  The  apj)licant  informed  Dr.  Geiger  that  ho  was  wounded  at  Saltville,  Virginia,  April  7th,  1864, 
and  Dr.  Hughes  states  that  this  particular  wound  was  received  at  Mount  Sterling,  .lune  9th,  1864.  The  applicant  alleges  that 
he  expectorated  the  ball  in  February,  1866;  he  told  Dr.  Geiger  that  it  was  ejected  on  March  26th,  1867.  Erastus  Moderwell, 
late  Major  12th  Ohio  Cavalry,  testifies  to  knowing  Milteidierger  intimately,  and  to  the  wound  of  the  lung  as  above  stated,  and 
that  the  soldier  was  under  his  immediate  command.  Major  Moderwell  was,  himself,  pensioned  for  a very  curious  injury.  He 
was  rcporte<l  by  his  regimental  surgeon,  Dr.  George  W.  Brooks,  as  having  received  “a  severe  gunshot  lleshwound  of  the 
abdomen,  at  Mount  Sterling,  Kentucky,  June  9th,  1864.”  His  name  does  not  appear  on  the  registers  of  any  general  hospital. 
He  was  furloughed  for  eight  months,  and  then  served  with  his  regiment  till  its  muster-out  in  November,  1865.  In  his  a))plication 
for  pension.  Dr.  W.  K.  Hughes  certifies  that  “the  ball  entered  on  a line  with,  and  five  inches  to  the  left  of,  the  umbilicus  a.nd 
passed  directly  through,  coming  out  near  the  spine.”  Examining  iSurgeon  W.  C.  Brown,  of  Geneseo,  Illinois,  reports,  July 
25th,  1866,  “that  the  ball  entered  parallel  to  tbe  umbilicus  four  or  five  inches  to  the  left  and  made  its  exit  near  the  spine  on  the 
same  side.  The  result  of  this  injury  is  partial  paralysis  of  the  left  leg.”  The  same  surgeon  reports,  November  21st,  1871,  that 
“a  small  portion  of  the  transverse  ])rocess  of  spine  was  taken  away  by  the  ball.”  J^xaniining  Surgeon  S.  C.  Plummer,  Eock 
Island,  January  1st,  1872,  reports  that  the  “ball  entered  two  and  a half  inches  above  and  one  inch  in  front  of  anterior  superior 
process  of  left  ilium,  ranging  backward  and  upward,  nipping  the  transverse  process  of  the  third  lumbar  vertebra  and  escaj)ed 
about  one  inch  to  the  left  of  the  spinous  process.  The  left  leg  is  partially  jjaralj’zinl,  and,  in  changeable  and  damp  weather, 
becomes  so  painful  as  to  require  the  use  of  opiates.”  This  pensioner  was  last  paid,  March  4th,  1872;  his  pension  increased  to  the 
maximum  (or  $25  per  month)  from  November  7th,  1871.  The  Pittshurqli  Evening  Chronicle  publishes  this  as  an  interesting  case 
of  wound  penetrating  the  abdomen,  and  announces  that  the  ball  can  ied  in  with  it  a gold  pen,  which  afterward  worked  its  way 
out  at  the  neck  ! 

The  next  abstract  was  read  at  a meeting  of  the  Association  of  Army  and  Aavy  Sur- 
geons, at  Richmond,  at  the  conclusion  of  a valuable  report  on  Gunshot  Wou7ids  of  the 
Chest,  by  Surgeon  W.  G.  Thom,  P.  A.  C.  S.  The  particulars  were  communicated  to  the 
reporter  by  Surgeons  W.  Selden  and  W.  J.  Moore,  P.  A.  C.  S.  The  case  was  printed  in 
the  Confederate  States  Medical  aud  Surgical  Journal  for  April,  1864  f'' 

Case. — “Mr.  E.  D.  Q.,  22  years  old,  of  scrofulous  temperament,  in  .lanuary,  1840,  was  leaning  on  his  gun,  the  muzzle  iu 
contact  with  his  left  side,  when  it  exploded,  tearing  a hole  in  the  chest  of  three  or  four  inches  in  diameter,  carrying  with  the 
load  of  shot  fragments  of  the  third,  fourth,  and  fifth  libs,  and  the  whole  of  a very  large,  heavy  English  gold  patent-lever  watch, 
except  the  ring  to  which  the  chain  was  attached,  which,  singular  to  say,  was  found  in  the  lining  of  his  waistcoat  on  the  right 
side.  Dr.  Selden  found  the  jiatient  apparently  about  to  expire,  and,  from  the  impending  suffocation  upon  the  ingress  of  air 
within  so  large  an  opening,  he  could  make  no  exploration  of  the  wound.  Closing  the  wound  with  a large  compress  and  bandage, 
opium  and  stimulants  were  freely  administered.  Eeaetion  took  place,  and,  in  a fortnight,  sufficient  adhesions  were  established  to 
permit  exposure  of  the  cavity  of  the  wound  and  to  recognize  and  remove  the  metal  face  of  the  watch  from  some  six  inches  at 
the  bottom  of  the  wound.  For  several  weeks  fragments  of  the  watch  continued  to  jiresent  themselves  and  were  extracted,  some 
from  ujion  the  diaphragm,  others  below  the  clavicle.  The  lung  collapsing,  was  not  torn  to  pieces,  though  w'ounded  in  several 
points.  Both  the  heart,  covered  by  the  pericardium,  and  the  aorta  were  exposed  to  view  and  to  touch.  Supjiuration  was 
enormous;  haemorrhages  frequent.  The  collapsed  lung  became  bound  down  by  adhesions.  The  whole  side  of  the  thoi’ax  sank. 
Sustained  by  every  article  of  nutritious  food  calculated  to  supply  an  inordinate  aj)petite,  the  jiatient’s  recovery  was  slow,  until 
the  wound,  progressively  reduced,  could  only  admit  a female  catheter.  The  supervention  of  the  tintement  metalUque  dining  the 
progi'ess  of  the  case  offered  the  enviable  opportunity  of  viewing  the  cause  of  its  ]>roduction.  Drs.  Andrews  and  Higgins 
(whose  ]).atient  Mr.  D.  was),  were  perfectly  assured  that  the  bursting  of  the  bubble  on  the  surface  of  the  jms  was  the  rationale 
of  the  sound.  Fragments  of  watch  and  bone,  together  with  shot  and  other  extraneous  matters,  continued  for  some  time  to  be 

* The  original  histories  of  the  cases  of  transfixion  of  tlie  cliest  hy  a gig-shaft,  witli  recovery  of  thirteen  years'  iluralion,  iiiul  hy  an  iron-pointed 
try -sail  yard,  in  the  person  of  a sailor,  who  suivived  many  years,  are  presened,  witli  the  instruments  of  penetration,  in  the  Hunterian  JInsemn  (sec  Hr. 
EAltLE's  account.  Am.  Jrmr.  Med.  Sci.,  N.  .S.,  Vol.  It.  p.  117).  Jlr.  .SOUTH  gives  a good  account  of  them  in  ids  Xiiles  to  Clielius.  Hr.  IIoi'STOX,  of 
Wheeling  (Am.  Jour.  Med.  Sci.  X.  S.,  Vol.  I.X,  p.  3-12),  records  a case  in  wliich  a piece  of  coarse  linen,  two  inches  and  a half  in  length  hy  two  in  width 
when  unrolled,  the  patch  of  a ball  that  had  pertbratod  the  lower  lobe  of  the  right  lung  twenty-five  years  previously,  was  found,  after  death,  in  a cavity 
opposite  the  fifth  intercostal  space.  The  cavity  was  lined  with  a tough  membrane,  and  communicated  with  several  hronehial  tubes.  The  speeiincn  was 
presented  to  the  Wistar  Museum.  .Surgeon  J.  .1.  li.  WluoilT's  account  of  the  case  of  (lencral  .Shields,  whose  right  chest  was  jierforated  hy  a canister 
shot  at  Cerro  Gordo,  April  18,  1847,  may  serve  the  junior  medical  officers  us  a model  clinical  history.  It  is  iirinted  in  Hr.  E.  II.  llA.MlLTOX's  J’raclical 
Treatise  on  Military  Surgery,  New  York,  ISfd,  p.  157. 


598 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[ClIAP.  V, 


ejected  by  expectoration  with  sputa.  Mr.  D.  possesses  now,  every  part  of  the  watch  except  tlie  liands,  a considerable  portion  of 
the  small  worls  having  been  expectorated.  Tbe  openings  into  the  lung  were  of  sufficient  size  to  allow  a current  of  air  to  escape, 
and,  if  directed  against  the  dame  of  a candle  to  extinguish  it.  Mr.  D.’s  liealth  continues  feeble,  but  is  as  robust  as  it  had  been 
during  the  past  five  years.” 

The  surgeon  will  not  forget  that  it  is  possible  that  the  ball  supposed  to  have  lodged 
in  the  chest  may  have  pouclied  the  clothing  and  been  withdrawn  when  the  patient  was 
undressed,*  and  on  the  other  hand  that  two  opposite  wounds  do  not  necessarily  imply 
perforation  by  a hall,  hut  may  indicate  the  lodgment  of  two  balls.  Of  halls  passing  from 
the  chest  into  the  abdomen,  and  voided  at  stool,  some  remarkable  examples  have  been 
adduced.  Of  those  encysted  in  the  lung  substance,  and  the  local  alterations  to  which  they 
give  rise,  and  of  those  producing  abscesses  and  thoracic  fistulm,  I shall  have  something  to 
add  farther  on.  They  are  less  dangerous  than  those  that  lie  free  in  the  cavity,  rolling  on 
the  diaphragm.  Such,  Baudens  would  have  us  search  for  with  a sound,  armed  with  a 
sharp  stylet,  to  be  thrust  through  the  intercostal  space  from  within  outward,  as  a guide 
for  incision,  when  the  seat  of  the  foreign  body  is  detected.  I concur  with  M.  Legouest 
that  it  is  better  to  make  the  incision  without  this  dangerous  auxiliary.  I think  that  the 
experience  I have  endeavored  to  sum  up  fully  warrants  the  employment,  with  due  dis- 
cretion, of  persevering  efforts  to  detect  and  extract  foreign  bodies  from  the  chest  in  the 
very  limited  number  of  cases  in  which  there  is  a probability  that  the  search  can  be  success- 
fully  prosecuted  without  jeopardy  to  life, — which,  perhaps,  is  but  a restatement  of  the 
pi'oposition  in  different  terms.  I have  ventured  to  include  with  the  operations  the  all- 
important  subject  of  the  treatment  of  wounded  arteries  in  the  clavicular  region,  an 
innovation  which  I trust  my  colleagues  will  approve.j* 

The  section  may  be  concluded  with  the  following  summary  of  operations  on  the  chest; 

Table  XXIII. 


Numerical  Statement  of  Four  Hundred  and  Ninety-four  Oi:)eration8  in  Cases  of  Injuries 

or  Diseases  of  the  Chest. 


OPERATION. 

Cases. 

Died. 

Discharged. 

Duty. 

Result 

Unknown. 

‘25 

20 

5 

Ligation  of  the  Internal  Mammary 

‘2 

2 

Ligation  of  tlie  Suprasca])ular 

1 

1 

8 

6 

2 

Ligation  of  the  Axillary 

13 

13 

Ligation  of  Branches  of  the  Axillary 

2 

1 

1 

Excision  tif  portions  of  tlie  Clavicle 

11 

7 

4 

4 

1 

2 

1 

Excisions  of  portions  of  the  Ribs 

4 

1 

3 

84 

24 

42 

18 

24 

15 

2 

Extraction  of  Balls  and  other  Foreign  Bodie.s 

316 

108 

119 

81 

8 

Aggregate 

494 

198 

185 

103 

8 

* Else  he  may  be  subjected  to  the  mortification  experienced  by  the  surgeon  mentioned  by  Dr.  FRASElt,  into  whose  charge  fell  an  officer  who  bore 
his  rough  pokings  patiently  for  a considerable  time,  and  then  inquired,  “ What  are  you  doing?  " and  met  the  reply,  “ Searching  for  the  ball, with  the 
ejaculation.  “ I wish  you  had  said  so  earlier,  because  you  will  find  it  in  my  waistcoat  pocket.”  It  is  remarkable  that  identically  the  same  incident 
occurred  to  Bordenave  in  the  case  of  the  Marquis  de  Besons  (see  Bagif.u,  Examtn  de  Plusieurs  Parties  de  la  Chirurgie,  Baris,  175fi,  p.  25). 

t Since  the  achievements  of  Dr.  Billroth  and  others  in  tbe  recent  Franco-German  war,  I am  led  to  regard  the  management  of  wounds  liable  to 
involve  the  great  vessels  at  the  upper  part  of  the  chest  as  perhaps  the  most  important  field  of  study  for  those  who  occupy  themselves  with  questions  of 
jvhat  the  French  term  la  haute  chirurgie. 


Sect.  III.  ] 


KECAPITULATION  AND  GENERAL  OBSERVATIONS. 


599 


Section  IV. 

, WOUNDS  AND  INJURIES  OF  THE  CHEST. 

Mortality,  Complications,  Diagnosis,  Treatment. 

In  the  preceding  sections  of  this  Chapter  some  particulars  have  been  presented  of 
five  hundred  cases  of  wounds  of  the  chest,  and  more  general  reference  has  been  made  to  an 
aggregate  of  over  twenty  thousand  such  injuries,  distributed  as  follows  ; 

Table  XXIV. 


Numerical  Statement  of  Twenty  Thousand  Six  TIundred  and  Seven  Cases  of  Wounds  and 
Injuries  of  the  Chest  reported  during  the  War. 


ClIARACTEU  OF  WOUND. 

Cases. 

Died. 

Discharged. 

Duty. 

Undeter- 

mined. 

Ratio  of 
Mortality. 

9 

1 

4 

4 

11 1 

Bayonet  Wounds 

29 

9 

6 

12 

2 

33.3 

27 

8 

5 

14 

29  6 

6 

4 

1 

1 

66.  6 

225 

5 

15 

205 

2.2 

Simple  and  Compound  Fractures  of  Ribs,  not  gunshot 

47 

4 

9 

25 

9 

10. 5 

Gunshot  Flesh  Wounds 

11,  549 

113 

1, 790 

8,988 

658 

1.0 

Gunshot  Penetrating  Wounds 

8,715 

5,260 

1,939 

1, 204 

312 

62.5 

Totals 

20, 607 

5,404 

3,769 

10, 453 

981 

27.5 

It  might  be  supposed  that,  with  so  large  a body  of  facts  determined  with  reasonable 
accurticy,  and  the  total  number  of  wounded  being  known  ajiproximatively,  it  would  be  easy 
to  compute  the  relative  frequency  of  wounds  of  the  chest  and  of  those  received  in  other 
regions  of  the  body.  But  it  must  be  considered,  that  the  complete  statistics  of  the  battle- 
field are  never  ascertained.  In  engagements  of  magnitude,  the  number  of  killed  in  action 
is  rarely  determined  with  precision,  for  both  victors  and  vanquished  report  many  “missing,* 
whose  fate  is  unknown.  The  exact  information  we  possess  of  the  character  of  the  wounds 
of  those  known  to  have  been  killed,  is  comparatively  small.  Doubtless,  a large  proportion, 
perhaps  the  largest  proportion,  of  speedily  mortal  wounds,  are  attended  by  lesions  of  the 
lungs  or  great  vessels.  The  men  fall  and  die,  more  or  less  rapidly,  from  syncope  or 
asphyxia ; but  all  precise  knowledge  of  the  nature  of  their  injuries  is  lost. 

If  it  is  attempted  to  frame  estimates  from  the  number  of  wounded  coming  under 
treatment  only,  other  difficulties  arise.  Several  wounds  in  the  same  individual  are 
vommon,  and  the  same  ball  traverses  frequently  several  organs  or  regions.  Therefore, 
approximations  only  are  attainable.  The  figures  in  Table  XXIV  are  taken  from  lists 
including  the  names  and  descriptions  of  injuries  of  two  hundred  and  fifty-three  thousand 
one  hundred  and  forty-two  (253,142)  wounded  men.'“'  Hence,  it  may  be  rouglily  stated 
that  the  proportion  of  wounds  of  the  chest  to  the  wlrole  numlier  received  in  field  or  siege 
operations  was  about  one  in  twelve. 

*When  the  lists  have  been  exhaustively  compared  and  verified,  it  is  estimated  that  this  aggregate  will  bp  augmented  to  about  two  hundred  anil 
seventy  thousand  (i270,000)  eaises  of  wounded  men  reported  by  name. 


600 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


For  tlie  last  year  of  the  War,  nearly  complete  numerical  returns  of  all  the  wounded 
in  action,  in  the  Union  Army,  exclusive  of  those  killed  in  battle,  are  available.  In  the 
following  statement  (Table  XXV)  is  set  forth  the  relative  proportion  of  wounds  of  the 
thoracic  walls  and  cavity  to  the  total  number  of  wounds,  excluding  only,  a few  reports  in 
which  the  flesh  and  penetrating  wounds  were  not  distinguished.  The  Confederate  wounded 
that  came  under  our  care,  are  not  included  in  this  return.  It  will  be  seen  that  the  mean 
proportion  of  all  chest  wounds  (7,173)  to  the  aggregate  of  wounds  of  all  regions  (105,540) 
is  a little  less  than  one  in  fifteen.  The  highest  ratio  is  for  the  open  field  fighting  of  the 
Army  of  the  Shenandoah  (9.38  per  cent.,  or  about  one  in  ten) ; the  lowest  for  the  force 
besieging  Mobile  by  regular  approaches  (3.83  per  cent.,  or  one  in  twenty-six  nearly). 
The  ratio  is  explained  by  the  unusual  predominance  of  the  proportion  of  head  injuries 
among  these  entrenched  troops. 

Table  XXV. 


Partial  Numerical  Statement  of  Gunshot  Wounds  of  the  Chest  in  the  Field  or  Primary 
Hospitals  in  various  Carupaigns  during  the  last  year  of  the  Rebellion,  1864-65. 


Battles,  Action,  or  Series  of  Engagements. 

WOtINDS  OF 

Thoracic  Farietes. 

Penetrating 
■Wounds  of  Chest. 

Missile. 

Total  'Wounded.  | 

Percentage  of  | 

Chest  'Wounds,  i 

Names  or  dates. 

Cases. 

Deaths. 

Cases. 

Deaths. 

Large  projec- 
tiles, casnoD 
shot.  »IieU, 
and  bomb  frag- 
ments, grape, 
and  canister. 

Small  proiec- 
tiles,  muvkct, 
carbine,  riilc, 
pistol  balls, 
and  small  mis- 
siles ftom 
shrapnel  and 
canister. 

*Army  of  the  Potomac  from  May  4th  to  August  31st,  1864 

1,013 

0 

1, 025 

366 

220 

2,  392 

38, 944 

6. 77 

Armies  of  the  Cumherland,  Tennessee,  and  Ohio  during  the 

Campaign  to  Atlanta  from  May  4th  to  September  8th,  18P4. . 

818 

28 

908 

408 

100 

1,618 

23, 308 

7.66 

Armies  of  the  Cumberland,  Tennessee,  and  Ohio,  and  Cavalry, 

General  Hood’s  invasion  cf  Tennessee,  from  October  25th  to 

December  31st,  1864 

132 

2 

86 

16 

19 

195 

3,010 

0.03 

General  Sherman’s  Campaign  in  1865  through  the  Carolinas. .. 

56 

1 

52 

22 

1 

105 

1,  553 

7.04 

Armies  cf  the  James  and  Ohio,  etc.,  from  Fort  Fisher  to  Golds- 

boro’,  N.  C.,  1865 

43 

1 

53 

13 

21 

70 

1,075 

8. 93 

Army  of  the  West  Mississippi  during  the  siege  of  IMobile,  from 

43 

38 

3 

14 

61 

2 111 

3 83 

Anny  cf  the  James  during  General  Grant’s  Campaign  against 

Petersburg  from  May  4th,  1864,  to  April  Cth,  1865 

475 

5 

400 

107 

86 

808 

16, 120 

5.80 

Engagements  in  the  Shenandoah  Valley,  May  4th  to  August 

2Cth,  18C4 

126 

3 

80 

22 

16 

189 

2, 196 

9.38 

Campaign  in  the  Shenandoah  Valley,  Aug.  21st  to  Dec.  3Cth,  1864. 

303 

193 

38 

38 

451 

7,542 

6.57 

*Army  cf  the  Potomac  from  Sept.  1st,  1864,  to  Apiil  9th,  1665. . . 

.301 

8 

248 

75 

30 

530 

9,101 

6.69 

Aggregate 

3,  970 

54 

3,203 

1,070 

545 

6,419 

105,  540 

6.79 

M.  Scrive,  from  extensive  data,'}*  derived  from  the  French  returns  from  the  pitched 
battles  in  the  Crimea  and  from  the  trenches  before  Sevastopol,  estimates  the  relative 
frecj^uency  of  chest  wounds  in  the  total  of  wounded  as  one  in  twelve  in  siege  operations, 
and  one  in  twenty  in  open  field  fighting. 

* Incomplete. 

tSciiiVli,  Relation  HHico-ChirurQicalc  de  la  Campagne  d' Orient^  P.^iris,  J857,  p.  443.  The  author  gives  the  relative  frequency  of  wounds, 
according  to  their  spat  in  the  principal  divisions  of  the  body  as,  in  sieges : For  the  head,  1 in  3.4  ; the  neck,  1 in  4G ; for  the  chest,  1 in  12 ; for  the 
abdomen  1 in  15;  the  upper  extremities,  1 in  G.2;  the  lop^er  extremities,  1 in  4.3.  In  open  field  actions:  For  the  head,  1 in  10;  the  neck,  1 in  112;  the 
phpst,  1 in  20 ; the  abdomen,  1 in  40 ; the  upper  extremities,  1 in  4.3 ; the  lower  extremities,  1 in  3.5. 


Sect.  IV.]  RELATIVE  FREQUENCY  OF  CHEST  WOUNDS.  601 

In  the  British  Army  in  the  Crimea,  the  proportion  of  chest  wounds  to  the  aggregate 
in  which  the  seat  of  injury  was  determined  was  as  one  in  sixteen.^ 

M.  Chenu  gives  the  relative  frequency  of  chest  wounds  to  the  total  number  of  wounded 
in  the  French  Army  in  the  Crimea”  as  one  in  twelve  and  one-sixth,  and  in  the  Italian 
war  of  1859,^  as  one  in  thirteen  and  eight-tenths. 

Dr.  StromeyeF  gives  the  proportion  of  chest  wounds  in  thirteen  hundred  and  ninety- 
four  hospital  cases  of  wounded  under  his  care  at  Langensalza,  as  one  in  twelve  and 
six-tenths.  After  the  battle  of  Idstedt,®  in  the  Danish  AAar  of  1855,  he  treated  twelve 
hundred  and  ten  cases,  and  the  iiroportion  of  chest  wounds  was  nearly  one  in  twelve. 

Demme* *’  tabulated  the  wounds  of  eight  thousand  five  hundred  Austrians,  and  of  eight 
thousand  five  hundred  and  ninety-five  French  and  Piedmontese,  in  the  hospitals  at  Pavia 
and  Brescia  and  Milan,  in  1859,  and  made  the  proportion  of  chest  wounds  to  the  aggregate 
one  in  twelve  and  a half  for  the  former,  about  one  in  fourteen  in  the  latter. 

Professor  H.  Maas,’’’  of  Breslau,  had  under  his  charge  in  the  Silesian  campaign  of  the 
Six-Weehs  War,  two  hundred  and  twelve  wounded,  of  whom  eighteen,  or  one  in  twelve, 
had  chest  wounds.  Professor  H.  Fischer®  treated,  at  the  siege  of  Metz,  eight  hundred 
and  seventy-five  wounded,  the  proportion  of  chest  wounds  being  about  one  in  twelve. 

Dr.  Bernhard  Beck**  reports,  after  the  action  at  Tauberbischofsheim,  fifty-seven 
wounded,  with  a proportion  of  chest  wounds  of  about  one  in  ten.  The  same  distinguished 
surgeon^®  reports  the  cases  of  four  thousand  three  hundred  and  forty-four  wounded  in  the 
engagements  about  Strasburg,  in  1870,  of  which  one-twelfth  were  chest  wounds.  Dr. 
SerrieP^  long  since  collected,  from  observations  by  H.  Larrey,  Jobert,  Dupuytren,  and 
Baudens,  the  statistics  of.  seven  hundred  and  eighty-four  cases  of  gunshot  wounds,  of 
which  fifty-three,  or  nearly  one  in  fifteen,  were  in  the  chest.  But  it  is  needless  to  recapit- 
ulate statistics  so  often  copied. 

After  Sedan,  six  hundred  and  ten  wounded  were  treated  at  the  Anglo-American 
ambulance  at  the  chateau  of  Asfeld,  on  the  battle-field,  about  one-twelfth  having  received 
chest  wounds.  Mr.  MacCormac^^  has  carefully  classified  these  injuries. 

^ The  total  number  of  Dritish  officers  wounded  during  the  Crimean  War  was  579,  of  which  number  54,  or  about  1 in  10,  received  chest  wounds. 
During  the  period  from  the  debarkment  till  the  end  of  March,  1855,  there  were  reported  among  non-commissioned  officers  and  men  4,434  wounded ; but 
in  1,815  of  these  the  seat  of  injury  was  undetermined.  Of  the  remaining  2,619  cases  of  wounds,  153  were  of  the  chest.  During  the  second  period,  from 
April  1,  1855,  to  the  end  of  the  War,  the  wounded  non-commissioned  officers  and  men  reported  numbered  7,153,  from  which  72  cases  remaining  under 
treatment  and  enumerated  in  the  first  category  should  be  deducted,  leaving  7,C81  determined  cases,  of  which  420  were  chest  wounds.  Hence, 
579  4-  2,619  + 7,081  = 10,279,  or  the  aggregate  of  determined  cases  of  wounds,  and  54  -p  153  -fi  420  = 627,  the  total  of  chest  wounds,  and 
10,279  627  = 16.3,  the  proportion  of  chest  wounds  to  the  aggregate. 

^ M.  Chknu  {op.  cii.,  pp.  627,  636)  gives  the  total  killed  and  wounded  of  the  French  Army  in  the  Crimea  as  50,826.  Deducting  10,240  killed,  there 
remain  40,586  wounded.  In  34,306,  the  seat  of  injury  was  reported,  and  2,818  were  returned  as  wounds  of  the  chest,  or  1 in  12  1-6. 

* In  the  Italian  War  of  1859,  M.  Chenu  {op.  ci7.,  T.  II,  pp.  474,  851)  states  the  French  losses  from  the  enemy's  fire  at  19,590,  including  2,536  killed 
outright.  Of  the  remaining  17,054  wounded,  1,052  received  wounds  of  the  chest,  or  J in  16.2. 

^ Stromeyeu,  L.  Erfahrungen  iiber  Schusswunden  im  Jahre  1866,  Hannover,  1867,  S.  18.  Of  1,394  cases  of  gunshot  wounds,  110,  or  1 in  12.6, 
were  of  the  chest. 

*DERSEL15E.  Maximen  der  Kriegsheillcunst,  Hannover,  1855,  S.  585.  “ Of  1,210  wounded  near  idstedt,  97  had  injuries  of  the  thorax,”  or  1 in  12.4 

® Demme.  Miliidr-Chirurgische  Studien^  Wurzburg,  1861,  Erste  Abth.,  S.  19.  Of  8,500  wounded  Austrians,  C80  were  struck  in  the  chest,  or  1 in 
12.5;  of  8,595  French  and  Sardinian  wounded,  595  Iiad  chest  wounds,  or  1 in  14.4. 

^Maas,  H.  Kriegschirurgische  Eeitrdge,  Breslau,  1870,  S.  72.  At  the  hospital  at  Kachod,  in  central  Silesia,  Professor  Maas  treated  212  wounded 
Prussians,  among  whom,  18,  or  1 in  11.7,  had  been  struck  in  the  chest. 

® Fischer,  H.  Kriegschirurgische  Erfahruvgen,  Erlangen,  1872,  Theil  I.,  S.  28.  At  the  hospitals  of  Forbach,  Styringen,  Keuenkirchen,  and 
Ottweiler,  under  Professor  Fischer's  charge,  of  a total  of  S75  cases  of  wounds,  76,  or  1 in  11.5,  were  of  the  chest. 

Beck,  B.  Kriegschirurgische  Erfahrungen^  Freiburg  i.  B.  1867,  p.  26.  Of  57  cases,  the  chest  was  injured  in  6,  or  l.in  9.5. 

*®Derseliie.  Chirurgie  der  SchussverUtzungen,  Freiburg  i.  B.,  1772,  Erste  llalftc,  S.  160.  Dr.  Beck  was  genenilarzt  of  the  fourteenth  German 
corps,  the  Bavarian  army  corps  of  General  Werder,  in  the  late  Franco-German  war.  He  reports  an  aggregate  of  4,344  wounded,  of  which  361  had  chest 
wounds,  or  1 in  12.03. 

**  Serrier.  Traiti  de  la  Nature,  des  Complications,  et  du  Traitement  des  Plaies  d'Armes  d Feu,  Paris,  1844,  p.  30. 

•^MacCORMAc,  W.  Notes  and  Recollections  of  an  Ambulance  Surgeon,  being  an  Account  of  Work  done  under  the  Red  Cross  during  the  Cam- 
paign  of  1870,  London,  1871,  p.  127.  M.  Duplessis,  chief  physician  of  the  military  liospitals  at  Sedan,  placed,  on  August  31,  1870,  the  day  before  tho 
great  battle,  the  barracks  at  Asfeld,  a hospital  of  384  beds,  in  charge  of  the  16  surgeons  of  the  Anglo-American  Ambulance.  Mr.  MacCorniac  reports 
that  they  received  610  wounded,  of  whom  54  had  received  wounds  of  the  chest,  or  1 in  11.29. 

70 


602 


AVOUNDS  AKD  lAMUIlIKS  OF  TIIP:  CHEST. 


[CliAr.  V, 


Tims  a comparison  of  the  returns  ol'  the  War  of  the  Kehellion  Avith  those  from  the 
Crimea,*  the  Danisii,  Italian,  Bohemian,  arul  Franco-German  aath's,  i)resents  a remarkable 
uniformity  in  the  comparatiA’e  frecjuency  of  Avouiids  according  to  their  seat. 

Of  information  regarding  the  seat  of  injury  in  those  killed  in  battle,  Ave  possess  but 
little,  and  that  little  is,  ibr  the  most  part,  in  the  shape  of  general  observations,  insuscep- 
tible of  reduction  to  numerical  estimates.  Dr.  Fraser  remarks  that  “if  it  Avere  not  for 
the  financial  objection,  a special  staff  of  medical  men  might  Avell  be  employed  during 
circumstances  similar  to  that  in  which  the  army  Avas  placed  before  Sebastopol,  or  in  any 
standing  camp  before  an  enemy,  to  ascertain  the  kinds  of  Avounds  Avhich  kill  on  the  field.” 
The  humane  objection  comes  in  also  ; for,  in  large  conflicts,  the  medical  staff  is  invariably 
insufficient  numerically,  and  all  auxiliaries  are  brought  into  requisition.  Yet,  in  our  lines 
before  Petersburg,  a zealous  and  indefatigable  surgeon,  to  Avhose  contributions  to  field 
surgery  I have  such  frequent  occasion  to  advert,  found  time  to  examine  nearly  all  of  the 
dead  bodies  left  on  the  field  after  a brisk  and  deadly  assault.  This  obserAmtion  of  Surgeon 


* 1 take  the  liberty  of  quoting  entire  Dr.  Fraser  s tables  of  the  chest  wounds  in  the  British  anny  in  the  Crimea,  and  of  the  relative  frequency  and 
mortality  of  this  class  of  injuries  in  other  campaigns.  The  information  contained  in  Table  V has  been  cited  by  many  authors,  with  scanty  acknowledg- 
ment. and  usually  with  slight,  but  not  advantageous,  alterations.  I agree  wffth  Dr.  Fraser  and  Dr.  Neudorfer  {Ilandhuch  dcr  Kriegschirurgie,  Leipzig, 
1867,  8.  553)  that  tlie  153  chest  w’ounds  of  the  first  period  in  the  Crimean  war  should  be  added  to  the  summary,  and  have,  accordingly,  added  them  in  the 
statement  in  the  text. 


“ Table  IV . 


Statistics  of  AVounds  of  tiik  Chest. 

I'otal  JVumher  of  all  Wounds,  1’2,094,  in  the  Crimean  War. 

WOUNDS. 

Cases. 

Per  Cent. 

TO  lOTAL  KUMBEIl  WOUNDED. 

I’erceritage  of  all  chest  wounds  to  total  number 

474* 

3.00 

wounded. 

Percentage  of  actual  lung  wound  to  total  number 

164 

1.35 

wounded. 

IMortality  of  all  chest  wounds  to  total  number 

135 

1.11 

wounded. 

JMortality  of  actual  lung  wound  to  total  number 

130 

1.07 

wounded. 

TO  TOTAL  STRENGTH. 

Percentage  of  all  chest  wounds 

474 

0.54 

I'ercentage  of  actual  lung  wounds 

104 

0.17 

Mortality  of  all  chest  wounds 

135 

0.14 

INIortality  of  actual  lung  wound 

130 

0.13 

I Mortality  of  all  chest  wounds . . . 
I Mortality  of  actual  lung  wound. 


Cases. 


474 

164 


Deaths. 


135 

130 


Per  Cent. 


28.  50 
70. 26 


* To  this  number  ought  properly  to  be  added  153,  being  the  number  of 
chest  wounds  received  during  the  first  period  of  the  war,  of  which  32  are 
reported  to  have  died,  making  a graml  total  of  627 ; but,  as  the  data  for  the 
first  jieriod  of  the  war  is  uncertain,  the  number  has  not  been  admitted  into 
the  calculation. 


Table  V. 

Showimj  the  A’umbcr  of  Chest  Wounds  on  the  occasions  named, 
a7i(l  from  the  Authorities  quoted,  with  the  Fercentage  of 
Deaths  to  Wounded. 


ACTIONS,  Etc. 

Wound. 

Died. 

Per  Cent. 

The  Director-General's  Records  prior  to 

39 

27 

70.00 

Crimean  War. 

Crimea 

474 

135 

28.50 

Sympheropol  (Russians) 

200 

197 

98.05 

Toulouse 

106 

50 

50.  00 

Quebec 

26 

2 

7.07 

Carlist  War 

29 

27 

100.  00 

Paris,  1830 

20* 

10 

50.00 

Paris,  1848 

9 

4 

44.  00 

Paris,  1850  

H 

5 

45.  30 

Battle  of  Kilet 

21 

11 

50.00 

Battle  of  Idstedt 

97 

17 

17.00 

Battle  of  Canton 

4 

4 

100.00 

M.  Meniere 

20 

20 

100.  00 

M.  Legouesl 

6 

3 

50.00 

Guy’s  Hospital  Reports 

72t 

9 

12.50 

Danish  War;  Report  of  Chief-Surgeon 

10 

2 

20.00 

Schytz.  Total  wounded,  227. 

Dr.  Kidd 

36 

24 

66.00 

Aggregate - . 

1,180 

547 

* De  Lumballe  and  Baudeiis. 

t Of  (his  number,  the  lung  was  really  wounded  in  two  cases  only.’ 


Sfxt.  IV.] 


RELATIVE  EREQUENCY  OF  CHEST  WOUNDS. 


603 


J.  A.  Liclell,  U.  S.  V.,  lias  already  been  recorded.^  On  the  morning  of  March  25th,  1865, 
he  examined  forty -three  bodies  of  soldiers  killed  in  the  combat  near  Fort  Steadman,  in 
the  lines  before  Petersburg;  twenty-three  were  shot  in  the  head,  fifteen  in  the  chest,  and 
five  in  the  abdomen.  “ The  bodies  of  all  those  wounded  in  the  abdomen  were  very  much 
blanched,  as  if  they  had  died  of  hgemorrhage,  and  the  same  remark  held  true  in  regard  to 
all  but  two  or  three  of  those  wounded  in  the  chest.”  On  the  evening  of  March  14th, 
1862,  I examined  the  bodies  of  nearly  all  of  those  killed  before  New  Berne,  and  ascer- 
tained the  seat  of  injury,  and  in  subsequent  engagements  of  the  Ninth  and  Eighteenth 
Corps,  in  North  Carolina,  I augmented  this  list  to  an  aggregate  of  seventy-six  observations 
of  the  bodies  of  those  slain  on  the  field.  The  mortal  wound  was  in  the  head  in  twenty- 
seven  ; in  the  neck  in  four,  including  two  in  which  the  ball  lodged  in  the  cervical  spine  ; 
in  the  chest  in  thirty-two,  the  heart  or  great  vessels  being  perforated  in  eight,  at  least ; 
in  the  abdomen  in  nine;  in  the  extremities  in  four.  In  one  of  the  last  division,  the 
femoral  artery  was  cut  nearly  across  ; in  another  the  thigh  was  torn  completely  away  by 
cannon  shot ; and  in  the  two  others,  there  was  frightful  comminuted  fracture  of  the  upper 
part  of  the  femur  from  large  projectiles. 

In  the  carefully  compiled  statistics  of  the  New  Zealand  War  of  1863-5,^  the  chest 
wounds  in  a total  of  wounded  of  four  hundred  and  sixty-three,  numbered  again  about  one 
in  twelve;  and  in  one  hundred  and  eighteen  cases,  in  which  the  region  of  the  body 
wounded,  in  men  killed  outright  on  the  battle-field,  was  accurately  ascertained,  the  mortal 
wound  was  found  in  the  head  in  forty,  the  neck  in  four,  the  chest  in  fifty-nine,  the  abdomen 
in  eleven,  the  thigh  in  four  ; the  chest  wounds  equalling  in  numbers  all  the  others. 

General-Arzt  F.  Loeffler  reports^  the  seat  of  injury  in  three  hundred  and  eighty-seven 
Prussians  killed  in  the  Danish  War  of  1864.  The  chest  wounds  numbered  one  hundred 
and  seventeen,  or  about  one-third. 

That  of  those  killed  in  battle,  from  one  third  to  one  half,  and  of  those,  wounded  in 
action,  one  twelfth,  receive  wounds  of  the  chest,  may  be  accepted  as  very  near  the  truth. 

* Surgical  licport  in  CIRCULAR  KO.  6,  S.  G.  O.,  1865,  p.  29,  and  Libell,  On  the  Wounds  of  Blood-vessels^  etc.,  already  cited,  New  York,  1870,  p.  12. 

^MOUAT,  J.,  Special  Report  on  Wounds  and  Injuries  received  in  Battle  in  the  New  Zealand  TFar  of  1863-4-5.  Extracted  from  the  Medical  and 
Surgical  History  of  the  New  Zealand  'War,  London,  1867,  in  Volume  VII  of  the  Statistical,  Sanitary,  and  Medical  Reports  of  the  Army  Medical 
Department,  presented  by  Director-General  T.  G.  Logan.  Of  463  wounded,  38  or  8.2  per  cent.,  received  wounds  of  the  chest,  or  about  1 in  12. 

3 1 venture  to  quote  entire  Dr.  Loeffler’s  invaluable  table,  from  his  GcnerahBericlit  iiber  den  Gesundheitsdienst  ini  Feldzuge  gegen  Bdnemark,  1864, 
Berlin,  1867,  Erster  Theil,  S.  46: 


INJURED  REGION. 

• 

PRUSSIANS. 

DANES. 

Total  killed  and  , 

wounded. 

Killed. 

Wounded. 

Died  of  Wounds. 

Total  of  killed  and 
died. 

Total  wounded. 

Fatal. 

C 

3 

^ o 

'goo 

Died  later.  i 

Total  died 
from  wounds. 

Died  within 
24  hours. 

Died  later. 

Total  died. 

Head 

468 

196 

272 

13 

12 

25 

221 

120 

8 

14 

22 

48 

8 

40 

3 

1 

4 

12 

26 

o 

o 

Chest 

254 

117 

137 

20 

37 

57 

174 

113 

15 

61 

76 

Abdomen  and  Pelvis 

147 

44 

103 

34 

25 

59 

103 

89 

31 

26 

57 

fjpinc  and  Back 

39 

7 

92 

3 

24 

27 

34 

80 

6 

26 

32 

610 

2 

608 

o 

' 51 

53 

317 

62 

()2 

Lower  Extremities 

720 

13 

716 

7 

83 

90 

103  _ 

458 

6 

140 

146 

Aggregate 

23.55 

387 

1968 

82 

233 

315 

702 

1203 

66 

331 

397 

604 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


» 


Mortality  of  Woxmds  of  the  Chest. — Great  diversity  of  opinion  Las  existed  and  still 
exists  as  to  tlie  comparative  fatality  of  chest  wounds.  With  the  data  mow  available  an 
approximate  solution  of  this  problem  should  be  attainable,  and  I propose  to  offer  facts  that 
must,  if  not  controverted,  determine  the  question,  from  the  statistical  point  of  view. 

If  we  assume  the  relation  of  chest  wounds  to  the  aggregate  of  wounds  to  be  about 
one  in  twelve,  or  8.3  per  cent.,  we  find,  in  the  first  place,  that  the  mortality  of  chest 
wounds  greatly  exceeds  the  average.  Dr.  B.  Klebs^  made  autopsies  in  the  cases  of  all 
those  who  died  in  the  military  hospitals  at  Carlsruhe,  in  August  and  September,  1870, 
from  the  consequences  of  w’ounds  and  operations.  Of  one  hundred  and  twenty-nine 
autopsies,  twenty  were  in  deaths  from  wounds  of  the  chest,  or  15.5  per  cent. 

On  the  other  hand,  the  proportion  of  recorded  survivors  after  chest  wounds  is  much 
less  than  the  average.  The  United  States  Commissioner  of  Pensions"  reports  seventy-six 
thousand  four  hundred  and  sixty-nine  pensioners  on  the  rolls  on  account  of  injinies  of  all 
sorts,  of  which  three  thousand  seven  hundred  and  thirty,  or  one  in  twenty,  or  4.8  per 
cent.,  are  pensioned  for  the  results  of  injuries  of  the  chest. 

Professor  Adolph  Hannover,^  of  Copenhagen,  informs  us  that  the  number  of  Danes 
pensioned  for  wounds,  after  the  war  of  1864,  was  fifteen  hundred  and  eighty-eight,  of 
whom  only  fifty-nine,  or  3.7  per  cent.,  had  received  wounds  of  the  chest. 

Dr.  George  WilliamsoiP  states  that  of  the  six  hundred  and  three  wounded  soldiers 
that  arrived  in  England  after  the  India  Mutiny,  only  nineteen,  or  3.15  per  cent.,  had 
received  chest  wounds. 

Pegarding  the  mortality  of  penetrating  wounds  of  the  chest  in  recent  wars,  I have 
been  enabled  to  collect  the  following  information  : 

In  the  New  Zealand  War,^  the  fatality  of  gunshot  wounds  of  the  lung  was  60.8  per 

cent. 

In  the  French  army  in  the  Crimea,  the  fatality  of  gunshot  wounds  of  the  chest  known 
to  have  been  penetrating  was  91.6.*^  In  the  British  army  in  the  Crimea,'^  the  mortality 
of  six  hundred  and  twenty-seven  chest  wounds  was  26.6  per  cent.  ; of  one  hundred  and 
sixty-four  actual  lung  wounds,  one  hundred  and  thirty,  or  79.26  per  cent.,  were  fatal. 


‘Klebs.  Beitrd^e  zur  Pathologischen  Anatomic  dcr  Schusswunden,  Leipzig,  1872,  S.  4.  Dr.  Klebs  observes  that  the  hospitals  contained  less 
than  the  usual  proportion  of  those  wounded  in  the  head,  chest,  and  abdomen,  the  graver  cases  being  left  in  hospitals  nearer  the  battle-field  than 
Carlsruhe. 

^Bakek,  J.  II.  Report  of  the  Commissioner  of  Pensions  to  the  Secretary  of  the  Interior,  for  the  year  ended  June  30,  1871,  pp.  6,  20,  Uon.  J.  11. 
Baker  slates  that  the  injuries  include  “all  the  forms  incident  to  the  life  of  a soldier,  but  so  largely  predominant  are  gunshot  wounds  that  practically 
they  might  have  been  so  classed.”  The  chest  wounds  arc  separated  in  the  report  into  external  and  internal,  and  2,507  of  the  former,  1,223  of  the  latter 
constitute  the  aggregate  of  3,730. 

3 IIaxkoveu.  Die  Ddnischen  Invaliden,  Berlin,  1870,  S-  8.  The  proportion  of  invalids  wounded  in  the  chest  is  as  1 in  26. 

WILT.IAMSOX.  Military  Surgery,  London,  1863,  p.  237.  Two  of  the  nineteen  died  shoi-tly  after  arrival.  See  Specimens  3637,  3638,  and  3669  in 
the  Kctlcy  Collection,  and  Plate  IT,  p.  86,  of  Dr.  Williamson’s  work.  The  proportion  of  th<;sc  surviving  chest  wounds  temporarily  was  as  1 in  31.7% 

® In  the  New  Zealand  War,  Inspector-General  Jlouat  {op.  cit.,  Vol.  vii,  p.  485)  reports  thirty-eight  cases  of  gunshot  wounds  of  the  chest.  Eleven 
were  wounds  of  the  muscles,  one  of  the  bones,  three  penetrated  the  chest  w’ithout  entering  the  lung.  Of  these  fifteen  patients,  twelve  resumed  duty  and 
three  were  invalided.  Of  twenty-three  wounds  of  the  lung,  fourteen  were  fatal,  eight  patients  were  invalided,  and  one  returned  to  duty.  The  mortality 
rate  for  all  cases  was  36.8  per  cent.,  for  the  penetrating  lung  wounds  60.8  per  cent.  Dr.  Mount’s  report  contains  a synopsis  of  the  prominent  points 
connected  with  the  twenty-three  cases  of  wounds  penetrating  the  lung  ; of  seven  additional  cases  of  penetrating  gunshot  ■wounds  of  the  chest  (wounded 
Jrlaori  prisoners),  six  resulted  fatally. 

M.  CllEXU  (op.  cit.,  p.  187).  From  the  total  of  2,818  classified  as  chest  wounds,  arc  to  be  abstracted  212  sabre  and  bayonet  wounds  and  333 
miscellaneous  injuries,  538  gunshot  contusions  with  62  deaths,  a mortality  of  11.5 per  cent.,  and  576  undetermined  gunshot  chest  wounds  with  1C4  deaths, 
or  28.4  per  cent.  There  remain  1,159  cases,  of  which  668,  with  87  deaths,  were  non-penetrating,  a mortality  of  12.0  per  cent.,  and  491,  with  450  deaths, 
or  91.6  j)or  cent.,  w’cre  penetrating, 

^ f-lATTHEW  {op.  cit.,  Vol.  II,  p.  313)  tabulates  only  the  474  cases  cf  the  second  period,  with  135  deaths.  I have  added  the  153  cases  with  32dcaths 
of  the  first  period.  The  mortality  cf  chest  wounds  in  the  Russian  army  in  the  Crimea  has  not,  as  I am  aware,  been  ofiicially  reported.  Dr.  Pirogoff 
expresses  his  rcgi'ct  (Grundzuge  dcr  Allgemeinen  Kriegschirurgic,  Leipsig,  1864,  S.  535)  that  he  cannot  furnish  any  statistical  data,  and  quotes  from 
Demme  and  Ctromeycr.  It  is  stated  by  Mount  that,  at  SjTnpheropcl,  the  Russians  had  200  patients  with  gunshot  wounds  of  the  chest,  cf  whom  197 
died.  'Phe  xSardinian  army  had  but  few  wounded  in  the  Crimea,  193  in  all ; of  whom  10  w’crc  killed  and  16  died  of  wounds,  according  to  the  table  cf  Dr. 
Comisetti,  jn’esident  of  the  Health  Board  of  the  .Sardinian  Army.  Tlie  effective  force  of  the  army  was  21,000. 


Skct.  IV.] 


MORTALITY  OF  CHEST  WOUNDS. 


605 


In  the  Italian  War  of  1859,  Demme^  reports  four  hundred  and  eighty-four  superficial, 
and  one  hundred  and  fifty-nine  penetrating,  gunshot  wounds  of  the  chest ; forty-three  of 
the  former  and  ninety-seven  of  the  latter  died  in  liospital,  or  mortality  rates  of  8.8  per 
cent.,  and  61  per  cent.  In  this  war,  the  early  mortality,  at  any  rate,  from  such  injuries 
among  the  Frenclr  was  much  less,  amounting  to  only  46.48  per  cent,  even  for  the  pene- 
trating gunshot  wounds  alone. 

In  the  first  Schleswig-Holstein  war,^  after  the  battle  of  Idstedt,  Dr.  Stromeyer  lost 
but  17.6  per  cent,  of  patients  in  the  Hanoverian  army  with  gunshot  wounds  of  the  chest. 

In  the  Danish  War  of  1864,^  the  mortality  of  all  gunshot  chest  wounds  was,  among 
the  Prussians  41.6  per  cent.,  among  the  Danish  prisoners  67.2  per  cent. 

In  the  Six-Weeks  War,  Dr.  Maas^  reports  twelve  gunshot  wounds  of  the  lung,  with 
only  four  fatal  cases,  or  33.3  per  cent.  Dr.  Stromeyer,* *^  at  Langensalza,  had  but  sixteen 
recoveries  in  forty-seven  penetrating  gunshot  wounds  of  the  chest,  a death  rate  of  65.9. 
Dr.  Biefel,’  at  the  hospital  at  Landeshut,  in  Silesia,  had  forty-four  cases  of  gunshot  wounds 
of  the  chest,  of  which  fifteen  were  penetrating.  The  twenty-nine  cases  with  superficial 
wounds  recovered.  Of  the  remainder,  eight,  or  53.3  per  cent.,  died. 

From  the  Franco-German  AVar,  numerous  partial  returns  have  already  been  received. 
At  Mannheim  and  AVeissenburg,  Professor  Theodor  Billroth®  lost  but  nine  of  thirty  patients 
with  penetrating  gunshot  wounds  of  the  chest. 

At  Aletz,  Dr,  H.  Fischer®  reports  the  proportion  of  fatal  gunshot  wounds  of  the  chest 
at  55.8  per  cent. 

After  Sedan,  Mr.  MacGormac  reports^®  the  mortality  of  penetrating  gunshot  wounds 
of  the  chest  at  the  Anglo-American  Ambulance  at  Asfeld,  as  54.8.  At  the  field  hospital 
a,t  Floing,  Generalstabsarzt  StromeyeP^  had  fourteen  cases  of  penetrating  chest  wounds, 
seven  of  whom  were  likely  (September  26th,  1870)  to  recover. 

* Demme,  ^illgemeine  Chirurgie  der  Kriegswunden^  Wurzburg",  18C4,  S.  90.  Demme  reports  in  all  two  hundred  and  three  cases  of  penetrating 
gunshot  wounds  of  the  chest;  but  states  that  forty -four  were  without  injury  of  the  viscera.  He  gives  his  farther  statistics  from  the  one  hundred  and 
fifty-nine  remaining  cases  and  drops  the  forty-four  cases.  This  is  one  of  the  many  careless  errors  in  Demme’s  statistics,  of  which  Dr.  Loeffler  justly 
complains.  They  abound  in  the  second  edition,  of  1863,  fur  which  reason,  I quote  usually  from  the  edition  of  1861. 

*31.  Chexu  {op.cit.  T.  II,  p.  474)  tabulates  one  thousand  fifty-two  chest  wounds;  deducting  thirtj'-seven  sabre,  bayonet,  and  lance  wounds, 
and  two  hundred  and  four  miscellaneous  injui'ies,  there  remain  eight  hundred  and  eleven  gunshot  wounds  distributed  as  follows:  contusions  forty-eight, 
with  seven  deaths;  fractures  one  hundred  and  twenty-eight,  with  twenty  deaths ; contused  wounds  three  hundred  and  seventy-nine,  with  four  deaths; 
penetrating  wounds  two  hundred  and  fifty-six,  with  one  hundred  and  nineteen  deaths,  or  46.48  per  cent. 

* July  2Cth,  1850.  Dr.  Stromeyer  had  seventeen  deaths  in  ninety-seven  patients  with  chest  wounds,  in  a total  of  twelve  hundred  and  ten  wounded. 
Maximen  der  Kricgsheilkunst,  S.  dS."). 

'*  Lceffleu  {lo:.  cit.)  From  the  table  quoted,  compiled  with  a precision  unattainable  except  in  a population  where  every'  individual  is  registered,  it 
appears  that  of  twenty -three  hundred  and  fifty-five  killed  and  wounded  Prussians,  two  hundred  and  fifty-four,  or  one  in  9.27,  received  wounds  of  the 
chest.  One  hundred  and  seventeen  of  the  two  hundred  and  fifty-four  fell  dead;  of  the  one  hundred  thirtj^-seven  remaining  wounded,  fifty-seven  died 
in  hospital  (twenty  within  forty-eight  hours),  or  41.6  per  cent.  Among  twelve  hundred  and  three  wounded  Danish  prisoners,  one  hundred  and  thirteen,  or 
one  in  10.6,  had  chest  wounds,  of  which  seventy -six,  or  67.2  per  cent.,  proved  fatal.  Dr.  Lcefiler  gives  us  the  assurance,  which,  in  his  case,  is  unnecessary, 
that  the  larger  mortality  among  the  prisoners  was  not  due  to  any  ditference  in  the  treatment  received  by  the  prisoners.  Professor  Pillroth  justly  extols 
the  statistics  of  Dr.  Lcefllcr,  as  examples  of  the  exactitude  possible  in  large  consolidated  surgical  statements.  I regret  that  I cannot  refer  to  the  second 
part  of  Dr.  Lceffler's  work,  which  doubtless  separates  the  penetrating  from  the  non-penetrating  chest  wounds,  and  gives  the  ulterior  mortality. 

®3Iaas.  Kriegschirurgische  Beilrdge,  S.  72.  ®Sth0MEYEU.  Erfahrungen  uber  Schusswunden,  S.  42. 

* Biefel.  Im  Reserve  Lazareth.  Kriegschirurgische  Aphorismen,  von  1866,  in  Langenbeck’s  Archiv  fiir  Klinischc  chirurgie,  B.  XI,  S.  369. 

®Billu0TH  {Chirurgische  Brief e aus  den  Kriegs-Lazarethen  in  Weissenburg  und  Manniieim,  1870,  Berlin,  1872,  S.  192)  reports  that  of  tliiify 

cases  of  penetrating  wounds  of  the  chest,  nine,  or  30  per  cent.,  died,  a result  so  much  more  favorable,  as  se^ral  of  the  fatal  cases  (cases  3,  12,  and 
26)  might  be  excluded  on  account  of  severe  complications  with  other  injuries,  and  as  one  of  the  wounded,  a convalescent,  fifty-seven  days  after  tho 
injury’,  was  attacked  by  typhus  and  died  in  consequence. 

®FisCHEn,  II.  {Kriegschirurgische  Erfahrungen^  ^rsXer  Theil,  vor  Erlangen^  1872,  S.  116)  says:  “Seventy-eight  gunshot  wounds  of  the 

thorax  were  treated,  and  of  these,  thirty’-four,  or  43.5  per  cent.,  were  perforating.  * * Of  the  seventy-eight  cases  of  gunshot  w'ounds  of  the  thorax, 
nineteen  died,  or  24.3  per  cent.  The  fatal  cases  were  all  in  consequence  of  perforating  wounds,  of  which  latter  class  therefore  55.8  per  cent,  died.”  Dr. 
Fischer  adds:  “Beally'  remarkable  is  the  fact  that  Billroth  lost  only  five  of  thirty  cases  of  this  kind,  or  16.6  per  cent.,  as  his  mode  of  treatment  varied 
little  fi-om  that  usually  employed.”  If  Dr.  Fischer  deducts  the  three  cases  of  amputation  and  one  of  typluis  from  the  mortality’,  he  should  deduct  them 
also  from  the  aggregate,  which  would  leave  twenty-six  cases  with  five  fatal,  or  19.2  per  cent.  But  it  will  hardly  be  claimed  that  this  constituted  the 
entire  ultimate  proportion  of  mortality. 

3lA('ConMAC  {op.  cVf.,  p.  126).  Of  fifty-four  wounds  of  the  chest  treated,  thirty'-onc  were  regarded  as  penetrating,  of  which  seventeen 
terminated  fatally'. 

Ibid.,  p.  122.  Tliere  were  at  this  Feld-Lazarcth  one  hundred  and  twenty’-onc  patients — sixty-four  Cicrmans,  fifty -seven  French. 


606 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


Regarding  the  mortality  of  wounds  of  the  chest  in  the  War  of  the  Rebellion,  we  have 
the  data  afforded  by  Table  XXV,  p.  600,  giving  the  gunshot  wounds  of  the  chest  for 
nearly  all  of  the  Union  soldiers  during  the  last  year  of  the  war.  Of  three  thousand  nine 
hundred  and  seventy  patients  with  superficial  wounds,  fifty-four  died,  or  1.3  per  cent.  ; of 
three  thousand  two  hundred  and  three  with  penetrating  wounds,  one  thousand  and  seventy 
died,  or  33.4  per  cent.,  a total  number  of  chest  wounds  of  seven  thousand  one  hundred  and 
seventy-three,  with  one  thousand  one  hundred  and  twenty-four  deaths,  or  15.6  per  cent. 
Rut  the  Endrcsidtat  does  not  appear  in  this  computation,  and  we  must  have  recourse  to 
the  aggregate  of  cases  of  penetrating  wounds  of  the  chest  collected  from  the  returns  of  the 
general  as  well  as  the  field  and  primary  hospitals.  These  results  are  set  forth  in  the 
following  statement  (Table  XXVI),  which  includes  the  cases  of  Confederate  j^i’isoners  as 
well  as  of  Union  soldiers  ; 

Table  XXVI. 


Numerical  Statement  of  Eight  Thoumnd  Seven  Hundred  and  Fifteen  Cases  of  Penetrating 
Gunshot  Wounds  of  the  Chest  reported  on  the  Returns  during  the  War. 


CHARACTER  OF  WOUND. 

Cases. 

Deaths. 

Discharged. 

Duty. 

Undeter- 

mined. 

Ratio  of 
Mortality. 

Missile  entered  and  passed  out,  traversing  tlie  cavity  of  the  thorax. 

i 

GO 

1,011 

1, 352 

403 

16 

36.5 

Missile  entered  the  thoracic  cavity  and  was  believed  to  have 

lodged  within  it .* 

484 

243 

189 

48 

4 

50.6 

Missile  stated  to  have  penetrated  the  cavity  of  the  chest  without 

specification  as  to  lodgment  or  exit 

1,780 

1,348 

65 

299 

68 

78.7 

Missile  entered  and  wounded  lung  without  specification  as  to 

lodgment  or  exit 

1,G83 

1,192 

110 

266 

115 

76.0 

Cases  described  as  severe  gunshot  jienetrating  wounds  of  the 

1,  304 

1,214 

90 

100. 

Missile  impacted  between  the  ribs,  but  external  to  the  pleural 

0 

1 

1 

100. 

Missile  fracturing  and  depressing  ribs  but  not  itself  entering  the 

thoracic  cavity 

446 

68 

176 

186 

16 

15.8 

Missile  perforating  chest  and  wounding  both  lungs 

58 

47 

7 

2 

2 

83.9 

Missile  j>enetrating  aiul  wounding  diajdiragm 

8 

8 

100. 

121 

89 

31 

1 

74.2 

AVilh  wounds  of  the  intercostal  and  internal  niannnarv  arteries... 

21 

17 

4 

80.9 

10 

6 

4 

60.0 

AVith  wound  of  the  heart 

12 

11 

1 

91.6 

3 

3 

100. 

With  wound  of  the  vena  cava 

1 

1 

100. 

1 

1 

100. 

Aggregate 

8,715 

5,260 

1, 939 

1,204 

312 

62.6 

One  thousand  five  hundred  and  sixty-five  Confederate  cases  are  included  in  the  state- 
ment in  Table  XXIV.  Seven  hundred  and  fifty  had  received  non-penetrating,  and  eight 
hundred  and  fifteen  penetrating,  wounds  of  the  chest.  Twelve  of  the  first  group  died,  and 
four  hundred  and  seventy-eight  of  the  second  group.  In  the  second  group,  two  hundred 
and  seventy-one  recovered,  and  sixty-six  were  returned  before  convalescence,  and  their 
ultimate  fate  is  unknown.  The  mortality  rate  for  the  determined  cases  of  penetrating 


Sect.  IV.] 


MORTALITY  OF  CHEST  WOUNDS. 


607 


gunshot  wounds  of  the  chest  in  Confederate  soldiers  is  therefore  63.8  per  cent.,  or  very 
little  more  than  the  mortality  of  the  Union  soldiers.  These  facts  are  taken  mainly  from 
the  registers  and  case-books  of  Confederate  hospitals,  or  from  printed  sources  of  information, 
or  from  the  registers  of  Union  hospitals  in  the  cases  of  Confederate  prisoners.  In  the 
latter  group  the  mortality  rate  is  but  slightly  above  the  average,  an  unexpected  result,  as  the 
depressing  effect  of  defeat  and  of  confinement  among  strangers  are  usually  more  manifest 
in  the  comparisons  of  mortality,  as  strikingly  shown  in  the  excessive  mortality  among  the 
Danish  prisoners,  as  pointed  out  by  Dr.  Loeffler  [loc.  cit.,  p.  56).  Of  course  there  is  usually 
a large  proportion  of  the  graver  injuries  among  prisoners,  and  a somewhat  larger  mortality 
is  to  be  anticipated. 

Abstracting  the  eight  hundred  and  fifteen  Confederate  cases,  and  the  two  hundred  and 
forty-six  undetermined  Union  cases  from  the  statement  of  eight  thousand  seven  hundred 
and  fifteen  penetrating  chest  wounds  included  in  Table  XXVI,  there  remain  seven  thou- 
sand six  hundred  and  fifty-four  determined  cases  of  Union  soldiers,  with  four  thousand 
seven  hundred  and  eighty-two  deaths,  or  62.4  per  cent. 

Apart  from  that  furnished  by  the  hospital  registers,  little  statistical  material  on  this 
subject,  as  regards  the  Confederate  army,  is  accessible.  The  paper  by  Surgeon  Thom,  read 
at  Richmond  in  1864,  would  be  valuable  if  correctly  printed,  and  it  is  to  be  desired 
that  the  author  may  revise  and  publish  it  in  fulfil  Surgeon  C.  Terry”  reports,  from  the 
battle  of  Chickamauga,  six  cases  of  penetrating  gunshot  wounds  of  the  chest,  with  four 
recoveries;  and  Surgeon  D.  C.  O’Keefe^  publishes  five  cases  with  only  one  fatal  result. 
Examples  of  recovery  after  injuries  of  this  nature  are  also  cited  by  Surgeons  Selden,  Thom, 
Read,  Baruch,  Michel,  and  Browne.^  All  of  them  are  included  in  my  estimates. 


^ Among  the  Confederate  writers,  Dr.  E.  Warren  (op.  cit.,  p.  370)  obser^'es  that  “wounds  of  the  lung  are  far  from  being  so  fatal  as  might  be 
supposed  in  advance.  Numerous  cases  have  come  under  my  own  observation,  during  the  present  w’ar,  in  which  rapid  recoveries  have  followed  the  most 
severe  penetrating  wounds  of  this  delicate  organ.  The  experience  of  Confederate  surgeons  will  confirm  the  assertion  that  unless  death  speedily  results 
from  luemon-hage  or  collapse,  a favorable  prognosis  may  be  formed  in  a majority  of  such  cases.”  The  writer  docs  not  indicate  the  degree  of  fatality 
which  might  be  errone(»usly  “supposed  in  advance,”  nor  describe  the  numerous  recoveries  he  has  witnessed  after  the  most  severe  lung  wounds,  and  the 
recorded  experience  of  Confederate  surgeons  invalidates  instead  of  confirming  the  assertion  that  the  majority  of  severe  lung  wounds  get  well.  Dr.  J.  J. 
Chisolm  (op.  cit.,  p.  310)  says:  “Wounds  of  the  chest,  when  taken  as  a class,  are,  perhaps,  the  most  fatal  of  gunshot  wounds.  * * Should  the  lung 
be  severely  injured,  the  case  usually  terminates  fatally.”  fben  relates  some  remarkable  examples  of  recovery,  and  adds:  “In  our  experience, 
penetrating  wounds  of  the  chest,  even  those  in  which  the  ball  had  clearly  traversed  the  lung,  are,  by  no  means,  so  fatal  an  injury  as  gunshot  wounds  of 
other  regions  of  the  trunk.”  The  apparent  contradiction  is  avoided  by  the  limitation  of  the  comparison  to  wounds  of  the  abdomen,  pelvis,  and  spine. 
“Under  the  expectant  plan  of  treatment,”  Dr.  Chisolm  continues,  “ which  consists  of  little  more  than  careful  nursing,  avoiding  all  active  treatment, 
more  especially  bloodletting,  we  have  succeeded  in  saving  a majority  of  our  wounded.  Surgeon  Thom,  in  a recent  report  to  the  association  of  army 
and  navy  surgeons,  give.s  a list  of  seventy-four  cases  of  gunshot  wounds  perforating  the  chest  and  transfixing  the  lungs,  as  reported  by  Confederate  anny 
surgeons.  Of  these,  twenty  died, — a mortality  of  25  per  cent., — which  indicates  clearly  the  advantages  of  the  expectant  course  of  treatment  for  this  as 
well  as  for  all  gunshot  wounds,  over  the  heroic  and  fatal  treatment  of  former  years.  As  far  as  could  be  ascertained,  bloodletting  had  been  resoried  to  in 
but  one  case  of  perforated  chest  wounds.”  On  referring  to  the  abstract  of  the  report  of  Surgeon  Thom,  chairman  of  the  committee  on  gunshot  wounds 
of  the  chest,  as  printed  in  the  Transactions  of  the  Association  of  Army  and  Navy  Surgeons,  at  page  GO,  of  the  April,  1864,  number  of  the  Confederate 
States  Medical  and  Surgical  Journal,  it  is  found  that,  after  a preliminarj'  dissertation  on  “the  general  treatment  of  injuries  of  the  lungs  from  missiles, 
penetrating  and  cutting  weapons;  the  time  and  manner  of  death  under  such  circumstances;  the  pathological  condition,  functional  embarrassment,  or 
usefulness  remaining  after  these  accidents ; the  mode  of  production  and  treatment  of  emphysema ; and  the  provisions  made  by  nature  for  accommodating 
foreign  bodies  retained  within  these  organs,  with  the  amount  of  disturbance  which  ensues,”  Dr.  Thom  “regretted  that  few  replies  had  been  received  to 
the  interrogatories  which  the  preparation  of  this  report  had  suggested,  and  that  he  could  furnish  only  seventy-four  cases  of  gnnshot  wounds  of  the  lungs, 
in  which  twenty  recovered,  from  which  limited  number  it  appeared  the  mortality  was  little  over  twenty-five  per  cent.,  or  one-quarter.  As  far  as  could 
be  ascertained,  bleeding  had  been  resorted  to  in  but  one  case,  and  that  recovered.”  If  twenty  of  the  seventy-four  cases  related  by  Dr.  Thom  “recovered.” 
the  mortality  was  72.9  per  cent,  and  not  “a  little  over  25  per  cent.”  It  may  be  that  there  is  here  a clerical  or  typographical  error,  and  that  the  writer 
meant  to  convey  that  twenty  cZied,  as  Dr.  Chisolm  interprets.  But  the  contradiction  destroys  the  statistical  value  of  the  report.  "Were  it  otherwise 
Dr.  Chisolm’s  assumption,  that  the  mortality  of  25  (27.2?)  per  cent.,  as  given  in  this  paper,  represented  the  results  of  Confederate  experience  of  the 
danger  of  gunshot  wounds  transfixing  the  lung,  would  be  untenable;  and  his  claim  that  this  startling  result  was  due  to  the  advantages  of  expectant  over 
depleting  treatment  is  XTnexpccted  from  a surgeon  usually  Tareful  and  accurate  in  his  statements.  I do  not  yield  to  Dr.  Chisolm  in  deprecating  the 
employment  in  chest  wounds  of  the  depleting  measures  of  former  years,  still  advocated  by  Professors  Gross  and  Erichsen  and  Stromeyer;  ])ut  to  maintain 
that  e.xpeetanoy  or  any  mode  of  treatment  can  reduce  the  mortality  of  lung  wounds  fifty  per  cent,  is  to  advance  a proposition  too  cgrcgiously  imj'robablc 
to  be  discussfed.  One  may  hope  that  it  was  througlj  inadvertence,  and  not  to  sustain  his  argument,  that  Dr.  Chusolin,  in  quoting  Dr.  Thom’s  allusion  to 
the  single  case  of  venesection  for  lung  wound,  omitted  the  words  “and  that  recovered.”  I have  had  the  files  of  the  Richmond  and  Louisville  Medical 
Journal,  the  Confederate  States  Medical  Journal,  the  American  Practitioner,  the  Nashville  Journal  <f  Medicine  and  Surgery,  the  New  Orleans  Journal 
of  Medicine,  the  Atlanta  Medical  and  Surgical  Journal,  and  the  Southern  Medical  and  Surgical  Journal,  vainly  searched  for  additional  information  on 
this  subject. 

2 Confederate  Stales  Medical  and  Surgical  Journal,  Vol.  I,  p.  75. 


^ Ibid.,  p.  25. 


^Ibid.,  Vol.  I. 


608 


WOUNDS  AND  INJUEIUS  OF  THE  CHEST. 


[Chap.  V, 


Three  hundred  and  ninety-five  abstracts  of  gunshot  wounds  are  cited  in  the  preceding 
pages  of  this  section.  It  is  obvious  that  they  were  selected  without  the  slightest  reference 
to  the  question  of  mortality,  yet  they  corroborate  in  a remarkable  manner  the  conclusions 
of  Table  XXVI.  Abstracting  eighty-five  cases  of  non-penetrating  wounds,  with  a mor- 
tality of  25.8  per  cent.,  there  remain  three  hundred  and  ten  cases  of  penetrating  wounds, 
with  one  hundred  and  ninety-two  deaths,  a mortality  of  61.9  per  cent.;  or,  separating  the 
Union  and  Confederate  cases,  there  are  twenty-seven  in  the  latter  and  fifteen  deaths;  two 
hundred  and  eighty-three  of  the  former,  with  one  hundred  and  seventy-seven  deaths,  a 
mortality  rate  of  55.5  and  62.5  per  cent,  respectively. 

I would  propose  to  substitute  for  the  table  commonly  quoted  (Table  V,  cited  from 
Dr.  Fraser,  p.  602,  ante)  the  following,  in  which  such  extreme  statements  as  those  regard- 
ing the  battle  of  Quebec,  the  street-fighting  in  Paris,  and  the  losses  of  the  Russians  at 
Sympheropol  are  excluded : 

Table  XXVII. 


Showmg  the  Wumher  of  Penetrating  Wou7ids  of  the  Chest  on  the  Occasions  7iamed,  and 
from  the  Authorities  quoted,  with  the  Piatio  of  the  Mortality. 


ACTION,  &C. 

Wounds. 

Died. 

Ratio  of 
lilortality. 

New  Zealand  War  (Mouat) 

23 

15 

60.8 

French  in  Crimea  (Chenu) 

491 

450 

91.6 

164 

130 

79.2 

French  in  Italy  (Chenu) 

256 

119 

46.48 

Austrians  and  Italians  (Demme) 

159 

97 

61.0 

Hannoverians  in  Schleswig-Holstein  (Stromeyer) 

97 

17 

17.6 

Prussians  in  Danish  War  of  1864  (Lceffler) 

137 

57 

41.6 

Danes  in  Danish  War  of  1864  (Lceffler) 

113 

76 

67.2 

Prussians  in  Six-Weeks  War  (Maas) 

12 

4 

33.3 

Prussians  at  Langensalza  (Stromeyer) 

47 

31 

65.9 

15 

30 

8 

53.3 

Germans  in  Franco-Prussian  War  (Billroth) 

9 

30.0 

Germans  near  Metz  (Fischer) 

34 

19 

55.8 

French  at  Sedan  (MacCormac) 

31 

17 

54.8 

Affnrecfate 

1, 609 

1,049 

65.2 

These  figures  establish  that  the  ordinary  percentage  of  deaths  in  large  series  of  cases 
commonly  classified  as  penetrating  wounds  of  the  chest ^ is  above  sixty  per  cent.;  that 
surgeons  erroneously  indulge  the  belief  that  they  save  a majority  of  their  patients  under 
these  circumstances;  and  that  the  more  rigorously  the  diagnoses  are  scrutinized  and  the 
final  results  traced,  the  higher  the  proportion  of  mortality  rises.  Dr.  hlatthew,  in  his 

^ I share  the  conviction  of  Neudorfeu  {Handbuch  de  Kriegschirurffie,  13.  I,  H.  II,  S.  554)  that  the  percentage  ( f niciTahty  of  aotnal  lung  wounds 
is  much  higher.  In  commenting  on  the  British,  French,  and  American  statistics  on  tliis  subject,  Neudorfer  says : “iJicse  liioi'  angefubrten  I\Iortalitats- 
zUTern  sind  aber  alle  viel  zu  klein ; in  der  Wirklichkeit  ist  die  Stcrblichkeitsziffer  viel  grosser,  weil  viele  von  denen,  welchc  r.ls  gcncsen,  eder  deren 
Schicksal  als  unbekannt  angefuhrt  ist,  nachtraglich  gestorben  sind.” 


I 


Skct.  IV.]  MORTALITY  OF  CHEST  WOUNDS.  609 

Surgical  History  of  the  Crimean  War,  in  the  summary  on  gunshot  wounds  of  the  chest 
(the  whole  article,  as  Mr.  Blenkins  justly  observes,  being  “replete  with  masterly  obser- 
vations”), remarks  that  “it  seems  very  doubtful  if  every  case  in  which  the  ball  was 
lodged  within  the  pleural  chest  lining  did  not  terminate  in  death,  and  the  instances  where 
recoveries  are  returned  (two  men  and  one  officer)  may  be  open  to  great  doubt  as  to 
whether  the  ball  had  actually  penetrated.”  Dr.  Fraser  believes  “that  in  the  human 
subject,  as  well  as  in  animals,  an  actual  wound  of  the  substance  of  the  lung  is  always, 
sooner  or  later,  mortal,  not  from  the  effect  of  inflammatory  action,  but,  in  recent  cases, 
from  the  sudden  cessation  of  proper  aeration  in  either  the  whole,  or  portions  of  one  or  two 
lungs;  or  sudden  hmmorrhage.”  The  opinions  of  Dr.  Macleod,  which  have  had  undue 
weight  in  this  country,  because  of  the  accessibility  of  his  Notes,  are  not  to  be  weighed  in 
comparison  with  those  of  Drs.  Matthew  and  Fraser;  for  his  observations  on  this  subject 
were  but  few,  and  those  published  do  not  sustain  his  conclusions,  which  are  conformed  to 
the  opinions  then  in  vogue. 

The  figures  that  I have  given  respecting  the  mortality  of  penetrating  chest  wounds 
conflict  with  those  offered  by  Assistant  Surgeons  Smart  (p.  510, — 150  cases,  49  deaths, 
or  32.6  per  cent.)  and  Billings  (Appendix,  p.  200, — 858  cases  at  Gettysburg,  with  295 
deaths,  or  34  per  cent.)  only  in  appearance.  It  was  impossible  for  those  officers  to  trace 
the  cases  to  their  terminations.  It  is  seen  in  Table  XXV,  that  I found  the  mortality,  in 
field  and 'primary  hospitals,  of  all  the  penetrating  wounds  of  the  chest  returned  in  the 
Union  army  for  the  last  year  of  the  war,  to  be  33.4  per  cent.,  or  nearly  the  proportions 
given  by  them.  I cannot  better  explain  the  difference  between  the  early  and  remote 
statistical  results  on  this  subject,  than  by  referring  to  the  very  carefully  studied  report  of 
Surgeon  J.  T.  Woods,  99th  Ohio  Volunteers,  of  fifty-five  cases  of  supposed  penetrating 
wounds  of  the  chest  that  he  observed  after  the  battle  of  Chickamauga. 

The  fifty-five  patients  had  all  been  wounded  by  conoidal  musket  balls  on  September 
19th  and  20th,  1863,  and  made  prisoners.  They  were  paroled  and  sent  to  the  Chattanooga 
hospitals  after  ten  days’  detention.  Hence,  the  series  includes  only  those  who  had  escaped 
the  dangers  of  early  heemorrhages.  Dr.  Woods  made  his  report  early  in  January,  1864, 
having  had  the  survivors  under  his  care  nearly  three  months.  It  was  believed  that  the 
lung  was  wounded  in  all  of  these  cases,  and,  with  few  exceptions,  they  were  perforations. 
Dr.  Woods  classified  them  according  to  their  precise  seat  as  follows : 

So  there  were  twenty-nine  apparent  re- 
coveries in  a series  of  cases  selected  from  those 
who  had  survived  penetrating  gunshot  wounds 
of  the  chest  for  ten  days,  or  a mortality  rate 
of  47.2  per  cent.  But  on  tracing  the  twenty- 
nine  survivors  to  the  base  hospitals,  it  is  found 
that  one  was  discovered  to  have  only  a non- 
penetrating fracture  of  the  sternum,  and  that 
seven  died,  several  of  them  within  three 
weeks  after  leaving  Chattanooga.  Hence, 
the  table  must  be  amended  to  fifty-four  cases, 
with  thirty-three  deaths,  or  a mortality  of 
61.6  per  cent. 

77 


r’EXETKATKG  ClIEST  WOUNDS  BY  COXOIDAL 
MUSKET  Ball. 

Cases. 

Dcatlis. 

fUp)>er  lobe 

G 

4 

j Middle  lobe 

5 

0 

Eiyht  Lunff 

j Lower  lobe 

3 

0 

^^Not  ascertained 

5 

5 

f Upper  lobe 

12 

3 

J Middle  lobe 

9 

4 

Left  I/any 

1 Lower  lobe 

7 

3 

(Not  ascertained 

G 

5 

BothlAinys 

. . - Not  stated 

2 

2 

Total 

55 

2G 

610 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V 


A false  interpretation  of  some  of  the  statistics  generally  quoted  by  systematic  authors 
is  one  of  the  causes  that  have  led  practitioners  to  form  too  low  an  estimate  of  the  gravity 
of  wounds  of  the  chest,  a cursory  and  partial  examination  of  the  figures  leading  to 
conclusions  very  different  from  those  which  the  author  thought  to  establish.  Thus, 
Guthrie,  who  fully  appreciated  the  fatality  of  penetrating  gunshot  wounds  of  the  chest, 
cites  [Comm.,  p.  462)  one  hundred  and  six  such  cases  after  the  battle  of  Toulouse  (see 
Table  V,  p.  602),  remarking  that  the  cavities  were  not  penetrated  in  all.  In  seven  weeks 
thirteen  had  recovered,  thirty-five  had  died,  and  fifty-seven  “ were  transferred  to  Bordeaux 
to  proceed  to  England,  some  to  die  and  some  to  be  pensioned,  but  few,  in  all  probability, 
to  return  to  the  service,  an  ultimate  loss  of  nearly  one-half,  if  the  cases  sent  to  England 
could  be  traced.”  But  they  were  not  traced,  and  it  is  a mere  assumption  to  put  the 
percentage  of  mortality  at  50,  as  even  Dr.  Fraser  has  done.’- 

Otlier  causes  of  the  inadequate  appreciation  of  the  gravity  of  wounds  of  the  lung  are 
the  prominence  given  to  exceptional  cases  of  recovery  after  very  severe  injuries  of  the 
chest  and  the  interest  they  naturally  awaken,^  and  also  the  comparative  frequency  of 
examples  that  are  to  be  met  with  in  authors  of  recoveries  after  perforations  of  the  chest 
by  the  rapier  or  bayonet,  or  by  small  pistol  balls. ^ Confining  their  attention  to  a limited 
number  of  cases,  some  writers  are  betrayed  into  the  error  of  regarding  the  latter  group  of 
injuries  very  lightly."' 


* The  ancients  were  less  sanguine  than  the  modems  in  this  matter.  Galen  (Lib.  V,  cap.  26)  pronounces  deep  wounds  of  the  lungs  fatal.  John 
Tagaultsays  (Institutionum  chirurgicarum  Lihri  Quinque,  cd.  Uffenbachii,  Francofurti,  1610,  Lib.  II,  c.  iii,  p.  736);  “Vulnera  autem  quae  pulmonibus 
incidunt,  ideo  curatu  sunt  ditlicillima,  imo  magna  ex  parte  insanabilia ; quoniam  promptissime  phlegmonem  excitant.”  IliCHARD  Wiseman  {Severall 
Chirurgical  Treatises,  (London,  1676,  Book  VI,  c.  viii,  p.  434  and  p.  436)  writes  “almost  all  thcise  wounds  made  by  gunshot  arc  mortal,”  and  “many 
instances  may  be  giyen  of  gunshots  in  the  breast,  but  few  do  recover  that  are  shot  in  the  lungs.  Plenck  says  {lastit.  Chirurg.,  1774)  “Magna  pulmonis 
vulnera  absolute  lethalia  sunt.” 

2 In  reading  the  history  of  Maiden's  case  {An  Account  of  a case  of  Recovery  after  the  Shaft  of  a Chaise  had  been  forced  through  the  Thorax, 
Lijndon,  1824,  4‘«),  many  readers  do  nut  pause  to  reflect  that  the  i)reparation  in  the  Royal  College  of  Surgeons  indicates  that  the  lungs  were  not  wounded, 
and  that  it  is  believed  that  the  foreign  body  passed  between  the  ribs  and  pleura.  Dr.  THOM  {loc.  cit.,  p.  60)  relates  a somewhat  similar  case  of  recovery 
on  the  authority  of  Dr.  Semple,  though  it  was  assumed  that  the  gig-shaft,  in  this  instance,  “passed  entirely  through  the  right  lung.”  The  sequel  of  the 
yet  more  marvelous  case  of  the  Prussian  sailor,  John  Taylor,  impaled  by  a try-sail  mast,  treated  at  the  London  Hospital  by  ANDREWS,  in  1831,  is  related 
in  1857  by  Dr.  A.  C.  Garuatt,  of  Massachusetts  {Boston  Med,  and  Surg.  Journal,  Vol.  LVII,  p.  488),  who,  on  a voyage  to  Liverpool,  enncountcrcd  this 
man  in  perfect  health,  twenty-six  years  after  the  reception  of  his  injury,  with  a large  depressed  semi-lunar  cicatrix  over  the  region  of  the  heart,  the  organs 
of  the  chest  on  auscultation  and  percussion  being  perfectly  normal.  Dr.  Garratt  took  the  man  to  London,  where  he  was  recognized  by  Professors  Partridge 
and  Fergusson,  and  appointed  janitor  of  the  Museum  of  the  London  Hospital. 

3 T’hus  Dr.  F.  11.  Hamilton  {Principles  and  Practice  of  Surgery,  1872)  announces  that  “pistol  balls,  with  small  shot,  seldom  prove  fatal  when 
lodged  within  the  chest,  unless  from  wounds  of  the  heart  or  great  vessels.”  In  sixteen  cases  of  fatal  penetrating  gunshot  wounds  of  the  chest  reported  in 
the  Army  during  the  i>ast  five  years  (Circular  No.  3,  S.  G.  O.,  1871,  A Report  on  Surgical  Cases  treated  in  the  Army,  etc.,  p.  29),  three  (Cases  LXXVII, 
LXXXl,  LXXXV)  were  instances  in  which  a pistol  ball  or  bird  shot  lodged  within  the  chest  without  injury  to  the  heart  or  great  vessels.  Of  the  first 
fifteen  hundred  cases  of  penetrating  gunshot  wounds  of  the  chest  entered  on  the  registers  of  the  late  war,  thirty-three  were  inflicted  by  pistol  balls. 
Twelve  of  these  were  fatal.  In  six  cases  the  ball  emerged,  in  four  it  lodged  within  the  thorax,  in  one  in  the  glenoid  cavity,  in  one  this  point  is  not  noted. 

**  Thus  Surgeon  Middleton  l\Iichel,  P.  A,  C.  S.,  adduces  {Confederate  States  Medical  and  Surgical  Journal,  p.  102),  in  his  dissertation  on  “healing 
of  gunshot  wounds  by  first  intention,”  illustrations  of  cases  of  rapid  recovery  after  transfixion  of  the  chest  by  the  bayonet  at  Spottsylvania.  He  writes 
“ That  such  prompt  cicatrization  occurs  after  punc^tured  wounds,  which  depends,  doubtless,  upon  the  rapidity  with  which  the  track  closes,  through  the 
elasticity  of  the  separated  tissues,  I had  several  opportunities  of  ascertaining  during  the  memorable  fights  of  the  11th  and  12th  of  May.  In  that 
remarkable  assault  on  our  breastworks,  ten  lines  deep,  in  which  the  enemy  exhibited  unwonted  boldness,  and  a persistent  constancy  of  purpose  only 
interrupted  by  night  and  only  terminated  by  a disastrous  repulse,  a bayonet  charge  ensued  which  presented  us  with  this  class  of  wounds  fur  the  first 
time.  Through  the  courtesy  of  my  friends,  Surgeon  L.  Guild,  Medical  Director  of  General  Lee's  army,  and  Surgeon  J.  T.  Gilmore,  Chief  Surgeon  of 
McLaw’s  division,  and  Surgeon  r»aruch,  3d  South  Carolina  battalion,  I examined  several  whose  chests  liad  been  entirely  transfixed  by  the  bayonet,  and 
who  were  all  doing  well.  Their  wounds  healed  in  less  than  forty-eight  hours ; two  had  expectorated  a little  blood,  but  careful  auscultation  could  detect 
no  abnormal  sounds;  there  was  but  little  pain  present,  and  no  cough ; no  hcemorrhage  of  any  account  from  the  wound  had  been  remarked.  Tlic  men 
were  seated  up  in  their  tents  on  the  fourth  day,  eating,  and  the  cordiiorm  and  punctured  wounds,  indicating  the  heel  and  point  of  the  bayonet,  already 
healed,  were  well  defined  on  the  respective  sides  of  the  chest.”  It  may  be  inferred  that  two  of  tlie  cases  mentioned  are  the  same  cited  by  Surgeon 
Baruch,  3d  South  Carolina  battalion,  at  page  133  of  the  same  Journal.  These  cases  {Finlder  and  Percival)  are  noted  on  page  470  cf  this  chapter,  tlxe 
reference  to  Dr.  Baruch’s  paper  being  inadvertently  omitted.  Dr.  Baruch  is  positive  that  the  right  lung  was  interested  in  Finklcr’s  case,  though  the 
hcemoptysis  was  the  only  symptom  of  lung  wound,  and  auscultation  gave  negative  results.  He  is  less  confident  in  Fcrcivars  case:  “ When  brought  to 
the  Infirmary,  his  countenance  was  pale  and  did  not  wear  that  expression  of  anxiety  so  peculiar  in  penetrating  wounds  of  the  chest ; his  symptoms 
indicated  a shock  to  the  nervous  system,  induced  by  the  intense  excitement  of  a hand-to-hand  conflict  with  the  drunken  and  infui’iated  foe.”  (“He  was 
lying  on  his  abdomen  and  partially  on  his  left  side  behind  a small  rail-pile,  when  he  was  transfixed”  is  the  immediately  preceding  statement.)  “Acting 
on  this  supposition,”  Dr.  Baruch  "administered  some  stimulants  and  anodynes,  which  partially  restored  the  patient,  and  enabled  him  to  recite  his 
encounter  with  the  enemy.”  * ** * “There  was  but  slight  dyspncea,  no  cough,  and  but  little  bloody  expectoration,  indicating  that  the  injury 

to  the  lung  was  not  extensive.  A careful  investigation  of  the  posture  of  the  patient  daring  the  reception  of  the  wound  convinced  me  that  the  weapon 
grazed  the  right  border  of  the  posterior  portion  of  the  left  lung,  passing  through  the  posterior  mediastinum  and  evading  the  heart,  which  was 
dis]>laced  by  the  patient's  lying  on  the  left  side.”  If  the  reader  cannot  thread  his  way  through  the  labyrinth  of  breastworks  “ten  lines  deep,”  nor  determine 


Sect.  IV.] 


COMPLICATIONS  OF  INJURIES  OF  THE  CHEST. 


611 


Complications. — The  punctured,  incised,  contused,  and  gunshot  wounds  and  injuries 
of  the  chest  that  have  been  examined,  with  some  features  in  common,  present  so  many 
differences  that  their  classification  is  difiicult.  Though  arranged  for  convenience  as  non- 
penetrating and  penetrating  wounds  and  injuries,  this  distinction  by  no  means  indicates 
their  extent  or  gravity, — an  innocuous  puncture  with  a capillary  trocar  falling  in  the  latter 
order,  and  ruptures  of  the  heart  or  laceration  of  the  lungs  without  external  wound  in  the 
former.  A division  into  injuries  of  the  walls  and  of  the  contained  viscera  is  not  more 
favorable  to  strict  definitions.  It  has  therefore  been  necessary  to  consider  these  injuries 
according  to  the  particular  structures  they  involve  and  the  complications  to  which  they 
give  rise.  The  latter  may  be  divided  into  primary  and  consecutive.  The  primary  com- 
plications are  hsemorrhage,  emphysema,  and  pneumothorax,  hsemothorax,  fractures  of  the 
bony  and  cartilaginous  case  and  of  the  clavicle  and  scapula,  hernia  of  the  lung,  and  the 
lodgement  of  foreign  bodies.  The  consecutive  complications  are  intermediary  haemorrhage 
and  heemothorax,  pleurisy,  hydrothorax  and  empyema,  pneumonia,  abscess  of  the  lung, 
carditis  and  pericarditis,  erysipelas,  gangrene,  tetanus,  pyaemia,  secondary  emphysema, 
fistula,  and  contraction  of  the  side  of  the  chest. 

Hcmiorrliage. — Bleeding  in  wounds  of  the  chest  is  primary,  intermediary,  or,  rarely, 
secondary,  and  proceeds  from  the  superficial  arteries,  the  intercostals,  and  mammaries,  the 
pulmonary  substance,  the  coronary  arteries,  and  the  heart  and  great  vessels.  Serious 
bleeding  from  superficial  chest  wounds  was  uncommon,  yet,  as  mentioned  in  a note  on 
page  519,  the  minor  vessels  sometimes  bleed  alarmingly  after  gunshot  wounds.  This  is 
noted  in  only  six  cases,  of  which  two  were  fatal  of  the  eleven  thousand  five  hundred  and 
forty-nine  cases  classified  as  non-penetrating  gunshot  wounds  of  the  chest.  When  the 
bleeding  is  not  readily  arrested  by  cold  water  and  compression,  the  safe  rule  of  exposing 
the  bleeding  vessel  and  placing  ligatures  above  and  below  the  wound  should  invariably 
be  followed,  without  trifling  with  styptics. 

Mention  has  been  made  of  many  wounds  in  the  subclavian  and  axillary  regions,  in 
which  the  vessels  were  implicated.*  In  such  cases,  if  the  vessels  were  largely  opened, 
immediately  mortal  haemorrhage  ensued.  If  the  wound  was  narrow,  or  the  orifice  in  the 
vessel  obstructed  by  a foreign  body,  or  the  bleeding  partially  arrested  by  compression,  a 
diffused  aneurism  formed.  If  the  haemorrhage  was  in  a great  measure  controlled  by 
pressure  and  plugging,  the  extravasation  of  blood  resulted  consecutively  in  a circumscribed 
aneurism.  The  results  of  ligating  the  proximal  end  of  the  main  trunk  were  deplorable, 
and,  in  their  discouragement  at  the  want  of  success  in  ligations  after  wounds  of  the  upper 
portion  of  the  axillary,  some  surgeons  regard  it  as  most  prudent  to  await  the  formation  of 
an  aneurism,  and  to  practice  an  ulterior  operation.  But,  whenever  it  is  within  the  range 
of  possibility,  both  ends  of  the  injured  vessel  should  be  tied.  It  is  very  difficult  to 

which  party  was  repulsed,  he  will  at  least  think  it  probable  that  Finkler  and  I^ercival  (whose  heart  was  providentially  displaced  into  the  jiosterior 
mediastinum)  were  two  of  the  sufferers,  although  he  might  not  agree  with  Dr.  Michel  that  the  cases  furnished  an  analogy  for  the  liealing  of  gunshot 
wounds  by  first  intention,  or  partake  of  Dr.  Baruch’s  conviction  of  the  innocuity  of  bayonet  wounds.  “The  limited  experience  derived  from  the  treat- 
ment of  these  cases  induces  me,”  writes  Dr.  Baruch  “ to  consider  bayonet  wounds  as  very  simple  injurie.s.”  * * This  dread  of  cold  steel  is,  in 

my  humble  opinion,  mainly  attributable  to  ignorance  of  the  nature  of  the  injuries  inflicted  by  it.  There  appears  to  exist  in  the  minds  of  men  a vague 
dread  of  transfixion  by  the  bayonet.  But  this  would  not  be  so  were  it  generally  known  that  bayonet  wounds  are  almost  harmless  when  compared  with 
the  ploughed  tracks  which  the  tenible  mini6  bores  through  the  tissues.”  * * “A  bayonet  wound  almost  invariably  heals  by  first  intention  under 

auspicious  circumstances.”  * * “Why  i.s  it  that  soldiers  have  such  a wholesome  dread  of  tlie  bayonet?”  Hknnen*  tells  us  (pj).  cit.  p.  374)  that 

“ bayonets  passing  along  or  through  the  muscles  covering  the  chest  and  its  vicinity,  demand  a peculiarity  of  attcntiiJii,  solely  from  the  danger  of  inflam- 
mation spreading  to  the  pleura,  or  the  lungs  and  heart,  or  of  troublesome  abscesses  forming.  In  this  view,  the  very  slightest  arc  interesting,  and  sometimes 
highly  dangerous,  particularly  in  persons  disposed  to  pulmonic  affections.” 

have  followed  M.  Legouest  in  including  these  lesions  with  wounds  of  the  chest,  a classification  which,  1 think,  presents  many  advantages.— 
COiU’lLKR. 


612 


WOUNDS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


clistinguisli  tlie  bleeding  I'rom  tlie  subscajmlar  and  circumflex  Iwanclics  from  tliat  of  the 
main  vessel,  the  degree  of  hsemorrhage  and  the  cessation  of  the  radial  i)ulse  being  about 
the  only  signs  to  aid  in  the  diagnosis.  Wounds  of  the  subclavian  and  axillary  veins  were 
controlled,  in  a few  instances,  by  compression.  In  these  injuries  and  in  the  operations 
which  they  require,  the  surgeon  is  confronted  with  the  danger  of  the  entrance  of  air  into 
the  vein,  a subject  which  Wepfer,  Bichat,  and  Nysten,  and,  in  this  country,  J.  C.  Warren, 
have  particularly  called  attention.^  Simultaneous  lesion  of  the  axillary  artery  and  vein 
gave  rise  to  aneurismal  varix  in  three  cases  of  incised  wounds  recorded  by  D.  J.  Larrey.^ 
This  condition  may  result  likewise  after  gunshot  wounds,  as  was  observed  by  Dupuytren 
and  rejiorted  by  Bcrard.’^  A case  of  successful  ligation  of  the  subclavian  for  aneurism 
reported  l)y  I)r.  Josiah  0.  Nott,^  in  1841,  is  also  cited  as  arterio-venous  in  its  character. 
Dr.  J.  P.  0.  WederstrandD  also  reports  an  aneurismal  vmlx  following  a gunshot  wound 
of  the  sul:)clavian  vein  and  artery,  which  the  patient  survived  seven  years,  when  he  died 
from  an  intercurrent  disease.  M.  LegouesD  details  a case  resulting  from  a musket  ball 
wound  in  the  left  axilla,  at  Balaclava. 

In  the  eight  thousand  seven  hundred  and  fifteen  cases  of  penetrating  wounds  of  the 
chest,  haemorrhage  is  noticed  as  a grave  complication  in  three  hundred  and  forty-six  cases, 
of  which  one  hundred  and  thirty-seven  resulted  fatally.  In  the  four  hundred  and  eleven 
abstracts  contained  in  this  chapter,  hsemorrhage  was  a prominent  feature  in  one  hundred 
and  one.’’'  Enough  evidence  has  been  adduced  of  the  dangers  of  lesions  of  the  internal 
mammary  and  intercostal  to  prove  that  they  are  not  to  be  discussed  in  the  tone  of  levity 
some  writers  have  adopted,  six  cases  of  the  former  and  eleven  out  of  fifteen  cases  of  the 
latter  having  proved  fatal.  When  the  difficulties  of  ligating  these  wounds  cannot  be 
surmounted,  the  efficacy  and  security  afforded  by  Desault’s  simple  mode  of  compression  by 
a pouch  stuffed  with  lint  should  be  borne  in  mind. 

Some  examples  liave  been  given  with  a view  to  prove  that  hsemorrhages  resulting 
from  injuries  of  the  subclavian,  primary  carotid,  and  even  the  innominate  vessels,  should 
not  be  regarded  as  without  the  legitimate  pale  of  operative  surgery.  The  brilliant  cases 
of  ligation  of  the  subclavian  by  Professor  Billroth,®  during  the  recent  Franco-German  war, 
should  be  compared  with  these  cases,  and  the.  question  examined  anew  if  it  is  not  possible 
to  save  life  under  these  circumstances,  or  at  least  to  postpone  the  fatal  issue  by  operative 
interference. 

Wounds  of  the  heart  and  great  vessels  have  been  already  noticed,  and,  if  space  per- 
mitted, the  pathological  material  in  the  Museum  and  the  literature  of  this  interesting 

* All  the  cases  aiiterior  to  his  time  are  cited  by  Mokgagni,  l)e  Sedihus  et  Cansis  Morhortim,  Epis.  V,  § 21  sqq.  See  MagendiE,  Sur  VEntrte 
accidentclle  dc  VAir  dans  Ics  Vetnes,  suj'  la  wort  suhitc  qui  cn  est  I'rJFet,  in  the  Journal  dc  JVti/siolngie  Escpcrimentale^  T.  I,  1821,  }>p.  190-199;  LEROY 
(d'fitiolles)  Notes  sur  les  Effets  de  V introduction  de  VAir  dans  le  Veins,  Arch.  Gen.  de  j\l6d.,  182iJ,  T.  Ill,  p.  410,  Juillet,  1824,  p.  4:J0;  SauceuOTTE, 
Des  Effets  j^ff^duits  seu  V ffconomie  animalc  par  la  Presence  de  VAir  atmosjdicrique  dans  Vappareil  circulatoire,  Th^se  de  Strasbourg,  1828;  DELPECII, 
Memorial  des  Ilospitaux  du  Midi,  November,  1830 ; Langenbeck,  Beitr'dfje^  zur  cliirurgischcn  Patliolugie  der  Venen,  Archives,  Berlin,  1861,  Erster 
Band,  S.  1 ; WATTi^rANN,  Sichc7'cs  lleilverfahren  he.i  Lnftemtriit  in  die  Venen,  "Wien,  1843. 

^Laruey,  I>.  j.,  Clinique  Chirurgicalc,  1'.  Ill,  p.  139,  and  TiulUtin  de  la  FacuUe  de  Medccinc,  T.  Ill,  p.  27. 

^ Dictionnaire  de  Medccinc  (cn  XXX)  Paris,  1833,  T.  IV,  p,  510. 

‘^NO'rr,  J.  C.,  Am.  Jour,  of  Med.  Sci.,  N.  S.,  Vol.  II,  p.  Ill,  and  Aimales  de  )a  Chirurgie  Eranejaise  ct  I^trangere,  T.  IV,  p.  120,  and  London 
Medical  Gazette,  October  22,  1841,  p.  158. 

® AVedEUBTR.vndt,  New  Orleans  Medical  News  and  Hospital  Gazette,  1854. 

®Legoue.st,  Chirurgie  d'Armee,  2d  ed.  p.  323. 

^In  the  twenty-three  cases  of  penetrating  gunshot  wound  of  the  lung  that  came  under  treatment  in  the  New  Zealand  War  (Mouat’s  report, 
already  cited,  i).  15),  six  terminated  fatally  from  primary,  and  three  from  intermediary,  iTaunorrhage. 

® Billrot  h,  Chirurgische  Brief c u.  s.  w.  S.  >22.  Professor  Billroth  tied  the  subclavian  three  times  and  assisted  at  two  otlicr  ligations  for  bleeding 
from  the  main  trunk.  One  of  the  patients  is  believed  to  have  ultimately  recovered.  I may  liere  mention  that  I am  informed  by  Dr.  White,  of  New 
Orleans,  that  he  examined  the  patient  on  whom  Dr.  Smyth,  in  1864,  successfully  ligated  the  innominata,  in  tlie  summer  of  1872,  and  found  the  man  in 
tolerable  health,  though  a small  tumor  with  an  aneurismal  thrill,  had  reappeared. 


Sect.  IV.] 


COMPLICATIONS  OF  IN.IURIES  OF  THE  CHEST. 


613 


subject  might  be  profitably  reviewed.^  I can  liere  only  refer  to  specimen  3388,  figured  on 
page  588,  as  suggesting  a possible  explanation  of  the  mode  in  which  balls  and  other  foreign 
bodies  may  gain  admission  to  the  cavities  of  the  heart  witliout  leaving  any  trace  of  wound 
in  the  walls  of  that  organ,  viz.,  by  gradual  absorption  of  the  wall  of  j)ulmonary  vein  com- 
pressed by  the  extraneous  body.  There  appears  to  be  no  means  of  accounting  for  the 
recorded  facts  relative  to  the  presence  of  balls  in  the  hearts  of  deer,  hogs,  etc.,  without  the 
slightest  evidence  of  any  lesion  of  the  cardiac  walls.  And  I may  mention,  briefly,  that 
Dr.  Carvallo’s  case®  of  non-penetrating  gunshot  wound  of  the  left  ventricle,  was  attended 
with  division  of  large  branches  of  the  coronary  artery,  as  in  the  cases  recorded  by  Lamotte^ 
and  Larrey.^  Haemorrhage  from  wounds  of  the  smaller  pulmonary  vessels,  and  from 
laceration  of  the  lung  tissue  will  be  considered  under  the  head  of  hoemothorax. 

Emphysema. — The  supervention  of  emphysema  is  noted  in  only  thirty-eight  of  the 
eight  thousand  seven  hundred  and  fifteen  cases  of  penetrating  wounds  of  the  chest.  In 
the  four  hundred  and  ten  abstracts  in  this  chapter,  its  presence  is  noted  in  seven  cases  only. 
The  following  is  an  example  of  this  complication  in  which  some  details  are  related  : 

Ca.se.— Private  William  H.  Mansfield,  Co.  D,  13tli  New  York  Cavalry,  aged  21  years,  was  wounded  while  attempting 
to  pass  the  line  at  Piedmont,  October  19th,  1864,  by  a conoidal  hall,  which  passed  through  the  muscles  of  the  left  arm  near  the 
shoulder,  entered  the  chest  near  the  axilla,  passed  through  the  cavity,  from  which  it  emerged  between  the  fourth  and  fifth  ribs, 
and  lodged  beneath  the  integument  between  the  scapula  and  the  .spine.  A considerable  degree  of  emi)hysema  su])ervened  in  tlio 
tissues  about  where  the  missile  lodged.  He  was  conveyed  to  the  field  ho.spital,  where  the  hall  was  excised  by  Assistant  Surgeon 
J.  T.  Burdick,  13th  New  Yoi-k  Cavalry.  Cold  compresses  were  applied,  with  continuous  ju’e.ssurc  to  the  hack.  Morphia  and 
tincture  of  veratrum  viride  were  freely  administered.  Quiet  was  enjoined,  and  the  patient  instructed  to  lay  u])on  his  left  side. 
He  recovered,  with  partial  atrophy  of  upper  lobe  of  left  lung.  lJischarge{l  from  service  in  June,  186.5.  Not  a pensioner. 

fllie  infrequency  of  this  complication  in  the  Confederate  service  is  noticed  by  Surgeons 
Chisolm  and  Jefiery.^  Dr.  Williamson*’  bears  similar  testimony  from  the  experience  of 
the  British  officers  in  India.  But,  though  rare,  this  complication  is  not  so  uncommon 
as  these  observations  would  imply.’’'  It  is  probable  that,  the  teachings  of  the  last  generation 
of  military  surgeons  having  dispelled  the  exaggerated  apprehensions  with  which  this 
phenomenon  was  regarded,  its  appearance  in  a limited  extent  was  not  always  regarded  as 
of  sufficient  moment  to  bejipecified. 

Such  was  the  influence  exerted  by  the  observations  of  Sauvages,  Littre,  Boyer,  and 
Larrey,®  that  the  celebrated  TIennen  wrote  [op.  cih,  p.  374)  that  “when  I first  entered  on 
the  practice  of  military  surgery,  the  fear  of  emphysema  actually  haunted  my  hours  of 
repose.”  But  it  has  since  been  shown  that,  though  a troublesome,  it  is  not  a dangerous 
sjunptom,  and  by  no  means  a frequent  one. 

^ Consult  the  authorities  cited  in  the  note  to  p.  527  and  refer  to  the  preparation  of  Professor  Theile,  in  the  museum  of  patholog-ical  anatomy  at  15ernc, 
in  which  a laceration  of  the  arch  of  the  aorta  was  not  fatal  for  several  months  after  the  accident;  also  the  recent  case  at  Carlsruhc,  which  Professor 
Billroth  alludes  to  {op.  cit.,  S.  113)  and  Dr.  SOCIX  describes  {Krier/schirurgische  Erfahrungen,  u.  s.  w'.,  Leipzig,  1872,  S.  48  : Lecrei>e,  wounded  at 
Worth.  August  Gth,  1870,  transferred  to  Carlsruhe.  * * Copious  haemorrhage  on  the  sixteenth  day ; death.”  'Dr.  Bcitrdgc  zur  path.  Anal,  der 

Schitsswunden^  Leipzig,  1872,  S.  12fi,  gives  the  notes  of  the  autopsy  made  August  20th,  1870,  and  remarks  on  the  slight  primary  bleeding. 

^C'AliVALLO,  p,  534,  and  Circular  No.  3,  S.  G.  O.,  1871,  p.  33,  and  Specimen  5929,  Section  I.  Army  Sledical  Museum. 

^LamoTTE.  TraitA  compUt  de  Chirurgie^  Paris,  1781,  T.  II,  p.  09.  Laruey.  Clinique  Chirurgicale,  T.II,  p.  291. 

^Chisolm.  {A  Manual  of  Military  Surgery,  3d  ed.,  p.  319):  “It  is  a sign  which  our  extensive  experience  shows  to  be  rarely  present.” 
jEFtTiitY,  11.  \V.,  Surgeon  C.  S.  N.  {Confederate  States  Med.  and  Surg^  Jour.,  vol.  I,  p.  39),  describes  a gunshot  wound  of  the  lung  attended  with 
emphysem4%  in  a seaman  of  the  C.  S.  Steamer  Isondiga,  and  remarks,  in  1804  : “Since  the  beginning  of  the  war,  this  is  the  second  case  of  wounded  lung 
in  which,  if  my  memory  serA’cs  me  aright,  I have  seen  emphysema,  and  in  which  there  was  no  expectoration  of  blood.”  So,  also,  the  authors  of  the 
Confederate  Manual  obser\*es  of  emphysema:  “ It  is  not  common  after  gunsliot  wounds,  but  occasional!}'  happens.” 

® Williamson.  Military  Surgery. -p.  IQ  •.  “It  is  seldom  that  emphysema  follows  a gunshot  wound,  but  is  somewhat  more  common  immediately 
after  sword  or  lance  wounds,  but  not  so  frequent  as  was  formerly  supposed.” 

’ MOUAT.  Jiritish  Stat.  San.  and  Med.  Hep.,  1805,  Vol.  VII.  p.  487.  In  the  twenty  •three  dctaile<l  report.s  of  penetrating  chest  wounds  in  the  New 
Zealand  war,  the  presence  of  emphysema  is  noted  in  six,  of  which  five  had  a favorable  termmatioh. 

®Bui.ssier,  vulgo  De  Salvages,  No.ujlogia  methodica  sietens  morhorum  classes,  Amsterdam,  1763.  LlTTHE,  Mem.  de  V Acad,  dcs  Sciences.  1813, 
p.  4 et  seq.  BOYEU,  TraiU  des  Maladies  chirurgir.ale.s,  Paris,  1846,  T.  V,  p.  613.  Boyer  states  that  tlie  humors  <if  the  eye  even  contain  air-bubbles  in 
some  cases.  Lauuey,  D.  J.,  Clinique  Chirurgicalc,  T.  II,  j).  88.  'I'his  great  surgeon  falls  into  the  error  of  stating  that  “ la  plupart  dcs  ])laie.s  pcnbtrante.s 
de  la  poitrinc  sont  suivies  d'un  emphyseme  plus  ou  moins  considerable.”  He  gives  an  excellent  jilate  of  a generalized  traumatic  emphysema,  {op.  cit., 
AUas,  T.  II,  pi.  4),  which  has  been  often  copied. 


WOUNDS  AND  INJURIES  OF  THE  OUEST. 


[CiiAr.  y, 


(WA 


It  will  be  understood  that  traumatic  emphysema  is  exclusively  considered  here.  The 
inflation  of  the  pulmonary  air  vessels,  termed  emphysema  by  the  physician,  a condition 
sometimes  resulting  in  the  production  of  hullse  on  the  surface  of  the  lungs,  and  rupture 
and  pneumo-thorax,  is  occasionally  observed  in  military  surgery,  in  laceration  of  the  lung 
by  concussion,  but  is  quite  distinct  from  the  condition  under  consideration. 

The  older  authors  were  in  error  not  only  regarding  the  frequency  of  emphysema  in 
penetrating  wounds  of  the  chest,  but  in  relation  to  its  importance  as  a sign  of  lung  wound. 
It  is  of  so  little  importance  in  this  respect,  that  I treat  of  it  here  instead  of  with  the 
symptoms  in  the  subsection  on  diagnosis.  Yet  great  faith  has  been  placed  in  this  sign. 
Lamotte  and  Perrein^  put  it  down  as  a certain  sign  of  lung  wound.  But  Dr.  Fraser’s 
analysis  of  modern  observations®  proves  that  emphysema  may  follow  penetrating  wounds 
of  the  chest  with  or  without  injury  to  the  lung,  complicated  or  not  with  fracture  of  the 
ribs.  In  fifty-one  cases  of  penetrating  gunshot  wounds  of  the  chest  studied  by  this  author 
{op.  cit.,  p.  66),  emphysema  was  present  in  seven.  Four  of  these  were  fatal  cases,  and  the 
lung  was  found  wounded  in  three  of  them.  Hennen  {op.  cit.,  p.  380)  says  of  emphysema: 
“The  plain  fact  is  that  it  does  not  occur  in  one  case  in  fifty,”  and  Neudorfer  {op.  cit.,  p. 
377)  remarks  that  “according  to  observations  made  in  the  wars  of  the  last  twenty  years, 
it  appears  to  follow  injuries  of  the  chest  in  only  one  out  of  two  hundred  cases,  and  that 
cases  of  its  extension  over  the  entire  surface  have  not  occurred  at  all.”  John  BelP  and 
0.  Mayer^  remark  upon  the  greater  frequency  of  emphysema  in  stabs  tlian  in  gunshot 
wounds.  This  is  probably  due  to  the  want  of  parallelism,  in  stabs,  of  the  tegumentary 
and  intercostal  orifices.  But  Baudens^  and  Dr.  Stromeyer®  offer  another  explanation  of 
the  rarity  of  emphysema  in  gunshot  wounds:  “That  the  ball  passing  into  the  substance 
of  the  lung  bruises  it  and  causes  an  immediate  extravasation  of  blood  in  the  lung  substance, 
so  that  no  air  can  pass  from  the  air-vessels  or  small  tubes  into  the  pleural  cavity.”  And 
Baudens  conceives  that  the  bronchial  tubes  possess  a resiliency  analogous  to  that  of  the 
arteries. 

The  treatment  of  emphysema  is  very  simple.  If  the  wound  is  oblique,  the  external 
and  internal  orifices  are  to  be  made  parallel  by  an  incision  through  the  skin  and  muscular 
tissue,  as  inculcated  by  Larrey  {loc.  cit.,  p.  888).  The  movements  of  the  chest  are  to  be 
confined  by  a bandage,  and,  if  the  extension  of  the  crackling  tumor  is  oppressive,  the 
air  is  to  be  liberated,  as  advised  and  practiced  by  Wiseman’  and  William  Hunter®  and 
more  modern  authors,®  by  puncture  or  incision. 

^Lamotte,  op.  cit.,  2dme  ed.,  T.  Ill,  Des  Playes  de  la poitrine ; FEiiREIN,  Ant.  Clemens  de  Chirurgic  pratique,  Paris,  1771. 

*The  British  Director-GeueraFs  Beport,  p.  G3,  says : “ The  wound  was  soon  followed  by  emphysema, *  * * showed  unmistakably  that  the  lung 

had  been  injured.”  The  same  ojiiniiiion  is  held  in  the  Lancet,  February  14th,  1852;  and  in  the  Medical  Times,  December  17th,  1853,  the  proof  of  lung 
wound  given  is  “ emphysema  and  dyspnoea;"  and  in  the  same  jounial,  on  April  Gth,  1841,  emphysema  is  again  adduced  as  a sign  of  lung  wound ; and 
on  April  27th.  1850,  in  the  same  journal,  a case  is  related  in  which  empysema  was  present,  but  no  other  symptom  of  lung  wound.  Preparations  of 
cases  in  which  emphysema  existed  when  the  lung  was  wounded  are  to  be  found  in  the  museums  of  St.  George’s  and  Guy’s  Hospitals. 

3 John  Bell.  Discourses  on  the  Nature  and  Cure  of  Wounds,  1795,  Part  II,  p.  11. 

"•C.  Mayer.  Traciatus  de  Vultieribus  pectoris  penetrantihus,  Petropolis,  1823,  p.  28. 

®Baudens.  Clinique  des  Plaies  d'Armes  d Feu,  Paris,  1836,  p.  260.  ® Stromeyer.  Maximen  der  Kriegsheilkunst,  Hannover,  1855,  S.  602. 

^Wiseman  {Seocrall  Chirurgicall  Treatises,  Folio,  London,  1676,  Book  V,  p.  3()8).  “A  fdotman  was  wounded  into  the  left  side  : He  cought  blond 
and  discharged  much  by  the  'Wound.  * * Some  few  days  after,  a Tumour  arising  about  a wound,  I gave  him  a visit  and  felt  the  swelled  Parts 

crackle  under  my  fingers.  Concluding  it  "Wind  got  out  from  the  cavity  within  the  T/iorax,  I made  an  Incision  into  the  Swelling  about  an  inch  long,  by 
which  the.  Wind  was  discharged.” 

^Hunter,  William.  Medical  Ohservations  and  Inquiries,  11,  vfiWx  characteristic  elegance  and  correctness,  describes  this  condition 

and  the  proper  remedj'’. 

^LOhmeyer,  C.  F.  {Die  Schusswunden,  n.  vf.,  133).  "Trifling  degrees  of  emphysema  generally  disappear  after  the  application  of  a soft 
compressive  bandage,  which  at  the  same  time  fixes  the  ribs  that  may  have  been  fractured,  as  it  principally  enforces  the  respiration  by  motions  of  the 
diaphragm.  But  when  the  emphysema  over  the  larger  portion  of  the  body  extends,  the  air  may  be  liberated  by  puncture  or  incision  of  the  skin,  or  its 
farther  extension  into  the  cellular  tis.sues  maybe  prevented  by  enlarging  the  wound,  that  the  air  filling  the  pleural  cavity  be  forced  directly  outward 
during  expiration." 


Sect.  IV.] 


COMPLICATIONS  OF  INJURIES  OF  THE  CHEST. 


615 


M.  Gossclin^  maintains  tliat  contusions  of  tlie  chest,  attended  hy  lacerations  of  the 
luno;  substance  witli  integrity  of  the  visceral  pleura,  may  cause  ('inphysema.  Perhaps  the 
case^  in  Guy’s  Hospital,  cited  by  Dr.  Fraser  (p.  66)  as  a ]a’oof  that  “emphysema,  taken 
hy  itself,  is  not  a certain  sign  of  lung  wound,”  was  of  tins  character.^ 

Fractures. — The  gravity  of  penetrating  wounds  of  the  chest  was  much  augmented  by 
the  existence  of  fracture,  especially  if  the  lesion  of  bone  was  at  the  point  of  entrance.  It 
was  formerly  believed,  and  is  still  maintained  by  Neudorfer,'^  that  all  gunshot  perforations 
of  the  chest  are  attended  by  fracture;  hut  many  instances  have  been  adduced  in  this 
work,  in  which  balls  have  entered  and  emerged  through  intercostal  spaces,  or  l)roken  the 
rilis  only  in  exit.  Unquestionably  the  size  of  missiles  is  here  an  inqxjriant  element,  and 
its  influence  is  apparent  in  the  mortality  rate  of  chest  wounds.  Dwelling  upon  this  point. 
Dr.  Socin,  in  his  recent  work,^  maintains  that  his  statistics  disprove  Dr.  Neudorfer’s  state- 
ment that  “the  intercostal  spaces  are  too  small  to  allow  even  the  Prussian  Langhlei  to 
slip  through,”  and  asserts  that  it  is  induhitalde  that  the  small  chassepot  missile  may  pass 
through  most  of  the  intercostal  spaces  without  interesting  the  hones,  and  contends  that 
“with  the  late  improved  arms,  perforating  gunshot  wounds  of  the  chest  are  not  rare,”  and 
that  “this,  no  doubt,  is  one  of  the  causes  of  the  more  favorable  results  lately  obtained.” 

In  the  reports  of  the  eight  thousand  seven  hundred  and  fifteen  penetrating  wounds 
accounted  for  in  Table  XXVI,  page  606,  the  presence  of  fracture  of  the  ribs,  in  cases  in 
which  the  missile  was  believed  not  to  have  entered  the  thoracic  cavity,  is  mentioned  in 
four  hundred  and  forty-six  cases.  In  cases  attended  by  penetration,  it  is  referred  to  in 
only  five  hundred  and  five  cases,  of  which  two  hundred  and  four  were  fatal,  altliough  it 
existed,  in  all  probability,  in  the  majority.  The  complication  of  chest  wounds  by  fractures 
of  the  sternum  is  recorded  in  fifty-one  cases,  by  fractures  of  the  verteljra3  in  ninety-two 
cases,  by  fractures  of  the  clavicle  in  one  hundred  and  thirty-six  cases,  and  by  fractures  of 
the  scapula  in  three  hundred  and  seventy-five  cases.  This,  however,  is  a very  imperfect 
summary.  It  includes  only  the  cases  in  which  the  lesion  named  is  directly  specihed  in  the 


' GossELI.N’  (liecherches  sur  Ics  Dichirurts  du  Poumon  sans  Fractures  des  Cotes  correspondantes,  M6m.  de  la  See.  do  Cliir.  de  Paris,  1847,  T.  I, 
p.  234.) 

^Seo  a case  in  Guy's  Hospital  Keports,  Second  Series,  Vol.  Ill,  seventh  case  in  Table  II,  p.  147 ; a “ contused  wound  on  the  right  side,  opposite 
tile  eighth  rib,  from  a fall  on  a spike;  iw fracture ; emphysema  of  nearly  tlie  whole  side  of  the  chest;  no  symptoms  wliatever. 

^ CUKUttENFELI)  {Bihliotheca  Chirurgica,  Vindibmim,  1781,  p.  C(i.l)  compiles,  mainly  from  WAhTllun  and  llALLElt,  three  quarto  pages  of  reference, 
to  writers  on  empneumatosis  or  emphysema.  Among  those  interesting  to  the  military  surgeon  are  the  observations  of  Smktil  s (Miscell.  Med.,  Franc, 
Kill,  Mb.  IV),  “ de  enormi  emphysemate  ex  pectoris  vulnere,  quod  die  quinto  evanuit;”  Bautholinus  (Hist.  Anat.  Cent.,  llafniae,  1C.54,  Cent.  V,  Obs. 
12),  " emphysema  ex  pulmonis  vulnere a case  reported  by  PE  run  Ksi'.tNXE  (in  Riviere's  Obs.  Med.),  “ de  emphysemate  a vulnere  pectoris WOUM 
{Epist.  Postil.,  llafnim,  1651),  “A  vulnere  pectoris  emphysema;”  Keies  (Elysius  jucundarum  qusestionum  campus.  Uruxell,  1661),  “emiihyseina  a 
pectoris  vulnere ;”  PAULUS  DE  SonuAlT  (Examen  Chirurgorum),  ” de  emphysemate  in  pectoris  A'ulnere ;”  Littue  (Comment,  ylcad.  Ao'.,  Anno.  1713), 
de  emiihysemate  ;”  Petit  {Traite  des  Mai.  Chir.,  1790,  T.  I,  p.  124),  “des  plaies'  de  poitrine;”  AsTituc  (Traile  des  Tumeurs  et  des  Ctceres,  Paris, 
ll.lO) ; SCIIUI.ZE,  De  Emphysemate,  Thesis,  Ilalaa,  1733  (in  Haller's  Disp.  Chir.,  Vol.  II,  p.  567) ; IlEWSO.x,  On  Emphysema  and  Wounds  of  the  Lung, 
in  Path.  Ohs.  and  Enq.,  London,  1767,  Vol.  Ill,  p.  372;  WILLIAM  HUNTER  {Med.  Obs.  and  Jnq.,  Vol.  11,  p.  17).  Sir  Andrew  Halliday  (Observations  on 
Emphysema,  London,  1807)  has  collected  most  of  the  observations  and  experiments  of  his  predecessors  and  added  much  valuable  material  of  his  own. 
Consult  also  the  articles  by  Bresciiet,  Murat,  BfiGiN,  and  JACQUEMET,  in  the  French  Dictionaries,  and  LASSUS 
[Path.  Chir.,  T.  II,  p.  331) ; AuERXETHY  (Surgical  and  Physiological  Works,  London,  1830,  Vol.  II,  p.  171) ; JOHN 
Bell  (Discourses  on  Wounds,  Part  II,  p.  11) ; RlCHTElt  (Anfangsgriinde  der  Wundarzneykunst,  B.  I,  S.  451) ; 
and,  among  later  writers,  DUPUYTREN  ( Clin.  Chir.,  T.  I,  p.  110)  ; Malgaigne  (Du  Traitement  des  grands  Emphyse- 
■ mes  traumaliques,  in  Bull,  de  Thdrap.,  T.  XXH,  p.  352)  ; Dolbeau  (De  1'Emphysi.me  traumatique,  Thdso  d'aggre- 
gation,  1860). 

■’Xeudorfer  (Handbuch  der  Kriegsehirurgie.  Leipsig,  1867,  S.,  581) : “Alle  perforirenden  Sehussverletzun- 
gen  der  Brust  sind  mit  Knochen-  oder  Knorpolverletzungen  combinirt.  Der  Intercostalraum  ist  auch  beim  Erwach- 
senen  zu  klein,  um  ein  Projectil  glatt  durch  schlUpfen  zu  lassen.” 

‘Socin,  A.,  Kriegschirurgische  Erfahrangen  gesammelt,  in  Carlsruhe,  1870  und  1871,  Lcipzieg,  1872,  S.  84. 

The  Langhlei,  or  missile  of  the  Prussian  needle-gun,  is  an  ovoid  solid  slug.  The  specimen  in  the  Museum  (No. 

4737,  Sect.  I)  weighs  514  grains  and  has  a calibre  .56  of  an  inch.  The  chassepot  missile  weighs  380  grains  and  has 
a calibre  of  .43  of  an  inch.  The  heavy  Russian  ball  used  in  the  Crimea,  and  many  of  the  conoidal  lialls  of  large  pqu.  302.— The  iirojectlles  of 

calibre  employed  in  the  War  of  the  Rebellion  almost  invariably  inflicted  fractures  in  striking  the  chest.  the  chassepot  aiid  needle-gun. 

(After  MacC’ormac.) 


WOUNDS  AND  IN.IUKTES  OK  THE  CITEST. 


[Chap.  V, 


61 G 

report,  omitting  those  where  its  existence  could  readily  be  inferred.  ]\roreover  the 
numerous  cases  in  which,  for  example,  the  clavicle,  scapula,  and  ribs  were  fractured  simul- 
taneously, are  entered  but  once,  under  the  head  of  the  injury  which  was  regarded  as  the 
most  severe. 

The  special  gunshot  fractures  of  the  clavicle,  scapula,  sternum,  and  ribs,  and  the 
operations  which  they  sometimes  involve,  have  been  fully  illustrated  in  preceding  portions 
of  this  chapter,  and  those  of  the  vertebrse,  in  Chapter  IV.  The  general  conclusion  that 
formal  primary  excisions  of  the  bones  of  the  trunk  for  injury  are  very  rarely  required, 
has  been  corroborated  by  the  recorded  experience  of  military  surgeons  abroad,  during  more 
recent  wars.  Though  exceptional  or  hypothetical  cases  might  be  presented,  in  which 
partial  or  complete  excisions  of  the  clavicle  or  scapula  might  be  justifiably  practiced,  the 
reparative  powers  of  nature  are  known  to  furnish  excellent  results  in  grave  injuries  of 
these  bones,  and  it  is  generally  agreed  that  the  removal  of  “primary  sequestrae,”  or  entirely 
detached  fragments,  should  be  commonly  the  limit  of  operative  interference.  Where 
extended  necrosis  occurs,  judicious  surgical  intervention  may  be  of  great  benefit.^ 

In  compound  fractures  of  the  ribs,  it  is  commonly  recommended  that  the  splintered 
extremities  should  be  resected  or  smoothed  olf,  especially  if  the  splinters  are  directed  inwards. 
But  this  is  a theoretical  rather  than  a practical  precept.  Dr.  Fischer  {op.  cit.,  p.  116) 
states  tliat  in  his  extended  experience  he  has  had  occasion  but  once  to  have  resource  to  this 
expedient.  Unless  bound  down  by  the  pleuritic  adhesions,  the  lung  usually  recedes  far 
enough  from  the  projecting  splinters  to  avoid  laceration.  If  necrosis  supervenes,  the  rib 
becomes  so  separated  from  the  soft  parts  tliat  partial  excisions  are  facilitated.  Dr.  Pirogotf  ^ 
warmly  inveighs  against  early  interference  in  these  cases.  Professor  Gross, ^ however,  has 
“met  with  shot  wounds  of  the  chest  where  the  ribs  were  so  much  shattered  as  to  require 
removal  with  the  cutting  pliers.”  But  he  adds  “the  instances  demanding  such  a procedure 
must  be  uncommon.” 

A number  of  exam|)les  of  gunshot  fractures  of  the  sternum  have  been  detailed. 
These  injuries  are  interesting  from  the  frequency  with  which  they  are  complicated  by 
lesions  of  the  internal  mammary  or  of  the  pericardium  and  great  vessels,  or  by  the  lodge- 
ment of  balls,  and  because  of  consecutive  necrosis  and  abscesses  in  the  mediastinum.^ * •* 

* Besides  the  operations  on  the  scapula  referred  to  in  the  text  and  note  at  p.  557,  the  reader  may  refer  to  the  cases  of  Drs.  E.  M.  Bartlett  {St.  Louis 
Med.  ayid  Surg.  Jour.,  1854,  Vol.  XII,  p.  C4),  and  T.  M.  Owens,  of  Arkansas  (Xew  Orleans  Med.  and  Surg.  Jour.,  Vol.  XI,  p.  164,  1854)  j Wutzer’s  case, 
in  Ortbach’s  dissertatitm,  Bonn,  1835;  a successful  case  recorded  by  Esmarch  in  a dissertation  published  at  Kiel,  in  1850;  and  cases  by  Jlazzoni  and 
Biagini,  in  the  Gazette  Med  de  Paris,  ixnd  Bulletin  dc  Therap).,T.yi\  {Fracture  of  the  body  of  the  Scapula, 'Edva.  Med.  and  Surg.  Jour., 

April,  1831) ; Smiley  ca5e5  of  Gunshot  Trow7M/5,  Boston  Med.  and  Surg.  Jour.,  1863,  Vol.  LXVIII,  p.  412)  reports  a case  of  gunshot  fracture 

of  spine  of  the  scapula,  with  extraction  of  fragments.  For  ojierations  on  tlie  clavicle  reft'r  to  DaavsoX,  \V.  W.  {Excision  of  the  Entire  Clavicle,  Boston 
Med.  and  Surg.  Jour.,  Vol.  II,  p.  95,  1868-69) ; Tryox,  J.  K.  {Exsection  of  Right  Clavicle,  Am.  Jour.  Med.  Sci.,  Vol.  XLIX,  p.  357,  1865);  Irvine 
{Excision  and  Regeneration  of  the  Entire  Clavicle,  London  Lancet,  1867,  Vol.  1,  p.  206). 

^'PlROGOV'F  {Grundzuge  der  Allgemeinen  Kriegsehirurgie,  ii).  ^’SI) : “Stromeyer  und  Demme  sprechen  sogar  von  der  Rippenresection ; welche  in 
dem  holstein’schen  unditalienischen  Kriege — im  letzten,  wie  es  scheiut,  selbst  friihzeitig — bei  comminutiven  Rippenbriichen  vorgenommen  worden  war. 
Gott  sei  Dank,  dass  uns  das  noch  fehlte ! ” 

3 Gross,  A.,  System  of  Surgery,  Yo\.  11,  p.  446,  1872.  Consult  also  Disdier,  De  Costarum  Frac^wra,  Paris,  1764,  T.  IV,  p.  686;  Verduc, 
Pathologic  de  Chirurgie,  Paris,  1703,  p.  395 ; Malgaigne,  Reclierches  sur  les  Variety  et  la  Traitement  dcs  fractures  de  Cotes,  in  Arch,  G§n.  do  Med. 
1838;  Gurlt,  E.,  Handhuch  der  Lchre  von  den  Knochenhruchen,  Hamm,  1864,  Zweiter  Theil,  S.  191;  DIEFFENBACH,  J.  F.,  Die  Operative  Chirurgie, 
Leipzig,  1848,  Zweiter  Band,  S.  400. 

•*  L.v  Martini£;re  {Sur  V Opa'ation  du  Trepan  au  Sternum,  in  M6in.  dc  FAcad^mie  Royale  de  Chirurgie,  T.  IV.,  p.  545),  to  whom  1 have  not  suffi- 
ciently expressed  my  obligations  on  the  notes  to  p.  572,  gives  au  excellent  account,  with  cases,  and  a handsome  plate,  of  the  injuries  and  diseases  of  this 
bone,  and  the  operations  practiced  on  it.  Consult  also  the  learned  Freind's  ( The  Zlistory  of  PhysieJe ; from  the  Time  of  Galen  to  the  beginning  of  the 
Sixteenth  Century,  London,  1726)  account  of  the  descriptions  by  Avenzoar  and  Salius  Diversus  of  abscesses  of  the  mediastinum.  ]\lost  of  the  older  sur- 
geons refer  very  deferentially  to  the  opinions  of  RealduS  Columbl'S  on  perforations  of  the  sternum,  in  his  work  De  re  anatomica ; but  Par6  desired  that 
he  should  have  treated  more  fully  of  diagnosis.  PURMANN,  M.  G.  {Lorheer-Krantz  oder  wundartzney,  Franckfurth  und  Leipzig,  1692,  p.  480)  treats  at 
length  of  the  subject,  and  practiced  the  operation  of  trepanning  the  sternum.  Among  the  moderns,  consult  Sabatier,  Mimoire  sur  les  Fractures  du 
Sternum,  in  M6m  dc  I’lnstitute,  an  VII,  T.  II,  p.  115;  Richerand.  Lc<jon  du  citoyen  Boyer  sur  les  Maladies  des  Os,  1803,  T.  I,  p.  99 ; DUBOS,  Maladies 
du  Sternum,  These  de  Paris,  1835.  ASIIIIURST,  On  Fracture  of  the  Sternum,  Am.  Jour.  iMed.  Sci.,  N.  S.  Vol.  XLl  V,  p.  406. 


Skct.  IV.] 


COMPLICATIONS  OF  INJURIES  OF  THE  CHEST. 


617 


Hernia  of  the  Lung. — This  complication  has  been  fully  considered  in  the  subsection 
beginning  on  page  514.  I have  only  to  add  that  it  has  been  very  rarely  observed  in  the 
late  wars  in  Europe;  descriptions  of  only  two  cases  having  been  found  recorded  by  recent 
writers.^  These  cases  were  observed  by  Dr.  H.  Beaunis®  at  Juranville,  in  an  ambulance 
of  the  Army  of  the  Loire. 

Lodgement  of  Foreign  Fodies. — A hundred  and  ninety-four  examples  have  been 
adduced  to  illustrate  the  numerous  varieties  of  lodgement  of  missiles,  fragments  of 
clothing  and  equipment,  and  other  foreign  bodies,  and  it  is  hoped  that  sufficient  evidence 
has  been  accumulated  on  this  point  to  guide  the  practitioner  to  the  safe  middle  path 
between  the  rash ' interference  and  timid  and  harmful  non-interference.  The  instances  in 
which  foreign  bodies  remain  sacculated  and  innocuous  within  the  tissues  for  lengthened 
periods,  have  been  shown  to  be  very  rare  in  comparison  with  those  in  which  serious  mischief 
and  danger  ultimately  arose.  The  peace  of  mind  which  the  extraction  of  the  foreign 
substances  invariably  induces  in  the  patient  is,  in  itself^  a strong  reason  for  using  every 
judicious  means  for  their  removal.  It  has  been  seen  that  foreign  bodies  may  be  buried 
either  in  the  soft  parts,  bones,  or  viscera,  of  the  thorax,  or  be  loosely  in  the  pleural, 
pericardial,  or  mediastinal  spaces.  No  attempts  to  remove  them  from  the  two  latter  situ- 
ations were  reported.  The  judicious  cautions  of  systematic  writers  on  the  use  of  the  probe 
have  received  due  attention,  and  it  has  been  shown  that  they  do  not  always  apply  to  old 
cases,  or  all  recent  cases,  and  that  careful  exploration  with  the  finger  or  gum  catheter  may 
sometimes  be  more  judicious  than  abstention,  and  the  circumstances  justifying  interference 
have  been  fully  illustrated.  Examples  of  the  expectoration  of  balls  in  coughing,  and  of 
their  escape  through  the  thoracic  walls  and  intestinal  canal,  have  been  cited.  A general 
survey  of  the  long  series  of  cases,  while  leading  to  the  inference  that  foreign  bodies  sooner  or 
later  produce  grave  accidents,  favors  a belief  in  the  possibility  of  recovery  with  lodgement.* 

The  other  primary  complications  of  penetrating  wounds  of  the  chest  may  be  most 
conveniently  considered  with  those  that  are  consecutive.  Of  these  the  most  important 
are  the  visceral  inflammations. 

Traumatic  Pleurisy. — This,  according  to  the  received  doctrines,  attended,  in  a greater 
or  less  degree,  all  of  the  cases  of  penetrating  wounds  of  the  chest;  but  the  instances  in 
which  it  is  referred  to  as  the  most-prominent  complication  number  only  ninety-four,  fifty-two 

* A hernia  of  the  lung  existed  in  the  case  of  Alexis  St.  Martin,  as  reported  by  Surgeon-General  Joseph  Lovell,  in  the  American  Medical  Recorder^ 
Vol.  VIII.  1825,  p.  14.  See  S^ond  Sarg.  Vol.  , p.  55. 

^Beauxis.  Impressions  de  Campagne.  In  Gazette  M^dicale  de  Paris,  3eme  S6rie,  T.  XXVI,  No.  52,  p.  593,  December  30,1871.  “We  had 
seventeen  cases  of  penetrating  gunshot  wounds  of  the  chest,  out  of  which  there  were  four  deaths  in  the  first  fortnight.  There  were  two  cases  of  hernia  of 
the  lung.  One  of  these  men  died  a few  days  after  the  reception  of  the  wound;  in  the  other,  I ligated  the  protruding  portion  of  the  lung,  which  was 
of  the  size  of  an  egg ; and  the  fourth  day  after,  the  day  of  our  departure,  no  serious  symptoms  had  supervened.  In  neither  of  these  cases  was  there  any 
tendency  towards  the  spontaneous  reduction  of  the  tumor.” 

* See  Manec,  case  of  an  iron  blade  lodged  in  the  lung  substance  for  fifteen  years  {Bulletin  de  la  Societi  Anatomigue^  Paris,  1829,  p.  51);  BEKCIION’fi 
{Gazette  Medicate^  1861,  pp.  209,  225,  1241)  rectification  of  the  history  of  the  convict  at  llocbefort,  cited  by  many  authors,  in  whose  chest,  between  the 
first  and  fourth  ribs,  was  found  the  fragment  of  a knife-blade  83  millimetres  (3^  inches)  in  length,  which  had  wounded  the  lung  and  lay  in  an  indurated 
canal,  formed  at  its  expense,  according  to  G.«ulleu  {Presse  Medicate^  T.  I,  p.  51).  Nisle  {Arch,  gin.  de  Med.,^  1831,  T.  XXV,  p.  253)  gives  the  case  of  a 
man  wounded  in  1814,  who  died  of  a cerebral  disorder  in  1830,  and,  at  the  autopsy,  the  ball  was  found  in  a cavity  of  the  size  of  an  egg,  in  tlie  lower  lobe 
of  the  right  lung.  MoOltE,  of  Plymouth  {London  Lancet,  January  9th,  1847),  gives  a case  in  which  a ball  lodged  near  the  surface  of  the  lung  for  fifty 
years.  vM.  IIIPPOLYTE  Lakuey  {Relation  Chirurgicale  des  I^cinements  du  Juillet,  1830;  cites  two  cases  of  ball  lodgement.  Surgeon  A KNOT,  of  the 
Grampus  {Medico-Chirurgical  Transactions,  Vol.  XJII,  1827,  ]>.  281),  reports  a case  of  a piece  of  hoop-iron  removed  from  a c^'st  in  the  left  lung,  ojiposite 
the  third  rib,  where  it  had  remained  for  fourteen  years,  the  sailor,  a man  44  years  of  age,  having  been  wounded  in  1812,  and  dying  from  inllurnmation  of 
the  lung  in  1826.  Leash  {Catalogue  of  the  Museum  of  the  Royal  College  of  Surgeons)  reports  the  history  of  Henry  liarrott,  1st  Life  Guards,  wounded  at 
Waterloo,  June  15th.  1815,  in  the  left  thorax  ; he  lived  forty-two  years  and  a hundred  and  seventeen  days.  The  ball  was  found  iu  an  abscess  containing 
a pint  of  pus.  In  cases  in  which  a blade  is  impacted  in  a rib  and  broken  short  off,  Gerard’s  expedient  of  pushing  it  out  with  tlie  finger  protected  hy  a 
thimble,  within  reach  of  the  forceps,  must  not  bo  forgotten.  See  in  the  Army  Medical  Museum,  SECT.  I,  Spec.  961,  a wet  preparation  of  lung,  with  a 

piece  of  bone  driven  into  its  substance  by  shot.  Case  of  John  W.  L , Co.  D,  3d  Wisconsin,  aged  20,  wounded  at  Antictam,  September  17tli,  1862; 

admitted  to  General  Hospital  at  Frederick,  .September  24th;  died  October  28tli,  1862. 

7.S 


618 


WOUNDS  AND  IN.TUDTES  OF  THE  CHEST. 


[Chap.  V, 


of  wliicli  were  fatal.  Surgeon  J.  T.  Woods  observes,  of  the  chest  wounds  he  treated  at 
Chickamauga: 

“ I have  been  astonished  at  the  noii-occuiTence  of  pleuritis,  the  wouuds  being  ragged,  injuring 
twice  both  thoracic  and  pulmonary  pleurae  with  spiculae  of  ribs  sometimes  thrown  inward,  to  irritate 
the  parts  and  aid  in  exciting  this  result ; but,  in  these  cases,  the  symptoms  of  plenritis  were  both 
infrequent  and  mild.” 

Mr.  Erichsen  says^  “whenever  the  pleura  is  wounded,  * * whether  the  lung  be 

injured  or  not,  pleurisy  necessarily  sets  in.”  But  Dr.  Fraser  [op.  cit,  p.  78)  believes  that 
“an  inflammatory  action  in  the  pleural  membrane  is  sometimes  the  effect  of  shot  or  bullet 
wound  in  the  chest,  but  not  a usual  consequence.”  There  can  be  no  doubt  that  the 
expressions  of  the  special  student  of  this  subject  depict  the  true  condition  of  things  far 
more  accurately  than  those  of  the  systematic  author. 

When  pleuritis  arose  after  chest  wounds,  its  symptoms  and  progress  were  not  to  be 
distinguished  from  those  observed  in  the  idiopathic  form  of  the  disease.  Lymphy  exuda- 
tions took  place,  adhesions  formed  between  the  costal  and  pulmonic  pleurse,  and  serous 
effusions  often  ensued,  as  will  be  more  fully  described  in  treating  of  hydrothorax.  The 
plastic  exudations  on  the  pleura  were  found  in  many  fatal  cases  to  be  very  thick  and  dense. 

One  of  the  most  remarkable  instances  of  this  excessive  thickening  of  the  pleura,  by 
inflammatory  exudation  following  mechanical  lesion  of  the  lungs,  is  illustrated  by  the 
preparation  No.  512,  of  the  surgical  series  of  the  Museum,  which  is 
imperfectly  figured  in  the  accompanying  cut  (Fig.  303); 

Case. — Private  William  B , Co.  F,  6th  Wisconsin  Volunteers,  aged  18  years,  was 

wounded  in  the  first  battle  in  whicli  his  regiment  participated,  at  Gainesville,  August  ‘28th,  186‘2, 
the  first  of  the  series  of  engagements  included  under  the  title  of  the  Second  Battle  of  Bull  Run. 
He  was  shot  through  the  right  chest,  and  was  left  upon  the  field  for  several  hours,  but  was  finally 
provided  with  shelter  at  a field  station  of  the  First  Army  Corps.  There  was  not  much  bleeding; 
but  a frequent  painful  cough,  with  bloody  sputa,  and  dyspnoea,  and  anxiety,  and  a quick  small 
pulse.  Occasional  stimulants,  with  small  anodynes,  and  cooling  drinks,  constituted  tlie  general 
treatment,  and  the  local  treatment  consisted  in  covering  the  orifices  of  the  wounds  with  compresses 
secured  by  adhesive  strips.  On  September  2d,  he  was  placed  in  an  ambulance  train,  and,  after  a 
weary  journey,  over  rough  roads,  of  over  thirty  miles,  he  was  admitted  to  College  Hospital,  George- 
town, September  6th,  1862,  according  to  the  memorandum  of  Acting  Assistant  Surgeon  J.  Morris 
Brown,  “with  a perforating  gunshot  wound  of  the  thoracic  cavity;  the  missile  entered  on  the  right 
side,  between  the  first  and  second  ribs,  about  one  and  a half  inches  from  the  costal  cartilages,  passed 
downward  and  backward,  perforated  the  right  lung,  and  emerged  at  the  angle  of  the  fifth  rib, 
which  it  comminuted,  besides  chipping  the  sixth.  There  was  effusion  in  the  right  pleura;  sonorous 
rales;  exaggerated  breathing;  he  also  spat  blood.”  The  prescription  book  of  the  hospital  is  the 
only  guide  to  the  progress  of  the  case  during  the  six  weeks  which  elapsed  before  its  fatal  termina- 
tion. Death  resulted  on  October  21st,  1862.  The  necropsy  revealed  the  track  of  the  ball.  The 
wood-cut  (Fig.  303)  represents  a preparation  of  the  right  lung  and  of  six  ribs  of  the  same  side. 
The  lung  is  collapsed  and  solidified  and  the  pleura  intensely  thickened  after  inflammation,  the 
pleura  puhnonalis  being  about  two  and  a half  lines  in  thickness.  There  is  a corresponding  thick- 
ening of  the  costal  membrane.  The  specimen  was  contributed,  with  a brief  note  of  the  case,  by 
Acting  Assistant  Surgeon  G.  K.  Smith. 

Similar  appearances  are  shown  in  specimen  3736,  figured  on  page  588  (Fig.  289),^ 
and  in  specimens  2424,  1142,  1315,  and  696,  of  the  Army  Medical  Museum.  Intense 
local  pleuritic  exudation  is  displayed  in  specimen  515,  case  of  8.  B , p.  490. 


Fig.  303. — Section  of  the 
right  thorax,  showing  a perfo- 
ration by  a musket  ball  through 
the  first  intercostal  space,  and 
extreme  thickening  of  the 
pulmonary  pleura.  Spec.  512, 
Sect.  I,  A.  M.  M. 


* Erichsen,  The  Science  and  Art  of  Surgery^  5th  ed.,  London,  1872,  Vol.I,  p.  436. 

2 Assistant  Surgeon  A.  A.  Woodliull,  U.  S.  A.,  cites  this  preparation  as  a proof  that  pneumonia  is  not  “a  necessary  consequence  of  gunshot  wound 
of  the  lung.”  There  is  indeed  no  evidence  that  there  was  local  infiammatitm  at  the  time  that  the  ball  penetrated  the  lung  substance,  and  though  the 
exudations  on  the  pleura  are  exceptionally  profuse;  yet,  at  the  time  of  death,  the  lung  tissue  was  pervious  in  near  proximity  to  the  ball,  floating  in 
water,  and  showing  little  if  any  trace  of  inflammatory  engorgement.  In  immediate  juxtaposition  with  the  ball,  the  lung  tis.sue  had  undergone  a cheesy 
metamorphosis 


Sect.  TV.] 


COMPTJO/VTTONS  OF  TN.TTTIITFS  OF  TTTF,  ('TTR8T. 


619 


The  pleuritic  exudations  sometimes  were  observed,  to  }dug  the  wound,  as  if  to  rejiair 
the  injury  to  the  serous  membrane,  as  was  observed  by  Dr.  John  Thomson^  after  Waterloo, 
and  by  John  Hunter  in  experiments  on  animals,  from  which  he  deduced  that  this  was  the 
natural  process  of  cure. 

Traumatic  Pneumonia. — Tins  is  noted  as  a grave  complication  in  two  hundred  and 
eighty-five  of  the  penetrating  and  seven  of  the  non-penetrating  wounds  of  the  chest,  and 
resulted  fatally  in  two  hundred  and  twenty-two  of  the  former  and  six  of  the  latter  group. 

In  an  interesting  report  of  1,562  cases  wounded  after  the  battle  of  Antietam,  at 
Hospital  Ho.  5,  at  Frederick,  Surgeon  Henry  S.  Flewit,  U.  S.  V.,  makes  the  following 
observations  on  wounds  of  the  lung: 

“Sixteen  cases  of  wounds  of  the  thorax  and  lungs  have  been  received.  The  number  of  eases 
of  undoubted  penetration  or  abrasion  of  the  lungs  was  fourteen.  Temporary  recoveries  of 
unmistakable  lung  wounds  have  occurred  in  six  cases.  The  word  temporary  is  used  advisedly. 
The  final  result  of  penetration  or  abrasion  of  lung  tissue  is  doubtful  in  every  case,  and  ultimately 
futal  ill  most.  The  temporary  recoveries  have  exceeded  the  iTroportion  of  the  best  foreign  military 
hospitals.  This  favorable  result  is  undoubtedly  due  in  a great  measure  to  the  season  of  the  year 
and  the  warmth  and  dryness  of  the  Maryland  autumnal  climate.  The  rapid  recurrence  of  traumatic 
pneumonia  complicated  and  obscured  the  physical  signs,  and  the  earlier  deaths  took  place  before 
means  were  provided  iov post-mortem  examinations.  In  all  the  fatal  cases  in  which  autopsies  have 
been  made,  traumatic  lesions  of  the  lung  tissue  were  discovered,  the  original  injury,  however, 
masked  by  the  products  of  excessive  inflammation  and  purulent  infiltration;  in  two  instances 
l)assing  rapidly  into  gangrene.  It  was  remarked  that  the  passage  of  the  ball  through  and  through 
was  more  unfavorable  than  where  it  remained  in  the  cavity.  No  instance  has  been  known  of  a ball 
lodging  on  the  diaphragm.  One  such  case  was  diagnosticated  by  a surgeon,  but  the  bullet  was 
subsequently  removed  from  the  centre  of  the  quadratus  lumhorum.  The  treatment  pursued  in  all 
the  cases  of  lung  wound  was  that  of  nutrition  and  stimulation.  Hurried  respiration  was  quieted 
by  aconite,  and  exalted  heart  action  subdued  by  veratrum  viride.  The  administration  of  these 
remedies  was  seldom  required  more  than  a few  times.  In  obviously  fatal  cases  from  this  as  well 
as  other  causes  euthanasia  was  sought  for  and  promoted  by  morphine,  administered  hypodermically 
or  through  the  wound  where  possible.  The  fatal  cases  rapidly  assumed  the  chai’acteristic  appear- 
ances of  the  closing  period  of  rapid  consumption,  accompanied  to  the  last  by  clear  intelligence  and 
the  remarkable  buoyancy  of  spirit  which  often  co-exists  with  the  suppurative  disintegration  of  this 
vital  oi’gan.  I have  observed  no  instance  of  traumatic  pneumonia  extending  to  the  opposite  lung. 
The  conservatism  of  nature  is  manifested  in  the  effort  at  limitation  and  arrest  of  inflammation  and 
suppuration,  and  in  the  extraordinary  success  occasionally  observed  in  cases  apparently  the  most 
hopeless.” 

Surgeon  Hewit  accompanies  his  report  with  the  following  abstracts  compiled  by  his 
assistant.  Dr.  Cherbonnier : 

Case. — Corporal  Emanuel  Fulp,  Co.  C,  27th  Indiana  Volunteers,  aged  40  years,  was  wounded  at  the  battle  of  Antietam, 
Maryland,  September  17th,  18G2,  by  a minie  ball,  which  entered  at  the  internal  angle  of  the  axilla,  passed  directly  through  the 
upper  lobe  of  the  left  lung  near  its  edge,  and  emerged  at  the  infra-spinous  fossa  of  the  scapula.  Acting  Assistant  Surgeon  A.  V. 
Cherbonnier,  who  reports  the  case,  states;  “When  first  seen  by  me,  October  20th,  1862,  he  was  suffering  with  some  shortness  of 
breath,  pain  in  side,  cough,  and  sputa  slightly  rusty.  He  had,  as  he  informed  me,  spat  blood  only  for  a few  days  after  the 
injury,  and  that  in  very  small  quantities.  The  wounds  presented  a healthy  appearance,  and  the  discharges  were  of  a healthy 
color  and  proper  consistency.  The  wounds  were  ordered  to  be  kept  perfectly  clean,  and  to  be  dressed  regularly  twice  a day, 
.simple  cerate  being  used.  For  the  pneumonia  that  was  apparent  from  the  pain,  shortness  of  breath,  and  sputa,  and  other  physical 
signs,  the  patient  was  put  upon  Bennett’s  plan  of  treatment  and  with  visible  effect  each  day.  On  October  2uth,  some  fragments 
of  bone  presented  themselves  near  the  point  of  exit  and  were  removed.  October  28th  : All  the  symptoms  better.  The  physical 
signs  of  the  second  stage  perceptibly  passing  away  and  the  lung  assuming  all  the  symptoms  of  mere  engorgement.  October 
30th;  Patient  sits  up  and  is  cheerful;  wound  suppur.ating  kindly;  patient  continued  to  improve,  in  fact,  walked  about  the  room. 


•Thomson  (Rep.  of  Obs.  in  Mil.  Hasp,  of  Belffium,  p.'Jl):  “ We  saw  several  cases  in  which  the  external  wounds  having  healed  during  tlio  con- 
tmuance  of  |>leuril5C  inHammation,  etc.” 


620 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


wlion,  on  Novonibor  8tli,  he  Imd  a chill,  followed  hy  fever,  thished  face,  and  hurried  re.spiration.  The  wounds  looked  dry  and 
had  suppurated  hut  slightly  on  that  day  and  the  day  previous.  He  continued  to  grow  worse  daily  and  died  November  15th. 
I’ost  mortem  revealed  the  left  cavity  of  the  chest  nearly  filled  with  pijs,  which  was  very  feetid,  and  some  serum  in  the  pericardium. 
The  lung  was  entirely  collapsed,  gray,  and  presented  the  appearance  of  a putrid  mass.” 

Case. — Private  li.  W.  Hill,  Co.  K,  8th  Louisiana  Volunteers,  was  admitted  to  Hospital  No.  5,  Frederick,  Maryland, 
November  23d,  1862,  with  a gunshot  penetrating  wound  of  the  chest,  received  at  Antietam,  September  17th.  A minie  ball  entered 
the  right  lung  between  the  thiril  and  f)urth  ribs,  going  directly  through  the  body.  The  case  was  progressing  favorably  on 
adnnssion.  He  had  been  very  low,  and  it  was  supposed  for  some  time  after  the  injury  that  he  would  die.  When  first  seen  at 
Frederick  he  was  suffering  with  some  cough — more  troublesome  at  night — expectoration  not  profuse  and  catarrhal ; right  shoulder 
depressed  and  the  chest  considerably  sunken  below  the  point  of  entrance;  the  lung  was  (juite  solidified  above;  broncophony. 
The  wound  was  still  sujtpurating,  though  slightly.  The  suppuration  had  been  very  profuse,  requiring  dressing  three  or  four 
times  a day.  On  November  28th,  1832,  he  was  sent  to  Richmond,  at  which  time  he  felt  quite  able  to  travel  and  was  in  excellent 

si) irits.  Without  the  occurrence  of  any  unexpected  symptom  he  would  recover  entirely.  Acting  Assistant  Surgeon  A.  V. 
Cherbonnier  reports  the  case. 

Case. — Private  Bernard  McGofern,  Co.  A,  C3d  New  York  Volunteers,  aged  41  years,  by  occupation  a hempdresser,  was 
wounded  at  Antietam,  September  17th,  1832,  and  admitted  to  Hospital  No.  5,  Frederick,  Maryland,  on  September  24th.  This 
is  another  case  of  penetrating  wound  of  the  lung.  Missile,  unknown,  but  supposed  to  be  a round  ball,  entered  the  left  side  of 
chest,  passing  through  second  and  third  ribs,  making  no  exit.  He  spat  blood  for  several  days  after  injury;  cough  very  trouble- 
some and  expectoration  very  profuse  and  thick.  Treated  after  Bennett’s  plan,  nourishing  and  stimnlating  diet,  with  marked 
benefit,  the  symptoms  diminishing  in  intensity  each  d.ay  until  his  discharge  from  the  hosjtital,  December  20th,  1862.  At  the  date 
of  his  discharge,  he  had  little  or  no  cough ; muscular  development  fair;  very  slight  shortness  of  breath,  and  the  chest  but  slightly 
deitressed.  His  spirits  and  appetite  were  excellent,  and,  as  he  expressed  it,  he  felt  (jiiite  well.  The  lung  presented  the  following 
characteristics  when  he  left:  Vesicular  murmur  faint,  but  heard ; bronchial  respiration;  lung  not  so  resonant  as  in  health.  He 
is  not  a pensioner.  Acting  Assistant  Surgeon  A.  V.  Cherbonnier  reports  the  case. 

Case. — Private  Charles  Eldridge,  Co.  E,  72d  Pennsylvania  Volunteers,  was  wounded  at  the  battle  of  Antietam,  September 
17th,  1862,  and  admitted  into  Hospital  No.  5,  Frederick,  Maryland,  on  the  23d.  Acting  Assistant  Surgeon  A.  V.  Cherbonnier 
states:  * * “Acouoidal  ball  entered  at  edge  of  posterior  fold  of  axilla,  injuring  ulnar  nerve  (paralysis  of  fifth  finger),  penetrating 
lung,  and  emerging  over  middle  bone  of  sternum.  This  certainly  was  the  most  interesting  case  that  came  to  this  hospital  for 
treatment  and  was  considered  a hopeless  one  from  the  beginning.  Patient  very  much  emaciated;  habitual  cough;  purulent 

sj) uta;  matter  for  days  emerging  from  sternum,  sometimes  amounting  to  four  ounces  a day;  air  also  escajting  from  wound;  left 
lung  doing  all  the  work;  exaggerated  breathing,  and  a state  of  hydro-pneumothorax  in  right  lung;  dulness  over  lower  two- 
thirds;  cavernous  breathing;  lung  pushed  by  fluid  against  spinal  column;  was  kept  constantly  propped  up  in  bed,  unable  to  lie 
down;  occasional  cupping;  attention  to  bowels  and  kidney;  generous  diet;  cod-liver  oil  and  brandy.  This  case  gradually  and 
steadily  improved.  During  the  course  of  treatment  he  committed  several  excesses  in  diet,  producing  dysentery,  which,  however, 
readily  yielded  to  treatment.  On  the  29th  of  December,  he  was  transferred  to  Hospital  No.  1.  He  had  been  walking  about  the 
ward  two  weeks  before  the  transfer.  Had  applied  for  his  discharge  and  was  considered  well  able  to  travel.  At  the  time  of 
transfer  right  side  of  chest  very  much  sunken;  entire  consolidation  of  lung  below  wound ; above  wound  very  slight  vesicular 
murmur  and  symptoms  of  slow  incipient  phthisis.”  Eldridge  was  discharged  March  6th,  1863,  and  pensioned  February  21st, 
1866.  Examining  Surgeon  J.  H.  Gallagher  reports  that  the  volume  of  the  lung  is  considerably  impaired;  that  he  has  a constant 
hacking  cough,  accompanied  by  pain,  and  that  deep  inspiration  causes  tearing  pain.  His  disability  is  rated  one-half  and 
permanent. 

Surgeon  J.  T.  Woods,  99tli  Ohio  Volunteers,  makes  the  following  observations  on  the 
treatment  of  traumatic  pneumonia  in  connection  with  the  perforating  chest  wounds  he 
reported  after  the  battle  of  Chickamauga : 

“ The  great  danger  is  pueutnonia,  the  treatment  of  which  is  not  only  delicate  and  difficult,  but 
likely  to  prove  unfortunate.  No  occasion  was  found  for  Guthrie’s  heroic  phlebotomy  or  for  active 
purgations.  No  indication  for  antimony  or  the  impairing  the  blood’s  plasticity  presented  itself. 
The  only  plausible  hope  for  successful  treatment  lies  iu  early  application  of  remedies,  and  in  this 
matter  lies  an  error  fraught  with  fatality.  The  patients  are  mingled  with  others  iu  crowds,  the  air 
is  often  impure,  and  this,  with  dejiressed  and  circumscribed  respiratory  power,  adds  fuel  to  the 
difficulty;  examinations  made  are  not  sufficiently  frequent  and  minute  to  detect  the  earliest  manifes- 
tations of  the  disease  while  within  the  control  of  medication.  Anodynes  sufficient  to  allay  the 
intense  suffering  are  dictated  both  by  philosophy  and  humanity,  upon  the  detection  of  pneumonia 
in  its  early  stages.  The  administration  of  tincture  of  veratrum  viride  sufficient  to  produce  its 
sedative  effect  and  thus  arrest  by  crushing  out  the  disease  at  once,  has  afforded  most  satisfactory 
results.  The  impression  is  made  suddenly  at  the  time  selected  by  the  surgeon,  and,  while  it  throws 
a barrier  iu  the  way  of  the  inflammatory  process,  it  leaves  no  traces  of  a destructive  i)rocess  of  a 
permanent  constitutional  character.  Great  atteiltiou  is  required  to  the  diet,  which  should  at  first 
be  light  and  made  more  nourishing  as  the  progress  of  diseased  action  taxes  more  severely  the 
constitutional  energies.” 


Skct.  IV.] 


COMPLICATIONS  OF  INJURIES  OF  THE  CHEST. 


621 


“Pneumonia  is  an  invariahle  sequence  of  wound  of  a lungf  says  Mr.  Erichsen/  in 
1869,  “and  constitutes  one  of  the  great  secondary  dangers  of  this  injury;  tlie  inflam- 
mation that  is  necessary  for  the  repair  of  the  wound  in  the  organ  having  frequently  a 
tendency  to  extend  to  some  distance  around  the  part  injured,  and  not  uncommonly  to 
terminate  in  abscess.”  Elis  American  editor  and  commentator.  Dr.  Ashhurst,®  is  more 
guarded.  “Pneumonia  and  pleurisy,”  he  says,  “(usually  limited  to  the  track  of  the 
wound)  probably  occur  in  most  cases  of  lung  wound,  which  are  not  rapidly  fatal.”  Mr. 
Erichsen’s  statement  appears  to  be  founded  on  general  inferences  and  imperfect  observa- 
tion ; Dr.  Ashhurt’s  concisely  embodies  the  results  of  his  analysis  of  the  evidence  on  this 
point.  Neither  statement  is  based,  apparently,  on  personal  pathological  investigations.^  It 
is  certain  that  pneumonia,  in  the  ordinary  acceptation  of  the  term,  is  not  an  invariable 
sequence  of  wounds  of  the  lung.  It  is  probable  that  it  is  not  a frequent  sequence.  Mr. 
Erichsen  proceeds  to  say  that  “traumatic  pneumonia  resembles  in  all  its  symptoms, 
auscultatory  as  well  as  general,  the  idiopathic  form  of  the  disease.”  This,  again,  is 
erroneous;  for  in  a large  number  of  wounds  of  the  lung,  the  organ  collapses,  and  a 
condition  unfavorable  to  hypersemia'* *  is  induced,  and  the  auscultatory  signs  are  modified. 
The  lung  does  not  play  and  the  ordinary  respiratory  murmur  is  not  produced.  Dr.  Eraser 
[op.  cit,  p.  69)  satisfied  himself  by  experiment  and  autopsies  that  pneumonia  was  of  rare 
occurrence  after  wounds  of  the  lung.  My  own  observations  and  dissections  confirm  me  in 
the  belief  that  his  arguments  cannot  be  successfully  impugned.^  It  is  obvious  that  in 
many  of  the  reports  of  penetrating  chest  wounds  in  the  War  of  the  Debellion,  the  existence 
of  consecutive  pneumonia  has  been  taken  for  granted.  Often  there  is  no  mention  of  the 
physical  signs  indicative  of  its  presence,  and,  frequently,  it  is  apparent  that  the  term  is 
not  used  in  a strict  sense;  but  that  pleurisy,  thoracic  effusions,  and  almost  any  agglomera- 
tion of  internal  disorders  are  included  under  this  title.  Dr.  Macleod  [Notes,  etc.,  p.  234) 
refers  to  a Russian  struck  by  a musket  ball  near  the  right  nipple;  the  ball  passed  behind 
the  sternum,  fracturing  it  badly,  and  escaped  close  to  the  left  nipple:  “double  pneumonia 
and  jjericarditis  followed.  The  whole  contents  of  the  thorax  were  found  implicated  in 
one  vast  inflammation.”  This  resembles  many  of  the  statements  made  in  our  reports. 
Dr.  Macleod  admits  that  he  was  not  present  at  the  autopsy,  and  his  observation  is  valueless 
as  regards  the  existence  of  inflammatory  exudations  in  the  lung  substance.  The  truth  is 
that  there  are  so  many  circumstances  to  impede  the  military  surgeon  in  arriving  at  a 
correct  physical  diagnosis,  and  in  completing  his  observations,  that  deficiencies  may  well 
be  excused.  He  is  often  in  the  midst  of  the  noise  and  confusion  of  warfare;  the  wounded 
man  cannot,  perhaps,  be  placed  in  a convenient  posture  for  auscultation ; the  facilities  for 
necroscopic  examination  are  not  available.  These  considerations  proportionately  enhance 
the  value  of  exact  observations. 

Dr.  Klebs  [oqj.  cit.,  p.  83),  in  his  report  of  the  one  hundred  and  twenty-nine  autopsies 
of  j)atients  dying  from  the  effects  of  gunshot  wounds,  at  Carlsruhe,  in  1870,  records 

* KiacilsEN  (J.  E.).  Set.  and  Art  of  Surgery,  5th  ed.,  London,  1869,  Vol.  I,  p.  435.  I have  italicised  the  statements  to  which  I particularly  demur. 

^AsiiUUltST  (J.,  Ju.).  The  l*rinciples  arid  Practice  of  Surgery^  Philadelphia,  1872. 

*80CIX  (Kriegschirurgische  Erfahrungen,  Leipzig,  1872,  8.74).  “ I was  astonished  to  find,  at  many  autopsies,  how  completely  even  long-shot 

channels  through  the  lungs  would  heal,  if  no  foreign  bodies  had  lodged.  I liave  no  doubf  that  a wound  through  the  lung  tissues  may  heal  i^er primam. 
1 can  also  remember  cases  of  shot  wounds,  in  which  the  thorax  was  entirely  perforated,  wliere  I could  trace,  with  the  greatest  ditliculty,  the  healed  or 
to-a-narroW'fistula-contracted  passage  of  the  missile,  while  the  pleural  oavitj*  was  in  a state  of  complete  suppuration.” 

^Professor  SciiUll  ( Wiener  Wochenschrift.,  Jan.,  1857)  remarks  that  in  shot  wounds  of  the  lung,  (me  of  the  elements  necessary  to  indime  pneumonia, 
the  rough  and  sudden  intlation  of  air  into  the  delicate  lung  structure,  is  wanting,  as  a wijundcd  lung  is  juirtially,  if  not  altogether,  undilatable. 

regret  that  1 have  been  unable  to  finish,  in  season  for  publication  in  this  place,  drawings  of  microscopical  preparations  of  lung  tissue  from  the 
vicinity  of  tracks  of  punctured  and  shot  wounds,  s(dected  from  the  thirty-one  post-mortem  examinations  that  I have  made,  dcmon.strating,  in  some 
instances,  the  non-existence  of  inflammation  in  close  proximity  to  the  wound.  I shall  avail  of  an  opportunity  of  introducing  them  hereafter. 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CTiai*.  V, 


twenty  j)08t-7nortem  examinations  in  cases  of  shot  wounds  of  the  lung,  and  remarks  of 
case  119:  “Dagegen  ist  es  der  einzige  von  mir  beobachtete  Fall,  in  welchem  sich  von 
dem  Schusskanal  aus  Pneumonie  entwickelte.”  Of  the  fifty-one  cases  of  penetrating 
wounds  of  the  chest  observed  by  Dr.  Fraser,  or  collected  in  Dr.  Matthew’s  report,  only 
thirteen  were  attended  by  pneumonia.  In  not  one  of  the  nine  fatal  cases  observed  by 
Dr.  Fraser,  in  which  the  lungs  were  wounded,  did  pneumonia  supervene.  It  was  pr^jsent 
in  one  out  of  nine  fatal  cases  in  which  the  lung  was  not  wounded,  and  in  two  out  of 
twelve  cases  of  recovery.  It  occurred  in  seven  of  the  twelve  fatal  cases,  and  three  of  the 
nine  cases  of  recovery  reported  by  Dr.  Matthew.^  Commenting  on  a series  of  autopsies 
of  patients  dying  from  wounds  of  the  lung,  after  the  battle  of  Worth,  Dr.  SociiF  observes: 
“I  was  astonished  to  find  at  many  autopsies  how  small  the  reaction  was  in  the  immediate 
vicinity  of  the  injured  parts.  Generally  the  lung  tissue  around  the  track  of  the  ball  is 
oidy  hejiatized  to  the  distance  of  two  or  three  millimetres.  Under  such  circumstances  it  is 
evident,  that,  if  no  bleeding  occurs,  and  this  may  happen  frequently  by  the  bruised 
condition  of  the  wound-canal,  such  an  injury  may  heal  without  any  serious  symptoms.” 

I might  accumulate  much  more  evidence  on  this  point,  but  I think  from  these  facts 
we  may  correctly  conclude  with  Dr.  Fraser,  that  ‘‘pneumonia  may  be,  but  is  not  of 
necessity, * **a  consequence  of  lung  wound;”  that  when  it  occurs  ‘‘it  can  rarely  be  diagnosed 
at  so  early  a period  after  the  receipt  of  the  injury  as  to  be  useful  as  a diagnostic  sign;” 
and  that  traumatic  pneumonia  differs  from  the  idiopathic  form  in  the  absence,  in  the 
former,  of  exudations  of  plastic  lymph  in  the  air-vesicles,  and  of  the  spreading  tendency 
of  the  constitutional  affection;  and  in  the  rarity  of  pus  formation,  unless  excited  by  the 
detention  of  foreign  bodies. 

Carditis  and  Pericarditis. — The  comparative  immunity  from  inflammation  after 
injury,  that  we  have  observed  in  the  parenchyma  of  the  lung,  when  contrasted  with  the 
effects  of  wounds  of  its  membrane,  is  yet  more  conspicuously  displayed  in  the  effects  of 
mechanical  lesions  upon  the  heart  and  its  serous  envelope.  Enough  examples  of  wounds 
of  the  heart,  in  which  the  fatal  issue  was  sufficiently  delayed  to  afford  time  for  the  devel- 
opment of  inflammatory  phenomena,  have  been  observed  to  warrant  the  conclusion  that 
parenchymatus  inflammation  of  this  organ  is  as  infrequently  the  result  of  injury  as  of 
disease.^  I have  examined  two  cases  where  patients  survived  a fortnight  or  more  after 
shot  wounds  grazing  the  heart,  in  which  the  pericardium  was  thickened  and  the  visceral 
as  well  as  the  reflected  layer  of  the  pericardium  was  thickly  coated  with  shaggy  exuda- 
tions; but  the  muscular  structure  presented  no  alterations  discernible  by  the  microscope.^ 
If  an  analogy  might  be  instituted  between  the  effect  of  tension  on  inflamed  striated  muscle 
in  the  trunk  or  extremities,  it  would  be  inferred  that  the  slightest  degree  of  inflammation 
of  the  muscular  structure  of  the  heart  would  cause  unendurable  anguish  in  its  movements 

* Matthew  {op.  tit.,  Vol.  II,  p.  321) : ‘‘Extensive  pneumonia  did  not  appear  to  be  a common  occurrence.  Pneumonic  consolidation  was  more 
generally  confined  to  the  neighborhood  of  the  injury,  or  at  all  events  to  the  lobe  implicated,  and  sometimes,  as  may  be  observed  in  the  cases  hereafter 
appended,  the  wound  in  the  lung  healed  with  hardly  a trace  of  tlie  inflammatory  process  in  the  substance  of  the  organ.” 

^SOCIX,  A.,  Kricgscliirurgische  Erfahrungen  u.  s.  w.  Leipzig.  1872,  S.  75. 

^See  ROKITANSKI,  A Manual  of  Pathological  Anatomy.  Translated  from  tlie  German  by  C.  H.  Moore.  Am.  cd.,  Philadelphia,  1855,  Vol.  IV, 

p.  131. 

**  Compare  Rixdfleiscii,  A Textbook  of  Pathological  Histology.  Translated  by  \V.  C.  Kloman,  M.  D.,  Philadelphia,  1872,  p.  231.  “ In  the  striated 

muscles  of  the  trunk  and  the  limbs  it  is  conformable  to  experience  that  even  the  slightest  degree  of  inflammation,  for  example,  even  that  slight  tumefac- 
tion which  we  find  accompanying  chronic  rheumatism,  and  (jf  which  it  has  not  yet  been  decided  whether  it  essentially  goes  beyond  a considerable  degree  of 
hyperaemia,  is  combined  with  the  severest  functional  disturbance.  The  muscle  rests  in  a contracted  condition.  The  slightest  attempt  to  stretch  it  meets 
with  the  most  decided  resistance  from  the  patient,  because  of  its  painfulncss.  If  we  attempt  to  transfer  these  experiences  to  the  licart  it  is  readily  manifest 
that  even  the  slightest  degree  of  diffuse  inflammation  must  have,  as  a consequence,  the  stoppage  of  the  lieart,  and,  therefore,  the  death  of  the  i)atient,  and 
that  only  subsequent  stages  of  the  inflammatory  process,  would,  in  general,  be  j)ossiblein  i»artial  affections.” 


Sect.  IV.] 


COMPLICATIONS  OF  INJUEIES  OF  THE  CHEST. 


623 


and  lead  to  its  stoppage.  On  the  other  hand,  in  all  of  the  cases  examined,  in  whicli  halls 
had  wounded  the  pericardium,  or  even  brushed  against  it,  the  physical  signs  of  pericarditis 
were  observed;  and  the  post-mortem  examinations  revealed  extensive  exudations  and 
efiusions.  The  progress  of  these  cases  to  their  fatal  termination  was  usually  very  rapid. ^ 

From  the  solid  exudations  on  the  serous  membranes,  in  wounds  of  the  chest,  we  pass 
to  the  consideration  of  the  gaseous  and  liquid  efl’usions  within  the  cavity  of  the  thorax 
that  often  attend  these  injuries.  The  illustrious  John  Hunter  pointed  out  this  distinction 
in  wounds  of  the  chest  compared  with  wounds  of  the  two  other  great  cavities, — the  head 
and  abdomen, — that  the  parts  “are  not  under  the  same  circumstances  that  other  contained 
and  containing  parts  are;  for  in  every  other  case  the  contained  and  containing  have  the 
same  degree  of  flexibility  or  proportion  in  size.  The  brain  and  skull  have  not  the  same 
flexibility,  but  they  bear  the  same  proportion  in  size.  From  this  circumstance  the  lungs 
immediately  collapse  when  either  wounded  themselves  or  when  a wound  is  made  into  the 
chest  and  not  allowed  to  heal  by  the  first  intention,  and  become  by  much  too  small  for 
the  cavity  of  the  thorax,  which  space  must  be  filled  either  with  air  or  blood,  or  both ; there- 
fore adhesion  cannot  readily  take  place;  but  it  very  often  happens  that  the  lungs  have 
previodsly  adhered,  which  will  frequently  be  an  advantage.” 

Pneumothorax. — Air  may  be  effused  in  the  pleural  cavity  by  a laceration  of  the  lung 
from  external  contusion,  or  the  rupture  of  air-vesicles,  or  of  vomicse  in  forced  expiration, 
or  by  wound  of  the  lung  by  a fractured  rib,  or,  lastly  and  most  commonly,  by  a wound 
penetrating  the  thoracic  walls.  It  is  generally  associated  with  emphysema;  but  either 
condition  may  exist  independently.  Where  there  is  an  external  wound,  communicating 
with  the  cavity,  the  air  is  sucked  in  on  inspiration  and  is  forced  out  in  expiration  in  an 
amount  corresponding  to  the  extent  to  which  the  lung  expands.  If  the  wound  is  small 
and  oblique,  or  tortuous,  the  air  finds  its  way  among  the  meshes  of  connective  tissue  and 
emphysema  is  established.  If  the  wound  is  large  and  communicates  directly  with  the 
cavity,  the  lung,  unless  connected  with  the  costal  pleura  by  adhesions,  soon  collapses,  and 
the  space  it  occupied  is  filled  with  air.  If  there  is  no  disturbance  of  the  equilibrium  of 
pressure  of  the  external  air  and  that  admitted  to  the  wounded  side,  the  patient  may 
breathe  with  comparative  comfort  with  the  sound  lung;  but  if  air  is  confined  and  con- 
densed in  the  injured  cavity,  the  sound  lung  is  compressed,  and  distressing  dyspnoea  arises. 
The  symptoms  of  pneumothorax,  then,  are  dyspnoea,  varying  in  degree,  exaggerated 
resonance  on  percussion,  absence  of  the  respiratory  murmur,  amphoric  respiration,  if  air 
inflates  at  all  the  collapsed  lung.  The  intercostal  spaces  are  effaced,  the  ribs  elevated, 
and  the  injured  side  enlarged,  if  there  is  obstruction  to  the  escape  of  the  air.  The  chief 
subjective  symptom  is  a sense  of  constriction  at  the  base  of  the  thorax. 

It  was  the  general  experience  during  the  war  that  traumatic  pneumothorax  very 
rarely  assumed  such  a phase  as  to  excite  alarm.  In  the  vast  series  of  cases  of  chest 

* 'ITic  following*  articles,  in  addition  to  those  cited  on  p.  534,  may  be  consulted  in  reference  to  lesions  of  the  heart  and  of  its  sac : COXR,  J.  K., 
Sonm  observations  on  Wounds  of  the  Hearty  Am.  Jour.  Med.  Sci.,  Vol.  IV,  p.  307,  ().  S.,  18:39;  Davis,  T.,  Foreign  Body  in  the  Heart  of  a Boy,  Am. 
Jour.  Med.  Sci.,  Vol.  XV,  p.  20.1,  O.  S.,  1834;  Wound  of  the  Heart,  Am.  Jour.  MciL  Sci.,  Vol.  XXV,  p.  22.5,  O.  S..  1839;  lilClIAUDS,  O.  W.,  Case  of 
Wound  of  the  Heart,  Boston  Med.  and  Surg.  .Join*.,  Vol.  XXXV,  p.  330,  1847;  TliUGIEN,  JOHN  W.  II.,  A Case  of  Wound  of  the  Left  Ventricle  of  the 
Heart;  Pattent  survived  five  days;  with  remarks,  Am.  Jour.  Med.  .Sei.,  Vol.  XX,  p.  99,  18-50;  HOPKINS,  Ji.  0.,  Gunshot  Wound  of  the  Heart;  Death 
two  weeks  after  the  Accident,  Boston  Med.  and  Surg.  Jour.,  Vol.  XLVII,  p.  534,  18.53 ; Bai.cii,  G.  B.,  A Case  of  Gunshot  Wound ; In  which  a Leaden 
Ball  remained  in  the  Walls  of  the  Heart  for  Twenty  Fears,  Boston  .Med.  and  Surg.  Jour.,  Vol.  LXIV,  p.  515.  1861  ; BOHEHTS,  J.  B.,  A Man  runs  Sixty 
Yards  aiul  lines  One  Hour  after  being  shot  through  both  Lungs  and  the  Bight  Auricle  if  the. Heart,  Hielitnond  and  Louisville  Med.  Jour.,  Vol.  XII, 
p.  G07, 1871 ; IkvUAlds,  M.,  Observation  de  jdaie penetrante  de  poi trine  avee  lesion  du  jJtricarde,  in  Bee.  de  M6m.  de  Med.,  de  Chir.  ct  de  I'harrn.,  Paris,  1836, 
T.  XL,  p.  32.5;  TOURNKL,  Observation  d'une  plaie  pinHrante  de  lapoitrine,  avec  lision  du  cceur,  dapounion  ct  de  la  branche  idirinigue  gauche,  in  li(X. 
de  Mem.  de  Med.,  etc.,  Paris.  1836,  T.  XXXIX.  p.  174. 


624 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CllAl-.  V, 


wounds,  tins  complication  is  noted  as  troublesome  in  less  than  half  a dozen. ^ Yet  there 
are  many  recorded  instances^  in  which  suffocation  appeared  imminent  from  the  wounding 
of  the  mediastinum  upon  the  sound  lung.  In  such  cases,  it  would  be  proper  to  dilate  the 
wound,  as  Boyer,  Dupuytren,  and  Guthrie  recommend,  or  to  practice  thoracentesis  if  the 
wound  has  entirely  closed,  guarding  against  the  readmission  of  air  by  attaching  a pipe  or 
bladder  to  the  canula  of  the  trocar.  Saussier^  has  collected  some  valuable  observations  on 
this  point. 

Hydrothorax. — Serous  effusion  into  the  cavities  of  the  pleura  or  pericardium  is  an 
occasional  result  of  traumatic  inflammation,  and  gives  rise  to  most  of  the  symptoms 
attending  other  liquid  effusions,  as  dyspnoea,  lividity  of  countenance,  and  the  other 
phenomena  attendant  on  imperfect  aeration  of  the  blood,  with  the  physical  signs  of  dulness 
on  percussion,  varying  according  to  posture,  and  oegophony.  In  most  cases  of  liquid 
effusion  in  the  chest  after  wounds,  the  extravasation  is  more  or  less  sanguinolent  or 
purulent,  and  hence,  in  the  clinical  histories,  few  cases  are  reported  under  this  head. 
AVhen  dyspnoea  is  urgent,  jJuracentesis  is  the  principal  and  reliable  remedy.^ 

Haemothorax. — Sanguineous  extravasation  within  the  pleural  cavity  may  result  from 
lesions  of  the  heart  or  arteries  proceeding  from  it  or  veins  emptying  in  it,  or  from 
wounds  of  the  mammaries  and  intercostals,  or  from  wounds  or  lacerations  of  the  sub- 
stance of  the  lung.  It  occurs  at  the  moment  of  the  wound  or  several  days  afterward, 
when  the  clots  obstructing  the  divided  vessels  fall.  It  may  rapidly  fill  the  sac  or  slowly 
accumulate,  varying  in  extent  and  rapidity  according  to  the  number  and  size  of  the 
vessels  wounded.  When  rapid  and  profuse  the  patient  perishes  promptly  from  asphyxia, 
and  hence  the  cause  of  many  deaths  'on  the  battle-field. When  less  copious,  and  grad- 
ually extravasated,  it  gives  rise  to  a series  of  phenomena  which  awaken  the  surgeon’s 
utmost  solicitude.  Dyspnoea  may  become  excessive  ; the  breathing  is  frequent  and 
labored  ; there  is  urgent  anxiety  and  oppression  and  agitation ; the  patient  seeks  to  sit 
upright  (orthopnoea)  or  can  tolerate  only  a dorsal  decubitus,  or  can  rest  only  on  the 
wounded  side,  or  throws  himself  from  one  posture  to  another,  drawing  up  the  thighs, 
elevating  the  head  and  shoulders,  in  short,  fighting  for  breath.  He  has  a sense  of  great 
constriction  and  weight  at  the  base  of  the  chest.  There  is  dulness  on  percussion,  and 
the  respiratory  murmur  is  absent  on  the  wmunded  side  to  the  level  of  the  effusion ; the 
intercostal  spaces  are  jirotuberant,  the  ribs  are  separated  and  raised,  the  hypochondriac 
region  is  prominent,  the  injured  side  moves  but  little  in  respiration.  These  physical 
signs  are  modified  when  air  is  present  in  the  cavity;  then  there  is  tympanitic  resonance 
above,  and  below  absolute  dulness.  The  undulations  of  the  fluid  are  felt  by  the  patient 
in  sudden  movements.  The  blood  gushes  out  of  the  wound  in  coughing  or  violent 
expiration.  Superadded  to  these  signs  are  those  of  copious  haemorrhage;  the  pulse  becomes 

* Abstracts  of  tlircc  of  these  cases  are  printed:  Beck,  jn  493;  Lewis,  p.  494;  Eldridgc,  p.  520.  Two  recovered;  the  third  was  attended  by  emphy- 
sema and  empyema,  and  the  patient  succumbed  from  exhaustion,  not  from  suffocation. 

2 BOYEU,  Ti'aiti  dcs  Mai.  Chir.,  T.  VII,  p.  301 ; DUPUYTREX,  Let^ons  Orales,  T.  VI,  p.  331 ; Gutiirie,  Comm.,  p.  439. 

^ Saussier,  Recherches  sur  la  Pneumothorax  et  les  Maladies  qui  la  produiscnt,  Paris,  1841,  p.  81.  iTAitD  {Dissertation  sur  les  Collections gazeuses 
qui  se  forment  dans  la  Poitrine,  Paris,  1801)  specially  studied  this  morbid  phenomenon.  Laexxec  {TraiU  de  V Auscultation  mediate  et  des  Maladies  des 
Poumoyis  et  dii  Cceur,  Paris,  1831)  treats  of  this  subject  with  characteristic  accuracy.  Our  immeasurable  obligations  to  him  and  to  Auenbrugger 
{Inventum  novum  ex  Percussione  Thoracis  humani,  Vienna,  1761)  are  never  to  be  forgotten  in  considering  the  diagnosis  of  affections  of  the  chest. 

■*  Duverney,  Sur  V Hydropisic  de  Poitrine,  in  Jil^m.  de  I'Acad.  des  Sciences  de  Paris,  1703,  p.  174  ; TeiciimaYER,  II.  F.,  Diss.  de  Jlydrope  Pectoris, 
lena,  1727;  Morand,  Sur  une  Ilydropisie  de  Poitrine  Guerie  par  Operation,  in  Mem.  de  TAcad.  royale  de  chirurgie,  1759,  T.  II,  p.  545;  VOGEL, 
Diss.  de  Hydrope  pectoris,  Gottingen,  1763;  Geiiler,  Diss.  de  Jlydrothoracc,  Leipzig,  1790;  OTTO,  Diss.  de  llydrothorace,  Franefort,  a.  v.,  1800; 
Maclean,  L.,  An  Inquiry  into  the  Nature,  Causes,  and  Cure  of  Ilydrothorax,  Sudbury,  1810. 

® Consult  Lidell  on  Traumatic  Uxmorrhage,  New  York,  1870. 


Sect.  IV.] 


COMPLICATIOKS  OF  INJURIES  OF  THE  CHEST. 


625 


frequent,  small,  irregular;  tlie  face  is  pallid,  tlie  lips  livid;  the  extremities  cold;  vertigo, 
singing  in  the  ears,  and  other  premonitions  of  syncope  supervene.  In  the  presence  of  this 
formidable  array  of  symptoms,  the  surgeon’s  first  thought  is  to  stanch  the  bleeding.  If  it 
proceeds  from  the  heart  or  greater  vessels,  he  can  do  nothing;  but  in  lesions  of  the  sub- 
clavians  and  carotids,  and  of  the  innominata  even,  he  will  compress,  and  if  the  haemorrhage 
can  be  temporarily  controlled,  he  should  apply  ligatures.  The  mammaries  and  intercostals 
will  be  tied,  if  possible,  and  can  always  be  controlled  by  compression.  There  remains  for 
consideration  only  the  bleeding  from  the  lung  tissue.  The  application  of  cold  to  the  chest, 
the  administration  of  cold  acidulated  drinks,  of  opium,  of  digitalis,  and  acetate  of  lead,  • 
perhaps,  may  be  of  some  utility;  but  the  important  point,  on  which  much  difference  of 
opinion  existed  during  the  war,  is  whether  the  wound  or  wounds  shall  be  kept  open  or 
closed.  Until  a comparatively  recent  period,  no  doubt  was  entertained  that  the  surest 
mode  of  arresting  the  luemorrhage  was  to  take  blood  from  the  arm.  But,  as  will  be  seen 
farther  on,  this  treatment  is  practically  abandoned  by  American  surgeons,  and  even  those 
who  still  rely  on  venesection  in  inflammation,  discountenance  “preventive  bleeding,’’  or  for 
hgernorrhage.^  The  results  of  opening  the  wound  and  giving  free  egress  to  the  blood,  and 
of  closing  it  and  allowing  the  blood  to  accumulate  and  to  arrest  the  bleeding  by  its  own 
pressure,  regardless  of  the  danger  of  asphyxia,  have  been  discussed  on  page  523.  Probably 
this  perplexing  problem  admits  of  no  invariable  solution.  Chassaignac^  proposed,  in  these 
cases,  to  encourage  collapse  of  the  lung,  and  thus  arrest  its  bleeding,  by  injecting  air  into 
the  pleural  cavity ; but  I do  not  know  that  this  theoretical  suggestion  has  ever  been  acted 
on.  Larrey  advised  that  the  wound  should  be  closed  uniformly.  I infer,  from  personal 
observation  and  from  the  reports,  that  the  most  judicious  surgeons  followed  what  may  be 
called  a mixed  plan,  which  is  described  by  M.  Legouest,^  whose  excellent  practical  precepts 
I have  always  pleasure  in  quoting.  In  the  first  place,  the  wound  should  be  closed,  and 
cold,  with  ice  if  accessible,  applied  to  the  chest,  and  warm  frictions  and  sinapisms  over  the 
extremities.  One  of  two  things  must  happen;  Either  the  haemorrhage  ceases,  the  pulse 
rises,  the  warmth  of  surface  is  restored,  the  fearful  array  of  symptoms  gradually  disappears ; 
or  else  the  bleeding  goes  on,  and  the  effects  of  the  effusion  are  more  and  more  menacing. 
Then  the  wound  must  be  reopened,  and,  if  necessary  for  the  evacuation  of  the  blood, 
enlarged.  If  the  escape  of  blood  does  not  relieve  the  patient,  but  only  weakens  him,  then 
the  wound  must  be  closed  again,  the  revulsive  applications  to  the  general  surface  and  the 
refrigerant  local  applications  resumed;  the  patient  laid  on  his  injured  side,  his  head  and 
shoulders  raised,  his  chest  bandaged,  if  he  can  tolerate  it,  and  thus  persevering,  opening 
and  closing  the  wound,  hoping  to  gain  time,  and  to  stave  off  the  most  pressing  danger. 
When  the  immediate  peril  is  passed,  the  efiusion  is  to  be  dealt  with,  and  this  may  be 
considered  in  treating  of  empyema.  Though  Hennen’s  observation,  that  where  the  third 
day  has  been  safely  got  over  great  hopes  may  be  held  out,  is  true  and  very  apposite  in 
this  connection,  yet  many  examples  of  intermediary  and  secondary  internal  hemorrhages 
were  observed  during  the  war,  and  the  surgeon  should  be  on  his  guard  against  such 
contingencies,  especially  when  the  position  of  the  wound  favors  the  supposition  that  an 
intercostal  or  internal  mammary  artery  may  have  been  wounded.  The  abstracts  detailed 


* Leoouest,  Chirurgie  d'Armic,  ed.  1872,  p.  353.  In  this  juncture,  the  majority  still  advise  liberally  repeated  bleedings,  saj’S  M.  Legouest; 
but : “iVous  repoussons  energiquement  les  saignees,  comine  6taDt  plus  nuisiblo  qu’utile.” 

^ Chassaionac,  Thfise,  1835,  p.  82.  ^ Legouest,  Chirurgie  d' Armce,  p.  353. 

79 


626 


WOUNDS  AND  INJURIES  OF  THE  CHEST, 


[Chap.  V, 


in  this  chapter,  include  twenty-one  cases  of  hsemothorax,  and  among  them  are  several  in 
which  the  internal  bleeding  took  place  in  the  third  week,  and  one,  described  on  page  493, 
had  fatal  bleeding  as  late  as  the  thirty-sixth  day.  Dr.  Stromeyer^  cites  similar  examples. 
John  Hunter’s®  admirable  account  of  hsemothorax  is  quoted  by  Mr.  Poland  in  his  article 
in  Holmes’s  System,  which  is  issued  to  medical  officers.  Dr.  Chisolm,^  in  his  excellent 
Manual,  gives  a graphic  account  of  a case  of  primary  hsemothorax,  in  which  the  extrava- 
sated  blood  was  evacuated  by  partial  inversion  of  the  body. 

When  hoemothorax  attends  a shot  perforation  opening  on  the  posterior  part  of  the 
chest,  the  blood  is  likely  to  gain  admission  to  the  muscular  interstices  and  to  dissect  its 
way  downward,  producing  the  lumbar  ecchymosis  so  much  commented  on  as  a sign  of 
penetrating  wounds  of  the  pleura.  Hennen  {op.  cit,  p.  397)  has  observed  this  phenomenon 
as  a sequence  of  wounds  of  the  infrascapular  vessels.  On  pages  575  and  576,  I have 
given  at  length  the  views  of  Valentin  and  Larrey  on  this  subject.  Surgeons  are  now  gen- 
erally agreed  that  lumbar  ecchymosis  is  of  secondary  importance  as  a sign  of  hsemothorax.^ 

The  blood  effused  in  the  pleural  cavity  rapidly  coagulates  in  the  costo-diaphragmatic 
angle  and  lower  part  of  the  chest;  and  here  it  is  that  the  cautions  in  regard  to  rash 
explorations  of  penetrating  chest  wounds,  on  which  surgical  teachers  justly  insist,  are 
especially  applicable;  for  a premature  disturbance  of  the  caillot  tutelaire  may  reopen  the 
mouths  of  the  bleeding  vessels.  The  presence  of  the  blood  commonly  provokes  an 
unwonted  serous  effusion  in  the  pleura.  A limited  effusion  may  be  absorbed,  even  when 
pneumothorax  coexists.  When  the  effusion  is  profuse,  the  blood  is  not  absorbed,  and  a 
part  remains  liquid,  with  diffluent  coagula  floating  in  it.  This  liquid  soon  undergoes  a 
purulent  or  putrid  decomposition,  which  is  indicated  by  a febrile  reaction,  with  evening 
exacerbations,  a dry  and  dusky  skin,  and  frequently  by  oedema  of  the  lower  limbs. 

The  blood  is  usually  unconfined  in  the  pleural  cavity,  but  it  may  be  encysted  by 
plastic  exudations.  Where  it  thus  becomes  circumscribed,  it  may  be  partially  absorbed, 
or  may  give  rise  to  an  abscess,  which,  through  a fortunate  conjunction  of  circumstances, 
may  make  its  exit  externally  or  be  discharged  through  the  bronchial  tubes. 

Empyema. — Traumatic  serous  and  bloody  effusions  in  the  chest,  if  not  absorbed, 
decompose,  and  by  the  irritation  they  induce  lead  to  the  formation  of  pus.  The  same 
result  is  engendered  by  the  presence  of  foreign  bodies,  and  by  necrosis  of  the  bony  case  of 
the  thorax.  Empyema  is,  therefore,  a somewhat  frequent  secondary  complication  of 
wounds  of  the  chest.  It  is  a subject  that  has  been  so  fully  illustrated  by  examples  in  the 

* Stromeyer,  li.  {Erfahrungen  uher  Schusswunden  ixn  Jahre  1866,  Hannover,  1867,  S.  42):  “Twice  did  it  happen,  that  men,  who  had  been  con- 
sidered cured,  were  allowed  to  go  about,  and  then  died  from  internal  bleeding  of  the  injured  intercostal  artery.  The  death  of  the  one  followed  on  the 
thirty-fifth,  and  of  the  other  on  the  fiftieth  day.” 

2 Hunter.  IForA-s  hy  Palmer^  Vol.  Ill,  p.  567,  and  A TrtaiUt  on  tliK  Bloody  Injlammation,  and  Gunsliot  Wounds ; by  the  late  JOHN  HUNTER, 
London,  1794,  p.  553. 

* Dr.  Chisolm  observes  (A  Manual  of  Military  Surgery,  1864,  p.  325) : “The  effect  of  this  escape  of  blood  from  the  cavity  of  the  chest  was 
exemplified  in  the  case  of  Major  Wheat,  who  was  shot  through  the  chest  at  the  first  battle  of  Manassas,  the  ball  entering  in  at  one  arm-pit  and  escaping 
from  the  other  on  a level  with  the  nipple.  Soon  haemorrhage  caused  great  oppression  and,  finally,  fainting.  When  he  partially  recovered  his  conscious- 
ness he  found  himself  surrounded  by  his  men,  who,  believing  him  dead,  had  stripped  his  body  of  every  vestige  of  rank,  so  as  to  prevent  recognition  by 
the  enemy.  One  of  his  men  (a  powerful  sergeant),  determined  to  save  the  body  from  indignities,  had  seized  the  major’s  arms  at  the  wrists,  and,  with 
the  assistance  of  a comrade,  had  slung  the  body  over  his  back,  drawing  the  arms  of  the  supposed  dead  man  over  each  shoulder,  and  in  this  position 
started  off  from  the  battle-field.  Major  Wheat  was  himself  a powerful  man,  and  his  weight,  in  addition  to  his  chest  being  drawn  forcibly  against  the 
broad  back  of  his  sergeant,  so  increased  the  pressure  upon  his  lungs  as  nearly  to  extinguish  the  flickering  spark  of  remaining  life,  when  he  suddenly  felt 
a gush  of  blood  and  air  from  both  arm-pits,  followed  by  such  immediate  relief  that  he  found  his  breath  returning,  and  when  he  reached  the  ambulance 
wagon  he  could  stand  up.  Arriving  at  the  hospital,  he  found  that  he  had  so  far  recovered,  under  this  rough  treatment,  that  he  could  walk  with  assist- 
ance. Quiet,  with  but  little  medication,  soon  completed  the  cure,  and,  in  course  of  time,  enabled  the  major  to  resume  his  command.” 

^ Sanson,  Des  Ilimorrhagies  traumatiques,  Paris,  1^36,  p.  260 ; Louis,  Mem.  de  V Acad,  de  Chirurgie,  T.  IV,  p.  24 ; Legouest  {op.  cit.,  p.  p.  358) ; 
Erichsen  (op.  cit.),  Vol.  I,  p,  434;  Dr.  Macleod  (op.  cit.,  p.  2.39)  says  it  appears  seldom.  Dr.  Ashhurst  (op.  cit.,  p.  360)  places  it  among  the  more 
trustworthy  physical  signs  of  hiemothorax;  but  on  the  authority  of  Valentin  and  Larrey.  Callisen,  Desgranges,  and  Chaussier  give  instances  in  which 
it  was  present  without  hmmothorax  existing  and  absent  where  there  was  efl'usion  of  blood  in  the  pleural  cavity. 


Sect.  IV.] 


COMPLICATIONS  OF  INJURIES  OF  THE  CHEST. 


627 


preceding  pages,  and  discussed  in  all  its  varieties  by  autliors,^  that  it  is  only  necessary 
here  to  advert  to  its  comparative  frequency,  and  to  the  sources  of  information  in  regard 
to  its  treatment.  In  the  subsection  on  thoracentesis,  the  practice  of  making  free  incisions 
for  the  evacuation  of  putrid  or  purulent  effusions,  as  preferable,  in  traumatic  cases,  to 
paracentesis  simply,  and  the  use  that  was  made  during  the  war  of  drainage-tubes,  injections, 
canulas,  etc.,  has  been  described.  I omitted,  however,  to  record  a plan  of  treatment 
proposed  by  Assistant  Surgeon  A.  H.  Smith,  wishing  to  ascertain  if  it  had  been  tested 
experimentally.  As  far  as  I can  learn,  it  has  not  been  used  practically  by  the  inventor  or 
by  others: 

In  a letter  to  the  Surgeon  General,  dated  Hospital  No.  13,  Nashville,  Tennessee,  May  20th, 
1863,  Assistant  Surgeon  A.  H.  Smith,  LT.  S.  A.,  transmitted  a mechanical  contrivance  designed  for 
use  in  the  treatment  of  penetrating  wounds  of  the  chest  not  involving  the  lung  to  such  an  extent 
as  to  cause  danger  from  hmmorrhage,  and  having  for  its  object  the  prevention  of  the  entrance  of  air 
into  the  pleural  cavity  through  the  wound,  while  at  the  same  time  the  air  and  other  matters  within 
the  cavity  are  to  be  permitted  to  escape.  The  appliance,  figured  in  the  adjoining  cut  (Fig.  301),  is 
thus  commented  upon  by  the  writer: 

It  is  merely  a valve  to  be  applied  to  the  chest  over  the  wound,  permitting 
the  air,  blood,  etc.,  to  pass  out,  but  preventing  the  passage  of  air  inward.  The 
whole  instrument  is  to  be  immersed  in  water,  and  when  perfectly  saturated  api)lied 
to  the  chest,  the  centre  corresponding  to  the  wound.  It  is  to  be  retained  in 
])osition  by  a bandage  wound  around  the  body,  having  a hole  in  it  for  the  piece 
of  intestine,  forming  the  valve,  to  pass  through.  By  keeping  the  instrument  con- 
stantly wet  the  leather  will  remain  closely  applied  to  the  skin,  while  the  proper 
action  of  the  valve  will,  at  the  same  time,  be  secured.  If  there  be  two  openings 
in  the  chest,  the  valve  is  applied  to  the  most  dej>endent  one,  the  other  being  closed. 

Even  in  a case  in  which  the  lung  is  already  collapsed,  I think  the  motion  of  the 
chest  would,  so  to  speak,  pump  out  the  air  in  the  pleura,  and,  unless  the  lung  be 
wounded  in  such  a way  as  to  open  a free  communication  between  the  bronchial 
tubes  and  the  pleural  cavity,  it  must  eventually  expand  again  to  its  normal 
dimensions.  And  even  if  air  entered  the  pleura  through  the  lung  as  rapidly  as  it 
was  pumped  out  through  the  external  wound,  there  would  still  be  a certain  amount  ‘ Fig.  304. — Dr.  A.  II.  Smith’s  apparatus  for  effusiuns 
of  circulation  of  air  through  the  lung,  which  might  in  the  end  be  of  great  advantage 
to  the  patient.  On  trial,  it  may  be  found  best  to  cover  the  inner  side  of  the  leather  Sect.  I,  A.  M.  M. 

with  some  adhesive  material,  and  keep  only  the  intestine  wet.  If  found  to  answer  the  purpose,  I would  propose  to  have  a 
number  of  these  valves  in  each  hospital  knapsack,  for  use  on  the  field.” 

Thoracentesis,  and  the  other  measures  employed  in  empyema,  have  been  discussed 
on  page  573  et.  seq. 


'Fabricius,  De  empyematis  vafura  et  curatione,  Rostock,  1626;  Marquaut  Schlegel,  Dissertatio  de  empycmate,  Jena,  1639;  liALDUS,  Dis- 
sertatio  de  empyemate,  Leyden,  1646;  CRAMEFER,’  Dissertatio  de  empyemate,  Leyden,  1647;  Wedel,  G.  W.,  Dissertatio  de  empyemate,  Jena,  1686; 
ECKIIOCT,  J.  vox,  Dissertatio  de  empyemate,  Leyden,  1709;  BOXETUS,  Sepulchretum  Anatomia  Practica,  T.  Ill,  p.  348,  Geneva,  1700;  INGRAM, 
Practical  Cases  and  Ohs.  in  Surgery,  London,  1751;  FURSTENAU,  In  Ephem.  nat.  curios.,  Vol.  IX,  p.  329,  01)s.  78,  1752;  WARNER,  Philosophical 
Transactions,  Vol.  XL,  p.  I;  Herrissant,  An  in  empyemate  necessaria  licet  raro  prospera  paracentesis  ? Paris,  1762;  A.  MONRO,  State  of  the  Facts 
concerning  the  first  Proposal  of  performing  the  Paracentesis  of  the  Thorax,  Edinb.,  1770 ; Marciiettis,  Sylloge  Observat.  Medico-chirurg.  rar.  ohs.  43, 
pp.  99,  102,  104,  Naples,  1772;  BROMFIELD,  Surg.  Ohs.  and  Cases,  Vol.  I,  p,  24,  1773;  NICOLAI,  De  utilitale  et  necessitate  paracenteseos  thoracis,  Jenae, 
1775;  Hemmanx,  Med.  chir.  Aufsdtze,  Berlin,  1788;  Flajani,  Collez.  d'osservaz.,  Roma.,  1802,  oss.  47,  p.  145;  GUMPRECllT,  De  pulmzmum  ahscessu 
aperiendo,  Gottingen,  1796;  Zang,  Darstellung  hluliger  heilkunstlerischer  Operationen,  Wien,  1821,  Band  III,  Tb.  I,  S.  132;  Peli.f.tan,  Mem.  sur  les 
ipanchemens  dans  la  poitrine  et  I’operation  de  Vempyime,  in  Clin.  Chir.,  T.  III.  p.  236,  Paris,  1810;  Albrecht,  De  paracenie.si  pectoris,  Berolini, 
1816;  Jackson,  S.,  Case  of  Effusion  into  the  Chest,  in  which  Paracentesis  was  performed,  Phil.  Jour,  of  Med.  and  1‘hys.  .Sci.,  182.5,  Vol.  X,  p.  119; 
FaURE,  Observation  sur  la  ponction  de  la  jmitrine,  pratique  pour  remedier  aux  divers  cas  d'epanchement  pleuritique,  Gaz.  Jled.  de  I’aris,  1836,  p.  759  ; 
SedillOT,  Ch.,  De  Voperation  de  I’cmpyeme,  Th2se  do  Concours  pour  la  Chair  de  JI6d.  opferatoire,  Paris,  1841 ; Roe,  Hamilton,  On  Paracentesis 
Thoracis  as  a Curative  Measure  in  Empyema,  etc.,  in  Lond.  med.-ch.  Transact.,  1844,  T.  XXVII,  p.  198;  TROUSSEAU,  Pleuresie,  Paracentesc  de  la 
poitrine,  in  Clin.  med.  de  V Hotel- Dieu,  1861,  T.  I,  p.  619;  HITCHCOCK,  A.,  Paracentesis  Thoracis,  Four  times  performed  on  the  same  Person,  37  lbs.  7 oz. 
of  Fluid  Discharged,  Partial  Recovery,  Boston  Med.  and  Surg.  Jour.,  Vol.  .50,  1854,  p.  69;  SllATTUCK,  Empyema,  Paracentesis,  Spontaneous  Opening, 
Death,  Boston  Med.  and  Surg.  Jour.,  Vol.  53,  1856,  pp.  80  and  81;  BOWDITCII,  IL,  On  Paracentesis  Thoracis,  Boston  Mod.  and  Surg.  J<jur.,  Vol.  .56, 
1857.  p.  349 ; Warren,  J.  M.  (Paracentesis  Thoracis),  Surgical  Observations,  with  Cases  and  Operations,  Chap.  IV,  p.  146;  Gairdner,  W.  T.,  Question 
of  Thoracentesis  and  the  mode  of  its  performance,  Clin.  Med.,  Edinburgli,  1862,  p.  369;  BOUDIN,  J.  C.  M.,  Htudes  sur  la  Thoracentise,  I’aris,  1849; 
L.andouzv,  IL,  De  la  respiration  tubaire  et  amphorique  dans  la  pleurisie  et  dzs  indications  d la  Thoracentise,  Paris,  1856,  Vei.PEAU,  A.  A.,  Discussion 
sur  la  Thoracentise,  Paris,  1665;  Verxay,  Indications  et  Contre-Indications  de  la  Thoracentise,  Paris,  1864  ; Billroth,  Die  Thoracenlese.  Handbuch 
dcr  Allgemeinen  und  .Speciellen  Chinirgic,  B.  III.  Th.  V,  S.  149;  BRILL,  J.,  De  empjyemale  internis  pratique  remediis  curando.  Hiss.  Slarburgi,  1834 ; 
McDon'NELL,  R.  L.,  Contributions  to  the  Diagnosis  of  Empyema,  Dublin,  1844;  Romburo,  A.,  Zur  chirurgischen  Thcrajric  des  Empyem,  Diss., 
Tubingen,  1869;  SCIILETrER,  W.  F.,  tjber  die  operative  Dehandlung  des  Empyems,  Loiiizig,  1870. 


628 


WOUNUS  AND  INJUEIES  OF  THE  CHEST. 


[Chap.  V, 


in  the  Lung. — Of  true  abscesses  of  the  lung,  or  vomicae,  many  examples 
have  been  related.  These  purulent  formations  were  generally  induced  by  the  presence  of 
foreign  bodies  in  the  lung.  In  rare  instances,  circumscribed  abscesses  broke  and  dis- 
charged into  the  bronchial  tubes;  more  frequently  they  opened  into  the  pleural  cavity. 
Sometimes,  when  seated  near  the  surface  of  the  lung,  they  pointed  externally;  and,  when 
the  integument  became  discolored,  the  pleural  surfaces  were  usually  found  to  have  formed 
adhesions,  and  the  pus  could  be  advantageously  evacuated  by  a free  incision.  This  form 
of  abscess  was  distinguished  from  that  resulting  from  caries  and  necrosis  of  the  ribs, 
sternum,  or  vertebrae.  The  Museum  possesses  several  specimens  illustrating  both  varieties, 
but  no  drawings  in  which  they  are  satisfactorily  represented.  Metastatic  abscesses,  or 
“foci,”  due  as  a rule  to  peripheral  thrombosis,  was  one  of  the  frequent  epiphenomena  of 
what  was  generally  designated  as  pyaemia.  But  this  complication  was  not  a common 
result  of  wounds  of  the  bony  case  of  the  thorax;  and,  in  the  few  instances  that  were 
reported,  the  pathological  specimens  were  not  preserved,  nor  were  the  morbid  appearances 
described  with  precision.  I am  forced,  therefore,  to  borrow  from  a case  of  joint  wound 
an  illustration  of  the  condition  in  question.  In  Plate  XIII,  the  external  appearance  of 
a metastatic  focus  in  the  lung  is  beautifully  delineated.  The  drawing  was  made  under  the 
supervision  of  my  predecessor,  Surgeon  J.  H.  Brinton,  U.  S.  V.,  who  also  supplied  the 
pathological  notes.  The  clinical  history  was  drawn  up  by  Surgeon  E.  Bentley,  U.  S.  V. : 

Case. — Corporal  Jesse  S , Co.  B,  4th  Ohio  Volunteers,  3d  division,  Second  Corps,  was  admitted  to  the  McVeigh 

Branch  of  the  3d  division  general  hospital,  Alexandria,  Virginia,  on  December  5th,  18G3,  with  a gunshot  wound  of  the  knee-joint, 
received  near  Mine  Bun,  Virginia,  November  27th.  A conical  ball  struck  the  knee  of  the  right  leg  just  below  the  patella,  on  its 
inner  and  anterior  aspect,  fracturing  the  inner  condyle  and  opening  the  joint,  passed  downward  and  forward,  and  was  extracted 
about  four  inches  from  the  ])oint  of  entrance.  At  the  time  of  the  patient’s  admission  to  the  Alexandria  hospital,  the  joint  and 
thigh  were  very  much  inflamed  and  diischarged  pus  copiously,  and  the  man  was  much  prostrated  and  terribly  anxious  as  to  the 
result  of  his  wound  ; but  after  being  washed  and  fed,  and  otherwise  cared  for,  he  appeared  much  recruited.  On  December  8th, 
the  o])erafion  of  excision  of  the  knee-joint  was  performed  by  Surgeon  Edwin  Bentley,  U.  S.  V.;  one  inch  of  the  femur,  and 
about  one  inch  and  a half  of  the  tibia  bones  being  removed.  The  hmmorrhage  was  slight,  but  the  condition  of  the  tissues  was 
not  very  satisfactoiy'.  The  patient  endured  the  ojieration  rvell,  and  the  reaction  was  good.  On  the  9th,  the  patient  complained 
of  sev'ere  pain  on  the  right  side  of  the  chest  over  the  lung,  which  continued  for  several  days;  no  pain  elsewhere.  On  the  night 
of  December  10th,  he  had  a severe  chill,  which  was  followed  by  two  still  more  severe  attacks  on  the  11th.  Stimulants  were 
freely  given,  with  raw  eggs  well  beaten  up  and  beef  essence  for  diet.  He  continued  to  have  chills  till  the  night  of  the  13th, 
when  he  was  seized  with  a very  severe  chill,  from  which  he  never  rallied,  and  died  on  the  morning  of  December  14th,  1803. 
Tha  post-7nortem  examination,  eighteen  hours  after  death,  showed  no  attempt  at  reparation,  and  there  was  considerable  sloughing, 
while  upon  the  inside  of  the  thigh  there  were  numbers  of  small  abscesses.  The  heart  and  left  lung  were  healthy,  but  the  right 
lung  was  infiltrated  with  pus,  and  a single  large  abscess  appeared  upon  the  surface  of  the  inferior  lobe.  There  was  no  pus  nor 
abscesses  found  in  the  liver,  but  it  was  very  much  softened.  The  stomach,  kidney,  and  intestines  were  perfectly  healthy.  The 
jireparations  in  the  case  were  sent  to  the  Cui-ator  of  the  Army  Medical  Museum,  Surgeon  J.  H.  Brinton,  U.  S.  V.,  w'ho  made 
tlie  following  memorandum  of  the  appearances  in  the  limb:  “Whole  joint  is  one  suppurating  mass;  pus  extending  up  and 
down,  far  dow'rl  under  g.astrocnemius,  and  up»between  the  muscles  of  the  thigh  on  the  inside;  a long  abscess  in  the  sheath  of 
the  vessels,  extending  up  to  the  middle  of  the  thigh.  Small  clot  in  femoral  artery,  three  inches  hmg  and  thin;  none  in  femor.al 
vein.  Surrounding  tissues  of  vessels  in  some  places  hardened,  where  pus  had  not  reached.  Lining  membrane  of  femoral  vein 
dirty  gray  and  softened.”  Clot  in  suphena  vein.  Dr.  Brinton  added  the  following  notes  of  the  preparation  of  the  lung, 
reju  esented  in  Plate  XIII,  received  at  the  Museum  December  15th,  1803:  “Apparently  a metastatic  abscess  very  circumscribed. 
M hen  examined,  found  to  be  a clot,  in  difierent  degrees  of  softening,  and  red  blood  corpuscles  in  every  state  of  change;  but  no 
pus.  The  greenish  mass  in  each  [condyle'?]  was  complete  circumscribed  gangrene  of  the  cancellated  bony  tissue  (coinciding 
with  Virchow’s  doctrine).  See  picture  painted  by  M.  Stauch.”  The  picture  is  very  accurately  copied  in  the  chromo-lithograph 
opposite,'  Plate  XIII. 

There  appears  to  be  no  reason  why  shot  fractures  of  the  ribs  should  not  be  followed 
by  metastatic  deposits  in  the  lungs,  the  intercostal  veins  communicating  with  the  pulmonary 

‘The  preparation  of  the  lung  •was  preserved  in  the  Army  Medical  ISIuseum  and  numbered  1910  of  the  surgical  series,  but  became  so  much 
decomposed  after  exposure  by  the  draughtsman,  that  it  was  discarded,  and  the  number  1910  was  assigned  to  another  specimen.  There  is  a partly 
finished  drawing  of  the  femoral  vessels  by  M.  Stauch,  which  has  been  copied  and  elaborated  by  ]\Ir.  Fabre,  with  a view  to  its  reproduction  in  chromo- 
lithograpliy.  The  excised  fragments  of  the  knee-joint  were  not  preserved.  The  adjacent  portions  of  tlie  diaphyses  of  the  femur  and  tibia  are  numbered 
1909,  Sect.  1,  A.  M.  I\I.,  and  are  figured  in  the  Catalogue,  p.  336,  FiG.  113.  See,  for  a note  of  the  case,  the  surgical  report  in  Circular  No.  6,  S.  G.  O., 
1805,  p.  59. 


PLATE  XIII.  METASTATIC  FOCUS  IN  THE  LUNG. 


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COMPLICATIO]S"S  OF  INJURIES  OF  THE  CHEST. 


629 


circulation  by  a short  route.  In  twelve  hundred  fatal  cases  of  penetrating  chest  wounds 
with  fracture,  pysemia  is  noted  as  the  cause  of  death  in  forty-nine,  and  some  of  these  cases 
were  attended  by  metastatic  deposits  in  the  lungs.  The  information  contiibuted  on  this 

subject  will  be  fully  considered  hereafter,  in  the  discussion  of  thrombosis  and  embolism  in 

1 

By  far  the  larger  number  of  cases  of  intrathoracic  abscesses  reported  were  due  to  the 
presence  of  foreign  bodies.  Examples  have  been  given  of  the  discharge  of  such  abscesses 
into  the  bronchial  tubes,  with  the  expulsion  of  the  extraneous  substances  in  coughing,^ 
and  cases  also  in  which  the  foreign  bodies  either  gained  admission  to  the  oesophagus,  or 
passed  through  the  diaphragm  and  entered  the  alimentary  .canal  lower  down  and  were 
voided  at  stool.^  More  commonly,  these  abscesses  discharged  through  the  thoracic  walls. 

Phthisical  Tendencies.' — Among  the  remote  effects  of  wounds  of  the  chest  are 
violent  inflammatory  affections,  ever  subject  to  relapse,  tedious  exfoliations  and  suppura- 
tions, and  a diseased  condition  which,  as  Hennen  says,  though  it  cannot  be  strictly  called 
pulmonary  consumption,  agrees  with  it  in  many  points,  particularly  in  cough,  emaciation, 
debility,  and  hectic.  The  pension  examiners  frequently  report  such  cases  as  “ consumption,” 
and  record  the  fatal  event  as  due  to  phthisis.  Invalids  that  have  been  wounded  in  the 
lung  are  almost  invariably  readily  affected  by  atmospheric  changes.  Yet  it  has  been 
claimed  that  a diseased  state  of  the  lungs  has  been  ameliorated  or  even  cured  by  a pene- 
trating wound.  Desgenettes^  communicated  a case  of  the  sort  to  Larrey,  and  the  latter® 
mentions  a case  of  an  ofiicer  with  “well  characterized  phthisis,”  and  in  like  manner 
Usher  Parsons®  entertained  a similar  belief,  and  Hennen,’’’  though  he  never  observed  such 
an  example  himself,  was  reluctant  to  discredit  the  testimony  on  the  subject.  Hone  of  the 
cases  or  autopsies  reported  since  the  war  appear  to  establish  any  relation  for  good  or  evil 
between  wounds  of  the  chest  and  true  tubercular  phthisis.® 

* Consult  ViKCHOW,  Die  Cellular-Pathologie  in  Hirer  Begriindung  auf  physiologische  und  pathologische  Gewehelelire^  Vierte  Auflagc,  Berlin,  1871, 
S.  234 ; Bokitaxski,  Lehrhuch  der  Pathologischen  Anatomie,  Wien,  1861,  Dritter  Band,  S.  76. 

* See  case  of  Colonel  Collis,  p.  584,  and  the  less  authenticated  case  of  Miltenberger,  p.  596.  Dr.  A.  J.  C.  Skeexe  {Med.  and  Snrg.  Reporter, 
I'hila.,  1862,  'N'ol.  IX,  p.  160)  reports  the  case  of  Sergeant  Allen  R.  Foote,  Co.  B,  3d  Michigan  Volunteers,  as  having  received  a penetrating  -wound  of 
the  right  lung,  and  expectorating  pieces  of  the  ball  eleven  weeks  after  the  injurj^.  This  circumstance  is  not  noted  in  the  reports  of  the  Chesapeake  and 
Long  Island  hospitals,  but  the  patient  is  recorded  in  the  latter  as  returned  to  duty  October  1st,  18G2.  The  sergeant  -w’as  promoted  to  a lieutenancy  in  the 
21st  Michigau  Volunteers,  March  3d,  1864,  and  mustered  out  June  8th,  1865.  A fourth* •*  case  is  printed  in  the  Boston  Medical  and  Surgical  Journal,  1668, 
Vol.  I,  N.  S.,  p.  339,  of  Private  A.  N.  Rossiter,  49th  ^Massachusetts  Volunteers,  said  to  have  been  wounded  at  Port  Hudson,  March  14t!i,  1863,  and  sufFering 
subsequently  from  haemoptysis,  and  coughing  up,  five  years  afterward,  a flattened  buckshot,  after  which  ‘“he  was  wholly  relieved  from  his  disagreeable 
symjdoms.”  He  is  not  a pensioner,  and  the  h(»spital  record  gives  the  diagnosis  “chronic  diarrhoea,”  without  indication  of  any  wound. 

3 See  cases  of  Stolpe,  p.  515,  and  of  Belt,  p.  584. 

•*  Desoeneitks  told  Larrey  that  in  the  painting  of  the  death  of  General  Wolfe,  by  Benjamin  West,  the  figure  supporting  the  fallen  hero  in  its 
arms  is  the  portrait  of  an  otDccr  who  received  a ball  in  his  chest  and  was  thus  cured  of  well-marked  ]>hthisis. 

® Larrey  {Memoires  de  Chirurgie  Militaire  et  Campagnes,  1812,  T.  HI,  p.  37()),  on  relating  this  statement  of  Desgenettes,  records  two  examples 
of  recovery  from  phthisis,  following  amputation  <.f  the  shoulder-joint,  as  “proofs  oi  the  salutary  etfects  of  certain  perturbing  causes  on  the  most  hopeless 
diseases,  and  an  explanation  of  phenomena  that  have  astonished  the  greatest  observers.”  One  is  the  case  of  Lieutenant  Colonel  Hoevemeur,  of  the  2d 
Dutch  Lancers,  the  other  of  a private  lancer  of  the  Guard,  in  whom  the  symptoms  of  pulmonary  phthisis  and  those  of  the  scrofulous  cachexy,  developed 
in  the  highest  degree,  entirely  disappeared.”  ® PARSONS.  AYia  England  Journal  of  Medicine  and  Surgery,  1818,  p.  209. 

^ IlEXNEX  {Principles  of  Military  Surgery,  3d  ed.,  18‘29,  p.  400) : “ An  instance  of  this  kind  has  never  come  under  my  notice;  although  I have 
very  resiiectable  living  authority  to  say  that  a strong  predisposition  to  phthisis  was  suspended  in  one  case  and  spasmodic  asthma  remarkably  relieved  in 
amjther,  by  penetrating  wounds  of  the  thorax.” 

® I think  the  doctrine  of  the  cure  of  pulmonary  consumption  through  the  agency  cf  penetrating  wounds  of  .the  chest  should  be  regarded  as  a 
fable,  perpetuated  by  respectful  comidiance  with  authority.  It  is  said  (T  rhalems,  by  Pliny  {Naturx  llistoriarum,  Lib.  VII,  Cap.  /,  p.  16(i^,  deploratus 
d medicis  vomiae  morho,  the  abcess  was  opened  by  a sword  thrust,  and  the  patient  -was  cured.  Guthrie  has  grouped  Phalerus,  on  what  authority  he 
does  not  state,  with  Jason  and  Prometheus,  and  says  that  being  expected  to  die  of  abscesses  of  the  lungs,  they  went  into  battle  for  the  j)urp<jse  of 
getting  killed;  but  being  only  run  through  the  body,  the  purulent  matter  escaped,  and  they  all  recovered  (OUTIIRIE).  Oth(?r  commentat(jrs  hold  that 
the  Scythian  vulture  performed  paracentesis  in  the  case  of  Prometheus.  Dr.  Macleod  says  {Notes,  etc.,  p.  2.56):  “V'critablc  phthisis  has,  however, 
as  is  well  known,  been  cured  by  the  rough  medication  of  a gunshot  wound.”  The  reader  will  find  some  interesting  obser^’ations  on  this  subject  in  Dr. 
Usher  PaRSONs  s Cases  of  Gunshot  Wounds  through  the.  Thorax,  xoith  Re.marics,  j>rinted  in  tlte  seventh  volume  (d  tlie  New  England  Journal  of  Medicine 
and  Surgery,  1818,  page  269.  In  relating  the  case  of  Captain  Charles  Gordon,  wounded  through  the  chest  in  a duel,  Dr.  Parsons  says  that  he  had  been 
“subject  to  cough,  and  was  threatened  with  a pulmonary  allcction,  all  whicli  the  bleeding  from  the  wound  appeared  to  remove.  A similar  instance  is 
related  to  me  by  Dr.  Wheaton,  of  Providence,  in  a case  where  a musket  ball  passed  through  the  right  lung  of  a young  man  laboring  under  phthisis 
pulinonalis.  The  hjenioiThage  was  very  profuse,  but  was  followed  by  a speedy  recovery  both  from  the  wuun<l  uinl  phthisical  aflcction.  Quere.  Do  i.ot 
these  facts  speak  in  favor  of  venesection  as  a remedy  in  cjnsumption  as  rccommcnd<!(l  by  Dr.  Gallup  V" 


630 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Thoracic  Fistuloi. — Fistulous  openings  in  the  walls  of  the  chest  were  occasionally 
observed  among  the  troublesome  consequences  of  penetrating  wounds  of  the  chest.  Of 
twelve  hundred  and  twenty-three  invalids  on  the  pension-roll  of  the  United  States,  for  the 
results  of  this  form  of  injury,  twenty-two  are  reported  with  thoracic  fistulse.  This 
condition  is  likely  to  arise  when  an  abscess  or  empyema  having  discharged  or  been  punc- 
tured through  the  chest  wall,  the  pleura  fails  to  adhere  near  the  orifice,  and  forms  a pouch 
in  which  the  pus  accumulates.  Some  examples  have  been  given  in  the  preceding  pages. 
(Cases  of  Young,  p.  479,  Kuhn,  p.  480,  Brownlee,  p.  488,  Henry,  p.  490,  Tomlinson,  p. 
502,  and  Bowman,  p.  577.)  The  following  is  an  instance  in  which  the  reducing  measures 
employed  did  not  avert  a fatal  termination  : 

Case. — Private  Janies  Parker,  Co.  G,  16tb  New  York,  aged  24  years,  was  wounded  at  Gaines’s  Hill,  Virginia,  June  27th, 
1862 ; the  ball  entered  between  the  eighth  and  ninth  ribs,  seven  inches  from  the  spine  on  the  right  side,  and  emerged  below  the 
head  of  the  tenth  rib,  one  inch  from  the  spine  on  the  same  side;  the  ninth  rib  was  fractured  about  midway  in  its  course.  He 
was  treated  in  the  field  and  transferred  to  Ascension  Hospital,  Washington,  on  July  4th.  On  admission,  there  was  no  emphysema 
or  other  sign  of  injury  to  the  pleura  or  lung.  Some  small  spiculse  of  bone,  which  had  worked  to  the  surface  posteriorly,  were 
removed,  and  the  chest  nearly  encircled  by  adhesive  straps.  Antimonial  and  saline  mixtures  were  administered,  and  low  diet 
ordered.  August  1st : Some  friction  sound  at  point  of  fracture,  but  no  effusion  and  no  pneumonia.  Tincture  of  veratrum  viride 
was  ordei-ed,  and,  as  the  pulse  was  105,  calomel  was  administered,  but  a better  diet  was  given  as  his  strength  was  failing.  A 
pulmonary  fistula  was  established  on  August  2d.  Air  issued,  with  a bubbling  sound,  anteriorly  and  posteriorly,  on  coughing  or 
sneezing.  Bj'  intercepting  the  air  by  pressure  between  the  points  of  wounding  and  the  point  of  fracture,  the  fistula  and  fracture 
were  found  to  be  identical  in  position.  There  was  no  effusion,  no  pneumonia,  no  collapse  of  the  lung,  and  no  emphysema,  on 
account,  it  was  supposed,  of  the  free  exit  afforded  by  the  wound  to  the  air,  and  it  was,  therefore,  judged  that  the  pleura  was 
adherent  about  the  point  of  fistula.  His  weakness  increasing,  punch,  iron,  and  quinine  were  ordered  freely.  The  bandage  was 
still  continued.  August  4th;  The  sputum  is  now  tinged  with  blood;  pidse,  105;  strength  poor;  fistula  still  exists.  A slight 
friction  sound  was  still  perceptible,  but  localized  at  the  fistula.  Vomiting  and  diarrhoea  have  set  in.  Anodynes  and  astringents 
were  given,  and  the  nutritious  diet  continued,  with  a diaphoretic  for  the  slight  pneumonia.  Over  the  subcutaneous  fistulous 
point  a compress  was  applied,  and  bandaged  firmly  in  hope  of  its  closing.  August  7th:  Pneumonic  sputum  disappeared. 
Anterior  orifice  closed  entirely;  posterior  one  cicatrizing;  fistula  entirely  gone.  There  is  now  no  dulness,  no  effusion,  though 
the  friction  sound  continues.  No  cough;  pulse,  95.  Compress  removed.  Bandage  and  nutritious  diet  continued.  Dian-hoea 
gone.  August  15th : The  pleurisy  is  marked,  the  fracture  uniting.  There  is  no  effusion  or  pneumonia,  and  the  patient  is  gaining 
strength  decidedly.  The  fistula  has  not  returned,  and  the  posterior  orifice  has  almost  healed.  His  diet  is  less  nourishing,  and 
the  antimonial  and  saline  preparations,  with  morphia  and  mercury  recommended.  He  was  discharged  from  service  on  September 
20th,  1862.  Acting  Assistant  Surgeon  W.  W.  Keen,  jr.,  reports  the  case.  Under  date  of  October  17th,  1863,  Pension  Examiner 
Benjamin  J.  Moses,  reports;  “The  ball  entered  the  anterior  and  lower  part  of  the  scapula  and  passed  out  close  to  the  spine, 
injui  ing  the  right  lung  and  producing  the  various  symptoms  of  consumption  under  which  he  appears  to  be  laboring  at  present.” 
He  died  on  January  10th,  1864. 

Professor  Gross  (op.  cit.,  Vol.  II,  p.  449)  indicates  the  proper  remedy  in  These  cases. 
A counter-opening  must  be  made  into  the  most  depending  portion  of  the  sac  and  ready 
drainage  ensured  by  a canula  or  elastic  tube.  Weak  astringent  and  detergent  injections  are 
also  indicated  in  these  cases.  Sometimes  the  fistula  communicates  with  the  bronchial 
tubes,  and  then  much  caution  is  requisite  in  the  employment  of  injections.  Dr,  Hannover, 
who  has  paid  much  attention  to  thg  remote  effects  of  gunshot  wounds,  refers  to  cases  of 
thoracic  fistula  among  the  Danish  invalids.^  M.  Chassaignac  treats  of  the  subject  with  his 
usual  minuteness.^  Dr.  Keudorfer^  dwells  on  the  necessity  of  frequent  renovation  of  the 
air  in  the  cavities  of  thoracic  abscesses.  The  detection  and  removal  of  the  irritating 
cause  to  which  the  persistence  of  the  fistula  is  due,  are  the  objects  the  surgeon  will  ever 
have  in  view. 


* Hannover  {Die  Ddnischen  Invatidcn  ans  dcm  Kricge  1864,  in  drztUcher  Bczichung,  Berlin,  1870,  S.  17)  observes:  “Whcie  lile  is  preserved 
after  gunshot  wounds  of  the  chest,  the  degree  of  invalidity  is  generally  insignificant,  and  the  capacity  for  labor  is  little  diminished ; in  several  cases, 
even  where  the  cavity  of  the  chest  was  penetrated,  the  ribs  fractured,  and  the  lung  injured,  a complete  cure  followed  in  the  course  of  several  years,  while 
in  others  a fatal  result  ensued,  or  the  patient  suiTered  from  a fistula  and  its  consequent  mischief.  In  a yet  living  patient,  the  connection  between  the  fistula 
and  the  lungs  is  so  large  that  injections  into  the  fistula  pass  through  the  windpipe  into  the  mouth.” 

^ Chassaignac.  Traite  pratique  de  la  Suppuration  et  du  Drainage  Chirurgicale,  Paris,  1859,  T.  II,  p.  'M7. 

^ KeudOrfer  {Ilatidhuch  de.r  Kriegsehirurgie,  Leipzig,  18G7,  Zweite  Iliilfte,  S.  655)  gbserves:  “I  wish  to  lay  especial  stress  upon  the  fact,  that 
the  air  in  the  suppurating  pleural  cavity  be  constantly  renewed  and  never  be  closed  in,  as  only  then  the  circumstances  are  the  same  as  a freely  opened 
abscess.  * * * It  is  a fact  that,  in  the  suppurating  pleural  cavity,  confined  air  is  pernicious ; it  is  this  that  chan  ges  healthy  pus  into  putrid  matter.” 


Sect.  IV.] 


COMPLICATIONS  OF  INJURIES  OF  THE  CHEST, 


631 


Collapse  of  the  Lung. — Collapse  of  the  lung,  partial  or  complete,  unless  the  organ  is 
already  adherent  to  the  thoracic  walls,  sooner  or  later  follows  upon  an  opening,  larger  than 
the  glottis,  being  made  into  the  pleural  cavity.^  This  phenomena  takes  place  whether  the 
lung  is  wounded  or  not,  but  more  rapidly  when  it  is  extensively  wounded.  The  falling 
away  of  the  lung  is  not  a uniform  consequence  of  a penetrating  wound  of  the  chest.  If 
the  wound  is  small,  or  if  it  is  at  a distance  from  the  free  margin  of  either  lobe,  the 
expanded  lung  remains  in  contact  with  the  costal  pleura,  and  often  remains  long  enough 
for  adventitious  adhesions  to  form.  When  the  lung  collapses,  unless  compressed  by  liquid 
effusion,  it  generally  is  partially  expanded  by  air  passing  from  the  sound  lung  into  the 
trachea,  and  thence,  on  closure  of  the  glottis,  into  the  bronchi  of  the  wounded  side.  It  is 
inflated  in  expiration  and  not  in  inspiration. 

The  experimental  enquiries  on  this  subject,  by  Hales  in  his  Statical  Enquiries,  by 
Hewson,  Hoadley,  Houston,  Van  Swieten,  Oruveilhier,  Halliday,  Graefe,  and  Dr.  Fraser,“ 
must  be  consulted  for  anything  approaching  a full  discussion  of  this  interesting  subject. 
In  connection  with  them  the  following  account  of  recent  experiments  will  be  valued: 

Assistant  Surgeon  A.  H.  Smith,  in  a letter  dated  Fort  Wadsworth,  New  York,  October  15th, 
1867,  details  some  experiments,  which  were  undertaken  with  a view  to  determine  why  certain  cases 
of  penetrating  wounds  of  the  chest  result  in  eollapse  of  the  lung,  while  in  other  cases  apparently 
similar  tbe  lung  remains  distended.  The  lungs  were  not  wounded  in  these  experiments: 

“ The  object  of  the  first  experiment  was  to  ascertain  the  manner  in  which  the  lung  collapses  when  air  is  admitted  into 
the  pleural  cavity.  An  animal  was  killed  by  a blow  upon  the  head,  the  trachea  exposed  and  secured  by  a ligature,  and  the 
lungs  brought  into  view  by  raising  the  sternum.  On  cutting  the  ligature  it  was  observed  that  the  lungs  did  not  recede  from  the 
thoracic  wall,  but  withdrew  themselves  from  the  sternum  toward  the  spinal  column,  keeping  their  external  surface  closely 
ajiplied  to  the  inner  surface  of  the  ribs.  This  was  evidently  due  to  the  pressure  of  the  atmosphere,  which  prevented  a separation 
of  the  two  smooth,  moist  pleural  surfaces,  while  it  permitted  one  to  slide  upon  the  other,  as  may  be  observed  when  two  moistened 
glass  plates  are  pressed  together.  This  observation  led  to  the  inquiry : what  would  be  the  result  if  the  chest  were  opened  at  a 
point  away  from  the  free  margin  of  the  lung?  It  was  anticipated  that,  in  this  case,  the  gliding  motion  above  described  would 
not  take  place,  as  the  air  would  not  have  access  to  that  portion  of  the  thoracic  cavity  which  must  be  the  first  left  vacant  by  the 
retraction  of  the  lung,  viz:  that  part  occupied  by  its  free  margin.  But  it  seemed  probable  that  the  lung  tissue,  contracting  at 
the  point  where  the  wound  had  left  a vacancy  in  the  thoracic  wall,  would  draw  with  it  a circle  of  the  lung-substance  immediately 
surrounding  and  then  form  a cup-like  depression,  the  circumference  of  which  would  go  on  increasing  (the  pleura  pulmonalis 
peeling,  as  it  were,  fi’om  the  pleura  costalis)  until  the  entire  lung  had  collapsed.  Experiments,  however,  afforded  a different 
result,  while  they  completely  justified  the  anticipation  with  regard  to  the  non-retraction  of  the  lung.  An  opening  was  made  in 
one  of  the  intefcostal  spaces  of  a recently  killed  animal,  care  being  takim  to  select  a point  as  distant  as  possible  from  the  margin 
of  the  lung  and  from  the  division  between  the  lobes.  The  pleura  costalis  being  carefully  opened,  the  lung  was  found  to  remain 
closely  applied  to  the  wall  of  the  chest,  showing  no  disposition  to  collapse,  except 
that  there  was  a slight  depression,  the  margin  of  wliich  corresponded  exactly 
with  the  margin  of  the  wound  in  the  pleura  costalis.  That  the  depression  did 
not  extend  farther  seemed  to  depend  upon  the  fact  that  it  could  not  exceed  a 
certain  depth  without  putting  upon  the  stretch  the  fibres  of  lung  tissue  radiating 
(see  Figure  305)  from  its  apex  to  the  surface  of  the  lung  at  a distance  from 
the  wound,  and  where  the  atmospheric  adhesion  to  the  chest  was  unimpaired. 

The  wound  before  described,  which  was  about  midway  between  the  sternum 
and  the  spine,  remaining  open  and  the  lung  plainly  visible  through  it,  a second 
opening  was  made  in  the  same  intercostal  space,  at  the  edge  of  the  sternum.  Immediately  there  was  a sound  of  air  rushing  into 
the  thorax,  and  the  lung  at  once  began  the  gliding  motion  before  mentioned,  the  specks  of  pigment  in  its  surface  passing  rapidly 
in  review  before  the  first  opening,  where  the  lung  could  be  seen  to  retain  its  contact  with  the  ribs  until  at  last  its  free  border 
passed  the  wound  and  disappeared,  when  this  opening,  for  the  first  time,  admitted  air  into  the  pleur.al  cavity.  By  inflating  the 
lung  through  the  trachea,  the  experiment  was  repeated  again  and  again  with  the  same  result,  the  lung  remaining  distended 

* This  has  been  denied  by  speculative  writers,  and  indeed  it  would  be  difficult  to  name  any  point  connected  with  the  mechanism  of  respiration  that 
has  not  been  called  in  question.  BENJAMIN  Bell  {System  of  Suryery.  1804,  Vol.  I,  p.  207)  taught  that  the  air  escaped  from  a wound  in  the  chest  during 
inspiration,  and  many  observers  have  reported  that  they  have  seen  pneumatoceles  diminish  in  volume  in  expiration.  Mr.  Ekichsen  says  that  collapse  of 
the  lung  has  been  more  frequently  spoken  about  than  seen,”  which  is  a worthy  exordium  to  the  conclusion  that  “when  it  does  occur  in  the  early  stage 
it  is,  I believe,  owing  to  the  compression  of  the  air  sucked  into  the  cavity  of  the  pleura  by  pneumothorax.” 

^IIEWSON,  Medical  Observations  and  Enquiries,  177C,  Vol.  Ill,  p.  321;  llOL'STON,  Philosophical  Transactions,  Vol.  IX,  p.  138;  Hoadley, 
Three  Gulstonian  Lectures  on  the  Organs  of  Respiration,  17:i7;  Van  .Swieien,  Philosophical  Transactions,  Vol.  IX,  p.  139;  CrUVEILIIIEK,  Anat. 
Path.  Liv.  XXI ; Graefe,  London  Lancet,  May,  1828;  Halliday,  Observations  on  Emphysema,  1807 ; Fraser,  op.  cit.,  p.  29. 


c c 


Fig.  305. — A — Depression  in  lung  opposite  wound. 
B — Lung  tissue  taking  its  fixed  point  at  C and 
opposing  farther  depression  in  the  direction  of  D. 


632 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[CiiAr.  V, 


wlieiiever  the  anterior  wound  was  kept  covered  with  the  finger,  but  retracting  the  instant  tlie  finger  was  removed.  These 
ol)servations  liave  since  been  rejieated  a sufficient  number  of  times  to  leave  no  doul)t,  that  in  the  dead  svbject  the  lung  will 
collapse  if  the  chest  he  punctured  at  or  very  near  the  free  margin  of  one  of  the  lobes,  while  it  will  remain  distended  if  the 
puncture  be  made  elsewhere.  In  the  living  animal  the  results  obtained  were  the  same,  except  that  the  lung  never  collapsed 
entirely  when  one  side  oidy  of  the  chest  was  opened.  A portion  of  the  air  in  the  lung  on  the  sound  side  evidently  passed  into 
the  other  lung  with  each  e.xpiration,  and  thus  kept  it^partially  expanded.  The  degree  of  this  expansion  depended  upon  the 
character  of  the  respiration.  Thus,  when  the  animal  was  fully  under  the  influence  of  an  anmsthetic  and  the  respiration  not 
afl'ected  by  the  will,  the  collapse  was  more  nearly  comjdete,  while  the  moment  consciousness  began  to  return  and  an  attempt  was 
made  to  use  the  voice,  the  inflation  of  the  lung  with  each  expiration  became  very  considerable,  and  when  a loud  shrill  cry  was. 
uttered  ; or,  in  other  words,  when  the  aperture  of  the  glottis  was  narrowed,  and,  at  the  same  time,  a forcible  expiratory  effort 
was  made,  the  lung  completely  filled  out  the  cavity  of  the  chest,  and  the  edge  of  one  of  the  lobes  was  thrust  out  through  the 
wound.  This  suggests  a method  of  reinflating  the  collapsed  lung,  if  thought  desirable,  in  similar  cases  in  the  human  subject. 
Nothing  more  would  be  necessary  than  to  instruct  the  patient  to  take  as  full  an  inspiration  as  possible,  the  wound  being  covered 
with  the  hand,  and  then,  uncovering  the  wound  and  closing  the  mouth  and  nostrils,  to  m.ake  a forcible  expiratory  effort.  The 
colla))sed  lung  would  then  be  partially  inflated,  and  by  repeating  the  manoeuvre  a sufficient  number  of  times  its  complete 
distension  would  be  effected.  .Several  of  the  above  e.xperiments  were  made  in  the  presence  of  Dr.  R.  F.  Weir,  late  Assistant 
.Surgeon  U.  S.  A.,  and  with  his  assistance.”  On  M.ay  27th,  18(59,  Dr.  Smith  communicated  the  following  report;  “Experiment 
1st,  March  10th,  1853. — A bullock  was  killed  by  cutting  the  throat;  ten  minutes  .afterward,  a stopcock  was  tied  firmly  in 
the  trachea  ami  closed.  An  opening  was  then  made  in  the  eighth  intercostal  space,  on  the  left  side,  nine  inches  from  the 
spinal  column;  air  immediately  entered  the  chest,  and  the  ribs  visibly  expanded;  as  the  trachea  was  completely  closed,  it 
woidd  seem  that  the  retractile  force  of  the  lung  tissue  in  the  last  moments  of  life  overcame  the  elasticity  of  the  ribs,  resulting 
in  a diminution  of  the  cavity  of  the  chest.  On  passing  the  finger  into  the  wound,  it  came  directly  upon  the  margin  of  one  of 
the  pulmonary  lobes.  Experiment  2d. — An  opening  was  made  in  the  seventh  intercostal  space,  on  the  right  side  of  the  same 
animal,  at  the  same  distance  from  the  spine.  The  result  was  precisely  the  same  as  in  experiment  1st.  The  wound  was  found 
to  be  opposite  to  the  margin  of  on'e  of  the  lobes  of  the  lung.  On  opening  the  stopcock,  both  lungs  immediately  collapsed. 
Expei'iment  3d. — One  of  the  smaller  lobes  was  detached  from  the  remainder  of  the  lung,  and  its  costal  surface  applied  to 
the  inner  surface  of  the  chest.  Seizing  it  in  the  middle,  between  the  thumb  and  finger,  and  nuaking  tr.action,  a considerable 
resistance  was  e.xperienced,  and  the  margin  drew  in  toward  the  centre  an  inch  or  more  before  any  separation  between  the  two 
serous  surfaces  took  place.  At  the  same  time,  a gliding  motion  from  side  to  side  was  easily  produced.  Experiment  4th,  March 
loth,  1858. — A large  dog  was  fully  chloroformed  and  a sm.all  opening  m.ade  in  about  the  middle  of  the  ninth  intercostal  .sp.ace  on 
the  left  side.  The  opening  came  directly  upon  the  edge  of  a pulmonary  lobe  ; air  entered  immediately  through  the  wound  and  the 
lung  collapsed.  The  opening  was  then  enlarged  to  the  extent  of  about  three  inches,  \vhen  the  lung  could  be  seen  ne.arly  collapsed, 
but  apparently  inflating  a little  with  each  e.\'piration.  The  animal  having  regained  partial  consciousness,  .and  the  wound  being 
closed  by  dr.awing  the  skin  over  it,  a faint  vocal  sound  w.as  audible  with  e.ach  expiration.  Uncovering  the  wound,  this  sound 
immediately  ce.ased,  but  returned  each  time  the  opening  was  closed.  A knife  being  p.assed  through  the  integument  with  the 
intention  of  dividing  the  medulla  oblongata,  loud  cries  were  uttered;  the  lung  was  distended,  and  a portion  of  it  was  thrust  through 
the  wound.  Experiment  5th. — Tlie  animal  having  been  killed  by  a blow  upon  the  head,  the  trachea  was  opened  and  a tube 
inserted,  through  which  the  lung  was  fully  inflated.  The  tube  was  then  closed.  An  opening  one-third  of  an  inch  in  length  was 
made  on  the  right  side,  between  the  ninth  and  tenth  ribs,  one-third  of  their  length  from  the  spine ; a continuous  surface  of  lung  was 
exposed;  on  opening  the  tube,  the  chest,  which  was  over  distended,  contracted,  the  lung  retaining  its  contact  with  the  chest,  but 
gliding  upw.ards  until  the  margin  of  a lobe  came  opposite  to  the  opening,  when  immedi.ate  collapse  took  pl.ace.  The  lung  was 
again  distended  and  an  opening  made  one  space  higher  up,  and  the  first  wound  covered ; no  marginal  line  was  visible  on  the  lung, 
yet  collapse  followed  when  the  tube  was  opened.  On  ex.amination,  it  w.as  found  that  the  lung  had  not  been  fully  distended;  its 
complete  expansion  being  prevented  by  air  imprisoned  in  the  deeper  portion  of  the  cavity  of  the  chest;  an  elastic  catheter  was 
therefore  introduced  into  this  space  through  the  wound,  thus  aftbrding  means  for  the  air  to  escape.  The  lung  was  now  inflated, 
the  catheter  withdrawn,  and  tlie  little  tube  in  the  trachea  opened,  the  first  opening  in  the  chest  being  covered.  No  collapse  took 
place ; the  same  was  the  result  avhen  an  opening  was  made  in  the  seventh  intercostal  space.  Experiment  Gth. — Raised  the 
sternum,  inflated  the  lungs,  and  allowed  the  air  to  escape;  the  left  lung  retr.acted,  keeping  its  outer  surface  in  contact  with  the 
inner  surface  of  the  chest.  The  right  lung  collapsed  irregul.arly.  Experiments  4,  5,  G were  performed  in  the  presence  of  Dr.  S. 
Traver,  Assist.ant  Surgeon  U.  S.  Navy.  Experiment  7th,  March  24th,  1838. — On  the  right  side  of  the  body  of  a man  who  died 
of  acute  diarrhoea,  a small  opening  was  made  two  and  .a  half  inches  below  and  external  to  the  nipple;  air  immediately  entered 
and  the  lung  collapsed.  It  was  found  that  the  liver  w.as  greatly  enlarged,  and  th.at  the  lung  did  not  extend  below  the  opening. 
Experiment  8th. — An  opening  was  m.ade  on  the  left  side  of  the  same  subject  two  and  a half  inches  .above  and  external  to  the 
nipple;  a continuous  surface  of  lung  was  exposed  to  the  extent  of  a circle  half  an  inch  in  diameter.  No  collapse  took  place;  but 
there  w.as  a cup-like  depression  of  the  exposed  portion  of  the  lung;  on  passing  the  handle  of  a scalpel  into  the  wound  and  lifting 
up  its  margin,  air  entered  .and  the  lung  snbsided.  I regret  that  this  subject  did  not  attract  my  attention  until  after  the  close  of  the 
war,  which  would  have  afforded  abundant  opportunities  for  testing  the  correctness  of  my  views.  One  case,  however,  of  which  I 
retain  a very  distinct  recollection,  has  an  import.ant  bearing  upon  this  question.  A private  of  the  43d  New  York  Volunteers  was 
woundeil  by  a musket  b.all  while  on  j)icket  before  Yorktown,  about  April  20th,  1832;  the  ball  entered  in  the  second  intercostal 
space  on  the  right  side,  directly  above  the  nipple,  and  emerged  through  the  centre  of  the  scapula,  appearing  not  to  have  injured 
the  ribs  either  at  its  entrance  or  exit.  There  was  no  collapse  of  the  lung,  as  I remember  tracing,  day  by  day,  the  physical  signs 
of  the  pneumonia  that  followed.  The  recovery  was  rem.ark.ably  rapid,  anil  the  last  of  .June  I met  the  patient  walking  in  the 
streets  of  New  York,  apjiarently  perfectly  well.  The  situation  of  the  wound  in  this  case  was  central  in  regard  to  the  ujiper 
lobe  of  the  lung,  which  goes  to  support  my  view;  it  is  possible,  however,  that  there  may  have  been  previously  existing  pleuritic 
adhesion,  but  the  likelihood  of  this  is  diminished  by  the  fact  th.at  the  ]>atient  was  not  more  than  17  or  18  years  of  age.”  * * 


Sect.  IV.] 


COMPLICATIONS  OF  INJURIES  OF  THE  CHEST. 


633 


Contraction  of  the^  Chest. — A deformation  of  the  thoracic  walls  is  one  of  the  remote 
results  of  severe  injuries  of  the  thorax.  After  the  absorption  or  evacuation  of  extensive 
pleuritic  effusions,  if  the  lung  remains  unexpanded,  the  side  of  the  chest  falls  in  to  accom- 
modate itself  to  the  crippled  lung,  and  there  is  a corresponding  incurvation  of  the  spinal 
column.  This  flattening  and  deformity  is  noted  as  extensive  in  about  twenty-five  cases 
of  pensioners  who  recovered  after  large  extravasations  in  the  pleural  cavity.  More 
limited  depressions  are  observed  in  a number  of  pensioners  who  have  suffered  from  necrosis 
and  loss  of  substance  of  the  ribs,  and  thoracic  flstulie.^  Mechanical  apparatus  have  not 
been  found  of  utility  in  these  cases.  In  a few  instances,  with  the  partial  resumption  of 
its  functions  by  the  lung,  the  deformity  of  the  chest  has  been  in  a great  measure  removed. 
It  was  in  cases  of  this  class  that  Bromfield*^  advised  the  use  of  wind  instruments  and 
pneumatic  apparatus  to  promote  the  inflation  of  the  injured  lung,  propositions  which  John 
Bell  ridiculed  in  his  lively  style. 

Secondary  Emphysema  and  Pneumothorax.  — These  affections  occurred  in  rare 
instances  as  secondary  complications,  very  obscure  and  perplexing  in  their  symptoms  and 
progress.  A veteran  at  the  Soldier’s  Home,  whose  left  arm  had  been  disarticulated  at 
the  shoulder,  received  a blow  from  the  fist,  or  from  a blunt  weapon,  over  the  right  nipple. 
Surgeon  Laub  found  no  fracture  of  the  ribs;  but  there  was  an  unnatural  resonance  on 
percussion,  cough,  and  a purulent  expectoration,  and,  after  a few  days,  a crackling  tumor 
appeared  and  spread  over  the  great  part  of  the  pectoral  muscle.  After  a few  weeks  there 
was  evidently  a communication  between  this  tumor  and  the  pleural  cavity,  and  metallic 
tinkling  and  the  signs  on  percussion,  indicated  the  presence  of  air  and  of  pus  in  that  cavity. 
The  arm  became  swollen  and  emphysematous,  and  pus  pointed  below  the  insertion  of  the 
coraco-brachialis,  and,  notwithstanding  a free  incision  here,  dissected  its  way  down  the 
forearm.  Soon  after,  there  was  profuse  hajmorrhage  from  the  incision  of  the  abscess,  and 
a tourniquet  was  made  to  compress  the  brachial  artery.  The  haemorrhage  recurring 
whenever  pressure  was  removed,  and  the  entire  arm  and  forearm  being  infiltrated  with 
■ pus  and  air,  the  bleeding  point  was  exposed  by  a very  free  incision  along  the  inner  border 
of  the  biceps,  and  ligatures  were  placed  above  and  below  upon  the  bleeding  vessel,  which 
was  the  collateralis  magna,  enlarged  to  nearly  the  size  of  the  brachial.  The  incision  was 
then  extended  upward  through  the  skin  and  fascia  nearly  into  the  axilla,  and  down  the 
forearm  to  the  annular  ligament.  Pus  and  gas  w^ere  freely  discharged.  The  immense 
wound,  in  a few  days,  assumed  a healthy  appearance,  the  ligatures  came  away  in  a 
fortnight,  and  the  arm  recovered  without  much  stiffness.  Meanwhile  the  tumor  in  the 
pectoral  region  subsided,  and  cough  and  purulent  expectoration  gradually  disappeared,  the 
normal  respiratory  murmur  was  restored,  and  in  a few  months,  under  a sustaining  regimen, 
with  cod-liver  oil,  porter,  and  other  restoratives,  the  man  regained  his  accustomed  health. 
Hennen  details  a curious  case  of  secondary  emphysema  at  page  385  of  his  masterly 
treatise,  and  one  of  the  cases  which  Guthrie  observed  after  Waterloo,  which  was  called  a 
hernia  of  the  lung,  would  appear,  from  the  brief  description,  to  have  presented  rather  the 
characters  of  secondary  emphysema.  In  the  latter  part  of  the  last  century  and  at  the 
commencement  of  the  present,  when  the  researches  of  j)hysicists  on  pneumatics  were 
exciting  great  popular  interest,  in  cases  of  secondary  pneumothorax,  surgeons  paid  great 

* Professor  GROSS  remarks  (A  St/stem  of  Surffery,  1862,  Vol.  II,  p.  449),  of  fistulous  thoracic  ahbcesscs : “The  cure  of  these  afiections,  which  is 
generally  followed  by  a remarkable  retrocession  of  the  walls  of  the  chest,  is  sometimes j>rornoted  b}'  weak  astringent  and  detergent  injections.” 

Chirurgical  Observations  and  Cases,  Loudon,  1773,  Vol.  II,  p.  93;  John  Bkll,  Discourses  on  ^'ounds,  Part  II,  i>.  19. 

cSO 


634 


WOUNDS  AND  INJUEIES  OF  THE  CHEST, 


[Chap.  V, 


attention  to  the  removal  of  the  air  by  suction,  and  various  adaptations  of  the  air-pump 
were  proposed  for  this  object.  Abernethy  treats  of  this  su])ject  with  his  accustomed 
acumen,  in  the  second  volume  of  his  Surgical  Observations  (p.  171). 

Wounds  of  the  CEsophagus,  Thoracic  Duct,  Nerves,  and  Diaphragm. — On  wounds 
of  the  pectoral  portion  of  the  gullet,  of  the  chyliferous  duct,  of  the  par  vagum,  and  other 
contents  of  the  posterior  mediastinum,  little  information  was  acquired  by  any  of  the  obser- 
vations made  during  the  war.  Benjamin  BelB  has  given  a learned  description  of  the 
symptoms  that  should  attend  lesions  of  the  canal  of  Pecquet  and  its  tributary  lymphatics ; 
but  it  is  drawn  partly  from  Mangetus,  and  more  largely  from  the  imagination.  Of  wounds 
of  the  nerves  our  information  was  greatly  extended  by  the  careful  investigations  of  Drs. 
Mitchell,  Keen,  and  Morehouse ; but,  with  the  exception  of  lesions  implicating  the  axillary 
plexus,  their  researches  embraced  few  cases  attended  by  wounds  of  the  chest.  On  wounds 
of  the  diaphragm  much  interesting  matter  was  contributed,  which  must  be  reserved  for 
consideration  under  the  head  of  wounds  and  injuries  of  the  abdomen. 

Wounds  of  Doth  Lungs. — I have  adduced,  at  page  497  et  seq.,  a number  of  examples 
of  recovery  after  shot  wounds  of  both  lungs,  and  have,  perhaps,  done  injustice  to  the 
reporters,  in  expressing  great  skepticism  as  to  the  accuracy  of  diagnosis  in  such  instances. 
I am  not  ignorant  that  Hemmann,  Schlichting,  Ravaton,  Van  Swieten,  Forestus,  and 
Schmucker,^  give  many  examples  of  both  sides  of  the  chest  being  opened  without  the 
accident  proving  fatal;  but  I know  of  no  modern  instance  in  which  the  cicatrix  of  a ball 
has  been  traced  through  the  substance  of  both  lungs  at  a remote  period  from  the  reception 
of  the  injury. 

Erysipelas  and  Gangrene. — These  complications  were  very  rare  in  the  chest  wounds 
treated,  except  in  a few  overcrowded  hospitals,  where  almost  every  solution  of  continuity 
became  the  seat  of  unhealthy  action.  In  the  eight  thousand  seven  hundred  and  fifteen 
cases  of  penetrating  wounds  of  the  chest,  erysipelas  is  noted  in  seventeen  cases,  of  which 
nine  proved  fatal;  and  gangrene  in  sixty-eight  cases,  with  fifty  deaths.  In  the  eleven 
thousand  eight  hundred  and  ninety-two  non-penetrating  injuries  of  the  chest,  erysipelas 
supervened  in  one  fatal  case,  and  gangrene  in  twenty-six  cases,  of  which  eleven  terminated 
fatally  (see  page  472).  Thus  it  appears  that  these  complications,  though  rare,  were  very 
fatal.  The  three  following  abstracts  are  gleaned  from  the  scanty  notes  of  cases  of 
gangrene  in  wounds  of  the  chest  reported  in  detail : 

Case. — Corporal  Charles  H.  Freas,  Co.  H,  84th  Pennsylvania  Volunteers,  was  wounded  in  the  left  side,  at  Chancellors- 
ville,  Virginia,  May  3d,  18G3,  by  aconoidal  hall.  He  was  conveyed  by  hospital  steamer  State  of  Maine  to  Annapolis,  Maryland, 
where  he  was  admitted  to  the  1st  Division  Hospital  on  May  17th.  The  missile  entered  immediately  under  the  head  of  clavicle, 
passed  through  and  emerged  at  superior  angle  of  scapula.  On  May  21st,  gangrene  set  in  at  orifice  of  exit,  and  on  May  22d 
the  wound  was  two  inches  in  diameter  and  covered  with  a thin  layer  of  slough;  on  June  27th,  slight  signs  of  granulations 
appeared  and  from  this  time  he  rapidly  improved,  and  on  July  15th  was  nearly  well.  The  treatment  consisted  of  administration 
of  stimulants  and  application  of  solution  of  creosote  and  vinegar,  and  nitric  acid  around  the  edges  of  the  wound.  In  October  he 
was  transferred  to  I’hiladelphia,  admitted  to  Satterleo  Hospital  October  27th,  and  returned  to  duty  May  3d,  18C4.  He  was 
discharged  the  service  August  25th,  1865.  The  case  is  reported  by  Acting  Assistant  Surgeon  L.  Smith.  Pension  Examiner  E. 
S.  Siinington,  Philadelphia,  reports,  February  13th,  1867  : “ Gunshot  wound  of  left  shoulder,  causing  contraction  of  muscles  ; he 
is  unable  to  raise  his  arm  to  use  it.  Disability  one-half  and  probably  permanent.” 

Case. — Private  Reuben  V.  Hilands,  Co.  C,  105th  Ohio  Volunteers,  aged  41  years,  received  a gunshot  penetrating  wound 
of  lung  at  Perry ville,  Kentucky,  October  8th,  1862.  He  was  treated  in  hospital  at  Perry ville  during  the  same  month,  and,  on 
January  14th,  1863,  was  admitted  to  hospital  at  Camp  Chase,  Ohio,  where  he  was  discharged  on  that  date.  The  ball  passed 

' Beli-,  B.  Of  Wound$  of  the  Thorax,  Chapter  III,  of  the  7th  edition  of  his  System  of  Surgery,  Edinburgh,  1801. 

^IlEMMAN'X,  Med.-chir.  Aiifsatze.  Berlin,  1778;  .ScilLlcirriNG,  Traiimatnlogia  nova  antiqun,  Amsterdam,  1748 ; IlAVATlON,  Chirurgie  d'Armee, 
ou  I'raite  des  Jdaies  d'armes  d feu  and  Pratique  Moderne  de  la  Chirurgie,  Paris,  1770;  Van  .Swieten,  Commentaria  in  llcrmanni  Poerhaave 
Aphorismus,  Paris,  1755;  FOUESTUs,  Observationum  Chirurgicarum  Op.  Omn.,  Francof.,  1010;  ScilMUCKEIt,  Chirurgische  Wahrnehmungen, 
Berlin.  1774. 


Skct.  IV.] 


DIAGNOSIS  AND  PKOGNOSIS. 


635 


tliroiigh  tlie  k'fl  scapula  and  upper  portion  of  lung,  emerged  at  the  base  of  neck  and  reentered,  immediately  passing  back  of 
trachea,  and,  removing  three  upper  molar  teeth  on  the  right  side,  came  out  in  front  of  the  lower  point  of  the  ear.  The  apparently 
erratic  course  of  the  bullet  may  be  accounted  foi'  by  the  position  of  soldier  when  wounded.  He  was  retreating,  and  stooped  with 
his  head  turned  to  the  left  looking  at  his  gun,  which  he  was  loading  when  struck.  Blood  issued  from  the  wound  of  the  neck  at 
every  expiration,  and  he  could  not  breathe  without  great  difficulty,  except  when  the  w'ound  in  neck  wms  closed.  March  Cth, 
186C,  Pension  Examining  Surgeon  C.  Byles,  who  reports  the  case,  states  that  the  left  lung  is  dull  on  percussion  and  silent  on 
auscultation;  the  wound  in  neck  occasioned  the  total  loss  of  his  voice,  wdiich  was  recently  instantaneously  restored  by  an  attack 
of  vomiting;  his  nervous  system  suflers  much,  whole  left  side  weak  and  paralyzed.  Pension  Examiner  J.  P.  Hosack,  of  Mercer, 
Pennsylvania,  reports,  January  18th,  1870,  that  the  weakness  of  lung,  shortness  of  breath,  stiffness  of  shoulder,  weakness  of 
arm,  and  painful  aphonia,  is  equivalent  to  total  disability. 

Case. — Piivate  John  IF.  Ellins,  Co.  G,  12th  Louisiana  Regiment,  aged  19  years,  was  wounded  at  Nashville,  Tennessee, 
December  15th,  18C4,  by  a conoidal  ball,  which  penetrated  the  right  lung.  He  was  received  into  Cumberland  Hospital, 
Nashville,  on  December  17th,  and  thence  transferred  to  Hospital  No.  1,  Nashville,  on  January  4th,  18G5.  The  wound  became 
gangrenous,  and  he  died  March  10th,  1865. 

Gangrene  of  the  walls  of  the  track  of  a musket  hall  tliniugh  the  lower  lobe  of  right 
lung  is  observed  in  Specimen  3348  of  the  Surgical  Section  of  the  Museum.^ 

Tetanus. — The  rarity  of  tetanus  as  a complication  of  chest  wounds,  an  observation  for 
which  we  are  indebted  to  Dr.  Fraser,^  is  undeniable,  and  is  interesting  in  connection  with 
diagnosis,  as  indicating  the  lesser  implication  of  the  sympathetic  nervous  system  in  lung 
wounds,  than  in  wounds  of  the  abdominal  cavity.  There  were  seventeen  instances  of 
tetanus  among  the  eight  thousand  seven  hundred  and  fifteen  cases  of  penetrating  wounds 
of  the  chest. 

Diagnosis  and  Prognosis. — Dr.  John  Jones, ^ our  Revolutionary  authority  in  military 
surger}^,  said,  “penetrating  wounds  of  the  thorax  are  in  general  pretty  easily  distinguished 
from  the  peculiar  symptoms  that  attend  them.  The  most  remarkable  of  these  is  the 
passage  of  the  air  through  the  wound  in  respiration  and  the  expectoration  of  frothy  blood 
from  the  lungs  when  they  are  wounded.”  To  these  accepted  signs,  emphysema,  dyspnoea, 
nervous  anxiety,  collapse  of  the  lung,  and,  later,  pleurisy  and  pneumonia  are  commonly 
added  by  modern  authors.  A cursory  examination  will  show  that  none  of  these  symptoms 
singly  merits  implicit  reliance,  though  their  concurrence  affords  strong  presumptive  proof  of 
wound  of  the  lung. 

Tromatopnoea. — The  passage  of  air  through  the  external  wound  was  once  regarded 
as  conclusive  evidence  of  wound  of  the  lung.^  This  is  disproved  by  observation  and 
■experiment.  Air  will  pass  freely  in  and  out  through  a small  opening  in  the  pleural  cavity 

^ Spec.  3348,  Sect.  I,  A.  M.  M.  “A  preparation  of  the  lower  portion  of  the  right  lung,  perforated  by  a conoidal  ball  which  entered  between  the 

sixth  and  seventh  ribs,  and  is  gangrenous.  Corporal  J.  P , Co.  A,  69th  Ohio,  Petersburg,  2Gth  June.  Admitted  to  hospital  at  Alexandria,  July  4th ; 

died  July  12th,  1864.” 

2 Traser.  Treatise  upon  Penetrating  Wounds  of  the  Chest,  p.  20.  The  proportion  of  cases  of  tetanus  given  in  the  text,  one  in  five  hundred  and 
twelve  cases,  does  not  appear  very  small.  But  there  W’ere  only  six  cases  of  tetanus  among  those  wounded  superficially  in  the  chest.  The  comparison 
should  therefore  be  instituted  between  the  twenty-three  cases  of  tetanus  and  the  total  of  twenty  thousand  six  hundred  and  seven  chest  wounds,  or  one  in 
eight  hundred  and  ninety-six  cases.  In  I*aris,in  1830,  out  of  three  hundred  and  ninety  gunshot  wounds,  there  was  but  a single  case  of  tetanus,  but  that  one 
occurred  in  a penetrating  wound  of  the  chest  (ISIeniere).  The  reports  of  the  Indian  Mutiny  refer  to  one  case  of  tetanus  in  the  small  series  of  chest  wounds 
CNVilliamson).  Of  twenty-nine  cases  of  tetanus  in  the  Crimea,  but  one  supervened  in  chest  wounds,  a case  of  trismus  in  a Prench  soldier  (Fraser). 
Larrey  does  not  mention  a case.  In  the  Danish  "NVar  of  1849-50,  in  nine  hundred  and  twelve  wounded,  no  case  of  tetanus  occurred  (Schytz).  Sir  Gilbert 
Blane  {Observations  on  the  Diseases  of  Seamen,  3d  ed.,  London,  1799,  p.  55.5)  states  that  in  a naval  action.  In  April,  1752,  of  eighty-eight  wounded, 
sixteen  had  tetanus.  Dr.  B.  Bkck  {Allgemeine  Militdr-drztliche  Zeitung,  No.  37,  Sept.  15th,  1872)  says  that  among  7,182  wounded  of  the  Fourteenth 
Corps  (Bavarians  under  General  Werder),  tetanus  occurred  in  only  forty-five  cases. 

^ Plain,  Concise,  Practical  Itemarhs,  on  the  Treatment  of  Wounds  and  Fractures;  To  which  is  added  an  appendix  on  Camp  and  Military 
Hospitals ; Princijtally  designed  for  the  Use  of  Young  Military  and  Naval  Surgeons  in  North  America  ; By  JOHN  JONES,  M.  D.,  Professor  of  Surgery  in 
King’s  College,  New  York ; Philadelphia,  Third  Street ; printed  and  sold  by  Robert  Bell.  8vo.  1776. 

^ Hence,  the  ‘‘waste  of  time  and  wax-tapers  in  ascertaining  the  exit  of  air  through  the  passage  ” to  which  Hennen  {3d  ed.  p.  375)  alludes.  Dr.  ,7. 
Thom.son  remarks  {Report  of  Observations  made  in  the  British  Military  Hospitals  in  Belgium  after  the  Battle  of  Waterloo,  Fdinburgh,  1816,  p.  80) 
that  “it  is  often  difficult  to  say,  in  wounds  of  the  chest,  whether  they  penetrate  into  the  sacs  of  the  pleura ; but  all  doubts  with  regard  to  this  point  aro 
removed  the  moment  we  obscr^'c  air  coming  out  of  the  wound  upon  coughing.”  Of  nine  fatal  cases  reported  by  Dr.  Fraser  {op.  cit.  p.  b’6)  of  pencti’ating 
chest  wounds  in  which  the  lungs  were  wounded,  this  symptom  was  present  in  two;  of  seven  fatal  cases  in  which  the  lung  was  not  wounded,  it  was 
present  in  one;  in  twelve  cases  of  recovery  it  wa.s  present  in  one.  It  was  present  in  two  out  of  twelve  fatal  cases,  in  the  British  Director  Goncral’s 
reports,  and  in  one  of  nine  eases  of  recovery.  Dr.  Williamson  {op.  cit.  p.  80)  mentions  that  “twelve  perforating  gunshot  wounds  of  the  chest  arrived  from 
India;”  * * in  four  instances,  if  is  mentioned  that  air  passed  out  of  the  wounds  in  the  chest.  * * “In  all  these  cases,  there  can  be  but  little 

doubt  of  the  lung  having  been  wounded.” 


636 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


when  the  lung  is  uninjured.  It  may  gurgle  in  a deep  oblique  emphysematous  wound  in 
the  soft  parts,  or  in  wounds  penetrating  the  anterior  mediastinum  and  pericardium,  and 
not  communicating  with  the  pleural  cavity.  When  there  is  a large  penetrating  wound  of 
the  pleural  cavity  and  the  lung  is  really  wounded,  tromatopnoea  ceases,  except  in  coughing 
and  sneezing,  for  the  simple  physical  reason  that  there  is  no  confined  body  of  air  subjected 
to  the  alternate  movements  of  the  thorax  (Fraser).  Tromatopnoea  was  not  a frequent 
symptom.  It  is  noted  in  forty-nine  instances  only,  among  the  eight  thousand  seven  hundred 
and  fifteen  cases  of  penetrating  wounds  of  the  chest.  Surgeon  J.  T.  Woods,  in  the  report 
from  Chattanooga  already  cited,  remarks  : 

“ Respiration  through  the  thoracic  opening,  exhibiting  the  characteristic  mucous  bubbling,  in 
cases  where  the  ball  could  not  have  failed  to  perforate  the  lung  tissue,  was  not  a common  symptom, 
but  occurred  with  most  certainty  when  the  perforation  was  in  the  upper  part,  and  this  occurrence 
was  accompanied  by  much  increased  difficulty  of  respiration, — a symptom  that  was  astonishingly 
slight  in  those  cases  in  which  the  above-mentioned  mechanical  difficulty  occurred,  or  pneumonia 
supervened.” 

Brigade  Surgeon  P.  Pineo,  U.  S.  V.,^  attached  much  importance  to  this  sign.  He 
writes,  in  the  second  year  of  the  war : 

“Of  Gunshot  Wounds  of  the  Lung,  let  me  say  one  word:  Three  cases  of  a bullet  passing 
through  the  substance  of  the  lung,  producing  emphysema,  and  the  air  issuing  from  the  aperture 
made  by  the  bullet,  so  as  to  make  the  case  unmistakable,  have  occurred  under  my  observation,  in 
which  the  patients  recovered.  There  has  been  some  question  about  the  probabilities  of  recovery 
in  gunshot  wounds  of  the  thorax,  and  I therefore  mention  these  cases,  thinking  that  you  may  be 
interested  to  know  of  such  favorable  results,  in  so  many  cases,  of  so  grave  a lesion.” 

Tromatopnoea  was  observed  in  only  eleven  of  the  cases  of  which  abstracts  have  been 
given  in  this  chapter.^  Of  these,  seven  recovered  and  four  died.  The  lung  was  wounded 
in  three  of  the  fatal  cases,  and  probably  in  the  fourth.  In  fifty-one  cases  analyzed  by 
Dr.  Frazer  {op  cit.,  p.  52)  it  was  present  in  seven.  This  sign  of  lung  wound  must  be 
regarded  as  infrequent  and  far  from  pathognomonic. 

Hoemoptysis. — Until  recently  most  writers  on  military  surgery  have  taught  that 
spitting  of  blood  soon  after  the  reception  of  a wound  of  the  chest  was  a certain  sign  that 
the  lung  was  wounded.^  This  view,  though  still  maintained  by  some  authors,^  is  now 
known  to  be  erroneous.  It  is  desirable,  therefore,  to  arrive  at  a correct  estimate  of  the 
diagnostic  value  of  this  symptom. 

* PlN'EO.  Boston  Medical  and  Surgical  Journal,  1862,  Vol.  LXV,  p.  373. 

2 Cases  of  Osborne,  p.  483;  L , p.  485  ; Kdkin,  p.  487  ; Brownlee,  p.  488  ; Berrien,,  p.  491 ; Collins,  p.  491 ; L , p.  492 ; Lewis,  p.  494;  Case 

2,  p.  510;  Dalien  and  Burke,  p.  575.  Dr.  Ashhurst  {Principles  and  Practice  of  Surgery,  1871,  p.  357)  regards  tromatopnoea  as  “perhaps,  more 
characteristic  than  any  other  single  symptom  of  wound  of  the  lung,”  though  he  has  “ witnessed  it  in  cases  in  which  there  was  every  reason  to  believe  that 
the  pleura  alone  was  injured.” 

*Bell  {Discourses  on  the  Nature  and  Cure  of  Wounds,  Edinburgh,  1795,  Part  II,  p.  37)  says:  “If  the  patient  spits  blood  he  fears  a wound  of  the 
lungs ; if  there  be  an  emphy.sema  he  is  sure  of  it and  also  at  p.  51 : “If  spitting  of  blood  and  the  emphysema,  or  windy  tumour,  come  on,  unquestionably 
he  is  wounded  in  the  lungs.”  SCIIMUCICEU  {Chirurgische  Wahrnehmungen,  Berlin,  1774,  Zweiter  Theil,  p.  26)  speaks  of  the  spitting  of  blood  as  evidence 
of  wound  of  the  lung.  IlECKEIt,  A.  P.  {Kurzer  Abriss  dcr  Chirurgia  Mcdica,  Berlin,  1808,  S.  793),  is  of  tlie  same  opinion.  Ballingall  {Outlines  of 
Military  Surgery,  Edinburgh,  1855,  5th  cd.,  p.  329)  regarded  haemoptysis  as  a more  certain  sign  than  the  issue  of  air  from  the  wound  in  expiration. 
“Symptoms  less  equivocal  are:  Bloody  expectoration;  severe,  urgent,  and  increasing  dyspnoea;  insupportable  anxiety  and  faintness  immediately 
succeeding  the  accident ; these  are  the  most  prominent  symptoms  of  a wounded  lung.”  GUTHUIE  (Commentaries,  etc.,  (^th  ed.,  pp.  4.53,  467,  474,  475)  is 
evidently  of  opinion  that  haemoptysis,  with  the  passage  of  air  by  the  wound,  is  proof  of  injury  of  the  lung.  TliOMSOX,  as  has  been  seen  (p.  635).  regarded 
tromatopnoea  as  pathognomon'e,  and  haemoptysis  as  a sign  of  nearly  equal  certainty.  (Bep.  of  Obs.  in  Mil.  Ilosp.  in  Belgium,  p.  80.)  “ That  the  lungs 

have  been  wounded  may  be  inferred  with  nearly  equal  certainty.”  Lawren’CE  (London  Lancet,  1830,  Lectures,  Vol.  1,  p.  555)  speaks  of  two  circum- 
stances, which,  viewed  in  combination,  showed  that  the  lung  had  suffered  direct  injury,  viz.,  haemoptysis  and  emphysema.  Stromeyer  (Maximen  der 
Kriegsheilkunst,  185.5,  S.  600)  says  that  in  shot  wounds  the  lung  is  always  contused,  “ wie  dies  sich  auch  aus  dem  Blutspcien  ergiebt,  welches  bci  dicssen 
AVunden  niemals  fehlt.” 

Dr.  MacLEOD  still  reiterates  (Notes  on  the  Surgery  of  the  War  in  the  Crimea,  p.  236)  the  routine  statement  “ blood  by  the  mouth  and  blood  and 
air  by  the  wound  are  unequivocal  proofs  that  the  lungs  have  been  injured.”  Assistant  Surgeon  T.  K.  BlliNlE,  Ist  Koyals  {London  Lancet,  1856,  p.  682), 
reports  two  cases  of  recovery  from  supposed  lung  wound,  the  diagnosis  being  based  on  the  presence  of  haemoptysis  ; IIaxcoCK  {London  Lancet,  1856.  i>. 
686)  mentions  several  cases  of  recovery  after  chest  wounds  in  which  wound  of  the  lung  was  “evidenced  by  expectoration  of  blood.”  AIa'ITMEW  {Surg. 
Uist.  Crimea,  Vol.  11,  pp.  315)  mentions  two  case.s  in  which  haem»)ptysis  took  place,  “rendering  it  highly  probable  that  the  lung  had  been  injured.” 


Si:cT.  IV.] 


DIAGNOSIS  AND  PROGNOSIS. 


637 


Mr.  Lawson  and  Dr.  Schwartz^  believe  that  ligemoptysis  is  invariably  present  in 
extensive  wounds  of  the  lung  only.  But  there  is  in  the  Museum  of  St.  George’s  Hospital 
a preparation  from  a patient  who  survived  for  eight  days  a laceration  of  the  lung  four 
inches  in  length  by  two  inches  in  depth,  and  had  no  haemoptysis. 

Of  the  cases  carefully  observed  in  the  Crimea  by  Dr.  Fraser,  only  one  out  of  nine 
fatal  with  wound  of  the  lung  had  haemoptysis.  Of  seven  fatal  cases,  in  which  the  lung 
was  not  wounded,  two  had  haemoptysis;  of  twelve  cases  of  recovery,  three  had  haemoptysis. 
The  appearance  of  this  symptom  is  only  noted  in  four  hundred  and  ninety-two,  of  the 
eight  thousand  seven  hundred  and  fifteen  penetrating  wounds  recorded  in  Table  XXVI, 
though  it  might  have  been  present  and  unmentioned  in  others.  It  was  absent  in  the 
larger  number  of  cases  of  undoubted  shot  wounds  of  the  lung,  of  which  specimens  are 
preserved  in  the  Army  Medical  Museum. 

Hennen^  recognized  that  bloody  sputa  was  not  indicative  necessarily  of  lung  wound. 
Mr.  Blenkins^  also  speaks  positively  on  this  point:  “Haemorrhage  from  the  lungs  by  the 
mouth,  or  bloody  expectoration  as  it  is  termed,  is  by  no  means  a certain  sign  of  wound  of 
those  organs.’’  • Dr.  Appia,^  also,  states  that  haemoptysis  is  not  a pathognomonic  symptom 
of  penetration;  it  may  be  only  the  casual  complication  of  some  superficial  injury.’’ 

Professor  Gross®  says:  “A  discharge  of  blood  by  the  mouth,  however,  is  not  a positive 
evidence  of  penetration  of  the  lung,  experience  having  shown  that  the  mere  concussion  of 
the  chest  by  a ball  or  shot  is  capable  of  producing  it.”  Dr.  Ashhurst,®  likewise,  correctly 
observes  that  in  wounds  of  the  pleura  and  lung,  “haemoptysis  is  usually,  but  by  no  means 
invariably,  present,  the  expectorated  matter  being  frothy  mucus  mixed  with  blood,  or 
more  rarely  pure  blood  in  considerable  amount.”  Dr.  Chisolm'’^  remarks:  “From  our 
large  experience  of  perforating  chest  wounds,  we  would  infer  that  the  spitting  of  blood 
is  a very  deceptive  diagnostic  sign  of  lung  wound.”  I have  adduced,  in  this  chapter, 
abstracts  of  nineteen  cases  in  which  there  was  haemoptysis  without  wound  of  the  lung. 
Four  were  unaccompanied  by  any  external  lesion.  The  existence  of  haemoptysis  is  noted 
in  only  twenty-four  of  two  hundred  cases  in  which  the  lungs  were  wounded.  Dr.  Fraser 
{op.  cit.,  p.  61),  Baudens  (op.  cit.,  p.  222),  and  Matthew  {op.  cit.,  p.  314),  cite  instances 
of  haemoptysis  in  cases  unattended  by  wound.  A similar  case  was  under  my  care:  H. 
W.  Torrey,  27th  Massachusetts  Volunteers,  aged  21.  years,  a tall,  slender  recruit,  was 
struck  in  the  left  side,  September  14th,  1861,  by  a comrade,  in  practicing  the  manual  of 
arms.  Copious  haemoptysis  ensued.  Xo  fracture.  Large  moist  crepitation  was  the  only 
modification  appreciable  on  auscultation  and  percussion.  Best  and  low  diet  were  enjoined, 
with  cold  acidulated  drinks  and  salines.  He  continued  to  cough  up  blood,  at  intervals, 
for  three  days,  and  then  rapidly  recovered. 

In  view  of  these  facts,  it  must  be  concluded  that  hasmoptysis  is  of  doubtful  value  as  a 
sign  of  lung  wound,  except  in  conjunction  with  other  symptoms. 


^ Lawson,  in  DruitVs  Vade  Mecum,  10th  ed.,  1870,  p.  484.  ScilWARTZ  {Beiirdge  zur  Lehre  von  den  Schnsswunden,  Schleswig,  1854,  S.  112^ : ‘’In 
severe  wounds  of  the  lung,  a groat  quantity  of  parti}*  dark,  partly  light-colored  blood  will  issue  from  the  mouth  and  the  opening  of  the  wound.” 

^IlENNEN  (Principles  of  Military  Surgery^  London,  1820,  p.  372) : “I  have  traced  a ball  by  dissection,  passing  into  the  cavity  of  the  thorax, 
making  the  circuit  of  the  lungs,  penetrating  nearly  opposite  the  point  of  entrance,  and  giving  the  appearance  of  the  man  having  been  shot  fairly  across, 
while  bloody  sputa  seemed  to  prove  the  fact,  and,  in  reality,  rendered  the  same  measures,  to  a certain  extent,  as  necessary  as  if  the  case  had  been 
literally  as  suspected.  Tlie  bloody  sputa,  however,  were  only  secondary,  and  neither  so  active  nor  alarming  as  those  which  pour  at  <ince  from  the  lung 
when  wounded.”  ^Blenkins.  Addition  to  article  Gwshot  ^younds  in  the  eighth  edition  of  Cooper's  Dictionar}',  Vol.  1,  j).  826. 

^ ArriA.  The  Ambulance  Surgeon,  llnglish  translati(.n  by  Messrs.  Xunn  and  Ldwards.  Ldinburgh,  1862,  p.  173. 

®(JUOSS.  A System  of  Surgery.  I'hiladeljdiia,  1872,  p.  447. 

® AsnilUItST.  The  J*rincijjlcs  and  Practice  of  Surgery,  1 hiladelphia,  1871,  p.  357. 

^ CinsOl.M.  A Manual  of  Military  Surgery.  Columbia,  18()4,  p.  318. 


638 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


Dyspnoea. — This  is  admitted  to  be  a very  uncertain  sign  of  wound  of  the  lung  or 
even  of  penetration  of  the  pleural  cavity.  It  may  be  present  when  the  lung  is  uninjured, 
or  absent  when  it  is  seriously  wounded.  It  may  be  due  altogether  to  moral  causes,  and 
constitute  one  of  the  chief  elements  of  the  condition  termed  shock  by  some  surgeons.^  It 
is  then  transitory.  It  is  most  intense  when  the  walls  of  the  thorax  expand  freely  on 
inspiration,  while  obstructions  in  the  bronchial  tubes  prevent  the  air  from  inflating  the 
vesicles  and  hinders  the  lung  from  following  the  movements  of  the  chest  wall.  When 
the  air  enters  and  passes  out  freely  through  a wound,  there  is  no  dyspnoea  unless  from 
compression  of  the  sound  lung  by  effusion,  or  from  hindrance  of  the  movements  of  the 
lung  by  old  adhesions  or  through  some  obscure  lesion  of  the  nerves ; for  when  the  lung  has 
collapsed  and  the  pressure  of  air  admitted  through  the  glottis  and  the  wound  is  equal,  the 
collapsed  lung  offers  no  opposition. 

Of  fifty-one  cases  of  penetrating  shot  wounds  of  the  chest,  analyzed  by  Dr.  Fraser, 
dyspnoea  was  present  in  thirteen  only,  as  follows:  in  three  of  nine  fatal  cases  in  which 
the  lung  was  wounded,  in  three  of  nine  fatal  cases  in  which  the  lung  was  uninjured,  in  two 
of  twelve  cases  of  recovery,  in  four  of  twelve  fatal  cases  from  Dr.  Matthew’s  report,  in  one 
of  nine  cases  of  recovery  from  the  same  report.  In  two  hundred  and  fifty-two  cases  of 
which  abstracts  are  given  in  this  chapter  in  which  the  symptoms  were  carefully  noted, 
dyspnoea  was  present  in  fifty — eighteen  of  recovery  and  thirty-two  fatal.^ 

Nervous  Anxiety. — Great  agitation,  nervous  anxiety,  and  general  prostration  some- 
times follow  the  reception*  of  wounds  of  the  chest.^  The  alarm  and  apprehension 
accompanying  this  depression  overcome  the  fortitude  of  men  of  the  steadiest  self-control 
and  most  devoted  courage.^  In  analyzing  this  condition,  the  surgeon  will  endeavor  to 
discriminate  between  the  symptoms  due  to  impeded  respiration,  those  arising  from  faintness 

^ Of  the  effect  of  venesection  in  relieving  dyspnoea,  as  practiced  in  some  instances,  in  the  Franco-Prussian  war  of  1870-71,  Dr.  H.  FiscHER 
{Kriegschirurgische  Erfahrungen,  Erlangen,  1872,  S.  12G)  remarks:  “In  cases  of  severe  dyspnoea  and  cyanosis  we  practiced  venesections.  If  not 
njade  too  copiously  the  desired  effect  is  reached;  momentary  relief  of  breathing  and  less  oppressed  circulation  of  blood,  without  depriving  the  patient 
of  more  blood  than  he  needs  for  the  approaching  tedious  suppuration.  * * * In  several  cases  we  observed  excellent  results,  * * * in  other  cases 
the  ellect  of  the  venesection  was  very  transient.  In  one  instance  we  made  repeated  venesection,  with  only  a very  rapidly  passing  relief.” 

2 Vidal  {Traiti  de  Paihologit  Exlerne  et  de  Midtciiie  Operatoire.,  Seme  6d.,  1860,  T.  IV,  p.  60)  remarks  that  slight  punctures  of  the  chest  may 
induce  dyspnoea,  cough,  and  nervous  anxiety:  “Les  piqiires  les  plus  l^geres  de  la  poitrine  peuvent  donner  lieu  aussi  a une  s^rie  de  ph6numenes  qui 
scmbleut  accuser  ordinairement  les  l6sions  les  plus  graves  de  l’6conomie;  ainsi:  refroidissement  do  la  peau,  resserrement  du  pouls,  suffocation,  sjmcope 
iiiemc,  toux,  enfin  la  plupart  des  symptdmes  de  la  lesion  d'un  orgaue  profond,  d'une  hemorrhagic  interne ; et  cependant  ni  organe,  ni  vaisseau  un  peu 
considerable  n'ont  6t6  leses.  On  observe  ces  i)h§nom6nes  surtout  dans  les  blessures  re<jues  en  duel.  Quel  que  soit  le  courage  des  champions,  au  mometit 
du  combat,  le  sang  ne  circule  pas  normalement  et  Finnervation  n’est  pas  r6gulicre,  on  n’est  pas  sans  Emotion  ; s’il  so  joint  a cet  6tat  moral  une  plaie  d la 
poitrine,  le  bless6  eo  con^oit  les  plus  vives  inquietudes,  et  si  la  peur  ne  la  pas  encore  pris,  il  est  voisin  d’en  etre  poss6d6.  On  conceit  alors  la  production 
des  ph^nomenes  que  je  viens  d'indiquer,  et  I'effet  salutaire,  sur  des  homines  peu  6clair6s,  des  succions  qu'on  faisait  autrefois,  accompagn^es  de  paroles 
plus  ou  moins  myst^rieuses  : le  tout  formait  une  pratique  qui  shdressait  au  moral  de  l individu,  lequel  6tait  bientot  radicaleraent  gu6ri  quand  le  danger 
n'^tait  pas  physique.  Ces  phenomdnes  nerveux  peuvent  aussi  s'expliquer  par  la  lesion  des  nerfs  qui  animent  les  parois  de  la  poitrine.  Or  on  sait  qu’il 
eii  est  de  respirateurs^  comme  le  dit  Ch.  Bell : eh  bien.  la  lesion  de  ces  nerfs  peut  donner  lieu  d une  toux,  une  suffocation,  qui  siinulent  singuli^rement 
unc  lesion  des  poumons  ou  un  epancheraent  pleuretique.” 

3 Professor  GROSS  {System.,  Vol.  II,  p.  445)  says : “ Death  from  mere  shock  is  by  no  means  uncommon  in  wounds  and  injuries  of  tho  chest ; cases 
of  the  kind  are  frequently  met  with  both  in  civil  and  military  practice,  and  their  occurrence  has  occasionally  been  noticed  where,  upon  dissection,  no 
serious  lesion  has  been  detected  to  account  for  so  untoward  a result.” 

■*It  is  within  the  observation  of  most  medical  men,  that  the  behaviour  of  men,  when  death  is  imminent,  though  partly  gnvenied  by  the  measure  of 
fortitude  and  courage  they  possess,  is  largely  affected  not  only  by  physical  but  by  mental  and  moral  causes,  and  especially  by  their  C(>nvictions  as  to  a 
future  state,  and  by  their  social  relations  in  the  present.  Religionists  of  equal  courage  may  betray  excessive  trepidation,  or  extreme  exaltation  and 
confidence  in  future  felicity.  Skeptics  may  contemplate  the  approach  of  dissolution  with  serene  indifference,  or  with  remoreeful  anguish.  Life  is  dear 
when  gladdened  by  domestic  joys  and  by  success ; little  valued  when  a lonely  struggle  with  adversity.  In  some  diseases,  as  in  cholera,  patients  com- 
monly manifest  little  concern  as  to  their  fate.  The  effects  of  severe  injuries  are  usually  attended  by  apprehension  and  anxiety,  especially  when  the 
great  cavities  are  penetrated;  but  this  is  not  a uniform  consequence.  It  is  most  common  and  characteristic  in  wounds  of  the  abdomen.  A factitious, 
transitory  calmness,  indicating,  perhaps,  that  the  sympathetic  nervous  system  is  overwhelmed,  is  dreaded  by  surgeons.  Such  a condition  is  occasionally 
noticed  when  limbs  are  torn  off.  General  Moreau's  case  was  an  instance.  It  has  been  remarked  that  those  dying  from  sword  wounds  have  a languid 
resigned  aspect,  while  those  killed  by  shot  present  a firm  defiant  expression,  and  differences  in  attitude  in  the  dead  on  the  field  have  also  been  nottul. 
(Observations  by  Chenu,  Perier,  Brinton.)  It  is  probable  that  these  differences  depend  very  much  upon  the  structure  implicated,  and  are  modified  as 
tho  mortal  wound  affects  the  nervous,  circulatory,  or  respiratory  system.  (See  Sir  BEN.TAMIN  COLLIXS  BuoDIK's  Psychological  Inquiries.  Being  a Scries 
of  Essays  intended  to  Illustrate  the  Mutual  Jtelatioyis  of  the  Physical  Organization  and  the  Mental  Faculties ; in  the  edition  of  his  works  collected  and 
arranged  by  Mr.  Charles  Hawkins,  London,  I860,  Vol.  I,  p.  117.)  • 


/ 


Sect.  IV.]  DIAGNOSIS  AND  PKOGNOSIS.  639 

from  loss  of  blood,  and  those  dependent  on  lesions  of  the  nervous  system,  and  on  mental 
and  moral  causes.  If  this  were  always  done,  there  would  be  fewer  vague  descriptions  of 
shock  and  of  conditions  of  undefinable,  indescribable  anxiety  and  nervous  depression. 
Authors  assert  that  patients  with  penetrating  wounds  of  the  chest  frequently  die  from 
shock,  when  dissection  reveals  no  appreciable  mortal  lesion.  I have  never  met  with  a case 
of  the  kind,  nor  with  a carefully  written  observation  corroborating  this  assertion.  Surgeon 
Baruch  describes  (p.  610,  ant^  an  expression  of  anxiety  as  very  peculiar  in  penetrating 
wounds  of  the  chest ; but  I am  satisfied  that  this  expression  is  much  less  common  in  such 
injuries  than  in  penetrating  wounds  of  the  abdomen,  and  that  the  explanation  is  to  be 
sought  in  the  lesser  implication  of  the  sympathetic  system  of  nerves  in  chest  wounds. 

Other  /Signs. — ^Apart  from  emphysema  and  lumbar  ecchymosis,  which  have  been 
discussed,  the  other  signs  of  penetrating  wounds  of  the  chest  are  those  attendant  on 
haemorrhages,  and  those  that  accompany  inflammations  or  intrathoracic  effusions,  and 
those  connected  with  the  appearance  of  the  wound,  and  in  some  instances  of  the  weapon. 
The  signs  due  to  haemorrhage  have  been  referred  to  on  pages  519,  530,  and  624,  in  treating 
of  wounds  of  the  blood-vessels,  and  of  the  heart,  and  of  haemothorax.  Great  attention 
should  be  directed  to  the  detection  of  the  bleeding  point  when  the  situation  of  the  wound 
indicates  the  probability  of  a lesion  of  the  intercostal  or  internal  mammary  arteries.  A 
spatula  or  curved  piece  of  card-board  introduced  between  the  lips  of  the  wound  may  render 
the  source  of  the  haemorrhage  visible,  or  the  finger  introduced  may  feel  the  warm  arterial 
jet;  or  it  may  be  requisite  to  enlarge  the  wound.  The  chest  should  be  exposed  and  cold 
applied  while  the  search  is  prosecuted.  The  feeble  pulse  and  clammy  skin  will  reveal, 
and  auscultation  and  percussion  will  guide,  in  the  more  copious  haemorrhages.  In  rare 
instances  of  wounds  in  the  sternal,  subclavian,  and  axillary  regions,  the  pulsation  of  the 
great  vessels  and  even  of  the  heart  may  be  seen.^  The  physical  signs  derived  from 
auscultation  and  percussion  furnish  the  most  reliable  indications  in  the  consecutive 
inflammations  and  effusions,  and  will  be  interpreted  in  connection  with  the  rational  signs. 
Though,  immediately  after  the  reception  of  the  injury,  there  may  be  moist  crepitus,  the 
gurgling  of  tromatopnoea,  various  friction  sounds absence  or  diminution  of  the  respiratory 
murmur,  and  modifications  in  resonance,  the  surgeon  will  listen  in  vain  for  uniform  sounds 
characteristic  of  particular  lesions.^ 

If  there  be  a wound  of  entrance  only,  the  presence  of  a foreign  body,  in  a shot  wound, 
will  be  suspected,  but  not  positively  affirmed,  for  the  missile  may  have  dropped  out  or 
have  been  removed  with  the  clothing.  If  there  are  two  wounds,  the  surgeon  will  not 
conclude  hastily  that  one  is  necessarily  a wound  of  exit ; for  it  may  happen  that  the  man 
has  been  struck  by  two  balls  and  that  both  have  lodged.  This  subject  of  the  diagnostic 
signs  of  entrance  and  exit  apertures,  will,  however,  be  fully  discussed  in  the  chapter  on 

^ See  HENNEN’s  case  LXII  {op.  cit.,  p.  395),  Lieut.  Colonel  II , wounded  at  Waterloo,  under  the  centre  of  the  left  clavicle:  “1  was  very 

curious  to  see  the  state  of  the  artery ; it  lay  awfully  pulsating  in  sHu,  which  uncovered  arteries  are  not  always  obsen’cd  to  do.”  See  also  Proh'ssor 
Billroth’s  cases  already  referred  to,  and  a number  cited  in  this  work. 

* Though  refusing  to  accept  Jobert’s  and  BouillaUd’s  bruits  dt  frottement  as  distinctive  and  pathognomonic  indications  of  wounds  of  tlie  heart,  I 
would  by  no  means  depreciate,  in  the  slightest  degree,  the  value  of  physical  exploration  in  such  cases.  One  cannot  but  read  with  a touching  interest 
the  recent  lectures  of  Professor  Piorry  on  the  utility  of  percussion  in  the  diagnosis  of  chest  wounds.  Though  desolated  by  the  afflictions  of  his  country, 
the  veteran  professor  says  that  he  wishes  to  impart  to  the  young  surgeons  whatevei  m a physician  can  olTcr,  and  has,  therefore,  printed  this  scries  of 
discourses  on  plessimetrism,  an  art,  which,  in  the  perfection  to  w’hich  Pn^fessor  Piorr  nas  carried  it,  will  perhaps  perish  with  him. 

®Mr.  EiilCHSEN,  The  Science  and  Art  of  Surgery,  5th  ed.,  Vol.  I,  p.  -134,  says  that  in  wounds  of  the  lung:  “On  auscultating  the  chest  immediately 
after  the  infliction  of  the  injurj’,  and  before  there  is  time  for  the  sui>ervention  of  any  consequences,  a loud  rough  crepitation  will  be  distinctly  audible 
at  and  around  the  seat  of  injury.”  The  surgeon  docs  not  have  an  opportunity  of  examining  the  wound  before  there  is  time  for  the  effusion  of  blood.  At 
the  earliest  moment  he  can  examine,  he  may  or  may  not  hear  loud  rough  crepitation,  near  or  distant,  according  to  the  extent  of  the  wound  and  the 
amount  of  effusion  in  the  larger  air-tubes. 


GiO 


WOUNDS  AND  INJURIES  OF  THE  CHEST. 


[Chap.  V, 


gunshot  wounds  in  general.^  The  surgeon  will  gain  all  the  information  he  can  from 
observing  the  external  wound,  using  his  finger,  as  far  as  he  judges  prudent,  to  determine 
the  extent  of  the  wound,  and  the  presence  or  absence  of  foreign  bodies,  but  not  employing 
the  probe  in  early  examinations-  He  will  next  endeavor  to  ascertain  if  the  lung  is 
wounded.  S.  Cooper  directs  to  “ make  the  patient  expire  strongly;  during  the  succeeding 
inspiration,  as  completely  as  possible  to  cover  the  wound,  to  prevent  the  entrance  of  external 
air ; after  once  or  twice  repeating  this  process,  if  air  continues  to  be  expelled,  the  lung 
must  be  wounded;”  but  this  plan  can  hardly  ever  be  made  satisfactory,  even  with  the  aid 
of  the  flame  of  a taper.  Th  einjection  of  liquids  into  the  cavity  to  determine  this  point 
is  dangerous,  and  has  long  since  been  condemned.  In  stabs  and  sword  thrusts,  something 
may  be  learned  from  the  extent  in  which  the  weapon  is  stained  with  blood.  The  aid  that 
may  be  derived  from  placing  the  patient  in  the  posture  in  which  the  wound  was  received, 
will  not  be  forgotten.  However  ingeniously  and  skilfully  the  examination  may  be  con- 
ducted, there  are  many  cases  in  which  the  surgeon  must  be  contented  to  remain  in  doubt, 
and  to  refrain  from  hazardous  explorations. 

The  extensive  and  varied  data  adduced  in  tlie  discussion  of  the  mortality  of  chest 
wounds,  and  especially  in  relation  to  penetrating  shot  wounds,  furnish  a reliable  basis  for 
a general  prognosis.  The  prognosis  of  individual  cases  must  be  formed  from  the  special 
circumstances  attending  them.  In  the  footnote^  may  be  found  the  aphorisms  on  this 
subject  formulated  by  John  Bell.  The  practitioner  will  bear  in  mind  that  the  chief  early 
danger  is  from  heernorrhage,  and  will  remember  the  encouraging  assurance  of  the 
experienced  Hennen,^  on  the  hopefulness  of  the  case  where  ‘‘the  third  day  has  been  safely 

^ I\Iedico*legal  questiuns  may  sometimes  depend  upon  the  solution  of  this  point.  A Confederate  officer  was  confined  in  the  military’  prison  at 
Norfolk,  in  18G3,  under  sentence  of  death  for  murder.  'NVhile  in  bed,  he  was  shot  through  the  left  chest,  by  the  colored  soldier  at  his  door, — the  smooth- 
bore musket,  in  the  sentinel’s  hands,  being  charged  with  a round  ball  and  three  buckshot,  the  distance  from  the  bed  to  the  sentinel's  post  being  about 
twelve  paces.  A little  below  and  witliin  the  left  nipple  were  three  wounds,  one  large  and  two  small,  the  edges  blackened,  stellate,  slightly  inverted. 
Between  the  spine  and  lower  angle  of  the  left  scapula  was  a single  wound,  large  and  ragged.  This  was  on  a plane  two  inches  and  more  lower  than  the 
anterior  wound.  There  was  profuse  haemothoras,  and  the  patient  died  in  thirty -six  hours.  Aware  of  his  approaching  end,  he  stated  that  he  had  raised 
himself  in  bed  to  change  his  position,  and  that  the  sentinel  appeared  at  the  door  and  ordered  him  to  lie  down,  and  fired  almost  immediately  after,  the 
cdiarge  taking  elfect  in  his  left  breast.  The  sentinel  testified  that  the  officer  sat  up  in  bed  and  was  endeavoring  to  raise  the  adjacent  window, — that  he 
thrice  ordered  him  to  lie  down,  and  then  fired,  W’hen  the  officer's  back  was  toward  him.  The  sergeant  of  the  guard  testified  that  the  sentinel  was 
instructed  to  fire,  if  the  prisoner  attempted  to  escape.  At  a court  of  enquiry,  it  was  argued  on  the  one  hand,  that  the  three  anterior  wounds  were  wounds 
of  entrance,  that  the  buckshot  had  probably  lodged,  and  that  the  ball  with  its  greater  momentum  had  emerged  at  a lower  plane.  On  the  other  side,  it 
was  contended  that  the  ragged  posterior  wound  marked  the  entrance  of  the  entire  charge ; that  the  three  anterior  wounds  marked  the  exit  of  the  ball 
and  buckshot. 

^ John  Bell  (op.  ci^.,  Part  II,  p.  51)  embodied  his  views  of  the  prognosis  in  the  following  series  of  aphorisms:  “1st.  If  the  patient  lies  oppressed, 
tossing,  insensible,  his  face  ghastly,  and  his  extremities  cold,  his  condition  is  very  doubtful,  it  looks  much  like  a wound  of  some  vessel  near  the  root  of 
the  lungs ; and  if  so,  he  is  surely  gone.  2dly.  If  the  oppression  come  on  more  slowly,  the  pulse  only  hurried  and  fluttering,  and  the  extremities  not  so 
cold,  there  is  reason  to  hope  that  his  wound  is  merely  in  the  edges  of  the  lungs ; and,  as  it  is  at  a distance  from  the  great  veins  and  arteries,  he  may 
escape.  3dly.  If  spitting  of  blood,  and  the  emphysema,  or  windy  tumor  comes  on,  unquestionably  he  is  wounded  in  the  lungs ; but  that  wound  is  not 
always  fatal.  If  either  the  blood  do  not  flow  in  upon  the  lungs  in  great  quantity,  or  if,  by  our  profuse  bleedings,  that  bloody  exudation  into  the  lungs 
can  be  restrained,  then  he  may’  be  saved.  4thly.  If,  when  there  is  muoh  oppression,  we  put  our  finger  into  the  wound,  let  some  blood  out,  and  so  give 
relief,  we  are  sure  that  the  sufl'oeation  proceeds  from  blood  extravasated  in  the  thorax ; and  that  kind  of  suftbeation  we  know  to  be  less  dangerous  by 
far  than  that  i)rocecding  from  blood  poured  into  the  proper  cavity’  or  cells  of  the  lungs,  i.  e.  int()  the  air-cells  into  which  we  draw  the  breath,  and  which, 
while  they  should  be  filled  with  air,  are  choked  with  blood.  5thly.  If  a bullet  jiasses  fairly  through  and  through,  the  patient  is  safer;  he  is  in  great 
danger,  if  it  stops,  whether  within  the  thorax  or  in  the  lungs ; for  when  it  passes  through,  as  soon  as  we  have  saved  him,  by  bleedings,  from  the  first 
dan'^’crs,  he  is  sas’ed.  But  when  it  remains  within  the  chest,  he  is  exposed  to  tedious  suppurations,  incurable  sores,  hectic,  wasting,  and  death;  and 
nothing  so  wearies  the  surgeon,  or  depresses  the  patient’s  hopes,  as  an  unceasing  flow  of  matter,  and  a fistulous  sore ; nor  can  anything  be  more  distress- 
ing to  the  surgeon  than  the  seeing  a patient  slipping  through  his  hands  (to  use  so  vulgar  a phrase),  more  especially’  if,  during  a lingering  distress,  he  has 
thought  it  necessary  to  sui^poii  the  friends  with  hopes  and  promises;  for  then  it  falls  peculiarly’  on  all  concerned, — on  the  surgeon,  who  has  suggested  or 
allowed  such  hopes,  as  well  as  on  those  who  have  permitted  themselves  to  be  thus  deceived.” 

3 Among  the  various  authorities  on  the  prognosi.s,  we  find  that  IlENNEN  (Mil.  Surg.  3d  od.  p.  391),  while  “unwilling  to  lull  cither  a patient  or  a 
surgeon  into  a false  security’,  or  to  underrate  the  real  dangers  <.'f  any’  case,”  has  “seen  many’  wounds  of  the  tliorax,  both  from  pike  and  sabre  thrusts, 
and  from  gunshot,  do  well  ultimately ; ” that  he  “cannot  but  hold  out  great  hopes  where  the  third  day’  has  been  safely’  got  over;  fur,  though  occasional 
hsemopty’sis  may’  come  on  at  almost  any’  period  during  a cure,  and  its  approach  can  neither  be  entirely’  prevented  nor  anticipated,  the  more  deadly 
hJEmorrhages  arc  usually  within  the  first  forty’-eight  hours  ; and  y’ct  to  this  alarming  symptom,  when  within  moderate  bounds,  the  safety’  of  the  sufferer 
is  often  due.”  This  guarded  statement  and  the  often-quoted  remark  of  Dr.  Gregory*,  of  Edinburgh,  that  of  twenty’-six  wounds  of  the  thorax  received  at 
the  battle  near  (Quebec,  two  only’  were  fatal,”  have  undoubtedly'  had  much  influence  with  jiractitioners  in  this  country’,  in  their  prognt)sis  of  chest  wounds, 
having  been  repeated  with  approval,  for  many  y’ears,  in  our  leading  medical  school,  by’  Professor  W.  Gibson.  Sir  Geouge  BallinGALL  taught 
(Outlines,  etc.,  5th  ed.)  that  “the  expanded  surface  of  the  thorax  renders  wounds  of  this  region  frequent  in  battle,  while  the  vital  importance  of  the 
organs  lodged  within  it  render  them  peculiarly  dangerous.”  GuTinilE  {Comm.  p.  4G2)  is  of  opinion  that  “gunshot  wounds  of  the  chest,  penetrating  the 


SiCCT.  IV.] 


DIAGNOSIS  AND  PROGNOSIS. 


611 


got  over;”  but  will  not  forget  that  Ilennen  had  to  deal  with  wounds  inflicted  by  the 
sword  and  pike  and  missile  of  the  “old  Brown  Bess,”  and  that  the  elongated  heavier  balls 
employed  in  modern  warfare  causes  injuries  more  deadly.  While  using  every  precaution 
to  arrest  inflammatory  complications  and  strictly  enjoining  low  diet  and  absolute  rest,  he 
will  not  anticipate  pleurisy  and  pneumonia  as  necessary  consequences,  or  indulge  in  prophy- 
lactic depletory  medication;  he  should  dread  effusions  more  than  inflammations.  If  he 
can  save  a third  of  the  patients  that  are  wounded  in  the  lung  he  may  esteem  himself 
happy,  and  the  survivors  thrice  fortunate. 

The  lamented  Tripler,  in  his  excellent  lecture  on  Wounds  of  the  Chesty  while  admit- 
ting that  the  signs  of  wounds  of  the  lung  are  singly  equivocal,  regrets  the  exceptions  taken 
by  Dr.  Fraser  to  the  generally  received  views  “as  calculated  to  do  injury  in  inexperienced 
hands,  by  unsettling  opinions  in  very  plain  cases,  thus  leading  to  indecision  in  practice 
and  uncertainty  in  diagnosis.”  It  is,  therefore,  proper  ^to  say  that  in  indicating  the 
uncertainty  of  individual  signs,  the  object  here  had  in  view  is  rather  the  encouragement 
of  the  inexperienced  in  the  careful  investigation  of  cases,  as  Dr.  Gerhard  was  wont  to  do, 
in  his  unsurpassed  clinical  instruction,  when  he  constantly  dwelt  upon  the  fallacy  of 
individual  symptoms  and-  exhorted  the  student  to  familiarize  himself  with  the  “whole 
case.”  It  may  further  be  proper  to  reiterate  that  a majority  of  the  signs  discussed,  when 
existing  in  conjunction,  may  establish  the  diagnosis  with  a precision  little  short  of 
certainty. 

I cite,  in  foot-note,  Samuel  Cooper’s  rules"  for  making  out  the  diagnosis  in  incised 
wounds  of  the  chest,  remarking  that  intra-pectoral  injections  are  not  now  considered  per- 
missible; and  a quaint  extract  from  the  oldest  work^  on  surgery  printed  in  English,  on  the 
means  of  determining  wounds  of  the  lung  by  the  passage  of  air.  I will  add  that  in  the 
latest  contributions  on  the  surgery  of  the  late  Franco-German  war,  the  influence  of*the 
size  of  projectiles  upon  the  fatality  of  shot  wounds  is  particularly  insisted  on,  and  the 
diminished  mortality  ascribed,  in  a measure,  to  the  small  bulk. of  the  chassepot  missile 
compared  with  the  large  conoidal  balls  used  in  most  muzzle-loading  arms.  And,  lastly, 
that  there  has  been  little  investigation  of  the  state  of  animal  temperature  in  cases  of  severe 
wounds,  and  that  aid  in  the  prognosis  of  chest  wounds  may  be  sought  in  careful  thermo- 
metric  observations. 

cavity,  are  always  exceedingly  dangerous.”  Mr.  G.  LawsOX  (Druitt  s Surgeon's  Vadc  Mecum^  10th  ed.,  1870,  p.  124)  says,  “the  prognosis  in  all  pene- 
trating wounds  of  the  chest  is  unfavorable,  particularly  if  the  ball  has  lodged.”  On  the  other  hand,  JOHN  Bell  declares  {Princiides  of  Surgery,  ed. 
1820,  Vol.  1,  p.  431,  and  Discourses  on  the  Nature  and  Cure  of  Wounds,  Part  II,  p.  3)  “a  wound  of  the  substance  of  the  lung  is  liir  from  being  mortal.” 
Among  German  authors,  RiCHTEii  {Anfangsgriinde  der  Wundarzneykunst,  Gottingen,  1800,  B.  IV,  S.  326)  says:  “Lung  wounds  arc  generally 
dangerous  on  account  of  the  fatal  loss  of  blood,  of  the  effusion  of  blood  into  the  cavity  of  the  chest,  or  of  pneumonia.”  Schwaktz,  H.  {Beitrdge  zur 
Lehre  von  den  Schusswunden,  Schleswig,  1854,  S.  114),  remarks:  “Die  Prognose  der  Brustwunden  mit  gleichzeitiger  Lungenverletzung  ist  ohne 
Ausnahme  eine  sehr  ungunstige.  * * * Sind  fremde  Korper,  als  Kugel,  Kleidungsstiicke,  Rippensplitter  in  der  Lunge  selbst  oder  auch  nur  im 
Pleura-Sack  geblieben,  so  ist  die  Prognose  urn  so  schlechter.”  Among  the  French,  the  opinions  of  Ravaton,  LaMotte,  and  others  have  been  cited. 
Vidal  says  (Traite  de  Path.  Ext.  et  de  Med.  Op.,  5dme  6d.,  T.  IV,  p.  71) : “ Wounds  of  the  lungs  are  certainly  dangerous ; but  if  compared  with  wounds 
of  other  viscera,  the  prognosis  will  appear  relatively  less  grave.  A wound  of  the  heart,  a wound  of  the  brain,  of  the  viscera  of  the  abdomen,  all  things 
being  otherwise  alike,  are  graver  than  wounds  of  the  lung.” 

^ Teipleii,  Handbook  for  the  Military  Surgeon,  Cincinnati,  1861,  Chapter  VI,  p.  74.  I have  not  often  referred  to  this  admirable  compendium, 
presuming  that  its  contents  are  as  “familiar  as  household  words”  to  Army  medical  officers. 

2 Cooper,  A Dictionary  of  Practical  Surgery,  1838,  Vol.  II,  p,  481 : 1.  Placing  the  wounded  person  in  the  same  posture  in  which  he  was  when 
he  received  the  wound,  and  then  carefully  examining,  with  the  finger  or  probe,  the  direction  and  depth  of  the  stab.  2.  The  examination,  if  possible,  of 
the  weapon,  so  as  to  see  how  much  of  it  is  stained  with  blood.  3.  The  injection  of  fluid  into  the  wound,  and  attention  to  whether  it  regurgitates  iinin(?di* 
ately  or  lodges  in  the  part.  4,  The  color  and  quantity  of  the  blood  discharged  from  the  wound  are  to  be  noticed,  and  whether  any  is  coughed  up.  5.  Wo 
are  to  examine  whether  air  escapes  from  the  wound  in  respiration ; and  whether  there  is  any  emphysema.  6.  Lastly,  the  state  of  the  pulse  and  breathing 
must  be  considered. 

3 In  Chapter  XLVIII,  “ Of  the  wounde  in  the  brest,”  in  the  English  version  of  Jiikrome  OF  BnVYXSWYKE’s  “ The  noble  expcryence  of  the  vertuous 
handywarkeof  surgeri,"  printed  “in  the  ycrc  of  our  lordc  God  MDXXV,  and  the  XXVI  day  of  Manflie  (reputed  the  first  work  <in  surgery  in  the 
English  language),  Hieronymus  says  “And  that  token  that  the  wounde  gothe  through  the  brest,  or  in  the  holncs  of  the  brest  is,  a.'*  the  wynde  coineth 
out  the  wounde,  princypaly  wlian  the  noso  and  the  mouth  is  stoppeth,  than  shall  yow  hage  a lytell  feder  on  a threde  afore  ye  woude,  is  the  woudp 
through  than  shall  meue  the  feder.” 

81 


642 


WOUNDS  AND  IN.IUDTES  OF  THE  CHEST. 


[CiiAr.  V, 


Treatment. — Besides  tlie  rules  that  govern  the  management  of  vrounds  and  injuries 
in  general,  the  local  and  constitutional  measures  that  are  especially  indicated  in  those  of 
the  chest,  in  their  several  suhdivisions,  are  here  to  be  considered. 

Local  Treatment. — To  secure  rest,  position  and  the  broad  chest  bandage  are  the  most 
generally  applicable  measures  in  injuries  of  the  thorax,  whether  attended  or  not  by  breach 
of  surface.  In  wounds,  after  stanching  the  bleeding,  cleansing  the  parts,  and  removing 
all  foreign  bodies,  the  further  conduct  of  the  surgeon  must  be  governed  by  the  extent 
and  nature  of  the  lesion.  All  superficial  wounds  should  be  closed,  with  a view  to  early 
adhesion.  In  extensive  incisions  and  lacerations,  it  will  be  proper  to  use  sutures  or 
serres-Jines ; but,  in  coughing  and  inadvertent  motions  of  the  patient,  they  often  tear  out; 
and,  usually,  simple  dressings^  will  suffice.  In  many  cases  of  penetrating  wounds,  surgeons 
preferred  to  support  the  injured  side  by  broad  strips  of  adhesive  plaster  made  to  encompass 
two-thirds  of  the  chest  and  fenestrated  at  the  wound.  This  was  considered  a very  secure 
dressing,  and  acceptable  to  the  patient.  A few  preferred  the  starch  bandage,  but  its 
application  was  not  always  convenient  in  the  field.  The  gypsum  bandage,  which  enjoys 
much  favor  among  the  Russian,^  Austrian,  and  some  North  German  military  surgeons,  was 
not  reported  to  have  been  used.  When  there  was  profuse  discharge,  the  compresses  were 
conveniently  covered  with  carded^oakum.^ 

In  profuse  primary  hgemorrhages,  it  was  always  customary  to  make  cold  applications 
to  the  chest,  ice  being  used  when  attainable.  Then,  if  the  bleeding  point  could  be  dis- 
covered, the  prudent  surgeon  did  not  rest  until  the  bleeding  was  arrested  by  the  ligature, 
or,  failing  in  this,  by  compression.  The  endeavor  to  find  and  secure  wounded  vessels, 
instead  of  plugging  the  wound  with  lint  and  Monsel’s  salt,  was  a distinction  between 
skilful  and  heedless  surgery.  When  it  was  impossible  to  reach  the  source  of  the  internal 
bleeding,  it  was  considered  best  to  close  the  wound  and  to  promote  the  occlusion  of  the 
bleeding  vessels  l^y  general  means.  In  connection  with  hsemothorax,  hermetically  sealing, 
wounds  of  arteries,  and  operations,  the  circumstances  that  should  decide  whether  the  wound 
should  be  left  open  or  closed  have  been  fully  discussed.  The  treatment  of  effusions  by 
thoracentesis  or  incisions,  the  management  of  foreign  bodies  and  of  fractures,  and  the 
dilatations  and  excisions  they  sometimes  necessitate,  have  also  been  considered  at  length. 
Stabs  were  not  very  common,  as  has  been  seen,  and  no  instance  of  the  use  of  suction  or 
the  “secret  dressing”^  is  mentioned  in  the  reports.  Whatever  else  pertains  to  the  local 
treatment  has  been  adverted  to  incidentally  in  connection  with  the  complications  or  in 
details  of  individual  cases. 

General  Treatment. — The  uncomplicated  non-penetrating  wounds  of  the  chest  require 
no  exceptional  measures  beyond  a judicious  restriction  of  the  diet  and  the  means  necessary 
to  ensure  rest.  Contusions  and  concussions,  with  internal  injuries,  may  call  for  active 

^ What  is  understood  by  “simple  dressing' ’’  in  the  I'nitcd  States  service,  is  the  approximation  of  the  wound  hy  adhesive  strips,  covered  by  a 
compress  spread  with  cerate,  or  saturated  with  water,  and  supported  by  a light  bandage,  with  oiled  silk  interpesed  if  water  dressing  is  used.  Antiseptic 
dressings  and  carbolized  ligatures  did  not  conic  into  use  until  after  the  war. 

2 PiROGOFF  der  AUgcme.incn  Kriegsehirurgie,  Leipzig,  1864,  S.  537)  writes;  “Had  there  been  more  time  and  a sufficient  supply  of 

gypsum,  1 should  have  ordered  the  gypsum  bandage  to  be  used  much  more  frequently  in  complicated  gunshot  fractures  of  the  ribs.  Unfortunately,  I had 
toreseiTC  our  gypsum  supply  solely  for  comminuted  fractures  of  the  extremities.  But  in  several  severe  cases  of  gunshot  fractures  of  the  ribs  the  gypsum 
bandage  was  applied  with  excellent  results. *  * * * i advise  the  young  surgeon  to  bestow  more  time  and  zeal  upon  the  proper  application  of  this 
bandage,  than  upon  the  extraction  of  Iragments  of  bone  or  wedged-in  missiles.”  JS’EUDORFEli  {Handhuch  dcr  Kriegschirurgie,  Leipzig,  1807,  Zweite 
Hiilfte,  S.  002)  says;  “It  is  therefore  necessary  to  prevent  tlie  voluntary  or  involuntary  large  expansion  of  the  chest  wall,  and  that  can  onl^'-  bo  done 
by  a suitable  gypsum  bandage.” 

* This  was  a favorite  dressing  in  all  freely  suppurating  wounds.  The  tarry  odor  masked  foul  smells,  and  the  fibres  of  the  oakum  were  light  and 
absorbed  well.  According  to  Mr.  Pollock  {London  Lancet,  Januarj",  1870)  its  advantages  arc  appreciated  in  LnglancL 

^ Consult  Axel,  L AH  de  aucer  Ics plaics,  sans  h servir  de  la  boiiche  d'u7i  homnic,  Amsterdam.  1707;  Lldwig,  De  Suctione  vulncrum  Pectoris^ 
Lipsim.  1768 ; LA  IVIOriE,  Traite  complei  de  cUirurgie,  1832,  Vol.  HI,  p.  20 ; J.  Bell,  Discourses  on  Woioids,  179.'),  P.nrt  IT,  p.  52. 


Sect.  IV.] 


GENEEAL  TEEATMENT. 


G43 


restorative  treatment ; but  the  main  interest  in  this  subject  centres  in  the  questions 
whether,  in  penetrating  wounds,  venesection  shall  be  practiced  to  avert  haemorrhage,  or  to 
arrest  or  subdue  inflammation  ? There  were  no  doubts  on  the  subject  until  recently.  The 
common  voice  of  the  profession  sanctioned  the  paradox  that  bleeding  was  the  surest  means 
of  arresting  internal  haemorrhage,  and  concurred  in  placing  venesection  foremost  among 
the  remedies  for  inflammation.  Long  after  the  investigations  of  medical  pathologists  had 
undermined  the  foundations  of  the  theory  of  bleeding  for  inflammation,  the  doctrine  that 
venesection  was  indispensable  in  the  treatment  of  wounds  of  the  chest  held  its  ground. 

Thou2;h  there  are  in  the  writing's  of  John  Hunter  and  John  Bell  some  evidences  of 
misgivings  as  to  the  necessity  of  the  heroic  depleting  measures  long  practiced  in  cases  of 
penetrating  wounds  of  the  chest,  I agree  with  Dr.  Ashhurst,  that  the  credit  of  the  first 
formal  protest  against  the  common  practice  of  venesection  in  these  cases  is  due  to  Dr. 
Patrick  Fraser,  whose  interesting  monograph,  giving  the  results  of  his  extended  personal 
observation  during  the  Crimean  War,  I have  repeatedly  quoted.  It  was  published  in 
1859,  when  it  required  no  little  courage  to  oppose  the  prevalent  practice,  described  by 
Ballingall,  at, the  military  medical  school  at  Edinburgh,  in  1855,  as  that  “ which  every 
sensible  writer  on  this  subject  has  taught  and  every  experienced  practitioner  has  adopted;  ” 
and  Mr.  Guthrie  was  alive,  to  castigate  the  cautious  or  recalcitrant  medical  officer  who 
dared  to  question  the  teachings  of  the  Peninsular  campaign.  Favored  by  the  wide-spread 
distrust  in  the  efficacy  of  depleting  measures  in  inflammation.  Dr.  Fraser’s  views  received 
much  consideration,  and  their  correctness  in  the  main  was  conceded  by  several  of  the 
leading  British  military  surgeons,  particularly  by  Dr.  Matthew,^  Mr.  Lawson,^  and  Mr. 
Blenkins.^  Dr.  Macleod  and  Mr.  Ganf^  opposed  the  salutary  change  in  practice,  the  former 
announcing  in  contradiction  of  the  official  annalist,  that,  in  the  Crimea,  “ it  was  very 
generally  observed  that  those  cases  did  best  in  which  early,  active,  and  repeated  bleedings 
were  had  recourse  to,”  and  the  latter  being  “ in  favor  of  decided,  and,  as  it  may  be  termed, 
knock-down  blood-letting.”  But,  as  the  facts  adduced  by  the  former  did  not  sustain  his 

— 5 

^ Dr.  Matthew  did  not  concede  the  utility'  of  venesection  in  hsem<;rrhagc,  but  admitted  that  its  value  in  traumatic  inflainmati!  n ^vas  overestimated: 
“Supposing  the  first  danger  of  death  by  excessive  loss  of  blood  not  to  have  arisen,  in  consequence  of  no  large  vessel  having  been  wounded,  or 
this  danger  to  have  passed  over,  the  means  adopted  by  nature  to  repair  the  mischief  appear  to  be  the  exudation  of  plastic  material  glueing  the  various 
parts  involved  in  the  injury  together,  and  thus  isolating  them ; and  the  more  effectually  and  perfectly  she  does  this,  the  greater  is  the  chance  of  safety 
to  the  patient ; and,  as  before  stated,  in  discussing  the  subject  of  wounds  of  the  head  we  believe  venesection  (for  any  other  purp«;se  than  that  of  a styptic, 
as  pointed  out  above)  to  be  not  only  useless,  but  positively  and  actively  injurious,  as  tending  to  prevent  or  render  less  perfect  tlic  adhesive  process. 
The  doctrine  of  the  older  surgeons,  that  adhesion  depended  upon  a less  degree  or  smaller  amount  of  the  same  process  which  pn.diu^cs  pus,  and  that  as 
inflammation  was  almost  certain  to  follow’  these  injuries,  prophylactic  bleedings,  to  as  great  an  extent  as  could  he  borne  with  safety  to  life,  should  be 
employed  as  tending  to  limit  the  inflammation  to  the  le.ss  degree,  or  the  adhesive  stage,  seems  in-t  at  all  tenable  in  the  present  day.  Adhesion  and  pus 
formation  seerfi  to  depend  upon  two  essentially  different  processes,  although  the  tenn  inflammation  has  been  applied  to  both;  and  although  we  are  at 
present  not  fully  acquainted  with  the  nature  of  the  difference,  the  opinion  apiicars  to  be  daily  gaining  ground  that  the  too  early  abstraction  of  large 
quantities  of  blood  favors  the  latter,  while  there  can  be  little  question  that  it  impedes  the  fonner  process.  AVc  are,  however,  b}’  no  means  prepared  to 
state  that  exceptional  cases  of  plethora,  in  which  such  prciphjdactic  venesection  may  be  beneficial,  .do  not  occasionally  occur;  but  they  ai'pear  to  be 
rare,  and  indeed  are  not  likely  to  exist  among  soldiers  on  active  field-seivuce.  Practical  experience  also,  to  which  all  theorcth'al  opinions  must  give 
way’,  seems,  during  the  late  war,  to  point  in  this  direction,  and  to  do  so  independent  of,  and  making  allowance  for,  the  cachectic  .state  before  alludt'd  t*q 
into  which  the  bulk  of  the  army  had  at  one  time  fallen.” 

2 LaWSOX,  G.  {On  Gunshot  Hounds  of  the  Thorax),  gave  his  opinion  that  bleeding  in  these  injuries  is  not  called  fi.r  as  rccianmendcd  by  Guthrie 
Hennen,  and  tjie  older  army  surgeons,  and  certainly  w’as  not  applicable  to  the  cases  occurrihg  in  the  Crimea. 

3 Ble.nkin'S.  Article — Gunshot  ^V(y^^nds,  in  the  8th  edition  of  Cooper's  Dictionary  of  Practical  Surgery,  London,  ISfil. 

■*  Maclkod,  Notes  on  the  Surgery  of  the  War  in  the  Crimea,  Churchill,  1858,  p.  237 ; Gant,  Tiie  Science  aiul  Practice  of  Surgery,  Churchill,  1871, 
p.  885.  I say  that  Dr.  Macleod’s  facts  do  n</t  support  his  conclusions,  because,  though  he  reports  eight  recoveries  in  thirteen  cases  (jf  shot  wounds  of  the 
chest,  it  is  not  at  all  clear  that  the  eight  recoveries  were  complete,  or  that  they  were  all  from  penetrating  wounds,  or  that  the  bleedings  practiced  were  of 
benefit,  and  because  what  he  thought  was  generally  observed,  was  denied  by  others,  who  had  equal  or  greater  opportunities  fur  observation.  Of  fifty- 
one  of  the  Crimean  cases  of  chest  wounds,  carefully  analyzed  by  Drs.  Matthew  and  Fraser,  free  venesection  was  employed  in  seven, — in  six  of  thirty  fatal 
cases,  and  in  one  of  twenty'-one  cases  of  recovery.  liow  lamely  Dr.  Maelecd’s  facts  support  his  conclusions  is  illustrated  by  tlie  cases  reported  by  him 
on  page  241.  a fatal  case  of  haemothorax  without  pneumonia,  largely  bled,  and  on  page  247,  “a  soldier  of  the  Huffs.  * * lie  was  largely  bled,  ujul  his 
symptoms  thereby  relieved.  Ten  hours  afteivvard  a return  <jf  the  difficulty  of  breathing  called  for  further  depletion  and  the  use  <jf  antimony.  Pneumonia 
followed V'  Mr.  Gant's  work  has  not  been  reprinted  in  this  country,  and  it  is  unnecessaiy  to  examine  the  results  of  liis  expcricmcc  at  Scutari.  'JTic  cases 
cited  by  Mr.  HOLE  {British  Medical  Journal,  August  7,  1858)  and  ^Ir.  MaCKAY  {Edinburgh  Medical  Journal,  Vol.  I,  p.  1)24)  in  laudation  of  venesectij.n, 
are  their  own  best  niiswer. 


WOUNnS  AND  IN.IITIIIKS  (Jl'’  TirH  CTT1':ST. 


[('n.\r.  V, 


(U1 

conclusions,  and  as  jn’actitioners  generally  were  inclining  to  the  opinion  tliat  it  was  belter 
for  tlieir  patients  to  be  set  np  than  to  bo  knocked  down,  tliesc  adverse  opinions  had  little 
influence. 

Opinions  had  also  undergone  a great  change  in  this  country,  and,  at  an  early  period 
of  the  A¥ar  of  the  Rebellion,  the  compilers  of  the  Confederate  surgical  Manual^  used  the 
following  emphatic  language  on  the  subject : 

“ Equally  impliilosophical  and  more  injuiious,  in  our  opinion,  than  even  the  use  of  the  last 
class  of  sedatives,  is  the  time-honored  absurdity  of  venesection.  It  conies  to  us  embalmed  in  the 
dicta  of  ‘ the  highest  authority,’  and  consecrated  by  the  owlish  wisdom  of  ‘ the  ancients,’  and,  until 
recently,  the  precept  has  met  with  submissive  and  unquestioning  acquiescence.  We  are  gratified 
to  find  that,  in  all  the  cases  of  arterial  hmmorrhage  collected  in  the  office  of  the  inspector,  not  one 
is  reported  wherein  the  expedient  was  practiced  by  a surgeon  of  the  Confederate  States.  The 
measure  is  one  which  has  doubtless  been  transferred  from  civil  practice,  where  it  has  been  found 
of  the  greatest  value,  but  in  a very  different  kind  of  hajmorrhage  from  that  to  which  some  military 
surgeons  have  sought  to  apply  it.  It  is  the  great  reliance — the  sheet-anchor — in  the  spontaneous 
hajmorrhages  resulting  from  general  plethora  or  local  visceral  engorgements.  For  these  too  much 
cannot  be  said  in  its  praise.  But  for  traiimaiic  pulmonary  hemorrhages,  the  measure  appears  to 
us  not  only  hazardous,  but  actually  injurious.  All  the  circumstances  are  different — the  cause  of 
the  bleeding  entirely  dissimilar — and  hence  the  result  of  the  remedy  is,  doubtless,  often  fatally 
adverse  to  the  ill-founded  expectation  ou  which  it  was  applied.  Exotics,  however  vigorous,  seldom 
continue  to  thrive.  So  have  we  found  that  the  traditions  of  civil  practice,  however  reliable,  will 
not  always  answer  as,  principles  of  military  surgery.” 

In  a report^  to  the  Surgeon  General,  published  and  circulated  immediately  upon  the 
conclusion  of  the  war,  I observed  that : 

“ In  the  treatment  of  penetrating  wounds  of  the  chest,  venesection  appears  to  have  been 
abandoned  altogether.  Uaemorrhage  was  treated  by  the  application  of  cold,  perfect  rest,  and  the 
administration  of  opium.  These  measures  seem  to  have  proved  adequate  generally.” 

This  statement  has  been  fully  corroborated  by  a more  extended  and  careful  examina- 
tion of  the  returns.  I can  learn  of  but  five  instances  of  venesection  after  chest  wounds, 
practiced  during  the  war,  four  observed  in  the  Union  and  one  in  the  Confedoi’ate  hospitals.^ 
Twice  bleeding  was  practiced,  by  direction  of  Surgeon  T.  Antisell,  U.  S.  V.,  in  cases  of 

traumatic  pneumonia,  that  terminated  fatally  (cases  of  A.  G , p.  483,  and  McClay, 

p.  550).  Three  patients,  all  of  whom  recovered,  were  bled  for  the  arrest  of  primary  profuse 
hmmoptysis.  The  cases  of  Kuhn  and  Ocjleshy'^  have  been  recorded  (pp.  479,  484).  The 
following  is  an  abstract  of  the  third  case  : 

Case. — Private  Eicliard  D.  Phelps,  Co.  E,  25tli  Ohio  Volunteers,  aged  19  years,  was  wounded  at  Gettysburg,  .July  1st, 
1863,  by  a fragment  of  shell,  which  entered  one  inch  above  and  just  to  the  inside  of  the  right  .axilla,  fractured  the  third  rib,  and 
passed  into  the  lung.  He  was  treated  in  the  hospital  of  the  11th  Corps,  Surgeon  Eobert  Thoinaine,  29th  New  York  Volunteers, 
in  charge,  until  the  11th,  when  he  was  transferred  to  S.attorlee  Hospital,  Philadelphia.  The  patient  st.ated  that  on  the  reception 
of  the  injury  he  hied  so  profusely  that  the  vein  of  the  left  arm  was  opened,  with  the  effect  of  soon  checking  the  internal  hsemor- 
rhages.  He  spat  up  blood,  however,  until  the  10th,  hut  no  secondary  haimorrhage  set  in.  His  strength  was  almost  exhausted, 
hut  he  gained  daily.  Cold-water  dressings  were  apjjlied.  When  admitted  to  Satterlee  Hospital,  the  wound,  which  was  .about  an 
inch  in  length,  was  nearly  healed.  The  probe  was  soon  arrested,  the  track  having  closed  centrally,  but  the  direction  of  the 
wound  was  downward  and  forward.  There  was  but  slight  discharge  and  no  expectoration.  The  lung,  on  percussion_  and 
auscultation,  revealed  dulness  and  bronchial  respiration  oyer  the  central  three-fourths,  with  no  respiration  over  the  point  of 
wound.  Expectorants,  extra  diet,  and  rest  were  ordered,  and  cold-water  dressings  applied  to  the  wound.  The  case  progressed 

* A Manual  of  Military  Surgery,  prepared  for  the  use  of  the  Confederate  States  Army,  page  97,  Richmond,  18C3. 

^ Circular  No.  G,  S.  G.  O.,  18fi5,  page  21. 

* See  remarks  of  Surgeon  C.  S.  Wood,  CCtb  New  York  Volunteers  (.Vl’l’EXmx,  p.  £8). 

■t  Tliis  is  very  probably  tlie  solitary  case  of  venesection  in  chest  wounds  mentioned  by  Drs.  Thom  and  Chisolm.  See  p.  607,  ante,  Note. 

® Neudokfer  (Handbuch  der  Kriegsehirurgie,  Zweite  Iiaifte,  S.  605,  in  1867),  after  liis  experience  in  the  Italian  wars  and  the  Mexican  invasion, 
writes;  "We  would,  therefore,  banish  venesection  from  the  treatment  of  gunshot  chest  wounds  not  onl^  as  an  antiphlogistic  or  curative,  but  as  a pro- 
phylactic measure ; and  even  as  an  hmmr.static  means,  we  cannot  admit  its  value ; as  A'cnesection,  aside  from  its  uncertainty  in  i.reventing  internal  bleeding, 
reduces  the  tone  of  the  wounded  man  and  endangers  his  life." 


Sect.  IV.] 


GEXKRAL  TREATMENT. 


645 


favorably,  and  by  July  18th  the  patient’s  general  health  was  hotter;  he  suffered  sliglit  pain  in  the  chest  a little  below  the  wound. 
On  August  1st,  he  was  transferred  to  the  hosiiital  at  Cainj)  Dennison,  Ohio,  at  which  time  tlu'  dulness  had  entirely  disappeared, 
and  he  was  doing  capitally,  with  every  prospect  of  complete  recovery.  Phelps  was  returiuKl  to  duty  on  Scptcmb(,‘r  22d,  1863  ; 
ho  is  not  a pensioner.  The  case  is  reported  by  Acting  Assistant  Surgeon  W.  W.  Keen,  jr. 

Dr.  Cliisolm  {op.  cit.,  p.  329)  deprecates  venesection  in  cliest  wounds,  and  gives  an’ 
outline  of  the  general  treatment  employed  by  the  Confederate  military  surgeons  : 

“Where  the  heart  and  pulse  are  both  weak — a comiiiou  condition  after  severe  wounds — in 
our  experience  the  abstraction  of  blood  will  occasion  a complete  prostration  of  strength,  and  may 
be  fatal.  There  is  no  reason  for  changing  the  plan  of  treatment  already  discussed  in  detail,  for 
combating  inflammation  following  gunshot  wounds,  and  which  is  equally  applTcable  to  chest  wounds. 
Even  when  the  lung  is  inflamed,  we  prefer  the  mild  antiphlogistic  and  expectant  treatment  to  the 
spoliative.  The  large  success  in  the  treatment  of  perforating  chest  wounds  in  the  Confederate 
hospitals  puts  forth,  in  a strong  light,  the  i)owers  of  nature  to  heal  all  wounds  when  least  interfered 
with  by  meddlesome  surgery.  Absolute  rest,  cooling  beverages,  moderate  nourishment,  avoiding 
over  stimulation,  with  small  doses  of  tartar  emetic,  veratrum,  or  digitalis,  the  liberal  use  of  opium, 
and  attention  to  the  intestinal  secretions,  will  be  required  in  all  cases,  and  in  most  will  compose 
the  entire  treatment.” 

Dr.  Asbburst^  testifies  that,  in  civil  practice,  he  “lias  found  no  reason  to  adopt  a 
different  mode  of  treatment  from  that  which  has  proved  successful  in  the  surgery  of 
war.”  It  may  be  regarded  as  generally  admitted  that  venesection  is  unnecessary  in 
penetrating  wounds  of  the  chest,  and  that  it  may  be  very  harmful,  and  that  the  “draining 
of  the  system  of  blood,”  commended  by  Bell,  Hennen,  Guthrie,  and  Cooper,  is  to  be 
numbered  with  the  errors  of  the  past.~ 

Of  the  pharmaceutical  preparations  employed  in  the  general  treatment  of  the  wounds 
of  the  chest,  discussed  in  this  chapter,  opium,  calomel,  antimony,  veratrum  viride,  aconite, 
digitalis,  hyoscyamus,  acetate  of  lead,  gallic  acid,  saline  and  other  purgatives,  hydrochlorate 
of  ammonia,  mineral  acids  and  salts  of  cjuinia,  and  epispasfics,  are  prominently  noticed. 

Opiu7n.— This  medicine  merits  the  first  place  among  these  remedies.’^  It  was  used 
almost  universally  in  all  cases  of  severe  wounds,  and  was  found  peculiarly  useful  in  pene- 
trating wounds  of  the  chest,  in  quieting  the  nervous  system,  and,  indirectly,  in  moderating 
hoemorrhage.  When  used  with  discretion,  there  can  be  no  question  of  its  great  utility.  The 
inexperienced  practitioner  should  not  forget  that  its  effects  upon  the  system  are  augmented 

1 Ashhukst,  I^rinc.  and  Prac.  of  Surg.,  Pliil.,  1871,  p.  399.  lu  his  additions  to  Mr.  Erichseu's  Science  and  Art  of  Surgery,  Am.  cd.  1SG9,  p.  399, 
Dr.  Ashhurst  remarks : “ The  treatment  -which  the  author  very  fairly  acknowledges  to  have  been  found  most  successful  by  military  surgeons  of  the  present 
day,  I have  found  equally  satisfactory  in  cases  of  penetrating  wound  of  the  chest,  met  with  in  civil  practice.  In  the  later  stages,  also,  the  restorative 
treatment,  which  is  now  almost  universally  adopted  in  cases  of  idiopathic  pneumonia,  will  generally  be  found  equally  etlicient,  in  those  of  a traumatic 
origin.  Perfect  rest,  quiet,  the  administration  of'opium,  with  plenty  of  milk,  beef-tea,  and  even  brandy,  if  necessary,  seem  to  me,  in  such  cases,  more 
truly  antiphlogistic  than  either  bleeding,  antimony,  calomel,  or  barley-water.” 

* Fischer,  K.  {Militairdrztliche  Skizzen  aus  Siiddcutschland  und  Bohmen,  Aarau,  1807,  p.  01),  thus  describes  the  expectant  policy  pursued  in  the 
Swiss  Ambulance  in  the  Bohemian  war  of  1800 : lie  states  that  he  had  accurate  notes  of  forty-five  cases  of  penetrating  shot  wounds  of  the  chest.  'I'wcnty- 
one  recovered  and  twenty-four  died,  or  were  likely  to  die,  at  the  date  of  the  report,  or  .54  per  cent.  “The  search  for  balls  and  fragments  of  ribs  was 
always  cautiously  made,  and  without  aggressive  manipulation  or  opei-ation.  Even  the  incised  wounds  were  not  closed  by  sutures,  but  care  was  taken  to 
assist  the  exit  of  pus  by  a suitable  position  of  the  patient.  Neither  general  nor  local  bleeding  was  resorted  to ; no  thoracentesis  or  drainage  was  employed ; 
neither  emetic  nor  laxative  prescribed;  but  rest,  well  ventilated  rooms,  and  nourishing  food,  with  simple  dressing  of  the  wound,  wore  provided.”  Dr. 
Fisher  regards  the  results  as  contrasting  very  favorably  witlx  the  results  he  witnessed  in  the  Italian  war  of  1850,  when  venesection  and  antimonials  were 
freely  used.  In  relation  to  the  removal  of  foreign  bodies,  NeudoiIFER  {Ilandbach  der  Kriegschirurgic,  /Cweitc  Iliilfte,  Eeipsig,  1807,  S.  590)  observes: 

“ As  desirable  as  it  is  to  remove  all  foreign  bodies  from  the  lung,  it  must  be  remarked,  that  their  presence  in  the  lung  is  less  injurious  than  in  tlie  pleural 
cavity.  In  the  lung  they  are  more  rcadil}'  euc^-sted.  ^Missiles  have  been  found  in  tlie  lung  that  had  remained  there  for  twenty  or  thirty  years  without 
causing  much  inconvenience,  and  such  cases  would  be  more  frequent  if  the  wounded  did  not  so  often  perish  from  the  opening  of  the  pleural  cavity.  But 
lierc  a discrimination  among  the  different  foreign  bodies  must  be  made.  A leaden  missile,  a fragment  of  shell,  a piece  of  stone,  can  bo  encysted  in  tho 
lung;  but  all  foreign  bodies  liable  to  decomposition,  such  as  wood  and  bone  splinters,  pieces  of  cotton,  linen,  and  cloth,  will  never  become  encysted.” 
SOCIX,  A.  (Kriegsehirurgische  Erfahrungen  gesamnielt  in  Carlsruhe,  1870  and  1871,  Leipzig,  1872,  S.  86) : “Tho  result  of  a largo  number  of  cases  cited 
proves  that  in  penetrating  gunshot  wounds,  where  the  lung  is  not  at  all  or  only  supoiTicially  injured,  or  perforated  in  its  long  diameter,  an  entirely 
expectant  treatment  can  prove  successful.  Where  the  entrance  wound  in  the  thorax  wall  does  not  remain  open,  but  closes  immediately  after  the  pas.sagc 
of  the  ball,  pneumothorax  does  not  appear,  a proof  that,  where  the  latter  exists,  it  was  caused  by  tlic  influx  of  tho  outer  air  into  the  pleural  cavity,  and 
very  rarely  by  the  egress  of  the  air  in  the  lung.” *  * 

^NeudoRFF.II  (Ilandhuch  der  Kriegsehirurgie,  JjCrgzig,  18C7,  Zweites  Heft.  Zweitc  S.  607)  remarks:  “Of  the  phannaceutio  means 

employed  in  injuries  of  the  chest,  opium  undoubtedly  oociipics  tlie  first  place.  1 have  previously  shown  the  beneficial  elfect  of  ojnum  after  any  injury  or 
operation.  a.s  it  miKloratcs  the  reaction  following  each  aggres.sion,  and  diminishes  the  interruptioxi  of  tlie  nervous  ccpiilibriiim.  But  in  cases  ol  injuries  of 
the  chest  as  well  as  of  the  abdomen,  it  is  to  be  considered  as  possessing  specific  powers,  not  to  be  replaced  by  any  narcotic  whatever.” 


(>1(5 


■\VOUi\J)S  ANP  INJURIES  OF  THE  CHEST. 


[('IIAI'.  V, 


after  profuse  loss  of  blood,  and  will  be  guarded  in  its  administration  under  such  circum- 
stances. hledical  Director  Ilewit  found  great  advantage  in  introducing  the  salts  of  morphia 
by  dusting  them  and  rubbing  them  in  upon  the  surface  of  wounds,  and  this  practice  was 
frequently  adopted  by  the  surgeons  under  his  direction,  and  was  reported  to  allay  local  pain 
very  promptl}^.  The  hypodermic  method  was  also  frequently  employed.  I think  Dr. 
Squibb  is  right  in  pronouncing  pure  opium,  in  substance,  more  reliable  than  any  preparation. 

Calomel. — On  account  of  their  supposed  control  over  inflammatory  processes,  mer- 
curial preparations  were  much  employed  in  traumatic  pleuritis  and  pneumonia.  They  may 
be  requisite  in  combating  the  tendency  to  exudations  in  carditis,  and  with  a view  to  promote 
the  absorption  of  serous  effusions  in  the  pleural  cavity.  But  the  estimate  of  their  efficacy 
in  the  earlier  stages  of  inflammation  following  penetrating  wounds  of  the  chest  has  steadily 
declined  of  late  years,  and  probably  has  not  yet  reached  its  proper  level.  Mr.  Wharton^ 
has  ably  directed  attention  to  the  fact  that  sufficient  importance  has  not  been  paid,  in  the 
treatment  of  these  lesions,  to  the  necessity  of  maintaining  the  blood  in  such  a condition  as 
to  favor  its  coagulability,  on  which  the  natural  reparative  process  depends,  and  that  great 
caution  should  therefore  be  exercised  in  administering  aiiy  drug  likely  to  appreciably 
diminish  the  normal  proportion  of  fibrin." 

Antimonials. — Tartrate  of  antimony  and  potash^  was  employed  to  a limited  extent 
to  reduce  the  force  of  the  circulation,  and  aid  in  the  suppression  of  hsemorrhage,  and  also 
to  combat  consecutive  inflammations.  But  this  remedy  shared  in  the  discredit  into  which 
venesection  had  fallen,  and  was  little  relied  on  by  Union  or  Confederate  surgeons. 

Veratrum  UirffZe.— The  rhizome  of  the  American  hellebore  or  Indian  poke,  })repared 
as  a tincture,  was  sufficiently  valued  to  be  admitted  and  retained  on  the  Army  Supply 
Table.  “ For  controlling  the  circulation,  liberal  use,”  Professor  Gross ^ teaches,  “ should  be 
madd  of  veratrum  viride,  its  effects  being  carefully  watched,  lest  too  much  cardiac  depres- 
sion should  arise.”  The  favorable  estimate  of  its  utility  in  traumatic  pneumonia  entertained 
by  Surgeon  Woods,  is  recorded  on  page  620.  It  was  much  esteemed  by  other  experienced 
surgeons.  I believe  that  any  good  results  to  be  obtained  from  it,  may  be  arrived  at  with 
greater  certainty  and  safety  by  using  antimonials  combined  with  narcotics.® 

Aconite. — Pharmacologists  reckon  this  arterial  sedative  as  useful  in  active  haemorrhage 
and  in  inflammations,  and  it  appears  to  have  been,  with  a few  surgeons,  a favorite  remedy 
in  some  of  the  complications  attending  wounds  of  the  chest.®  - 

* Wharton.  Two  Cases  of  Penetrating  Wounds  of  the  Chest.  Dublin  Quar.  Jour,  of  Med.  Sci.,  Vol.  XL,  18C5,  p.  111.  The  author  regrets  that 
in  the  management  of  one  of  the  cases  he  had  recourse  to  the  exhibition  of  mercury,  even  to  a limited  extent. 

2 By  Surgeon  General  IIammoND's  Circular  No.  G,  S.  G.  O.,  May  4th,  i8G3,  calomel  and  tartar  emetic  were  directed  to  be  stricken  from  the  Army 
Supply  Table,  on  the  ground  tliat  ‘‘no  doubt  can  exist  that  more  harm  has  resulted  from  the  misuse  of  both  these  agents,  than  benefit  from  their  proper 
administration.”  Both  resumed  their  places  in  the  Standard  Supply  Table  promulgated  in  Circular  No.  6,  S.  G.  O.,  l^Iay  0th,  18G7. 

3 ‘‘It  is  but  rarely  that  the  sedation  produced  by  nauseants,  such  as  antimony  and  ipecac,  can  be  of  judicious  application  in  a case  of  profuse  traumatic 
liffimoryhagc,  threatening  a fatal  termination.  Such  remedies  depress  the  vital  powers  too  decidedly,  and  yet  often  fail  to  arrest  the  sanguineous  flow. 
Antimonial  preparations  are  often  injurious,  if  long  continued,  by  their  disorganizing  effect  on  the  blood.” — Manual  of  Mil.  Sur.  for  the  use  of  the  Con- 
federate States  Army,  Richmond,  1863,  p.  97.  DemME,  reviewing  the  therapeutic  management  of  chest  wounds  after  the  Italian  War  of  1859,  remarks 
{Militdr-chirurgischc  Studien  in  den  Jtalienischen  Lazarethen  von  18.59,  Wurzburg,  1861,  B.  II,  S.  114):  “I  cannot  sufficiently  caution  the  army  surgeon 
against  the  routine  treatment  by  tartarized  antimon}’’  in  the  majority  of  cases..  It  must  not  be  forgotten  that  our  cases  are  entirely  different  from  those  of 
the  medical  practitioner  in  diseases  of  the  chest.  When  it  is  necessary  to  reduce  arterial  action,  digitalis  or  veratria  should  be  used.” 

* Gross,  A Sgstem  of  Surgery,  1872,  Vol.  II.  p.  447.  Refer  also  to  Professor  GEORGE  B.  WOOD  {A  Treatise  on  Therapeutics  and  Pharmacology^ 
Philadelphia,  1868,  Vol.  II,  p.  1.53) ; Professor  WILLIAM  Tully  (J/aZerta  J/edfea  or  PZiarmacofo/;?/  and  JherapcuiicSt  Springfield,  1858,  Vol.  I,  Part  II, 
p.  927).  See  Surgeon  Crosry’b  remarks  (Aitendix,  p.  1 1),  and  those  of  Surgeon  PllELl’S  (Appe.sdix,  p.  262) ; PERCY  {Trans.  Am.  Med.  Assoc..,  1864) ; 
Bullock  (Am.  Jour,  of  Pharm.,  Vol.  XXIX,  p.  204,  and  March,  18GG,  p.  98) ; NORWOOD,  Va.  Med.  and  Sarg.  Jour.,  Vol.  I,  p.  198. 

® Pharmacologists  arc  not  agreed  as  to  the  number  or  physiological  effects  of  the  alkaloids  in  veratrum  viride.  I have  often  obseiwed  the  effects  of 
the  administration  of  this  remedy  in  cases  of  pneumonia,  in  the  practice  of  Professor  Tally,  who  intr-  duced  the  remedy,  and  in  the  practice  of  his 
disciples,  and  thus  became  convinced  of  its  uncertainty,  and  liability  to  produce,  in  large  doses,  toSric  effects  analogous  to  those  caused  by  tobacco. 

See  Pereira,  The  Elements  of  Materia- Medica  and  Therapeutic.^,  3d  Am.  ed.,  1854,  Vol.  11,  p.  1085,  and  Kdinh.  Journ.  of  Mat.  and  Gtogr.  Sci., 
July,  18G0,  p.  235,  and  FLEMING,  An  Inquiry  into  the  Medicinal  Properties  of  the  Acotiitum  Napcllus.  1 knew  of  two  instances  of  fatal  poisoning  of 
officers,  through  mistakes  in  dispensing  the  strong  liucturc  of  aconite  at  the  field  dispensaries.  See  ORFILA,  Traitc  dc  Toxicologic,  5t.ine  cd.,  1852. 


Sect.  IV.] 


GE'S'EllAL  TKEATMEA’T. 


G47 


Digitalis. — This  medicine,  usually  in  the  form  of  alcoholic  extract,  was  often 
employed;  hut  did  not  obtain  that  general  confidence  which  is  placed  in  its  remedial 
powers  by  the  Russian  military  surgeons.  It  was  used  as  a succedaneum.  Surgeons 
generally  did  not  accept  Dr.  Fuller’s  views  as  to  its  physiological  action,  and  followed  the 
precepts  of  our  eminent  teacher.  Professor  AVood,  in  its  therapeutical  ap])lications.' 

Hyoscyamus  was  occasionally  used  as  a substitute  or  adjuvant  to  opium,  oi’,  in  com- 
bination with  colo^mth,  in  purgative  pills.^ 

Acetate  of  Lead. — The  neutral  acetate  was  emidoyed  not  infrecpiently  in  hsemoptysis, 
and  in  cases  complicated  with  diarrhoea,  and  was  usually  combined  with  opium.  Sometimes 
saturnine  lotions  were  used  to  moisten  the  compresses  placed  on  irritable  wounds.'^ 

Gallic  Acid. — Gallic  acid,  tannic  acid,  and  vegetable  astringents  in  substance  are 
mentioned  among  the  prescriptions  in  cases  of  chest  wounds,  especially  in  those  in  which 
there  were  hsemorrhages  or  intestinal  fluxes.^ 

Saline  and  Other  Purgatives. — Sulphate  of  magnesia,  Rochelle  salt,  jalap,  colocynth, 
and  the  compound  cathartic  pill  of  the  pharmacopoeia,  were  sometimes  employed;  but 
usually  the  patients  had  loose  bowels  already,  and  these  remedies,  and  laxative  enemata, 
were  not  often  called  in  requisition.  A few  surgeons,  mindful  of  the  ancient  haemostatic 
credit  of  sulphate  of  soda,  prescribed  a black  draught  with  glauber  salt,  when  purgatives 
were  indicated.  AVith  the  same  motive,  turpentine  was  occasionally  made  a constituent  of 
purgative  and  expectorant  mixtures.® 

Hydrochlorate  of  Ammonia. — Sal  ammoniac  was  used  to  a very  limited  extent  in  the 
progress  of  cases  followed  by  pneumonia,  but  did  not  enjoy  the  favor  with  which  it  is 
regarded  by  the  German  military  surgeons.  Its  admitted  liquefactive  influence  upon  the 
blood  should  contraindicate  its  administration  in  haemorrhages  and  traumatic  pneumonia.® 
Tonics. — Dilute  aromatic  sulphuric  acid  in  sweetened  water  was  a favorite  prescrip- 
tion for  a drink  for  patients  who  had  suffered  from  haemorrhage.  The  salts  of  quinia  were 
largely  used  in  cases  with  malarial  and  pyaemic  complications.  Arsenic  was  employed, 
though  much  less  frequently,  in  similar  conditions.  Ferruginous  preparations  and  vegetable 
tonics  were  administered  during  the  convalescent  stage. ^ 

Stimulants. — Diffusible  stimulants  were  much  used  in  the  depression  immediately 
following  the  reception  of  the  injury,  and  often  injudiciously  and  without  medical  advice, 
and  reaction  and  the  danger  of  haemorrhage  were  thereby  augmeiited.  The  cautious  use 
of  ammonia  and  brandy  was  requisite  in  cases  attended  by  great  prostration- at  the  outset.® 
In  the  later  stages,  alcoholic  stimulants  and  carbonate  of  ammonia,  in  conjunction  with 
concentrated  nutriment,  were  important  adjuncts  to  the  restorative  treatment.  Ergotinc 
was  prescribed  as  an  hsemostatic  in  a few  instances,  but  no  evidence  of  its  utility  is  given. 

^ Consult  Wood  (A  Treatise  on  Therapeutics  and  Pharmacology^  Phila.,  18G8,  Vol.  II,  p.  103);  GUDLEii  {Commentaires  TherapeutiqueSy  Paris, 
J868,  p.  103) ; Homolle  and  Quevenxe  (Arch,  de  Physiologic,  1854,  p.  223) ; TitAUBE  (Ai'ch.  Gen.  de  Med.,  T.  XXVIII,  p.  338). 

2 On  its  effects,  consult  LEMATTRE,  Arch.  Gen.  de  Med.,  Aodt,  1865,  p.  186;  GaN'OD,  Med.  Times  and  Gaz.,  Dec.,  1857,  p.  589;  SCIIROFF,  Wochefi' 
hlatt  der  Ges.  dc.r  Aerzte  zu  TVten,  Juni  16,  1865;  Stille,  Therapeutics  ajtd  Materia-Medica,  3d  ed.,  1868,  Vol.  I,  p.  765. 

* Consult  Goulard,  Traill  sur  Us  ejfets  des  preparations  deplomh.,  Pezenas,  1760. 

^ Refer  to  Weaver,  Am.  Jour,  of  Pharm.,  Vol.  XXIX,  p.  82;  GUBLEU,  Commentaires  Thlrapeutiques,  p,  579;  Gmelin,  Chimie  Organique 
appliquee  d la  Phys.  ei  d la  Med.,  Paris,  1823;  and  papers  by  Drs.  Neale  and  Grantham  and  M.  Saumon. 

® Wood  and  Bache,  The  Dispensatory  of  the  United  States  of  America,  12th  ed.,  1865,  pp.  792,  828;  HAMILTON,  Observations  on  the  Utility  and 
Administration  of  Purgative  Medicines  in  Surgical  Diseases,  Edinburgh,  1815. 

* Consult  Gubler,  Commentaires  Thlrapeutiques,  1868,  p.  403.  Forits  employment  in  inhalation,  see  DacOBTA,  Inhalatioi-is,  etc.,  pamphlet,  p.  86, 
Phil.,  1867;  GarROD,  The  Essentials  of  Materia- Medica  and  Therapeutics,  London,  1868,  p.  49. 

^ See  Carson,  Synopsis  of  the  Course  of  Lectures  on  Materia- Medica  and  Pharmacy  delivered  at  the  University  of  Pennsylvania,  Philadelphia, 
1851,  p.  72;  ROYLE  and  Headland,  A Manual  of  Materia-Medica  and  Pharmacy,  3d  ed. ; TULLY,  Mat. -Med.  and  Phar.,  Vol.  I,  Part  11,  p.  1103;  Baylk, 
Bibliotheque  de  Therapeutique,  1837,  T.  IV,  p.  222:  LlNDLEY,  Flora-Medica,  London,  1838,  p.  426;  UAFriNEsQUK,  Medical  Flora,  Philadelphia,  1828,  p.  206. 

* Consult  Forbes,  Physiological  Effects  of  Alcoholic  Drinks,  Boston,  1848;  Aitken,  The  Science  and  Practice  of  Medicine,  3d  ed.,  London,  1864, 
Vol.  II,  p.  691 ; Bennett,  Clinical  Ler.tures  on  the  Principles  and  Practice  of  Medicine,  2d  Am.  cd.,  1863,  p.  646 ; ASHIIURST,  Prin.  and  Pract.  of  Surg., 
1871 : " Beef-tea  and  even  brandy  will,  according  to  my  experience,  be  more  often  required  in  cases  of  lang  wound  than  calomel  or  autimon}',”  p.  359. 


648 


WOUNDS  AND  INJURIES  OF  THE  CHEST CONCLUDED. 


[Chap.  V, 


Epispastics. — Ijai'go  blisters  were  recommended  by  high  authority^  and  were  often 
emj)loyed  in  cases  of  traumatic  pneumonia,  even  in  the  early  stages.  There  wore  many 
surgeons  who  considered  their  efficacy  in  controlling  inflammatory  processes  sufficiently 
great  to  counterbalance  the  suffering  they  caused,  the  hindrance  to  auscultation  and  percus- 
sion, and  liability  to  gangrene  and  diphtheritic  infection  their  raw  surfaces  presented. 

Doubtless  a wise  selection  and  combination  of  some  of  these  remedies  may  materially 
modify  and  shorten  the  duration  of  some  of  the  complications  of  wounds  of  the  chest;  but, 
with  the  exception  of  opium,  they  are  all  subsidiary  to  the  operative  treatment,  the  rigid 
enforcement  of  mental  and  physical  rest,  the  regulation  of  the  air,  and  of  the  diet.  The 
latter  should  be  severely  restricted  at  first,  and,  though  later,  nutritious  food  is  of 
advantage,  it  should  long  bo  of  liquid  form  and  easy  of  assimilation.  I dwell  upon  this 
jioint,  because  the  reports  show  that  many  surgeons  erred  in  allowing  solid  animal  food  at 
too  early  a period.^ 


• See  Gross,  A System  of  Surgery,  Vol.  II,  p.  447. 

2 Stadlander,  JJiss.  de  pulmovum  vtdn..  Franc.,  1683 ; CrceseR,  J.  H.,  Dissertatio  dc  thoracis  vvlnerihus,  Lngduna  IlatavoiTim,  1716 ; KCOY,  A., 
Pissertatio  de  vulnerihus  thoraces,  Fugduni,  1738;  Frickk,  J.  H.  G.,  Dissertatio  de  covtusionihus  Gottingen,  171)2;  llERHOLDT,  Demerh  ungen 

iiher  die  chirurgische  Bchandhwg  tiefer  Wunden  dcr  Brust,  Kopenhagen,  1801;  VERllsG,  iJber  die  cindringenden  Brustwunden,  4to,  'NVien,  1801; 
IvUMl’BE,  E.,  Dissertation  sur  les  Plaics  d'Armes  d fcitpcnHrautcs  dans  Ja  Poitrine,  4to,  Paris,  1814  ; BauDON,  Dissertation  sur  le.s  plaies pcnctrantes  de 
jmitrine,  1815,  These  de  I* *aris,  No.  3G6;  Fauret,  F.,  Dissertation  sur  les  penetrantes  de  poitrine,  etc.,  1823,  These  de  Paris,  No.  107;  Mayer, 

C.,  Tractatus  de  vvlnerihtis  pectoris  2'>encirantihus  imjirimis  cum.  Ilacmorrhagia  covjunctis,  Heidelberg,  1823;  FRASER,  P.,  A Treatise  upon  Penetrating 
^'ounds  of  the  Chest,  London,  1851).  Dr.  Fraser  gives  a list  (p.  14)  which  I take  the  liberty  to  quote,  of  all  the  cases  of  penetrating  wounds  of  the 
chest  recorded  in  the  Lancet,  Medical  Times,  Medical  Gazette,  and  Medico-chirurgical  Transactions  from  their  commencement:  “Laxcet,  1832, 
August  11th,  p.  604;  October  27fh,  p.  151);  1838,  June  2d,  p.  350;  1841,  August  Hth,  p.  724;  1846,  Slay  Sth,  p.  533;  1847,  January  8th,  p.  67; 
1851,  April  6th,  p.  416;  1852,  February  Hth,  p.  193;  1856,  June  21st,  p.  682,  and  p.  685;  MeuiCO-CiiIRURGICAE  Traxsactions,  1825,  Vol.  VII,  p. 
315;  1826,  Vol.  IX.  p.  204;  1841,  October,  p.  564;  1842,  October,  p.  615;  MEDICAL  Gazetie,  1828,  Marcb  29th,  p.  512:  1820,  October  24tb,  p.  124; 
IH30,  Januaiw  16th,  p.  520;  1835,  IMay  2d,  p.  146;  1837,  November  18tb,  p.  302;  1838,  August  ISth,  p.  802;  1840,  February  7th,  p.  721  ; 1843,  Jday 
20th,  p.  322;  184.5,  September  26th,  p.  980;  1847,  January  22d,  p.  13ti2;  1849,  March  16th,  p.  483;  1850,  October  18th,  p.  713;  MEDICAL  TIMES,  1844, 

April  6th,  p.  21 ; December  7th,  p.  231 ; 1847,  August  20th,  p.  512;  April  8th,  p.  ; 1853,  December  17th,  p.  638;  JIEDICAL  TIMES  AND  GazeITE, 

Vol.  XXXVI,  pp.  242,  604.”  For  practical  observations  on  gunshot  wounds  of  the  chest  during  the  5Var  of  the  Rehcllion,  sec  Appendix  to  Part  /,  of  the 
Medical  and  Surgical  TUstory,  as  follows : By  Surgeon  A.  B.  Crosby,  U.  S.  V.,  p.  11 ; by  Surgeon  C.  S.  Wood,  Gtltli  New  York  Volunteers,  p.  88 ; by 
Assistant  Surgeon  J.  S.  Billings,  U.  S.  A.,  p.  200;  by  Surgeon  A.  J.  Phelps,  U.  S.  V.,  p.  261;  by  Surgeon  W.  W.  Blair,  58th  Indiana  Volunteers,  p. 
263;  by  Surgeon  D.  G.  Brinton,  U.  S.  V.,  p.  293;  by  Surgeon  H.  S.  Ilewit,  U.  S.  V.,  p.  312.  In  the  American  medical  periodicals,  the  following  articles 
may  be  found,  in  uiblition  to  those  already  referred  to  : G.\LLOUPE,  Gunshot  )yound  of  Chest ; Ball  removed  after  seventeen  years,  Boston  Med.  and  Surg. 
■lour.,  N.  S.,  1872,  Vol.  IX,  p.  267  ; Kirkijimde,  T.  S.,  Gunshot  JVound  of  the  Thorax,  Am.  Jour.  Sled.  Sci.,  Vol.  XV,  p.  357,  O.  S.,  1834  ; D'Avicnon,  F.  J., 
Extensive  iro««d  of  the  Tltorax,  Jtccovery,  Boston  Med.  and  Surg.  Jour.,  Vol.  XXXIV,  p.  231,  1846;  BlantoN,  A.  IM.,  Case  of  Gunshot  Wound  of  (he 
Chest,  Am.  Jour.  Med.  Scj.,  Vol.  XVII.  p.  23,  1849;  HOOKER,  A.,  Penetrating  Woundof  the  Chest,  Death  in  eighteen  days,  Boston  IMed.  and  Surg.  Jour., 
Vol.  LXII.  p.  223.  i860:  AsililL’RST,  J.,  Jr.,  Casts  of  Penetrating  Wounds  of  the  Chest  and  Throat,  illustrating  some  imj^ortant  Practical  Points,  Am. 
Jour,  I\Ied.  Soi.,  Vol.  XLIII,  p.  61,  1862;  LOMBARD,  J.  S.,  Case,  of  Pneumonia  following  Gunshot  Wound  of  the  Chest,  Boston  liled.  and  Surg.  Jour.,  Vol. 
LXVIll,  p.  471,  1863;  CABOT,  Gunshot  Wound  of  (he  Chest,  Boston  Med.  and  Surg.  Jour.,  Vol.  LXVIll,  p.  100,  1663;  WALES,  P.  S.,  Gunshot  Wound 
of  the  Chest,  Am.  Jour.  Med.  Sci..  N.  S.,  Vol.  XLV,  p.  380,  1863;  SMILEY’,  T.  T.,  Gunshot  Wounds,  from  Arkansas  Post,  Two  Case^  of  Chest  Wounds, 
Boston  Mod.  and  Surg.  Jour.,  Vol.  LXIX,  p.  153, 1863.  The  following  references  may  also  be  advantageously  consulted ; WarREN,  J.  IM.,  Wound  in  Chest 
from  Grapeshof,  Surgical  Observations,  with  Operations,  Boston,  1867,  p.  550;  CARRE,  M.,  Considh'ations  sur  les  Plaics  de  la  Poitrine, 

compliquees  de  Lesions  aiix  Poumons,  in  Pec.  de  M6m.  de  Med.,  Paris,  1826,  T.  XIX,  p.  144  ; Gama,  Observation  d'une  Plait  Penetrante  de  la  Poitrine., 
Pec.  dc  Mem.  de  Med.,  Paris,  1822,  T.  XII,  p.  177;  IIIRN,  Observations  sur  une  Plait  Pcnetrantcdela  Poitrine,  suiviedeV  ExjmUionde  plusicurs  J*vrlions 
de  la  Membrane  muqueuse  qui  tapissc  V intrricur  de  la  Trachh  aricre,  Pcc.  de  Mem.  dc  Died.,  Paris,  1819,  T.  VI,  p.  276;  Kries,  II.  ().,  De  Vulncribus 
l*cctoris  Penetrantibus,  Berolini,  1828;  PecIILIN,  J.  N.,  Sisiens  Jlistoriam  Vulneris  Thoracis  e.t  in  cam  Commentarium  in  Halleu's  Dispiit.  Cbir.  T. 
n.  p.  531;  Scil.MID,  H.,  Ueher  Penetrirende  Brustwunden,  Jena,  1867;  PlCHTER,  A.  G.,  Anfangsgriinde  dcr  Wundarzncyl’unst,  Gottingen,  1860; 
SacMERING,  S.  T.,  De  Morbis  Vasorum  Ahsorbentium,  Trajceta  ad  Moen,  1795;  IlEURMANN,  G.,  Abhandlung  dcr  Vornchmsten  Chirurg.  Gperationen, 
Kopenhagen  und  Leipzig,  1756:  ValenTIN,  de  qmitrine  ai'tc  ipanchement ; dcs  signes  des  epanchements  dc  sang,  etc.,  in  Jicch.  crit.  sur  la 

chirurgie  moderne.  Paris,  1762 ; MarJOLIN,  Dictionnaire  cn  30  volumes,  1842,  T.  XXV,  p.  413 : Anger,  B.,  Plaics  Penetrantes  dc  Poitrine,  Paris,  1866. 

* Besides  the  specimens  already  referred  to,  the  following  preparations  in  the  Army  Medical  Museum,  Section  1,  illustrate  shot  wouiUls  of  the  bing : 

Si>ec.  603. — “ A wet  iirejiaration  of  the  left  lung,  showing  ulceration  of  the  apex,  following  gunslnjt.  Private  W.  B.  T.,  Co.  E,  4lh  Maine  Volunteers 
A bullet  entered  to  the  left  of  the  seventh  cervical  vertebra,  and  was  cut  out  on  the  field,  just  behind  the  right  btemo-cleido-inastoidcus,  opposite  the 
fourth  cervical  vertebra,  Fredericksburg,  December  13th;  admitted  bcspitul,  Washington,  December  It'th;  hajniorrhagc  from  the  anterior  wound  and 
cough  appeared  on  21st ; air  issued  from  p(;Rtcrior  wound  on  27th  ; died  on  28th  Decomher,  1862.  The  right  humerus  was  fractured  near  the  elbow,  also. 
Contributed  by  Acting  Assistant  kSurgeoii  F.  P.  Sprague”  {Cat.  Burg.  Sect.  Army  Med.  Museum,  p.  480).  Spec.  606. — ” A preparation  of  the  right  lung, 
showing  a perforation  of  the  apex,  followed  by  ulceration.  A bullet  entered  near  the  stenio-clcido-mastoideus,  three-fourihs  of  an  inch  above  the  clavicle, 
and  escaped  an  inch  to  the  right  cf  the  fourth  dorsal  vertebra.  The  specimen  is  badly  cut,  as  if  in  dissection.  Private  V.  B.  C.,  Co.  C,  IGth  Maine 
Volunteers;  Fredericksburg,  13th  December;  admitted  hospital  at  Washington  on  18th;  cough  appeared  on  2Cth;  haimorrhages  from  anterior  wound 
until  24tli;  died  3Cth  Decemher,  1862.  Contributed  by  Acting  Assistant  Surgeon  F.  P.  Sprague”  {Cat.  Sio'g.  Sect.  Army  Med.  Mu.^icum,  p.  479). 
Sqiec.  960. — “ A preparation  of  a portion  of  the  left  lung,  with  a battered  ecnoidal  ball  lodged  near  the  apex.  M.  F.,  88th  New  York  Volunteers;  Antietam, 
September  Hth,  1862;  admitted  hosjntal  at  Frederick  on  21st,  with  gunshe  t fracture  head  cf  humerus,  which  was  excised  on  the  2.5th : died  cn  October 
Sth,  1863,  from  pleuro-pneumonia”  (Cat.  Surg.  Sect.  Army  Med.  Museum,  p.  478).  In  all  wars  much  valuable  pathological  material  is  wasted.  Klels, 
E.  {Beitr'dge  zur  Patholvgischen  Anatomic  der  Schusswunden,  Leipzig,  1872.  note,  S.  123).  ”1  may  be  permitted  to  express  my  regrets,  that  the  large 

material  under  Billroth’s  direction,  as  regard  jmthological  anatomy,  was  not  entrusted  to  a teehnioally-oducatod  investigator,  as  was  done  at  Carlsruhc. 
Where  every  surgeon  makes  his  own  collection  of  specimens,  the  material  becomes  scattered,  and  only  so  much  of  it  will  be  preserved  as  is  of  sc*ciille«l 
chirurgical  inij)ortance,  a term  of  frequently  very  doubtful  significance.” 


Sfxt.  IV.] 


GENEEAL  TREATMENT. 


619 


There  are  a certain  number  of  cases  of  penetrating  wounds  of  the  cliest  that  will 
prove  fatal  in  spite  of  any  treatment,  and  a certain  number  will  recover  if  left  to  them- 
selves. Between  these  extremes  lie  a number  of  cases,  some  of  which  will  recover, 
if  properly  treated,  who  would  otherwise  have  died,  and  some  will  recover  perfectly,  who 
would  have  been  left  with  damaged  organs  if  no  treatment  had  been  employed.  And  it 
is  in  regard  to  the  treatment  of  these  manageable  cases  that  it  is  most  difficult  to  lay 
down  positive  rules.  They  are  those  in' which  experience  is  so  useful,  and  the  appreciation 
of  shades  of  difference  scarcely  to  be  expressed  in  words ; but  recognized  by  the  educated 
eve  and  ear  and  hand  of  the  enlightened  and  accomplished  surgeon,  who  has  attained  that 
point  where  scientific  principles  seem  almost  to  merge  in  the  application  of  the  rules  of  art. 
Such  a practitioner  possesses  knowledge  which  he  cannot  convey  didactically.  It  may  be 
noticed  that  our  foremost  systematic  writer  on  surgery  still  teaches,  in  the  last  edition  of 
his  work,^  that  the  strictest  depletory  measures  should  be  employed  in  penetrating  wounds 
of  the  chest,  and  the  most  rigorous  antiphlogistic  regimen, — provided,  always,  that  “the 
system  has  not  been  too  much  drained  of  blood  by  the  accident,”  and  “the  pulse  is  full 
and  hard  and  frequent,”  and  the  countenance  is  “hot  and  flushed.”  Whereas,  “if  the 
reverse  be  true,”  lowering  agents  should  be  refrained  from.  Yet,  though,  during  the 
war,  he  continually  visited  the  military  hospitals  in  various  parts  of  the  country,  and  gave, 
whenever  his  laborious  avocations  permitted,  the  benefit  of  his  wise  counsel  and  matured 
experience  to  his  junior  brethren,  and  must  have  encountered  many  cases  of  injuries  of  the 
chest,  he  appears  never  to  have  met  with  one,  at  a juncture  when  the  depleting  measures 
he  recommends  could  be  considered  opportune. 

Dr.  Fraser  has  collected  a number  of  cases  in  which  it  would  appear  that  patients 
with  chest  wounds  were  literally  bled  to  death.  It  would  be  easy  to  augment  the  list,  and 
to  present,  on  the  other  hand,  instances  as  numerous,  in  which  patients  survived  enormous 
depletion;  and  the  advocates  of  phlebotomy  would  reply,  that  the  instances  only  proved 
that  the  former  group  of  cases  embraced  those  that  seemed  to  demand  excessive  depletion, 
and  were  of  such  a character  as  would  probably  terminate  fatally  under  any  treatment, 
not  that  the  remedy  had  worked  any  ill  to  the  patients.  It  does  not  appear  that  the 
subject  admits  of  solution  by  the  numerical  method.  The  statistics  evoked  in  connection 
with  Dr.  Bennett’s  extended  therapeutic  enquiry  into  the  utility  of  venesection  in  pneu- 
monia, by  no  means  proved  that  phlebotomy  was  always  prejudicial  in  that  disease;  but 
simply  that  excessive  bleedings  in  very  old  or  young  or  slender  persons  were  invariably 
harmful;  while,  of  the  largest  series  of  cases  collected  on  this  subject,"  that  in  which  the 
mortality  was  lowest,  was  taken  from  the  army  lists,  for  periods  when  moderate  l)leeding 
was  the  prevailing  practice.  But  the  assumption  that  blood-letting,  by  withdrawing  from 
the  circulating  medium  its  excess  of  flbrine,  and  other  assumptions  equally  false,  and  all 
tending  to  the  conclusion,  that  the  greater  part  of  the  blood  must  be  abstracted  in  order 
that  the  disease  might  be  cured, — to  bleeding  as  far  as  consistent  to  life,  as  Ballingall 
expressed  it, — without  limit,  as  John  Bell  taught, — led  to  the  most  reckless  and  injudicious 
treatment,  in  which  the  reaction  of  exhaustion  was  constantly  mistaken  for  renewed 
inflammation,  and  met  by  repeated  venesection.  The  reaction  following  the  discovery  of 

1 Gross,  a System  of  Surgery^  5th  cd.,  1672,  Vol,  II,  p.  447. 

2 See  the  British  and  Foreign  Med-Chir.  llcciew^  Vot.  XXIF,  July,  1858.  They  arc  collected  from  very  varimiR  sources,  and  their  value  in  the 
author's  own  estimation  is  apparently  not  great ; for  though  he  strictly  analyses  those  that  admit  of  it,  he  does  not  even  sum  up  tlic  figures  which  he  gives 
as  a whole. 

82 


650 


WOUNDS  AND  INJURIES  OE  THE  CHEST — CONCLUDED. 


[Chap.  V, 


the  fallacy  of  these  assumptious  led  to  such  a state  of  feeling  that  a practitioner  now 
hardly  dares  to  use  the  lancet,  whatever  his  views  of  its  employment  may  be,  and  the 
advantages  that  might  be  secured  by  bleeding  in  injuries  of  the  lung,  in  vigorous  subjects, 
in  the  first  day  or  two  after  the  reception  of  the  injury,  and  by  the  use  of  leeches  and 
scarified  cups  in  pleurisy  and  cardiac  complications,  are  very  rarely  sought.^  In  like 
manner,  the  want  of  confidence  in  the  efficacy  of  mercurials  in  inflammation  appears  to 
have  arisen  from  a growing  conviction  that  their  employment  is  based  upon  a false  theory.® 
In  the  surgery  of  the  blood-vessels  of  the  chest,  I conceive  we  may  fairly  look  for  improve- 
ment. It  will  not  be  claimed  that  all  the  fatal  cases  of  lesions  of  the  mammary,  inter- 
costal, axillary,  and  subclavian  arteries,  that  have  been  narrated  in  tliis  chapter,  were 
necessarily  beyond  the  resources  of  art.  It  is  surely  possible  to  reduce  the  great  disparity 
in  the  mortality  of  ligations  for  traumatic  causes,  as  compared  with  the  results  of  operations 
for  aneurism.  I rejoice  to  find  myself  so  fully  in  accord  with  my  friend.  Dr.  Lidell,  on 
this  subject;  and  heartily  applaud  his  vigorous  invectives  against  temporizatioU  with 
compresses  and  styptics,  when  serious  bleeding  is  going  on.  “Never  be  afraid  to  look  your 
enemy  in  the  face”  is  as  good  advice  for  the  surgeon  as  for  the  soldier. 


* Consult  Sir  Thomas  Watson’s  Practice,  of  Physic.,  5th  London  ed» ; Bennett,  J.  H.,  Clinical  Lectures  on  the  Principles  and  Practice  of 
Medicine,  2d  Am.  ed  , 1863,  p.  648;  BuYant,  The  Practice  of  Surgery,  London,  1872,  p.  152. 

* Dr.  Baiiclay,  Medical  Errors,  p.  119,  says : “ The  treatment  of  acute  inflammations  by  calomel  and  opium,  which  was  deduced  from  the 
supposed  action  of  mercury  as  a solvent  of  fibrine,  has  not  been  very  long  introduced  into  practice.  A few  years  ago  experience  would  have  been  said 
to  be  universally  in  its  favor,  especially  in  the  treatment  of  inflammation  of  serous  membranes.  Now,  not  a few  of  the  most  intelligent  members  of  the 
profession  discard  it  altogether,  and  a certain  vague  feeling  of  doubt  as  to  its  efllcacy  more  or  less  pervades  all  classes.” 

The  following  extract  from  remarks  by  Mr.  Henry  Smith,  Medical  Times,  Nov.  23d,  1850,  p.  234,  should  have  appeared  in  the  foot-notes  to  page  613 : 

‘‘I  found,  after  deatli,  several  ribs  broken,  and  the  lung  severely  lacerated  by  their  broken  and  rugged  extremities ; yet  no  bleeding  from  the  mouth 
had  occurred ; even  if  the  patient  lives  for  days  and  weeks,  and  the  lung  be  severely  wounded,  there  may  be  no  hsemorrhage ; the  absence  of  it  was 
striking  in  a patient  of  Mr.  Partridge,  who  had  received  a gunshot  wound  in  his  left  side,  and  who  lived  nearly  three  weeks.  The  ordinary  signs  of 
pneumonia  soon  appeared,  but  there  was  no  haemorrhage,  and  It  was  considered  probable  that  the  ball  had  only  taken  a superficial  course.  On  post-mortem 
examination,  however,  it  was  found  that  the  ball  had  traversed  the  substance  of  the  lung,  and  the  most  intense  inflammation  had  ensued,  which  caused 
the  death  of  the  patient.  Sometimes  emphysema — although,  as  a general  rule,  it  follows  an  injury  to  the  lung  from  a broken  rib— will  not  be  apparent ; 
if,  with  other  symptoms,  which  are  even  somewhat  dubious,  this  be  present,  it  will  set  the  question  at  rest.  Haemorrhage,  even  although  a most  important 
sign,  as  regards  the  treatment  which  is  to  be  pursued,  is  not  conclusive  of  an  injury  to  the  lung ; nor,  on  the  other  hand,  as  has  before  been  stated,  does  its 
absence  clearly  indicate  that  there  is  none.” 


INDEX  OF  REPORTERS 


Page. 

Abraham 293 

Adolphus 

Adams 440 

Adler 494 

Agaud 461 

Ainsworth 56 

Akin 481 

Albright 43 

Alexander,  C.  T 56 

Alexander,  S.  T 273 

Alden 83, 92, 329, 348, 396,  567 

Allen,  H 86, 112, 160, 288, 351,  438, 

487, 505, 529, 541,  568,  575,  587 

Allen,  B.  W 107, 129, 244, 245, 246, 275, 287 

Allen,  L.H 190 

Alle.n,  N 222 

Allen,  J.L 330 

ALSDORE 226 

Ames,  A.  E 291, 479 

Ames,  A.  H 491 

Antisell J18,  367, 477, 483,  528, 550,  554 

Anawalt 172 

Ansell y.  .255, 435 

Anderson 285 

Armsby 45 

Arthur 167, 202, 437 

Armstrong,  J.  E 240 

Armstrong,  J.  A 520 

Artaud 283, 363 

Atwood 59 

Atkinson 274, 417 

Atwater Ill 

Atwater,  H.  H 430 

Avery 330 

Ayres 23,444,546 

Ayer 290 

Azpell 58,  538 

Bailey 37, 45 

Baily 220 

BaCUE,  D 38 

Bache,  T.  H 40,  80, 163, 367 

Barnum 39 

Bacon,  P.,  Jr 83, 276 

Bacon,  C 448 

Bardin 119 

Batwell 147, 209, 265,  412 

Bald-win 161,277 

Bates,  E.  F i08, 349 

Bates,  W.  S 239 

Bates,  J 292, 479 

Bard  WELL 178, 226 

Baxter 189, 274 

Bartholf 198, 204, 237, 250, 330, 520 

Bassett 239 

Bartholow 458 

Bartlett 487 

Backus 487 

Barr 502,  506 

Bennett,  John 42 

Bennett,  W.  C 73 

Bennett,  E 193 


Page. 

Bentley 44, 45, 53, 54, 

58, 76,  86,  88, 133, 183, 184, 188, 201, 
206, 248, 265, 268, 289, 302,  350, 351, 
353,  354,  356,  360,  364,  365, 426,  436, 
437, 441,  445, 450, 467,  473,  557,  628 


Benedict 101,539 

Beel 119 

BELLOWS 150 

Bell,  James 178 


Bell,  John 

Bell,  j.  B 

Benson 

Beach  

Beck 

Belknap 

Beeser 

BEUST 

Becker 

Billings 

Bigelow,  J.  K 
Bigelow,  h.  J 
Bigelow,  C.  P 

Bing 

Bliss,  D.  W... 


203 

227 

178, 208 

213 

218 

289 

291 

432 

547 

60,  231,  292,  302 

164 

193 

249 

461 

49,  59, 125, 

143, 171,  238,  248,  266,  268,  269, 
272, 278, 279, 281, 284, 296, 301, 


Bliss,  Z.  E . 
Blossom  . . . 
Blackrurn 
Blackman  . 

Blein 

Bontecou.. 


Bos  worth 

Borbs 

Bowling 

BOWEN,  W.  H . . 
Bowen,  C.  11..“ 
BOWEN,  W 

Bowen,  II.  F . . . 

Bockee 

Boynton 

Bradley,  W.  A 
Bradley,  W.  H 

Bradley,  E 

Breed 

Brown,  E.  O... 
Browne,  P.  F.  . 
Brown,  j.  N . . . 
Brown,  j.  A . . . 
BROWN,  J.  II  . . . 
Brown,  F.  H ... 
Brow.n,  j.  m... 
Brinton,  r>.  G . 
Bkinton,  j.  H.. 

Briggs 

Brumley  

Brillantowski 


346,  349,  408,  412,  516,  583,  590 

53,  217,  356 

175 

236 

369 

559 

4, 20,  43, 82, 

124, 148, 241, 250, 264,  346, 350, 
355, 432,  438,  451, 456,  493,  528, 
529, 530, 548,  551,  555,  578,  579 

41 

54 

59 

201 

444,  584 

461 

221, 456 

274 

413 

47 

175,481 

178,289 

54, 73,  302, 526, 546,  573 

54,78 

78, 451,  503,  542 

231 

233, 419 

238 

540 

618 

183,  501 

. . .58, 367,  401, 402,-515,  589, 628 

59 

78,501,506 

92,200 


Brewer 

Bradford,  G.  \V  ... 
Bradford,  F.  G.  H 

Breakby 

Brookes 

Brooks,  E 

Brooks,  O.  D 

B rattan 

Brock  

Bruraker  

Bryant,  H 

Breneman  


Page. 

141,  461 

177 

216 

178, 192,  505, 506 

180 

203, 246, 431 

285 

186 

211 

577 

213,  490,562 

254 


Burke 

Buchanan 

Buckm.vn,  j.  W.  . 
Bl'ch.\nan,  W.  F 

Butler,  j.  II 

Butler,  T.  S 

Butler,  W.  H . . . 

Buzzell 

Burpee 

Burmeister 

Burdick 

Burt 

Bundy 

BUCK,  A.  A 

Buck,  G 

Buck,  II.  A 

Buckingham,  A . 

BUELL 


43,58 

59 

114 

244 

18 

240 

476 

lOL 

108, 159, 354, 364 

139, 163 

172,239,  013 

229 

234 

354 

....  373,  375,  376 

405 

573 

411 


Byrne 74,75,143, 

201,  273, 349, 35.5, 425,  435, 438 

■BYLES,  C 635 

Calhoun 39,  48, 77, 363,  367 

Camac 41 

Carter 92, 3.54 

Cahoon 100 

Carvallo 116, 441 

Carell 126, 215, 300,  557 

Canniff 129 

Cake 134 

Carson 187 

Camprell,  j 205 

Camprell,  C 229 

Carroll,  t 206 

Carroll,  R.  W.  W 418 

Cass 249, 360 

Cantwell 277, 420 

Castle 410 

Cameron 496 

Carpe.nter 584 

Ciiamrers 40, 458 

Chapel 71 

Chajirerlain,  C.  N 98,  .501 

CIIAMRERLAIN,  -W.  JI 234, 37],  409,  5.59 

Cherronnier 105,  dl9, 620 

Christian 114 

Chandler 134 

Churchill 190, 237, 240 

Chase,  I.  .S 236, 473 

Chase,  E.  G 247 


II 


INDEX  OF  KEPOKTERS, 


Page. 

Choate 2:!8 

CmilST 275 

ClIEEVEll 279 

Chapin 5(iC 

Clahk,  a.  P 21 

Clark,  C.  II 138 

CLARK,  C.  C.  P 174 

Clark,  E.  A 211, 370 

C;lauk,  a.  M 25],  503,  504 

Clark,  C.  JI 293,  362 

Cloak 41,  55 

Clapp,  A.  M 48 

Clapp,  IV.  a 355 

Clkizer 196 

Cleaver 208 

ClEXDEXIN,  W 229,303,524 

Cr.EXDEMX,  W.  II 291 

C'LIiJlEXTS 227 


Day,  W.  E 
De.yn 


DeGraw 

Derby,  A.  R 
Derby,  G . . - 
Devendouf  . 

Devens 

Delay  AN 


Page. 

423 

Ill,  205,  213,  248, 

249,  252,  253,  273,  435,  480,  493,  556 

534 

85 

71 

180 

232 

488 


Dickinson 75 

Dieffexhach 177 

Dickie 528 

Dorr 274 

Dodge 108 

Draixe 38 

Draper 301 

Dunglison 227 


Dunton 


372 


Cleary 393 

Cooper 22 

Colby 17 

Conner 54. 181, 224, 249, 254, 30) , 327,  560 

Collins 72 

Cogswell 83 

Cobb 84 

Coventry 116 

Cornell 119, 501 

Coale 143 

Coleman 164 

COWGILL 164, 212 

Cowles 175 

t:oRLis 186 

CONKLING 186,290 

cook,  G.  W 238,  526 

Cook,  A.  P 451 

Colburn 240 

Colvin 288 

COJIBS 290 

Conover 294, 473, 593 

Cole 298 

Coombs 393 

COE 480 

CROSBY',  T.  U 51,73,330 

Crosby,  a.  H 445 

CROSBY,  H 588 

CROYVE 57 

CllOPP 119 


DUSENBURY 

DUTTON 

Dudley 

Dwinelle 

Dyer 

Eastman 

Edyvards 

Edelin 

Edgar — 

Ellis,  C.  M 

Ellis,  J.  W 

Elliot 

Ellsyvorth,  J.  W 

Elrod 

Ella 

Ely 

Em.yxuel 

Emory 

Evans 

Eva  RTS 

E.ylley,  C.  E 

F ALLEY',  J.  \V 

Fay,  j.  K 

Fay,  j.  YV 

Farquelle 

Farnsyvortii 

Farrar 

fercusson 

feris 


426 

433 

....488,489 
181,  488, 489 

462 

132 

33 

266 

270 


494 

.269,  274, 418,  574,  587 

291,  495 

292 

397 

577 

209 

445 

183 

501,  502,  506 

105, 585 

574 

208 

353 

458 

491 

586 

163, 192 

186 


Craig,  YV.  II 442,  488 

CRAIG,  15.  F 363,482 

CRAWFORD 398 

CUMMINSKEY 103,  130, 189,  215,  230,  403,  .501 

CURP.IiY 160 

CUJIMINS 197 

Cutter 294 

CUTLER 239 

CULBERTSON 369,  372,  378,  418 

CURTIS,  E 539 

CURTIS,  I.  15 573 

Daggett 407 

Dana :86 

Dare 205 

D.YVIES 419,  432 

D.vvis,  A 221 

Davis,  J 41 

Davis,  P.  C 5.5,  406,  462 

Daives 77 

Day,  n.  15 104, 120,  208,223,  237 

Day,  15.  j 288 


FINLEY',  C.  A . 
FINLEY,  S.  M . 

FINN 

Fitch 

Fisher 

Fischer 

Fisk,  C.  L — 

Fisk,  S.  A 

Flandr.yu  ... 

FOLSOJI 

Foye 

Foryvood 

Forbes  

Foster,  F.  1’ 
Foster,  T.  A. 

Foisseit 

Fox 

FONTS 

Frantz 

French,  .1.  O 
French,  G.  F 


22 

59, 4.51 

462 

107 

149 

588 

197,  240,  496 

500 

92, 174 

46 

55,  516 

71 

370 

418 

238,  458 

128 

242,  286 

271 

,.50,54 

232 

.363,451  489 


Page. 

Franklin 289, 292, 350, 452, 523 

Frasse 356 


Fuller,  G.  E 
Fuller,  S.  E 
Gallagher  . . 

Gale 

Galloway  . . 

Galloupe 

Gay 

Gaucelon... 

G.idd 

Gardner 

Germaine... 
Gesner 


442 

539 

114, 179,  480,620 
191, 192,366,397 

239 

242 

277 

302,  360 

430 

496, 550 

334 

290 


Geiger 

Gibson 

Gill 

Gilroy 

Gouley 

Goldsmith,  M 

Goldsmith,  YV.  YV. 

Goddard  

Goslin 

Good 

Goodman 

Gordon 

Graham 

Green,  YY*^.  1^ . . ... 

Green,  M.  L 

Green,  J.  B 

Guee.ne,  a.  S 

Gray 

Gross 

Grube 

Griswold,  C.  D . . 
Griswold,  l.  D . . 

Greenleae 

Grove 

Griffith 

Grier 

Guilford 


596 

250 

487 

526 

58 

74 

102 


. 131, 435, 494,  535 

211,254 

J.  223 

351,  408 

461 

37,347 

56 


179 

484 

5.59 

85 


130, 133,  236,  249,  291,  539 

142 

239 

297 

243 

275,  373,  546 

279 

326,405 

120 


IIappersETT 40,  470 

Hammer 42, 129,  .369 

Hartshorn 53 

n.AYWOOD 76 

Hayes ,54,  75,  76,  82,  88, 107,  177, 


222,  229,  230,  231,  330,  347,  491,  558 


Hammond,  YV.  A 
Ha.mmond,  U.  D . 
Hajimond,  YV.  E. 

Hand,  D.  YV 

Hand,  A.  F 

Hayhlton,  E.  H . 
Hamilton,  C.  A . 

Harding 

Hasbuouck 

Hanna 

Hay 

Hazen 


58 

188 

200,  447,  521 

74,  46'6 

222 

110,488,  517,  532 

476 

172, 194 

178 

183 

188,433 

197 


Hart 219,  586 

Hartsyvick - 233 


Hazleton 239 

Hall,  A.  D 364,574 

Hall,  J.  A 559 

IlACIlENBERC. 439 

Harris 459 

IlAMU.M 459 

Hermann 17 


INDEX  OF  REPODTEEP. 


Ill 


Patjo. 

Pkwit 35G,  5G6 

HKICI1HOI.I) 31 

HEARD ■ 33 

Helshy 41, 338 

Hesnixg,  T.  S 4C,  135, 339 

Herbst 54, 304, 4G1 

Heger 72 

Herrick 78 

HEXUT 129 

Henson 174 

HELM,  J.  C 225 

Helm,  W.  H 468 

Helmer 223, 330 

Herndon 279 

Hendricks,  J.  G 284 

Hendricks,  E.  F 136,  556 

Hewitson 348 

Hendrickson 420 

Herriman 554 

Herron 501 

Hickman,  T.  G 72 

Hickman,  N 80 

Hildreth,  G.  D ■. 238,369 

Hildreth,  J.  S 419 

Hirshfield 413 

Hill 553 

Hilburn ; 482 

Hitchcock 533 

Higgins 483, 523 

Homans 49, 54, 55 

Homiston 43 

Horton 37, 58 

Hopkinson 81, 118, 130, 

148, 199, 220,  271,  276,  277, 353, 476 

Hodge 108,  230,  291,  327,  346 

HOPl’IN 118 

Hosack 163,  635 

Hobbins ■■ 173 

Horn 182 

Houts 182,246 

Howell 185 

Hooper 223 

Hogeboom 275 

Howard.  .282,497, 499, 500, 503,  504, 505,  517, 550 

Horner 290 

Hodgen 325, 485,  540 

Holley 362 

Hope 410 

Horwitz 441 

Hogan 462, 551 

Hobart 463 

Hoy 500 

Hood 528 

Hupp 31, 192 

Hunt 53 

Hubbard,  S 56 

Hubbard,  H.  B 229 

Hubbard,  V.  B 550 

Huron 60 

Huber 533 

Hurd,  H.  S 133 

Hurd,  J.  S , 190 

Huntington 173 

Hubbell 215 

Hutton 221 

Hutchings 238 

Hutchinson , 262 

Hyde,  J.  N 367 


Pane. 

Hyde,  J.  H 104,476 

IMPEY 42 

Ingram 37, 286, 292, 475,  529 

IsilAM 42.470,573 

Irwin 506 

Janes 72, 350 

JAMAR 265 

Jackson 496 

Jewell 105, 116, 295, 502 

Jewett 480 

Jessup 290 

Johnson,  H.  B 234 

Johnson,  K.  L 560 

JONES 30 

JONES,  W.  P 75 

JONES,  G.  S . . .118, 119, 232,  242, 29J,  354,  409, 451 

JONES,  R.  K 208,  232 

JONES,  W 1 214 

Jones,  C.  W 299, 356,  359,  364,  590 

JONES,  J C 396 

Jones,  W.  B 460 

JUDSON 42,  87, 168, 

184,  265, 272,  352, 378,  432,  439, 
475, 483,  485, 548,  563, 564,  593 

Kayes 405 

Keating 348, 447 

Kenderdine 38 

Kendall 56 

Kennedy,  J.  F 81 

Kennedy,  D 261 

Kelly,  F.  \V 82 

KELLY,  E.  B.  P 281 

Kern 106 

Keen 115, 175, 

176, 207,  370,  407, 430,  447, 475,  630 

Keenon 45, 142, 216,  285,  419 

Kellogg,  A.  H 173 

Kellogg,  G 176 

Kemper 225 

Kempster 273 

Kenney 230 

Kerr., 266 

Kedzie 487 

Kipp 32,146 

Kitchen 33 

King,  J.  S 58 

lasG,  C.  B 354 

King,  J.  E 104 

KISHER 174 

KILBURN 254 

KIBBIE 232 

Knowles 18 

Kneeland 51,  59, 443,  502 

Koehler 278 

Kirker 442 

Lawrence 238 

Lambert 285 

Lathrop 329 

Langmaid 416 

Legler 38, 151 

Lewis,  J.  B 56, 133, 169, 211, 262 

Lewis,  R.  S 230 

Lewis,  R.  J 458 

Leale 59,502,575 

IjEsher 191 

Leighton 201, 229 

Levergood 239 

LEAvrrr 248, 252, 556 


Papje. 

LeConte 2.57 

liESLIE 292 

Leedom 331 

Leidy 431,  569 

Livesay’ 293 

Lidell 40, 49, 110, 122, 161, 195, 

203,  263,  204,  349,  446,  524,  543,  559 

Lineaweaver 347,  499 

LIEBOLD 416 

LONGWILL 104,  482 

Longenecker 132,  585 

Looms 223, 232, 282, 410, 533 

Logan 3.56 

Lowell 388 

Lord 582 

LOUGHRAN .458, 577 

Loughridge 499 

Lockhart 533 

Ludlow 37, 554 

Lyman,  J.B 129 

Lyman,  S.  W 510 

Lynn 191 

Lyster 199 

Lytle 529 

MacDonald 116 

Matlock,  J.  M 4 

Matlock,  W.  H 569 

Mackenzie 58 

MANSON 77 

Marshall 82 

Maull 120 

JIACE 550 

Martin,  O 176, 194, 238,  411, 461 

Martin,  H.  A 269 

May 201,208,449,574 

Mahon 228 

MaNSITELD 216,  328 

MACKAY 290 

Marsh 477 

Maxwell 582 

McKee,  J.  C 22, 77, 160, 199, 

240,  244, 245,  251, 252, 284,  332,  349, 
350, 353,  374, 490, 496, 536,  567,  569 

MCKEE,  J.  G 346 

MCKIBBIN 47 

McAllister 55 

McMahon 50,  60,  297,  347,  471,  574 

McClellan.  ...  71, 74, 80, 83, 87, 113, 287, 401, 541 

McClelland 538 

McDermont 75, 124, 225, 492 

McParlin 76,81,352 

McEWEN 83 

McCall 8.5, 106,  ill,  165, 195, 206, 

280, 348, 474, 499, 500, 505,  554,  567 

McCaw 102 

McCook,  G 117, 131, 

216, 225, 226, 367, 405, 410, 411, 483 

McIntosh 178, 196 

McCann 179 

MCNEILY,  T.  S 194,234 

Mcknight 208, 480 

McNulty 272 

McLean 286 

McGlaugulin 295 

McArthur 320 

McDonnell 350 

McClure,  a.  r .353 

McClure,  A.  W 460 


INDEX  OF  REPOETEES 


IV 


Page. 

McFalls 309 

MCNeilly,  R 419 

McQueston,  C.  a 452 

McQueston,  C.  B 521 

McReykolds 479 

McKay 482, 497 

McJilton 582 

McMillen 526 

McEldeuey 574 

MEACHAM 36,  43,  470 

Meagher 163, 359, 474, 590 

MeaRS 102, 179,  292 

Means 129 

Metcalf 292 

Merrill,  A 368 

Merrill,  C.  S 577 

Mendenhall 408, 412 

Mead 477 

Miles,  B.  B 55, 109, 

169,  300,  354,  361, 439,  444,  408,  5<:3 

Miles,  W.  H — 408 

Mitchell 106 

Mintzer 116 

Miller 416 

Moseley 72, 70, 

120, 171, 240, 247, 253, 254, 255, 260, 
277,  298,  340,  349,  359,  300,  393,  540 

Mott 70, 105, 401 

Moon 104, 225, 207, 275, 295, 302 

Morrison 211 

Morris,  T.  C 228 

Morris,  J 484 

Morgan,  D 270 

Morgan,  W.  P 347 

Morton 277, 378, 413, 555 

Moody 416 

MOSES 73, 144,  202,  274,  393,  551,  630 

Morehouse 124 

Montgomery 103, 243, 378 

Mullen 146, 449 

MURSICK 200,  247, 

248,  250,  254,  353,  366,  440,  459,  502 

Muliiallen 490 

MUNN 504 

MYGATT 462 

Nagle 489 

Newell 18 

Nelson,  J.  C 121, 3.50 

Nelson,  A.  W 582 

Neff 162 

Neill 108,177, 182,197, 

236,  280, 357,  358,  300,  304,  474,  520 

Neil 171, 223,232,480 

Neilson 479 

NIGLAS 142 

Nichols 223, 280 

Nicholson 502 

Notson 34 

NORVAL 42,  78 

NORRIS,  J.  W.  S 197 

NORRIS,  W.  P 417,  418,  492,  508 

Norris,  A.  L 433 

Norris,  J 545 

Nordman 372 

North 493 

Nye 230 

Oakley 191, 582 

O'Brien 403 

( I’CciNNIil.1 330 


Page. 

Oliver 493 

O’Keefe 210, 245, 270,  281,  491 


Orton,  S.  II 72,438 

Orton,  j.  G 102, 106, 234, 308 

OrMSRY 204 

Otis,  D.  A 233 

Orro 224 

Otterson 368 

OWEN,  G.  S 183 

OWEN,  D.  C 190 

Owens 237, 484 

OWINGS 409, 442 

Paullin 21 

Palmer,  J.  C 558 

Palmer,  E 34 

Palmer,  G.  S 41, 185 

Palmer,  T.  M 79,120 

Palmer,  II 133,  215,  286,  340,  350, 456,  523 

Pancoast 41, 82, 217, 

297,  353,  304,  390, 443,  407,  539 

Page,  C.  G 42 

Page,  C 202,499 

Page,  W.  H 240 

Patten 117 

PARiiER,  \V.  S 102 

Parker,  F.  S 179,245,295 

Paine 174 

Packard 358 

Parke 352 

Peters 44, 113, 122, 165, 196, 416, 407, 492,  549 

Peter,  P 197 

Peter,  R 470 

Pe.abody 72 


Pettinos 202 

PERRY,  D.  O 238 

Perry,  1 4il 

Perin 287 

Peck 369, 419 

Perdue 477 

Pfoutz 117 

PH  ELI'S,  S 372 

Phelps,  a.  j 77 

Phillips,  John 129 

Phillips,  James 446 

Phillips,  J.  H 527 

Phillips,  H.  J 554 

Pitts,  J.  C 104, 283 

PierpONT 237 

Pierce 238 

I’kjuette 470 

Pick 589 

PINEO 636 

Plumb 269 

Pl.ant 583 

Powers,  E.  M 37, 351 

Powers,  C 88 

Pope 78 

Porter,  G.  L 171, 440 

PORTER,  P.C 188 

Porter,  C 224,327 

Porter,  F.  S 235, 469 

Porter,  I.  G 578 

PO.MEROY 194 

Powell 241, 558 

Post,  John 209 

Post,  L 241 

Potter,  W.  W 331,  .529 

Potter,  11.  A 357 

PRAI.1 109 


Page. 

Prince 269 

Price 296 

Purdy Ill 

Putnam 280 

Quick 205, 233, 305, 480, 481, 564, 589 

Rankin,  S 50 

Rankin,  A.  C 471 

Ramsey 291, 409 

Rahter 329, 451 

Read,  J.  B 54, 98, 99 

Reed,  T.  B.  .72,  76, 116, 173,  215, 279,  458,  539,  555 

Reed,  Z 103 

Redeb,  C.  T 73 

Reuer,  N.  B 348 

Reeder 284 

REAMY 396 

Reynolds 420 

Reyburn 436 

Reese 541 

Rhodes • 120 

Rice,  N.  P 48 

RICE,  C.  D 74,78,214 

Rice,  P.  B 226 

Rich 78 

Rivers 225 

Rims 228 

Richardson 406 

Rigeu 470 

Rockwell 49 

Robie 57 

Robbins 132, 239 

Robinson 163 

Roberts,  J 171 

Roberts,  James 436 

Roberts,  W.  E 414 

Rowland,  j.  R 188 

Rowland,  Charles 20, 179, 

239, 404, 478, 489, 490 

ROEMER 279, 282 

Ropes 370 

Robertson 481 

Romig 515 

Rulison 17 

Rust 19 

RUSH ?.  77 

RUBACH 237 

Russell,  J 290 

Russell,  E 461 

Salter 73, 77, 408 

Sanger 117, 501 

Sanders 125 

Sanborn 177 

Sargent,  G.  P — 262 

Sargent,  W 462 

Sapp,  S.  C 293 

Sapp.  E 496 

Sawtelle 352,  410,  401,  424 

SafforD 359 

Sands 370 

Schell 38, 112, 129, 182, 193, 226, 471 

Schultz 40 

Schafhirt 57 

Scholl 187 

ScoviLL 237 


SCARFF 474 

Seyffarth 33,567 

Searle 136, 197 

SelDEN .543 

Sheldon 41, 74, 82,  80,  289,  .540 


INDEX  OF  REPORTERS, 


V 


Page. 

SllAKP 108 

SllUMAHD 139 

SliERMAX,  S.  N 141, 1S8, 230, 555 

Shekievk,  a.  M 393 

Sherman,  B.  S 515 

Shurlock 243, 270 

Sheets 251 

SHirM.^N 2C9 

Shedd 584 

SlILMEU 437,  447 

SURADY 539,  502 

SUI 19,  54,  436 

Simons 87 

SIMINGTON 100,  034 

SILUM.VN 113 

SlvlLLERN 444 

Smith,  E.  H 33,129 

Smith,  S.  B 50 

Smith,  J.  S 50,92 

Sjiith,  E.  S 54 

Smith,  J.  R 55, 81 

S.MITH,  J.  B 73 

Smith,  G.  M 75 

Smith,  G.  K 81, 618 

SlUTH,  E.  A 100, 104,  258, 289,  356 

SSHTH,  T.  F L16 

Smith,  D.  P 125,266,268 

Smith,  J.  O 201 

Smith,  A.  G 272 

Smith,  J.  W 373 

Smith,  A.  A 485,522 

S-MITH,  L.  a 487 

Smith,  T.  B 585 

Smith,  A.  H 631 

Smith,  L 634 

.Smyser 113, 134 

Smiley 133, 213, 271, 331 

Small 442 

SmULL 205,437 

Smart 509 

Snow 238 

Spencer 74, 83, 552 

Spaldlng,  j.  W 133, 238 

Spalding,  P 224 

Sprague 331 

Squire 210, 407, 553 

Stuckslager 50 

Stahl 51 

STORROW 73,  264,  351,  522 

Stearns,  II.  P 79, 122,  355, 466 

Stearnes,  j.  G 98, 187 

Sterling 134, 589 

Stickney 173 

STANFORD 202 

Stewart,  J.  L 224 

Stewart,  P 279 

Stewart,  W.  D 585 

Stii.lwkll 204, 297 

Sttuckler 228 

Stone,  B 233 

Stone,  L.  R 461 

Stratton 230 

Strickland 240, 563 

Stevens 24o 

Streeter 278 

Study 28.5, 470 

Stanway 289 

Sta.nchfield 330 


Page. 

Stanton,  D 301 

Stanton,  j.  O 407, 585 

Stonelake 564 

Sturgis 419 

Stichley 579 

SUCKLEY 38,237,504 

Sutton 88 

Summers 331, 302, 499 

Swift 117, 171,226,515 

SWARTS 1S4 

Swesserott 281 

Sweet 300 

SWARTZWELDER 477 

Taylor,  R.  R 38 

Taylor,  G 72 

Taylor,  J.  II 72, 88, 145 

Taylor,  L 72, 74, 115,  350 

Taylor,  M.  K 218 

Taylor,  J.  S 416 

Taliaferro 50, 55, 105, 100 

TEED 102 

Terry 198 

Tiirelkeld 39,84 

Thom 76, 597 

Thayer 113 

Thompson,  J.  W 233 

Thompson,  E.  A 130 

TIIOJIPSON,  J.  H 219 

Thomson 123, 181, 207, , 297, 

351, 354,  361,  392,  405, 421, 436, 
440,  444,  440,  447,  400,  487,  527, 
572, 573,  576, 578,  579, 583,  .589 

Thorne 125 

Thorn 221 

Thomas,  II.  L 456,  538,  540 

THOJIAS,  W.  B 22.5,  494 

Thorpe 460 

Thomain 515 

Tuts 228 

Tice 283 

Todd,  J.  M 209, 228 

Todd,  C.  II 420 

Toward 290,370,490 

TOWNSEND 540 

Trull 79,87 

Trenor,  j.  B 102 

TRENOR,  J 242 

Treadwell 103, 238 

Tryon,  a.  W 251,290 

Tryon,  j.  R 558 

Trowbridge 287, 330 

Treganowan 500 

Tuit 147,  IGl 

TURNER 286 

Turney 289 

Udell 192 

UPILYM,  J.  B 124, 184,  347 

UPHAm,  G.  B 550 

VANDERKIEFT 57,  71, 121, 170,  355,  432 

Varian,  W 114, 117,  559 

Vanderveer 131,  102 

Vanderiiuli 180 

Van  Duyn 193 

Van  Slyck 510 

Valk 393 

VENABLE 58 

VOSBURGII 149 

Van  Tagen 507 


Page. 

Wardner 19,  41, 102, 108, 208, 410,  523 

Ward,  W.  F 39,135 

Ward,  S.  B 58 

IVaTSON,  a.  T 57 

Watson,  R.  R 499 

Waters,  E.  G 103,574 

Waterman 131 

Wagner,  F.B 189 

Wagner,  C 267, 300, 407, 588 

Wagenseller 191 

Walker 241 

Wakefield 305 

Walsh 459 

Watkins,  A.  P 585 

Webster 18, 74, 214, 269, 352, 5.55 

Weir 21, 142, 235, 299, 303, 355, 

300,  377,  417,  420,  431,  450,  531, 559 

Wells -54 

WELLFORD 73, 125 

WESTON 117,225 

WetmorE 232,  282 

WELCH 458 

White,  J.  A 40 

White,  J.  1 108 

White,  H.  B 271 

Whitehill 174 

Wheeler 231 

WllISERY 285 

WHITING 351 

Williams,  J.  W 17,214 

Williams,  P 174 

Withers 53 

Wilder,  a.  M 82,200,  204,212 

Wilder,  B.  G 302,  427,  445,  533,  553 

Wiley 88 

WILLEY 217,  289 

Willard,  S.  D 134, 185,288 

Willard,  J • 276 

WILLARD,  A 401 

WILSON,  B.  B 123 

Wilson,  J.  F 193, 471, 531 

WILSON,  J.  R 239 

WILSON,  M.  W 520 

Wilson,  Albert 582 

WILCOXSON 268 

Win  ANTS 320 

Winslow 421 

WILLIS 462 

WIRTII 582 

Woodward,  A.  T 53 

Woodward,  j.  j 77 

Woodward,  B 210 

Woodworth 77, 79 

WOLVERTON 79 

WOODIIULL 131, 285 

WOLFE 214 

WOOD 221, 233, 242, 275 

WOODS .>. 501 

WOODRITF 300 

Wright 137 

WYNKOOP 138, 187,480 

YVyman 231 

Yates 34 

YaUGAN 97 

Yandell 272 

Young 105, 235 

Younglove 430 

ZeaRING 527 


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